2023 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,  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, and up to eight
million six hundred twelve thousand dollars each state fiscal  year  for
the   period  April  first,  two  thousand  twenty-three  through  March
thirty-first, two thousand twenty-six, 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,  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, and up to
one million seven hundred five thousand dollars each state  fiscal  year
for  the  period  April  first,  two thousand twenty-three through March
thirty-first, two thousand twenty-six, 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, 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,  and  up  to  four  million  three  hundred sixty thousand
dollars for each fiscal year for the period April  first,  two  thousand
twenty-three  through March thirty-first, two thousand twenty-six, 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),  (d)
and (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,
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,  and  up  to  four   hundred
eighty-seven  thousand  dollars  each  state  fiscal year for the period
April first, two thousand twenty-three through March  thirty-first,  two
thousand twenty-six, 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,  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, and up to one
million six hundred five thousand dollars each state fiscal year for the
period  April   first,   two   thousand   twenty-three   through   March
thirty-first,  two  thousand twenty-six, 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.