Bill Text: NY A06261 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to accountable care organizations and medical home multipayor programs designed to reduce health care costs and promote effective use of resources.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-01-04 - referred to health [A06261 Detail]
Download: New_York-2011-A06261-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
6261
2011-2012 Regular Sessions
I N A S S E M B L Y
March 11, 2011
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Health
AN ACT to amend the public health law, the social services law, the
public authorities law, and chapter 57 of the laws of 2008 amending
the public health law relating to medical home demonstration programs,
in relation to accountable care organizations and medical home multi-
payor programs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. The public health law is amended by adding a new article
2 44-A to read as follows:
3 ARTICLE 44-A
4 ACCOUNTABLE CARE ORGANIZATIONS
5 SECTION 4420. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE.
6 4421. DEFINITIONS.
7 4422. ESTABLISHMENT OF ACCOUNTABLE CARE ORGANIZATIONS.
8 4423. CERTIFICATE OF AUTHORITY.
9 S 4420. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE. THE LEGIS-
10 LATURE INTENDS TO FACILITATE THE ABILITY OF ACCOUNTABLE CARE ORGANIZA-
11 TIONS TO ASSUME A LARGER ROLE IN DELIVERING A FULL ARRAY OF HEALTH CARE
12 SERVICES, FROM PRIMARY AND PREVENTIVE CARE THROUGH ACUTE INPATIENT
13 HOSPITAL AND POST-HOSPITAL CARE. THE LEGISLATURE FINDS THAT THE FORMA-
14 TION AND OPERATION OF ACCOUNTABLE CARE ORGANIZATIONS UNDER THIS ARTICLE
15 CAN BE CONSISTENT WITH THE PURPOSES OF FEDERAL AND STATE ANTI-TRUST,
16 ANTI-REFERRAL, AND OTHER STATUTES, INCLUDING REDUCING OVER-UTILIZATION
17 AND EXPENDITURES. THE LEGISLATURE FINDS THAT THE DEVELOPMENT OF ACCOUNT-
18 ABLE CARE ORGANIZATIONS UNDER THIS ARTICLE WILL REDUCE HEALTH CARE
19 COSTS, PROMOTE EFFECTIVE ALLOCATION OF HEALTH CARE RESOURCES, AND
20 ENHANCE THE QUALITY AND ACCESSIBILITY OF HEALTH CARE. THE LEGISLATURE
21 FINDS THAT THIS ARTICLE IS NECESSARY TO PROMOTE THE FORMATION OF
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09961-02-1
A. 6261 2
1 ACCOUNTABLE CARE ORGANIZATIONS AND PROTECT THE PUBLIC INTEREST AND THE
2 INTERESTS OF PATIENTS AND HEALTH CARE PROVIDERS.
3 S 4421. DEFINITIONS. AS USED IN THIS ARTICLE, THE FOLLOWING TERMS
4 SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES
5 OTHERWISE:
6 1. "ACCOUNTABLE CARE ORGANIZATION" AND "ACO" MEAN AN ACCOUNTABLE CARE
7 ORGANIZATION CERTIFIED BY THE COMMISSIONER UNDER THIS ARTICLE.
8 2. "CERTIFICATE OF AUTHORITY" OR "CERTIFICATE" MEANS A CERTIFICATE OF
9 AUTHORITY ISSUED BY THE COMMISSIONER UNDER THIS ARTICLE.
10 3. "HEALTH CARE PROVIDER" MEANS AN ENTITY LICENSED OR CERTIFIED UNDER
11 ARTICLE TWENTY-EIGHT OR THIRTY-SIX OF THIS CHAPTER; AN ENTITY LICENSED
12 OR CERTIFIED UNDER ARTICLE SIXTEEN, THIRTY-ONE OR THIRTY-TWO OF THE
13 MENTAL HYGIENE LAW; OR A HEALTH CARE PRACTITIONER LICENSED OR CERTIFIED
14 UNDER TITLE EIGHT OF THE EDUCATION LAW OR A LAWFUL COMBINATION OF SUCH
15 HEALTH CARE PRACTITIONERS; IT MAY ALSO INCLUDE OTHER ENTITIES THAT
16 PROVIDE TECHNICAL ASSISTANCE, INFORMATION SYSTEMS AND SERVICES, CARE
17 COORDINATION AND OTHER SERVICES TO HEALTH CARE PROVIDERS AND PATIENTS
18 PARTICIPATING IN AN ACO.
19 4. "PRIMARY CARE" MEANS THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
