Assembly Bill A6261

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6261

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                             March 11, 2011
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
  Committee on Health

AN ACT to amend the public health law,  the  social  services  law,  the
  public  authorities  law,  and chapter 57 of the laws of 2008 amending
  the public health law relating to medical home demonstration programs,
  in relation to accountable care organizations and medical home  multi-
  payor programs

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The public health law is amended by adding  a  new  article
44-A to read as follows:
                              ARTICLE 44-A
                     ACCOUNTABLE CARE ORGANIZATIONS
SECTION 4420. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE.
        4421. DEFINITIONS.
        4422. ESTABLISHMENT OF ACCOUNTABLE CARE ORGANIZATIONS.
        4423. CERTIFICATE OF AUTHORITY.
  S  4420. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE. THE LEGIS-
LATURE INTENDS TO FACILITATE THE ABILITY OF ACCOUNTABLE  CARE  ORGANIZA-
TIONS  TO ASSUME A LARGER ROLE IN DELIVERING A FULL ARRAY OF HEALTH CARE
SERVICES, FROM PRIMARY  AND  PREVENTIVE  CARE  THROUGH  ACUTE  INPATIENT
HOSPITAL  AND  POST-HOSPITAL CARE. THE LEGISLATURE FINDS THAT THE FORMA-
TION AND OPERATION OF ACCOUNTABLE CARE ORGANIZATIONS UNDER THIS  ARTICLE
CAN  BE  CONSISTENT  WITH  THE PURPOSES OF FEDERAL AND STATE ANTI-TRUST,
ANTI-REFERRAL, AND OTHER STATUTES, INCLUDING  REDUCING  OVER-UTILIZATION
AND EXPENDITURES. THE LEGISLATURE FINDS THAT THE DEVELOPMENT OF ACCOUNT-
ABLE  CARE  ORGANIZATIONS  UNDER  THIS  ARTICLE  WILL REDUCE HEALTH CARE
COSTS, PROMOTE  EFFECTIVE  ALLOCATION  OF  HEALTH  CARE  RESOURCES,  AND
ENHANCE  THE  QUALITY  AND ACCESSIBILITY OF HEALTH CARE. THE LEGISLATURE
FINDS THAT THIS  ARTICLE  IS  NECESSARY  TO  PROMOTE  THE  FORMATION  OF

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09961-02-1

              

A. 6261                             2

ACCOUNTABLE  CARE  ORGANIZATIONS AND PROTECT THE PUBLIC INTEREST AND THE
INTERESTS OF PATIENTS AND HEALTH CARE PROVIDERS.
  S  4421.  DEFINITIONS.  AS  USED  IN THIS ARTICLE, THE FOLLOWING TERMS
SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT  CLEARLY  REQUIRES
OTHERWISE:
  1.  "ACCOUNTABLE CARE ORGANIZATION" AND "ACO" MEAN AN ACCOUNTABLE CARE
ORGANIZATION CERTIFIED BY THE COMMISSIONER UNDER THIS ARTICLE.
  2. "CERTIFICATE OF AUTHORITY" OR "CERTIFICATE" MEANS A CERTIFICATE  OF
AUTHORITY ISSUED BY THE COMMISSIONER UNDER THIS ARTICLE.
  3.  "HEALTH CARE PROVIDER" MEANS AN ENTITY LICENSED OR CERTIFIED UNDER
ARTICLE TWENTY-EIGHT OR THIRTY-SIX OF THIS CHAPTER; AN  ENTITY  LICENSED
OR  CERTIFIED  UNDER  ARTICLE  SIXTEEN,  THIRTY-ONE OR THIRTY-TWO OF THE
MENTAL HYGIENE LAW; OR A HEALTH CARE PRACTITIONER LICENSED OR  CERTIFIED
UNDER  TITLE  EIGHT OF THE EDUCATION LAW OR A LAWFUL COMBINATION OF SUCH
HEALTH CARE PRACTITIONERS; IT  MAY  ALSO  INCLUDE  OTHER  ENTITIES  THAT
PROVIDE  TECHNICAL  ASSISTANCE,  INFORMATION  SYSTEMS AND SERVICES, CARE
COORDINATION AND OTHER SERVICES TO HEALTH CARE  PROVIDERS  AND  PATIENTS
PARTICIPATING IN AN ACO.
  4.  "PRIMARY  CARE"  MEANS  THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
RICS, OR PRIMARY CARE GYNECOLOGY, WITHOUT REGARD TO BOARD CERTIFICATION,
AND SHALL APPLY TO ANY HEALTH CARE PROVIDER ACTING WITHIN HIS,  HER,  OR
ITS LAWFUL SCOPE OF PRACTICE.
  5.  "THIRD-PARTY HEALTH CARE PAYER" INCLUDES, IN ADDITION TO ITS ORDI-
NARY MEANINGS, 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.
  S  4422.  ESTABLISHMENT  OF  ACCOUNTABLE  CARE  ORGANIZATIONS.  1.  AN
ACCOUNTABLE CARE ORGANIZATION IS A NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY
WHICH (A) IS AN ORGANIZATION OF 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 ACCOUNTABIL-
ITY  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. AN ACO SHALL:
  (A)  HAVE A GOVERNANCE SYSTEM THAT REASONABLY, EQUITABLY AND DEMOCRAT-
ICALLY REPRESENTS THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, EMPLOY-
EES OF PARTICIPATING HEALTH CARE  PROVIDERS,  THE  ACO'S  ENROLLEES  AND
PATIENTS, AND THE GENERAL PUBLIC.
  (B)  DEFINE THE POPULATION PROPOSED TO BE SERVED BY THE ACO, WHICH MAY
INCLUDE REFERENCE TO A GEOGRAPHICAL AREA AND PATIENT CHARACTERISTICS.
  (C) INCLUDE AN ADEQUATE NETWORK OF PARTICIPATING HEALTH CARE PROVIDERS
TO PROVIDE THE HEALTH CARE FOR WHICH THE ACO IS  ACCOUNTABLE,  INCLUDING
PRIMARY CARE HEALTH CARE PROVIDERS, AND AT LEAST ONE FEDERALLY-QUALIFIED
HEALTH CENTER (PROVIDED THAT THE COMMISSIONER MAY WAIVE THIS REQUIREMENT
IF THERE IS NO FEDERALLY-QUALIFIED HEALTH CENTER SERVING THE AREA SERVED
BY THE ACO).
  (D)  HAVE DEFINED MECHANISMS FOR PROVIDING, MANAGING, AND COORDINATING
HIGH QUALITY HEALTH CARE FOR THE ACO'S  PATIENTS,  INCLUDING:  ELEVATING
THE  SERVICES OF PRIMARY CARE HEALTH CARE PROVIDERS TO MEET PATIENT-CEN-
TERED  MEDICAL  HOME  STANDARDS;  COORDINATING  INTENSIVE  SERVICES  FOR
COMPLEX  HIGH-NEED  PATIENTS;  PROVIDING ACCESS TO HEALTH CARE PROVIDERS
THAT ARE NOT PARTICIPANTS IN THE ACO; AND PROVIDING ACCESS TO  THE  FULL
RANGE OF REPRODUCTIVE HEALTH CARE FOR THE POPULATION SERVED.

