reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter IX - Physician Profiling › Part 1000 - Physician Profiles › Section 1000.4 - Collection of initial profile information

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The department shall send an initial
				profile survey to every currently or newly State licensed and registered
				physician in New York State which reflects all the data elements required by
				Public Health Law, section 2995-a(1), some elements of which shall be prepared
				by the department using data sources other than the physician. Such initial
				profile survey must be completed, signed and returned by each physician to the
				address designated by the department on the survey and postmarked within 30
				days of the date of the letter transmitting such initial profile survey to the
				physician.
(b) Physicians shall be
				given the opportunity to correct factual inaccuracies that appear in the
				profile. Once the department receives a physician's completed and signed
				initial profile survey and enters the data into the physician profile database,
				the department will provide to the physician a copy of his or her profile in
				the form to be used for public dissemination, hereafter referred to as the
				review copy, prior to such public dissemination. The physician shall note any
				corrections on the review copy and return it to the department signed and
				postmarked within 10 days of the date of the letter transmitting the review
				copy to the physician; otherwise, the department will publicly disseminate the
				physician's profile information as received on the physician's initial profile
				survey.
(c) Subsequent to receiving
				the physician's review copy, if returned within the time frame required by
				subdivision (b) of this section, the department will provide to the physician a
				copy of any medical malpractice information in the form to be used for public
				dissemination, hereafter referred to as the medical malpractice review copy.
				Physicians shall correct any factual inaccuracies on the medical malpractice
				review copy and return it to the department postmarked within 10 days of the
				date of the letter transmitting the medical malpractice review copy to the
				physician, or, in the instance where the physician has two or fewer medial
				malpractice settlements over the most recent 10-year period and opts to access
				the panel review process, shall provide additional factual clinical information
				pursuant to section
				1000.3(b)(2)(ii)
				of this Part. If the physician does not respond in accordance with the
				timeframes set forth in this subdivision, the department will publicly
				disseminate the physician's medical malpractice information provided on the
				medical malpractice review copy.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter IX - Physician Profiling › Part 1000 - Physician Profiles › Section 1000.5 - Updating self-reported information

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except for optional information provided
				on physician profiles, physicians shall notify the department of any change in
				profile information within 30 days of such change. Any change in optional
				information must be reported to the department within 365 days of such
				change.
(b) Physicians shall submit
				changes to physician profile information either electronically using the
				department's secure web site or on forms prescribed by the department.
				Physicians shall attest to the truthfulness, completeness and correctness of
				any changes submitted to the department.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
				applies to assisted living residences, enhanced assisted living residences and
				special needs assisted living residences as defined herein.
(b) The requirements of this Part shall be in
				addition to those required of an adult care facility pursuant to 18 NYCRR Parts
				485, 486, 487 and 488. In the event of a conflict between any provision of this
				Part and a provision of 18 NYCRR Parts 485, 486, 487 and 488, the applicable
				provision of this Part shall supercede the applicable provision of such Part
				under 18 NYCRR, to the extent of such conflict.
(c) Any person, partnership, corporation,
				organization, agency, government unit or other entity which operates an
				assisted living residence is subject to the jurisdiction of the department, and
				must comply with this Part or cease operating such program.
(d) An assisted living operator shall comply
				with all applicable statutes, rules and regulations required for maintaining a
				valid operating certificate issued pursuant to title 2 of article 7 of the
				Social Services Law and shall obtain and maintain all other licenses, permits,
				registrations, or other government approvals required in addition to
				requirements under such article.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.4 - Operating certificates and additional certifications; authority limited to operator

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An
				operator of an assisted living residence must comply with the following
				standards in addition to the applicable standards contained in 18 NYCRR section
				485.5.
(b) Only the following may
				be issued an operating certificate by the department for the purpose of
				operating an assisted living residence:
(1) a
				natural person;
(2) a partnership
				composed only of natural persons;
(3) a public corporation as defined in
				section
				66 of
				the General Construction Law;
(4) a
				business corporation other than a corporation whose shares are traded on a
				national securities exchange or are regularly quoted on a national
				over-the-counter market or a subsidiary of such corporation or a corporation
				any of the stock of which is owned by another corporation;
(5) a not-for-profit corporation;
(6) a limited liability company provided that
				if a limited liability company has a member that is a corporation, a limited
				liability company or a partnership, the shareholders of the member corporation,
				the members of the member limited liability company, or the partners of the
				membership must be natural persons;
(7) a social services district; or
(8) other governmental agency.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.5 - Applications for licensure as an assisted living residence; certification as enhanced assisted living and special needs assisted living

