§ 2807-M — Distribution of the professional education pools

§ 2807-m. Distribution of the professional education pools. 1.\nDefinitions. For purposes of this section, the following definitions\nshall apply, unless the context clearly requires otherwise:\n (a) "Clinical research" means patient-oriented research, epidemiologic\nand behavioral studies, or outcomes research and health services\nresearch that is approved by an institutional review board by the time\nthe clinical research position is filled.\n (b) "Clinical research plan" means a plan submitted by a consortium or\nteaching general hospital for a clinical research position which\ndemonstrates, in a form to be provided by the commissioner, the\nfollowing:\n (i) financial support for overhead, supervision, equipment and other\nresources equal to the amount of funding provided pursuant to\nsubparagraph (i) of paragraph (b) of subdivision five-a of this section\nby the teaching general hospital or consortium for the clinical research\nposition;\n (ii) experience the sponsor-mentor and teaching general hospital has\nin clinical research and the medical field of the study;\n (iii) methods, data collection and anticipated measurable outcomes of\nthe clinical research to be performed;\n (iv) training goals, objectives and experience the researcher will be\nprovided to assess a future career in clinical research;\n (v) scientific relevance, merit and health implications of the\nresearch to be performed;\n (vi) information on potential scientific meetings and peer review\njournals where research results can be disseminated;\n (vii) clear and comprehensive details on the clinical research\nposition;\n (viii) qualifications necessary for the clinical research position and\nstrategy for recruitment;\n (ix) non-duplication with other clinical research positions from the\nsame teaching general hospital or consortium;\n (x) methods to track the career of the clinical researcher once the\nterm of the position is complete; and\n (xi) any other information required by the commissioner to implement\nsubparagraph (i) of paragraph (b) of subdivision five-a of this section.\n (xii) The clinical review plan submitted in accordance with this\nparagraph may be reviewed by the commissioner in consultation with\nexperts outside the department of health.\n (c) "Clinical research position" means a post-graduate residency\nposition which:\n (i) shall not be required in order for the researcher to complete a\ngraduate medical education program;\n (ii) may be reimbursed by other sources but only for costs in excess\nof the funding distributed in accordance with subparagraph (i) of\nparagraph (b) of subdivision five-a of this section;\n (iii) shall exceed the minimum standards that are required by the\nresidency review committee in the specialty the researcher has trained\nor is currently training;\n (iv) shall not be previously funded by the teaching general hospital\nor supported by another funding source at the teaching general hospital\nin the past three years from the date the clinical research plan is\nsubmitted to the commissioner;\n (v) may supplement an existing research project;\n (vi) shall be equivalent to a full-time position comprising of no less\nthan thirty-five hours per week for one or two years;\n (vii) shall provide, or be filled by a researcher who has formalized\ninstruction in clinical research, including biostatistics, clinical\ntrial design, grant writing and research ethics;\n (viii) shall be supervised by a sponsor-mentor who shall either (A) be\nemployed, contracted for employment or paid through an affiliated\nfaculty practice plan by a teaching general hospital which has received\nat least one research grant from the National Institutes of Health in\nthe past five years from the date the clinical research plan is\nsubmitted to the commissioner; (B) maintain a faculty appointment at a\nmedical, dental or podiatric school located in New York state that has\nreceived at least one research grant from the National Institutes of\nHealth in the past five years from the date the clinical research plan\nis submitted to the commissioner; or (C) be collaborating in the\nclinical research plan with a researcher from another institution that\nhas received at least one research grant from the National Institutes of\nHealth in the past five years from the date the clinical research plan\nis submitted to the commissioner; and\n (ix) shall be filled by a researcher who is (A) enrolled or has\ncompleted a graduate medical education program, as defined in paragraph\n(i) of this subdivision; (B) a United States citizen, national, or\npermanent resident of the United States; and (C) a graduate of a\nmedical, dental or podiatric school located in New York state, a\ngraduate or resident in a graduate medical education program, as defined\nin paragraph (i) of this subdivision, where the sponsoring institution,\nas defined in paragraph (q) of this subdivision, is located in New York\nstate, or resides in New York state at the time the clinical research\nplan is submitted to the commissioner.\n (d) "Consortium" means an organization or association, approved by the\ncommissioner in consultation with the council, of general hospitals\nwhich provide graduate medical education, together with any affiliated\nsite; provided that such organization or association may also include\nother providers of health care services, medical schools, payors or\nconsumers, and which meet other criteria pursuant to subdivision six of\nthis section.\n (e) "Council" means the New York state council on graduate medical\neducation.\n (f) "Direct medical education" means the direct costs of residents,\ninterns and supervising physicians.\n (g) "Distribution period" means each calendar year set forth in\nsubdivision two of this section.\n (h) "Faculty" means persons who are employed by or under contract for\nemployment with a teaching general hospital or are paid through a\nteaching general hospital's affiliated faculty practice plan and\nmaintain a faculty appointment at a medical school. Such persons shall\nnot be limited to persons with a degree in medicine.\n (i) "Graduate medical education program" means a post-graduate medical\neducation residency in the United States which has received\naccreditation from a nationally recognized accreditation body or has\nbeen approved by a nationally recognized organization for medical,\nosteopathic, podiatric or dental residency programs including, but not\nlimited to, specialty boards.\n (j) "Indirect medical education" means the estimate of costs, other\nthan direct costs, of educational activities in teaching hospitals as\ndetermined in accordance with the methodology applicable for purposes of\ndetermining an estimate of indirect medical education costs for\nreimbursement for inpatient hospital service pursuant to title XVIII of\nthe federal social security act (medicare).\n (k) "Medicare" means the methodology used for purposes of reimbursing\ninpatient hospital services provided to beneficiaries of title XVIII of\nthe federal social security act.\n (l) "Primary care" residents specialties shall include family\nmedicine, general pediatrics, primary care internal medicine, and\nprimary care obstetrics and gynecology. In determining whether a\nresidency is in primary care, the commissioner shall consult with the\ncouncil.