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2010 New York Code
PBH - Public Health
Article 28 - (2800 - 2822) HOSPITALS
2807-M - Distribution of the professional education pools.
§ 2807-m. Distribution of the professional education pools. 1.
Definitions. For purposes of this section, the following definitions
shall apply, unless the context clearly requires otherwise:
(a) "Clinical research" means patient-oriented research, epidemiologic
and behavioral studies, or outcomes research and health services
research that is approved by an institutional review board by the time
the clinical research position is filled.
(b) "Clinical research plan" means a plan submitted by a consortium or
teaching general hospital for a clinical research position which
demonstrates, in a form to be provided by the commissioner, the
following:
(i) financial support for overhead, supervision, equipment and other
resources equal to the amount of funding provided pursuant to
subparagraph (i) of paragraph (b) of subdivision five-a of this section
by the teaching general hospital or consortium for the clinical research
position;
(ii) experience the sponsor-mentor and teaching general hospital has
in clinical research and the medical field of the study;
(iii) methods, data collection and anticipated measurable outcomes of
the clinical research to be performed;
(iv) training goals, objectives and experience the researcher will be
provided to assess a future career in clinical research;
(v) scientific relevance, merit and health implications of the
research to be performed;
(vi) information on potential scientific meetings and peer review
journals where research results can be disseminated;
(vii) clear and comprehensive details on the clinical research
position;
(viii) qualifications necessary for the clinical research position and
strategy for recruitment;
(ix) non-duplication with other clinical research positions from the
same teaching general hospital or consortium;
(x) methods to track the career of the clinical researcher once the
term of the position is complete; and
(xi) any other information required by the commissioner to implement
subparagraph (i) of paragraph (b) of subdivision five-a of this section.
(xii) The clinical review plan submitted in accordance with this
paragraph may be reviewed by the commissioner in consultation with
experts outside the department of health.
(c) "Clinical research position" means a post-graduate residency
position which:
(i) shall not be required in order for the researcher to complete a
graduate medical education program;
(ii) may be reimbursed by other sources but only for costs in excess
of the funding distributed in accordance with subparagraph (i) of
paragraph (b) of subdivision five-a of this section;
(iii) shall exceed the minimum standards that are required by the
residency review committee in the specialty the researcher has trained
or is currently training;
(iv) shall not be previously funded by the teaching general hospital
or supported by another funding source at the teaching general hospital
in the past three years from the date the clinical research plan is
submitted to the commissioner;
(v) may supplement an existing research project;
(vi) shall be equivalent to a full-time position comprising of no less
than thirty-five hours per week for one or two years;
(vii) shall provide, or be filled by a researcher who has formalized
instruction in clinical research, including biostatistics, clinical
trial design, grant writing and research ethics;
(viii) shall be supervised by a sponsor-mentor who shall either (A) be
employed, contracted for employment or paid through an affiliated
faculty practice plan by a teaching general hospital which has received
at least one research grant from the National Institutes of Health in
the past five years from the date the clinical research plan is
submitted to the commissioner; (B) maintain a faculty appointment at a
medical, dental or podiatric school located in New York state that has
received at least one research grant from the National Institutes of
Health in the past five years from the date the clinical research plan
is submitted to the commissioner; or (C) be collaborating in the
clinical research plan with a researcher from another institution that
has received at least one research grant from the National Institutes of
Health in the past five years from the date the clinical research plan
is submitted to the commissioner; and
(ix) shall be filled by a researcher who is (A) enrolled or has
completed a graduate medical education program, as defined in paragraph
(i) of this subdivision; (B) a United States citizen, national, or
permanent resident of the United States; and (C) a graduate of a
medical, dental or podiatric school located in New York state, a
graduate or resident in a graduate medical education program, as defined
in paragraph (i) of this subdivision, where the sponsoring institution,
as defined in paragraph (q) of this subdivision, is located in New York
state, or resides in New York state at the time the clinical research
plan is submitted to the commissioner.
(d) "Consortium" means an organization or association, approved by the
commissioner in consultation with the council, of general hospitals
which provide graduate medical education, together with any affiliated
site; provided that such organization or association may also include
other providers of health care services, medical schools, payors or
consumers, and which meet other criteria pursuant to subdivision six of
this section.
(e) "Council" means the New York state council on graduate medical
education.
(f) "Direct medical education" means the direct costs of residents,
interns and supervising physicians.
(g) "Distribution period" means each calendar year set forth in
subdivision two of this section.
(h) "Faculty" means persons who are employed by or under contract for
employment with a teaching general hospital or are paid through a
teaching general hospital's affiliated faculty practice plan and
maintain a faculty appointment at a medical school. Such persons shall
not be limited to persons with a degree in medicine.
(i) "Graduate medical education program" means, for purposes of
subparagraph (i) of paragraph (b) of subdivision five-a of this section,
a post-graduate medical education residency in the United States which
has received accreditation from a nationally recognized accreditation
body or has been approved by a nationally recognized organization for
medical, osteopathic, podiatric or dental residency programs including,
but not limited to, specialty boards.