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The following
				standards will apply to applicants for licensure as an assisted living
				residence and certification as enhanced assisted living and special needs
				assisted living, in addition to those contained in 18 NYCRR section 485.6
				unless expressly provided otherwise in this section.
(b) In order to operate an assisted living
				residence, an operator must be licensed as an adult home or enriched housing
				program. Applications for licensure as an assisted living residence must be
				filed with the department.
(1) Applications
				may be filed simultaneously with an application for licensure as an adult home
				or enriched housing program.
(2)
				Applications for assisted living licensure must include all licensed adult home
				or enriched housing program beds on the facility's operating certificate, or in
				the same building, excluding assisted living program beds.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.6 - General provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The operator of
				an assisted living residence must provide, through its employees and agents, an
				organized program of care, supervision and services which meets the standards
				set forth in this Part; assures the protection of resident rights; and promotes
				the social, physical and mental well-being of its residents.
(b) No entity shall establish, operate,
				provide, conduct or offer assisted living in this State, or hold itself out as
				an entity which otherwise meets the definition of assisted living or advertise
				itself as assisted living or by a similar term, without obtaining the approval
				of the department to operate as an adult home or enriched housing program
				pursuant to title 2 of article 7 of the Social Services Law, obtaining the
				approval of the department to operate as an assisted living residence pursuant
				to article 46-B of the Public Health Law and this Part, and otherwise acting in
				accordance with this Part. An entity may simultaneously apply for approval to
				operate as an adult home or enriched housing program and as an assisted living
				residence pursuant to article 46-B of the Public Health Law and this Part. This
				provision shall not apply to assisted living programs approved by the
				department pursuant to section 461-1 of the Social Services Law.
(c) The knowing operation of an assisted
				living residence or enhanced assisted living residence without the prior
				written approval of the department shall be a Class A misdemeanor.
(d) The requirements of this Part shall be
				in addition to those required of an adult care facility. In the event of a
				conflict between any provision of article 46-B of the Public Health Law and a
				provision of article 7 of the Social Services Law or a regulation adopted
				thereunder, the applicable provision of article 46-B of the Public Health Law
				and the applicable provision of this Part which implements such statute shall
				supercede article 7 of the Social Services Law or the applicable provision
				thereunder to the extent of such conflict. The operator shall operate and
				maintain the residence in compliance with the regulations of the department and
				with other applicable Federal, State and local statutes and
				regulations.
(e)
(1) Upon request by an applicant or
				operator, the department may waive nonstatutory requirements of this Part. An
				applicant or operator must request and receive written approval prior to
				operating in accordance with any waiver. Applications for a waiver must be
				submitted in writing to the department and must include:
(i) the specific regulation for which a waiver is
				sought;
(ii) the reason the waiver
				is necessary; and
(iii) a
				description of what will be done to achieve or maintain the purpose of the
				regulation to be waived and to protect the health, safety and well-being of the
				residents.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.7 - Admission and retention standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				Unless stated otherwise in this section, an operator of an assisted living
				residence shall admit and retain only those individuals who meet the admission
				and retention standards prescribed in 18 NYCRR section 487.4(a)-(e) or
				488.4(a)-(d), depending upon the facility's certification under 18
				NYCRR.
(b) An adult home certified
				pursuant to 18 NYCRR Part 487 or an enriched housing program certified pursuant
				to 18 NYCRR Part 488 in possession of a retention standards waiver for one or
				more residents as of June 3, 2005 shall not be required to apply for and obtain
				enhanced assisted living certification pursuant to section
				1001.4(n) of this
				Part with respect to the residents included in such existing waiver, and
				limited to the conditions of such waiver; however, such waiver expires when
				such resident or residents either are discharged from the facility or
				die.
(c) Any resident of an adult
				home certified pursuant to 18 NYCRR Part 487 or an enriched housing program
				certified pursuant to 18 NYCRR Part 488 or an assisted living residence
				licensed pursuant to this Part who is currently occupying a bed under the
				retention standards waiver shall be allowed to continue to occupy such bed so
				long as the resident is within the conditions of the waiver granted; provided,
				no other resident shall be allowed to occupy a bed within such facility or
				residence under such retention standards waiver once the bed has been
				vacated.
(d) An operator possessing
				an enhanced assisted living certificate issued by the department pursuant to
				section 1001.4(n) of this
				Part may admit persons either from an assisted living residence or from the
				community, and may retain persons who exceed the admission and retention
				standards of an assisted living residence, provided that the enhanced assisted
				living residence can provide or arrange an adequate and safe plan of care in
				accordance with the ISP. Such individuals may include those who:
(1) are chronically chairfast and unable to
				transfer, or chronically require the physical assistance of one or more
				person(s) to transfer;
(2)
				chronically require the physical assistance of one or more person(s) to
				walk;
(3) chronically require the
				physical assistance of one or more person(s) to climb or descend
				stairs;
(4) are dependent on
				medical equipment and require more than intermittent or occasional assistance
				from medical personnel; or
(5) have
				chronic unmanaged urinary or bowel incontinence.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.9 - Resident funds and valuables

