Relates to accountable care organizations which are certified by the department of health to provide integrated health services and reduce health care costs.

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S6228A-2011 Actions

• Jun 21, 2012: SUBSTITUTED BY A8869B
• Jun 21, 2012: ORDERED TO THIRD READING CAL.1465
• Jun 21, 2012: COMMITTEE DISCHARGED AND COMMITTED TO RULES
• Jun 12, 2012: PRINT NUMBER 6228B
• Jun 12, 2012: AMEND AND RECOMMIT TO FINANCE
• Jun 5, 2012: REPORTED AND COMMITTED TO FINANCE
• May 29, 2012: PRINT NUMBER 6228A
• May 29, 2012: AMEND (T) AND RECOMMIT TO HEALTH
• Jan 13, 2012: REFERRED TO HEALTH

S6228A-2011 Meetings

Health: Jun 5, 2012

S6228A-2011 Votes

S6228A-2011 Memo

BILL NUMBER:S6228A         REVISED 06/12/12

TITLE OF BILL:
An act
to amend the public health,
in relation to accountable care organizations

PURPOSE:
To regulate and promote the formation of accountable care
organizations and protect the public interest and the interests of
patients and health care providers.

SUMMARY OF PROVISIONS:
Amends Article 29-E of the Public Health Law to remove the
"demonstration" designation of the ACO program and remove the cap on
the number of certificates of authority for accountable care
organizations (ACO). The sunset of authority for the issuance of ACO
certificates is extended from December 31, 2015 to December 31, 2016.

Provides for an expedited state certificate of authority to a
federally authorized Medicare only ACO. To enable Medicare-only ACOs
to begin functioning, the law's protections of an ACO from state laws
relating to anti-trust, restraint of trade, fee-splitting, as well as
protection for peer-review activities, would be granted to
Medicare-only ACOs regardless of whether the Commissioner has made
regulations on those items. Other provisions of Article 29-E not
requiring rulemaking would immediately apply to Medicare-only ACOs,
including section 2999-g, subdiv. 7, which clarifies that the
provision of services by an ACO be construed as the practice of a
profession under title 8 of the Education Law.

Requires that an ACO shall have a governance system, modeled on the
federal ACO governance regulations, that represents the participating
health care providers and patients.

Requires the commissioner to provide public disclosure of additional
statistical data relating to services, performance, quality and
payment measures.

The ACO shall use best efforts to include federally-qualified health
centers that are willing and available to join the ACO on reasonable
terms.

An ACO may seek to focus on providing health care services to patients
with one or more chronic conditions or special needs. However, an ACO
may not otherwise, on the basis of a person's medical or demographic
characteristics, discriminate for or against or discourage or
encourage any person or persons with respect to enrolling or
participating in the ACO.

An ACO shall not, by incentives or otherwise, discourage a health care
provider from providing or an enrollee or patient from seeking
appropriate health care services.

An ACO shall not discriminate against or disadvantage a patient or
patient's representative for the exercise of patient autonomy.

Patient, and health care provider participation in an ACO shall be on
a voluntary basis.

Authorizes the commissioner to seek federal grants, approvals and
waivers to facilitate the development of ACOs, and requires detailed
disclosure of such applications to the legislature.

Allows a third-party payer to offer incentives for consumers to
participate in an ACO and prohibits discriminating against a consumer
for participating.

An ACO may seek to focus on providing health care services to patients
with one of more chronic conditions or special needs. However, an ACO
may not otherwise, on the basis of a person's medical or demographic
characteristics, discriminate for or against or discourage or
encourage any person or persons with respect to enrolling or
participating in the ACO. An ACO shall not, by incentives or
otherwise, discourage a health care provider from providing or an
enrollee or patient from seeking appropriate health care services. An
ACO shall not discriminate against or disadvantage a patient or
patient's representative for the exercise of patient autonomy.

The bill amends section 2818 of the Public Health Law to allow HEAL-NY
funding for allocation by the commissioner in relation to the
development of ACOs without competitive bid.

DOH would have authority to provide technical assistance to health
care providers and consumer assistance in a program, and to provide
assistance to the establishment of programs.

A workgroup will consider how to include ACOs in Medicaid managed care
and other Medicaid care management programs.

JUSTIFICATION:
In 2011 the Legislature established a demonstration program for
establishing accountable care organizations. ACO legislation was
needed first to provide a legal "safe harbor" for payers and
providers to come together without violating anti-trust and other
laws. Second, Medicaid and other payers need legal authority to
participate in new payment methodologies with ACOs.

However, the third, and perhaps most important need, to protect the
rights and interests of patients, health care providers, and the
general public, was only partly addressed. For this reason, and

because of the newness of the ACO concept, the law allowed DOH to
certify only 7 ACOs.

Since the passage of the demonstration program it has become clear
that the limitation on the number of allowed ACOs is limiting the
ability of New York organizations to apply for federal ACO designation.
The bill provides a more complete legal structure for ACOs.
Strengthening protections for patients and providers goes hand in
hand with the removal of the limit on the number of ACOS that may be
authorized.