(j) "Indirect medical education" means the estimate of costs, other
than direct costs, of educational activities in teaching hospitals as
determined in accordance with the methodology applicable for purposes of
determining an estimate of indirect medical education costs for
reimbursement for inpatient hospital service pursuant to title XVIII of
the federal social security act (medicare).
(k) "Medicare" means the methodology used for purposes of reimbursing
inpatient hospital services provided to beneficiaries of title XVIII of
the federal social security act.
(l) "Primary care" residents specialties shall include family
medicine, general pediatrics, primary care internal medicine, and
primary care obstetrics and gynecology. In determining whether a
residency is in primary care, the commissioner shall consult with the
council.
(m) "Regions", for purposes of this section, shall mean the regions as
defined in paragraph (b) of subdivision sixteen of section twenty-eight
hundred seven-c of this article as in effect on June thirtieth, nineteen
hundred ninety-six. For purposes of distributions pursuant to
subdivision five-a of this section, except distributions made in
accordance with paragraph (a) of subdivision five-a of this section,
"regions" shall be defined as New York city and the rest of the state.
(n) "Regional pool" means a professional education pool established on
a regional basis by the commissioner from funds available pursuant to
sections twenty-eight hundred seven-s and twenty-eight hundred seven-t
of this article.
(o) "Resident" means a person in a graduate medical education program
which has received accreditation from a nationally recognized
accreditation body or in a program approved by any other nationally
recognized organization for medical, osteopathic or dental residency
programs including, but not limited to, specialty boards.
(p) "Shortage specialty" means a specialty determined by the
commissioner, in consultation with the council, to be in short supply in
the state of New York.
(q) "Sponsoring institution" means the entity that has the overall
responsibility for a program of graduate medical education. Such
institutions shall include teaching general hospitals, medical schools,
consortia and diagnostic and treatment centers.
(r) "Weighted resident count" means a teaching general hospital's
total number of residents as of July first, nineteen hundred
ninety-five, including residents in affiliated non-hospital ambulatory
settings, reported to the commissioner. Such resident counts shall
reflect the weights established in accordance with rules and regulations
adopted by the state hospital review and planning council and approved
by the commissioner for purposes of implementing subdivision twenty-five
of section twenty-eight hundred seven-c of this article and in effect on
July first, nineteen hundred ninety-five. Such weights shall not be
applied to specialty hospitals, specified by the commissioner, whose
primary care mission is to engage in research, training and clinical
care in specialty eye and ear, special surgery, orthopedic, joint
disease, cancer, chronic care or rehabilitative services.
(s) "Adjustment amount" means an amount determined for each teaching
hospital for periods prior to January first, two thousand nine by:
(i) determining the difference between (A) a calculation of what each
teaching general hospital would have been paid if payments made pursuant
to paragraph (a-3) of subdivision one of section twenty-eight hundred
seven-c of this article between January first, nineteen hundred
ninety-six and December thirty-first, two thousand three were based
solely on the case mix of persons eligible for medical assistance under
the medical assistance program pursuant to title eleven of article five
of the social services law who are enrolled in health maintenance
organizations and persons paid for under the family health plus program
enrolled in approved organizations pursuant to title eleven-D of article
five of the social services law during those years, and (B) the actual
payments to each such hospital pursuant to paragraph (a-3) of
subdivision one of section twenty-eight hundred seven-c of this article
between January first, nineteen hundred ninety-six and December
thirty-first, two thousand three.
(ii) reducing proportionally each of the amounts determined in
subparagraph (i) of this paragraph so that the sum of all such amounts
totals no more than one hundred million dollars;
(iii) further reducing each of the amounts determined in subparagraph
(ii) of this paragraph by the amount received by each hospital as a
distribution from funds designated in paragraph (a) of subdivision five
of this section attributable to the period January first, two thousand
three through December thirty-first, two thousand three, except that if
such amount was provided to a consortium then the amount of the
reduction for each hospital in the consortium shall be determined by
applying the proportion of each hospital's amount determined under
subparagraph (i) of this paragraph to the total of such amounts of all
hospitals in such consortium to the consortium award;
(iv) further reducing each of the amounts determined in subparagraph
(iii) of this paragraph by the amounts specified in paragraph (t) of
this subdivision; and
(v) dividing each of the amounts determined in subparagraph (iii) of
this paragraph by seven.
(t) "Extra reduction amount" shall mean an amount determined for a
teaching hospital for which an adjustment amount is calculated pursuant
to paragraph (s) of this subdivision that is the hospital's
proportionate share of the sum of the amounts specified in paragraph (u)
of this subdivision determined based upon a comparison of the hospital's
remaining liability calculated pursuant to paragraph (s) of this
subdivision to the sum of all such hospital's remaining liabilities.
