2013 New York Consolidated Laws
PBH - Public Health
Article 29-AA - (2959-A) PATIENT CENTERED MEDICAL HOMES
2959-A - Multipayor patient centered medical home program.

 
    § 2959-a. Multipayor patient centered medical home program. 1. (a) The
  commissioner is authorized to establish medical home multipayor programs
  (referred  to  in this section as a "program") whereby enhanced payments
  are made to primary care  clinicians  and  clinics  statewide  that  are
  certified  as  medical  homes  for  the purpose of improving health care
  outcomes and efficiency through improved access, patient care continuity
  and coordination of health services.
    (b) As used in this section:
    (i) "clinic" means a general hospital  providing  outpatient  care  or
  diagnostic  and treatment center, licensed under article twenty-eight of
  this chapter; and
    (ii) "primary care clinician" means a physician,  nurse  practitioner,
  or midwife acting within his or her lawful scope of practice under title
  eight  of  the  education  law  and  who is practicing in a primary care
  specialty.
    (iii) "primary  care  medical  home  collaborative"  means  an  entity
  approved  by  the commissioner which shall include but not be limited to
  health  care  providers,  which  may  include  but  not  be  limited  to
  hospitals,  diagnostic  and  treatment  centers,  private  practices and
  independent practice associations, and payors of health  care  services,
  which  may  include  but  not  be limited to employers, health plans and
  insurers.
    2. (a) In order to promote improved quality of, and access to,  health
  care  services  and promote improved clinical outcomes, it is the policy
  of the state to encourage  cooperative,  collaborative  and  integrative
  arrangements  among  payors  of  health  care  services  and health care
  services providers who might otherwise be competitors, under the  active
  supervision  of  the  commissioner.  It  is  the  intent of the state to
  supplant competition with such arrangements and regulation only  to  the
  extent  necessary  to  accomplish  the  purposes of this article, and to
  provide state action immunity under the state and federal antitrust laws
  to payors of health care services and  health  care  services  providers
  with  respect  to  the  planning,  implementation  and  operation of the
  multipayor patient centered medical home program.
    (b) The commissioner or his or her duly authorized representative  may
  engage  in  appropriate  state  supervision  necessary  to promote state
  action immunity under the state and  federal  antitrust  laws,  and  may
  inspect  or  request additional documentation from payors of health care
  services and health care services providers to verify that medical homes
  certified pursuant to this section operate in accordance with its intent
  and purpose.
    3.  The  commissioner  is  authorized  to  participate  in,   actively
  supervise,   facilitate   and   approve  a  primary  care  medical  home
  collaborative for each program around the state to  establish:  (a)  the
  boundaries  of  each  program and the providers eligible to participate,
  provided that the boundaries  of  programs  may  overlap;  (b)  practice
  standards  for  each  medical home program adopted with consideration of
  existing standards developed  by  the  National  Committee  for  Quality
  Assurance  ("NCQA"), the Joint Commission of Accreditation of Healthcare
  Organizations   ("JCAHCO"   or   the   "Joint   Commission"),   American
  Accreditation   Healthcare  Commission  ("URAC"),  American  College  of
  Physicians, the American Academy  of  Family  Physicians,  the  American
  Academy  of  Pediatrics,  and  the American Osteopathic Association; the
  American Academy of Nurse Practitioners, and  the  American  College  of
  Nurse  Practitioners; (c) standards for implementation and use of health
  information technology, including participation  in  health  information
  exchanges   through   the  statewide  health  information  network;  (d)
  methodologies by which payors will provide enhanced rates of payment  to