LEGISLATIVE HISTORY:
New bill.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
Immediately.

S6228A-2011 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                   6228--A

                              I N  SENATE

                              January 13, 2012
                                 ___________

  Introduced  by Sens. HANNON, GOLDEN, JOHNSON, LARKIN, MARTINS, McDONALD,
    RANZENHOFER -- read twice and ordered printed, and when printed to  be
    committed  to  the  Committee  on Health -- committee discharged, bill
    amended, ordered reprinted as amended and recommitted to said  commit-
    tee

  AN  ACT  to  amend  the  public  health, in relation to accountable care
    organizations

    THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
  BLY, DO ENACT AS FOLLOWS:


    Section  1. Article 29-E of the public health law, as added by section
  66 of part H of chapter 59 of the laws of 2011, is amended  to  read  as
  follows:

                                ARTICLE 29-E
           ACCOUNTABLE CARE ORGANIZATIONS [DEMONSTRATION PROGRAM]
  Section 2999-n. Accountable care organizations; findings; purpose.
          2999-o. Definitions.
          2999-p. Establishment of [ACO demonstration program] ACOS.
          2999-q. Accountable care organizations; requirements.
          2999-r. Other laws.
    S  2999-n.  Accountable  care  organizations;  findings; purpose. [The
  legislature intends to test the ability of  accountable  care  organiza-
  tions  to  assume a role in delivering an array of health care services,
  from primary and preventive care through acute  inpatient  hospital  and
  post-hospital care.] The legislature finds that the formation and opera-
  tion  of  accountable care organizations under this article, and subject
  to appropriate regulation, can be consistent with the purposes of feder-
  al and state anti-trust, anti-referral, and  other  statutes,  including
  reducing  over-utilization  and expenditures. The legislature finds that
  the development of accountable care  organizations  under  this  article
  will  reduce  health  care costs, promote effective allocation of health
  care resources, and enhance the  quality  and  accessibility  of  health
  care.  The  legislature  finds that this article is necessary to promote
  the formation of accountable care organizations and protect  the  public
  interest and the interests of patients and health care providers.

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD13268-08-2

 S. 6228--A                          2

    S  2999-o.  Definitions.  As used in this article, the following terms
  shall have the following meanings, unless the context  clearly  requires
  otherwise:

    1.  "Accountable  care organization" or "ACO" means an organization of
  clinically integrated health care providers certified by the commission-
  er under this article.
    2. "ACO PARTICIPANT" OR "PARTICIPANT" MEANS  A  HEALTH  CARE  PROVIDER
  THAT IS ONE OF THE HEALTH CARE PROVIDERS THAT COMPRISE THE ACO.
    3.  Certificate  of authority" or "certificate" means a certificate of
  authority issued by the commissioner under this article.
    [3.] 4. "CMS" MEANS THE FEDERAL  CENTERS  FOR  MEDICARE  AND  MEDICAID
  SERVICES.
    5. "CMS REGULATIONS" MEANS APPLICABLE FEDERAL LAWS AND CMS REGULATIONS
  AND POLICIES.
    6.  "Health  care  provider"  includes but is not limited to an entity
  licensed or certified under article twenty-eight or thirty-six  of  this
  chapter;  an entity licensed or certified under article sixteen, thirty-
  one or thirty-two of the mental hygiene law; or a  health  care  practi-
  tioner licensed or certified under title eight of the education law or a
  lawful  combination  of  such  health  care  practitioners; and may also
  include, to the extent provided by regulation of the commissioner, other
  entities that provide  technical  assistance,  information  systems  and
  services,  care coordination and other services to health care providers
  and patients participating in an ACO.
    [4.] 7. "MEDICARE-ONLY ACO" MEANS  AN  ACO  ISSUED  A  CERTIFICATE  OF
  AUTHORITY  UNDER SUBDIVISION FOUR OF SECTION TWENTY-NINE HUNDRED NINETY-
  NINE-P OF THIS ARTICLE.
    8. "Primary care" means the health care  fields  of  family  practice,
  general pediatrics, primary care internal medicine, primary care obstet-
  rics, or primary care gynecology, without regard to board certification,
  provided by a health care provider acting within his, her, or its lawful
  scope of practice.
    [5.]  9. "Third-party health care payer" has its ordinary meanings and
  may include any entities provided for by regulation of the commissioner,
  which may include an entity such as a pharmacy benefits manager,  fiscal
  administrator,  or administrative services provider that participates in
  the administration of a third-party health care payer system.
    [6. Any references to the "department of financial services"  and  the
  "superintendent of financial services" in this article shall mean, prior
  to  October third, two thousand eleven, respectively, the "department of
  insurance" and the "superintendent of insurance."]
    S 2999-p. Establishment of [ACO demonstration  program]  ACOS.  1.  An
  accountable  care  organization:  (a)  is  an organization of clinically
  integrated health care providers that work together to provide,  manage,
  and  coordinate health care (including primary care) for a defined popu-
  lation; with a mechanism for shared governance; the ability  to  negoti-
  ate, receive, and distribute payments; and accountability for the quali-
  ty,  cost,  and  delivery  of  health  care  to  the  ACO's patients; in
  accordance with this article; and (b) has been issued a  certificate  of
  authority by the commissioner under this article.
    2.  The  commissioner shall establish a [demonstration] program within
  the department to [test the ability] PROMOTE AND  REGULATE  THE  USE  of
  ACOs  to  deliver  an  array  of health care services for the purpose of
  improving the  quality,  coordination  and  accountability  of  services
  provided to patients in New York.

