S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9901
 
                           I N  A S S E M B L Y
 
                              April 26, 2024
                                ___________
 
 Introduced by M. of A. KELLES -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend  the public health law, in relation to establishing a
   pilot program in New York state for the establishment and operation of
   certain rural health zones
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Legislative  findings. The legislature finds that collab-
 oration and innovation are needed to address significant gaps in health-
 care in rural areas of the state.  To  provide  rural  populations  with
 better  access  to  healthcare, the Rural Health Zone Pilot Program will
 work to improve the health of the targeted zone populations to standards
 consistent with quality, high levels  of  access  to  care  and  patient
 outcomes  that  reflect  a  patient-centric approach to physical, behav-
 ioral, and social well-being. A review of  current  practices  in  rural
 communities  is  required  to  identify  areas  for improvement to local
 health planning and infrastructure investment to improve access to  care
 and  clinical  outcomes.  This  healthcare  review, coupled with capital
 resources, programmatic support, and economic incentives, will create  a
 healthier  population,  revitalize  the  workforce,  and  create greater
 opportunities for economic development  within  our  rural  communities.
 Ultimately,  the Rural Health Zone Pilot Program will establish an inno-
 vative organizational replacement for a rural health care model that  is
 no longer viable.
   §  2. Article 29-A of the public health law is amended by adding a new
 title 1-B to read as follows:
                                 TITLE 1-B
                      RURAL HEALTH ZONE PILOT PROGRAM
   SECTION 2958-B. RURAL HEALTH ZONE PILOT PROGRAM.
   § 2958-B. RURAL HEALTH ZONE PILOT PROGRAM. 1. THE COMMISSIONER  SHALL,
 WITHIN  MONIES  APPROPRIATED  THEREFORE,  ESTABLISH  A RURAL HEALTH ZONE
 PILOT PROGRAM. THE COMMISSIONER SHALL ESTABLISH PILOT RURAL HEALTH ZONES
 IN:
   (A) ORANGE, SULLIVAN, AND ULSTER COUNTIES;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14489-01-4
 A. 9901                             2
 
   (B) ORLEANS, GENESEE AND WYOMING  COUNTIES  AND  CONTIGUOUS  AREAS  OF
 EASTERN ERIE AND NIAGARA AND WESTERN MONROE COUNTIES;
   (C) CORTLAND AND TOMPKINS COUNTIES; AND
   (D)  A  ZONE TO BE DETERMINED BY THE GOVERNOR, THE TEMPORARY PRESIDENT
 OF THE SENATE, AND THE SPEAKER OF THE ASSEMBLY NO LATER THAN THIRTY DAYS
 AFTER THE EFFECTIVE DATE OF THIS ACT.
   2. (A) THE COMMISSIONER SHALL ESTABLISH IN  EACH  PILOT  RURAL  HEALTH
 ZONE  A  RURAL  HEALTH  ZONE  BOARD. THE POWERS AND DUTIES OF EACH PILOT
 RURAL HEALTH ZONE SHALL BE VESTED IN AND EXERCISED BY RURAL HEALTH  ZONE
 BOARDS ESTABLISHED FOR EACH ZONE CONSISTENT WITH THIS TITLE.
   (B)  EACH RURAL HEALTH ZONE BOARD SHALL BE COMPRISED OF AT LEAST EIGHT
 MEMBERS, WHICH SHALL CONSIST OF:
   (I) THE PUBLIC HEALTH COMMISSIONER FROM EACH COUNTY  IN  THE  ZONE  OR
 SUCH OTHER PERSON APPOINTED BY THE LOCAL COUNTY EXECUTIVE;
   (II)  ONE  REPRESENTATIVE  OF  THE  DEPARTMENT,  AS  DESIGNATED BY THE
 COMMISSIONER;
   (III) TWO MEMBERS APPOINTED BY THE GOVERNOR; ONE MEMBER  APPOINTED  BY
 THE  TEMPORARY  PRESIDENT  OF  THE  SENATE;  ONE MEMBER APPOINTED BY THE
 SPEAKER OF THE ASSEMBLY; ONE MEMBER APPOINTED BY THE MINORITY LEADER  OF
 THE  SENATE;  AND  ONE  MEMBER  APPOINTED  BY THE MINORITY LEADER OF THE
 ASSEMBLY. EACH BOARD MEMBER APPOINTED BY  THE  GOVERNOR,  THE  TEMPORARY
 PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEAD-
 ER  OF THE SENATE AND MINORITY LEADER OF THE ASSEMBLY SHALL BE REPRESEN-
 TATIVE OF BUSINESS, HEALTH SYSTEMS DELIVERY, HEALTH  CARE  FINANCING  OR
 THE PUBLIC.
