N.Y. Public Health Law § 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-nine, 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, 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, and up to one million seven

hundred five thousand dollars each state fiscal year for the period

April first, two thousand twenty-six through March thirty-first, two

thousand twenty-nine, 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, 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, and up

to four million three hundred sixty thousand dollars for each fiscal

year for the period April first, two thousand twenty-six through March

thirty-first, two thousand twenty-nine, 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, 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, and up to four hundred eighty-seven thousand dollars each

state fiscal year for the period April first, two thousand twenty-six

through March thirty-first, two thousand twenty-nine, 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) Scholars in medicine and science and scholarships in medicine

programs. 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, 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, and up

to one million six hundred five thousand dollars each state fiscal year

for the period April first, two thousand twenty-six through March

thirty-first, two thousand twenty-nine, 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 scholars in

medicine and science and scholarships in medicine programs 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.