2010 New York Code
PBH - Public Health
Article 28 - (2800 - 2822) HOSPITALS
2814 - Health networks, global budgeting, and health care demonstrations.

* §   2814.   Health  networks,  global  budgeting,  and  health  care
  demonstrations. 1. For the purposes of this section unless  the  context
  clearly requires otherwise:
    (a)  "Board"  shall mean the temporary statewide health advisory board
  established  pursuant  to  section  nine  hundred  fifty-seven  of   the
  executive law.
    (b)  "Proposal"  shall mean a design or plan developed, as a result of
  funds received pursuant to this section, to operate  a  network,  global
  budget, or regional health care demonstration.
    2.  (a)  Notwithstanding  any  inconsistent  provision  of law, within
  amounts available therefor, the commissioner shall make grants  pursuant
  to  this  section to (i) health care providers to facilitate development
  of health networks  or  health  care  demonstrations  (ii)  health  care
  providers  alone or in conjunction with third party payors to facilitate
  development of global budgets and  (iii)  an  organization  demonstrably
  representing  the  interests  of the region or communities of the region
  which demonstrate the support of the respective health systems agency to
  facilitate development of health care demonstrations or global  budgets.
  Such  networks,  demonstrations,  or global budgets shall be designed to
  improve cost  effectiveness  of  health  care  services,  establish  and
  improve  provider coordinated planning and management mechanisms, and/or
  improve provider management of  care  or  improve  continuity  of  care.
  Health   care  providers  eligible  to  receive  funding  under  section
  twenty-nine hundred fifty-two of this chapter shall not be eligible  for
  grants under this section for development of health networks.
    (b)  Grants made pursuant to this section shall provide planning funds
  which may include, but need not be limited to, funding to:
    (i) assess the health care needs of  the  population  and  develop  an
  operational plan to meet these needs;
    (ii)  plan  for  and  carry  out  any organizational changes needed to
  integrate services; and
    (iii) facilitate financing  arrangements  such  as  risk  sharing  and
  capitation.
    3.  In  awarding  grants  under  this  section, the commissioner shall
  consult with the appropriate  local  health  systems  agency  and  shall
  consider  the recommendations of the temporary statewide health advisory
  board on the grant proposals and to the extent practicable  assure  that
  there  is  a  sufficiently  representative  geographic  distribution  of
  grantees including rural, urban,  and  suburban  grantees.  Grants  made
  pursuant to this section shall be used solely for the planning of health
  networks,  global  budgets  or  health  care  demonstrations.  Prior  to
  awarding grants, the commissioner shall first  take  into  consideration
  other  financial  resources  available  to the applicant to conduct such
  planning.
    4. In order to be eligible for a grant under this section,  applicants
  shall  prepare  and  submit to the commissioner, the temporary statewide
  health care advisory board, and the respective health systems agency  an
  application which contains the following:
    (a)  identification of the principal investigator or applicant for the
  demonstration;
    (b)  a  description  of  the  nature  and  scope  of  the   activities
  contemplated;
    (c)  a  description  of  the geographic area and populations currently
  served by the entity;
    (d) a description of the community or population to be served;
    (e) a description  of  the  anticipated  benefits  and  advantages  to
  providers and consumers of services;

(f)  a description of the estimated expenses, including administrative
  expenses,  which  will  be  incurred   in   the   development   of   the
  demonstration; and
    (g) the time frame proposed for the development of the health network,
  global budgeting demonstration, or health care demonstration.
    (h)  the process that the eligible organization used in seeking public
  participation and local involvement in the development  of  the  program
  plan; and
    (i) the goals of the program, including information on how the program
  plan  will  maintain and promote access to and delivery of high quality,
  appropriate health or health related  items  and  services  for  persons
  residing in the region covered by the program.
    5.  Any  grant  recipient  seeking  to  implement a proposal developed
  pursuant to this section, except recipients of health networking grants,
  shall submit such  proposal  to  the  temporary  statewide  health  care
  advisory  board, in such form and content determined by the board, which
  shall evaluate such proposal and consider whether the proposal is likely
  to:
    (a) aid in meeting the priority  health  needs  and  concerns  in  the
  region  as  identified  in and supported by evidence in the proposal and
  consistent with recommendations of the regional health systems agency;
    (b) enhance the quality of care as evidenced by outcome indicators;
    (c)  improve  the  cost-effectiveness  of  services  by  the  entities
  involved;
    (d)  improve  the efficient utilization of the entities' resources and
  capital equipment;
    (e) enhance the provision of services  that  would  otherwise  not  be
  available;
    (f) result in the elimination of unnecessary duplication of resources;
    (g) reduce costs to individuals being served by the network;
    (h) foster information sharing, communications and cooperation between
  health care providers; and
    (i) foster and improve the management and continuity of care.
    6.  In  addition,  the  board  shall require that the proposal contain
  assurances that there will be  equitable  provider  involvement  in  the
  determination of any rates and rate setting methodology. The board shall
  also  require  a  description  of  how  the  proposed initiative will be
  evaluated and assurance that the grantee will submit annual  reports  to
  the  governor  and  legislature concerning the status and experiences of
  the initiative.
    7. The temporary statewide health advisory board  shall  forward  only
  proposals   recommended   for   operation   to   the   commissioner  for
  authorization. In granting his  authorization,  the  commissioner  shall
  certify that the proposal will:
    (a) improve the cost effectiveness of health care services;
    (b)  improve  the  quality  of  care delivered as evidenced by outcome
  indicators; and
    (c) improve access to appropriate health care services.
    8. Upon request by an applicant or grantee the  commissioner  and  the
  respective health system agency shall provide technical assistance.
    9.  The  commissioner shall submit to the chairs of the senate finance
  committee and the assembly ways and means committee and  the  chairs  of
  the  assembly  and  senate  health  committees,  a  copy of any proposal
  authorized by the commissioner pursuant to this section  not  more  than
  thirty days after approval.
    10.  With  the  exception of health networks, global budgets or health
  care demonstrations that seek  to  implement  alternative  reimbursement
  methodologies  in  general  hospital settings only and/or for ambulatory

services associated with general hospital outpatient and diagnostic  and
  treatment  center  settings regarding payment for the medical assistance
  program, as provided for in  subdivisions  ten  and  eleven  of  section
  twenty-eight  hundred  seven  of this article, no health network, global
  budget or health care demonstration that seeks to implement  alternative
  reimbursement  methodologies  shall  be  approved or implemented without
  approval pursuant to a  chapter  of  the  laws  to  be  enacted  by  the
  legislature.
    * NB Expired June 30, 1996