(u) "Allotment amount" shall mean an amount determined for teaching
hospitals as follows:
(i) for a hospital for which an adjustment amount pursuant to
paragraph (s) of this subdivision does not apply, the amount received by
the hospital pursuant to paragraph (a) of subdivision five of this
section attributable to the period January first, two thousand three
through December thirty-first, two thousand three, or
(ii) for a hospital for which an adjustment amount pursuant to
paragraph (s) of this subdivision applies and which received a
distribution pursuant to paragraph (a) of subdivision five of this
section attributable to the period January first, two thousand three
through December thirty-first, two thousand three that is greater than
the hospital's adjustment amount, the difference between the
distribution amount and the adjustment amount.
2. Regional pools. (a) The commissioner shall establish regional pools
for each of the periods January first, nineteen hundred ninety-seven
through December thirty-first, nineteen hundred ninety-seven, January
first, nineteen hundred ninety-eight through December thirty-first,
nineteen hundred ninety-eight, and January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine
and on and after January first, two thousand from funds available
pursuant to sections twenty-eight hundred seven-s and twenty-eight
hundred seven-t of this article.
(b) For periods prior to January first, two thousand nine, each
regional pool shall be distributed on a monthly basis to teaching
general hospitals for costs associated with graduate medical education
provided by such teaching general hospitals in accordance with the
distribution methodology set forth in subdivision three of this section;
provided however, teaching general hospitals with a resident count of
zero as of July first of the year preceding the distribution period
shall not be eligible for distributions pursuant to this section.
General hospitals may elect to have their distribution paid through the
consortium.
3. Regional pool distributions. (a) Distributions to teaching general
hospitals shall be made from the regional pools described in subdivision
two of this section for each period prior to January first, two thousand
nine, less amounts set aside pursuant to subdivision five of this
section. To be eligible to participate in distributions pursuant to this
section, a teaching general hospital and consortium must be in
compliance with graduate medical education reporting requirements set
forth in subdivision four of this section.
(b) For periods prior to January first, two thousand nine, each
teaching general hospital in a region shall have a proxy calculated for
its graduate medical education costs as follows:
(i) The direct medical education portion of the proxy shall be the
product of: the teaching general hospital's medicare direct medical
education payment amount per resident for federal fiscal year nineteen
hundred ninety-five--ninety-six and the teaching general hospital's
weighted resident count as of July first, nineteen hundred ninety-five
and the teaching general hospital's inpatient percentage of total costs
and percentage of inpatient days, excluding medicare days, patient days
eligible for payments by governmental agencies, the comprehensive motor
vehicle insurance reparations act, workers' compensation law, volunteer
firefighters' benefit law, volunteer ambulance workers' benefit law and
self-pay patient days, to total days as such costs and days are reported
in the institutional cost report for periods ending March thirty-first,
nineteen hundred ninety-five, June thirtieth, nineteen hundred
ninety-five or December thirty-first, nineteen hundred ninety-five,
whichever is applicable. The teaching general hospital's medicare direct
medical education payment amount for purposes of this calculation shall
not exceed one hundred fifty percent of the regional average per
resident amount for the region in which the teaching general hospital is
located.
(ii) The indirect medical education portion of the proxy for a
teaching general hospital shall be calculated using the medicare
resident per bed formula in existence on June thirtieth, nineteen
hundred ninety-six, except the teaching general hospital's weighted
resident count as of July first, nineteen hundred ninety-five and number
of certified acute care beds as of January first, nineteen hundred
ninety-five shall be used in the application of the formula. The formula
result shall be applied to the teaching general hospital's applicable
case mix neutral and wage adjusted medicare standardized rate amount for
federal fiscal year nineteen hundred ninety-five--ninety-six. The result
of this application shall be multiplied by the teaching general
hospital's total number of discharges as reported in the institutional
cost report for periods ending March thirty-first, nineteen hundred
ninety-five, June thirtieth, nineteen hundred ninety-five or December
thirty-first, nineteen hundred ninety-five, whichever is applicable,
excluding discharges relating to patients eligible for medicare,
payments by governmental agencies, payments pursuant to the
comprehensive motor vehicle insurance reparations act, payments pursuant
to the workers' compensation law, the volunteer firefighters' benefit
law, the volunteer ambulance workers' benefit law, and self-pay
patients, and applicable weighting factors developed in accordance with
subdivision three of section twenty-eight hundred seven-c of this
article as in effect in nineteen hundred ninety-five. For teaching
general hospitals which are specialty hospitals reimbursed on a per diem
basis, the applicable case mix neutral and wage adjusted medicare
standardized rate amount for purposes of this calculation shall be the
amount determined for the majority of teaching general hospitals within
a region.
(iii) The teaching general hospital's graduate medical education proxy
shall equal the sum of its direct medical education proxy and indirect
medical education proxy.