\n (m) "Regions", for purposes of this section, shall mean the regions as\ndefined in paragraph (b) of subdivision sixteen of section twenty-eight\nhundred seven-c of this article as in effect on June thirtieth, nineteen\nhundred ninety-six. For purposes of distributions pursuant to\nsubdivision five-a of this section, except distributions made in\naccordance with paragraph (a) of subdivision five-a of this section,\n"regions" shall be defined as New York city and the rest of the state.\n (n) "Regional pool" means a professional education pool established on\na regional basis by the commissioner from funds available pursuant to\nsections twenty-eight hundred seven-s and twenty-eight hundred seven-t\nof this article.\n (o) "Resident" means a person in a graduate medical education program\nwhich has received accreditation from a nationally recognized\naccreditation body or in a program approved by any other nationally\nrecognized organization for medical, osteopathic or dental residency\nprograms including, but not limited to, specialty boards.\n (p) "Shortage specialty" means a specialty determined by the\ncommissioner, in consultation with the council, to be in short supply in\nthe state of New York.\n (q) "Sponsoring institution" means the entity that has the overall\nresponsibility for a program of graduate medical education. Such\ninstitutions shall include teaching general hospitals, medical schools,\nconsortia and diagnostic and treatment centers.\n (r) "Weighted resident count" means a teaching general hospital's\ntotal number of residents as of July first, nineteen hundred\nninety-five, including residents in affiliated non-hospital ambulatory\nsettings, reported to the commissioner. Such resident counts shall\nreflect the weights established in accordance with rules and regulations\nadopted by the state hospital review and planning council and approved\nby the commissioner for purposes of implementing subdivision twenty-five\nof section twenty-eight hundred seven-c of this article and in effect on\nJuly first, nineteen hundred ninety-five. Such weights shall not be\napplied to specialty hospitals, specified by the commissioner, whose\nprimary care mission is to engage in research, training and clinical\ncare in specialty eye and ear, special surgery, orthopedic, joint\ndisease, cancer, chronic care or rehabilitative services.\n (s) "Adjustment amount" means an amount determined for each teaching\nhospital for periods prior to January first, two thousand nine by:\n (i) determining the difference between (A) a calculation of what each\nteaching general hospital would have been paid if payments made pursuant\nto paragraph (a-3) of subdivision one of section twenty-eight hundred\nseven-c of this article between January first, nineteen hundred\nninety-six and December thirty-first, two thousand three were based\nsolely on the case mix of persons eligible for medical assistance under\nthe medical assistance program pursuant to title eleven of article five\nof the social services law who are enrolled in health maintenance\norganizations and persons paid for under the family health plus program\nenrolled in approved organizations pursuant to title eleven-D of article\nfive of the social services law during those years, and (B) the actual\npayments to each such hospital pursuant to paragraph (a-3) of\nsubdivision one of section twenty-eight hundred seven-c of this article\nbetween January first, nineteen hundred ninety-six and December\nthirty-first, two thousand three.\n (ii) reducing proportionally each of the amounts determined in\nsubparagraph (i) of this paragraph so that the sum of all such amounts\ntotals no more than one hundred million dollars;\n (iii) further reducing each of the amounts determined in subparagraph\n(ii) of this paragraph by the amount received by each hospital as a\ndistribution from funds designated in paragraph (a) of subdivision five\nof this section attributable to the period January first, two thousand\nthree through December thirty-first, two thousand three, except that if\nsuch amount was provided to a consortium then the amount of the\nreduction for each hospital in the consortium shall be determined by\napplying the proportion of each hospital's amount determined under\nsubparagraph (i) of this paragraph to the total of such amounts of all\nhospitals in such consortium to the consortium award;\n (iv) further reducing each of the amounts determined in subparagraph\n(iii) of this paragraph by the amounts specified in paragraph (t) of\nthis subdivision; and\n (v) dividing each of the amounts determined in subparagraph (iii) of\nthis paragraph by seven.\n (t) "Extra reduction amount" shall mean an amount determined for a\nteaching hospital for which an adjustment amount is calculated pursuant\nto paragraph (s) of this subdivision that is the hospital's\nproportionate share of the sum of the amounts specified in paragraph (u)\nof this subdivision determined based upon a comparison of the hospital's\nremaining liability calculated pursuant to paragraph (s) of this\nsubdivision to the sum of all such hospital's remaining liabilities.\n (u) "Allotment amount" shall mean an amount determined for teaching\nhospitals as follows:\n (i) for a hospital for which an adjustment amount pursuant to\nparagraph (s) of this subdivision does not apply, the amount received by\nthe hospital pursuant to paragraph (a) of subdivision five of this\nsection attributable to the period January first, two thousand three\nthrough December thirty-first, two thousand three, or\n (ii) for a hospital for which an adjustment amount pursuant to\nparagraph (s) of this subdivision applies and which received a\ndistribution pursuant to paragraph (a) of subdivision five of this\nsection attributable to the period January first, two thousand three\nthrough December thirty-first, two thousand three that is greater than\nthe hospital's adjustment amount, the difference between the\ndistribution amount and the adjustment amount.\n 2. Regional pools. (a) The commissioner shall establish regional pools\nfor each of the periods January first, nineteen hundred ninety-seven\nthrough December thirty-first, nineteen hundred ninety-seven, January\nfirst, nineteen hundred ninety-eight through December thirty-first,\nnineteen hundred ninety-eight, and January first, nineteen hundred\nninety-nine through December thirty-first, nineteen hundred ninety-nine\nand on and after January first, two thousand from funds available\npursuant to sections twenty-eight hundred seven-s and twenty-eight\nhundred seven-t of this article.\n (b) For periods prior to January first, two thousand nine, each\nregional pool shall be distributed on a monthly basis to teaching\ngeneral hospitals for costs associated with graduate medical education\nprovided by such teaching general hospitals in accordance with the\ndistribution methodology set forth in subdivision three of this section;\nprovided however, teaching general hospitals with a resident count of\nzero as of July first of the year preceding the distribution period\nshall not be eligible for distributions pursuant to this section.\nGeneral hospitals may elect to have their distribution paid through the\nconsortium.\n 3. Regional pool distributions. (a) Distributions to teaching general\nhospitals shall be made from the regional pools described in subdivision\ntwo of this section for each period prior to January first, two thousand\nnine, less amounts set aside pursuant to subdivision five of this\nsection. To be eligible to participate in distributions pursuant to this\nsection, a teaching general hospital and consortium must be in\ncompliance with graduate medical education reporting requirements set\nforth in subdivision four of this section.