20 GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
21 RICS, OR PRIMARY CARE GYNECOLOGY, WITHOUT REGARD TO BOARD CERTIFICATION,
22 AND SHALL APPLY TO ANY HEALTH CARE PROVIDER ACTING WITHIN HIS, HER, OR
23 ITS LAWFUL SCOPE OF PRACTICE.
24 5. "THIRD-PARTY HEALTH CARE PAYER" INCLUDES, IN ADDITION TO ITS ORDI-
25 NARY MEANINGS, AN ENTITY SUCH AS A PHARMACY BENEFITS MANAGER, FISCAL
26 ADMINISTRATOR, OR ADMINISTRATIVE SERVICES PROVIDER THAT PARTICIPATES IN
27 THE ADMINISTRATION OF A THIRD-PARTY HEALTH CARE PAYER SYSTEM.
28 S 4422. ESTABLISHMENT OF ACCOUNTABLE CARE ORGANIZATIONS. 1. AN
29 ACCOUNTABLE CARE ORGANIZATION IS A NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY
30 WHICH (A) IS AN ORGANIZATION OF HEALTH CARE PROVIDERS THAT WORK TOGETHER
31 TO PROVIDE, MANAGE, AND COORDINATE HEALTH CARE (INCLUDING PRIMARY CARE)
32 FOR A DEFINED POPULATION; WITH A MECHANISM FOR SHARED GOVERNANCE; THE
33 ABILITY TO NEGOTIATE, RECEIVE, AND DISTRIBUTE PAYMENTS; AND ACCOUNTABIL-
34 ITY FOR THE QUALITY, COST, AND DELIVERY OF HEALTH CARE TO THE ACO'S
35 PATIENTS; IN ACCORDANCE WITH THIS ARTICLE; AND (B) HAS BEEN ISSUED A
36 CERTIFICATE OF AUTHORITY BY THE COMMISSIONER UNDER THIS ARTICLE.
37 2. AN ACO SHALL:
