N.Y. PBH Law § 2959-A — New York Code / Act PBH / Article 29-AA / Section 2959-A
Multipayor patient centered medical home program
Status: in_force

§ 2959-a. Multipayor patient centered medical home program. 1. (a) The\ncommissioner is authorized to establish medical home multipayor programs\n(referred to in this section as a "program") whereby enhanced payments\nare made to primary care clinicians and clinics statewide that are\ncertified as medical homes for the purpose of improving health care\noutcomes and efficiency through improved access, patient care continuity\nand coordination of health services.\n  (b) As used in this section:\n  (i) "clinic" means a general hospital providing outpatient care or\ndiagnostic and treatment center, licensed under article twenty-eight of\nthis chapter; and\n  (ii) "primary care clinician" means a physician, nurse practitioner,\nor midwife acting within his or her lawful scope of practice under title\neight of the education law and who is practicing in a primary care\nspecialty.\n  (iii) "primary care medical home collaborative" means an entity\napproved by the commissioner which shall include but not be limited to\nhealth care providers, which may include but not be limited to\nhospitals, diagnostic and treatment centers, private practices and\nindependent practice associations, and payors of health care services,\nwhich may include but not be limited to employers, health plans and\ninsurers.\n  2. (a) In order to promote improved quality of, and access to, health\ncare services and promote improved clinical outcomes, it is the policy\nof the state to encourage cooperative, collaborative and integrative\narrangements among payors of health care services and health care\nservices providers who might otherwise be competitors, under the active\nsupervision of the commissioner. It is the intent of the state to\nsupplant competition with such arrangements and regulation only to the\nextent necessary to accomplish the purposes of this article, and to\nprovide state action immunity under the state and federal antitrust laws\nto payors of health care services and health care services providers\nwith respect to the planning, implementation and operation of the\nmultipayor patient centered medical home program.\n  (b) The commissioner or his or her duly authorized representative may\nengage in appropriate state supervision necessary to promote state\naction immunity under the state and federal antitrust laws, and may\ninspect or request additional documentation from payors of health care\nservices and health care services providers to verify that medical homes\ncertified pursuant to this section operate in accordance with its intent\nand purpose.\n  3. The commissioner is authorized to participate in, actively\nsupervise, facilitate and approve a primary care medical home\ncollaborative for each program around the state to establish: (a) the\nboundaries of each program and the providers eligible to participate,\nprovided that the boundaries of programs may overlap; (b) practice\nstandards for each medical home program adopted with consideration of\nexisting standards developed by the National Committee for Quality\nAssurance ("NCQA"), the Joint Commission of Accreditation of Healthcare\nOrganizations ("JCAHCO" or the "Joint Commission"), American\nAccreditation Healthcare Commission ("URAC"), American College of\nPhysicians, the American Academy of Family Physicians, the American\nAcademy of Pediatrics, and the American Osteopathic Association; the\nAmerican Academy of Nurse Practitioners, and the American College of\nNurse Practitioners; (c) standards for implementation and use of health\ninformation technology, including participation in health information\nexchanges through the statewide health information network; (d)\nmethodologies by which payors will provide enhanced rates of payment to\ncertified medical homes; (e) requirements for collecting data relating\nto the providing and paying for health care services under the program\nand providing of data to the commissioner, payors and health care\nproviders under the program, to promote the effective operation and\nevaluation of the program, consistent with protection of the\nconfidentiality of individual patient information; and (f) provisions\nunder which the commissioner may terminate the program.\n  3-a. The commissioner may develop or approve (a) methodologies to pay\nadditional amounts for medical homes that meet specific process or\noutcome standards established by each multipayor patient centered\nmedical home collaborative; (b) alternative methodologies for payors of\nhealth care services to health care providers under the program; (c)\nprovisions for payments to providers that may vary by size or form of\norganization of the provider, or patient case mix, to accommodate\ndifferent levels of resources and difficulty to meet the standards of\nthe program; (d) provisions for payments to entities that provide\nservices to health care providers to assist them in meeting medical home\nstandards under the program such as the services of community health\nworkers.\n  4. The commissioner is authorized to establish an advisory group of\nstate agencies and stakeholders, such as professional organizations and\nassociations, and consumers, to identify legal and/or administrative\nbarriers to the sharing of care management and care coordination\nservices among participating health care services providers and to make\nrecommendations for statutory and/or regulatory changes to address such\nbarriers.