2023 New York Laws › SOS - Social Services › Article 5 - Assistance and Care › Title 11 - Medical Assistance for Needy Persons › 364-G - Medical Assistance Capitation Rate Demonstration Project.

*  §  364-g. Medical assistance capitation rate demonstration project.
  1. The department and the county of Monroe are authorized to participate
  in the "Monroe County Medicap Plan" research and demonstration  project,
  for  the purpose of testing the feasibility of converting from a fee for
  service payment system to a capitation payment  system  as  a  means  of
  financing  health  care  services  for  medicaid  recipients residing in
  Monroe county.
2. The department  shall  undertake  the  research  and  demonstration
  project  authorized by this section only if it has determined that there
  is a reasonable expectation that the total cost of benefits  under  such
  project would be less than the total cost of benefits if the project was
  not in effect.
3. Expenditures made in connection with the research and demonstration
  project   authorized   by   this  section  shall  be  subject  to  state
  reimbursement in accordance with  a  schedule  of  reimbursable  amounts
  approved by the department, the department of health and the director of
  the budget.
4.  The  department  shall,  in  a  manner  to  be decided upon by the
  commissioner, determine what portion  of  the  total  expenditures  made
  under  the research and demonstration project authorized by this section
  are attributable to the provision of the services specified in paragraph
  (g) of subdivision one of section three hundred  sixty-eight-a  of  this
  title, and shall ensure that the increased state reimbursement available
  for such services shall be provided.
5.  Notwithstanding  any inconsistent provision of this chapter or any
  other law to the contrary, the commissioner may, subject to the approval
  of the director of the budget, apply for appropriate waivers of  federal
  law  and  regulation, and shall be authorized to waive any provisions of
  sections three hundred sixty-six, three hundred sixty-seven-b and  three
  hundred  sixty-eight-a of this title and accompanying regulations of the
  department, consistent with waivers approved by the  federal  department
  of  health  and  human  services, when such action would be necessary to
  assist in promoting the objectives of this section;  provided,  however,
  that in the event that the research and demonstration project authorized
  by  this section requires a waiver of article twenty-eight or forty-four
  of the public health law or accompanying regulations of  the  department
  of health, the project shall be conducted jointly with the department of
  health,  and the commissioner of health may waive such provisions of the
  public health law or department of health regulations with the  approval
  of the commissioner and the director of the budget.
6.  Every  person  eligible  for  or  receiving medical assistance who
  resides in the county of Monroe shall participate in  the  demonstration
  project  authorized  by this section except for good cause as defined by
  the commissioner in regulation.
7.  Notwithstanding  any  inconsistent  provisions  of  this  section,
  participation in the project authorized by this section shall not affect
  a  recipient's  medical assistance eligibility or the scope of available
  medical services to which he or she is entitled.
8. The department and the county of Monroe shall jointly submit to the
  governor and the legislature a long term care capitation  implementation
  plan by March thirty-first, nineteen hundred eighty-five.
9.  Providers  participating in the research and demonstration project
  authorized by this section shall submit reports to the commissioner,  at
  such times as he may require, evaluating the results of such project.
10. The department shall submit to the governor and the legislature an
  interim  report  and  a  final report evaluating the project's impact on
  medicaid costs, access to services, quality of services rendered and any
  other subjects which the commissioner shall deem relevant.  The  interim

  report  shall  be due January first, nineteen hundred eighty-six and the
  final report shall be due at the conclusion of the project.
11.  This  section  shall  be  effective  if,  and as long as, federal
  financial participation is  available  for  expenditures  made  for  the
  project conducted pursuant to the provisions of this section.
* NB Expired March 31, 1988 per sub 11