§ 2999-P — Establishment of ACOs

§ 2999-p. Establishment of ACOs. 1. An accountable care organization:\n(a) is an organization of clinically integrated health care providers\nthat work together to provide, manage, and coordinate health care\n(including primary care) for a defined population; with a mechanism for\nshared governance; the ability to negotiate, receive, and distribute\npayments; and accountability for the quality, cost, and delivery of\nhealth care to the ACO's patients; in accordance with this article; and\n(b) has been issued a certificate of authority by the commissioner under\nthis article.\n 2. The commissioner shall establish a program within the department to\npromote and regulate the use of ACOs to deliver an array of health care\nservices for the purpose of improving the quality, coordination and\naccountability of services provided to patients in New York.\n 3. The commissioner may issue a certificate of authority to an entity\nthat meets conditions for ACO certification as set forth in regulations\nmade by the commissioner pursuant to section twenty-nine hundred\nninety-nine-q of this article. The commissioner shall not issue any new\ncertificate under this article after December thirty-first, two thousand\ntwenty-eight.\n 4. (a) Notwithstanding subdivision three of this section, the\ncommissioner shall issue a certificate of authority as a Medicare-only\nACO to an entity authorized by CMS to be an accountable care\norganization under the Medicare program, upon receiving an application\nto be a Medicare-only ACO from the entity documenting its status under\nthis subdivision. A certificate of authority under this subdivision\nshall only apply to the Medicare-only ACO's actions in relation to\nMedicare beneficiaries under its authorization from CMS.\n (b) To the extent consistent with CMS regulations, a Medicare-only ACO\nshall be subject to:\n (i) subdivision seven of section twenty-nine hundred ninety-nine-q and\nsubdivisions one, two and three of section twenty-nine hundred\nninety-nine-r of this article, without regard to whether the\ncommissioner has made regulations under this article; and\n (ii) other provisions of this article to the extent specifically\nprovided by the commissioner in regulations consistent with this\narticle.\n 5. The commissioner may limit, suspend, or terminate a certificate of\nauthority if an ACO is not operating in accordance with this article.\n 6. The commissioner is authorized to seek federal approvals and\nwaivers to implement this article, including but not limited to those\napprovals or waivers necessary to obtain federal financial\nparticipation.\n