   3.  ALL  APPOINTEES  OF  EACH RURAL HEALTH ZONE BOARD SHALL BE MADE NO
 LATER THAN SIXTY DAYS AFTER THE EFFECTIVE DATE OF THIS TITLE. EACH BOARD
 SHALL MEET AS FREQUENTLY AS DEEMED NECESSARY BUT AT LEAST FOUR TIMES  IN
 EACH  CALENDAR  YEAR.  MEMBERS  OF EACH BOARD SHALL DESIGNATE ONE OF ITS
 MEMBERS AS ITS CHAIR. EACH BOARD SHALL ENACT AND FROM TIME TO  TIME  MAY
 AMEND  BY-LAWS  IN  RELATION TO ITS MEETINGS AND THE TRANSACTIONS OF ITS
 BUSINESS.  EACH APPOINTMENT SHALL BE MADE FOR THE DURATION OF THE  PILOT
 PROGRAM.  ANY VACANCY SHALL BE FILLED BY THE APPOINTING AUTHORITY WITHIN
 SIXTY  DAYS. THE MEMBERS OF EACH BOARD SHALL SERVE WITHOUT COMPENSATION,
 EXCEPT THAT MEMBERS SHALL BE ALLOWED THEIR NECESSARY AND ACTUAL EXPENSES
 INCURRED IN THE PERFORMANCE OF THEIR  DUTIES  UNDER  THIS  SECTION.  THE
 DEPARTMENT  OF HEALTH AND THE EMPIRE STATE DEVELOPMENT CORPORATION SHALL
 PROVIDE EACH BOARD WITH SUCH FACILITIES, ASSISTANCE, AND  DATA  AS  WILL
 ENABLE EACH BOARD TO CARRY OUT ITS POWERS AND DUTIES WITHIN REASON. EACH
 BOARD  SHALL  HAVE  THE  POWER  TO  RETAIN LEGAL COUNSEL AND CONSULTANTS
 DEEMED NECESSARY BY EACH BOARD TO CARRY OUT ITS POWERS AND  DUTIES.  THE
 MEMBERS  OF  EACH  BOARD  SHALL  RECUSE  THEMSELVES FROM DISCUSSIONS AND
 ACTIONS WHERE A CONFLICT OF INTEREST MAY EXIST  AND  SHALL  NOT  RECEIVE
 CONFIDENTIAL  INFORMATION, DATA OR MATERIAL RELATED TO AN ENTITY WHERE A
 CONFLICT OF INTEREST MAY EXIST. EACH BOARD WILL HAVE  THE  AUTHORITY  TO
 DETERMINE THE GEOGRAPHIC SCOPE OF THE ZONE CONSISTENT WITH THE AUTHORIZ-
 ING STATUTE AND SUBJECT TO REVIEW AND CONFIRMATION BY THE COMMISSIONER.
   4. EACH RURAL HEALTH ZONE BOARD SHALL REVIEW CURRENT COMMUNITY HEALTH-
 CARE  NEEDS, INFRASTRUCTURE, AND BARRIERS TO CARE WITHIN THE PILOT RURAL
 HEALTH ZONE AND DEVELOP A RURAL  HEALTH  ZONE  TRANSFORMATION  PLAN.  IN
 CONNECTION  WITH THE DEVELOPMENT OF THE RURAL HEALTH ZONE TRANSFORMATION
 PLAN, EACH HOSPITAL, RURAL HEALTH CLINIC AND FEDERALLY QUALIFIED  HEALTH
 CENTER  WITHIN  THE  ZONE,  AND OTHER SAFETY NET PROVIDERS, MANAGED CARE
 ORGANIZATIONS AND HEALTHCARE SERVICES PROVIDERS AS  IDENTIFIED  BY  EACH
 BOARD, SHALL SUBMIT A PROPOSED RURAL HEALTH TRANSFORMATION PLAN FOR SUCH
 FACILITY  OR  CLINIC  THAT  THE  ORGANIZATION PROPOSES TO IMPLEMENT UPON
 A. 9901                             3
 
 APPROVAL BY THE BOARD AND RECEIPT OF NECESSARY FUNDING. EACH BOARD SHALL
 HOLD AT LEAST ONE PUBLIC HEARING WITH A PUBLIC COMMENT PERIOD IN EACH OF
 THE COUNTIES COMPRISING THE ZONE ON ITS RURAL HEALTH ZONE TRANSFORMATION
 PLAN UPON AT LEAST THIRTY DAYS NOTICE TO THE PUBLIC.