\n (b) For periods prior to January first, two thousand nine, each\nteaching general hospital in a region shall have a proxy calculated for\nits graduate medical education costs as follows:\n (i) The direct medical education portion of the proxy shall be the\nproduct of: the teaching general hospital's medicare direct medical\neducation payment amount per resident for federal fiscal year nineteen\nhundred ninety-five--ninety-six and the teaching general hospital's\nweighted resident count as of July first, nineteen hundred ninety-five\nand the teaching general hospital's inpatient percentage of total costs\nand percentage of inpatient days, excluding medicare days, patient days\neligible for payments by governmental agencies, the comprehensive motor\nvehicle insurance reparations act, workers' compensation law, volunteer\nfirefighters' benefit law, volunteer ambulance workers' benefit law and\nself-pay patient days, to total days as such costs and days are reported\nin the institutional cost report for periods ending March thirty-first,\nnineteen hundred ninety-five, June thirtieth, nineteen hundred\nninety-five or December thirty-first, nineteen hundred ninety-five,\nwhichever is applicable. The teaching general hospital's medicare direct\nmedical education payment amount for purposes of this calculation shall\nnot exceed one hundred fifty percent of the regional average per\nresident amount for the region in which the teaching general hospital is\nlocated.\n (ii) The indirect medical education portion of the proxy for a\nteaching general hospital shall be calculated using the medicare\nresident per bed formula in existence on June thirtieth, nineteen\nhundred ninety-six, except the teaching general hospital's weighted\nresident count as of July first, nineteen hundred ninety-five and number\nof certified acute care beds as of January first, nineteen hundred\nninety-five shall be used in the application of the formula. The formula\nresult shall be applied to the teaching general hospital's applicable\ncase mix neutral and wage adjusted medicare standardized rate amount for\nfederal fiscal year nineteen hundred ninety-five--ninety-six. The result\nof this application shall be multiplied by the teaching general\nhospital's total number of discharges as reported in the institutional\ncost report for periods ending March thirty-first, nineteen hundred\nninety-five, June thirtieth, nineteen hundred ninety-five or December\nthirty-first, nineteen hundred ninety-five, whichever is applicable,\nexcluding discharges relating to patients eligible for medicare,\npayments by governmental agencies, payments pursuant to the\ncomprehensive motor vehicle insurance reparations act, payments pursuant\nto the workers' compensation law, the volunteer firefighters' benefit\nlaw, the volunteer ambulance workers' benefit law, and self-pay\npatients, and applicable weighting factors developed in accordance with\nsubdivision three of section twenty-eight hundred seven-c of this\narticle as in effect in nineteen hundred ninety-five. For teaching\ngeneral hospitals which are specialty hospitals reimbursed on a per diem\nbasis, the applicable case mix neutral and wage adjusted medicare\nstandardized rate amount for purposes of this calculation shall be the\namount determined for the majority of teaching general hospitals within\na region.\n (iii) The teaching general hospital's graduate medical education proxy\nshall equal the sum of its direct medical education proxy and indirect\nmedical education proxy.\n (c) For periods prior to January first, two thousand nine, a\ndistribution amount for each teaching general hospital shall be\ncalculated from the applicable regional pool described in subdivision\ntwo of this section as adjusted pursuant to paragraph (d) of this\nsubdivision based upon its percentage of the regional total of the\ngraduate medical education proxies, except that for purposes of this\nparagraph the statewide amount used to compute such distribution amounts\nshall be four hundred ninety million dollars on an annual basis for the\nperiods January first, two thousand through December thirty-first, two\nthousand two and two hundred forty-five million dollars for the period\nJanuary first, two thousand three through June thirtieth, two thousand\nthree, less amounts set aside each period pursuant to subdivision seven\nof this section.\n (d) For periods prior to January first, two thousand nine, each\nteaching general hospital shall receive a distribution from the\napplicable regional pool based on its distribution amount determined\nunder paragraph (c) of this subdivision adjusted by a reduction amount\nthat is determined as follows:\n (i) the commissioner shall establish a reduction percentage by\ndividing twenty-seven million dollars each year for the period January\nfirst, two thousand through December thirty-first, two thousand ten and\nsix million seven hundred fifty thousand dollars for the period January\nfirst, two thousand eleven through March thirty-first, two thousand\neleven, by the sum of initial hospital distribution amounts calculated\npursuant to paragraph (c) of this subdivision;\n (ii) the commissioner shall multiply the reduction percentage by the\namount calculated pursuant to paragraph (c) of this subdivision for each\nteaching general hospital;\n (iii) each teaching general hospital shall have its initial\ndistribution amount as determined pursuant to paragraph (c) of this\nsubdivision reduced by an amount up to the amount calculated pursuant to\nsubparagraph (ii) of this paragraph and subject to the requirements of\nsubparagraph (iv) of this paragraph, provided, however, that if the sum\nof reduction amounts for all facilities thus calculated is less than\ntwenty-seven million dollars on a statewide basis each year for the\nperiod January first, two thousand through December thirty-first, two\nthousand ten and six million seven hundred fifty thousand dollars for\nthe period January first, two thousand eleven through March\nthirty-first, two thousand eleven, the commissioner may increase the\nreduction percentage subject to the provisions of subparagraph (iv) of\nthis paragraph so that the sum of the reduction amounts for all\nfacilities is twenty-seven million dollars each year for the period\nJanuary first, two thousand through December thirty-first, two thousand\nten and six million seven hundred fifty thousand dollars for the period\nJanuary first, two thousand eleven through March thirty-first, two\nthousand eleven.\n (iv) for distribution periods prior to January first, two thousand\neleven, an individual hospital's reduction amount shall not exceed the\nhospital's projected losses for treating medicaid and uninsured patients\nafter all other projected medical assistance, including all other\nprojected disproportionate share payments for the applicable period.\nSuch cap on the reduction amount shall also not be reconciled to reflect\nactual medicaid and uninsured losses for the applicable period.\n (e) Effective April first, two thousand four through December\nthirty-first, two thousand eight, the distribution amount calculated\npursuant to paragraphs (c) and (d) of this subdivision for each\nnon-public teaching general hospital shall be reduced by the amount\ncalculated and included in rates pursuant to paragraph (d) of\nsubdivision twenty-five of section twenty-eight hundred seven-c of this\narticle.