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				requirements of this section shall be in addition to those required of an adult
				home or enriched housing program in accordance with 18 NYCRR sections 487.6 and
				488.6.
(b) An assisted living
				operator or employee of a residence or any other entity which is a
				representative payee of a resident of such residence pursuant to designation by
				the social security administration or which otherwise assumes management
				responsibility over the funds of a resident shall maintain such funds in a
				fiduciary capacity to the resident. Any interest on money received and held for
				the resident shall be the property of the individual resident.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.10 - Resident services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				operator shall be responsible for the provision or arrangement of resident
				services, which shall include, at a minimum, housing, 24-hour on-site
				monitoring, daily food service, case management services, development of an
				individualized service plan, personal care and/or home care services.
(b) Unless conflicted or contradicted by
				subdivision (a) of this section, the operator shall be responsible for the
				provision or arrangement of resident services pursuant to the facility's
				certification as either an adult home or enriched housing program as prescribed
				in 18 NYCRR Part 487 or 488, respectively.
(c) The services to be provided to the
				resident shall be delineated in the signed residency agreement executed
				pursuant to section
				1001.8(f) of this
				Part and shall be consistent with the resident's individualized service plan
				developed pursuant to section
				1001.7(k) of this
				Part.
(d) Additional services,
				supplies or amenities may be available from the operator directly or through
				arrangements with the operator and may be subject to additional charges,
				provided the provision of such services, supplies or amenities and charges for
				such are specified in the residency agreement executed pursuant to section
				1001.8(f) of this
				Part.
(e) Residents shall have the
				ability to receive services from service providers with whom the operator does
				not have an arrangement. The operator shall assist the resident in arranging
				such services, if necessary, and, as part of the operator's case management
				responsibility, shall be responsible for coordinating the care the operator
				provides or arranges with the care provided by such other service
				providers.
(f) Residents shall have
				the right to choose their health care providers, notwithstanding any other
				agreement to the contrary.
(g)
				Monitoring.
(1) The operator shall designate
				sufficient staff who shall be responsible for monitoring residents
				on-site.
(2) Monitoring shall be
				provided at any hour of the day or night of the week, and shall include but not
				be limited to the ability:
(i) to respond to
				urgent or emergency needs or requests for assistance with appropriate staff;
				and
(ii) to identify abrupt or
				progressive changes in behavior, appearance, or in performing basic activities
				of daily living which may signify the need for re-assessment and changes in
				service as reflected on the individualized service plan.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.11 - Personnel

