Section 2999-E. Demonstration projects

1.   Notwithstanding   any
  inconsistent  regulation  of  the  department,   the   commissioner   is
  authorized and shall select up to five demonstration projects throughout
  the  state,  pursuant  to  a  competitive  bid  or  request for proposal
  process, which have been determined by the commissioner to encompass one
  or more of the following elements:
    (a) use of the workgroup metrics  to  measure  and  reward  physician,
  clinic and hospital performance;
    (b)  involvement  of  multiple  payers, including government programs,
  multiple providers and  multiple  communities  voluntarily  agreeing  to
  employ  the  workgroup  metrics to reward physician, clinic and hospital
  performance for quality improvement;
    (c) use of information technology to share patient  information  among
  providers to improve coordination of patient care;
    (d)   targeted   improvement   in   care   coordination   through  the
  participation of multiple stakeholders;
    (e) collection, analysis and public  reporting  on  the  risk-adjusted
  measures, incentives and processes utilized, and outcomes; and
    (f)  programs  to enhance patient self-management through adherence to
  treatment plans.
    2. In evaluating proposed  demonstration  projects,  the  commissioner
  shall  consider  the  degree  to  which  a proposed project reflects the
  elements listed above including demonstrated commitments on the part  of
  all practitioners, providers and payors to participate.
    3.  (a)  There shall be no more than five demonstration projects under
  this title.
    (b) Where any demonstration project involves recipients  of  Medicaid,
  family  health  plus,  or  child health plus, those recipients shall not
  constitute more than half the individuals covered by  the  demonstration
  project  and  their  health  care,  measured  in  the  amount  of annual
  reimbursement, shall not cover more than half of the health care covered
  by the demonstration project.
    (c) No demonstration  project  shall  limit  the  scope  or  terms  of
  coverage  or  limit  the  grounds  or  procedural rights for appealing a
  denial of reimbursement for a health care  service,  for  any  consumer,
  enrollee, or recipient subject to the demonstration project.
    * NB Expires April 1, 2011