A. 6261                             3

  (E) HAVE DEFINED MECHANISMS FOR RECEIVING AND DISTRIBUTING PAYMENTS TO
THE  ACO'S  PARTICIPATING  HEALTH  CARE  PROVIDERS,  INCLUDING INCENTIVE
PAYMENTS (WHICH MAY INCLUDE MEDICAL  HOME  PAYMENTS)  AND  PAYMENTS  FOR
HEALTH  CARE  SERVICES FROM THIRD-PARTY HEALTH CARE PAYERS AND PATIENTS.
AN  ACO  MAY INCLUDE MECHANISMS FOR POOLING PAYMENTS RECEIVED BY PARTIC-
IPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS AND PATIENTS.
  (F) HAVE REASONABLE MECHANISMS AND CRITERIA FOR ACCEPTING HEALTH  CARE
PROVIDERS TO PARTICIPATE IN THE ACO THAT ARE RELATED TO THE NEEDS OF THE
PATIENT POPULATION TO BE SERVED AND NEEDS AND PURPOSES OF THE ACO AND DO
NOT DISCRIMINATE ON OTHER GROUNDS.
  (G)  HAVE A LEADERSHIP AND MANAGEMENT STRUCTURE THAT INCLUDES CLINICAL
AND ADMINISTRATIVE SYSTEMS AND CLINICAL PARTICIPATION.
  (H) HAVE APPROPRIATE QUALITY ASSURANCE  MECHANISMS,  GRIEVANCE  PROCE-
DURES FOR HEALTH CARE PROVIDERS AND PATIENTS, AND PROCEDURES FOR REVIEW-
ING AND APPEALING PATIENT CARE DECISIONS.
  (I)  PROVIDE  SATISFACTORY EVIDENCE OF THE CHARACTER AND COMPETENCE OF
THE ACO.
  (J) HAVE THE ABILITY TO OPERATE ON A FISCALLY  SOUND  AND  FINANCIALLY
RESPONSIBLE BASIS, INCLUDING REASONABLE CAPITALIZATION AND RESERVES, AND
CONSIDERING THE PAYMENT ARRANGEMENTS ENTERED INTO BY THE ACO.
  (K)  IN  ITS  APPLICATION  AND  FROM  TIME TO TIME, AS REQUIRED BY THE
COMMISSIONER, PROVIDE THE COMMISSIONER WITH INFORMATION AND DATA  RELAT-
ING TO:
  (I)  THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INDIVID-
UAL HEALTH CARE PRACTITIONERS AFFILIATED WITH SUCH HEALTH CARE  PROVIDER
WHO PROVIDE HEALTH CARE TO THE HEALTH CARE PROVIDER'S PATIENTS.
  (II)  DATA, INCLUDING ENCOUNTER DATA, RELATING TO THE NATURE, OUTCOME,
AND QUALITY OF, AND PAYMENT FOR, HEALTH CARE PROVIDED BY THE PARTICIPAT-
ING HEALTH CARE PROVIDER TO THE PARTICIPATING PATIENT.
  (L) HAVE MECHANISMS TO PROMOTE  EVIDENCE-BASED  HEALTH  CARE,  PATIENT
ENGAGEMENT,  COORDINATION  OF CARE, ELECTRONIC HEALTH RECORDS, AND OTHER
ENABLING TECHNOLOGIES.
  3. THE COMMISSIONER,  IN  CONSULTATION  WITH  HEALTH  CARE  PROVIDERS,
THIRD-PARTY  HEALTH  CARE  PAYERS,  ADVOCATES REPRESENTING PATIENTS, THE
SUPERINTENDENT OF INSURANCE, AND OTHER APPROPRIATE PARTIES, SHALL:
  (A) ESTABLISH APPROPRIATE REQUIREMENTS FOR ACOS TO PROMOTE  COMPLIANCE
WITH THE PURPOSES OF THIS ARTICLE.
  (B)  ESTABLISH  APPROPRIATE PERFORMANCE STANDARDS FOR, AND MEASURES TO
ASSESS, THE QUALITY OF CARE PROVIDED BY AN ACO, SUCH AS MEASURES OF:
  (I) CLINICAL PROCESSES AND OUTCOMES;
  (II) PATIENT AND, WHERE PRACTICABLE, CAREGIVER EXPERIENCE OF CARE;
  (III) UTILIZATION, SUCH AS RATES OF HOSPITAL ADMISSION FOR  AMBULATORY
CARE  SENSITIVE  CONDITIONS,  EMERGENCY ROOM USE, AND HOSPITAL RE-ADMIS-
SIONS.
  (C) PROVIDE FOR PUBLIC DISCLOSURE, ON  THE  DEPARTMENT'S  WEBSITE,  OF
STATISTICAL  DATA  RELATING TO THE QUALITY OF SERVICES, PERFORMANCE, AND
OTHER CHARACTERISTICS OF ACOS, WHICH IS APPROPRIATELY ADJUSTED FOR  CASE
MIX AND EXCLUDES ANY INDIVIDUAL PATIENT IDENTIFYING INFORMATION.
  (D) MAKE REGULATIONS, SET STANDARDS, AND TAKE OTHER ACTIONS TO PROMOTE
THE  ABILITY OF AN ACO TO PARTICIPATE IN APPLICABLE FEDERAL PROGRAMS FOR
ACCOUNTABLE CARE ORGANIZATIONS.
  4. (A) IN ORDER TO PROMOTE IMPROVED QUALITY  AND  EFFICIENCY  OF,  AND
ACCESS  TO, HEALTH CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES,
IT SHALL BE THE POLICY OF THE STATE RELATING TO ACOS TO ENCOURAGE  COOP-
ERATIVE,  COLLABORATIVE  AND  INTEGRATIVE ARRANGEMENTS AMONG THIRD-PARTY
HEALTH CARE PAYERS AND HEALTH CARE  PROVIDERS  WHO  MIGHT  OTHERWISE  BE