\n (f) Effective January first, two thousand five through December\nthirty-first, two thousand eight, each teaching general hospital shall\nreceive a distribution from the applicable regional pool based on its\ndistribution amount determined under paragraphs (c), (d) and (e) of this\nsubdivision and reduced by its adjustment amount calculated pursuant to\nparagraph (s) of subdivision one of this section and, for distributions\nfor the period January first, two thousand five through December\nthirty-first, two thousand five, further reduced by its extra reduction\namount calculated pursuant to paragraph (t) of subdivision one of this\nsection.\n 4. Reporting requirements. Each teaching general hospital and\nconsortium shall furnish to the department such reports and information\nas may be required by the commissioner to implement this section and to\nassess the cost, quality and health system needs for graduate medical\neducation, including, but not limited to:\n (a) each teaching general hospital and site other than a general\nhospital at which residents receive training shall describe annually its\ngraduate medical education program or programs and report the number of\nresidents in each program; and\n (b) each consortium shall provide annually a list of the teaching\ngeneral hospitals and sites other than general hospitals at which\nresidents receive training participating in the consortium as members\nand an implementation report relating to achievement of the goals and\nobjectives of the consortium plan; and\n (c) each teaching general hospital and sponsoring institution shall\njointly prepare and submit to the commissioner on an annual basis an\ninstitutional graduate medical education budget reflecting all sources\nof graduate medical education revenue and expenditures for a calendar\nyear. In a form and manner to be specified by the commissioner, such\nbudget shall be prepared and reviewed by the residency training director\nand certified by the chief executive officer as to accuracy and\ncompleteness prior to submission to the commissioner. Such budget shall\nbe submitted to the commissioner by February first, two thousand nine\nfor the two thousand nine calendar year and each February first,\nthereafter.\n 5. Supplemental distributions. (a) Up to thirty-one million dollars\nannually for the periods January first, two thousand through December\nthirty-first, two thousand three, and up to twenty-five million dollars\nplus the sum of the amounts specified in paragraph (n) of subdivision\none of this section for the period January first, two thousand five\nthrough December thirty-first, two thousand five, and up to thirty-one\nmillion dollars annually for the period January first, two thousand six\nthrough December thirty-first, two thousand seven, shall be set aside\nand reserved by the commissioner from the regional pools established\npursuant to subdivision two of this section for supplemental\ndistributions in each such region to be made by the commissioner to\nconsortia and teaching general hospitals in accordance with a\ndistribution methodology developed in consultation with the council and\nspecified in rules and regulations adopted by the commissioner.\n (b) Funds available shall be distributed to consortia and teaching\ngeneral hospitals that substantially meet the following training goals\nand objectives:\n (i) reducing the number of graduate medical education programs and/or\nthe number of residents in such programs;\n (ii) increasing the number of residents training in underserved areas;\n (iii) increasing the number of residents training in ambulatory care\nfacilities;\n (iv) improving the quality of training programs;\n (v) increasing training of minorities; and\n (vi) such other factors as may be specified in rules and regulations\nadopted by the commissioner in consultation with the council.\n The distribution of funds pursuant to this subdivision shall not be\nconditioned on a consortia or teaching general hospital reducing the\nnumber of graduate medical education programs and/or the number of\nresidents in such program.\n (c) In the event that funds available under this subdivision are not\ndistributed to consortia or teaching general hospitals in accordance\nwith this subdivision, such funds shall be distributed to teaching\ngeneral hospitals in accordance with the methodology described in\nsubdivision three of this section.\n (d) Notwithstanding any other provision of law or regulation, for the\nperiod January first, two thousand five through December thirty-first,\ntwo thousand five, the commissioner shall distribute as supplemental\npayments the allotment specified in paragraph (n) of subdivision one of\nthis section.\n 5-a. Graduate medical education innovations pool. (a) Supplemental\ndistributions. (i) Thirty-one million dollars for the period January\nfirst, two thousand eight through December thirty-first, two thousand\neight, shall be set aside and reserved by the commissioner from the\nregional pools established pursuant to subdivision two of this section\nand shall be available for distributions pursuant to subdivision five of\nthis section and in accordance with section 86-1.89 of title 10 of the\ncodes, rules and regulations of the state of New York as in effect on\nJanuary first, two thousand eight; provided, however, for purposes of\nfunding the empire clinical research investigation program (ECRIP) in\naccordance with paragraph eight of subdivision (e) and paragraph two of\nsubdivision (f) of section 86-1.89 of title 10 of the codes, rules and\nregulations of the state of New York, distributions shall be made using\ntwo regions defined as New York city and the rest of the state and the\ndollar amount set forth in subparagraph (i) of paragraph two of\nsubdivision (f) of section 86-1.89 of title 10 of the codes, rules and\nregulations of the state of New York shall be increased from sixty\nthousand dollars to seventy-five thousand dollars.\n (ii) For periods on and after January first, two thousand nine,\nsupplemental distributions pursuant to subdivision five of this section\nand in accordance with section 86-1.89 of title 10 of the codes, rules\nand regulations of the state of New York shall no longer be made and the\nprovisions of section 86-1.89 of title 10 of the codes, rules and\nregulations of the state of New York shall be null and void.\n (b) Empire clinical research investigator program (ECRIP). Nine\nmillion one hundred twenty thousand dollars annually for the period\nJanuary first, two thousand nine through December thirty-first, two\nthousand ten, and two million two hundred eighty thousand dollars for\nthe period January first, two thousand eleven, through March\nthirty-first, two thousand eleven, nine million one hundred twenty\nthousand dollars each state fiscal year for the period April first, two\nthousand eleven through March thirty-first, two thousand fourteen, up to\neight million six hundred twelve thousand dollars each state fiscal year\nfor the period April first, two thousand fourteen through March\nthirty-first, two thousand seventeen, up to eight million six hundred\ntwelve thousand dollars each state fiscal year for the period April\nfirst, two thousand seventeen through March thirty-first, two thousand\ntwenty, up to eight million six hundred twelve thousand dollars each\nstate fiscal year for the period April first, two thousand twenty\nthrough March thirty-first, two thousand twenty-three, and up to eight\nmillion six hundred twelve thousand dollars each state