N.Y. Public Health Law § 2816: Statewide planning and research cooperative system

* § 2816. Statewide planning and research cooperative system. 1. (a)

The statewide planning and research cooperative system in the department

is continued, as provided in and subject to this section, within amounts

appropriated for that purpose. The system shall be developed and

operated by the commissioner in consultation with the council, as may be

specified by regulation of the commissioner. Any component or components

of the system may be operated under a different name or names, and may

be structured as separate systems. In making regulations under this

section, subsequent to April first, two thousand eleven, the

commissioner shall consult with the superintendent of financial services

or the head of any agency that succeeds the department of financial

services, health care providers, third-party health care payers, and

advocates representing patients; protect the confidentiality of

patient-identifiable information; promote the accuracy and completeness

of reporting; and minimize the burden on institutional and

non-institutional health care providers and third-party health care

payers.

(b) As used in this section, unless the context clearly requires

otherwise:

(i) "Health care" means any services, supplies, equipment, or

prescription drugs referred to in subdivision two of this section.

(ii) "Health care provider" includes, in addition to its common

meanings, a clinical laboratory, a pharmacy, an entity that is an

integrated organization of health care providers, and an accountable

care organization of health care providers.

(iii) "System" means the statewide planning and research cooperative

system under this section, and any separate system under this

subdivision.

(iv) "Third-party health care payer" includes, but is not limited to,

an insurer, organization or corporation licensed or certified pursuant

to article thirty-two, forty-three or forty-seven of the insurance law,

or article forty-four of the public health law; or an entity such as a

pharmacy benefits manager, fiscal administrator, or administrative

services provider that participates in the administration of a

third-party health care payer system.

(v) "Covered person" is a person covered under a third-party health

care payer contract, agreement, or arrangement.

2. Notwithstanding any provision of law to the contrary, regulations

governing the system shall include, but not be limited to, the

following:

(a) Specification of patient, covered person, claims, and other data

elements and format which shall be reported including data related to:

(i) inpatient hospitalization data from general hospitals;

(ii) ambulatory surgery data from hospital-based ambulatory surgery

services and all other ambulatory surgery facilities licensed under this

article;

(iii) emergency department data from general hospitals;

(iv) outpatient, clinical laboratory, and prescription data, including

but not limited to data from or relating to services, supplies,

equipment, and prescription drugs provided or ordered by general

hospitals and diagnostic and treatment centers licensed under this

article, pharmacies, clinical laboratories, and other health care

providers;

(v) covered person and claims data; and

(vi) the data specified in this paragraph shall include the

identification of patients transferred, admitted or treated subsequent

to a medical, surgical or diagnostic procedure by a licensed health care

professional or at a health care site or facility.

(b) Standards to assure the protection of patient privacy in data

collected, published, released, used and accessed under this section,

including compliance with applicable federal law.

(c) Standards for the publication, release, and use of and access to

data reported in accordance with this section, including fees to be

charged.

(d) Provisions requiring specified health care providers and

third-party health care payers to report data to the system, with

specifications of the data, circumstances, format, time and method of

reporting.

(e) Provisions to acquire data relating to health care provided (i) to

patients for whom there is no third-party health care payer and (ii)

under arrangements that do not involve fee-for-service payment.

(f) Phased-in implementation of the system.

3. The commissioner may provide that the system may participate in or

cooperate with a similar system operated by, or receive information from

or provide information to, a regional or national entity or another

jurisdiction, including making appropriate agreements and applying for

approvals, provided that the protections for health care providers,

patients, and third-party health care payers in this section are

preserved and comparable provisions are included in the other system.

4. The commissioner may provide for access to data in the system by a

health care provider relating to a patient being treated by the health

care provider, subject to this section and applicable state and federal

law.

5. In operating the system, the commissioner shall consider national

standards, including but not limited to those approved by the National

Uniform Billing Committee (NUBC) or required under national electronic

data interchange (EDI) standards for health care transactions. The

commissioner shall also consider the use of the Statewide Health

Information Network for New York in relation to the system.

6. Notwithstanding any inconsistent provision of law to the contrary,

including but not limited to section one hundred two of the executive

law, such rules and regulations may describe data elements by reference

to information reasonably available to regulated parties, as such

material may be amended in the future, even though such material cannot

be precisely identified to the extent that it is amended in the future;

provided, however, that the commissioner shall precisely identify and

publish such data elements.

7. The commissioner may contract with one or more entities to operate

any part of the system subject to this section.

8. The commissioner may accept grants and enter into contracts as may

be necessary to provide funding for the system.

9. The commissioner shall publish an annual report relating to health

care utilization, cost, quality, and safety, including data on health

disparities.

* NB Effective until March 31, 2029

* § 2816. Statewide planning and research cooperative system. 1. The

statewide planning and research cooperative system in the department is

continued, as provided in this section. The statewide planning and

research cooperative system shall be developed and operated by the

commissioner in consultation with the council, and shall be comprised of

such data elements as may be specified by regulation.

2. Regulations governing the statewide planning and research

cooperative system shall include, but not be limited to, the following:

(a) Specification of patient and other data elements and format to be

reported including data related to:

(i) inpatient hospitalization data from general hospitals;

(ii) ambulatory surgery data from hospital-based ambulatory surgery

services and all other ambulatory surgery facilities licensed under this

article;

(iii) emergency department data from general hospitals;

(iv) outpatient clinic data from general hospitals and diagnostic and

treatment centers licensed under this article, provided, however, that

notwithstanding subdivision one of this section the commissioner, in

consultation with the health care industry, is authorized to promulgate

or adopt any rules or regulations necessary to implement the collection

of data pursuant to this subparagraph; and

(v) the data specified in this paragraph shall include the

identification of patients transferred, admitted or treated subsequent

to a medical, surgical or diagnostic procedure by a licensed health care

professional at a site or facility other than those specified in

subparagraph (i), (ii), (iii) or (iv) of this paragraph.

(b) Standards to assure the protection of patient privacy in data

collected and released under this section.

(c) Standards for the publication and release of data reported in

accordance with this section.

* NB Effective March 31, 2029