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The operator
				shall designate an individual to be responsible for operating the residence in
				compliance with applicable law and regulations and through direct performance
				or coordination.
(b) Unless
				otherwise stated in this section, the operator shall ensure sufficient staff in
				number and qualifications to conduct the functions specified for an adult home
				or enriched housing program as prescribed in 18 NYCRR Part 487 or 488,
				respectively.
(c) The operator
				shall provide staff sufficient in number and qualified by training and
				experience to render, at a minimum, those services mandated by law or
				regulation, including:
(1) Case management.
(i) Staff shall carry out the functions
				specified in section
				1001.10(i) of
				this Part.
(ii) In an assisted
				living residence where the approved capacity is less than 25 beds, a qualified
				case manager shall be on site for at least 20 hours per week and available to
				provide case management services.
(iii) In a residence with 25 or more beds, a
				qualified case manager shall be on site on a basis of one hour per week per
				each additional bed up to a maximum of 40 hours per week and available to
				provide case management services as follows:
Resident census
Case manager hours
						  required
1-24
20 hours/week
25-44
20 hours/week +1 hour/week/each bed over
						  24 up to 40 hours
(iv)
				In a residence of 45 or more beds one or more case managers must be onsite at
				least 40 hours and available to assure that case management services adequately
				meet the needs of the residents.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.12 - Records and reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The operator
				must collect and maintain such information, records or reports as determined by
				the department to be necessary including those records set forth in Parts 485,
				487 and 488 of Subchapter D of this Title.
(b) The operator must maintain complete,
				accurate and current personal records for each resident which must be available
				for review and inspection by department staff or designees and which contain at
				a minimum:
(1) personal data, including
				identification of the resident's next of kin, family or resident's
				representative, legal representative, if any, and the name and address of the
				person or persons to be contacted in the event of an emergency;
(2) medical evaluations and other medical
				information;
(3) health care proxy
				or other advance directives, if applicable;
(4) pre-admission evaluation and subsequent
				functional and social evaluations;
(5) individualized service plans;
(6) medication assistance record;
				and
(7) case management notes which
				include details of referrals, service coordination and such other
				correspondence and papers as are available to document the activities
				undertaken to meet the resident's needs.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.14 - Disaster and emergency planning