fiscal year for\nthe period April first, two thousand twenty-three through March\nthirty-first, two thousand twenty-six, shall be set aside and reserved\nby the commissioner from the regional pools established pursuant to\nsubdivision two of this section to be allocated regionally with\ntwo-thirds of the available funding going to New York city and one-third\nof the available funding going to the rest of the state and shall be\navailable for distribution as follows:\n Distributions shall first be made to consortia and teaching general\nhospitals for the empire clinical research investigator program (ECRIP)\nto help secure federal funding for biomedical research, train clinical\nresearchers, recruit national leaders as faculty to act as mentors, and\ntrain residents and fellows in biomedical research skills based on\nhospital-specific data submitted to the commissioner by consortia and\nteaching general hospitals in accordance with clause (G) of this\nsubparagraph. Such distributions shall be made in accordance with the\nfollowing methodology:\n (A) The greatest number of clinical research positions for which a\nconsortium or teaching general hospital may be funded pursuant to this\nsubparagraph shall be one percent of the total number of residents\ntraining at the consortium or teaching general hospital on July first,\ntwo thousand eight for the period January first, two thousand nine\nthrough December thirty-first, two thousand nine rounded up to the\nnearest one position.\n (B) Distributions made to a consortium or teaching general hospital\nshall equal the product of the total number of clinical research\npositions submitted by a consortium or teaching general hospital and\naccepted by the commissioner as meeting the criteria set forth in\nparagraph (b) of subdivision one of this section, subject to the\nreduction calculation set forth in clause (C) of this subparagraph,\ntimes one hundred ten thousand dollars.\n (C) If the dollar amount for the total number of clinical research\npositions in the region calculated pursuant to clause (B) of this\nsubparagraph exceeds the total amount appropriated for purposes of this\nparagraph, including clinical research positions that continue from and\nwere funded in prior distribution periods, the commissioner shall\neliminate one-half of the clinical research positions submitted by each\nconsortium or teaching general hospital rounded down to the nearest one\nposition. Such reduction shall be repeated until the dollar amount for\nthe total number of clinical research positions in the region does not\nexceed the total amount appropriated for purposes of this paragraph. If\nthe repeated reduction of the total number of clinical research\npositions in the region by one-half does not render a total funding\namount that is equal to or less than the total amount reserved for that\nregion within the appropriation, the funding for each clinical research\nposition in that region shall be reduced proportionally in one thousand\ndollar increments until the total dollar amount for the total number of\nclinical research positions in that region does not exceed the total\namount reserved for that region within the appropriation. Any reduction\nin funding will be effective for the duration of the award. No clinical\nresearch positions that continue from and were funded in prior\ndistribution periods shall be eliminated or reduced by such methodology.\n (D) Each consortium or teaching general hospital shall receive its\nannual distribution amount in accordance with the following:\n (I) Each consortium or teaching general hospital with a one-year ECRIP\naward shall receive its annual distribution amount in full upon\ncompletion of the requirements set forth in items (I) and (II) of clause\n(G) of this subparagraph. The requirements set forth in items (IV) and\n(V) of clause (G) of this subparagraph must be completed by the\nconsortium or teaching general hospital in order for the consortium or\nteaching general hospital to be eligible to apply for ECRIP funding in\nany subsequent funding cycle.\n (II) Each consortium or teaching general hospital with a two-year\nECRIP award shall receive its first annual distribution amount in full\nupon completion of the requirements set forth in items (I) and (II) of\nclause (G) of this subparagraph. Each consortium or teaching general\nhospital will receive its second annual distribution amount in full upon\ncompletion of the requirements set forth in item (III) of clause (G) of\nthis subparagraph. The requirements set forth in items (IV) and (V) of\nclause (G) of this subparagraph must be completed by the consortium or\nteaching general hospital in order for the consortium or teaching\ngeneral hospital to be eligible to apply for ECRIP funding in any\nsubsequent funding cycle.\n (E) Each consortium or teaching general hospital receiving\ndistributions pursuant to this subparagraph shall reserve seventy-five\nthousand dollars to primarily fund salary and fringe benefits of the\nclinical research position with the remainder going to fund the\ndevelopment of faculty who are involved in biomedical research, training\nand clinical care.\n (F) Undistributed or returned funds available to fund clinical\nresearch positions pursuant to this paragraph for a distribution period\nshall be available to fund clinical research positions in a subsequent\ndistribution period.\n (G) In order to be eligible for distributions pursuant to this\nsubparagraph, each consortium and teaching general hospital shall\nprovide to the commissioner by July first of each distribution period,\nthe following data and information on a hospital-specific basis. Such\ndata and information shall be certified as to accuracy and completeness\nby the chief executive officer, chief financial officer or chair of the\nconsortium governing body of each consortium or teaching general\nhospital and shall be maintained by each consortium and teaching general\nhospital for five years from the date of submission:\n (I) For each clinical research position, information on the type,\nscope, training objectives, institutional support, clinical research\nexperience of the sponsor-mentor, plans for submitting research outcomes\nto peer reviewed journals and at scientific meetings, including a\nmeeting sponsored by the department, the name of a principal contact\nperson responsible for tracking the career development of researchers\nplaced in clinical research positions, as defined in paragraph (c) of\nsubdivision one of this section, and who is authorized to certify to the\ncommissioner that all the requirements of the clinical research training\nobjectives set forth in this subparagraph shall be met. Such\ncertification shall be provided by July first of each distribution\nperiod;\n (II) For each clinical research position, information on the name,\ncitizenship status, medical education and training, and medical license\nnumber of the researcher, if applicable, shall be provided by December\nthirty-first of the calendar year following the distribution period;\n (III) Information on the status of the clinical research plan,\naccomplishments, changes in research activities, progress, and\nperformance of the researcher shall be provided upon completion of\none-half of the award term;\n (IV) A final report detailing training experiences, accomplishments,\nactivities and performance of the clinical researcher, and data,\nmethods, results and analyses of the clinical research plan shall be\nprovided three months after the clinical research position ends; and\n (V) Tracking information concerning past researchers, including but\nnot limited to (A) background information, (B) employment history, (C)\nresearch status, (D) current research activities, (E) publications and\npresentations, (F) research support, and (G) any other information\nnecessary to track the researcher; and\n (VI) Any other data or information required by the commissioner to\nimplement this subparagraph.