NY Pub Health L § 2807-M (2021)
2021 New York Laws PBH - Public Health Article 28 - Hospitals 2807-M - Distribution of the Professional Education Pools.

§  2807-m.  Distribution  of  the  professional  education  pools.  1. Definitions. For purposes of this  section,  the  following  definitions shall apply, unless the context clearly requires otherwise:  (a) "Clinical research" means patient-oriented research, epidemiologic and  behavioral  studies,  or  outcomes  research  and  health  services research that is approved by an institutional review board by  the  time the clinical research position is filled.  (b) "Clinical research plan" means a plan submitted by a consortium or teaching  general  hospital  for  a  clinical  research  position  which demonstrates, in  a  form  to  be  provided  by  the  commissioner,  the following:  (i)  financial  support for overhead, supervision, equipment and other resources  equal  to  the  amount  of  funding  provided   pursuant   to subparagraph  (i) of paragraph (b) of subdivision five-a of this section by the teaching general hospital or consortium for the clinical research position;  (ii) experience the sponsor-mentor and teaching general  hospital  has in clinical research and the medical field of the study;  (iii)  methods, data collection and anticipated measurable outcomes of the clinical research to be performed;  (iv) training goals, objectives and experience the researcher will  be provided to assess a future career in clinical research;  (v)  scientific  relevance,  merit  and  health  implications  of  the research to be performed;  (vi) information on potential  scientific  meetings  and  peer  review journals where research results can be disseminated;  (vii)  clear  and  comprehensive  details  on  the  clinical  research position;  (viii) qualifications necessary for the clinical research position and strategy for recruitment;  (ix) non-duplication with other clinical research positions  from  the same teaching general hospital or consortium;  (x)  methods  to  track the career of the clinical researcher once the term of the position is complete; and  (xi) any other information required by the commissioner  to  implement subparagraph (i) of paragraph (b) of subdivision five-a of this section.  (xii)  The  clinical  review  plan  submitted  in accordance with this paragraph may be reviewed  by  the  commissioner  in  consultation  with experts outside the department of health.  (c)  "Clinical  research  position"  means  a  post-graduate residency position which:  (i) shall not be required in order for the researcher  to  complete  a graduate medical education program;  (ii)  may  be reimbursed by other sources but only for costs in excess of the funding  distributed  in  accordance  with  subparagraph  (i)  of paragraph (b) of subdivision five-a of this section;  (iii)  shall  exceed  the  minimum  standards that are required by the residency review committee in the specialty the researcher  has  trained or is currently training;  (iv)  shall  not be previously funded by the teaching general hospital or supported by another funding source at the teaching general  hospital in  the  past  three  years  from the date the clinical research plan is submitted to the commissioner;  (v) may supplement an existing research project;  (vi) shall be equivalent to a full-time position comprising of no less than thirty-five hours per week for one or two years;  (vii) shall provide, or be filled by a researcher who  has  formalized instruction  in  clinical  research,  including  biostatistics, clinical trial design, grant writing and research ethics;  (viii) shall be supervised by a sponsor-mentor who shall either (A) be employed,  contracted  for  employment  or  paid  through  an affiliated faculty practice plan by a teaching general hospital which has  received at  least  one  research grant from the National Institutes of Health in the past five  years  from  the  date  the  clinical  research  plan  is submitted  to  the commissioner; (B) maintain a faculty appointment at a medical, dental or podiatric school located in New York state  that  has received  at  least  one  research grant from the National Institutes of Health in the past five years from the date the clinical  research  plan is  submitted  to  the  commissioner;  or  (C)  be  collaborating in the clinical research plan with a researcher from another  institution  that has received at least one research grant from the National Institutes of Health  in  the past five years from the date the clinical research plan is submitted to the commissioner; and  (ix) shall be filled by a  researcher  who  is  (A)  enrolled  or  has completed  a graduate medical education program, as defined in paragraph (i) of this subdivision; (B)  a  United  States  citizen,  national,  or permanent  resident  of  the  United  States;  and  (C)  a graduate of a medical, dental or  podiatric  school  located  in  New  York  state,  a graduate or resident in a graduate medical education program, as defined in  paragraph (i) of this subdivision, where the sponsoring institution, as defined in paragraph (q) of this subdivision, is located in New  York state,  or  resides  in New York state at the time the clinical research plan is submitted to the commissioner.  (d) "Consortium" means an organization or association, approved by the commissioner in consultation with  the  council,  of  general  hospitals which  provide  graduate medical education, together with any affiliated site; provided that such organization or association  may  also  include other  providers  of  health  care  services, medical schools, payors or consumers, and which meet other criteria pursuant to subdivision six  of this section.  (e)  "Council"  means  the  New York state council on graduate medical education.  (f) "Direct medical education" means the direct  costs  of  residents, interns and supervising physicians.  (g)  "Distribution  period"  means  each  calendar  year  set forth in subdivision two of this section.  (h) "Faculty" means persons who are employed by or under contract  for employment  with  a  teaching  general  hospital  or  are paid through a teaching  general  hospital's  affiliated  faculty  practice  plan   and maintain  a  faculty appointment at a medical school. Such persons shall not be limited to persons with a degree in medicine.  (i) "Graduate medical education program" means a post-graduate medical education  residency  in  the   United   States   which   has   received accreditation  from  a  nationally  recognized accreditation body or has been approved by  a  nationally  recognized  organization  for  medical, osteopathic,  podiatric  or dental residency programs including, but not limited to, specialty boards.  (j) "Indirect medical education" means the estimate  of  costs,  other than  direct  costs,  of educational activities in teaching hospitals as determined in accordance with the methodology applicable for purposes of determining  an  estimate  of  indirect  medical  education  costs   for reimbursement  for inpatient hospital service pursuant to title XVIII of the federal social security act (medicare).  (k) "Medicare" means the methodology used for purposes of  reimbursing inpatient  hospital services provided to beneficiaries of title XVIII of the federal social security act.  (l)   "Primary   care"  residents  specialties  shall  include  family medicine,  general  pediatrics,  primary  care  internal  medicine,  and primary  care  obstetrics  and  gynecology.  In  determining  whether  a residency is in primary care, the commissioner shall  consult  with  the council.  (m) "Regions", for purposes of this section, shall mean the regions as defined  in paragraph (b) of subdivision sixteen of section twenty-eight hundred seven-c of this article as in effect on June thirtieth, nineteen hundred  ninety-six.  For  purposes   of   distributions   pursuant   to subdivision  five-a  of  this  section,  except  distributions  made  in accordance with paragraph (a) of subdivision  five-a  of  this  section, "regions" shall be defined as New York city and the rest of the state.  (n) "Regional pool" means a professional education pool established on a  regional  basis  by the commissioner from funds available pursuant to sections twenty-eight hundred seven-s and twenty-eight  hundred  seven-t of this article.  (o)  "Resident" means a person in a graduate medical education program which  has  received  accreditation   from   a   nationally   recognized accreditation  body  or  in  a  program approved by any other nationally recognized organization for medical,  osteopathic  or  dental  residency programs including, but not limited to, specialty boards.  (p)   "Shortage   specialty"  means  a  specialty  determined  by  the commissioner, in consultation with the council, to be in short supply in the state of New York.  (q) "Sponsoring institution" means the entity  that  has  the  overall responsibility  for  a  program  of  graduate  medical  education.  Such institutions shall include teaching general hospitals, medical  schools, consortia and diagnostic and treatment centers.  (r)  "Weighted  resident  count"  means  a teaching general hospital's total  number  of  residents  as  of  July   first,   nineteen   hundred ninety-five,  including  residents in affiliated non-hospital ambulatory settings, reported to  the  commissioner.  Such  resident  counts  shall reflect the weights established in accordance with rules and regulations adopted  by  the state hospital review and planning council and approved by the commissioner for purposes of implementing subdivision twenty-five of section twenty-eight hundred seven-c of this article and in effect on July first, nineteen hundred ninety-five.  Such  weights  shall  not  be applied  to  specialty  hospitals,  specified by the commissioner, whose primary care mission is to engage in  research,  training  and  clinical care  in  specialty  eye  and  ear,  special  surgery, orthopedic, joint disease, cancer, chronic care or rehabilitative services.  (s) "Adjustment amount" means an amount determined for  each  teaching hospital for periods prior to January first, two thousand nine by:  (i)  determining the difference between (A) a calculation of what each teaching general hospital would have been paid if payments made pursuant to paragraph (a-3) of subdivision one of  section  twenty-eight  hundred seven-c   of  this  article  between  January  first,  nineteen  hundred ninety-six and December thirty-first,  two  thousand  three  were  based solely  on the case mix of persons eligible for medical assistance under the medical assistance program pursuant to title eleven of article  five of  the  social  services  law  who  are  enrolled in health maintenance organizations and persons paid for under the family health plus  program enrolled in approved organizations pursuant to title eleven-D of article five  of  the social services law during those years, and (B) the actual payments  to  each  such  hospital  pursuant  to  paragraph   (a-3)   of  subdivision  one of section twenty-eight hundred seven-c of this article between  January  first,  nineteen  hundred  ninety-six   and   December thirty-first, two thousand three.  (ii)  reducing  proportionally  each  of  the  amounts  determined  in subparagraph (i) of this paragraph so that the sum of all  such  amounts totals no more than one hundred million dollars;  (iii)  further reducing each of the amounts determined in subparagraph (ii) of this paragraph by the amount received  by  each  hospital  as  a distribution  from funds designated in paragraph (a) of subdivision five of this section attributable to the period January first,  two  thousand three  through December thirty-first, two thousand three, except that if such amount was  provided  to  a  consortium  then  the  amount  of  the reduction  for  each  hospital  in the consortium shall be determined by applying the proportion  of  each  hospital's  amount  determined  under subparagraph  (i)  of this paragraph to the total of such amounts of all hospitals in such consortium to the consortium award;  (iv) further reducing each of the amounts determined  in  subparagraph (iii)  of  this  paragraph  by the amounts specified in paragraph (t) of this subdivision; and  (v) dividing each of the amounts determined in subparagraph  (iii)  of this paragraph by seven.  (t)  "Extra  reduction  amount"  shall mean an amount determined for a teaching hospital for which an adjustment amount is calculated  pursuant to   paragraph   (s)   of   this  subdivision  that  is  the  hospital's proportionate share of the sum of the amounts specified in paragraph (u) of this subdivision determined based upon a comparison of the hospital's remaining  liability  calculated  pursuant  to  paragraph  (s)  of  this subdivision to the sum of all such hospital's remaining liabilities.  (u)  "Allotment  amount"  shall mean an amount determined for teaching hospitals as follows:  (i) for  a  hospital  for  which  an  adjustment  amount  pursuant  to paragraph (s) of this subdivision does not apply, the amount received by the  hospital  pursuant  to  paragraph  (a)  of subdivision five of this section attributable to the period January  first,  two  thousand  three through December thirty-first, two thousand three, or  (ii)  for  a  hospital  for  which  an  adjustment  amount pursuant to paragraph  (s)  of  this  subdivision  applies  and  which  received   a distribution  pursuant  to  paragraph  (a)  of  subdivision five of this section attributable to the period January  first,  two  thousand  three through  December  thirty-first, two thousand three that is greater than the  hospital's  adjustment   amount,   the   difference   between   the distribution amount and the adjustment amount.   2. Regional pools. (a) The commissioner shall establish regional pools for  each  of  the  periods January first, nineteen hundred ninety-seven through December thirty-first, nineteen  hundred  ninety-seven,  January first,  nineteen  hundred  ninety-eight  through  December thirty-first, nineteen hundred  ninety-eight,  and  January  first,  nineteen  hundred ninety-nine  through December thirty-first, nineteen hundred ninety-nine and on and after  January  first,  two  thousand  from  funds  available pursuant  to  sections  twenty-eight  hundred  seven-s  and twenty-eight hundred seven-t of this article.  (b) For periods prior  to  January  first,  two  thousand  nine,  each regional  pool  shall  be  distributed  on  a  monthly basis to teaching general hospitals for costs associated with graduate  medical  education provided  by  such  teaching  general  hospitals  in accordance with the distribution methodology set forth in subdivision three of this section; provided however, teaching general hospitals with a  resident  count  of zero  as  of  July  first  of the year preceding the distribution period  shall not be  eligible  for  distributions  pursuant  to  this  section. General  hospitals may elect to have their distribution paid through the consortium.   3. Regional pool distributions.  (a) Distributions to teaching general hospitals shall be made from the regional pools described in subdivision two of this section for each period prior to January first, two thousand nine,  less  amounts  set  aside  pursuant  to  subdivision five of this section. To be eligible to participate in distributions pursuant to this section,  a  teaching  general  hospital  and  consortium  must  be   in compliance  with  graduate  medical education reporting requirements set forth in subdivision four of this section.  (b) For periods prior  to  January  first,  two  thousand  nine,  each teaching  general hospital in a region shall have a proxy calculated for its graduate medical education costs as follows:  (i) The direct medical education portion of the  proxy  shall  be  the product  of:  the  teaching  general  hospital's medicare direct medical education payment amount per resident for federal fiscal  year  nineteen hundred  ninety-five--ninety-six  and  the  teaching  general hospital's weighted resident count as of July first, nineteen  hundred  ninety-five and  the teaching general hospital's inpatient percentage of total costs and percentage of inpatient days, excluding medicare days, patient  days eligible  for payments by governmental agencies, the comprehensive motor vehicle insurance reparations act, workers' compensation law,  volunteer firefighters'  benefit law, volunteer ambulance workers' benefit law and self-pay patient days, to total days as such costs and days are reported in the institutional cost report for periods ending March  thirty-first, nineteen   hundred   ninety-five,   June   thirtieth,  nineteen  hundred ninety-five or  December  thirty-first,  nineteen  hundred  ninety-five, whichever is applicable. The teaching general hospital's medicare direct medical  education payment amount for purposes of this calculation shall not exceed one  hundred  fifty  percent  of  the  regional  average  per resident amount for the region in which the teaching general hospital is located.  (ii)  The  indirect  medical  education  portion  of  the  proxy for a teaching  general  hospital  shall  be  calculated  using  the  medicare resident  per  bed  formula  in  existence  on  June thirtieth, nineteen hundred ninety-six, except  the  teaching  general  hospital's  weighted resident count as of July first, nineteen hundred ninety-five and number of  certified  acute  care  beds  as  of January first, nineteen hundred ninety-five shall be used in the application of the formula. The formula result shall be applied to the teaching  general  hospital's  applicable case mix neutral and wage adjusted medicare standardized rate amount for federal fiscal year nineteen hundred ninety-five--ninety-six. The result of  this  application  shall  be  multiplied  by  the  teaching  general hospital's total number of discharges as reported in  the  institutional cost  report  for  periods  ending  March thirty-first, nineteen hundred ninety-five, June thirtieth, nineteen hundred  ninety-five  or  December thirty-first,  nineteen  hundred  ninety-five,  whichever is applicable, excluding  discharges  relating  to  patients  eligible  for   medicare, payments   by   governmental   agencies,   payments   pursuant   to  the comprehensive motor vehicle insurance reparations act, payments pursuant to the workers' compensation law, the  volunteer  firefighters'  benefit law,   the  volunteer  ambulance  workers'  benefit  law,  and  self-pay patients, and applicable weighting factors developed in accordance  with subdivision  three  of  section  twenty-eight  hundred  seven-c  of this article as in effect  in  nineteen  hundred  ninety-five.  For  teaching general hospitals which are specialty hospitals reimbursed on a per diem basis,  the  applicable  case  mix  neutral  and  wage adjusted medicare  standardized rate amount for purposes of this calculation shall  be  the amount  determined for the majority of teaching general hospitals within a region.  (iii) The teaching general hospital's graduate medical education proxy shall  equal  the sum of its direct medical education proxy and indirect medical education proxy.  (c)  For  periods  prior  to  January  first,  two  thousand  nine,  a distribution   amount  for  each  teaching  general  hospital  shall  be calculated from the applicable regional pool  described  in  subdivision two  of  this  section  as  adjusted  pursuant  to paragraph (d) of this subdivision based upon its percentage  of  the  regional  total  of  the graduate  medical  education  proxies,  except that for purposes of this paragraph the statewide amount used to compute such distribution amounts shall be four hundred ninety million dollars on an annual basis for  the periods  January  first, two thousand through December thirty-first, two thousand two and two hundred forty-five million dollars for  the  period January  first,  two thousand three through June thirtieth, two thousand three, less amounts set aside each period pursuant to subdivision  seven of this section.  (d)  For  periods  prior  to  January  first,  two thousand nine, each teaching  general  hospital  shall  receive  a  distribution  from   the applicable  regional  pool  based  on its distribution amount determined under paragraph (c) of this subdivision adjusted by a  reduction  amount that is determined as follows:  (i)  the  commissioner  shall  establish  a  reduction  percentage  by dividing twenty-seven million dollars each year for the  period  January first,  two thousand through December thirty-first, two thousand ten and six million seven hundred fifty thousand dollars for the period  January first,  two  thousand  eleven  through  March thirty-first, two thousand eleven, by the sum of initial hospital distribution  amounts  calculated pursuant to paragraph (c) of this subdivision;  (ii)  the  commissioner shall multiply the reduction percentage by the amount calculated pursuant to paragraph (c) of this subdivision for each teaching general hospital;  (iii)  each  teaching  general  hospital  shall   have   its   initial distribution  amount  as  determined  pursuant  to paragraph (c) of this subdivision reduced by an amount up to the amount calculated pursuant to subparagraph (ii) of this paragraph and subject to the  requirements  of subparagraph  (iv) of this paragraph, provided, however, that if the sum of reduction amounts for all facilities thus  calculated  is  less  than twenty-seven  million  dollars  on  a  statewide basis each year for the period January first, two thousand through  December  thirty-first,  two thousand  ten  and  six million seven hundred fifty thousand dollars for the  period  January  first,   two   thousand   eleven   through   March thirty-first,  two  thousand  eleven,  the commissioner may increase the reduction percentage subject to the provisions of subparagraph  (iv)  of this  paragraph  so  that  the  sum  of  the  reduction  amounts for all facilities is twenty-seven million dollars  each  year  for  the  period January  first, two thousand through December thirty-first, two thousand ten and six million seven hundred fifty thousand dollars for the  period January  first,  two  thousand  eleven  through  March thirty-first, two thousand eleven.  (iv) for distribution periods prior to  January  first,  two  thousand eleven,  an  individual hospital's reduction amount shall not exceed the hospital's projected losses for treating medicaid and uninsured patients after all  other  projected  medical  assistance,  including  all  other projected  disproportionate  share  payments  for the applicable period.  Such cap on the reduction amount shall also not be reconciled to reflect actual medicaid and uninsured losses for the applicable period.  (e)   Effective  April  first,  two  thousand  four  through  December thirty-first, two thousand eight,  the  distribution  amount  calculated pursuant  to  paragraphs  (c)  and  (d)  of  this  subdivision  for each non-public teaching general hospital shall  be  reduced  by  the  amount calculated   and   included  in  rates  pursuant  to  paragraph  (d)  of subdivision twenty-five of section twenty-eight hundred seven-c of  this article.  (f)  Effective  January  first,  two  thousand  five  through December thirty-first, two thousand eight, each teaching general  hospital  shall receive  a  distribution  from the applicable regional pool based on its distribution amount determined under paragraphs (c), (d) and (e) of this subdivision and reduced by its adjustment amount calculated pursuant  to paragraph  (s) of subdivision one of this section and, for distributions for the  period  January  first,  two  thousand  five  through  December thirty-first,  two thousand five, further reduced by its extra reduction amount calculated pursuant to paragraph (t) of subdivision one  of  this section.   4.   Reporting   requirements.  Each  teaching  general  hospital  and consortium shall furnish to the department such reports and  information as  may be required by the commissioner to implement this section and to assess the cost, quality and health system needs  for  graduate  medical education, including, but not limited to:  (a)  each  teaching  general  hospital  and  site other than a general hospital at which residents receive training shall describe annually its graduate medical education program or programs and report the number  of residents in each program; and  (b)  each  consortium  shall  provide  annually a list of the teaching general hospitals and  sites  other  than  general  hospitals  at  which residents  receive  training  participating in the consortium as members and an implementation report relating to achievement of  the  goals  and objectives of the consortium plan; and  (c)  each  teaching  general hospital and sponsoring institution shall jointly prepare and submit to the commissioner on  an  annual  basis  an institutional  graduate  medical education budget reflecting all sources of graduate medical education revenue and expenditures  for  a  calendar year.  In  a  form  and manner to be specified by the commissioner, such budget shall be prepared and reviewed by the residency training director and certified  by  the  chief  executive  officer  as  to  accuracy  and completeness  prior to submission to the commissioner. Such budget shall be submitted to the commissioner by February first,  two  thousand  nine for  the  two  thousand  nine  calendar  year  and  each February first, thereafter.   5. Supplemental distributions.  (a) Up to thirty-one  million  dollars annually  for  the  periods January first, two thousand through December thirty-first, two thousand three, and up to twenty-five million  dollars plus  the  sum  of the amounts specified in paragraph (n) of subdivision one of this section for the period  January  first,  two  thousand  five through  December  thirty-first, two thousand five, and up to thirty-one million dollars annually for the period January first, two thousand  six through  December  thirty-first,  two thousand seven, shall be set aside and reserved by the commissioner from  the  regional  pools  established pursuant   to   subdivision   two   of  this  section  for  supplemental distributions in each such region to be  made  by  the  commissioner  to consortia   and   teaching   general  hospitals  in  accordance  with  a distribution methodology developed in consultation with the council  and specified in rules and regulations adopted by the commissioner.  (b)  Funds  available  shall  be distributed to consortia and teaching general hospitals that substantially meet the following  training  goals and objectives:  (i)  reducing the number of graduate medical education programs and/or the number of residents in such programs;  (ii) increasing the number of residents training in underserved areas;  (iii) increasing the number of residents training in  ambulatory  care facilities;  (iv) improving the quality of training programs;  (v) increasing training of minorities; and  (vi)  such  other factors as may be specified in rules and regulations adopted by the commissioner in consultation with the council.   The distribution of funds pursuant to this subdivision  shall  not  be conditioned  on  a  consortia  or teaching general hospital reducing the number of graduate medical  education  programs  and/or  the  number  of residents in such program.  (c)  In  the event that funds available under this subdivision are not distributed to consortia or teaching  general  hospitals  in  accordance with  this  subdivision,  such  funds  shall  be distributed to teaching general hospitals  in  accordance  with  the  methodology  described  in subdivision three of this section.  (d)  Notwithstanding any other provision of law or regulation, for the period January first, two thousand five through  December  thirty-first, two  thousand  five,  the  commissioner shall distribute as supplemental payments the allotment specified in paragraph (n) of subdivision one  of this section.   5-a.  Graduate  medical  education  innovations pool. (a) Supplemental distributions. (i) Thirty-one million dollars  for  the  period  January first,  two  thousand  eight through December thirty-first, two thousand eight, shall be set aside and reserved  by  the  commissioner  from  the regional  pools  established pursuant to subdivision two of this section and shall be available for distributions pursuant to subdivision five of this section and in accordance with section 86-1.89 of title 10  of  the codes,  rules  and  regulations of the state of New York as in effect on January first, two thousand eight; provided, however,  for  purposes  of funding  the  empire  clinical research investigation program (ECRIP) in accordance with paragraph eight of subdivision (e) and paragraph two  of subdivision  (f)  of section 86-1.89 of title 10 of the codes, rules and regulations of the state of New York, distributions shall be made  using two  regions  defined as New York city and the rest of the state and the dollar amount  set  forth  in  subparagraph  (i)  of  paragraph  two  of subdivision  (f)  of section 86-1.89 of title 10 of the codes, rules and regulations of the state of New  York  shall  be  increased  from  sixty thousand dollars to seventy-five thousand dollars.  (ii)  For  periods  on  and  after  January  first, two thousand nine, supplemental distributions pursuant to subdivision five of this  section and  in  accordance with section 86-1.89 of title 10 of the codes, rules and regulations of the state of New York shall no longer be made and the provisions of section 86-1.89 of  title  10  of  the  codes,  rules  and regulations of the state of New York shall be null and void.  (b)  Empire  clinical  research  investigator  program  (ECRIP).  