(c) For periods prior to January first, two thousand nine, a
distribution amount for each teaching general hospital shall be
calculated from the applicable regional pool described in subdivision
two of this section as adjusted pursuant to paragraph (d) of this
subdivision based upon its percentage of the regional total of the
graduate medical education proxies, except that for purposes of this
paragraph the statewide amount used to compute such distribution amounts
shall be four hundred ninety million dollars on an annual basis for the
periods January first, two thousand through December thirty-first, two
thousand two and two hundred forty-five million dollars for the period
January first, two thousand three through June thirtieth, two thousand
three, less amounts set aside each period pursuant to subdivision seven
of this section.
(d) For periods prior to January first, two thousand nine, each
teaching general hospital shall receive a distribution from the
applicable regional pool based on its distribution amount determined
under paragraph (c) of this subdivision adjusted by a reduction amount
that is determined as follows:
(i) the commissioner shall establish a reduction percentage by
dividing twenty-seven million dollars each year for the period January
first, two thousand through December thirty-first, two thousand ten and
six million seven hundred fifty thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven, by the sum of initial hospital distribution amounts calculated
pursuant to paragraph (c) of this subdivision;
(ii) the commissioner shall multiply the reduction percentage by the
amount calculated pursuant to paragraph (c) of this subdivision for each
teaching general hospital;
(iii) each teaching general hospital shall have its initial
distribution amount as determined pursuant to paragraph (c) of this
subdivision reduced by an amount up to the amount calculated pursuant to
subparagraph (ii) of this paragraph and subject to the requirements of
subparagraph (iv) of this paragraph, provided, however, that if the sum
of reduction amounts for all facilities thus calculated is less than
twenty-seven million dollars on a statewide basis each year for the
period January first, two thousand through December thirty-first, two
thousand ten and six million seven hundred fifty thousand dollars for
the period January first, two thousand eleven through March
thirty-first, two thousand eleven, the commissioner may increase the
reduction percentage subject to the provisions of subparagraph (iv) of
this paragraph so that the sum of the reduction amounts for all
facilities is twenty-seven million dollars each year for the period
January first, two thousand through December thirty-first, two thousand
ten and six million seven hundred fifty thousand dollars for the period
January first, two thousand eleven through March thirty-first, two
thousand eleven.
(iv) for distribution periods prior to January first, two thousand
eleven, an individual hospital's reduction amount shall not exceed the
hospital's projected losses for treating medicaid and uninsured patients
after all other projected medical assistance, including all other
projected disproportionate share payments for the applicable period.
Such cap on the reduction amount shall also not be reconciled to reflect
actual medicaid and uninsured losses for the applicable period.
(e) Effective April first, two thousand four through December
thirty-first, two thousand eight, the distribution amount calculated
pursuant to paragraphs (c) and (d) of this subdivision for each
non-public teaching general hospital shall be reduced by the amount
calculated and included in rates pursuant to paragraph (d) of
subdivision twenty-five of section twenty-eight hundred seven-c of this
article.
(f) Effective January first, two thousand five through December
thirty-first, two thousand eight, each teaching general hospital shall
receive a distribution from the applicable regional pool based on its
distribution amount determined under paragraphs (c), (d) and (e) of this
subdivision and reduced by its adjustment amount calculated pursuant to
paragraph (s) of subdivision one of this section and, for distributions
for the period January first, two thousand five through December
thirty-first, two thousand five, further reduced by its extra reduction
amount calculated pursuant to paragraph (t) of subdivision one of this
section.
4. Reporting requirements. Each teaching general hospital and
consortium shall furnish to the department such reports and information
as may be required by the commissioner to implement this section and to
assess the cost, quality and health system needs for graduate medical
education, including, but not limited to:
(a) each teaching general hospital and site other than a general
hospital at which residents receive training shall describe annually its
graduate medical education program or programs and report the number of
residents in each program; and
(b) each consortium shall provide annually a list of the teaching
general hospitals and sites other than general hospitals at which
residents receive training participating in the consortium as members
and an implementation report relating to achievement of the goals and
objectives of the consortium plan; and
(c) each teaching general hospital and sponsoring institution shall
jointly prepare and submit to the commissioner on an annual basis an
institutional graduate medical education budget reflecting all sources
of graduate medical education revenue and expenditures for a calendar
year. In a form and manner to be specified by the commissioner, such
budget shall be prepared and reviewed by the residency training director
and certified by the chief executive officer as to accuracy and
completeness prior to submission to the commissioner. Such budget shall
be submitted to the commissioner by February first, two thousand nine
for the two thousand nine calendar year and each February first,
thereafter.
5. Supplemental distributions. (a) Up to thirty-one million dollars
annually for the periods January first, two thousand through December
thirty-first, two thousand three, and up to twenty-five million dollars
plus the sum of the amounts specified in paragraph (n) of subdivision
one of this section for the period January first, two thousand five
through December thirty-first, two thousand five, and up to thirty-one
million dollars annually for the period January first, two thousand six
through December thirty-first, two thousand seven, shall be set aside
and reserved by the commissioner from the regional pools established
pursuant to subdivision two of this section for supplemental
distributions in each such region to be made by the commissioner to
consortia and teaching general hospitals in accordance with a
distribution methodology developed in consultation with the council and
specified in rules and regulations adopted by the commissioner.
