2959 - Adirondack medical home multipayor demonstration program.
* § 2959. Adirondack medical home multipayor demonstration program. 1. The commissioner is authorized to establish an Adirondack medical home multipayor demonstration program and may certify certain clinicians and clinics in the upper northeastern region of New York as medical homes eligible for enhanced payments for services provided to: recipients eligible for medical assistance pursuant to title eleven of article five of the social services law ("Medicaid fee-for-service"); enrollees eligible for medical assistance pursuant to such title and enrolled in approved managed care organizations pursuant to section three hundred sixty-four-j of such title ("Medicaid managed care"); enrollees eligible for Family Health Plus and enrolled in approved organizations pursuant to title eleven-D of article five of the social services law ("Family Health Plus"); enrollees eligible for the child health insurance program and enrolled in approved organizations pursuant to title one-A of article twenty-five of this chapter ("Child Health Plus Program"); enrollees and subscribers of commercial managed care plans operating in accordance with the provisions of article forty-four of this chapter or by health maintenance organizations organized and operating in accordance with 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 this demonstration program is to improve health care outcomes and efficiency through patient care continuity and coordination of health services. 2. (a) In order to promote improved quality of, and access to, health care services and promote improved clinical outcomes to the residents in the upper northeastern region of New York, it shall be the policy of the state relating to the demonstration program to encourage cooperative, collaborative and integrative arrangements between payors of health care services and health care services providers who might otherwise be 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 antitrust laws, the intent of the state is to supplant competition with such arrangement to the extent necessary to accomplish the purposes of this article relating to the demonstration program, and provide state action immunity under the state and federal antitrust laws with respect to the planning, implementation and operation of the Adirondack medical home multipayor demonstration program and payors of medical services and health care services providers. (b) The commissioner or his or her duly authorized representative may also 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 demonstration is implemented in accordance with its intent and purpose. 3. The commissioner, for purpose of the demonstration program, is authorized to participate in, actively supervise, facilitate and approve a primary care medical home collaborative with health care services providers, which may include hospitals, diagnostic and treatment centers, and private practices, and payors of health care services, including employers, health plans and insurers, to establish: (a) the boundaries of the demonstration and the providers eligible to participate; (b) practice standards for the medical home consistent with existing standards developed by national accrediting and professional organizations including the joint principles of the American College of Physicians ("ACP"), the American Academy of Family Physicians ("AAFP"), the American Academy of Pediatrics ("AAP"), the American Osteopathic Association ("AOA"), and as further defined by "Patient Centered Medical Home," as represented in certification programs developed by theNational Committee for Quality Assurance ("NCQA"); (c) methodologies by which payors will provide enhanced rates of payment to certified medical homes; and (d) methodologies to pay additional amounts for medical homes that meet specific process or outcome standards established by the Adirondack medical home collaborative. 4. Patient and health care services provider participation in the Adirondack medical home multipayor demonstration program shall be on a voluntary basis. 5. Clinics and clinicians participating in this demonstration 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 clinics and clinicians that are certified as medical homes under this title; and (b) To pay additional amounts for medical homes that meet specific process or outcome standards specified by the commissioner, in consultation with the Adirondack medical home collaborative. * NB Repealed April 1, 2014