N.Y. Public Health Law § 2814: Health networks, global budgeting, and health care demonstrations

* § 2814. Health networks, global budgeting, and health care

demonstrations. 1. For the purposes of this section unless the context

clearly requires otherwise:

(a) "Board" shall mean the temporary statewide health advisory board

established pursuant to section nine hundred fifty-seven of the

executive law.

(b) "Proposal" shall mean a design or plan developed, as a result of

funds received pursuant to this section, to operate a network, global

budget, or regional health care demonstration.

2. (a) Notwithstanding any inconsistent provision of law, within

amounts available therefor, the commissioner shall make grants pursuant

to this section to (i) health care providers to facilitate development

of health networks or health care demonstrations (ii) health care

providers alone or in conjunction with third party payors to facilitate

development of global budgets and (iii) an organization demonstrably

representing the interests of the region or communities of the region

which demonstrate the support of the respective health systems agency to

facilitate development of health care demonstrations or global budgets.

Such networks, demonstrations, or global budgets shall be designed to

improve cost effectiveness of health care services, establish and

improve provider coordinated planning and management mechanisms, and/or

improve provider management of care or improve continuity of care.

Health care providers eligible to receive funding under section

twenty-nine hundred fifty-two of this chapter shall not be eligible for

grants under this section for development of health networks.

(b) Grants made pursuant to this section shall provide planning funds

which may include, but need not be limited to, funding to:

(i) assess the health care needs of the population and develop an

operational plan to meet these needs;

(ii) plan for and carry out any organizational changes needed to

integrate services; and

(iii) facilitate financing arrangements such as risk sharing and

capitation.

3. In awarding grants under this section, the commissioner shall

consult with the appropriate local health systems agency and shall

consider the recommendations of the temporary statewide health advisory

board on the grant proposals and to the extent practicable assure that

there is a sufficiently representative geographic distribution of

grantees including rural, urban, and suburban grantees. Grants made

pursuant to this section shall be used solely for the planning of health

networks, global budgets or health care demonstrations. Prior to

awarding grants, the commissioner shall first take into consideration

other financial resources available to the applicant to conduct such

planning.

4. In order to be eligible for a grant under this section, applicants

shall prepare and submit to the commissioner, the temporary statewide

health care advisory board, and the respective health systems agency an

application which contains the following:

(a) identification of the principal investigator or applicant for the

demonstration;

(b) a description of the nature and scope of the activities

contemplated;

(c) a description of the geographic area and populations currently

served by the entity;

(d) a description of the community or population to be served;

(e) a description of the anticipated benefits and advantages to

providers and consumers of services;

(f) a description of the estimated expenses, including administrative

expenses, which will be incurred in the development of the

demonstration; and

(g) the time frame proposed for the development of the health network,

global budgeting demonstration, or health care demonstration.

(h) the process that the eligible organization used in seeking public

participation and local involvement in the development of the program

plan; and

(i) the goals of the program, including information on how the program

plan will maintain and promote access to and delivery of high quality,

appropriate health or health related items and services for persons

residing in the region covered by the program.

5. Any grant recipient seeking to implement a proposal developed

pursuant to this section, except recipients of health networking grants,

shall submit such proposal to the temporary statewide health advisory

board, in such form and content determined by the board, which shall

evaluate such proposal and consider whether the proposal is likely to:

(a) aid in meeting the priority health needs and concerns in the

region as identified in and supported by evidence in the proposal and

consistent with recommendations of the regional health systems agency;

(b) enhance the quality of care as evidenced by outcome indicators;

(c) improve the cost-effectiveness of services by the entities

involved;

(d) improve the efficient utilization of the entities' resources and

capital equipment;

(e) enhance the provision of services that would otherwise not be

available;

(f) result in the elimination of unnecessary duplication of resources;

(g) reduce costs to individuals being served by the network;

(h) foster information sharing, communications and cooperation between

health care providers; and

(i) foster and improve the management and continuity of care.

6. In addition, the board shall require that the proposal contain

assurances that there will be equitable provider involvement in the

determination of any rates and rate setting methodology. The board shall

also require a description of how the proposed initiative will be

evaluated and assurance that the grantee will submit annual reports to

the governor and legislature concerning the status and experiences of

the initiative.

7. The temporary statewide health advisory board shall forward only

proposals recommended for operation to the commissioner for

authorization. In granting his authorization, the commissioner shall

certify that the proposal will:

(a) improve the cost effectiveness of health care services;

(b) improve the quality of care delivered as evidenced by outcome

indicators; and

(c) improve access to appropriate health care services.

8. Upon request by an applicant or grantee the commissioner and the

respective health system agency shall provide technical assistance.

9. The commissioner shall submit to the chairs of the senate finance

committee and the assembly ways and means committee and the chairs of

the assembly and senate health committees, a copy of any proposal

authorized by the commissioner pursuant to this section not more than

thirty days after approval.

10. With the exception of health networks, global budgets or health

care demonstrations that seek to implement alternative reimbursement

methodologies in general hospital settings only and/or for ambulatory

services associated with general hospital outpatient and diagnostic and

treatment center settings regarding payment for the medical assistance

program, as provided for in subdivisions ten and eleven of section

twenty-eight hundred seven of this article, no health network, global

budget or health care demonstration that seeks to implement alternative

reimbursement methodologies shall be approved or implemented without

approval pursuant to a chapter of the laws to be enacted by the

legislature.

* NB Expired June 30, 1996