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				Operators of assisted living residences that are adult homes must maintain
				compliance with the disaster and emergency planning requirements stated at 18
				NYCRR section 487.12.
(b) Operators
				of assisted living residences that are enriched housing programs must maintain
				compliance with the disaster and emergency planning requirements stated at 18
				NYCRR section 488.12.
(c) Emergency
				plans and procedures must include an evacuation plan to address any emergency
				situation that necessitates full or partial evacuation.
(d) Emergency plans and procedures must
				explicitly address the coordination and allocation of roles and
				responsibilities between assisted living residence employees and the employees
				of each home care services agency that has admitted a resident of the assisted
				living residence. The assisted living residence must maintain documentation
				that all assisted living residence employees, and all home care services agency
				employees, and their supervisors, who provide services to residents, are
				familiar with and understand their roles and responsibilities in the event of a
				disaster or emergency.
(e)
				Operators of assisted living residences shall obtain from the department's
				Health Provider Network (HPN) an HPN account, if the operator does not already
				have one by virtue of operating an adult home or enriched housing program.
				Operators shall maintain compliance with all of the provisions of 18 NYCRR
				sections 487.12(k) and 488.12(k) for adult homes and enriched housing programs,
				respectively.
(f) Operators of
				residences with enhanced assisted living certification must update the written
				disaster and emergency plan at least twice a year, and periodically, but at
				least annually, review the written plan with existing staff.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.15 - Inspection and enforcement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Unless
				otherwise specified in this section, an operator of an assisted living
				residence shall be subject to the inspection and enforcement authority,
				standards and remedies of 18 NYCRR Part 486, and Social Services Law, sections
				460-c, 460-d, 461-a and 461-f, both with respect to the operation of the
				residence in compliance with the provisions of Public Health Law, article 46-B
				and this Part, and the operation of an adult home or enriched housing program
				in compliance with the provisions of Social Services Law, article 7 and of 18
				NYCRR sections 485, 486, 487, 488, 492 through 494.
(b) The commissioner is authorized to receive
				and investigate complaints regarding the condition, operation and quality of
				care of any entities holding themselves out as assisted living or advertising
				themselves by a similar term.
(c)
				The commissioner is authorized to make necessary investigations to procure
				information to implement the provisions of this Part.
(d) Inspection of unlicensed facilities.
(1) For the purposes of assessing whether an
				unlicensed facility is an assisted living residence subject to the licensure
				and inspection of the department, the department may inspect any facility which
				reasonably appears to the department to be an assisted living residence. The
				needs of the residents, the care and services provided, the physical plant and
				the administration of the facility may be assessed in accordance with
				applicable statute and regulation.
(2) Upon arrival at the facility for purposes
				of conducting an inspection pursuant to this section, the department
				representative must give verbal notice to the operator, administrator or other
				person in charge that the inspection will be conducted unless such person
				objects to the inspection, and that if such person does object, the department
				is empowered to request the Attorney General to apply for a court order
				granting the department access to the facility.
(3) If access to the facility is denied to
				the department representatives by the operator, administrator or other person
				in charge, the department is authorized to request the Attorney General to
				apply, without notice to the operator or administrator, to the Supreme Court in
				the county in which the facility is located for an order granting the
				department access to such facility.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter X - Assisted Living Residences › Part 1001 - Assisted Living Residences › Section 1001.16 - Contracts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the event
				that an operator contracts with a separate entity to perform any aspect of the
				residence's operation or management, the provisions of 18 NYCRR section 485.10
				will apply. In addition, the operator must comply with the provisions of this
				section.
(b) Management contracts.
(1) For purposes of this Part, a management
				contract is an agreement between the operator and a management entity for the
				purpose of managing the day-to-day operations of a residence or any part
				thereof, subject to the direction and supervision of the operator. The
				following shall not be considered management contracts:
(i) a contract solely for the provision of
				professional or other services;
(ii) an employment contract; or
(iii) a contract for the provision of
				administrative, consulting or support services if all of the following factors
				are present:
(a) the residence's operator
				retains responsibility for the day-to-day operations of the
				residence;
(b) the contracting
				entity has no authority to hire or fire any personnel working in the
				residence;
(c) the contracting
				entity does not exercise control of the books and records of the
				residence;
(d) the contracting
				entity has no authority to dispose of assets or to incur any liability on
				behalf of the residence; and
(e)
				the contracting entity has no authority to adopt or enforce policies regarding
				the operation of the residence.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XI - Limits On Administrative Expenses And Executive Compensation › Part 1002 - Limits On Administrative Expenses And Executive Compensation › Section 1002.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part:
(a) Administrative expenses are those
				expenses authorized and allowable pursuant to applicable agency regulations,
				contracts or other rules that govern reimbursement with State funds or
				State-authorized payments that are incurred in connection with the covered
				provider's overall management and necessary overhead that cannot be attributed
				directly to the provision of program services.
(1) Such expenses include but are not limited
				to the following expenses, if otherwise authorized and allowable pursuant to
				applicable agency regulations, contracts or other rules that govern
				reimbursement with State funds or State-authorized payments:
(i) that portion of the salaries and benefits
				of staff performing administrative and coordination functions that cannot be
				attributed to particular program services, including but not limited to the
				executive director or chief executive officer, financial officers such as the
				chief financial officer or controller and accounting personnel, billing,
				claiming or accounts payable and receivable personnel, human resources
				personnel, public relations personnel, administrative office support personnel,
				and information technology personnel, where such expenses cannot be attributed
				directly to the provision of program services;
(ii) that portion of legal expenses that
				cannot be attributed directly to the provision of program services;
				and
(iii) that portion of expenses
				for office operations that cannot be attributed directly to the provision of
				program services, including telephones, computer systems and networks,
				professional and organizational dues, licenses, permits, subscriptions,
				publications, audit services, postage, office supplies, conference expenses,
				publicity and annual reports, insurance premiums, interest charges and
				equipment that is expensed (rather than depreciated) in cost reports, where
				such expenses cannot be attributed directly to the provision of program
				services.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XI - Limits On Administrative Expenses And Executive Compensation › Part 1002 - Limits On Administrative Expenses And Executive Compensation › Section 1002.5 - Reporting

