New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter XII - Innovative Delivery Models
Part 1003 - Accountable Care Organizations
Section 1003.14 - Legal Protections; State Action Immunity
Current through Register Vol. 46, No. 12, March 20, 2024
(a)
In determining whether to provide state action immunity, the Department may impose such conditions as necessary to ensure that the activities of the ACO are consistent with the purposes of Article 29-E and/or are necessary to ameliorate any potential disadvantages.
If the Department determines to provide state action immunity, such determination shall be reflected on the certificate of authority or in an amendment thereto. In such case, the State shall provide active state supervision and the ACO shall provide such materials or information as is requested by the Department for such purpose.
(b) An ACO certified pursuant to this Part shall not be considered to be in violation of Article 131-A of the Education Law relating to fee splitting in the following circumstances:
(c) Health care providers, as defined in Title 2-D of Article 2 of the Public Health Law, who participate in or contract with an ACO certified pursuant to this Part, and who make referrals to other health care providers within the scope of the ACO's functions, activities and services, shall not be considered to be in violation of Title 2-D of Article 2 of the Public Health Law relating to health care practitioner referrals.
(d) A medical assistance provider, as defined in section 366-d of the Social Services Law, that enters into arrangements with an ACO certified pursuant to this Part, one or more of its ACO participants, or a combination thereof, shall not be in violation of section 366-d of the Social Services Law.
(e) In order to obtain the protections under subdivisions (b), (c), (d) and (e) of this section, contracts or arrangements shall be authorized as reasonably related to the purposes of the ACO and contemporaneously documented by the governing body of the ACO and a description of the contract or arrangement shall be publicly disclosed;
(f) The provision of health care services directly or indirectly by an ACO certified pursuant to this Part shall not be considered the practice of a profession under Title 8 of the Education Law.