38 (A) HAVE A GOVERNANCE SYSTEM THAT REASONABLY, EQUITABLY AND DEMOCRAT-
39 ICALLY REPRESENTS THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, EMPLOY-
40 EES OF PARTICIPATING HEALTH CARE PROVIDERS, THE ACO'S ENROLLEES AND
41 PATIENTS, AND THE GENERAL PUBLIC.
42 (B) DEFINE THE POPULATION PROPOSED TO BE SERVED BY THE ACO, WHICH MAY
43 INCLUDE REFERENCE TO A GEOGRAPHICAL AREA AND PATIENT CHARACTERISTICS.
44 (C) INCLUDE AN ADEQUATE NETWORK OF PARTICIPATING HEALTH CARE PROVIDERS
45 TO PROVIDE THE HEALTH CARE FOR WHICH THE ACO IS ACCOUNTABLE, INCLUDING
46 PRIMARY CARE HEALTH CARE PROVIDERS, AND AT LEAST ONE FEDERALLY-QUALIFIED
47 HEALTH CENTER (PROVIDED THAT THE COMMISSIONER MAY WAIVE THIS REQUIREMENT
48 IF THERE IS NO FEDERALLY-QUALIFIED HEALTH CENTER SERVING THE AREA SERVED
49 BY THE ACO).
50 (D) HAVE DEFINED MECHANISMS FOR PROVIDING, MANAGING, AND COORDINATING
51 HIGH QUALITY HEALTH CARE FOR THE ACO'S PATIENTS, INCLUDING: ELEVATING
52 THE SERVICES OF PRIMARY CARE HEALTH CARE PROVIDERS TO MEET PATIENT-CEN-
53 TERED MEDICAL HOME STANDARDS; COORDINATING INTENSIVE SERVICES FOR
54 COMPLEX HIGH-NEED PATIENTS; PROVIDING ACCESS TO HEALTH CARE PROVIDERS
55 THAT ARE NOT PARTICIPANTS IN THE ACO; AND PROVIDING ACCESS TO THE FULL
56 RANGE OF REPRODUCTIVE HEALTH CARE FOR THE POPULATION SERVED.
A. 6261 3
1 (E) HAVE DEFINED MECHANISMS FOR RECEIVING AND DISTRIBUTING PAYMENTS TO
2 THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INCENTIVE
3 PAYMENTS (WHICH MAY INCLUDE MEDICAL HOME PAYMENTS) AND PAYMENTS FOR
4 HEALTH CARE SERVICES FROM THIRD-PARTY HEALTH CARE PAYERS AND PATIENTS.
5 AN ACO MAY INCLUDE MECHANISMS FOR POOLING PAYMENTS RECEIVED BY PARTIC-
6 IPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS AND PATIENTS.
7 (F) HAVE REASONABLE MECHANISMS AND CRITERIA FOR ACCEPTING HEALTH CARE
8 PROVIDERS TO PARTICIPATE IN THE ACO THAT ARE RELATED TO THE NEEDS OF THE
9 PATIENT POPULATION TO BE SERVED AND NEEDS AND PURPOSES OF THE ACO AND DO
10 NOT DISCRIMINATE ON OTHER GROUNDS.
11 (G) HAVE A LEADERSHIP AND MANAGEMENT STRUCTURE THAT INCLUDES CLINICAL
12 AND ADMINISTRATIVE SYSTEMS AND CLINICAL PARTICIPATION.
13 (H) HAVE APPROPRIATE QUALITY ASSURANCE MECHANISMS, GRIEVANCE PROCE-
14 DURES FOR HEALTH CARE PROVIDERS AND PATIENTS, AND PROCEDURES FOR REVIEW-
15 ING AND APPEALING PATIENT CARE DECISIONS.
16 (I) PROVIDE SATISFACTORY EVIDENCE OF THE CHARACTER AND COMPETENCE OF
17 THE ACO.
18 (J) HAVE THE ABILITY TO OPERATE ON A FISCALLY SOUND AND FINANCIALLY
19 RESPONSIBLE BASIS, INCLUDING REASONABLE CAPITALIZATION AND RESERVES, AND
20 CONSIDERING THE PAYMENT ARRANGEMENTS ENTERED INTO BY THE ACO.
21 (K) IN ITS APPLICATION AND FROM TIME TO TIME, AS REQUIRED BY THE
22 COMMISSIONER, PROVIDE THE COMMISSIONER WITH INFORMATION AND DATA RELAT-
23 ING TO:
24 (I) THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INDIVID-
25 UAL HEALTH CARE PRACTITIONERS AFFILIATED WITH SUCH HEALTH CARE PROVIDER
26 WHO PROVIDE HEALTH CARE TO THE HEALTH CARE PROVIDER'S PATIENTS.
27 (II) DATA, INCLUDING ENCOUNTER DATA, RELATING TO THE NATURE, OUTCOME,
28 AND QUALITY OF, AND PAYMENT FOR, HEALTH CARE PROVIDED BY THE PARTICIPAT-
29 ING HEALTH CARE PROVIDER TO THE PARTICIPATING PATIENT.
30 (L) HAVE MECHANISMS TO PROMOTE EVIDENCE-BASED HEALTH CARE, PATIENT
31 ENGAGEMENT, COORDINATION OF CARE, ELECTRONIC HEALTH RECORDS, AND OTHER
32 ENABLING TECHNOLOGIES.
33 3. THE COMMISSIONER, IN CONSULTATION WITH HEALTH CARE PROVIDERS,
34 THIRD-PARTY HEALTH CARE PAYERS, ADVOCATES REPRESENTING PATIENTS, THE
35 SUPERINTENDENT OF INSURANCE, AND OTHER APPROPRIATE PARTIES, SHALL:
36 (A) ESTABLISH APPROPRIATE REQUIREMENTS FOR ACOS TO PROMOTE COMPLIANCE
37 WITH THE PURPOSES OF THIS ARTICLE.
38 (B) ESTABLISH APPROPRIATE PERFORMANCE STANDARDS FOR, AND MEASURES TO
39 ASSESS, THE QUALITY OF CARE PROVIDED BY AN ACO, SUCH AS MEASURES OF:
40 (I) CLINICAL PROCESSES AND OUTCOMES;
41 (II) PATIENT AND, WHERE PRACTICABLE, CAREGIVER EXPERIENCE OF CARE;