A. 6261                             4

COMPETITORS,  UNDER  THE  ACTIVE SUPERVISION OF THE COMMISSIONER. TO THE
EXTENT SUCH ARRANGEMENTS MIGHT BE ANTI-COMPETITIVE  WITHIN  THE  MEANING
AND  INTENT  OF  THE  FEDERAL OR STATE ANTITRUST LAWS, THE INTENT OF THE
STATE  IS  TO SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS AND WITH REGU-
LATION UNDER THIS ARTICLE, TO THE EXTENT  NECESSARY  TO  ACCOMPLISH  THE
PURPOSES  OF  THIS  ARTICLE  RELATING  TO ACOS, AND PROVIDE STATE ACTION
IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS WITH RESPECT TO  THE
PLANNING,  IMPLEMENTATION  AND  OPERATION OF ACOS AND THIRD-PARTY HEALTH
CARE PAYERS AND HEALTH CARE PROVIDERS.  THE COMMISSIONER  SHALL  PROVIDE
REASONABLE  AND APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
ACTION IMMUNITY UNDER THE STATE AND  FEDERAL  ANTITRUST  LAWS,  AND  MAY
INSPECT,  REQUIRE,  OR  REQUEST  ADDITIONAL DOCUMENTATION AND TAKE OTHER
ACTIONS UNDER THIS ARTICLE TO VERIFY AND MAKE SURE THAT THIS ARTICLE  IS
IMPLEMENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
  (B) TO THE EXTENT THE FORMATION OR OPERATION OF AN ACO OR ITS ARRANGE-
MENTS  WITH  THIRD-PARTY HEALTH CARE PAYERS OR HEALTH CARE PROVIDERS MAY
VIOLATE THE FEDERAL CIVIL MONETARY PAYMENT LAWS,  OR  FEDERAL  OR  STATE
ANTI-KICKBACK, PATIENT REFERRAL, OR FEE-SPLITTING LAWS, THE COMMISSIONER
SHALL  PROVIDE  REASONABLE  AND APPROPRIATE REGULATION, SUPERVISION, AND
WAIVERS UNDER THOSE STATUTES AND THEIR REGULATIONS TO ENABLE SUCH FORMA-
TION, OPERATION OR ARRANGEMENTS TO PROCEED AND TO MAKE SURE THAT THEY DO
SO CONSISTENTLY WITH THE PURPOSES OF THIS ARTICLE.
  (C) THE PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY AN
ACO THROUGH HEALTH CARE PROVIDERS SHALL NOT BE CONSIDERED  THE  PRACTICE
OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCATION LAW BY THE ACO.
  5.  (A)  AN  ACO  (I)  SHALL BE DEEMED TO BE A HEALTH PLAN, SOLELY FOR
PURPOSES OF ARTICLE FORTY-NINE OF THIS CHAPTER, EXCEPT WHERE  THE  FUNC-
TIONS  OF  A  HEALTH PLAN UNDER THAT ARTICLE ARE THE RESPONSIBILITY OF A
THIRD-PARTY HEALTH CARE PAYER, AND (II) SHALL BE DEEMED TO BE A  MANAGED
CARE  PRODUCT,  SOLELY FOR PURPOSES OF ARTICLE FORTY-EIGHT OF THE INSUR-
ANCE LAW, EXCEPT WHERE THE FUNCTIONS OF A  MANAGED  CARE  PRODUCT  UNDER
THAT ARTICLE ARE THE RESPONSIBILITY OF A THIRD-PARTY HEALTH CARE PAYER.
  (B)  WHERE  AN  ACO  CONTRACTS  WITH AN ENROLLEE OR PATIENT TO PROVIDE
HEALTH CARE SERVICES TO THAT PERSON, WHERE PAYMENT FOR THOSE SERVICES IS
NOT PRIMARILY THE RESPONSIBILITY OF A  THIRD-PARTY  HEALTH  CARE  PAYER,
NOTHING IN THIS ARTICLE SHALL PRECLUDE THE ACO FROM BEING DEEMED TO BE A
HEALTH  MAINTENANCE  ORGANIZATION  SUBJECT TO ARTICLE FORTY-FOUR OF THIS
CHAPTER OR ENGAGED IN THE BUSINESS OF INSURANCE AND SUBJECT TO  APPLICA-
BLE  PROVISIONS  OF  THE INSURANCE LAW, INCLUDING ARTICLE FORTY-EIGHT OF
THE INSURANCE LAW.
  6. (A) (I) AN ACO MAY ENTER INTO ARRANGEMENTS WITH ONE OR MORE  THIRD-
PARTY  HEALTH  CARE PAYERS TO ESTABLISH PAYMENT METHODOLOGIES FOR HEALTH
CARE SERVICES FOR THE THIRD-PARTY HEALTH CARE PAYER'S ENROLLEES PROVIDED
BY THE ACO OR FOR WHICH THE ACO IS RESPONSIBLE, SUCH AS FULL OR  PARTIAL
CAPITATION   OR   OTHER  ARRANGEMENTS.  SUCH  ARRANGEMENTS  MAY  INCLUDE
PROVISION FOR THE ACO TO RECEIVE AND DISTRIBUTE PAYMENTS  TO  THE  ACO'S
PARTICIPATING  HEALTH  CARE  PROVIDERS, INCLUDING INCENTIVE PAYMENTS AND
PAYMENTS FOR HEALTH CARE SERVICES FROM THIRD-PARTY  HEALTH  CARE  PAYERS
AND  PATIENTS.  AN  ACO  MAY  INCLUDE  MECHANISMS  FOR  POOLING PAYMENTS
RECEIVED BY PARTICIPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY  PAYERS
AND PATIENTS.
  (II)  THE  COMMISSIONER,  IN  CONSULTATION  WITH THE SUPERINTENDENT OF
INSURANCE, MAY AUTHORIZE A THIRD-PARTY HEALTH CARE PAYER TO  PARTICIPATE
IN PAYMENT METHODOLOGIES WITH AN ACO UNDER THIS PARAGRAPH, NOTWITHSTAND-
ING  ANY  CONTRARY  PROVISION  OF  THIS  CHAPTER, THE INSURANCE LAW, THE

