New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 1 - General Provisions › Part 708 - Appropriateness Review › Section 708.4 - General review criteria

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 specific review criteria for specific services, as set forth in section
					 708.5 of this Part, relate to the
					 need, accessibility and availability, financial viability, cost effectiveness
					 and quality of the service as characteristics of appropriateness, and shall
					 consider, where appropriate, the following general considerations:
(1) the relationship of the health service
					 being reviewed to the applicable health systems plans, annual implementation
					 plans, and State Health Plan;
(2)
					 the relationship of the service being reviewed to the long-range development
					 plan, if any, of the person or entity providing such service;
(3) the need that the population served has
					 for the service, and the extent to which low- income persons, handicapped
					 persons, and other underserved groups have access to such service;
(4) the availability of less costly or more
					 effective alternative methods of providing the service being
					 reviewed;
(5) the relationship of
					 the service being reviewed to the existing health care system of the area in
					 which such service is provided;
(6)
					 the availability of resources, including health manpower, management personnel
					 and funds for capital and operating costs, for the provision of the service
					 being reviewed, and the availability of alternative uses of these resources for
					 the provision of other health services.
(7) the special needs and circumstances of
					 those persons or entities which provide a substantial portion of their services
					 or resources, or both, to individuals not residing in the health service areas
					 in which such persons or entities are located, or in adjacent health services
					 areas. These persons or entities may include medical and other
					 health-profession schools, multidisciplinary clinics, and specialty
					 centers;
(8) the special needs and
					 circumstances of Health Maintenance Organizations (HMO's). In the case of
					 areawide reviews which result in institution-specific findings regarding
					 services provided by or through an HMO, the needs and circumstances shall be
					 limited to:
(i) the needs of enrolled members
					 and reasonably anticipated new members of the HMO for the existing
					 institutional health services provided by the organization;
(ii) whether the services can be obtained
					 from non-HMO, or other HMO, providers in a reasonable and cost-effective manner
					 which is consistent with the basic method of operation of the HMO;
					 and
(iii) any other factors which
					 the commissioner may propose, consistent with the National Health Planning and
					 Resources Development Act of 1974, Public Law 93641, as amended;
(9) the special needs and
					 circumstances of biomedical and behavioral research projects which are designed
					 to meet a national need and for which local conditions offer special
					 advantages;
(10) the contribution
					 of the existing institutional health services in meeting the health- related
					 needs of members of medically underserved groups and other groups which have
					 traditionally experienced difficulties in obtaining equal access to health
					 services--for example, low-income persons, racial and ethnic minorities, women
					 and handicapped persons--particularly those needs identified in the applicable
					 health systems plan and annual implementation plan as deserving of
					 priority;
(11) the special
					 circumstances of health service institutions with respect to the need for
					 conserving energy;
(12) the effect
					 of competition on the supply of the health services being reviewed;
(13) improvements or innovations in the
					 financing and delivery of health services which foster competition and serve to
					 promote quality assurance and cost effectiveness; and
(14) the quality of care provided by the
					 services or facilities in the past.