New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter A - Medical Facilities-minimum Standards › Article 2 - Hospitals › Part 408 - Central Services Facility Rural Health Networks (csfrhn) › Section 408.2 - Network operational plans (nop)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Network operational plan shall mean a
					 written plan, including periodic updates of such a plan, prepared by a CSFRHN,
					 with the involvement of consumers unaffiliated with health care providers,
					 describing the steps to be taken by such network and its participating
					 providers to enhance access, by residents of the affected rural area, including
					 special populations, to necessary health care services while promoting cost
					 efficiencies in the provision of services.
(b) The commissioner shall not approve a
					 network operational plan until he/she has considered the recommendations of the
					 HSA(s) having jurisdiction in the region in which the network intends to
					 operate and is satisfied that the plan complies with the provisions of section
					 2957 of the
					 Public Health Law, and meets the following requirements:
(1) establishes an organizational structure
					 that includes a decisionmaking structure representative of participating
					 providers and consumers, mission statement, goals, operating principles, and
					 written agreements between the network and all affiliated providers, copies of
					 which shall be submitted with a proposed plan;
(2) provides for the delivery of at least
					 acute care, comprehensive primary care, and emergency medical care;
(3) ensures the provision of appropriate high
					 quality health care services in accordance with prevailing standards of care
					 and practice. At a minimum the plan shall demonstrate that:
(i) the roles and responsibilities of the
					 network and its participating providers in quality assurance/improvement
					 activities are identified. Quality assurance/improvement activities conducted
					 by the network on behalf of one or more of its participating providers shall be
					 specifically delineated;
(ii) a
					 strategy for monitoring, coordinating and assuring that the quality
					 assurance/improvement programs of network participants comply with existing
					 criteria and standards applicable to participants. At a minimum this strategy
					 shall assure that:
(a) both process and
					 outcome based measures are included in network provider quality assessment
					 programs;
(b) a network-wide
					 communication and information system, or plans for such system, is available
					 and contains the capacity to track patients throughout the system and provide
					 network providers with the necessary information to enhance continuity of care;
					 and
(c) procedures will be in place
					 that delineate the duties and responsibilities of medical/professional and
					 ancillary support staff necessary to ensure the provision of high quality
					 services by network provider;
(4) ensures that all potential patients in
					 the network service area have access to necessary services. At a minimum the
					 plan shall provide assurances that:
(i)
					 residents of the network service area shall be provided with information
					 sufficient to make them aware of available services;
(ii) providers of the three required minimum
					 services are located so as to ensure reasonable access to services by all
					 residents of the area served by the network as determined by the commissioner;
					 and
(iii) on-call systems are in
					 place to provide 24-hour a day coverage within the network for at least the
					 three required minimum services in settings appropriate to patient
					 needs;
(5) provides for
					 the efficient and effective coordination of affiliated network providers in
					 planning and evaluating both the integration and provision of services. At a
					 minimum this element of a network operational plan shall include:
(i) an organizational structure, or plans for
					 such structure, for ensuring coordination among network members and other
					 appropriate agencies involved in planning for health and health related
					 services in the network's service area; and
(ii) a coordinated system for developing and
					 using community service plans, county municipal health plans, and other
					 appropriate existing or proposed health plans such as those of appropriate
					 state and regional agencies including the HSAs;
(6) provides for the pooling and sharing of
					 existing resources to facilitate greater system efficiencies; and
(7) establishes terms and conditions to
					 ensure that no hospital, physician or other licensed or certified health care
					 provider operating in good standing, serving the network service area, and
					 willing to meet the terms and conditions of the network as defined in the
					 network operational plan, shall be denied the ability to participate therein.
					 Such terms and conditions may include, but need not be limited to, a
					 prospective participant's ability to deliver services in accordance with
					 prevailing standards of care and/or practice and a participant's willingness to
					 participate in coordinated network quality assurance and improvement programs,
					 peer review programs, credentialing systems, utilization review programs,
					 medical record systems, consultation services, specialty services,
					 communications systems and data collection systems. Such terms and conditions
					 may also include provisions for the payment and reimbursement of services
					 provided by network participants.