A. 6261                             5

SOCIAL SERVICES LAW, OR THE ELDER LAW, ON FINDING THAT THE PAYMENT METH-
ODOLOGY IS CONSISTENT WITH THE PURPOSES OF THIS ARTICLE.
  (III) NO THIRD-PARTY HEALTH CARE PAYER SHALL:
  (A) IMPOSE ANY DEDUCTIBLE, CO-PAYMENT OR OTHER FORM OF CO-INSURANCE ON
ANY  ENROLLEE  OR  PATIENT  IN  CONNECTION  WITH THE ENROLLEE OR PATIENT
PARTICIPATING IN AN ACO THAT IS HIGHER THAN IT WOULD  OTHERWISE  IMPOSE;
OR
  (B)  MAKE  ANY  DISTINCTION  OR DISCRIMINATION AGAINST ANY ENROLLEE OR
PATIENT IN CONNECTION WITH THE ENROLLEE OR PATIENT PARTICIPATING  IN  AN
ACO, OR IMPOSE ANY RESTRICTION ON WHICH OF ITS ENROLLEES OR PATIENTS MAY
PARTICIPATE IN AN ACO; PROVIDED THAT
  (C)  THIS  SUBDIVISION  SHALL  NOT  BE  CONSTRUED TO BAR A THIRD-PARTY
HEALTH CARE PAYER FROM PROVIDING INCENTIVES FOR ENROLLEES OR PATIENTS TO
PARTICIPATE IN AN ACO; AND
  (D) ENROLLEE, PATIENT, AND HEALTH CARE PROVIDER  PARTICIPATION  IN  AN
ACO SHALL BE ON A VOLUNTARY BASIS.
  (B)  WITH RESPECT TO ARRANGEMENTS INVOLVING PUBLIC HEALTH COVERAGE AND
AN ACO, THE COMMISSIONER:
  (I) SHALL SEEK TO PROMOTE THE ESTABLISHMENT OF ACOS;
  (II) MAY PROMOTE USE OF RISK-ADJUSTMENT AND  STOP-LOSS  METHODOLOGIES;
AND
  (III)  MAY  ESTABLISH  PAYMENT  METHODOLOGIES,  INCLUDING FOR MEDICAID
FEE-FOR-SERVICE AND MEDICAID MANAGED CARE.
  (C) AN ACO MAY SEEK TO FOCUS ON  PROVIDING  HEALTH  CARE  SERVICES  TO
PATIENTS  WITH ONE OR MORE CHRONIC CONDITIONS OR SPECIAL NEEDS. HOWEVER,
AN ACO MAY NOT OTHERWISE, ON THE BASIS OF A PERSON'S  MEDICAL  OR  DEMO-
GRAPHIC  CHARACTERISTICS,  DISCRIMINATE  FOR OR AGAINST OR DISCOURAGE OR
ENCOURAGE ANY PERSON OR PERSONS WITH RESPECT TO ENROLLING OR PARTICIPAT-
ING IN THE ACO.
  (D) AN ACO SHALL NOT, BY INCENTIVES OR OTHERWISE, DISCOURAGE A  HEALTH
CARE  PROVIDER  FROM  PROVIDING  OR  AN ENROLLEE OR PATIENT FROM SEEKING
APPROPRIATE HEALTH CARE SERVICES.
  (E) AN ACO SHALL NOT DISCRIMINATE AGAINST OR DISADVANTAGE A PATIENT OR
PATIENT'S REPRESENTATIVE FOR THE EXERCISE OF PATIENT AUTONOMY.
  7. THE COMMISSIONER IS AUTHORIZED TO SEEK FEDERAL  GRANTS,  APPROVALS,
AND  WAIVERS  TO  IMPLEMENT  THIS  ARTICLE,  INCLUDING FEDERAL FINANCIAL
PARTICIPATION UNDER  PUBLIC  HEALTH  COVERAGE.  THE  COMMISSIONER  SHALL
PROVIDE  COPIES OF APPLICATIONS AND OTHER DOCUMENTS SEEKING SUCH FEDERAL
GRANTS, APPROVALS, AND WAIVERS TO  THE  CHAIRS  OF  THE  SENATE  FINANCE
COMMITTEE,  THE  ASSEMBLY  WAYS  AND MEANS COMMITTEE, AND THE SENATE AND
ASSEMBLY HEALTH COMMITTEES SIMULTANEOUSLY WITH THEIR SUBMISSION  TO  THE
FEDERAL GOVERNMENT.
  8.  THE  COMMISSIONER MAY DIRECTLY, OR BY CONTRACT WITH NOT-FOR-PROFIT
ORGANIZATIONS, PROVIDE:
  (A) CONSUMER ASSISTANCE TO PATIENTS PARTICIPATING  IN  OR  CONSIDERING
PARTICIPATING IN AN ACO AS TO MATTERS RELATING TO ACOS;
  (B)  TECHNICAL  AND  OTHER ASSISTANCE TO HEALTH CARE PROVIDERS PARTIC-
IPATING IN AN ACO AS TO MATTERS RELATING TO THE ACO;
  (C) ASSISTANCE TO ACOS TO PROMOTE THEIR FORMATION  AND  IMPROVE  THEIR
OPERATION, INCLUDING ASSISTANCE UNDER SECTION TWENTY-EIGHT HUNDRED EIGH-
TEEN OF THIS CHAPTER;
  (D) INFORMATION SHARING AND OTHER ASSISTANCE AMONG ACOS TO IMPROVE THE
OPERATION OF ACOS.
  S  4423.  CERTIFICATE  OF AUTHORITY. 1. THE COMMISSIONER SHALL ISSUE A
CERTIFICATE OF AUTHORITY TO AN APPLICANT THAT SATISFIES THE REQUIREMENTS
UNDER THIS ARTICLE FOR ESTABLISHMENT OF AN ACO.