Nine million one hundred twenty thousand  dollars  annually  for  the  period January  first,  two  thousand  nine  through December thirty-first, two thousand ten, and two million two hundred eighty  thousand  dollars  for the   period   January   first,   two  thousand  eleven,  through  March thirty-first, two thousand  eleven,  nine  million  one  hundred  twenty thousand  dollars each state fiscal year for the period April first, two thousand eleven through March thirty-first, two thousand fourteen, up to  eight million six hundred twelve thousand dollars each state fiscal year for  the  period  April  first,  two  thousand  fourteen  through  March thirty-first,  two  thousand  seventeen, up to eight million six hundred twelve  thousand  dollars  each  state  fiscal year for the period April first, two thousand seventeen through March thirty-first,  two  thousand twenty, and up to eight million six hundred twelve thousand dollars each state  fiscal  year  for  the  period  April  first, two thousand twenty through March thirty-first, two  thousand  twenty-three,  shall  be  set aside   and  reserved  by  the  commissioner  from  the  regional  pools established pursuant to subdivision two of this section to be  allocated regionally  with  two-thirds  of the available funding going to New York city and one-third of the available funding going to  the  rest  of  the state and shall be available for distribution as follows:   Distributions  shall  first  be made to consortia and teaching general hospitals for the empire clinical research investigator program  (ECRIP) to  help  secure federal funding for biomedical research, train clinical researchers, recruit national leaders as faculty to act as mentors,  and train  residents  and  fellows  in  biomedical  research skills based on hospital-specific data submitted to the commissioner  by  consortia  and teaching  general  hospitals  in  accordance  with  clause  (G)  of this subparagraph. Such distributions shall be made in  accordance  with  the following methodology:  (A)  The  greatest  number  of clinical research positions for which a consortium or teaching general hospital may be funded pursuant  to  this subparagraph  shall  be  one  percent  of  the total number of residents training at the consortium or teaching general hospital on  July  first, two  thousand  eight  for  the  period  January first, two thousand nine through December thirty-first, two  thousand  nine  rounded  up  to  the nearest one position.  (B)  Distributions  made  to a consortium or teaching general hospital shall equal the  product  of  the  total  number  of  clinical  research positions  submitted  by  a  consortium or teaching general hospital and accepted by the commissioner  as  meeting  the  criteria  set  forth  in paragraph  (b)  of  subdivision  one  of  this  section,  subject to the reduction calculation set forth in  clause  (C)  of  this  subparagraph, times one hundred ten thousand dollars.  (C)  If  the  dollar  amount for the total number of clinical research positions in the region  calculated  pursuant  to  clause  (B)  of  this subparagraph  exceeds the total amount appropriated for purposes of this paragraph, including clinical research positions that continue from  and were  funded  in  prior  distribution  periods,  the  commissioner shall eliminate one-half of the clinical research positions submitted by  each consortium  or teaching general hospital rounded down to the nearest one position. Such reduction shall be repeated until the dollar  amount  for the  total  number of clinical research positions in the region does not exceed the total amount appropriated for purposes of this paragraph.  If the  repeated  reduction  of  the  total  number  of  clinical  research positions in the region by one-half does  not  render  a  total  funding amount  that is equal to or less than the total amount reserved for that region within the appropriation, the funding for each clinical  research position  in that region shall be reduced proportionally in one thousand dollar increments until the total dollar amount for the total number  of clinical  research  positions  in  that region does not exceed the total amount reserved for that region within the appropriation. Any  reduction in  funding will be effective for the duration of the award. No clinical research  positions  that  continue  from  and  were  funded  in   prior distribution periods shall be eliminated or reduced by such methodology.  (D)  Each  consortium  or  teaching general hospital shall receive its annual distribution amount in accordance with the following:  (I) Each consortium or teaching general hospital with a one-year ECRIP award  shall  receive  its  annual  distribution  amount  in  full  upon completion of the requirements set forth in items (I) and (II) of clause (G) of this subparagraph. The requirements set forth in items  (IV)  and (V)  of  clause  (G)  of  this  subparagraph  must  be  completed by the consortium or teaching general hospital in order for the  consortium  or teaching  general  hospital to be eligible to apply for ECRIP funding in any subsequent funding cycle.  (II) Each consortium or teaching  general  hospital  with  a  two-year ECRIP  award  shall receive its first annual distribution amount in full upon completion of the requirements set forth in items (I) and  (II)  of clause  (G)  of  this  subparagraph. Each consortium or teaching general hospital will receive its second annual distribution amount in full upon completion of the requirements set forth in item (III) of clause (G)  of this  subparagraph.  The requirements set forth in items (IV) and (V) of clause (G) of this subparagraph must be completed by the  consortium  or teaching  general  hospital  in  order  for  the  consortium or teaching general hospital to be eligible  to  apply  for  ECRIP  funding  in  any subsequent funding cycle.  (E)   Each   consortium   or   teaching   general  hospital  receiving distributions pursuant to this subparagraph shall  reserve  seventy-five thousand  dollars  to  primarily  fund salary and fringe benefits of the clinical  research  position  with  the  remainder  going  to  fund  the development of faculty who are involved in biomedical research, training and clinical care.  (F)  Undistributed  or  returned  funds  available  to  fund  clinical research positions pursuant to this paragraph for a distribution  period shall  be  available to fund clinical research positions in a subsequent distribution period.  (G) In order  to  be  eligible  for  distributions  pursuant  to  this subparagraph,  each  consortium  and  teaching  general  hospital  shall provide to the commissioner by July first of each  distribution  period, the  following  data  and information on a hospital-specific basis. Such data and information shall be certified as to accuracy and  completeness by  the chief executive officer, chief financial officer or chair of the consortium  governing  body  of  each  consortium  or  teaching  general hospital and shall be maintained by each consortium and teaching general hospital for five years from the date of submission:  (I)  For  each  clinical  research  position, information on the type, scope, training objectives,  institutional  support,  clinical  research experience of the sponsor-mentor, plans for submitting research outcomes to  peer  reviewed  journals  and  at  scientific  meetings, including a meeting sponsored by the department, the name  of  a  principal  contact person  responsible  for  tracking the career development of researchers placed in clinical research positions, as defined in  paragraph  (c)  of subdivision one of this section, and who is authorized to certify to the commissioner that all the requirements of the clinical research training objectives   set   forth   in  this  subparagraph  shall  be  met.  