(b) Funds available shall be distributed to consortia and teaching
general hospitals that substantially meet the following training goals
and objectives:
(i) reducing the number of graduate medical education programs and/or
the number of residents in such programs;
(ii) increasing the number of residents training in underserved areas;
(iii) increasing the number of residents training in ambulatory care
facilities;
(iv) improving the quality of training programs;
(v) increasing training of minorities; and
(vi) such other factors as may be specified in rules and regulations
adopted by the commissioner in consultation with the council.
The distribution of funds pursuant to this subdivision shall not be
conditioned on a consortia or teaching general hospital reducing the
number of graduate medical education programs and/or the number of
residents in such program.
(c) In the event that funds available under this subdivision are not
distributed to consortia or teaching general hospitals in accordance
with this subdivision, such funds shall be distributed to teaching
general hospitals in accordance with the methodology described in
subdivision three of this section.
(d) Notwithstanding any other provision of law or regulation, for the
period January first, two thousand five through December thirty-first,
two thousand five, the commissioner shall distribute as supplemental
payments the allotment specified in paragraph (n) of subdivision one of
this section.
5-a. Graduate medical education innovations pool. (a) Supplemental
distributions. (i) Thirty-one million dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight, shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
and shall be available for distributions pursuant to subdivision five of
this section and in accordance with section 86-1.89 of title 10 of the
codes, rules and regulations of the state of New York as in effect on
January first, two thousand eight; provided, however, for purposes of
funding the empire clinical research investigation program (ECRIP) in
accordance with paragraph eight of subdivision (e) and paragraph two of
subdivision (f) of section 86-1.89 of title 10 of the codes, rules and
regulations of the state of New York, distributions shall be made using
two regions defined as New York city and the rest of the state and the
dollar amount set forth in subparagraph (i) of paragraph two of
subdivision (f) of section 86-1.89 of title 10 of the codes, rules and
regulations of the state of New York shall be increased from sixty
thousand dollars to seventy-five thousand dollars.
(ii) For periods on and after January first, two thousand nine,
supplemental distributions pursuant to subdivision five of this section
and in accordance with section 86-1.89 of title 10 of the codes, rules
and regulations of the state of New York shall no longer be made and the
provisions of section 86-1.89 of title 10 of the codes, rules and
regulations of the state of New York shall be null and void.
(b) Empire clinical research investigator program (ECRIP). Nine
million one hundred twenty thousand dollars annually for the period
January first, two thousand nine through December thirty-first, two
thousand ten, and two million two hundred eighty thousand dollars for
the period January first, two thousand eleven through March
thirty-first, two thousand eleven, shall be set aside and reserved by
the commissioner from the regional pools established pursuant to
subdivision two of this section to be allocated regionally with
two-thirds of the available funding going to New York city and one-third
of the available funding going to the rest of the state and shall be
available for distribution as follows:
Distributions shall first be made to consortia and teaching general
hospitals for the empire clinical research investigator program (ECRIP)
to help secure federal funding for biomedical research, train clinical
researchers, recruit national leaders as faculty to act as mentors, and
train residents and fellows in biomedical research skills based on
hospital-specific data submitted to the commissioner by consortia and
teaching general hospitals in accordance with clause (G) of this
subparagraph. Such distributions shall be made in accordance with the
following methodology:
(A) The greatest number of clinical research positions for which a
consortium or teaching general hospital may be funded pursuant to this
subparagraph shall be one percent of the total number of residents
training at the consortium or teaching general hospital on July first,
two thousand eight for the period January first, two thousand nine
through December thirty-first, two thousand nine rounded up to the
nearest one position.
(B) Distributions made to a consortium or teaching general hospital
shall equal the product of the total number of clinical research
positions submitted by a consortium or teaching general hospital and
accepted by the commissioner as meeting the criteria set forth in
paragraph (b) of subdivision one of this section, subject to the
reduction calculation set forth in clause (C) of this subparagraph,
times one hundred ten thousand dollars.
(C) If the dollar amount for the total number of clinical research
positions in the region calculated pursuant to clause (B) of this
subparagraph exceeds thirty percent of the funding available pursuant to
this paragraph, or an amount equal to the sum of one clinical research
position per teaching general hospital in the region, whichever is
greater, including clinical research positions that continue from and
were funded in prior distribution periods, the commissioner shall
eliminate one-half of the clinical research positions submitted by each
consortium or teaching general hospital rounded down to the nearest one
position. Such reduction shall be repeated until the dollar amount for
the total number of clinical research positions in the region does not
exceed thirty percent of the regional pool, or an amount equal to the
sum of one clinical research position per teaching general hospital in
the region, whichever is greater. No clinical research positions that
continue from and were funded in prior distribution periods shall be
eliminated by such reduction.