  certified  medical  homes; (e) requirements for collecting data relating
  to the providing and paying for health care services under  the  program
  and  providing  of  data  to  the  commissioner,  payors and health care
  providers  under  the  program,  to  promote the effective operation and
  evaluation  of  the  program,  consistent   with   protection   of   the
  confidentiality  of  individual  patient information; and (f) provisions
  under which the commissioner may terminate the program.
    3-a. The commissioner may develop or approve (a) methodologies to  pay
  additional  amounts  for  medical  homes  that  meet specific process or
  outcome  standards  established  by  each  multipayor  patient  centered
  medical  home collaborative; (b) alternative methodologies for payors of
  health care services to health care providers  under  the  program;  (c)
  provisions  for  payments  to providers that may vary by size or form of
  organization of the  provider,  or  patient  case  mix,  to  accommodate
  different  levels  of  resources and difficulty to meet the standards of
  the program; (d)  provisions  for  payments  to  entities  that  provide
  services to health care providers to assist them in meeting medical home
  standards  under  the  program  such as the services of community health
  workers.
    4. The commissioner is authorized to establish an  advisory  group  of
  state  agencies and stakeholders, such as professional organizations and
  associations, and consumers, to  identify  legal  and/or  administrative
  barriers  to  the  sharing  of  care  management  and  care coordination
  services among participating health care services providers and to  make
  recommendations  for statutory and/or regulatory changes to address such
  barriers.
    5. Patient, payor and health care services provider  participation  in
  the  multipayor  patient  centered  medical  home  program shall be on a
  voluntary basis.
    6. Clinics and primary care clinicians participating in a program  are
  not  eligible for additional enhancements or bonuses under the statewide
  patient centered medical home program established  pursuant  to  section
  three  hundred sixty-four-m of the social services law. The commissioner
  shall develop or approve  a  method  for  determining  payment  under  a
  program  where  a  provider  participates, or a patient is served, in an
  area where program boundaries overlap.
    7. Subject to  the  availability  of  funding  and  federal  financial
  participation, the commissioner is authorized:
    (a)  To  pay enhanced rates of payment under Medicaid fee-for-service,
  Medicaid managed care, family health  plus  and  child  health  plus  to
  clinics  and  clinicians  that are certified as patient centered medical
  homes under this title;
    (b) To pay additional amounts for medical  homes  that  meet  specific
  process   or   outcome   standards  specified  by  the  commissioner  in
  consultation  with  each  multipayor  patient  centered   medical   home
  collaborative;
    (c)  To  authorize  alternative  payment  methodologies under Medicaid
  fee-for-service, Medicaid managed care, family  health  plus  and  child
  health  plus  for health care providers and to serve the purposes of the
  program,  including  payments  to  entities  under  paragraph   (g)   of
  subdivision three of this section; and
    (d) To test new models of payment to high volume Medicaid primary care
  medical  home  practices  that incorporate risk adjusted global payments
  combined with care management and pay for performance adjustments.
    8. (a) The commissioner is authorized to contract  with  one  or  more
  entities  to  assist  the  state  in implementing the provisions of this
  section. Such entity or entities shall be the same  entity  or  entities
  chosen  to assist in the implementation of the health home provisions of

  section  three  hundred  sixty-five-l  of  the  social   services   law.
  Responsibilities  of the contractor shall include but not be limited to:
  developing   recommendations   with   respect   to    program    policy,
  reimbursement,  system  requirements, reporting requirements, evaluation
  protocols, and provider  and  patient  enrollment;  providing  technical
  assistance  to  potential  medical  home and health home providers; data
  collection;  data  sharing;  program  evaluation,  and  preparation   of
  reports.
    (b) Notwithstanding any inconsistent provision of sections one hundred
  twelve  and one hundred sixty-three of the state finance law, or section
  one hundred forty-two of the economic development law, or any other law,
  the commissioner is authorized to enter into  a  contract  or  contracts
  under  paragraph  (a) of this subdivision without a request for proposal
  process, provided, however, that:
    (i) The department shall post on its website, for a period of no  less
  than thirty days:
    (1)  A description of the proposed services to be provided pursuant to
  the contract or contracts;
    (2) The criteria for selection of a contractor or contractors;
    (3) The period of time during which a prospective contractor may  seek
  selection,   which  shall  be  no  less  than  thirty  days  after  such
  information is first posted on the website; and
    (4) The manner  by  which  a  prospective  contractor  may  seek  such
  selection, which may include submission by electronic means;
    (ii)  All reasonable and responsive submissions that are received from
  prospective contractors in timely  fashion  shall  be  reviewed  by  the
  commissioner; and
    (iii)  The  commissioner  shall  select such contractor or contractors
  that, in his or her discretion, are best suited to serve the purposes of
  this section.
    9. The commissioner may directly, or by contract, provide:
    (a) technical assistance to a primary care medical home  collaborative
  in relation to establishing and operating a program;
    (b)  consumer  assistance to patients participating in a program as to
  matters relating to the program;
    (c)  technical  and  other  assistance  to   health   care   providers
  participating  in  a  program  as  to  matters  relating to the program,
  including achieving medical home standards;
    (d) care coordination  provider  technical  and  other  assistance  to
  individuals  and entities providing care coordination services to health
  care providers under a program; and
    (e) information sharing and other assistance among programs to improve
  the operation of programs, consistent with applicable laws  relating  to
  patient confidentiality.
    10. The commissioner shall, to the extent necessary for the purpose of
  this  section,  submit  the  appropriate waivers and other applications,
  including, but not limited to, those  authorized  pursuant  to  sections
  eleven  hundred  fifteen  and  nineteen  hundred  fifteen of the federal
  social security act, or successor provisions, and any other  waivers  or
  applications   necessary  to  achieve  the  purposes  of  high  quality,
  integrated, and cost effective care and integrated financial eligibility
  policies under Medicaid, family health plus and  child  health  plus  or
  Medicare. Copies of such original waiver and other applications shall be
  provided  to  the  chairman  of  the  senate  finance  committee and the
  chairman of the assembly ways and means  committee  simultaneously  with
  their submission to the federal government.
    11.  The  Adirondack  medical  home  multipayor  demonstration program
  (including  the  Adirondack  medical  home   collaborative)   previously

  established under section twenty-nine hundred fifty-nine of this chapter
  is continued and shall be deemed to be a program under this section.
    12.  The  commissioner  shall  annually report to the governor and the
  legislature on the operation of the programs and their effectiveness  in
  achieving the purposes of this section, with particular reference to the
  quality,  cost,  and outcomes for enrollees in Medicaid fee-for-service,
  Medicaid managed care, family health plus and child health plus.