Such certification shall be provided  by  July  first  of  each  distribution period;  (II)  For  each  clinical  research position, information on the name, citizenship status, medical education and training, and medical  license number  of  the researcher, if applicable, shall be provided by December thirty-first of the calendar year following the distribution period;  (III) Information  on  the  status  of  the  clinical  research  plan, accomplishments,   changes   in   research   activities,  progress,  and  performance of the researcher  shall  be  provided  upon  completion  of one-half of the award term;  (IV)  A  final report detailing training experiences, accomplishments, activities  and  performance  of  the  clinical  researcher,  and  data, methods,  results  and  analyses  of the clinical research plan shall be provided three months after the clinical research position ends; and  (V) Tracking information concerning past  researchers,  including  but not  limited  to (A) background information, (B) employment history, (C) research status, (D) current research activities, (E)  publications  and presentations,  (F)  research  support,  and  (G)  any other information necessary to track the researcher; and  (VI) Any other data or information required  by  the  commissioner  to implement this subparagraph.  (H)  Notwithstanding  any  inconsistent provision of this subdivision, for periods on and after April first, two thousand thirteen, ECRIP grant awards  shall  be  made  in  accordance  with  rules   and   regulations promulgated by the commissioner. Such regulations shall, at a minimum:  (1)  provide  that ECRIP grant awards shall be made with the objective of securing federal funding for biomedical research,  training  clinical researchers,  recruiting  national leaders as faculty to act as mentors, and training residents and fellows in biomedical research skills;  (2) provide that ECRIP grant applicants may include  interdisciplinary research  teams  comprised  of  teaching  general  hospitals  acting  in collaboration  with  entities  including  but  not  limited  to  medical centers, hospitals, universities and local health departments;  (3) provide that applications for ECRIP grant awards shall be based on such  information requested by the commissioner, which shall include but not be limited to hospital-specific data;  (4) establish the qualifications for  investigators  and  other  staff required for grant projects eligible for ECRIP grant awards; and  (5)  establish a methodology for the distribution of funds under ECRIP grant awards.  (c) Physician loan repayment program. One million nine  hundred  sixty thousand  dollars  for  the  period  January  first,  two thousand eight through December thirty-first, two  thousand  eight,  one  million  nine hundred  sixty  thousand  dollars  for  the  period  January  first, two thousand nine through December  thirty-first,  two  thousand  nine,  one million  nine  hundred  sixty  thousand  dollars  for the period January first, two thousand ten through December thirty-first, two thousand ten, four hundred ninety thousand dollars for the period January  first,  two thousand  eleven  through  March  thirty-first, two thousand eleven, one million seven hundred thousand dollars each state fiscal  year  for  the period  April first, two thousand eleven through March thirty-first, two thousand fourteen, up to one million seven hundred five thousand dollars each state fiscal year for the period April first, two thousand fourteen through March thirty-first, two thousand seventeen, up  to  one  million seven  hundred  five  thousand  dollars  each  state fiscal year for the period April first, two thousand seventeen through  March  thirty-first, two  thousand  twenty, and up to one million seven hundred five thousand dollars each state fiscal year for the period April first, two  thousand twenty  through  March thirty-first, two thousand twenty-three, shall be set aside and reserved by  the  commissioner  from  the  regional  pools established  pursuant  to  subdivision  two of this section and shall be available for purposes of physician loan repayment  in  accordance  with subdivision  ten of this section. Notwithstanding any contrary provision of this section, sections one hundred twelve and one hundred sixty-three of the state finance law, or any other contrary provision of  law,  such funding  shall be allocated regionally with one-third of available funds  going to New York city and two-thirds of available funds  going  to  the rest  of the state and shall be distributed in a manner to be determined by the commissioner without a competitive bid or  request  for  proposal process as follows:  (i) Funding shall first be awarded to repay loans of up to twenty-five physicians  who  train  in  primary care or specialty tracks in teaching general hospitals, and who enter and remain in primary care or specialty practices in underserved communities, as determined by the commissioner.  (ii) After distributions in accordance with subparagraph (i)  of  this paragraph,  all  remaining  funds  shall  be  awarded  to repay loans of physicians who enter and remain in primary care or  specialty  practices in underserved communities, as determined by the commissioner, including but  not  limited  to  physicians working in general hospitals, or other health care facilities.  (iii) In no case shall less than fifty percent of the funds  available pursuant   to   this   paragraph   be  distributed  in  accordance  with subparagraphs (i) and (ii) of this paragraph to physicians identified by general hospitals.  (iv) In addition to the funds allocated under this paragraph, for  the period April first, two thousand fifteen through March thirty-first, two thousand  sixteen,  two  million  dollars  shall  be  available  for the purposes described in subdivision ten of this section;  (v) In addition to the funds allocated under this paragraph,  for  the period April first, two thousand sixteen through March thirty-first, two thousand  seventeen,  two  million  dollars  shall  be available for the purposes described in subdivision ten of this section;  (vi) Notwithstanding any provision of law to the contrary, and subject to the extension of the Health Care Reform Act of 1996, sufficient funds shall be available for the purposes described in subdivision ten of this section in amounts necessary to fund the remaining year commitments  for awards made pursuant to subparagraphs (iv) and (v) of this paragraph.  (d)  Physician  practice  support.  Four million nine hundred thousand dollars for  the  period  January  first,  two  thousand  eight  through December  thirty-first,  two  thousand  eight, four million nine hundred thousand dollars annually for the period  January  first,  two  thousand nine  through  December  thirty-first, two thousand ten, one million two hundred twenty-five thousand dollars for the period January  first,  two thousand  eleven  through  March thirty-first, two thousand eleven, four million three hundred thousand dollars each state fiscal  year  for  the period  April first, two thousand eleven through March thirty-first, two thousand fourteen, up to  four  million  three  hundred  sixty  thousand dollars  each state fiscal year for the period April first, two thousand fourteen through March thirty-first, two thousand seventeen, up to  four million  three hundred sixty thousand dollars for each state fiscal year for the  period  April  first,  two  thousand  seventeen  through  March thirty-first,  two thousand twenty, and up to four million three hundred sixty thousand dollars for each fiscal year for the period April  first, two   thousand   twenty   through   March   thirty-first,  two  thousand twenty-three, shall be set aside and reserved by the  commissioner  from the  regional  pools  established  pursuant  to  subdivision two of this section and shall  be  available  for  purposes  of  physician  practice support.   