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Reporting by
				covered providers. Beginning after the effective date of this regulation,
				covered providers shall submit a completed EO No. 38 disclosure form for each
				covered reporting period. Such form shall be submitted no later than 180
				calendar days following the covered reporting period, unless otherwise
				authorized. Such form shall be submitted in the manner and form specified by
				the department or its designee. Covered providers shall further provide the
				information requested in that form, and any other information requested, upon
				the request of the department or its designee at any time during the term of or
				prior to the execution of any contract or agreement with such
				provider.
(b) Covered providers
				receiving State funds or State-authorized payments from county or local
				government or an entity contracting on behalf of such government must report
				directly to the department as required by this section. The county or local
				government shall advise such covered providers of their obligation to report
				directly to the department under this section, but shall not be responsible for
				receiving or forwarding such reports to the department.
(c) Failure to report. A covered provider's
				failure to submit a completed EO No. 38 disclosure form, or to provide
				additional or clarifying information at the request of the department or its
				designee, may result in the termination or non-renewal of a contract or
				agreement for State funds or State-authorized payments.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part shall
				be applicable to every person or entity seeking state certification to
				establish and operate an accountable care organization (ACO) pursuant to
				Article 29-E of the Public Health Law. Only a person or entity issued a
				certificate of authority shall be afforded the protections under section
				1003.14 or may avail itself of the
				exemptions from the Insurance Law under section
				1003.11 of this Part.
(b) No application is required pursuant to
				this Part for a Medicare-only ACO whose shared losses may not exceed ten
				percent of the benchmark established under the contract with Centers for
				Medicare and Medicaid Services (CMS). Such Medicare-only ACO shall receive
				certification through an expedited process under subdivision (4) of section
				2999-p of
				the Public Health Law and shall only be subject to sections
				1003.6,
				1003.11,
				1003.12,
				1003.13 and
				1003.14 of this Part. A
				certificate of authority received through this expedited process shall only
				apply to the Medicare-only ACO's actions related to Medicare beneficiaries
				under its authorization from CMS.
(c) No application is required pursuant to
				this Part for a Medicare-only ACO whose shared losses may exceed ten percent of
				the benchmark established under the contract with CMS. Such Medicare-only ACO
				shall receive certification through an expedited process under subdivision 4 of
				section
				2999-p of
				the Public Health Law and shall only be subject to sections
				1003.5,
				1003.6,
				1003.11,
				1003.12,
				1003.13 and
				1003.14 of this Part. A
				certificate of authority received through this expedited process shall only
				apply to the Medicare-only ACO's actions related to Medicare beneficiaries
				under its authorization from CMS.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.3 - Certificate of Authority

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				Commissioner may issue a certificate of authority if the applicant has met the
				requirements of Article 29-E of the Public Health Law and this Part, except
				that a Medicare-only ACO need not meet such requirements except as provided in
				section
				2999-r of
				the Public Health Law and specifically in this Part. The Commissioner shall
				evaluate an ACO application based on the information contained in and submitted
				with the application. The Commissioner will notify an applicant if the
				application is incomplete and provide the applicant an opportunity to submit
				the required information to complete the application. An application that
				remains incomplete 90 days after receiving a request from the Commissioner for
				additional information may be denied.
(b) The following conditions must be
				satisfied in order for the Commissioner to approve an application:
(1) The ACO must demonstrate the capability
				to provide, manage and coordinate health care (including primary care) for a
				defined population including, where practicable, elevating the services of
				primary care health care providers to meet patient centered medical home
				standards, coordinating services for complex high need patients and providing
				access to health care providers that are not part of the ACO;
(2) There is participation of clinically
				integrated health care providers and other ACO participants that are
				accountable for the quality, cost and delivery of health care to the ACO's
				defined population;
(3) There is a
				governance, leadership and management structure which is reasonably and
				equitably representative of the ACO participants and its patients;
				and
(4) There is documentation of
				satisfactory character and competence required to conduct the affairs of the
				ACO in its best interests and in the public interest and so as to provide
				proper services for the patients to be served.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.4 - Application Requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
				person or entity seeking to obtain a certificate of authority shall submit such
				application on forms prescribed by the Commissioner. The application must be
				signed by the chief executive officer, president, chairman of the board, or
				other authorized representative of the applicant. The application shall include
				information about its ACO participants and its providers/suppliers
				participating in the program as is necessary to implement the program,
				including:
(1) The name and address of all
				ACO participants with a description of the services to be provided by
				each;
(2) Certification that the
				ACO and its ACO participants have agreed to become accountable for the quality,
				cost, and overall care of the individuals attributed to the ACO;
(3) Criteria for accepting health care
				providers and other ACO participants to participate in the ACO; and
(4) A plan detailing how the ACO will use
				best efforts to include among its participants federally qualified health
				center(s) (FQHCs) that are willing to be a participant and that serve the area
				and population served by the ACO.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.5 - Medicare-Only ACOs Sharing Losses