(D) Each consortium or teaching general hospital shall receive fifty
percent of its annual distribution amount calculated pursuant to this
subparagraph once the requirements set forth in clause (G) of this
subparagraph have been met. The remaining distribution amount shall be
disbursed subsequent to the submission of information required pursuant
to clause (G) of this subparagraph.
(E) Each consortium or teaching general hospital receiving
distributions pursuant to this subparagraph shall reserve seventy-five
thousand dollars to primarily fund salary and fringe benefits of the
clinical research position with the remainder going to fund the
development of faculty who are involved in biomedical research, training
and clinical care.
(F) Undistributed or returned funds available to fund clinical
research positions pursuant to this paragraph for a distribution period
shall be available to fund clinical research positions in a subsequent
distribution period.
(G) In order to be eligible for distributions pursuant to this
subparagraph, each consortium and teaching general hospital shall
provide to the commissioner by July first of each distribution period,
the following data and information on a hospital-specific basis. Such
data and information shall be certified as to accuracy and completeness
by the chief executive officer, chief financial officer or chair of the
consortium governing body of each consortium or teaching general
hospital and shall be maintained by each consortium and teaching general
hospital for five years from the date of submission:
(I) For each clinical research position, information on the type,
scope, training objectives, institutional support, clinical research
experience of the sponsor-mentor, plans for submitting research outcomes
to peer reviewed journals and at scientific meetings, including a
meeting sponsored by the department, the name of a principal contact
person responsible for tracking the career development of researchers
placed in clinical research positions, as defined in paragraph (c) of
subdivision one of this section, and who is authorized to certify to the
commissioner that all the requirements of the clinical research training
objectives set forth in this subparagraph shall be met. Such
certification shall be provided by July first of each distribution
period;
(II) For each clinical research position, information on the name,
citizenship status, medical education and training, and medical license
number of the researcher, if applicable, shall be provided by December
thirty-first of the calendar year following the distribution period;
(III) Information on the status of the clinical research plan,
accomplishments, changes in research activities, progress, and
performance of the researcher shall be provided six months after the
clinical research position has commenced and every six months thereafter
for a full-time position and for a half-time position, one year after
the clinical research position has commenced and every year thereafter;
(IV) A final report detailing training experiences, accomplishments,
activities and performance of the clinical researcher, and data,
methods, results and analyses of the clinical research plan shall be
provided three months after the clinical research position ends; and
(V) Any other data or information required by the commissioner to
implement this subparagraph.
(c) Ambulatory care training. Four million nine hundred thousand
dollars for the period January first, two thousand eight through
December thirty-first, two thousand eight, four million nine hundred
thousand dollars for the period January first, two thousand nine through
December thirty-first, two thousand nine, four million nine hundred
thousand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten, and one million two hundred
twenty-five thousand dollars for the period January first, two thousand
eleven through March thirty-first, two thousand eleven, shall be set
aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section and shall be
available for distributions to sponsoring institutions to be directed to
support clinical training of medical students and residents in
free-standing ambulatory care settings, including community health
centers and private practices. Such funding shall be allocated
regionally with two-thirds of the available funding going to New York
city and one-third of the available funding going to the rest of the
state and shall be distributed to sponsoring institutions in each region
pursuant to a request for application or request for proposal process
with preference being given to sponsoring institutions which provide
training in sites located in underserved rural or inner-city areas and
those that include medical students in such training.
(d) Physician loan repayment program. One million nine hundred sixty
thousand dollars for the period January first, two thousand eight
through December thirty-first, two thousand eight, one million nine
hundred sixty thousand dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine, one
million nine hundred sixty thousand dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten,
and four hundred ninety thousand dollars for the period January first,
two thousand eleven through March thirty-first, two thousand eleven,
shall be set aside and reserved by the commissioner from the regional
pools established pursuant to subdivision two of this section and shall
be available for purposes of physician loan repayment in accordance with
subdivision ten of this section. Such funding shall be allocated
regionally with one-third of available funds going to New York city and
two-thirds of available funds going to the rest of the state and shall
be distributed in a manner to be determined by the commissioner as
follows:
(i) Funding shall first be awarded to repay loans of up to twenty-five
physicians who train in primary care or specialty tracks in teaching
general hospitals, and who enter and remain in primary care or specialty
practices in underserved communities, as determined by the commissioner.
(ii) After distributions in accordance with subparagraph (i) of this
paragraph, all remaining funds shall be awarded to repay loans of
physicians who enter and remain in primary care or specialty practices
in underserved communities, as determined by the commissioner, including
but not limited to physicians working in general hospitals, or other
health care facilities.
(iii) In no case shall less than fifty percent of the funds available
pursuant to this paragraph be distributed in accordance with
subparagraphs (i) and (ii) of this paragraph to physicians identified by
general hospitals.
