2023 New York Laws › PBH - Public Health › Article 28 - Hospitals › 2814 - Health Networks, Global Budgeting, and Health Care Demonstrations.

* §   2814.   Health  networks,  global  budgeting,  and  health  care
demonstrations. 1. For the purposes of this section unless  the  context
clearly requires otherwise:
(a)  "Board"  shall mean the temporary statewide health advisory board
established  pursuant  to  section  nine  hundred  fifty-seven  of   the
executive law.
(b)  "Proposal"  shall mean a design or plan developed, as a result of
funds received pursuant to this section, to operate  a  network,  global
budget, or regional health care demonstration.
2.  (a)  Notwithstanding  any  inconsistent  provision  of law, within
amounts available therefor, the commissioner shall make grants  pursuant
to  this  section to (i) health care providers to facilitate development
of health networks  or  health  care  demonstrations  (ii)  health  care
providers  alone or in conjunction with third party payors to facilitate
development of global budgets and  (iii)  an  organization  demonstrably
representing  the  interests  of the region or communities of the region
which demonstrate the support of the respective health systems agency to
facilitate development of health care demonstrations or global  budgets.
Such  networks,  demonstrations,  or global budgets shall be designed to
improve cost  effectiveness  of  health  care  services,  establish  and
improve  provider coordinated planning and management mechanisms, and/or
improve provider management of  care  or  improve  continuity  of  care.
Health   care  providers  eligible  to  receive  funding  under  section
twenty-nine hundred fifty-two of this chapter shall not be eligible  for
grants under this section for development of health networks.
(b)  Grants made pursuant to this section shall provide planning funds
which may include, but need not be limited to, funding to:
(i) assess the health care needs of  the  population  and  develop  an
operational plan to meet these needs;
(ii)  plan  for  and  carry  out  any organizational changes needed to
integrate services; and
(iii) facilitate financing  arrangements  such  as  risk  sharing  and
capitation.
3.  In  awarding  grants  under  this  section, the commissioner shall
consult with the appropriate  local  health  systems  agency  and  shall
consider  the recommendations of the temporary statewide health advisory
board on the grant proposals and to the extent practicable  assure  that
there  is  a  sufficiently  representative  geographic  distribution  of
grantees including rural, urban,  and  suburban  grantees.  Grants  made
pursuant to this section shall be used solely for the planning of health
networks,  global  budgets  or  health  care  demonstrations.  Prior  to
awarding grants, the commissioner shall first  take  into  consideration
other  financial  resources  available  to the applicant to conduct such
planning.
4. In order to be eligible for a grant under this section,  applicants
shall  prepare  and  submit to the commissioner, the temporary statewide
health care advisory board, and the respective health systems agency  an
application which contains the following:
(a)  identification of the principal investigator or applicant for the
demonstration;
(b)  a  description  of  the  nature  and  scope  of  the   activities
contemplated;
(c)  a  description  of  the geographic area and populations currently
served by the entity;
(d) a description of the community or population to be served;
(e) a description  of  the  anticipated  benefits  and  advantages  to
providers and consumers of services;
(f)  a description of the estimated expenses, including administrative
expenses,  which  will  be  incurred   in   the   development   of   the
demonstration; and
(g) the time frame proposed for the development of the health network,
global budgeting demonstration, or health care demonstration.
(h)  the process that the eligible organization used in seeking public
participation and local involvement in the development  of  the  program
plan; and
(i) the goals of the program, including information on how the program
plan  will  maintain and promote access to and delivery of high quality,
appropriate health or health related  items  and  services  for  persons
residing in the region covered by the program.
5.  Any  grant  recipient  seeking  to  implement a proposal developed
pursuant to this section, except recipients of health networking grants,
shall submit such proposal to the temporary  statewide  health  advisory
board,  in  such  form  and content determined by the board, which shall
evaluate such proposal and consider whether the proposal is likely to:
(a) aid in meeting the priority  health  needs  and  concerns  in  the
region  as  identified  in and supported by evidence in the proposal and
consistent with recommendations of the regional health systems agency;
(b) enhance the quality of care as evidenced by outcome indicators;
(c)  improve  the  cost-effectiveness  of  services  by  the  entities
involved;
(d)  improve  the efficient utilization of the entities' resources and
capital equipment;
(e) enhance the provision of services  that  would  otherwise  not  be
available;
(f) result in the elimination of unnecessary duplication of resources;
(g) reduce costs to individuals being served by the network;
(h) foster information sharing, communications and cooperation between
health care providers; and
(i) foster and improve the management and continuity of care.
6.  In  addition,  the  board  shall require that the proposal contain
assurances that there will be  equitable  provider  involvement  in  the
determination of any rates and rate setting methodology. The board shall
also  require  a  description  of  how  the  proposed initiative will be
evaluated and assurance that the grantee will submit annual  reports  to
the  governor  and  legislature concerning the status and experiences of
the initiative.
7. The temporary statewide health advisory board  shall  forward  only
proposals   recommended   for   operation   to   the   commissioner  for
authorization. In granting his  authorization,  the  commissioner  shall
certify that the proposal will:
(a) improve the cost effectiveness of health care services;
(b)  improve  the  quality  of  care delivered as evidenced by outcome
indicators; and
(c) improve access to appropriate health care services.
8. Upon request by an applicant or grantee the  commissioner  and  the
respective health system agency shall provide technical assistance.
9.  The  commissioner shall submit to the chairs of the senate finance
committee and the assembly ways and means committee and  the  chairs  of
the  assembly  and  senate  health  committees,  a  copy of any proposal
authorized by the commissioner pursuant to this section  not  more  than
thirty days after approval.
10.  With  the  exception of health networks, global budgets or health
care demonstrations that seek  to  implement  alternative  reimbursement
methodologies  in  general  hospital settings only and/or for ambulatory
services associated with general hospital outpatient and diagnostic  and

treatment  center  settings regarding payment for the medical assistance
program, as provided for in  subdivisions  ten  and  eleven  of  section
twenty-eight  hundred  seven  of this article, no health network, global
budget  or health care demonstration that seeks to implement alternative
reimbursement methodologies shall be  approved  or  implemented  without
approval  pursuant  to  a  chapter  of  the  laws  to  be enacted by the
legislature.
* NB Expired June 30, 1996