   5.  (A)  THE COMMISSIONER SHALL ESTABLISH A RURAL HEALTH ZONE FUND FOR
 EACH ZONE FOR THE PURPOSES OF ASSISTING THE BOARD IN  CARRYING  OUT  ITS
 POWERS AND DUTIES UNDER THIS TITLE. THE COMMISSIONER SHALL, ON AN ANNUAL
 BASIS,  SPECIFY FUNDS FOR EACH ZONE TO THE RESPECTIVE FUND, AND SHALL BE
 ADMINISTERED AND DISBURSED IN ACCORDANCE WITH THIS TITLE.
   (B) CONSISTENT WITH BUDGETED  APPROPRIATIONS  TO  EACH  FUND  AND  THE
 PROVISIONS OF THIS TITLE, EACH BOARD SHALL HAVE FULL AUTHORITY TO ESTAB-
 LISH,  EVALUATE AND AWARD GRANTS, CONTRACTS, LOANS, INCLUDING FORGIVABLE
 LOANS, AND PROVIDE STATE INCOME AND OTHER TAX CREDITS AND ABATEMENTS FOR
 PERSONS AND ENTITIES THAT ARE PROVIDING OR SUPPORTING  THE  DELIVERY  OF
 HEALTH CARE SERVICES AND RELATED INFRASTRUCTURE IN EACH ZONE.  EACH ZONE
 MAY  AWARD  ECONOMIC  BENEFITS  TO QUALIFIED PERSONS OR ENTITIES WHO ARE
 PROVIDING OR SUPPORTING THE PROVISION OF HEALTHCARE SERVICES TO INDIVID-
 UALS WHO WORK OR RESIDE IN THE ZONE SUCH ECONOMIC BENEFITS AS  DESCRIBED
 IN ARTICLE 18-B OF THE GENERAL MUNICIPAL LAW OR REFERRED BY SECTION NINE
 HUNDRED  SIXTY-SIX  OF  THE GENERAL MUNICIPAL LAW. EACH ZONE MAY PROVIDE
 GRANTS, CONTRACTS OR OTHER BUDGETARY SUPPORT  TO  HOSPITALS  AND  HEALTH
 SYSTEMS  THAT  ARE PRIMARILY LOCATED OUTSIDE THE ZONE BUT THAT AFFILIATE
 WITH, PROVIDE SERVICE TO, OR HAVE HOSPITAL OR CLINIC SITES IN THE ZONE.
   6. IN ADDITION TO THE OBLIGATION AND AUTHORITY OF EACH BOARD TO ESTAB-
 LISH AND IMPLEMENT A RURAL HEALTH ZONE TRANSFORMATION  PLAN,  EACH  ZONE
 SHALL  EVALUATE  THE  POTENTIAL FOR ESTABLISHING A GLOBAL MEDICAL BUDGET
 FOR THE SAFETY NET PROVIDERS, INCLUDING HOSPITALS, RURAL HEALTH  CLINICS
 AND  FEDERALLY  QUALIFIED HEALTH CENTERS. THE GLOBAL MEDICAL BUDGETS MAY
 INCLUDE  VOLUNTARY  PARTICIPATION  OF  PRIVATE  THIRD-PARTY  PAYORS  FOR
 PROPORTIONAL  FUNDING OF SUCH BUDGETS BASED ON THEIR RELATIVE ENROLLMENT
 IN SUCH ZONE. IN THE EVENT THAT A BOARD DETERMINES THAT A GLOBAL MEDICAL
 BUDGET IS NOT WARRANTED OR RECOMMENDED FOR  SAFETY  NET  PROVIDERS,  THE
 BOARD  SHALL  EVALUATE  AND  IDENTIFY  ANY ALTERNATIVE THIRD-PARTY PAYOR
 REIMBURSEMENT MODELS OR CHANGES THAT MAY BE WARRANTED TO ACHIEVE A  MORE
 STABLE AND SUSTAINABLE FORM AND AMOUNT OF COMPENSATION TO THE SAFETY NET
 PROVIDERS  FOR  THEIR  SERVICES TO THE ZONE POPULATION. EACH BOARD SHALL