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  2. THE COMMISSIONER MAY LIMIT, SUSPEND, OR TERMINATE A CERTIFICATE  OF
AUTHORITY IF THE ACO IS NOT OPERATING IN ACCORDANCE WITH THIS ARTICLE.
  3.  THE  COMMISSIONER  SHALL  ESTABLISH, BY REGULATION, REASONABLE AND
APPROPRIATE PROCEDURES UNDER THIS SECTION,  CONSISTENT  WITH  THE  STATE
ADMINISTRATIVE PROCEDURE ACT.
  4.  THE  COMMISSIONER  SHALL  NOT APPROVE ANY CERTIFICATE OF AUTHORITY
UNDER THIS ARTICLE AFTER DECEMBER THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
  S 2. Subdivision 1 of section 2 of the public health law is amended by
adding eight new paragraphs (o), (p), (q), (r), (s), (t), (u),  and  (v)
to read as follows:
  (O)  "MEDICAID"  OR "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
FIVE OF THE SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
  (P) "FAMILY HEALTH PLUS" MEANS TITLE ELEVEN-D OF ARTICLE FIVE  OF  THE
SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
  (Q)  "CHILD  HEALTH  PLUS" MEANS TITLE ONE-A OF ARTICLE TWENTY-FIVE OF
THIS CHAPTER AND THE PROGRAM THEREUNDER.
  (R) "MEDICAID MANAGED CARE"  MEANS  MEDICAID  PROVIDED  UNDER  SECTION
THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW.
  (S)  "MEDICAID  FEE-FOR-SERVICE"  MEANS  MEDICAID  PROVIDED OTHER THAN
UNDER MEDICAID MANAGED CARE.
  (T) "MEDICARE" MEANS TITLE XVIII OF THE FEDERAL  SOCIAL  SECURITY  ACT
AND THE PROGRAMS THEREUNDER.
  (U)  "EPIC"  MEANS TITLE THREE OF ARTICLE TWO OF THE ELDER LAW AND THE
PROGRAM THEREUNDER.
  (V) "PUBLIC HEALTH COVERAGE" MEANS MEDICAID, CHILD HEALTH PLUS, FAMILY
HEALTH PLUS, MEDICARE (TO THE EXTENT IT IS SUBJECT TO STATE LAW  IN  THE
CONTEXT IN WHICH THE TERM IS USED), AND EPIC.
  S  3.  Paragraph  (b)  of subdivision 1 of section 364-j of the social
services law, as amended by chapter 649 of the laws  of  1996,  subpara-
graphs  (i)  and  (ii) as amended by chapter 433 of the laws of 1997, is
amended to read as follows:
  (b) "Managed care provider". An entity that provides or  arranges  for
the  provision  of  medical  assistance services and supplies to partic-
ipants directly or indirectly (including by  referral),  including  case
management; and:
  (i)  is  authorized  to operate under article forty-four of the public
health law or article forty-three of the insurance law and  provides  or
arranges,  directly  or  indirectly  (including by referral) for covered
comprehensive health services on a full capitation basis; [or]
  (ii) is authorized  as  a  partially  capitated  program  pursuant  to
section  three  hundred sixty-four-f of this title or section forty-four
hundred three-e of the public health law or section 1915b of the  social
security act; OR
  (III)  IS  AN ACCOUNTABLE CARE ORGANIZATION UNDER ARTICLE FORTY-FOUR-A
OF THE PUBLIC HEALTH LAW.
  S 4. Section 2818 of the public health law is amended by adding a  new
subdivision 6 to read as follows:
  6.  NOTWITHSTANDING SUBDIVISIONS ONE AND TWO OF THIS SECTION, SECTIONS
ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW,
OR ANY OTHER INCONSISTENT PROVISION OF LAW, OF THE FUNDS  AVAILABLE  FOR
EXPENDITURE  PURSUANT  TO THIS SECTION, TEN MILLION DOLLARS MAY BE ALLO-
CATED AND DISTRIBUTED BY THE COMMISSIONER WITHOUT A COMPETITIVE  BID  OR
REQUEST  FOR  PROPOSAL  PROCESS FOR GRANTS TO ACCOUNTABLE CARE ORGANIZA-
TIONS UNDER ARTICLE FORTY-FOUR-A OF THIS  CHAPTER  FOR  THE  PURPOSE  OF
PROMOTING  THEIR  FORMATION AND IMPROVING THEIR OPERATION. CONSIDERATION
RELIED UPON BY  THE  COMMISSIONER  IN  DETERMINING  THE  ALLOCATION  AND

