Current through Register Vol. 46, No. 39, September 25, 2024
(a) Network operational plan shall mean a
written plan, including periodic updates of such a plan, prepared by a CSFRHN,
with the involvement of consumers unaffiliated with health care providers,
describing the steps to be taken by such network and its participating
providers to enhance access, by residents of the affected rural area, including
special populations, to necessary health care services while promoting cost
efficiencies in the provision of services.
(b) The commissioner shall not approve a
network operational plan until he/she has considered the recommendations of the
HSA(s) having jurisdiction in the region in which the network intends to
operate and is satisfied that the plan complies with the provisions of section
2957 of the
Public Health Law, and meets the following requirements:
(1) establishes an organizational structure
that includes a decisionmaking structure representative of participating
providers and consumers, mission statement, goals, operating principles, and
written agreements between the network and all affiliated providers, copies of
which shall be submitted with a proposed plan;
(2) provides for the delivery of at least
acute care, comprehensive primary care, and emergency medical care;
(3) ensures the provision of appropriate high
quality health care services in accordance with prevailing standards of care
and practice. At a minimum the plan shall demonstrate that:
(i) the roles and responsibilities of the
network and its participating providers in quality assurance/improvement
activities are identified. Quality assurance/improvement activities conducted
by the network on behalf of one or more of its participating providers shall be
specifically delineated;
(ii) a
strategy for monitoring, coordinating and assuring that the quality
assurance/improvement programs of network participants comply with existing
criteria and standards applicable to participants. At a minimum this strategy
shall assure that:
(a) both process and
outcome based measures are included in network provider quality assessment
programs;
(b) a network-wide
communication and information system, or plans for such system, is available
and contains the capacity to track patients throughout the system and provide
network providers with the necessary information to enhance continuity of care;
and
(c) procedures will be in place
that delineate the duties and responsibilities of medical/professional and
ancillary support staff necessary to ensure the provision of high quality
services by network provider;
(4) ensures that all potential patients in
the network service area have access to necessary services. At a minimum the
plan shall provide assurances that:
(i)
residents of the network service area shall be provided with information
sufficient to make them aware of available services;
(ii) providers of the three required minimum
services are located so as to ensure reasonable access to services by all
residents of the area served by the network as determined by the commissioner;
and
(iii) on-call systems are in
place to provide 24-hour a day coverage within the network for at least the
three required minimum services in settings appropriate to patient
needs;
(5) provides for
the efficient and effective coordination of affiliated network providers in
planning and evaluating both the integration and provision of services. At a
minimum this element of a network operational plan shall include:
(i) an organizational structure, or plans for
such structure, for ensuring coordination among network members and other
appropriate agencies involved in planning for health and health related
services in the network's service area; and
(ii) a coordinated system for developing and
using community service plans, county municipal health plans, and other
appropriate existing or proposed health plans such as those of appropriate
state and regional agencies including the HSAs;
(6) provides for the pooling and sharing of
existing resources to facilitate greater system efficiencies; and
(7) establishes terms and conditions to
ensure that no hospital, physician or other licensed or certified health care
provider operating in good standing, serving the network service area, and
willing to meet the terms and conditions of the network as defined in the
network operational plan, shall be denied the ability to participate therein.
Such terms and conditions may include, but need not be limited to, a
prospective participant's ability to deliver services in accordance with
prevailing standards of care and/or practice and a participant's willingness to
participate in coordinated network quality assurance and improvement programs,
peer review programs, credentialing systems, utilization review programs,
medical record systems, consultation services, specialty services,
communications systems and data collection systems. Such terms and conditions
may also include provisions for the payment and reimbursement of services
provided by network participants.
(c) Periodic updates and revisions of network
operational plans. The governing board of a central services facility rural
health network shall annually review the network's operational plan, and amend
it as necessary subject to the prior approval of the commissioner.
(1) When an operational plan is proposed to
be amended, the network shall simultaneously notify the commissioner and the
health systems agency (HSA) having geographical jurisdiction in the region in
which the network operates or intends to operate regarding all such proposed
amendments. The network shall also provide reasonable prior notification to the
public, by publication in a newspaper of general circulation in the service
area, and through such other media as the network deems appropriate, of all
significant amendments as described below.
(2) If, upon review, the commissioner finds
that such amendment(s) are significant, he shall not issue a determination
concerning such amendment(s) until he has received the recommendations of the
health systems agency having jurisdiction. Significant amendments shall include
but need not be limited to those materially affecting any of the criteria set
forth in subdivision (3) of section
2957 of the
Public Health Law, additions or deletions of network participants and changes
in the geographic area being served by the network. In the event that a
significant overlap in the service areas of two or more CSFRHNs is proposed,
the commissioner may require one or more of the CSFRHNs to amend its defined
service area.
(d) Upon
request of a CSFRHN, through its proposed network operational plan, or a
proposed amendment thereto, the commissioner may permit the network to make
application for, or fulfill regulatory requirements on behalf of, network
participating providers for purposes including, but not necessarily limited to,
certificate of need, quality assurance, reimbursement, and professional
credentialing and privileging.
(e)
All amendments shall be described in an annual report which shall be submitted
to the commissioner no later than March 31st of the following year. Such report
shall describe in detail the manner and extent to which a network and its
affiliated providers have achieved the efficiencies proposed in the network
operational plan and have effected increased access to necessary health care
services.
(f) No CSFRHN shall
discontinue operation or implementation of a network operational plan unless it
has first received the commissioner's approval of a plan of closure pursuant to
section 401.3(g)-(j) of
this Title.