(e) Physician practice support. Four million nine hundred thousand
dollars for the period January first, two thousand eight through
December thirty-first, two thousand eight, four million nine hundred
thousand dollars annually for the period January first, two thousand
nine through December thirty-first, two thousand ten, and one million
two hundred twenty-five thousand dollars for the period January first,
two thousand eleven through March thirty-first, two thousand eleven,
shall be set aside and reserved by the commissioner from the regional
pools established pursuant to subdivision two of this section and shall
be available for purposes of physician practice support. Such funding
shall be allocated regionally with one-third of available funds going to
New York city and two-thirds of available funds going to the rest of the
state and shall be distributed in a manner to be determined by the
commissioner as follows:
(i) Preference in funding shall first be accorded to teaching general
hospitals for up to twenty-five awards, to support costs incurred by
physicians trained in primary or specialty tracks who thereafter
establish or join practices in underserved communities, as determined by
the commissioner.
(ii) After distributions in accordance with subparagraph (i) of this
paragraph, all remaining funds shall be awarded to physicians to support
the cost of establishing or joining practices in underserved
communities, as determined by the commissioner, and to hospitals and
other health care providers to recruit new physicians to provide
services in underserved communities, as determined by the commissioner.
(iii) In no case shall less than fifty percent of the funds available
pursuant to this paragraph be distributed to general hospitals in
accordance with subparagraphs (i) and (ii) of this paragraph.
(f) Study on physician workforce. Five hundred ninety thousand dollars
annually for the period January first, two thousand eight through
December thirty-first, two thousand ten, and one hundred forty-eight
thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, shall be set aside and
reserved by the commissioner from the regional pools established
pursuant to subdivision two of this section and shall be available to
fund a study of physician workforce needs and solutions including, but
not limited to, an analysis of residency programs and projected
physician workforce and community needs. The commissioner shall enter
into agreements with one or more organizations to conduct such study
based on a request for proposal process.
(g) Diversity in medicine/post-baccalaureate program. Notwithstanding
any inconsistent provision of section one hundred twelve or one hundred
sixty-three of the state finance law or any other law, one million nine
hundred sixty thousand dollars annually for the period January first,
two thousand eight through December thirty-first, two thousand ten, and
four hundred ninety thousand dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven shall be
set aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section and shall be
available for distributions to the Associated Medical Schools of New
York to fund its diversity program including existing and new
post-baccalaureate programs for minority and economically disadvantaged
students and encourage participation from all medical schools in New
York. The associated medical schools of New York shall report to the
commissioner on an annual basis regarding the use of funds for such
purpose in such form and manner as specified by the commissioner.
(h) In the event there are undistributed funds within amounts made
available for distributions pursuant to this subdivision, such funds may
be reallocated and distributed in current or subsequent distribution
periods in a manner determined by the commissioner for any purpose set
forth in this subdivision.
5-b. Other graduate medical education reforms. Any funds specifically
appropriated for the purposes of this subdivision shall be used to fund
innovative graduate medical education reforms to be determined by the
commissioner in consultation with the council, including, but not
limited to, (a) development of primary care residency and specialty
position training tracks for graduates to serve rural or inner-city
communities, (b) development of regional pilot network programs to
affiliate major academic centers with community teaching general
hospitals, (c) support for faculty development programs, including
designating faculty to mentor students and residents in primary care,
(d) support training in fields which serve the geriatric population; (e)
increase training in cultural competence, (f) promote training of
physicians who will serve persons with developmental disabilities, and
(g) any other reforms necessary to improve patient care management,
interdisciplinary training, or quality in graduate medical education
programs. Such funding shall be distributed to consortia and teaching
general hospitals in each region on a competitive basis pursuant to a
request for proposal process.
6. Consortia. (a) A consortium must:
(i) have a governing body and such committees as appropriate which
should be responsible for the policy coordination and administration of
residency programs and which provides all members of the consortium an
opportunity to participate in the establishment of consortium policy
goals and objectives;
(ii) have procedures and criteria for processing applications by
health care providers in the region for participation in the consortium;
(iii) establish policies to evaluate and to maintain and improve the
quality of training programs;
(iv) have a mechanism for resolving educational and financial
allocation disputes among participating members; and
(v) comply with such further requirements as the commissioner may
reasonably require for purposes of implementing this section to achieve
state policy goals and objectives regarding graduate medical education.
(b) Nothing in this section shall preclude a consortium from having
members from different regions and from allocating regional pool
distributions among regions.
(c) To the extent consortia might be anti-competitive within the
meaning and intent of the federal and state antitrust laws, it is the
intent of the legislature to supplant competition with such arrangements
to the extent necessary to accomplish the purposes of this section, and
provide state action immunity under the federal antitrust laws with
respect to the planning, implementation and operation of consortia and
participation therein by hospitals, other providers of health care
services, medical schools, payors and consumers.