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
				Medicare-only ACO may not enter into a contract under which its shared losses
				may exceed ten percent of the benchmark established under its contract with CMS
				unless:
(1) Medical claims of the ACO
				participants are paid by CMS on a fee-for-service basis directly to the ACO
				participants and the ACO does not directly or indirectly receive, pay or
				transfer any claims payments;
(2)
				Any shared savings or shared losses under the two-sided model will be tabulated
				and transferred in a lump sum between CMS and the ACO only at year
				end;
(3) In lieu of a lump sum
				payment from the ACO to CMS, the ACO has an option to instead reduce future fee
				for service CMS payments below the standard Medicare fee schedule until the
				balance due has been extinguished;
(4) The ACO has placed funds in an escrow
				account (under terms and computations specified in the contract with CMS) equal
				to at least 25 percent of the potential maximum deficit payment due from the
				ACO to CMS in a particular year.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.6 - Legal Structure and Responsibilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) The proposed ACO shall be a business
				corporation, not-for-profit corporation, limited liability company or
				partnership formed under the laws of New York State.
(2) A foreign corporation, limited liability
				company or partnership shall not be a proper applicant for a certificate of
				authority.
(3) If an ACO is formed
				among multiple independent ACO participants, it must be formed as a legal
				entity separate and apart from any of the ACO participants.
(4) No person shall file a certificate of
				incorporation or articles of organization, or amendment thereto, containing
				powers related to the operation of an ACO, or an independent practice
				association acting as an ACO, with the Secretary of State, without first having
				submitted the proposed certificate, articles or amendment to the Commissioner
				for his or her review and approval.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.7 - Governing Body

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The governing
				body shall be responsible for the oversight and strategic direction of the ACO,
				holding those responsible for management of the ACO accountable for the ACO's
				activities as described in this Part.
(b) The governing body must have a
				transparent governing process which shall include, but not be limited to:
(1) Holding periodic meetings at least twice
				each calendar year, of the governing body to conduct the business of the
				ACO;
(2) Making available the
				schedule of governing body meetings and issuing prior notice of meetings to
				members of the governing body; and
(3) Consideration of input from ACO
				participants or their designated representatives in the composition and control
				of the ACO's governing body.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.8 - Leadership and Management

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An ACO
				must have a leadership and management structure that supports the delivery of
				an array of health care services for the purpose of improving quality of care,
				health outcomes and coordination and accountability of services provided to
				patients.
(b) The ACO's operations
				must be managed by an executive officer, manager, general partner, or similar
				party whose appointment and removal are under the control of the ACO's
				governing body and whose leadership team has demonstrated the ability to
				influence or direct clinical practice to improve efficiency processes and
				health outcomes.
(c) The ACO's
				organization and management structure must include an organizational chart, a
				list of committees (including names of committee members) and their structures,
				and job descriptions for senior administrative and clinical leaders.
(d) The ACO's finances, including dividends
				and other return on capital, debt structure, executive compensation, and ACO
				participant compensation, shall be arranged and conducted to maximize the goals
				of the ACO, as outlined in subdivision (a) of this section.
(e) The clinical management and oversight
				must be managed by a medical director who is a licensed physician pursuant to
				Title 8 of the Education Law and one of its ACO participants, and who is
				physically present on a regular basis at any of the clinics, offices, or other
				locations participating in the ACO.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.9 - Quality Management and Improvement Program