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DISTRIBUTION  OF  THESE  FUNDS SHALL INCLUDE, BUT NOT BE LIMITED TO, THE
NEED FOR AND CAPACITY OF THE ACCOUNTABLE CARE ORGANIZATION TO ACCOMPLISH
THE PURPOSES OF ARTICLE FORTY-FOUR-A OF THIS CHAPTER IN THE AREA  TO  BE
SERVED.
  S 5. The opening paragraph of section 1680-j of the public authorities
law,  as  amended  by  section 54 of part B of chapter 58 of the laws of
2005, is amended to read as follows:
  Notwithstanding any other provision of law to the contrary, the dormi-
tory authority of the state of New York is hereby  authorized  to  issue
bonds  or  notes  in one or more series in an aggregate principal amount
not to exceed seven hundred fifty million dollars excluding bonds issued
to fund one or more debt service reserve funds, to pay costs of issuance
of such bonds, and bonds or notes issued to refund  or  otherwise  repay
such  bonds  or  notes  previously issued, for the purposes of financing
project costs authorized under section twenty-eight hundred eighteen  of
the  public health law. Of such seven hundred fifty million dollars, ten
million dollars shall be made available to the community health  centers
capital  program  established  pursuant  to section twenty-eight hundred
seventeen of the public health law; AND TEN  MILLION  DOLLARS  SHALL  BE
MADE AVAILABLE TO ACCOUNTABLE CARE ORGANIZATIONS UNDER SUBDIVISION EIGHT
OF  SECTION FORTY-FOUR HUNDRED TWENTY-TWO AND SUBDIVISION SIX OF SECTION
TWENTY-EIGHT HUNDRED EIGHTEEN OF THE PUBLIC HEALTH LAW.
  S 6. The article heading of article 27-L of the public health law,  as
added  by  section  16  of part OO of chapter 57 of the laws of 2008, is
amended to read as follows:
                  MEDICAL HOME [DEMONSTRATION] PROGRAMS
  S 7. The public health law is amended by adding a new  section  2799-t
to read as follows:
  S 2799-T. MEDICAL HOME MULTIPAYOR PROGRAMS. 1. (A) THE COMMISSIONER IS
AUTHORIZED  TO  ESTABLISH  MEDICAL HOME MULTIPAYOR PROGRAMS (REFERRED TO
IN THIS SECTION AS A "PROGRAM") AND IN RELATION TO A PROGRAM MAY CERTIFY
CERTAIN PRIMARY CARE CLINICIANS AND CLINICS AS  MEDICAL  HOMES  ELIGIBLE
FOR  ENHANCED PAYMENTS FOR SERVICES PROVIDED TO: RECIPIENTS ELIGIBLE FOR
MEDICAID FEE-FOR-SERVICE; ENROLLEES ELIGIBLE FOR AND ENROLLED  IN  MEDI-
CAID  MANAGED CARE; ENROLLEES ELIGIBLE FOR AND ENROLLED IN FAMILY HEALTH
PLUS; ENROLLEES ELIGIBLE FOR AND ENROLLED IN CHILD HEALTH  PLUS;  ENROL-
LEES  AND  SUBSCRIBERS  OF COMMERCIAL MANAGED CARE PLANS OPERATING UNDER
ARTICLE FORTY-FOUR OF THIS CHAPTER OR HEALTH  MAINTENANCE  ORGANIZATIONS
OPERATING  UNDER ARTICLE FORTY-THREE OF THE INSURANCE LAW; ENROLLEES AND
SUBSCRIBERS OF OTHER COMMERCIAL INSURANCE  PRODUCTS;  AND  EMPLOYEES  OF
EMPLOYER-SPONSORED SELF-INSURED PLANS. THE PURPOSE OF THE PROGRAMS IS TO
IMPROVE  HEALTH  CARE  OUTCOMES  AND EFFICIENCY THROUGH IMPROVED ACCESS,
PATIENT CARE CONTINUITY, AND COORDINATION OF HEALTH SERVICES.
  (B) AS USED IN THIS SECTION:
  (I) "CLINIC" MEANS A GENERAL HOSPITAL PROVIDING OUTPATIENT CARE  OR  A
DIAGNOSTIC  AND TREATMENT CENTER, LICENSED UNDER ARTICLE TWENTY-EIGHT OF
THIS CHAPTER; AND
  (II) "PRIMARY CARE CLINICIAN" MEANS A HEALTH CARE PRACTITIONER  ACTING
WITHIN  HIS  OR  HER  LAWFUL  SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE
EDUCATION LAW WHO IS: (A) A PHYSICIAN OR NURSE  PRACTITIONER  PRACTICING
IN  A  PRIMARY  CARE  SPECIALTY; (B) A PHYSICIAN, NURSE PRACTITIONER, OR
MIDWIFE PRACTICING PRIMARY GYNECOLOGICAL CARE FOR  FEMALE  PATIENTS;  OR
(C)  A  PHYSICIAN OR NURSE PRACTITIONER PRACTICING IN A NON-PRIMARY CARE
SPECIALTY, FOR A PATIENT WHO  HAS  A  CHRONIC  CONDITION  THAT  REQUIRES
SPECIALTY  CARE, WHERE THE SPECIALIST HEALTH CARE PRACTITIONER REGULARLY
AND CONTINUALLY PROVIDES TREATMENT FOR THAT CONDITION TO THE PATIENT;