\n (H) Notwithstanding any inconsistent provision of this subdivision,\nfor periods on and after April first, two thousand thirteen, ECRIP grant\nawards shall be made in accordance with rules and regulations\npromulgated by the commissioner. Such regulations shall, at a minimum:\n (1) provide that ECRIP grant awards shall be made with the objective\nof securing federal funding for biomedical research, training clinical\nresearchers, recruiting national leaders as faculty to act as mentors,\nand training residents and fellows in biomedical research skills;\n (2) provide that ECRIP grant applicants may include interdisciplinary\nresearch teams comprised of teaching general hospitals acting in\ncollaboration with entities including but not limited to medical\ncenters, hospitals, universities and local health departments;\n (3) provide that applications for ECRIP grant awards shall be based on\nsuch information requested by the commissioner, which shall include but\nnot be limited to hospital-specific data;\n (4) establish the qualifications for investigators and other staff\nrequired for grant projects eligible for ECRIP grant awards; and\n (5) establish a methodology for the distribution of funds under ECRIP\ngrant awards.\n (c) Physician loan repayment program. One million nine hundred sixty\nthousand dollars for the period January first, two thousand eight\nthrough December thirty-first, two thousand eight, one million nine\nhundred sixty thousand dollars for the period January first, two\nthousand nine through December thirty-first, two thousand nine, one\nmillion nine hundred sixty thousand dollars for the period January\nfirst, two thousand ten through December thirty-first, two thousand ten,\nfour hundred ninety thousand dollars for the period January first, two\nthousand eleven through March thirty-first, two thousand eleven, one\nmillion seven hundred thousand dollars each state fiscal year for the\nperiod April first, two thousand eleven through March thirty-first, two\nthousand fourteen, up to one million seven hundred five thousand dollars\neach state fiscal year for the period April first, two thousand fourteen\nthrough March thirty-first, two thousand seventeen, up to one million\nseven hundred five thousand dollars each state fiscal year for the\nperiod April first, two thousand seventeen through March thirty-first,\ntwo thousand twenty, up to one million seven hundred five thousand\ndollars each state fiscal year for the period April first, two thousand\ntwenty through March thirty-first, two thousand twenty-three, and up to\none million seven hundred five thousand dollars each state fiscal year\nfor the period April first, two thousand twenty-three through March\nthirty-first, two thousand twenty-six, shall be set aside and reserved\nby the commissioner from the regional pools established pursuant to\nsubdivision two of this section and shall be available for purposes of\nphysician loan repayment in accordance with subdivision ten of this\nsection. Notwithstanding any contrary provision of this section,\nsections one hundred twelve and one hundred sixty-three of the state\nfinance law, or any other contrary provision of law, such funding shall\nbe allocated regionally with one-third of available funds going to New\nYork city and two-thirds of available funds going to the rest of the\nstate and shall be distributed in a manner to be determined by the\ncommissioner without a competitive bid or request for proposal process\nas follows:\n (i) Funding shall first be awarded to repay loans of up to twenty-five\nphysicians who train in primary care or specialty tracks in teaching\ngeneral hospitals, and who enter and remain in primary care or specialty\npractices in underserved communities, as determined by the commissioner.\n (ii) After distributions in accordance with subparagraph (i) of this\nparagraph, all remaining funds shall be awarded to repay loans of\nphysicians who enter and remain in primary care or specialty practices\nin underserved communities, as determined by the commissioner, including\nbut not limited to physicians working in general hospitals, or other\nhealth care facilities.\n (iii) In no case shall less than fifty percent of the funds available\npursuant to this paragraph be distributed in accordance with\nsubparagraphs (i) and (ii) of this paragraph to physicians identified by\ngeneral hospitals.\n (iv) In addition to the funds allocated under this paragraph, for the\nperiod April first, two thousand fifteen through March thirty-first, two\nthousand sixteen, two million dollars shall be available for the\npurposes described in subdivision ten of this section;\n (v) In addition to the funds allocated under this paragraph, for the\nperiod April first, two thousand sixteen through March thirty-first, two\nthousand seventeen, two million dollars shall be available for the\npurposes described in subdivision ten of this section;\n (vi) Notwithstanding any provision of law to the contrary, and subject\nto the extension of the Health Care Reform Act of 1996, sufficient funds\nshall be available for the purposes described in subdivision ten of this\nsection in amounts necessary to fund the remaining year commitments for\nawards made pursuant to subparagraphs (iv) and (v) of this paragraph.\n (d) Physician practice support. Four million nine hundred thousand\ndollars for the period January first, two thousand eight through\nDecember thirty-first, two thousand eight, four million nine hundred\nthousand dollars annually for the period January first, two thousand\nnine through December thirty-first, two thousand ten, one million two\nhundred twenty-five thousand dollars for the period January first, two\nthousand eleven through March thirty-first, two thousand eleven, four\nmillion three hundred thousand dollars each state fiscal year for the\nperiod April first, two thousand eleven through March thirty-first, two\nthousand fourteen, up to four million three hundred sixty thousand\ndollars each state fiscal year for the period April first, two thousand\nfourteen through March thirty-first, two thousand seventeen, up to four\nmillion three hundred sixty thousand dollars for each state fiscal year\nfor the period April first, two thousand seventeen through March\nthirty-first, two thousand twenty, up to four million three hundred\nsixty thousand dollars for each fiscal year for the period April first,\ntwo thousand twenty through March thirty-first, two thousand\ntwenty-three, and up to four million three hundred sixty thousand\ndollars for each fiscal year for the period April first, two thousand\ntwenty-three through March thirty-first, two thousand twenty-six, shall\nbe set aside and reserved by the commissioner from the regional pools\nestablished pursuant to subdivision two of this section and shall be\navailable for purposes of physician practice support. Notwithstanding\nany contrary provision of this section, sections one hundred twelve and\none hundred sixty-three of the state finance law, or any other contrary\nprovision of law, such funding shall be allocated regionally with\none-third of available funds going to New York city and two-thirds of\navailable funds going to the rest of the state and shall be distributed\nin a manner to be determined by the commissioner without a competitive\nbid or request for proposal process as follows:\n (i) Preference in funding shall first be accorded to teaching general\nhospitals for up to twenty-five awards, to support costs incurred by\nphysicians trained in primary or specialty tracks who thereafter\nestablish or join practices in underserved communities, as determined by\nthe commissioner.