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An ACO must develop and implement a
				quality management and improvement program that is supervised by a medical
				director and shall include organizational arrangements and ongoing procedures
				for the identification, evaluation, resolution and follow-up of potential and
				actual problems in health care administration and delivery.
(b) A health care information system shall be
				maintained that collects, analyzes, integrates and reports data necessary to
				develop and implement the quality management program.
(c) The quality management procedures shall
				include defined methods for the identification and selection of standardized
				quality measures applicable to the populations served by the ACO. Quality
				performance metrics are to be derived from multiple sources, including but not
				limited to administrative (claims and encounter) data, medical record reviews,
				participant complaints, consumer surveys, disease registries and other data
				sources as deemed necessary. The ACO shall address deficiencies identified
				through these processes using a standard quality improvement
				methodology.
(d) The ACO shall have
				a process for peer review to monitor provider performance.
(e) The ACO shall have a process for ensuring
				licensed, certified and/or registered health care professionals meet and
				maintain standards for the practice of their profession.
(f) The Commissioner shall have the right to
				review documents such as meeting minutes, and/or other materials related to the
				quality management and improvement program to ensure that an appropriate
				quality management and improvement program is in place.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.10 - Quality Performance Standards and Reporting

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The Department shall collect for
				dissemination via a statewide health information system, health care data from
				ACO entities pursuant to the quality assurance reporting requirements developed
				by the Department in consultation with the National Committee on Quality
				Assurance (NCQA).
(b) The
				Department shall thereafter prepare the collected data from the ACO for
				publication. The Department will provide each ACO with a copy of the data prior
				to publication. The ACO will be provided an opportunity, in a manner and time
				determined by the Department, to correct factual inaccuracies, and to file a
				statement in a form prescribed by the Department concerning the data.
(c) The Department shall thereafter make the
				collected data from the ACOs, along with any corrections made pursuant to
				subdivision (b) of this section, organized and segregated by type of product
				and type of organization offering the product, available on its public website.
				Such data will be shared with the Superintendent of Financial Services.
				Information published on the website shall not include patient-identifying
				information and shall be subject to all applicable provisions of law and
				regulation regarding confidentiality of patient information.
(d) All ACO data submitted shall include the
				following statement: "THE DATA COLLECTED BY THE DEPARTMENT IS ACCURATE TO THE
				BEST OF THE KNOWLEDGE OF DEPARTMENT STAFF, BASED ON THE INFORMATION SUPPLIED BY
				THE ACO WHICH IS THE SUBJECT OF THE DATA."
(e) Notwithstanding the above, an ACO that
				has a contractual arrangement with a third party health care payer to cover
				health care services for a defined population must submit required measures for
				the eligible population attributed to the ACO.
(f) The ACO's quality performance shall be
				equal to or exceed statewide and/or national benchmarks and/or demonstrate
				improvement over time on multiple performance measures of care to maintain
				participation in the program.
New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter XII - Innovative Delivery Models › Part 1003 - Accountable Care Organizations › Section 1003.11 - Payment and Third Party Health Care Payer

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An ACO may enter into arrangements with
				one or more third party health care payers to establish payment methodologies
				for health care services provided to the third party health care payer's
				enrollees provided by the ACO or for which the ACO is responsible.
(b) Unless it has in force and effect a valid
				license issued pursuant to Article 11 of the Insurance Law or a certificate of
				authority issued pursuant to Article 44 of the Public Health Law, an ACO or a
				participant may not enter into any arrangement that constitutes doing an
				insurance business under section
				1101 of the
				Insurance Law, including an arrangement that provides for full or partial
				capitation, shared losses or any other arrangement in which the ACO or the
				provider contractually assumes the liability for the delivery of specified
				health care services except:
(1) an ACO or an
				ACO participant may enter into such an arrangement when the ACO contracts with
				a managed care organization certified pursuant to Article 44 of the Public
				Health Law, an insurer authorized pursuant to the Insurance Law to write
				accident and health insurance in New York, or a corporation licensed pursuant
				to Article 43 of the Insurance Law; or
(2) a Medicare-only ACO that contracts with
				CMS may enter into an arrangement that provides for shared losses provided
				that, if the shared losses may exceed ten percent of the benchmark, the ACO
				meets all of the requirements of sections
				1003.5,
				1003.6,
				1003.11,
				1003.12,
				1003.13 and
				1003.14 of this
				Part.