N.Y. Public Health Law § 2999-p: Establishment of ACOs

§ 2999-p. Establishment of ACOs. 1. An accountable care organization:

(a) is an organization of clinically integrated health care providers

that work together to provide, manage, and coordinate health care

(including primary care) for a defined population; with a mechanism for

shared governance; the ability to negotiate, receive, and distribute

payments; and accountability for the quality, cost, and delivery of

health care to the ACO's patients; in accordance with this article; and

(b) has been issued a certificate of authority by the commissioner under

this article.

2. The commissioner shall establish a program within the department to

promote and regulate the use of ACOs to deliver an array of health care

services for the purpose of improving the quality, coordination and

accountability of services provided to patients in New York.

3. The commissioner may issue a certificate of authority to an entity

that meets conditions for ACO certification as set forth in regulations

made by the commissioner pursuant to section twenty-nine hundred

ninety-nine-q of this article. The commissioner shall not issue any new

certificate under this article after December thirty-first, two thousand

twenty-eight.

4. (a) Notwithstanding subdivision three of this section, the

commissioner shall issue a certificate of authority as a Medicare-only

ACO to an entity authorized by CMS to be an accountable care

organization under the Medicare program, upon receiving an application

to be a Medicare-only ACO from the entity documenting its status under

this subdivision. A certificate of authority under this subdivision

shall only apply to the Medicare-only ACO's actions in relation to

Medicare beneficiaries under its authorization from CMS.

(b) To the extent consistent with CMS regulations, a Medicare-only ACO

shall be subject to:

(i) subdivision seven of section twenty-nine hundred ninety-nine-q and

subdivisions one, two and three of section twenty-nine hundred

ninety-nine-r of this article, without regard to whether the

commissioner has made regulations under this article; and

(ii) other provisions of this article to the extent specifically

provided by the commissioner in regulations consistent with this

article.

5. The commissioner may limit, suspend, or terminate a certificate of

authority if an ACO is not operating in accordance with this article.

6. The commissioner is authorized to seek federal approvals and

waivers to implement this article, including but not limited to those

approvals or waivers necessary to obtain federal financial

participation.