\n (ii) After distributions in accordance with subparagraph (i) of this\nparagraph, all remaining funds shall be awarded to physicians to support\nthe cost of establishing or joining practices in underserved\ncommunities, as determined by the commissioner, and to hospitals and\nother health care providers to recruit new physicians to provide\nservices in underserved communities, as determined by the commissioner.\n (iii) In no case shall less than fifty percent of the funds available\npursuant to this paragraph be distributed to general hospitals in\naccordance with subparagraphs (i) and (ii) of this paragraph.\n (e) Work group. For funding available pursuant to paragraphs (c), (d)\nand (e) of this subdivision:\n (i) The department shall appoint a work group from recommendations\nmade by associations representing physicians, general hospitals and\nother health care facilities to develop a streamlined application\nprocess by June first, two thousand twelve.\n (ii) Subject to available funding, applications shall be accepted on a\ncontinuous basis. The department shall provide technical assistance to\napplicants to facilitate their completion of applications. An applicant\nshall be notified in writing by the department within ten days of\nreceipt of an application as to whether the application is complete and\nif the application is incomplete, what information is outstanding. The\ndepartment shall act on an application within thirty days of receipt of\na complete application.\n (f) Study on physician workforce. Five hundred ninety thousand dollars\nannually for the period January first, two thousand eight through\nDecember thirty-first, two thousand ten, one hundred forty-eight\nthousand dollars for the period January first, two thousand eleven\nthrough March thirty-first, two thousand eleven, five hundred sixteen\nthousand dollars each state fiscal year for the period April first, two\nthousand eleven through March thirty-first, two thousand fourteen, up to\nfour hundred eighty-seven thousand dollars each state fiscal year for\nthe period April first, two thousand fourteen through March\nthirty-first, two thousand seventeen, up to four hundred eighty-seven\nthousand dollars for each state fiscal year for the period April first,\ntwo thousand seventeen through March thirty-first, two thousand twenty,\nup to four hundred eighty-seven thousand dollars each state fiscal year\nfor the period April first, two thousand twenty through March\nthirty-first, two thousand twenty-three, and up to four hundred\neighty-seven thousand dollars each state fiscal year for the period\nApril first, two thousand twenty-three through March thirty-first, two\nthousand twenty-six, shall be set aside and reserved by the commissioner\nfrom the regional pools established pursuant to subdivision two of this\nsection and shall be available to fund a study of physician workforce\nneeds and solutions including, but not limited to, an analysis of\nresidency programs and projected physician workforce and community\nneeds. The commissioner shall enter into agreements with one or more\norganizations to conduct such study based on a request for proposal\nprocess.\n (g) Diversity in medicine/post-baccalaureate program. Notwithstanding\nany inconsistent provision of section one hundred twelve or one hundred\nsixty-three of the state finance law or any other law, one million nine\nhundred sixty thousand dollars annually for the period January first,\ntwo thousand eight through December thirty-first, two thousand ten, four\nhundred ninety thousand dollars for the period January first, two\nthousand eleven through March thirty-first, two thousand eleven, one\nmillion seven hundred thousand dollars each state fiscal year for the\nperiod April first, two thousand eleven through March thirty-first, two\nthousand fourteen, up to one million six hundred five thousand dollars\neach state fiscal year for the period April first, two thousand fourteen\nthrough March thirty-first, two thousand seventeen, up to one million\nsix hundred five thousand dollars each state fiscal year for the period\nApril first, two thousand seventeen through March thirty-first, two\nthousand twenty, up to one million six hundred five thousand dollars\neach state fiscal year for the period April first, two thousand twenty\nthrough March thirty-first, two thousand twenty-three, and up to one\nmillion six hundred five thousand dollars each state fiscal year for the\nperiod April first, two thousand twenty-three through March\nthirty-first, two thousand twenty-six, shall be set aside and reserved\nby the commissioner from the regional pools established pursuant to\nsubdivision two of this section and shall be available for distributions\nto the Associated Medical Schools of New York to fund its diversity\nprogram including existing and new post-baccalaureate programs for\nminority and economically disadvantaged students and encourage\nparticipation from all medical schools in New York. The associated\nmedical schools of New York shall report to the commissioner on an\nannual basis regarding the use of funds for such purpose in such form\nand manner as specified by the commissioner.\n (h) In the event there are undistributed funds within amounts made\navailable for distributions pursuant to this subdivision, such funds may\nbe reallocated and distributed in current or subsequent distribution\nperiods in a manner determined by the commissioner for any purpose set\nforth in this subdivision.\n 5-b. Other graduate medical education reforms. Any funds specifically\nappropriated for the purposes of this subdivision shall be used to fund\ninnovative graduate medical education reforms to be determined by the\ncommissioner in consultation with the council, including, but not\nlimited to, (a) development of primary care residency and specialty\nposition training tracks for graduates to serve rural or inner-city\ncommunities, (b) development of regional pilot network programs to\naffiliate major academic centers with community teaching general\nhospitals, (c) support for faculty development programs, including\ndesignating faculty to mentor students and residents in primary care,\n(d) support training in fields which serve the geriatric population; (e)\nincrease training in cultural competence, (f) promote training of\nphysicians who will serve persons with developmental disabilities, and\n(g) any other reforms necessary to improve patient care management,\ninterdisciplinary training, or quality in graduate medical education\nprograms. Such funding shall be distributed to consortia and teaching\ngeneral hospitals in each region on a competitive basis pursuant to a\nrequest for proposal process.