A. 6261                             8

  (III) "PRIMARY  CARE  MEDICAL  HOME  COLLABORATIVE"  MEANS  AN  ENTITY
APPROVED  BY  THE COMMISSIONER WHICH SHALL INCLUDE BUT NOT BE LIMITED TO
HEALTH CARE PROVIDERS, WHICH MAY INCLUDE BUT NOT BE  LIMITED  TO  HOSPI-
TALS,  DIAGNOSTIC AND TREATMENT CENTERS, PRIVATE PRACTICES AND INDEPEND-
ENT PRACTICE ASSOCIATIONS, AND PAYORS OF HEALTH CARE SERVICES, WHICH MAY
INCLUDE BUT NOT BE LIMITED TO EMPLOYERS, HEALTH PLANS AND INSURERS.
  2.  (A)  IN  ORDER  TO PROMOTE IMPROVED QUALITY AND EFFICIENCY OF, AND
ACCESS TO, HEALTH CARE SERVICES AND PROMOTE IMPROVED CLINICAL  OUTCOMES,
IT  SHALL BE THE POLICY OF THE STATE RELATING TO THE PROGRAMS TO ENCOUR-
AGE COOPERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS BETWEEN  AND
AMONG PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE PROVIDERS WHO MIGHT
OTHERWISE  BE  COMPETITORS,  UNDER THE ACTIVE SUPERVISION OF THE COMMIS-
SIONER. TO THE EXTENT SUCH ARRANGEMENTS MIGHT BE ANTI-COMPETITIVE WITHIN
THE MEANING AND INTENT OF THE FEDERAL ANTITRUST LAWS, THE INTENT OF  THE
STATE  IS TO SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS, AND WITH REGU-
LATION UNDER THIS SECTION TO THE  EXTENT  NECESSARY  TO  ACCOMPLISH  THE
PURPOSES  OF  THIS  SECTION  RELATING TO THE PROGRAMS, AND PROVIDE STATE
ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS WITH  RESPECT
TO THE PLANNING, IMPLEMENTATION AND OPERATION OF THE PROGRAMS AND PAYORS
OF HEALTH CARE SERVICES AND HEALTH CARE PROVIDERS.
  (B)  THE COMMISSIONER OR HIS OR HER DULY AUTHORIZED REPRESENTATIVE MAY
ENGAGE IN APPROPRIATE  STATE  SUPERVISION  NECESSARY  TO  PROMOTE  STATE
ACTION  IMMUNITY  UNDER  THE  STATE  AND FEDERAL ANTITRUST LAWS, AND MAY
INSPECT OR REQUEST ADDITIONAL DOCUMENTATION TO VERIFY THAT  THE  PROGRAM
IS IMPLEMENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
  3.  THE  COMMISSIONER,  FOR  PURPOSES OF THE PROGRAM, IS AUTHORIZED TO
PARTICIPATE IN, ACTIVELY SUPERVISE, FACILITATE  AND  APPROVE  A  PRIMARY
CARE MEDICAL HOME COLLABORATIVE FOR A PROGRAM TO ESTABLISH:
  (A) THE BOUNDARIES OF THE PROGRAM AND THE HEALTH CARE PROVIDERS ELIGI-
BLE  TO  PARTICIPATE; PROVIDED THAT THE BOUNDARIES OF PROGRAMS MAY OVER-
LAP;
  (B) PRACTICE STANDARDS FOR THE MEDICAL HOME ADOPTED WITH CONSIDERATION
OF EXISTING STANDARDS DEVELOPED BY NATIONAL ACCREDITING AND PROFESSIONAL
ORGANIZATIONS INCLUDING, BUT NOT LIMITED TO, THE NATIONAL COMMITTEE  FOR
QUALITY  ASSURANCE  ("NCQA"),  THE  JOINT COMMISSION OF ACCREDITATION OF
HEALTHCARE ORGANIZATIONS ("JCAHCO" OR THE "JOINT COMMISSION"),  AMERICAN
ACCREDITATION HEALTHCARE COMMISSION ("URAC"), AMERICAN COLLEGE OF PHYSI-
CIANS,  THE  AMERICAN ACADEMY OF FAMILY PHYSICIANS, THE AMERICAN ACADEMY
OF PEDIATRICS, AND THE AMERICAN OSTEOPATHIC ASSOCIATION;
  (C) METHODOLOGIES BY WHICH  PAYORS  WILL  PROVIDE  ENHANCED  RATES  OF
PAYMENT TO CERTIFIED MEDICAL HOMES;
  (D)  METHODOLOGIES  TO  PAY  ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT
MEET SPECIFIC PROCESS OR OUTCOME STANDARDS ESTABLISHED  BY  THE  PRIMARY
CARE MEDICAL HOME COLLABORATIVE OF THE PROGRAM;
  (E)  ALTERNATIVE  METHODOLOGIES  FOR PAYORS OF HEALTH CARE SERVICES TO
HEALTH CARE PROVIDERS UNDER THE PROGRAM;
  (F) PROVISIONS FOR PAYMENTS TO PROVIDERS THAT MAY VARY BY SIZE OR FORM
OF ORGANIZATION OF THE PROVIDER, OR  PATIENT  CASE  MIX  TO  ACCOMMODATE
DIFFERENT  LEVELS  OF  RESOURCES AND DIFFICULTY TO MEET THE STANDARDS OF
THE PROGRAM;
  (G) PROVISIONS FOR PAYMENTS TO NOT-FOR-PROFIT  ENTITIES  THAT  PROVIDE
SERVICES TO HEALTH CARE PROVIDERS TO ASSIST THEM IN MEETING MEDICAL HOME
STANDARDS  UNDER  THE  PROGRAM  SUCH AS THE SERVICES OF COMMUNITY HEALTH
WORKERS;
  (H) REQUIREMENTS FOR COLLECTING DATA RELATING  TO  THE  PROVIDING  AND
PAYING  FOR HEALTH CARE SERVICES UNDER THE PROGRAM AND PROVIDING OF DATA