Notwithstanding  any  contrary  provision  of  this  section, sections one hundred twelve and one hundred  sixty-three  of  the  state finance  law, or any other contrary provision of law, such funding shall be allocated regionally with one-third of available funds going  to  New York  city  and  two-thirds  of available funds going to the rest of the state and shall be distributed in a  manner  to  be  determined  by  the  commissioner  without  a competitive bid or request for proposal process as follows:  (i)  Preference in funding shall first be accorded to teaching general hospitals for up to twenty-five awards, to  support  costs  incurred  by physicians  trained  in  primary  or  specialty  tracks  who  thereafter establish or join practices in underserved communities, as determined by the commissioner.  (ii) After distributions in accordance with subparagraph (i)  of  this paragraph, all remaining funds shall be awarded to physicians to support the   cost   of   establishing   or  joining  practices  in  underserved communities, as determined by the commissioner,  and  to  hospitals  and other  health  care  providers  to  recruit  new  physicians  to provide services in underserved communities, as determined by the commissioner.  (iii) In no case shall less than fifty percent of the funds  available pursuant  to  this  paragraph  be  distributed  to  general hospitals in accordance with subparagraphs (i) and (ii) of this paragraph.  (e) Work group. For funding available pursuant to paragraphs  (c)  and (d) (e) of this subdivision:  (i)  The  department  shall  appoint a work group from recommendations made by associations  representing  physicians,  general  hospitals  and other  health  care  facilities  to  develop  a  streamlined application process by June first, two thousand twelve.  (ii) Subject to available funding, applications shall be accepted on a continuous basis. The department shall provide technical  assistance  to applicants  to facilitate their completion of applications. An applicant shall be notified in writing  by  the  department  within  ten  days  of receipt  of an application as to whether the application is complete and if the application is incomplete, what information is  outstanding.  The department  shall act on an application within thirty days of receipt of a complete application.  (f) Study on physician workforce. Five hundred ninety thousand dollars annually for the  period  January  first,  two  thousand  eight  through December   thirty-first,  two  thousand  ten,  one  hundred  forty-eight thousand dollars for the  period  January  first,  two  thousand  eleven through  March  thirty-first,  two thousand eleven, five hundred sixteen thousand dollars each state fiscal year for the period April first,  two thousand eleven through March thirty-first, two thousand fourteen, up to four  hundred  eighty-seven  thousand dollars each state fiscal year for the  period  April  first,   two   thousand   fourteen   through   March thirty-first,  two  thousand  seventeen, up to four hundred eighty-seven thousand dollars for each state fiscal year for the period April  first, two  thousand seventeen through March thirty-first, two thousand twenty, and up to four hundred eighty-seven thousand dollars each  state  fiscal year  for  the  period  April  first,  two thousand twenty through March thirty-first, two thousand twenty-three, shall be set aside and reserved by the commissioner from the  regional  pools  established  pursuant  to subdivision  two  of this section and shall be available to fund a study of physician workforce needs and solutions including,  but  not  limited to,  an analysis of residency programs and projected physician workforce and community needs. The commissioner shall enter into  agreements  with one  or  more organizations to conduct such study based on a request for proposal process.  (g) Diversity in medicine/post-baccalaureate program.  Notwithstanding any  inconsistent provision of section one hundred twelve or one hundred sixty-three of the state finance law or any other law, one million  nine hundred  sixty  thousand  dollars annually for the period January first, two thousand eight through December thirty-first, two thousand ten, four hundred ninety thousand  dollars  for  the  period  January  first,  two  thousand  eleven  through  March  thirty-first, two thousand eleven, one million seven hundred thousand dollars each state fiscal  year  for  the period  April first, two thousand eleven through March thirty-first, two thousand  fourteen,  up to one million six hundred five thousand dollars each state fiscal year for the period April first, two thousand fourteen through March thirty-first, two thousand seventeen, up  to  one  million six  hundred five thousand dollars each state fiscal year for the period April first, two thousand  seventeen  through  March  thirty-first,  two thousand twenty, and up to one million six hundred five thousand dollars each  state  fiscal year for the period April first, two thousand twenty through March thirty-first, two  thousand  twenty-three,  shall  be  set aside   and  reserved  by  the  commissioner  from  the  regional  pools established pursuant to subdivision two of this  section  and  shall  be available  for  distributions  to  the Associated Medical Schools of New York  to  fund  its  diversity  program  including  existing   and   new post-baccalaureate  programs for minority and economically disadvantaged students and encourage participation from all  medical  schools  in  New York.  The  associated  medical  schools of New York shall report to the commissioner on an annual basis regarding the  use  of  funds  for  such purpose in such form and manner as specified by the commissioner.  (h)  In  the  event  there are undistributed funds within amounts made available for distributions pursuant to this subdivision, such funds may be reallocated and distributed in  current  or  subsequent  distribution periods  in  a manner determined by the commissioner for any purpose set forth in this subdivision.   5-b. Other graduate medical education reforms. Any funds  specifically appropriated  for the purposes of this subdivision shall be used to fund innovative graduate medical education reforms to be  determined  by  the commissioner  in  consultation  with  the  council,  including,  but not limited to, (a) development of  primary  care  residency  and  specialty position  training  tracks  for  graduates  to serve rural or inner-city communities, (b) development  of  regional  pilot  network  programs  to affiliate   major  academic  centers  with  community  teaching  general hospitals, (c)  support  for  faculty  development  programs,  including designating  faculty  to  mentor students and residents in primary care, (d) support training in fields which serve the geriatric population; (e) increase training  in  cultural  competence,  (f)  promote  training  of physicians  who  will serve persons with developmental disabilities, and (g) any other reforms necessary  to  improve  patient  care  management, interdisciplinary  training,  or  quality  in graduate medical education programs. Such funding shall be distributed to  consortia  and  teaching general  hospitals  in  each region on a competitive basis pursuant to a request for proposal process.   