Section 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  the

  National  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