N.Y. Social Services Law § 364-m: Statewide patient centered medical home program

* § 364-m. Statewide patient centered medical home program. 1. The

commissioner of health is authorized to certify certain clinicians and

clinics as health care homes in order to improve health outcomes and

efficiency through patient care continuity and coordination of health

services. These providers will be eligible for enhanced payments for

services provided to: recipients eligible for Medicaid fee-for-service;

enrollees eligible for Medicaid managed care; enrollees eligible for and

enrolled in Family Health Plus organizations pursuant to title eleven-D

of this article ("Family Health Plus"); and enrollees eligible for and

enrolled in Child Health Plus. As used in this section "clinic" means a

general hospital providing outpatient care or a diagnostic and treatment

center, licensed under article twenty-eight of the public health law.

2. By December first, two thousand nine, the commissioner of health

shall develop and implement standards of certification for patient

centered medical homes for Medicaid fee-for-service and Medicaid managed

care, Family Health Plus and Child Health Plus programs. In developing

such standards, the commissioner of health shall: (a) consider existing

standards developed by national accrediting and professional

organizations; and (b) consult with national and local organizations

working on medical home models, physicians, hospitals, clinics, health

plans and consumers and their representatives.

3. To maintain their certification, patient centered medical homes

must: (a) renew their certification at a frequency determined by the

commissioner of health; and (b) provide data to the department of health

and to health plans in which the patient is enrolled to permit the

commissioner of health to evaluate the impact of patient centered

medical homes on quality, outcomes and cost.

4. Subject to the availability of funding and federal financial

participation, the commissioner of health is authorized:

(a) To pay enhanced rates of payment to clinics and clinicians that

are certified as patient centered medical homes under this section. Such

enhancements may be tiered based on the level of standard achieved by

the clinician or clinic; and

(b) To pay additional amounts for patient centered medical homes that

meet specific process or outcome standards specified by the commissioner

of health.

5. By December thirty-first, two thousand twelve, the commissioner of

health shall report to the governor and the legislature on the impact of

the statewide patient centered medical home program on quality, cost and

outcomes for enrollees in Medicaid fee-for-service, Medicaid managed

care, Family Health Plus and Child Health Plus.

* NB Repealed April 1, 2028