\n 6. Consortia. (a) A consortium must:\n (i) have a governing body and such committees as appropriate which\nshould be responsible for the policy coordination and administration of\nresidency programs and which provides all members of the consortium an\nopportunity to participate in the establishment of consortium policy\ngoals and objectives;\n (ii) have procedures and criteria for processing applications by\nhealth care providers in the region for participation in the consortium;\n (iii) establish policies to evaluate and to maintain and improve the\nquality of training programs;\n (iv) have a mechanism for resolving educational and financial\nallocation disputes among participating members; and\n (v) comply with such further requirements as the commissioner may\nreasonably require for purposes of implementing this section to achieve\nstate policy goals and objectives regarding graduate medical education.\n (b) Nothing in this section shall preclude a consortium from having\nmembers from different regions and from allocating regional pool\ndistributions among regions.\n (c) To the extent consortia might be anti-competitive within the\nmeaning and intent of the federal and state antitrust laws, it is the\nintent of the legislature to supplant competition with such arrangements\nto the extent necessary to accomplish the purposes of this section, and\nprovide state action immunity under the federal antitrust laws with\nrespect to the planning, implementation and operation of consortia and\nparticipation therein by hospitals, other providers of health care\nservices, medical schools, payors and consumers.\n (d) Each approved consortium shall submit a plan for each period\ndefined in subdivision two of this section for approval by the\ncommissioner, in consultation with the council, for allocation of funds\ncollected pursuant to paragraph (c) of subdivision three of this section\nto participating general hospitals which provide graduate medical\neducation and sites other than general hospitals at which residents\nreceive training.\n 8. Revenue from distributions pursuant to this section shall be\nincluded in gross revenue received for purposes of the assessments\npursuant to subdivision eighteen of section twenty-eight hundred seven-c\nof this article and for purposes of the assessments pursuant to section\ntwenty-eight hundred seven-d of this article.\n 10. Physician loan repayment program. (a) Beginning January first,\ntwo thousand eight, the commissioner is authorized, within amounts\navailable pursuant to subdivision five-a of this section, to make loan\nrepayment awards to primary care physicians or other physician\nspecialties determined by the commissioner to be in short supply,\nlicensed to practice medicine in New York state, who agree to practice\nfor at least five years in an underserved area, as determined by the\ncommissioner. Such physician shall be eligible for a loan repayment\naward of up to one hundred fifty thousand dollars over a five year\nperiod distributed as follows: fifteen percent of total loan debt not to\nexceed twenty thousand dollars for the first year; fifteen percent of\ntotal loan debt not to exceed twenty-five thousand dollars for the\nsecond year; twenty percent of total loan debt not to exceed thirty-five\nthousand dollars for the third year; and twenty-five percent of total\nloan debt not to exceed thirty-five thousand dollars per year for the\nfourth year; and any unpaid balance of the total loan debt not to exceed\nthe maximum award amount for the fifth year of practice in such area.\n (b) Loan repayment awards made to a physician pursuant to paragraph\n(a) of this subdivision shall not exceed the total qualifying\noutstanding debt of the physician from student loans to cover tuition\nand other related educational expenses, made by or guaranteed by the\nfederal or state government, or made by a lending or educational\ninstitution approved under title IV of the federal higher education act.\nLoan repayment awards shall be used solely to repay such outstanding\ndebt.\n (c) In the event that a five-year commitment pursuant to the agreement\nreferenced in paragraph (a) of this subdivision is not fulfilled, the\nrecipient shall be responsible for repayment in amounts which shall be\ncalculated in accordance with the formula set forth in subdivision (b)\nof section two hundred fifty-four-o of title forty-two of the United\nStates Code, as amended.\n (d) The commissioner is authorized to apply any funds available for\npurposes of paragraph (a) of this subdivision for use as matching funds\nfor federal grants for the purpose of assisting states in operating loan\nrepayment programs pursuant to section three hundred thirty-eight I of\nthe public health service act.\n (e) The commissioner may postpone, change or waive the service\nobligation and repayment amounts set forth in paragraphs (a) and (c),\nrespectively of this subdivision in individual circumstances where there\nis compelling need or hardship.\n (f)(i) When a physician is not actually practicing in an underserved\narea, he or she shall be deemed to be practicing in an underserved area\nif he or she practices in a facility or physician's office that\nprimarily serves an underserved population as determined by the\ncommissioner, without regard to whether the population or the facility\nor physician's office is located in an underserved area.\n (ii) In making criteria and determinations as to whether an area is an\nunderserved area or whether a facility or physician's office primarily\nserves an underserved population, the commissioner may make separate\ncriteria and determinations for different specialties.\n 11. The commissioner shall conduct a study of (i) the need for\nexpansion of the physician loan repayment program under subdivision ten\nof this section to include dentists, midwives, nurse practitioners, and\nphysician assistants; (ii) the level of funding appropriate for that\nexpansion; and (iii) appropriate sources of funding for the future of\nthe program and the expansion. The study may include examination of\npossible expansion of other programs to recruit people to enter health\ncare professions and serve in underserved areas. The commissioner shall\nconduct the study in consultation with representatives of the affected\nprofessions, educational institutions and training programs that educate\nand train people for those professions, appropriate health care\nproviders, affected communities and other interested parties. The\ncommissioner shall report to the governor and the legislature on the\nfindings of the study and recommendations by December first, two\nthousand eight.\n 12. Notwithstanding any provision of law to the contrary, applications\nsubmitted on or after April first, two thousand sixteen, for the\nphysician loan repayment program pursuant to paragraph (c) of\nsubdivision five-a of this section and subdivision ten of this section\nor the physician practice support program pursuant to paragraph (d) of\nsubdivision five-a of this section, shall be subject to the following\nchanges:\n (a) Awards shall be made from the total funding available for new\nawards under the physician loan repayment program and the physician\npractice support program, with neither program limited to a specific\nfunding amount within such total funding available;\n (b) An applicant may apply for an award for either physician loan\nrepayment or physician practice support, but not both;\n (c) An applicant shall agree to practice for three years in an\nunderserved area and each award shall provide up to forty thousand\ndollars for each of the three years; and\n (d) To the extent practicable, awards shall be timed to be of use for\njob offers made to applicants.\n