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This entry was published on 2020-04-17
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SECTION 2999-P
Establishment of ACOs
Public Health (PBH) CHAPTER 45, ARTICLE 29-E
§ 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-four.

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.