42 (III) UTILIZATION, SUCH AS RATES OF HOSPITAL ADMISSION FOR AMBULATORY
43 CARE SENSITIVE CONDITIONS, EMERGENCY ROOM USE, AND HOSPITAL RE-ADMIS-
44 SIONS.
45 (C) PROVIDE FOR PUBLIC DISCLOSURE, ON THE DEPARTMENT'S WEBSITE, OF
46 STATISTICAL DATA RELATING TO THE QUALITY OF SERVICES, PERFORMANCE, AND
47 OTHER CHARACTERISTICS OF ACOS, WHICH IS APPROPRIATELY ADJUSTED FOR CASE
48 MIX AND EXCLUDES ANY INDIVIDUAL PATIENT IDENTIFYING INFORMATION.
49 (D) MAKE REGULATIONS, SET STANDARDS, AND TAKE OTHER ACTIONS TO PROMOTE
50 THE ABILITY OF AN ACO TO PARTICIPATE IN APPLICABLE FEDERAL PROGRAMS FOR
51 ACCOUNTABLE CARE ORGANIZATIONS.
52 4. (A) IN ORDER TO PROMOTE IMPROVED QUALITY AND EFFICIENCY OF, AND
53 ACCESS TO, HEALTH CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES,
54 IT SHALL BE THE POLICY OF THE STATE RELATING TO ACOS TO ENCOURAGE COOP-
55 ERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS AMONG THIRD-PARTY
56 HEALTH CARE PAYERS AND HEALTH CARE PROVIDERS WHO MIGHT OTHERWISE BE
A. 6261 4
1 COMPETITORS, UNDER THE ACTIVE SUPERVISION OF THE COMMISSIONER. TO THE
2 EXTENT SUCH ARRANGEMENTS MIGHT BE ANTI-COMPETITIVE WITHIN THE MEANING
3 AND INTENT OF THE FEDERAL OR STATE ANTITRUST LAWS, THE INTENT OF THE
4 STATE IS TO SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS AND WITH REGU-
5 LATION UNDER THIS ARTICLE, TO THE EXTENT NECESSARY TO ACCOMPLISH THE
6 PURPOSES OF THIS ARTICLE RELATING TO ACOS, AND PROVIDE STATE ACTION
7 IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS WITH RESPECT TO THE
8 PLANNING, IMPLEMENTATION AND OPERATION OF ACOS AND THIRD-PARTY HEALTH
9 CARE PAYERS AND HEALTH CARE PROVIDERS. THE COMMISSIONER SHALL PROVIDE
10 REASONABLE AND APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
11 ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS, AND MAY
12 INSPECT, REQUIRE, OR REQUEST ADDITIONAL DOCUMENTATION AND TAKE OTHER
13 ACTIONS UNDER THIS ARTICLE TO VERIFY AND MAKE SURE THAT THIS ARTICLE IS
14 IMPLEMENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
15 (B) TO THE EXTENT THE FORMATION OR OPERATION OF AN ACO OR ITS ARRANGE-
16 MENTS WITH THIRD-PARTY HEALTH CARE PAYERS OR HEALTH CARE PROVIDERS MAY
17 VIOLATE THE FEDERAL CIVIL MONETARY PAYMENT LAWS, OR FEDERAL OR STATE
18 ANTI-KICKBACK, PATIENT REFERRAL, OR FEE-SPLITTING LAWS, THE COMMISSIONER
19 SHALL PROVIDE REASONABLE AND APPROPRIATE REGULATION, SUPERVISION, AND
20 WAIVERS UNDER THOSE STATUTES AND THEIR REGULATIONS TO ENABLE SUCH FORMA-
21 TION, OPERATION OR ARRANGEMENTS TO PROCEED AND TO MAKE SURE THAT THEY DO
22 SO CONSISTENTLY WITH THE PURPOSES OF THIS ARTICLE.
23 (C) THE PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY AN
24 ACO THROUGH HEALTH CARE PROVIDERS SHALL NOT BE CONSIDERED THE PRACTICE
25 OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCATION LAW BY THE ACO.
26 5. (A) AN ACO (I) SHALL BE DEEMED TO BE A HEALTH PLAN, SOLELY FOR
27 PURPOSES OF ARTICLE FORTY-NINE OF THIS CHAPTER, EXCEPT WHERE THE FUNC-
28 TIONS OF A HEALTH PLAN UNDER THAT ARTICLE ARE THE RESPONSIBILITY OF A
29 THIRD-PARTY HEALTH CARE PAYER, AND (II) SHALL BE DEEMED TO BE A MANAGED
30 CARE PRODUCT, SOLELY FOR PURPOSES OF ARTICLE FORTY-EIGHT OF THE INSUR-
31 ANCE LAW, EXCEPT WHERE THE FUNCTIONS OF A MANAGED CARE PRODUCT UNDER
32 THAT ARTICLE ARE THE RESPONSIBILITY OF A THIRD-PARTY HEALTH CARE PAYER.
33 (B) WHERE AN ACO CONTRACTS WITH AN ENROLLEE OR PATIENT TO PROVIDE
34 HEALTH CARE SERVICES TO THAT PERSON, WHERE PAYMENT FOR THOSE SERVICES IS
35 NOT PRIMARILY THE RESPONSIBILITY OF A THIRD-PARTY HEALTH CARE PAYER,
36 NOTHING IN THIS ARTICLE SHALL PRECLUDE THE ACO FROM BEING DEEMED TO BE A
37 HEALTH MAINTENANCE ORGANIZATION SUBJECT TO ARTICLE FORTY-FOUR OF THIS
38 CHAPTER OR ENGAGED IN THE BUSINESS OF INSURANCE AND SUBJECT TO APPLICA-
39 BLE PROVISIONS OF THE INSURANCE LAW, INCLUDING ARTICLE FORTY-EIGHT OF
40 THE INSURANCE LAW.
41 6. (A) (I) AN ACO MAY ENTER INTO ARRANGEMENTS WITH ONE OR MORE THIRD-
42 PARTY HEALTH CARE PAYERS TO ESTABLISH PAYMENT METHODOLOGIES FOR HEALTH
43 CARE SERVICES FOR THE THIRD-PARTY HEALTH CARE PAYER'S ENROLLEES PROVIDED
44 BY THE ACO OR FOR WHICH THE ACO IS RESPONSIBLE, SUCH AS FULL OR PARTIAL
45 CAPITATION OR OTHER ARRANGEMENTS. SUCH ARRANGEMENTS MAY INCLUDE
46 PROVISION FOR THE ACO TO RECEIVE AND DISTRIBUTE PAYMENTS TO THE ACO'S
47 PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INCENTIVE PAYMENTS AND
48 PAYMENTS FOR HEALTH CARE SERVICES FROM THIRD-PARTY HEALTH CARE PAYERS
49 AND PATIENTS. AN ACO MAY INCLUDE MECHANISMS FOR POOLING PAYMENTS
50 RECEIVED BY PARTICIPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS
51 AND PATIENTS.
52 (II) THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF
53 INSURANCE, MAY AUTHORIZE A THIRD-PARTY HEALTH CARE PAYER TO PARTICIPATE
54 IN PAYMENT METHODOLOGIES WITH AN ACO UNDER THIS PARAGRAPH, NOTWITHSTAND-
55 ING ANY CONTRARY PROVISION OF THIS CHAPTER, THE INSURANCE LAW, THE
A. 6261 5
1 SOCIAL SERVICES LAW, OR THE ELDER LAW, ON FINDING THAT THE PAYMENT METH-
2 ODOLOGY IS CONSISTENT WITH THE PURPOSES OF THIS ARTICLE.
3 (III) NO THIRD-PARTY HEALTH CARE PAYER SHALL:
4 (A) IMPOSE ANY DEDUCTIBLE, CO-PAYMENT OR OTHER FORM OF CO-INSURANCE ON
5 ANY ENROLLEE OR PATIENT IN CONNECTION WITH THE ENROLLEE OR PATIENT
6 PARTICIPATING IN AN ACO THAT IS HIGHER THAN IT WOULD OTHERWISE IMPOSE;
7 OR
8 (B) MAKE ANY DISTINCTION OR DISCRIMINATION AGAINST ANY ENROLLEE OR
9 PATIENT IN CONNECTION WITH THE ENROLLEE OR PATIENT PARTICIPATING IN AN
10 ACO, OR IMPOSE ANY RESTRICTION ON WHICH OF ITS ENROLLEES OR PATIENTS MAY
11 PARTICIPATE IN AN ACO; PROVIDED THAT
12 (C) THIS SUBDIVISION SHALL NOT BE CONSTRUED TO BAR A THIRD-PARTY
13 HEALTH CARE PAYER FROM PROVIDING INCENTIVES FOR ENROLLEES OR PATIENTS TO
14 PARTICIPATE IN AN ACO; AND
15 (D) ENROLLEE, PATIENT, AND HEALTH CARE PROVIDER PARTICIPATION IN AN
16 ACO SHALL BE ON A VOLUNTARY BASIS.
17 (B) WITH RESPECT TO ARRANGEMENTS INVOLVING PUBLIC HEALTH COVERAGE AND
18 AN ACO, THE COMMISSIONER:
19 (I) SHALL SEEK TO PROMOTE THE ESTABLISHMENT OF ACOS;
20 (II) MAY PROMOTE USE OF RISK-ADJUSTMENT AND STOP-LOSS METHODOLOGIES;
