N.Y. PBH Law § 2805-X — New York Code / Act PBH / Article 28 / Section 2805-X
Hospital-home care-physician collaboration program
Status: in_force

§ 2805-x. Hospital-home care-physician collaboration program. 1. The\npurpose of this section shall be to facilitate innovation in hospital,\nhome care agency and physician collaboration in meeting the community's\nhealth care needs. It shall provide a framework to support voluntary\ninitiatives in collaboration to improve patient care access and\nmanagement, patient health outcomes, cost-effectiveness in the use of\nhealth care services and community population health. Such collaborative\ninitiatives may also include payors, skilled nursing facilities and\nother interdisciplinary providers, practitioners and service entities.\n  2. For purposes of this section:\n  (a) "Hospital" shall include a general hospital as defined in this\narticle or other inpatient facility for rehabilitation or specialty care\nwithin the definition of hospital in this article.\n  (b) "Home care agency" shall mean a certified home health agency, long\nterm home health care program or licensed home care services agency as\ndefined in article thirty-six of this chapter.\n  (c) "Payor" shall mean a health plan approved pursuant to article\nforty-four of this chapter, or article thirty-two or forty-three of the\ninsurance law.\n  (d) "Practitioner" shall mean any of the health, mental health or\nhealth related professions licensed pursuant to title eight of the\neducation law.\n  3. The commissioner is authorized to provide financing including, but\nnot limited to, grants or positive adjustments in medical assistance\nrates or premium payments, to the extent of funds available and\nallocated or appropriated therefor, including funds provided to the\nstate through federal waivers, funds made available through state\nappropriations and/or funding through section twenty-eight hundred\nseven-v of this article, as well as waivers of regulations under title\nten of the New York codes, rules and regulations, to support the\nvoluntary initiatives and objectives of this section.\n  4. Hospital-home care-physician collaborative initiatives under this\nsection may include, but shall not be limited to:\n  (a) Hospital-home care-physician integration initiatives, including\nbut not limited to:\n  (i) transitions in care initiatives to help effectively transition\npatients to post-acute care at home, coordinate follow-up care and\naddress issues critical to care plan success and readmission avoidance;\n  (ii) clinical pathways for specified conditions, guiding patients'\nprogress and outcome goals, as well as effective health services use;\n  (iii) application of telehealth/telemedicine services in monitoring\nand managing patient conditions, and promoting self-care/management,\nimproved outcomes and effective services use;\n  (iv) facilitation of physician house calls to homebound patients\nand/or to patients for whom such home visits are determined necessary\nand effective for patient care management;\n  (v) additional models for prevention of avoidable hospital\nreadmissions and emergency room visits;\n  (vi) health home development;\n  (vii) development and demonstration of new models of integrated or\ncollaborative care and care management not otherwise achievable through\nexisting models; and\n  (viii) bundled payment demonstrations for hospital-to-post-acute-care\nfor specified conditions or categories of conditions, in particular,\nconditions predisposed to high prevalence of readmission, including\nthose currently subject to federal/state penalty, and other discharges\nwith extensive post-acute needs;\n  (b) Recruitment, training and retention of hospital/home care direct\ncare staff and physicians, in geographic or clinical areas of\ndemonstrated need. Such initiatives may include, but are not limited to,\nthe following activities:\n  (i) outreach and public education about the need and value of service\nin health occupations;\n  (ii) training/continuing education and regulatory facilitation for\ncross-training to maximize flexibility in the utilization of staff,\nincluding:\n  (A) training of hospital nurses in home care;\n  (B) dual certified nurse aide/home health aide certification; and\n  (C) dual personal care aide/HHA certification;\n  (iii) salary/benefit enhancement;\n  (iv) career ladder development; and\n  (v) other incentives to practice in shortage areas; and\n  (c) Hospital - home care - physician collaboratives for the care and\nmanagement of special needs, high-risk and high-cost patients, including\nbut not limited to best practices, and training and education of direct\ncare practitioners and service employees.\n  (d) Collaborative programs to address disparities in health care\naccess or treatment, and/or conditions of higher prevalence, in certain\npopulations, where such collaborative programs could provide and manage\nservices in a more effective, person-centered and cost-efficient manner\nfor reduction or elimination of such disparities.\n  (i) Such programs may target one or more disparate conditions, or\nareas of under-service, evidenced in defined populations, including but\nnot be limited to:\n  (A) cardiovascular disease;\n  (B) hypertension;\n  (C) diabetes;\n  (D) chronic kidney disease;\n  (E) obesity;\n  (F) asthma;\n  (G) sickle cell disease;\n  (H) sepsis;\n  (I) lupus;\n  (J) breast, lung, prostate and colorectal cancers;\n  (K) geographic shortage of primary care, prenatal/obstetric care,\nspecialty medical care, home health care, or culturally and\nlinguistically compatible care;\n  (L) alcohol, tobacco, or substance abuse;\n  (M) post-traumatic stress disorder and other conditions more prevalent\namong veterans of the United States military services;\n  (N) attracting members of minority populations to the field and\npractice of medicine; and\n  (O) such other areas approved by the commissioner.\n  (ii) Collaborative hospital-home care-physician, and as applicable\nadditional partner, models may include under such disparities programs:\n  (A) service planning and design;\n  (B) recruitment of specialty personnel and/or specialty training of\nprofessionals or other direct care personnel (including physicians, home\ncare and hospital staffs), patients and informal caregivers;\n  (C) continuing medical education and clinical training for physicians,\nfollow-up evaluations, and supporting educational materials;\n  (D) use of evidenced-based approaches and/or best practices to\ntreatment;\n  (E) reimbursement of uncovered services;\n  (F) bundled or other integrated payment methods to support the\nnecessary, coordinated and cost-effective services;\n  (G) regulatory waivers to facilitate flexibility in provider\ncollaboration and person-centered care;\n  (H) patient/family peer support and education;\n  (I) data collection, research and evaluation of efficacy; and/or\n  (J) other components or innovations satisfactory to the commissioner.\n  (iii) Nothing contained in this paragraph shall prevent a physician,\nphysicians group, home care agency, or hospital from individually\napplying for said grant.\n  (iv) The commissioner shall consult with physicians, home care\nagencies, hospitals, consumers, statewide associations representative of\nsuch participants, and other experts in health care disparities, in\ndeveloping an application process for grant funding or rate adjustment,\nand for request of state regulatory waivers, to facilitate\nimplementation of disparities programs under this paragraph.\n  5. Hospitals and home care agencies which are provided financing or\nwaivers pursuant to this section shall report to the commissioner on the\npatient, service and cost experiences pursuant to this section,\nincluding the extent to which the project goals are achieved. The\ncommissioner shall compile and make such reports available on the\ndepartment's website.\n