(d) Each approved consortium shall submit a plan for each period
defined in subdivision two of this section for approval by the
commissioner, in consultation with the council, for allocation of funds
collected pursuant to paragraph (c) of subdivision three of this section
to participating general hospitals which provide graduate medical
education and sites other than general hospitals at which residents
receive training.
7. Notwithstanding any inconsistent provision of section one hundred
twelve or one hundred sixty-three of the state finance law or any other
law, up to one million dollars for the period January first, two
thousand through December thirty-first, two thousand, one million six
hundred thousand dollars annually for the periods January first, two
thousand one through December thirty-first, two thousand eight, one
million five hundred thousand dollars annually for the periods January
first, two thousand nine through December thirty-first, two thousand
ten, and three hundred seventy-five thousand dollars for the period
January first, two thousand eleven through March thirty-first, two
thousand eleven, shall be set aside and reserved by the commissioner
from the regional pools established pursuant to subdivision two of this
section and shall be available for distributions to the New York state
area health education center program for the purpose of expanding
community-based training of medical students. In addition, one million
dollars annually for the period January first, two thousand eight
through December thirty-first, two thousand ten, and two hundred fifty
thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, shall be set aside and
reserved by the commissioner from the regional pools established
pursuant to subdivision two of this section and shall be available for
distributions to the New York state area health education center program
for the purpose of post-secondary training of health care professionals
who will achieve specific program outcomes within the New York state
area health education center program. The New York state area health
education center program shall report to the commissioner on an annual
basis regarding the use of funds for each purpose in such form and
manner as specified by the commissioner.
8. Revenue from distributions pursuant to this section shall be
included in gross revenue received for purposes of the assessments
pursuant to subdivision eighteen of section twenty-eight hundred seven-c
of this article and for purposes of the assessments pursuant to section
twenty-eight hundred seven-d of this article.
10. Physician loan repayment program. (a) Beginning January first,
two thousand eight, the commissioner is authorized, within amounts
available pursuant to subdivision five-a of this section, to make loan
repayment awards to primary care physicians or other physician
specialties determined by the commissioner to be in short supply,
licensed to practice medicine in New York state, who agree to practice
for at least five years in an underserved area, as determined by the
commissioner. Such physician shall be eligible for a loan repayment
award of up to one hundred fifty thousand dollars over a five year
period distributed as follows: fifteen percent of total loan debt not to
exceed twenty thousand dollars for the first year; fifteen percent of
total loan debt not to exceed twenty-five thousand dollars for the
second year; twenty percent of total loan debt not to exceed thirty-five
thousand dollars for the third year; and twenty-five percent of total
loan debt not to exceed thirty-five thousand dollars per year for the
fourth year; and any unpaid balance of the total loan debt not to exceed
the maximum award amount for the fifth year of practice in such area.
(b) Loan repayment awards made to a physician pursuant to paragraph
(a) of this subdivision shall not exceed the total qualifying
outstanding debt of the physician from student loans to cover tuition
and other related educational expenses, made by or guaranteed by the
federal or state government, or made by a lending or educational
institution approved under title IV of the federal higher education act.
Loan repayment awards shall be used solely to repay such outstanding
debt.
(c) In the event that a five-year commitment pursuant to the agreement
referenced in paragraph (a) of this subdivision is not fulfilled, the
recipient shall be responsible for repayment in amounts which shall be
calculated in accordance with the formula set forth in subdivision (b)
of section two hundred fifty-four-o of title forty-two of the United
States Code, as amended.
(d) The commissioner is authorized to apply any funds available for
purposes of paragraph (a) of this subdivision for use as matching funds
for federal grants for the purpose of assisting states in operating loan
repayment programs pursuant to section three hundred thirty-eight I of
the public health service act.
(e) The commissioner may postpone, change or waive the service
obligation and repayment amounts set forth in paragraphs (a) and (c),
respectively of this subdivision in individual circumstances where there
is compelling need or hardship.
(f)(i) When a physician is not actually practicing in an underserved
area, he or she shall be deemed to be practicing in an underserved area
if he or she practices in a facility or physician's office that
primarily serves an underserved population as determined by the
commissioner, without regard to whether the population or the facility
or physician's office is located in an underserved area.
(ii) In making criteria and determinations as to whether an area is an
underserved area or whether a facility or physician's office primarily
serves an underserved population, the commissioner may make separate
criteria and determinations for different specialties.
11. The commissioner shall conduct a study of (i) the need for
expansion of the physician loan repayment program under subdivision ten
of this section to include dentists, midwives, nurse practitioners, and
physician assistants; (ii) the level of funding appropriate for that
expansion; and (iii) appropriate sources of funding for the future of
the program and the expansion. The study may include examination of
possible expansion of other programs to recruit people to enter health
care professions and serve in underserved areas. The commissioner shall
conduct the study in consultation with representatives of the affected
professions, educational institutions and training programs that educate
and train people for those professions, appropriate health care
providers, affected communities and other interested parties. The
commissioner shall report to the governor and the legislature on the
findings of the study and recommendations by December first, two
thousand eight.
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