21 AND
22 (III) MAY ESTABLISH PAYMENT METHODOLOGIES, INCLUDING FOR MEDICAID
23 FEE-FOR-SERVICE AND MEDICAID MANAGED CARE.
24 (C) AN ACO MAY SEEK TO FOCUS ON PROVIDING HEALTH CARE SERVICES TO
25 PATIENTS WITH ONE OR MORE CHRONIC CONDITIONS OR SPECIAL NEEDS. HOWEVER,
26 AN ACO MAY NOT OTHERWISE, ON THE BASIS OF A PERSON'S MEDICAL OR DEMO-
27 GRAPHIC CHARACTERISTICS, DISCRIMINATE FOR OR AGAINST OR DISCOURAGE OR
28 ENCOURAGE ANY PERSON OR PERSONS WITH RESPECT TO ENROLLING OR PARTICIPAT-
29 ING IN THE ACO.
30 (D) AN ACO SHALL NOT, BY INCENTIVES OR OTHERWISE, DISCOURAGE A HEALTH
31 CARE PROVIDER FROM PROVIDING OR AN ENROLLEE OR PATIENT FROM SEEKING
32 APPROPRIATE HEALTH CARE SERVICES.
33 (E) AN ACO SHALL NOT DISCRIMINATE AGAINST OR DISADVANTAGE A PATIENT OR
34 PATIENT'S REPRESENTATIVE FOR THE EXERCISE OF PATIENT AUTONOMY.
35 7. THE COMMISSIONER IS AUTHORIZED TO SEEK FEDERAL GRANTS, APPROVALS,
36 AND WAIVERS TO IMPLEMENT THIS ARTICLE, INCLUDING FEDERAL FINANCIAL
37 PARTICIPATION UNDER PUBLIC HEALTH COVERAGE. THE COMMISSIONER SHALL
38 PROVIDE COPIES OF APPLICATIONS AND OTHER DOCUMENTS SEEKING SUCH FEDERAL
39 GRANTS, APPROVALS, AND WAIVERS TO THE CHAIRS OF THE SENATE FINANCE
40 COMMITTEE, THE ASSEMBLY WAYS AND MEANS COMMITTEE, AND THE SENATE AND
41 ASSEMBLY HEALTH COMMITTEES SIMULTANEOUSLY WITH THEIR SUBMISSION TO THE
42 FEDERAL GOVERNMENT.
43 8. THE COMMISSIONER MAY DIRECTLY, OR BY CONTRACT WITH NOT-FOR-PROFIT
44 ORGANIZATIONS, PROVIDE:
45 (A) CONSUMER ASSISTANCE TO PATIENTS PARTICIPATING IN OR CONSIDERING
46 PARTICIPATING IN AN ACO AS TO MATTERS RELATING TO ACOS;
47 (B) TECHNICAL AND OTHER ASSISTANCE TO HEALTH CARE PROVIDERS PARTIC-
48 IPATING IN AN ACO AS TO MATTERS RELATING TO THE ACO;
49 (C) ASSISTANCE TO ACOS TO PROMOTE THEIR FORMATION AND IMPROVE THEIR
50 OPERATION, INCLUDING ASSISTANCE UNDER SECTION TWENTY-EIGHT HUNDRED EIGH-
51 TEEN OF THIS CHAPTER;
52 (D) INFORMATION SHARING AND OTHER ASSISTANCE AMONG ACOS TO IMPROVE THE
53 OPERATION OF ACOS.
54 S 4423. CERTIFICATE OF AUTHORITY. 1. THE COMMISSIONER SHALL ISSUE A
55 CERTIFICATE OF AUTHORITY TO AN APPLICANT THAT SATISFIES THE REQUIREMENTS
56 UNDER THIS ARTICLE FOR ESTABLISHMENT OF AN ACO.
A. 6261 6
1 2. THE COMMISSIONER MAY LIMIT, SUSPEND, OR TERMINATE A CERTIFICATE OF
2 AUTHORITY IF THE ACO IS NOT OPERATING IN ACCORDANCE WITH THIS ARTICLE.
3 3. THE COMMISSIONER SHALL ESTABLISH, BY REGULATION, REASONABLE AND
4 APPROPRIATE PROCEDURES UNDER THIS SECTION, CONSISTENT WITH THE STATE
5 ADMINISTRATIVE PROCEDURE ACT.
6 4. THE COMMISSIONER SHALL NOT APPROVE ANY CERTIFICATE OF AUTHORITY
7 UNDER THIS ARTICLE AFTER DECEMBER THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
8 S 2. Subdivision 1 of section 2 of the public health law is amended by
9 adding eight new paragraphs (o), (p), (q), (r), (s), (t), (u), and (v)
10 to read as follows:
11 (O) "MEDICAID" OR "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
12 FIVE OF THE SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
13 (P) "FAMILY HEALTH PLUS" MEANS TITLE ELEVEN-D OF ARTICLE FIVE OF THE
14 SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
15 (Q) "CHILD HEALTH PLUS" MEANS TITLE ONE-A OF ARTICLE TWENTY-FIVE OF
16 THIS CHAPTER AND THE PROGRAM THEREUNDER.
17 (R) "MEDICAID MANAGED CARE" MEANS MEDICAID PROVIDED UNDER SECTION
18 THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW.
19 (S) "MEDICAID FEE-FOR-SERVICE" MEANS MEDICAID PROVIDED OTHER THAN
20 UNDER MEDICAID MANAGED CARE.
21 (T) "MEDICARE" MEANS TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT
22 AND THE PROGRAMS THEREUNDER.
23 (U) "EPIC" MEANS TITLE THREE OF ARTICLE TWO OF THE ELDER LAW AND THE
24 PROGRAM THEREUNDER.
25 (V) "PUBLIC HEALTH COVERAGE" MEANS MEDICAID, CHILD HEALTH PLUS, FAMILY
26 HEALTH PLUS, MEDICARE (TO THE EXTENT IT IS SUBJECT TO STATE LAW IN THE
27 CONTEXT IN WHICH THE TERM IS USED), AND EPIC.
28 S 3. Paragraph (b) of subdivision 1 of section 364-j of the social
29 services law, as amended by chapter 649 of the laws of 1996, subpara-
30 graphs (i) and (ii) as amended by chapter 433 of the laws of 1997, is
31 amended to read as follows:
32 (b) "Managed care provider". An entity that provides or arranges for
33 the provision of medical assistance services and supplies to partic-
34 ipants directly or indirectly (including by referral), including case
35 management; and:
36 (i) is authorized to operate under article forty-four of the public
37 health law or article forty-three of the insurance law and provides or
38 arranges, directly or indirectly (including by referral) for covered
39 comprehensive health services on a full capitation basis; [or]
40 (ii) is authorized as a partially capitated program pursuant to
41 section three hundred sixty-four-f of this title or section forty-four
42 hundred three-e of the public health law or section 1915b of the social
43 security act; OR
44 (III) IS AN ACCOUNTABLE CARE ORGANIZATION UNDER ARTICLE FORTY-FOUR-A
45 OF THE PUBLIC HEALTH LAW.
46 S 4. Section 2818 of the public health law is amended by adding a new
47 subdivision 6 to read as follows:
48 6. NOTWITHSTANDING SUBDIVISIONS ONE AND TWO OF THIS SECTION, SECTIONS
49 ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW,
50 OR ANY OTHER INCONSISTENT PROVISION OF LAW, OF THE FUNDS AVAILABLE FOR
51 EXPENDITURE PURSUANT TO THIS SECTION, TEN MILLION DOLLARS MAY BE ALLO-
52 CATED AND DISTRIBUTED BY THE COMMISSIONER WITHOUT A COMPETITIVE BID OR
53 REQUEST FOR PROPOSAL PROCESS FOR GRANTS TO ACCOUNTABLE CARE ORGANIZA-
54 TIONS UNDER ARTICLE FORTY-FOUR-A OF THIS CHAPTER FOR THE PURPOSE OF
55 PROMOTING THEIR FORMATION AND IMPROVING THEIR OPERATION. CONSIDERATION
56 RELIED UPON BY THE COMMISSIONER IN DETERMINING THE ALLOCATION AND
A. 6261 7
1 DISTRIBUTION OF THESE FUNDS SHALL INCLUDE, BUT NOT BE LIMITED TO, THE
2 NEED FOR AND CAPACITY OF THE ACCOUNTABLE CARE ORGANIZATION TO ACCOMPLISH
3 THE PURPOSES OF ARTICLE FORTY-FOUR-A OF THIS CHAPTER IN THE AREA TO BE
4 SERVED.
5 S 5. The opening paragraph of section 1680-j of the public authorities
6 law, as amended by section 54 of part B of chapter 58 of the laws of
7 2005, is amended to read as follows:
8 Notwithstanding any other provision of law to the contrary, the dormi-
9 tory authority of the state of New York is hereby authorized to issue
10 bonds or notes in one or more series in an aggregate principal amount
11 not to exceed seven hundred fifty million dollars excluding bonds issued
12 to fund one or more debt service reserve funds, to pay costs of issuance
13 of such bonds, and bonds or notes issued to refund or otherwise repay
14 such bonds or notes previously issued, for the purposes of financing
15 project costs authorized under section twenty-eight hundred eighteen of
16 the public health law. Of such seven hundred fifty million dollars, ten
17 million dollars shall be made available to the community health centers
18 capital program established pursuant to section twenty-eight hundred
19 seventeen of the public health law; AND TEN MILLION DOLLARS SHALL BE
20 MADE AVAILABLE TO ACCOUNTABLE CARE ORGANIZATIONS UNDER SUBDIVISION EIGHT
21 OF SECTION FORTY-FOUR HUNDRED TWENTY-TWO AND SUBDIVISION SIX OF SECTION
22 TWENTY-EIGHT HUNDRED EIGHTEEN OF THE PUBLIC HEALTH LAW.
23 S 6. The article heading of article 27-L of the public health law, as
24 added by section 16 of part OO of chapter 57 of the laws of 2008, is
25 amended to read as follows:
26 MEDICAL HOME [DEMONSTRATION] PROGRAMS
27 S 7. The public health law is amended by adding a new section 2799-t
28 to read as follows:
29 S 2799-T. MEDICAL HOME MULTIPAYOR PROGRAMS. 1. (A) THE COMMISSIONER IS
30 AUTHORIZED TO ESTABLISH MEDICAL HOME MULTIPAYOR PROGRAMS (REFERRED TO
31 IN THIS SECTION AS A "PROGRAM") AND IN RELATION TO A PROGRAM MAY CERTIFY
32 CERTAIN PRIMARY CARE CLINICIANS AND CLINICS AS MEDICAL HOMES ELIGIBLE
33 FOR ENHANCED PAYMENTS FOR SERVICES PROVIDED TO: RECIPIENTS ELIGIBLE FOR
34 MEDICAID FEE-FOR-SERVICE; ENROLLEES ELIGIBLE FOR AND ENROLLED IN MEDI-
35 CAID MANAGED CARE; ENROLLEES ELIGIBLE FOR AND ENROLLED IN FAMILY HEALTH
36 PLUS; ENROLLEES ELIGIBLE FOR AND ENROLLED IN CHILD HEALTH PLUS; ENROL-
37 LEES AND SUBSCRIBERS OF COMMERCIAL MANAGED CARE PLANS OPERATING UNDER
38 ARTICLE FORTY-FOUR OF THIS CHAPTER OR HEALTH MAINTENANCE ORGANIZATIONS
39 OPERATING UNDER ARTICLE FORTY-THREE OF THE INSURANCE LAW; ENROLLEES AND
40 SUBSCRIBERS OF OTHER COMMERCIAL INSURANCE PRODUCTS; AND EMPLOYEES OF
41 EMPLOYER-SPONSORED SELF-INSURED PLANS. THE PURPOSE OF THE PROGRAMS IS TO
42 IMPROVE HEALTH CARE OUTCOMES AND EFFICIENCY THROUGH IMPROVED ACCESS,
43 PATIENT CARE CONTINUITY, AND COORDINATION OF HEALTH SERVICES.
44 (B) AS USED IN THIS SECTION:
