§ 2814 — Health networks, global budgeting, and health care demonstrations

* § 2814. Health networks, global budgeting, and health care\ndemonstrations. 1. For the purposes of this section unless the context\nclearly requires otherwise:\n (a) "Board" shall mean the temporary statewide health advisory board\nestablished pursuant to section nine hundred fifty-seven of the\nexecutive law.\n (b) "Proposal" shall mean a design or plan developed, as a result of\nfunds received pursuant to this section, to operate a network, global\nbudget, or regional health care demonstration.\n 2. (a) Notwithstanding any inconsistent provision of law, within\namounts available therefor, the commissioner shall make grants pursuant\nto this section to (i) health care providers to facilitate development\nof health networks or health care demonstrations (ii) health care\nproviders alone or in conjunction with third party payors to facilitate\ndevelopment of global budgets and (iii) an organization demonstrably\nrepresenting the interests of the region or communities of the region\nwhich demonstrate the support of the respective health systems agency to\nfacilitate development of health care demonstrations or global budgets.\nSuch networks, demonstrations, or global budgets shall be designed to\nimprove cost effectiveness of health care services, establish and\nimprove provider coordinated planning and management mechanisms, and/or\nimprove provider management of care or improve continuity of care.\nHealth care providers eligible to receive funding under section\ntwenty-nine hundred fifty-two of this chapter shall not be eligible for\ngrants under this section for development of health networks.\n (b) Grants made pursuant to this section shall provide planning funds\nwhich may include, but need not be limited to, funding to:\n (i) assess the health care needs of the population and develop an\noperational plan to meet these needs;\n (ii) plan for and carry out any organizational changes needed to\nintegrate services; and\n (iii) facilitate financing arrangements such as risk sharing and\ncapitation.\n 3. In awarding grants under this section, the commissioner shall\nconsult with the appropriate local health systems agency and shall\nconsider the recommendations of the temporary statewide health advisory\nboard on the grant proposals and to the extent practicable assure that\nthere is a sufficiently representative geographic distribution of\ngrantees including rural, urban, and suburban grantees. Grants made\npursuant to this section shall be used solely for the planning of health\nnetworks, global budgets or health care demonstrations. Prior to\nawarding grants, the commissioner shall first take into consideration\nother financial resources available to the applicant to conduct such\nplanning.\n 4. In order to be eligible for a grant under this section, applicants\nshall prepare and submit to the commissioner, the temporary statewide\nhealth care advisory board, and the respective health systems agency an\napplication which contains the following:\n (a) identification of the principal investigator or applicant for the\ndemonstration;\n (b) a description of the nature and scope of the activities\ncontemplated;\n (c) a description of the geographic area and populations currently\nserved by the entity;\n (d) a description of the community or population to be served;\n (e) a description of the anticipated benefits and advantages to\nproviders and consumers of services;\n (f) a description of the estimated expenses, including administrative\nexpenses, which will be incurred in the development of the\ndemonstration; and\n (g) the time frame proposed for the development of the health network,\nglobal budgeting demonstration, or health care demonstration.\n (h) the process that the eligible organization used in seeking public\nparticipation and local involvement in the development of the program\nplan; and\n (i) the goals of the program, including information on how the program\nplan will maintain and promote access to and delivery of high quality,\nappropriate health or health related items and services for persons\nresiding in the region covered by the program.\n 5. Any grant recipient seeking to implement a proposal developed\npursuant to this section, except recipients of health networking grants,\nshall submit such proposal to the temporary statewide health advisory\nboard, in such form and content determined by the board, which shall\nevaluate such proposal and consider whether the proposal is likely to:\n (a) aid in meeting the priority health needs and concerns in the\nregion as identified in and supported by evidence in the proposal and\nconsistent with recommendations of the regional health systems agency;\n (b) enhance the quality of care as evidenced by outcome indicators;\n (c) improve the cost-effectiveness of services by the entities\ninvolved;\n (d) improve the efficient utilization of the entities' resources and\ncapital equipment;\n (e) enhance the provision of services that would otherwise not be\navailable;\n (f) result in the elimination of unnecessary duplication of resources;\n (g) reduce costs to individuals being served by the network;\n (h) foster information sharing, communications and cooperation between\nhealth care providers; and\n (i) foster and improve the management and continuity of care.\n 6. In addition, the board shall require that the proposal contain\nassurances that there will be equitable provider involvement in the\ndetermination of any rates and rate setting methodology. The board shall\nalso require a description of how the proposed initiative will be\nevaluated and assurance that the grantee will submit annual reports to\nthe governor and legislature concerning the status and experiences of\nthe initiative.\n 7. The temporary statewide health advisory board shall forward only\nproposals recommended for operation to the commissioner for\nauthorization. In granting his authorization, the commissioner shall\ncertify that the proposal will:\n (a) improve the cost effectiveness of health care services;\n (b) improve the quality of care delivered as evidenced by outcome\nindicators; and\n (c) improve access to appropriate health care services.\n 8. Upon request by an applicant or grantee the commissioner and the\nrespective health system agency shall provide technical assistance.\n 9. The commissioner shall submit to the chairs of the senate finance\ncommittee and the assembly ways and means committee and the chairs of\nthe assembly and senate health committees, a copy of any proposal\nauthorized by the commissioner pursuant to this section not more than\nthirty days after approval.\n 10. With the exception of health networks, global budgets or health\ncare demonstrations that seek to implement alternative reimbursement\nmethodologies in general hospital settings only and/or for ambulatory\nservices associated with general hospital outpatient and diagnostic and\ntreatment center settings regarding payment for the medical assistance\nprogram, as provided for in subdivisions ten and eleven of section\ntwenty-eight hundred seven of this article, no health network, global\nbudget or health care demonstration that seeks to implement alternative\nreimbursement methodologies shall be approved or implemented without\napproval pursuant to a chapter of the laws to be enacted by the\nlegislature.\n * NB Expired June 30, 1996\n