2023 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.