NY Pub Health L § 2959-A (2021)
2021 New York Laws PBH - Public Health Article 29-AA - 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.