45 (I) "CLINIC" MEANS A GENERAL HOSPITAL PROVIDING OUTPATIENT CARE OR A
46 DIAGNOSTIC AND TREATMENT CENTER, LICENSED UNDER ARTICLE TWENTY-EIGHT OF
47 THIS CHAPTER; AND
48 (II) "PRIMARY CARE CLINICIAN" MEANS A HEALTH CARE PRACTITIONER ACTING
49 WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE
50 EDUCATION LAW WHO IS: (A) A PHYSICIAN OR NURSE PRACTITIONER PRACTICING
51 IN A PRIMARY CARE SPECIALTY; (B) A PHYSICIAN, NURSE PRACTITIONER, OR
52 MIDWIFE PRACTICING PRIMARY GYNECOLOGICAL CARE FOR FEMALE PATIENTS; OR
53 (C) A PHYSICIAN OR NURSE PRACTITIONER PRACTICING IN A NON-PRIMARY CARE
54 SPECIALTY, FOR A PATIENT WHO HAS A CHRONIC CONDITION THAT REQUIRES
55 SPECIALTY CARE, WHERE THE SPECIALIST HEALTH CARE PRACTITIONER REGULARLY
56 AND CONTINUALLY PROVIDES TREATMENT FOR THAT CONDITION TO THE PATIENT;
A. 6261 8
1 (III) "PRIMARY CARE MEDICAL HOME COLLABORATIVE" MEANS AN ENTITY
2 APPROVED BY THE COMMISSIONER WHICH SHALL INCLUDE BUT NOT BE LIMITED TO
3 HEALTH CARE PROVIDERS, WHICH MAY INCLUDE BUT NOT BE LIMITED TO HOSPI-
4 TALS, DIAGNOSTIC AND TREATMENT CENTERS, PRIVATE PRACTICES AND INDEPEND-
5 ENT PRACTICE ASSOCIATIONS, AND PAYORS OF HEALTH CARE SERVICES, WHICH MAY
6 INCLUDE BUT NOT BE LIMITED TO EMPLOYERS, HEALTH PLANS AND INSURERS.
7 2. (A) IN ORDER TO PROMOTE IMPROVED QUALITY AND EFFICIENCY OF, AND
8 ACCESS TO, HEALTH CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES,
9 IT SHALL BE THE POLICY OF THE STATE RELATING TO THE PROGRAMS TO ENCOUR-
10 AGE COOPERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS BETWEEN AND
11 AMONG PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE PROVIDERS WHO MIGHT
12 OTHERWISE BE COMPETITORS, UNDER THE ACTIVE SUPERVISION OF THE COMMIS-
13 SIONER. TO THE EXTENT SUCH ARRANGEMENTS MIGHT BE ANTI-COMPETITIVE WITHIN
14 THE MEANING AND INTENT OF THE FEDERAL ANTITRUST LAWS, THE INTENT OF THE
15 STATE IS TO SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS, AND WITH REGU-
16 LATION UNDER THIS SECTION TO THE EXTENT NECESSARY TO ACCOMPLISH THE
17 PURPOSES OF THIS SECTION RELATING TO THE PROGRAMS, AND PROVIDE STATE
18 ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS WITH RESPECT
19 TO THE PLANNING, IMPLEMENTATION AND OPERATION OF THE PROGRAMS AND PAYORS
20 OF HEALTH CARE SERVICES AND HEALTH CARE PROVIDERS.
21 (B) THE COMMISSIONER OR HIS OR HER DULY AUTHORIZED REPRESENTATIVE MAY
22 ENGAGE IN APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
23 ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS, AND MAY
24 INSPECT OR REQUEST ADDITIONAL DOCUMENTATION TO VERIFY THAT THE PROGRAM
25 IS IMPLEMENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
26 3. THE COMMISSIONER, FOR PURPOSES OF THE PROGRAM, IS AUTHORIZED TO
27 PARTICIPATE IN, ACTIVELY SUPERVISE, FACILITATE AND APPROVE A PRIMARY
28 CARE MEDICAL HOME COLLABORATIVE FOR A PROGRAM TO ESTABLISH:
29 (A) THE BOUNDARIES OF THE PROGRAM AND THE HEALTH CARE PROVIDERS ELIGI-
30 BLE TO PARTICIPATE; PROVIDED THAT THE BOUNDARIES OF PROGRAMS MAY OVER-
31 LAP;
32 (B) PRACTICE STANDARDS FOR THE MEDICAL HOME ADOPTED WITH CONSIDERATION
33 OF EXISTING STANDARDS DEVELOPED BY NATIONAL ACCREDITING AND PROFESSIONAL
34 ORGANIZATIONS INCLUDING, BUT NOT LIMITED TO, THE NATIONAL COMMITTEE FOR
35 QUALITY ASSURANCE ("NCQA"), THE JOINT COMMISSION OF ACCREDITATION OF
36 HEALTHCARE ORGANIZATIONS ("JCAHCO" OR THE "JOINT COMMISSION"), AMERICAN
37 ACCREDITATION HEALTHCARE COMMISSION ("URAC"), AMERICAN COLLEGE OF PHYSI-
38 CIANS, THE AMERICAN ACADEMY OF FAMILY PHYSICIANS, THE AMERICAN ACADEMY
39 OF PEDIATRICS, AND THE AMERICAN OSTEOPATHIC ASSOCIATION;
40 (C) METHODOLOGIES BY WHICH PAYORS WILL PROVIDE ENHANCED RATES OF
41 PAYMENT TO CERTIFIED MEDICAL HOMES;
42 (D) METHODOLOGIES TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT
43 MEET SPECIFIC PROCESS OR OUTCOME STANDARDS ESTABLISHED BY THE PRIMARY
44 CARE MEDICAL HOME COLLABORATIVE OF THE PROGRAM;
45 (E) ALTERNATIVE METHODOLOGIES FOR PAYORS OF HEALTH CARE SERVICES TO
46 HEALTH CARE PROVIDERS UNDER THE PROGRAM;
47 (F) PROVISIONS FOR PAYMENTS TO PROVIDERS THAT MAY VARY BY SIZE OR FORM
48 OF ORGANIZATION OF THE PROVIDER, OR PATIENT CASE MIX TO ACCOMMODATE
49 DIFFERENT LEVELS OF RESOURCES AND DIFFICULTY TO MEET THE STANDARDS OF
50 THE PROGRAM;
51 (G) PROVISIONS FOR PAYMENTS TO NOT-FOR-PROFIT ENTITIES THAT PROVIDE
52 SERVICES TO HEALTH CARE PROVIDERS TO ASSIST THEM IN MEETING MEDICAL HOME
53 STANDARDS UNDER THE PROGRAM SUCH AS THE SERVICES OF COMMUNITY HEALTH
54 WORKERS;
55 (H) REQUIREMENTS FOR COLLECTING DATA RELATING TO THE PROVIDING AND
56 PAYING FOR HEALTH CARE SERVICES UNDER THE PROGRAM AND PROVIDING OF DATA
A. 6261 9
1 TO THE COMMISSIONER, PAYORS AND HEALTH CARE PROVIDERS UNDER THE PROGRAM,
2 TO PROMOTE THE EFFECTIVE OPERATION AND EVALUATION OF THE PROGRAM,
3 CONSISTENT WITH PROTECTION OF THE CONFIDENTIALITY OF INDIVIDUAL PATIENT
4 INFORMATION; AND
5 (I) PROVISIONS UNDER WHICH THE COMMISSIONER MAY TERMINATE THE PROGRAM.
