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This entry was published on 2014-09-22
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SECTION 2999-O
Definitions
Public Health (PBH) CHAPTER 45, ARTICLE 29-E
§ 2999-o. Definitions. As used in this article, the following terms
shall have the following meanings, unless the context clearly requires
otherwise:

1. "Accountable care organization" or "ACO" means an organization of
clinically integrated health care providers certified by the
commissioner under this article.

2. "ACO participant" or "participant" means a health care provider
that is one of the health care providers that comprise the ACO.

3. Certificate of authority" or "certificate" means a certificate of
authority issued by the commissioner under this article.

4. "CMS" means the federal centers for Medicare and Medicaid services.

5. "CMS regulations" means applicable federal laws and CMS regulations
and policies.

6. "Health care provider" includes but is not limited to 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; and may
also include, to the extent provided by regulation of the commissioner,
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.

7. "Medicare-only ACO" means an ACO issued a certificate of authority
under subdivision four of section twenty-nine hundred ninety-nine-p of
this article.

8. "Primary care" means the health care fields of family practice,
general pediatrics, primary care internal medicine, primary care
obstetrics, or primary care gynecology, without regard to board
certification, provided by a health care provider acting within his,
her, or its lawful scope of practice.

9. "Third-party health care payer" has its ordinary meanings and may
include any entities provided for by regulation of the commissioner,
which may include 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.