New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter XII - Innovative Delivery Models
Part 1003 - Accountable Care Organizations
Section 1003.9 - Quality Management and Improvement Program

(a) An ACO must develop and implement a quality management and improvement program that is supervised by a medical director and shall include organizational arrangements and ongoing procedures for the identification, evaluation, resolution and follow-up of potential and actual problems in health care administration and delivery.

(b) A health care information system shall be maintained that collects, analyzes, integrates and reports data necessary to develop and implement the quality management program.

(c) The quality management procedures shall include defined methods for the identification and selection of standardized quality measures applicable to the populations served by the ACO. Quality performance metrics are to be derived from multiple sources, including but not limited to administrative (claims and encounter) data, medical record reviews, participant complaints, consumer surveys, disease registries and other data sources as deemed necessary. The ACO shall address deficiencies identified through these processes using a standard quality improvement methodology.

(d) The ACO shall have a process for peer review to monitor provider performance.

(e) The ACO shall have a process for ensuring licensed, certified and/or registered health care professionals meet and maintain standards for the practice of their profession.

(f) The Commissioner shall have the right to review documents such as meeting minutes, and/or other materials related to the quality management and improvement program to ensure that an appropriate quality management and improvement program is in place.