 PROVIDE THEIR REVIEW AND RECOMMENDATIONS TO THE COMMISSIONER WITHIN  TWO
 YEARS  OF THE ESTABLISHMENT OF THE BOARD. IN MAKING ITS RECOMMENDATIONS,
 EACH ZONE SHALL SEEK CONSULTATION  AND  COMMENT  FROM  ZONE  SAFETY  NET
 PROVIDERS AND PRIVATE THIRD-PARTY PAYORS WHO PROVIDE COVERAGE TO EMPLOY-
 ERS  AND  INDIVIDUALS THAT ARE LOCATED IN THE ZONE. A COPY OF THE RECOM-
 MENDATIONS OF EACH BOARD REQUIRED BY THIS SECTION SHALL ALSO BE PROVIDED
 TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE  SPEAKER  OF
 THE  ASSEMBLY, THE CHAIR OF THE SENATE STANDING COMMITTEE ON HEALTH, THE
 CHAIR OF THE ASSEMBLY HEALTH COMMITTEE AND THE CHAIR OF THE  LEGISLATIVE
 COMMISSION  ON  THE  DEVELOPMENT  OF RURAL RESOURCES. EACH BOARD AND THE
 DEPARTMENT SHALL NOT HAVE AUTHORITY TO ADOPT  OR  IMPLEMENT  ANY  GLOBAL
 HEALTH  BUDGETS FOR ANY SAFETY NET PROVIDERS ABSENT ENACTMENT OF FURTHER
 LEGISLATION.
   7. EACH BOARD WILL CONSULT WITH, AND PROVIDE RECOMMENDATIONS  TO,  THE
 COMMISSIONER AND THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL REGARDING
 NECESSARY  CHANGES  TO STATE REGULATORY CODES OR ESTABLISHMENT STANDARDS
 FOR ENTITIES THAT ARE PROVIDING SERVICES IN THE RURAL HEALTH  ZONES  AND
 IDENTIFY  RECOMMENDED  STATE  LEGISLATIVE  CHANGES.  THE COMMISSIONER IS
 AUTHORIZED TO WAIVE, MODIFY OR SUSPEND THE PROVISIONS OF RULES AND REGU-
 LATIONS PROMULGATED PURSUANT TO THIS CHAPTER IF THE COMMISSIONER  DETER-
 A. 9901                             4
 
 MINES  THAT SUCH WAIVER, MODIFICATION OR SUSPENSION IS NECESSARY FOR THE
 SUCCESSFUL IMPLEMENTING OF THE PILOT PROGRAM AUTHORIZED PURSUANT TO THIS
 TITLE AND PROVIDED THAT THE COMMISSIONER  DETERMINES  THAT  THE  HEALTH,
 SAFETY  AND  GENERAL  WELFARE OF PEOPLE RECEIVING HEALTH CARE UNDER SUCH
 RURAL DENTISTRY PILOT PROGRAM WILL NOT BE IMPAIRED AS A RESULT  OF  SUCH
 WAIVER, MODIFICATION, OR SUSPENSION.
   8.  THE COMMISSIONER SHALL APPLY FOR FUNDING AND TECHNICAL SUPPORT FOR
 THE PROJECT FROM THE CENTERS FOR MEDICARE AND MEDICAID  SERVICES  OFFICE
 OF  INNOVATIONS IN ACCORDANCE WITH SECTION 1115-A OF THE SOCIAL SECURITY
 ACT, 42 U.S.C. 1315-A. THE COMMISSIONER AND EACH BOARD  SHALL  EVALUATE,
 IN  CONNECTION  WITH  SUCH APPLICATION, ANY POTENTIAL CHANGES TO ITS NEW
 YORK STATE MEDICAID PLAN AND DEMONSTRATION PROJECT AND WAIVER THAT WOULD
 APPLY IN THE ZONES DURING THE PERIOD OF THE PILOT PROGRAM.