A. 6261                             9

TO THE COMMISSIONER, PAYORS AND HEALTH CARE PROVIDERS UNDER THE PROGRAM,
TO PROMOTE THE  EFFECTIVE  OPERATION  AND  EVALUATION  OF  THE  PROGRAM,
CONSISTENT  WITH PROTECTION OF THE CONFIDENTIALITY OF INDIVIDUAL PATIENT
INFORMATION; AND
  (I) PROVISIONS UNDER WHICH THE COMMISSIONER MAY TERMINATE THE PROGRAM.
  4. PATIENT AND HEALTH CARE PROVIDER PARTICIPATION IN THE PROGRAM SHALL
BE ON A VOLUNTARY BASIS.
  5.  CLINICS AND PRIMARY CARE CLINICIANS PARTICIPATING IN A PROGRAM ARE
NOT ELIGIBLE FOR ADDITIONAL ENHANCEMENTS OR BONUSES UNDER THE  STATEWIDE
MEDICAL  HOME  PROGRAM,  ESTABLISHED  PURSUANT  TO SECTION THREE HUNDRED
SIXTY-FOUR-M OF THE  SOCIAL  SERVICES  LAW,  FOR  SERVICES  PROVIDED  TO
PARTICIPANTS  IN MEDICAID FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY
HEALTH PLUS OR CHILD HEALTH PLUS.
  6. SUBJECT TO  THE  AVAILABILITY  OF  FUNDING  AND  FEDERAL  FINANCIAL
PARTICIPATION, THE COMMISSIONER IS AUTHORIZED:
  (A)  TO  PAY ENHANCED RATES OF PAYMENT UNDER MEDICAID FEE-FOR-SERVICE,
MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS TO CLIN-
ICS AND PRIMARY CARE CLINICIANS THAT  ARE  CERTIFIED  AS  MEDICAL  HOMES
UNDER THIS SECTION;
  (B)  TO  PAY  ADDITIONAL  AMOUNTS FOR MEDICAL HOMES THAT MEET SPECIFIC
PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER, IN CONSULTA-
TION WITH THE PRIMARY CARE MEDICAL HOME COLLABORATIVE  OF  THE  PROGRAM;
AND
  (C)  TO  AUTHORIZE  ALTERNATIVE  PAYMENT  METHODOLOGIES UNDER MEDICAID
FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY  HEALTH  PLUS  AND  CHILD
HEALTH  PLUS  FOR HEALTH CARE PROVIDERS AND TO SERVE THE PURPOSES OF THE
PROGRAM, INCLUDING PAYMENTS TO NOT-FOR-PROFIT ENTITIES  UNDER  PARAGRAPH
(G) OF SUBDIVISION THREE OF THIS SECTION.
  7.  THE  COMMISSIONER MAY DIRECTLY, OR BY CONTRACT WITH NOT-FOR-PROFIT
ORGANIZATIONS, PROVIDE:
  (A) TECHNICAL ASSISTANCE TO A PRIMARY CARE MEDICAL HOME  COLLABORATIVE
IN RELATION TO ESTABLISHING AND OPERATING A PROGRAM;
  (B)  CONSUMER  ASSISTANCE TO PATIENTS PARTICIPATING IN A PROGRAM AS TO
MATTERS RELATING TO THE PROGRAM;
  (C) TECHNICAL AND OTHER ASSISTANCE TO HEALTH  CARE  PROVIDERS  PARTIC-
IPATING  IN  A  PROGRAM AS TO MATTERS RELATING TO THE PROGRAM, INCLUDING
ACHIEVING MEDICAL HOME STANDARDS;
  (D) CARE COORDINATION PROVIDER TECHNICAL AND OTHER ASSISTANCE TO INDI-
VIDUALS AND ENTITIES PROVIDING CARE COORDINATION SERVICES TO HEALTH CARE
PROVIDERS UNDER A PROGRAM; AND
  (E) INFORMATION SHARING AND OTHER ASSISTANCE AMONG PROGRAMS TO IMPROVE
THE OPERATION OF PROGRAMS CONSISTENT WITH APPLICABLE  LAWS  RELATING  TO
PATIENT CONFIDENTIALITY.
  8.  THE COMMISSIONER SHALL, TO THE EXTENT NECESSARY FOR THE PURPOSE OF
THIS SECTION, SUBMIT THE APPROPRIATE  WAIVERS  AND  OTHER  APPLICATIONS,
INCLUDING,  BUT  NOT  LIMITED  TO, THOSE AUTHORIZED PURSUANT TO SECTIONS
ELEVEN HUNDRED FIFTEEN AND  NINETEEN  HUNDRED  FIFTEEN  OF  THE  FEDERAL
SOCIAL  SECURITY  ACT, OR SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS OR
APPLICATIONS NECESSARY TO ACHIEVE THE PURPOSES OF  HIGH  QUALITY,  INTE-
GRATED,  AND  COST  EFFECTIVE  CARE AND INTEGRATED FINANCIAL ELIGIBILITY
POLICIES UNDER MEDICAID, FAMILY HEALTH PLUS AND  CHILD  HEALTH  PLUS  OR
MEDICARE. COPIES OF SUCH ORIGINAL WAIVER AND OTHER APPLICATIONS SHALL BE
PROVIDED  TO THE CHAIRMAN OF THE SENATE FINANCE COMMITTEE AND THE CHAIR-
MAN OF THE ASSEMBLY WAYS AND MEANS COMMITTEE SIMULTANEOUSLY  WITH  THEIR
SUBMISSION TO THE FEDERAL GOVERNMENT.

A. 6261                            10

  9.  THE  ADIRONDACK  MEDICAL  HOME  MULTIPAYOR  DEMONSTRATION  PROGRAM
(INCLUDING THE ADIRONDACK MEDICAL HOME COLLABORATIVE) PREVIOUSLY  ESTAB-
LISHED  UNDER  SECTION TWENTY-NINE HUNDRED FIFTY-NINE OF THIS CHAPTER IS
CONTINUED AND SHALL BE DEEMED TO BE A PROGRAM UNDER THIS SECTION.
  10.  THE  COMMISSIONER  SHALL  ANNUALLY REPORT TO THE GOVERNOR AND THE
LEGISLATURE ON THE OPERATION OF THE PROGRAMS AND THEIR EFFECTIVENESS  IN
ACHIEVING THE PURPOSES OF THIS SECTION, WITH PARTICULAR REFERENCE TO THE
QUALITY,  COST,  AND OUTCOMES FOR ENROLLEES IN MEDICAID FEE-FOR-SERVICE,
MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS.
  11. NO PROGRAM SHALL BE APPROVED UNDER THIS SECTION AFTER APRIL FIRST,
TWO THOUSAND SIXTEEN.
  S 8. Paragraph o of section 21 of part OO of chapter 57 of the laws of
2008 amending the public health law  relating  to  medical  home  demon-
stration programs, is amended to read as follows:
  o. section 2799-S OF THE PUBLIC HEALTH LAW AS ADDED BY SECTION sixteen
of  this  act  shall take effect January 1, 2009 and shall expire and be
deemed repealed 3 years after such effective date; and
  S 9. This act shall take effect immediately; provided however that the
amendments to section 364-j of the social services law made  by  section
three  of this act shall not affect the repeal of such section and shall
be deemed to repeal therewith.