N.Y. Public Health Law 2814 – Health networks, global budgeting, and health care demonstrations
* § 2814. Health networks, global budgeting, and health care demonstrations. 1. For the purposes of this section unless the context clearly requires otherwise:
Terms Used In N.Y. Public Health Law 2814
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- General hospital: means a hospital engaged in providing medical or medical and surgical services primarily to in-patients by or under the supervision of a physician on a twenty-four hour basis with provisions for admission or treatment of persons in need of emergency care and with an organized medical staff and nursing service, including facilities providing services relating to particular diseases, injuries, conditions or deformities. See N.Y. Public Health Law 2801
- Health system: means a group of one or more hospitals and providers affiliated through ownership, governance, membership or other means. See N.Y. Public Health Law 2801
- Hospital: means a facility or institution engaged principally in providing services by or under the supervision of a physician or, in the case of a dental clinic or dental dispensary, of a dentist, or, in the case of a midwifery birth center, of a midwife, for the prevention, diagnosis or treatment of human disease, pain, injury, deformity or physical condition, including, but not limited to, a general hospital, public health center, diagnostic center, treatment center, a rural emergency hospital under 42 USC 1395x(kkk), or successor provisions, dental clinic, dental dispensary, rehabilitation center other than a facility used solely for vocational rehabilitation, nursing home, tuberculosis hospital, chronic disease hospital, maternity hospital, midwifery birth center, lying-in-asylum, out-patient department, out-patient lodge, dispensary and a laboratory or central service facility serving one or more such institutions, but the term hospital shall not include an institution, sanitarium or other facility engaged principally in providing services for the prevention, diagnosis or treatment of mental disability and which is subject to the powers of visitation, examination, inspection and investigation of the department of mental hygiene except for those distinct parts of such a facility which provide hospital service. See N.Y. Public Health Law 2801
- Provider: means an individual or entity, whether for profit or nonprofit, whose primary purpose is to provide professional health care services. See N.Y. Public Health Law 2801
(a) "Board" shall mean the temporary statewide health advisory board established pursuant to § 957 of the executive law.
(b) "Proposal" shall mean a design or plan developed, as a result of funds received pursuant to this section, to operate a network, global budget, or regional health care demonstration.
2. (a) Notwithstanding any inconsistent provision of law, within amounts available therefor, the commissioner shall make grants pursuant to this section to (i) health care providers to facilitate development of health networks or health care demonstrations (ii) health care providers alone or in conjunction with third party payors to facilitate development of global budgets and (iii) an organization demonstrably representing the interests of the region or communities of the region which demonstrate the support of the respective health systems agency to facilitate development of health care demonstrations or global budgets. Such networks, demonstrations, or global budgets shall be designed to improve cost effectiveness of health care services, establish and improve provider coordinated planning and management mechanisms, and/or improve provider management of care or improve continuity of care. Health care providers eligible to receive funding under section twenty-nine hundred fifty-two of this chapter shall not be eligible for grants under this section for development of health networks.
(b) Grants made pursuant to this section shall provide planning funds which may include, but need not be limited to, funding to:
(i) assess the health care needs of the population and develop an operational plan to meet these needs;
(ii) plan for and carry out any organizational changes needed to integrate services; and
(iii) facilitate financing arrangements such as risk sharing and capitation.
3. In awarding grants under this section, the commissioner shall consult with the appropriate local health systems agency and shall consider the recommendations of the temporary statewide health advisory board on the grant proposals and to the extent practicable assure that there is a sufficiently representative geographic distribution of grantees including rural, urban, and suburban grantees. Grants made pursuant to this section shall be used solely for the planning of health networks, global budgets or health care demonstrations. Prior to awarding grants, the commissioner shall first take into consideration other financial resources available to the applicant to conduct such planning.
4. In order to be eligible for a grant under this section, applicants shall prepare and submit to the commissioner, the temporary statewide health care advisory board, and the respective health systems agency an application which contains the following:
(a) identification of the principal investigator or applicant for the demonstration;
(b) a description of the nature and scope of the activities contemplated;
(c) a description of the geographic area and populations currently served by the entity;
(d) a description of the community or population to be served;
(e) a description of the anticipated benefits and advantages to providers and consumers of services;
(f) a description of the estimated expenses, including administrative expenses, which will be incurred in the development of the demonstration; and
(g) the time frame proposed for the development of the health network, global budgeting demonstration, or health care demonstration.
(h) the process that the eligible organization used in seeking public participation and local involvement in the development of the program plan; and
(i) the goals of the program, including information on how the program plan will maintain and promote access to and delivery of high quality, appropriate health or health related items and services for persons residing in the region covered by the program.
5. Any grant recipient seeking to implement a proposal developed pursuant to this section, except recipients of health networking grants, shall submit such proposal to the temporary statewide health advisory board, in such form and content determined by the board, which shall evaluate such proposal and consider whether the proposal is likely to:
(a) aid in meeting the priority health needs and concerns in the region as identified in and supported by evidence in the proposal and consistent with recommendations of the regional health systems agency;
(b) enhance the quality of care as evidenced by outcome indicators;
(c) improve the cost-effectiveness of services by the entities involved;
(d) improve the efficient utilization of the entities' resources and capital equipment;
(e) enhance the provision of services that would otherwise not be available;
(f) result in the elimination of unnecessary duplication of resources;
(g) reduce costs to individuals being served by the network;
(h) foster information sharing, communications and cooperation between health care providers; and
(i) foster and improve the management and continuity of care.
6. In addition, the board shall require that the proposal contain assurances that there will be equitable provider involvement in the determination of any rates and rate setting methodology. The board shall also require a description of how the proposed initiative will be evaluated and assurance that the grantee will submit annual reports to the governor and legislature concerning the status and experiences of the initiative.
7. The temporary statewide health advisory board shall forward only proposals recommended for operation to the commissioner for authorization. In granting his authorization, the commissioner shall certify that the proposal will:
(a) improve the cost effectiveness of health care services;
(b) improve the quality of care delivered as evidenced by outcome indicators; and
(c) improve access to appropriate health care services.
8. Upon request by an applicant or grantee the commissioner and the respective health system agency shall provide technical assistance.
9. The commissioner shall submit to the chairs of the senate finance committee and the assembly ways and means committee and the chairs of the assembly and senate health committees, a copy of any proposal authorized by the commissioner pursuant to this section not more than thirty days after approval.
10. With the exception of health networks, global budgets or health care demonstrations that seek to implement alternative reimbursement methodologies in general hospital settings only and/or for ambulatory services associated with general hospital outpatient and diagnostic and treatment center settings regarding payment for the medical assistance program, as provided for in subdivisions ten and eleven of section twenty-eight hundred seven of this article, no health network, global budget or health care demonstration that seeks to implement alternative reimbursement methodologies shall be approved or implemented without approval pursuant to a chapter of the laws to be enacted by the legislature.
* NB Expired June 30, 1996