   9. WITHIN SIX MONTHS FROM  THE  EFFECTIVE  DATE  OF  THIS  TITLE,  THE
 COMMISSIONER,  IN  CONSULTATION WITH EACH BOARD, SHALL ESTABLISH UNIFORM
 DATA MEASUREMENT AND REPORTING TOOL FOR THE ZONES TO REVIEW AND EVALUATE
 PROGRESS DURING THE PILOT PROGRAM, INCLUDING RELEVANT  COSTS,  COMMUNITY
 HEALTH OUTCOMES AND SOCIAL DETERMINATES OF HEALTH, AND SHALL INCORPORATE
 POPULATION  HEALTH  DATA THAT IS CURRENTLY BEING TRACKED AND REPORTED BY
 THE STATE AT THE COUNTY AND REGIONAL LEVEL. NO LATER THAN TWELVE  MONTHS
 AFTER  THE  APPROVAL OF THE PILOT PROGRAM, AND ANNUALLY THEREAFTER, IN A
 FORM THAT CONFORMS TO THE DATA MEASUREMENT AND REPORTING SYSTEM  CREATED
 BY  THE COMMISSIONER, EACH BOARD SHALL REPORT TO THE COMMISSIONER ON THE
 PROGRESS OF THE PROGRAM. SUCH REPORTS SHALL BE  PUBLICLY  AVAILABLE  AND
 SHALL  BE  PROVIDED  TO  THE  GOVERNOR,  THE  TEMPORARY PRESIDENT OF THE
 SENATE, THE SPEAKER OF THE ASSEMBLY, THE CHAIR OF  THE  SENATE  STANDING
 COMMITTEE  ON HEALTH, THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE AND THE
 CHAIR  OF  THE  LEGISLATIVE  COMMISSION  ON  THE  DEVELOPMENT  OF  RURAL
 RESOURCES.  THE  COSTS  FOR THE REPORTING REQUIREMENTS SET FORTH IN THIS
 SECTION SHALL BE ALLOCATED FROM THE DEPARTMENT'S GENERAL OPERATING BUDG-
 ET.
   10. EACH ZONE MAY COLLABORATE AND COORDINATE THEIR PLANNING AND ACTIV-
 ITIES WITH OTHER ZONES TO PROMOTE EFFICIENCY, SHARE BEST  PRACTICES  AND
 AVOID UNNECESSARY DUPLICATION OF EFFORTS OR RESOURCES.
   11.  THE RURAL HEALTH ZONE PILOT PROGRAM SHALL HAVE A DURATION OF FIVE
 YEARS FROM THE DATE OF THE FIRST ADOPTION OF A RURAL HEALTH ZONE  TRANS-
 FORMATION  PLAN  BY  EACH  BOARD. THE PILOT PROGRAM MAY BE EXTENDED FROM
 TIME TO TIME BY FURTHER LEGISLATION OR BY THE COMMISSIONER  AS  REQUIRED
 TO  MEET  THE  REQUIREMENTS FOR ANY STATE INNOVATION GRANT RECEIVED FROM
 CENTERS FOR MEDICARE AND MEDICAID SERVICES RELATED TO THE PILOT PROGRAM.
   12. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, FOR GRANTS,  CONTRACTS
 AND  ALLOCATIONS THAT ARE SET FORTH AND CONSISTENT WITH THE PLAN ADOPTED
 BY THE ADMINISTRATIVE BOARD, EACH ZONE WILL NOT BE SUBJECT  TO  PROCURE-
 MENT, GRANT AWARD OR COMPETITIVE BIDDING REQUIREMENTS.
   13.  THE  ACTIVITIES OF THE ZONES, EACH BOARD AND HEALTHCARE PROVIDERS
 AND PARTICIPANTS IN FURTHERANCE OF THE RURAL HEALTH  ZONE  PLANNING  AND
 IMPLEMENTATION AND OTHER EFFORTS DESCRIBED IN THIS TITLE SHALL BE EXEMPT
 FROM  THE  PROVISIONS AND PENALTIES OF ARTICLE TWENTY-TWO OF THE GENERAL
 BUSINESS LAW RESPECTING ARRANGEMENTS  AND  AGREEMENTS  IN  RESTRAINT  OF
 TRADE. TO THE GREATEST EXTENT POSSIBLE, SUCH ACTIVITIES SHALL BE SUBJECT
 TO  THE  OVERSIGHT OF EACH BOARD, THE COMMISSIONER AND THE PUBLIC HEALTH
 AND PLANNING COUNCIL TO PROVIDE STATE ACTION IMMUNITY  UNDER  STATE  AND
 FEDERAL ANTITRUST LAW.
   § 3. This act shall take effect immediately.