Current through Register Vol. 45, No. 52, December 27, 2023
(a)
(1) The
proposed ACO shall be a business corporation, not-for-profit corporation,
limited liability company or partnership formed under the laws of New York
State.
(2) A foreign corporation,
limited liability company or partnership shall not be a proper applicant for a
certificate of authority.
(3) If an
ACO is formed among multiple independent ACO participants, it must be formed as
a legal entity separate and apart from any of the ACO participants.
(4) No person shall file a certificate of
incorporation or articles of organization, or amendment thereto, containing
powers related to the operation of an ACO, or an independent practice
association acting as an ACO, with the Secretary of State, without first having
submitted the proposed certificate, articles or amendment to the Commissioner
for his or her review and approval.
(b) Upon obtaining a certificate of
authority, the ACO shall be authorized and required to establish, own, operate
and manage an ACO of clinically integrated independent health care providers
that work together through a shared governance structure to:
(1) Provide, manage and coordinate health
care including primary care, for a defined population focusing on patient
centeredness, patient engagement and promoting evidence-based
medicine;
(2) Be accountable for
quality, cost, and delivery of health care to ACO patients;
(3) Negotiate, receive and distribute any
shared savings or losses; and
(4)
Establish, report and ensure provider compliance with health care criteria
including quality performance standards.
(c) The ACO shall, and shall require its
participants, to:
(1) Provide notification to
their patients at the point of care that the ACO participants are participating
in an ACO pursuant to a certificate of authority issued by the
Department;
(2) Post signs in their
facilities to notify patients that they are participating in an ACO pursuant to
a certificate of authority issued by the Department;
(3) Make available to patients upon request
standardized written notices approved by the Department regarding participation
in an ACO;
(4) Prohibit the
provision of gifts or other remuneration to patients as inducements for
receiving items or services from or remaining in an ACO or with ACO
participants.
(5) Marketing
materials promoting the ACO must:
(i) Use
template language developed by the Department, if available;
(ii) Not be used in a discriminatory manner
or for discriminatory purposes; and
(iii) Comply with paragraph (4) of this
subdivision regarding inducements.
(d) The powers and purposes of the ACO shall
include the following:
(1) Notwithstanding any
other provision to the contrary, nothing contained herein shall, except to the
extent the corporation or company has already received certification or
licensure, authorize the corporation or company to:
(i) Establish, operate, construct, lease or
maintain a hospital or to provide hospital services or health-related services
or to operate a certified home health agency, a hospice, or a managed care
organization, or to provide a comprehensive health services plan as defined and
covered by Articles 28, 36, 40, and 44 of the Public Health Law, respectively,
including to solicit, collect, or otherwise raise or obtain any funds,
contributions or grants from any source for the establishment or operation of
any hospital;
(ii) Establish,
operate, construct, lease or maintain an adult care facility as provided by
Article 7 of the Social Services Law, including to solicit, collect or
otherwise raise or obtain funds, contributions or grants from any source for
the establishment or operation of any such facility; and
(iii) Engage in the business of insurance
unless authorized by a valid license in force and effect issued pursuant to or
exempt under this Part or the Insurance Law.
(e) Expand the purposes and powers beyond the
corporation's or company's current certification or licensure without seeking
the appropriate regulatory approvals.
(f) If the ACO is formed as a partnership,
the partnership agreement must contain the purposes and powers required in
subdivision (d) of this section.
(g) Notwithstanding the provisions of
sections
98-1.2(w)
and
98-1.5(b)(6)(vii)
of Part 98 of this Title, an independent practice association may be an ACO
participant or may be certified as an ACO pursuant to Article 29-E of the
Public Health Law and this Part.
(1) An
independent practice association certified as an ACO under this Part may,
subject to any limitations contained in its certificate of authority, also
contract with third party health care payers.
(2) The functions, activities and services
undertaken by the independent practice association acting as an ACO shall be
clearly distinguished from its functions, activities and services as an
independent practice association through the maintenance of separate records,
reports and accounts for the ACO.
(h) A health home certified as an ACO under
this Part, subject to any limitation contained in its certificate of authority,
may contract with third party health care payers.
(i) A Medicare-only ACO that applied for a
certificate of authority pursuant to Article 29-E of the Public Health Law
prior to adoption of this Part, within ninety days of adoption, shall amend its
certificate of incorporation, articles of organization or partnership agreement
to comply with the requirements of this section.
Adopted,
New
York State Register December 31, 2014/Volume XXXVI, Issue 52,
eff. 12/31/2014