6 4. PATIENT AND HEALTH CARE PROVIDER PARTICIPATION IN THE PROGRAM SHALL
7 BE ON A VOLUNTARY BASIS.
8 5. CLINICS AND PRIMARY CARE CLINICIANS PARTICIPATING IN A PROGRAM ARE
9 NOT ELIGIBLE FOR ADDITIONAL ENHANCEMENTS OR BONUSES UNDER THE STATEWIDE
10 MEDICAL HOME PROGRAM, ESTABLISHED PURSUANT TO SECTION THREE HUNDRED
11 SIXTY-FOUR-M OF THE SOCIAL SERVICES LAW, FOR SERVICES PROVIDED TO
12 PARTICIPANTS IN MEDICAID FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY
13 HEALTH PLUS OR CHILD HEALTH PLUS.
14 6. SUBJECT TO THE AVAILABILITY OF FUNDING AND FEDERAL FINANCIAL
15 PARTICIPATION, THE COMMISSIONER IS AUTHORIZED:
16 (A) TO PAY ENHANCED RATES OF PAYMENT UNDER MEDICAID FEE-FOR-SERVICE,
17 MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS TO CLIN-
18 ICS AND PRIMARY CARE CLINICIANS THAT ARE CERTIFIED AS MEDICAL HOMES
19 UNDER THIS SECTION;
20 (B) TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT MEET SPECIFIC
21 PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER, IN CONSULTA-
22 TION WITH THE PRIMARY CARE MEDICAL HOME COLLABORATIVE OF THE PROGRAM;
23 AND
24 (C) TO AUTHORIZE ALTERNATIVE PAYMENT METHODOLOGIES UNDER MEDICAID
25 FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD
26 HEALTH PLUS FOR HEALTH CARE PROVIDERS AND TO SERVE THE PURPOSES OF THE
27 PROGRAM, INCLUDING PAYMENTS TO NOT-FOR-PROFIT ENTITIES UNDER PARAGRAPH
28 (G) OF SUBDIVISION THREE OF THIS SECTION.
29 7. THE COMMISSIONER MAY DIRECTLY, OR BY CONTRACT WITH NOT-FOR-PROFIT
30 ORGANIZATIONS, PROVIDE:
31 (A) TECHNICAL ASSISTANCE TO A PRIMARY CARE MEDICAL HOME COLLABORATIVE
32 IN RELATION TO ESTABLISHING AND OPERATING A PROGRAM;
33 (B) CONSUMER ASSISTANCE TO PATIENTS PARTICIPATING IN A PROGRAM AS TO
34 MATTERS RELATING TO THE PROGRAM;
35 (C) TECHNICAL AND OTHER ASSISTANCE TO HEALTH CARE PROVIDERS PARTIC-
36 IPATING IN A PROGRAM AS TO MATTERS RELATING TO THE PROGRAM, INCLUDING
37 ACHIEVING MEDICAL HOME STANDARDS;
38 (D) CARE COORDINATION PROVIDER TECHNICAL AND OTHER ASSISTANCE TO INDI-
39 VIDUALS AND ENTITIES PROVIDING CARE COORDINATION SERVICES TO HEALTH CARE
40 PROVIDERS UNDER A PROGRAM; AND
41 (E) INFORMATION SHARING AND OTHER ASSISTANCE AMONG PROGRAMS TO IMPROVE
42 THE OPERATION OF PROGRAMS CONSISTENT WITH APPLICABLE LAWS RELATING TO
43 PATIENT CONFIDENTIALITY.
44 8. THE COMMISSIONER SHALL, TO THE EXTENT NECESSARY FOR THE PURPOSE OF
45 THIS SECTION, SUBMIT THE APPROPRIATE WAIVERS AND OTHER APPLICATIONS,
46 INCLUDING, BUT NOT LIMITED TO, THOSE AUTHORIZED PURSUANT TO SECTIONS
47 ELEVEN HUNDRED FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL
48 SOCIAL SECURITY ACT, OR SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS OR
49 APPLICATIONS NECESSARY TO ACHIEVE THE PURPOSES OF HIGH QUALITY, INTE-
50 GRATED, AND COST EFFECTIVE CARE AND INTEGRATED FINANCIAL ELIGIBILITY
51 POLICIES UNDER MEDICAID, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS OR
52 MEDICARE. COPIES OF SUCH ORIGINAL WAIVER AND OTHER APPLICATIONS SHALL BE
53 PROVIDED TO THE CHAIRMAN OF THE SENATE FINANCE COMMITTEE AND THE CHAIR-
54 MAN OF THE ASSEMBLY WAYS AND MEANS COMMITTEE SIMULTANEOUSLY WITH THEIR
55 SUBMISSION TO THE FEDERAL GOVERNMENT.
A. 6261 10
1 9. THE ADIRONDACK MEDICAL HOME MULTIPAYOR DEMONSTRATION PROGRAM
2 (INCLUDING THE ADIRONDACK MEDICAL HOME COLLABORATIVE) PREVIOUSLY ESTAB-
3 LISHED UNDER SECTION TWENTY-NINE HUNDRED FIFTY-NINE OF THIS CHAPTER IS
4 CONTINUED AND SHALL BE DEEMED TO BE A PROGRAM UNDER THIS SECTION.
5 10. THE COMMISSIONER SHALL ANNUALLY REPORT TO THE GOVERNOR AND THE
6 LEGISLATURE ON THE OPERATION OF THE PROGRAMS AND THEIR EFFECTIVENESS IN
7 ACHIEVING THE PURPOSES OF THIS SECTION, WITH PARTICULAR REFERENCE TO THE
8 QUALITY, COST, AND OUTCOMES FOR ENROLLEES IN MEDICAID FEE-FOR-SERVICE,
9 MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS.
10 11. NO PROGRAM SHALL BE APPROVED UNDER THIS SECTION AFTER APRIL FIRST,
11 TWO THOUSAND SIXTEEN.
12 S 8. Paragraph o of section 21 of part OO of chapter 57 of the laws of
13 2008 amending the public health law relating to medical home demon-
14 stration programs, is amended to read as follows:
15 o. section 2799-S OF THE PUBLIC HEALTH LAW AS ADDED BY SECTION sixteen
16 of this act shall take effect January 1, 2009 and shall expire and be
17 deemed repealed 3 years after such effective date; and
18 S 9. This act shall take effect immediately; provided however that the
19 amendments to section 364-j of the social services law made by section
20 three of this act shall not affect the repeal of such section and shall
21 be deemed to repeal therewith.