6. Consortia. (a) A consortium must:  (i) have a governing body and such  committees  as  appropriate  which should  be responsible for the policy coordination and administration of residency programs and which provides all members of the  consortium  an opportunity  to  participate  in  the establishment of consortium policy goals and objectives;  (ii) have procedures  and  criteria  for  processing  applications  by health care providers in the region for participation in the consortium;  (iii)  establish  policies to evaluate and to maintain and improve the quality of training programs;  (iv)  have  a  mechanism  for  resolving  educational  and   financial allocation disputes among participating members; and  (v)  comply  with  such  further  requirements as the commissioner may reasonably require for purposes of implementing this section to  achieve state policy goals and objectives regarding graduate medical education.  (b)  Nothing  in  this section shall preclude a consortium from having members  from  different  regions  and  from  allocating  regional  pool distributions among regions.  (c)  To  the  extent  consortia  might  be anti-competitive within the meaning and intent of the federal and state antitrust laws,  it  is  the intent of the legislature to supplant competition with such arrangements to  the extent necessary to accomplish the purposes of this section, and provide state action immunity under  the  federal  antitrust  laws  with respect  to  the planning, implementation and operation of consortia and participation therein by  hospitals,  other  providers  of  health  care services, medical schools, payors and consumers.  (d)  Each  approved  consortium  shall  submit  a plan for each period defined  in  subdivision  two  of  this  section  for  approval  by  the commissioner,  in consultation with the council, for allocation of funds collected pursuant to paragraph (c) of subdivision three of this section to  participating  general  hospitals  which  provide  graduate  medical education  and  sites  other  than  general hospitals at which residents receive training.   8. Revenue from  distributions  pursuant  to  this  section  shall  be included  in  gross  revenue  received  for  purposes of the assessments pursuant to subdivision eighteen of section twenty-eight hundred seven-c of this article and for purposes of the assessments pursuant to  section twenty-eight hundred seven-d of this article.   10.  Physician  loan repayment program.   (a) Beginning January first, two thousand eight,  the  commissioner  is  authorized,  within  amounts available  pursuant  to subdivision five-a of this section, to make loan repayment  awards  to  primary  care  physicians  or   other   physician specialties  determined  by  the  commissioner  to  be  in short supply, licensed to practice medicine in New York state, who agree  to  practice for  at  least  five  years in an underserved area, as determined by the commissioner. Such physician shall be  eligible  for  a  loan  repayment award  of  up  to  one  hundred  fifty thousand dollars over a five year period distributed as follows: fifteen percent of total loan debt not to exceed twenty thousand dollars for the first year;  fifteen  percent  of total  loan  debt  not  to  exceed  twenty-five thousand dollars for the second year; twenty percent of total loan debt not to exceed thirty-five thousand dollars for the third year; and twenty-five  percent  of  total loan  debt  not  to exceed thirty-five thousand dollars per year for the fourth year; and any unpaid balance of the total loan debt not to exceed the maximum award amount for the fifth year of practice in such area.  (b) Loan repayment awards made to a physician  pursuant  to  paragraph (a)   of   this  subdivision  shall  not  exceed  the  total  qualifying outstanding debt of the physician from student loans  to  cover  tuition and  other  related  educational  expenses, made by or guaranteed by the federal or state  government,  or  made  by  a  lending  or  educational institution approved under title IV of the federal higher education act. Loan  repayment  awards  shall  be used solely to repay such outstanding debt.  (c) In the event that a five-year commitment pursuant to the agreement referenced in paragraph (a) of this subdivision is  not  fulfilled,  the recipient  shall  be responsible for repayment in amounts which shall be calculated in accordance with the formula set forth in  subdivision  (b) of  section  two  hundred  fifty-four-o of title forty-two of the United States Code, as amended.  (d) The commissioner is authorized to apply any  funds  available  for purposes  of paragraph (a) of this subdivision for use as matching funds for federal grants for the purpose of assisting states in operating loan  repayment programs pursuant to section three hundred thirty-eight  I  of the public health service act.  (e)  The  commissioner  may  postpone,  change  or  waive  the service obligation and repayment amounts set forth in paragraphs  (a)  and  (c), respectively of this subdivision in individual circumstances where there is compelling need or hardship.  (f)(i)  When  a physician is not actually practicing in an underserved area, he or she shall be deemed to be practicing in an underserved  area if  he  or  she  practices  in  a  facility  or  physician's office that primarily  serves  an  underserved  population  as  determined  by   the commissioner,  without  regard to whether the population or the facility or physician's office is located in an underserved area.  (ii) In making criteria and determinations as to whether an area is an underserved area or whether a facility or physician's  office  primarily serves  an  underserved  population,  the commissioner may make separate criteria and determinations for different specialties.   11. The commissioner shall  conduct  a  study  of  (i)  the  need  for expansion  of the physician loan repayment program under subdivision ten of this section to include dentists, midwives, nurse practitioners,  and physician  assistants;  (ii)  the  level of funding appropriate for that expansion; and (iii) appropriate sources of funding for  the  future  of the  program  and  the  expansion.  The study may include examination of possible expansion of other programs to recruit people to  enter  health care  professions and serve in underserved areas. The commissioner shall conduct the study in consultation with representatives of  the  affected professions, educational institutions and training programs that educate and   train  people  for  those  professions,  appropriate  health  care providers,  affected  communities  and  other  interested  parties.  The commissioner  shall  report  to  the governor and the legislature on the findings of  the  study  and  recommendations  by  December  first,  two thousand eight.   12. Notwithstanding any provision of law to the contrary, applications submitted  on  or  after  April  first,  two  thousand  sixteen, for the physician  loan  repayment  program  pursuant  to   paragraph   (c)   of subdivision  five-a  of this section and subdivision ten of this section or the physician practice support program pursuant to paragraph  (d)  of subdivision  five-a  of  this section, shall be subject to the following changes:  (a) Awards shall be made from the  total  funding  available  for  new awards  under  the  physician  loan  repayment program and the physician practice support program, with neither program  limited  to  a  specific funding amount within such total funding available;  (b)  An  applicant  may  apply  for an award for either physician loan repayment or physician practice support, but not both;  (c) An applicant shall  agree  to  practice  for  three  years  in  an underserved  area  and  each  award  shall  provide up to forty thousand dollars for each of the three years; and  (d) To the extent practicable, awards shall be timed to be of use  for job offers made to applicants.