\n  5. Patient, payor and health care services provider participation in\nthe multipayor patient centered medical home program shall be on a\nvoluntary basis.\n  6. Clinics and primary care clinicians participating in a program are\nnot eligible for additional enhancements or bonuses under the statewide\npatient centered medical home program established pursuant to section\nthree hundred sixty-four-m of the social services law. The commissioner\nshall develop or approve a method for determining payment under a\nprogram where a provider participates, or a patient is served, in an\narea where program boundaries overlap.\n  7. Subject to the availability of funding and federal financial\nparticipation, the commissioner is authorized:\n  (a) To pay enhanced rates of payment under Medicaid fee-for-service,\nMedicaid managed care, family health plus and child health plus to\nclinics and clinicians that are certified as patient centered medical\nhomes under this title;\n  (b) To pay additional amounts for medical homes that meet specific\nprocess or outcome standards specified by the commissioner in\nconsultation with each multipayor patient centered medical home\ncollaborative;\n  (c) To authorize alternative payment methodologies under Medicaid\nfee-for-service, Medicaid managed care, family health plus and child\nhealth plus for health care providers and to serve the purposes of the\nprogram, including payments to entities under paragraph (g) of\nsubdivision three of this section; and\n  (d) To test new models of payment to high volume Medicaid primary care\nmedical home practices that incorporate risk adjusted global payments\ncombined with care management and pay for performance adjustments.\n  8. (a) The commissioner is authorized to contract with one or more\nentities to assist the state in implementing the provisions of this\nsection. Such entity or entities shall be the same entity or entities\nchosen to assist in the implementation of the health home provisions of\nsection three hundred sixty-five-l of the social services law.\nResponsibilities of the contractor shall include but not be limited to:\ndeveloping recommendations with respect to program policy,\nreimbursement, system requirements, reporting requirements, evaluation\nprotocols, and provider and patient enrollment; providing technical\nassistance to potential medical home and health home providers; data\ncollection; data sharing; program evaluation, and preparation of\nreports.\n  (b) Notwithstanding any inconsistent provision of sections one hundred\ntwelve and one hundred sixty-three of the state finance law, or section\none hundred forty-two of the economic development law, or any other law,\nthe commissioner is authorized to enter into a contract or contracts\nunder paragraph (a) of this subdivision without a request for proposal\nprocess, provided, however, that:\n  (i) The department shall post on its website, for a period of no less\nthan thirty days:\n  (1) A description of the proposed services to be provided pursuant to\nthe contract or contracts;\n  (2) The criteria for selection of a contractor or contractors;\n  (3) The period of time during which a prospective contractor may seek\nselection, which shall be no less than thirty days after such\ninformation is first posted on the website; and\n  (4) The manner by which a prospective contractor may seek such\nselection, which may include submission by electronic means;\n  (ii) All reasonable and responsive submissions that are received from\nprospective contractors in timely fashion shall be reviewed by the\ncommissioner; and\n  (iii) The commissioner shall select such contractor or contractors\nthat, in his or her discretion, are best suited to serve the purposes of\nthis section.\n  9. The commissioner may directly, or by contract, provide:\n  (a) technical assistance to a primary care medical home collaborative\nin relation to establishing and operating a program;\n  (b) consumer assistance to patients participating in a program as to\nmatters relating to the program;\n  (c) technical and other assistance to health care providers\nparticipating in a program as to matters relating to the program,\nincluding achieving medical home standards;\n  (d) care coordination provider technical and other assistance to\nindividuals and entities providing care coordination services to health\ncare providers under a program; and\n  (e) information sharing and other assistance among programs to improve\nthe operation of programs, consistent with applicable laws relating to\npatient confidentiality.\n  10. The commissioner shall, to the extent necessary for the purpose of\nthis section, submit the appropriate waivers and other applications,\nincluding, but not limited to, those authorized pursuant to sections\neleven hundred fifteen and nineteen hundred fifteen of the federal\nsocial security act, or successor provisions, and any other waivers or\napplications necessary to achieve the purposes of high quality,\nintegrated, and cost effective care and integrated financial eligibility\npolicies under Medicaid, family health plus and child health plus or\nMedicare. Copies of such original waiver and other applications shall be\nprovided to the chairman of the senate finance committee and the\nchairman of the assembly ways and means committee simultaneously with\ntheir submission to the federal government.\n  11. The Adirondack medical home multipayor demonstration program\n(including the Adirondack medical home collaborative) previously\nestablished under section twenty-nine hundred fifty-nine of this chapter\nis continued and shall be deemed to be a program under this section.\n