 S. 6228--A                          3

    3.  The commissioner may issue a certificate of authority to an entity
  that meets conditions for ACO certification as set forth in  regulations
  [promulgated]  MADE  by the commissioner pursuant to section twenty-nine
  hundred ninety-nine-q of this article. The commissioner shall not [issue
  more  than  seven  certificates under this article, and shall not] issue
  any new certificate under this article after December thirty-first,  two
  thousand [fifteen] SIXTEEN.
    4.  (A) NOTWITHSTANDING SUBDIVISION THREE OF THIS SECTION, THE COMMIS-
  SIONER SHALL ISSUE A CERTIFICATE OF AUTHORITY AS A MEDICARE-ONLY ACO  TO
  AN ENTITY AUTHORIZED BY CMS TO BE AN ACCOUNTABLE CARE ORGANIZATION UNDER
  THE   MEDICARE   PROGRAM,   UPON   RECEIVING  AN  APPLICATION  TO  BE  A
  MEDICARE-ONLY ACO FROM THE ENTITY  DOCUMENTING  ITS  STATUS  UNDER  THIS
  SUBDIVISION.  A  CERTIFICATE  OF  AUTHORITY UNDER THIS SUBDIVISION SHALL
  ONLY APPLY TO THE MEDICARE-ONLY ACO'S ACTIONS IN  RELATION  TO  MEDICARE
  BENEFICIARIES UNDER ITS AUTHORIZATION FROM CMS.
    (B) TO THE EXTENT CONSISTENT WITH CMS REGULATIONS, A MEDICARE-ONLY ACO
  SHALL BE SUBJECT TO:

    (I)  SUBDIVISIONS  ONE,  TWO  AND THREE OF SECTION TWENTY-NINE HUNDRED
  NINETY-NINE-R OF THIS ARTICLE, WITHOUT REGARD TO WHETHER THE COMMISSION-
  ER HAS MADE REGULATIONS UNDER THIS ARTICLE; AND
    (II) OTHER PROVISIONS OF  THIS  ARTICLE  TO  THE  EXTENT  SPECIFICALLY
  PROVIDED  BY  THE COMMISSIONER IN REGULATIONS CONSISTENT WITH THIS ARTI-
  CLE.
    5. The commissioner may limit, suspend, or terminate a certificate  of
  authority if an ACO is not operating in accordance with this article.
    [5.]  6.  The commissioner is authorized to seek federal approvals and
  waivers to implement this article, including but not  limited  to  those
  approvals  or  waivers  necessary  to  obtain  federal financial partic-
  ipation.
    S 2999-q. Accountable care organizations; requirements. 1. The commis-
  sioner shall [promulgate] MAKE  regulations  establishing  criteria  for
  certificates   of  authority,  quality  standards  for  ACOs,  reporting
  requirements and other matters deemed to be appropriate and necessary in
  the operation and evaluation of [the demonstration program]  ACOS  UNDER
  THIS ARTICLE. In [promulgating] MAKING such regulations, the commission-
  er  shall  consult with the superintendent of financial services, health
  care providers, third-party health care payers,  advocates  representing
  patients,  and  other  appropriate  parties.  SUCH  REGULATIONS SHALL BE
  CONSISTENT, TO THE EXTENT PRACTICAL AND CONSISTENT  WITH  THIS  ARTICLE,
  WITH  CMS REGULATIONS FOR ACCOUNTABLE CARE ORGANIZATIONS UNDER THE MEDI-
  CARE PROGRAM.
    2. Such regulations may, and shall as necessary for purposes  of  this
  article, address matters including but not limited to:

    (a)  The  governance,  leadership  and management structure of the ACO
  THAT REASONABLY AND EQUITABLY REPRESENTS THE ACO'S PARTICIPANTS AND  THE
  ACO'S  PATIENTS,  including the manner in which clinical and administra-
  tive systems and clinical participation will be managed;
    (b) Definition of the population proposed to be  served  by  the  ACO,
  which  may  include reference to a geographical area and patient charac-
  teristics;
    (c) The character, competence and fiscal responsibility and  soundness
  of an ACO and its principals, if and to the extent deemed appropriate by
  the commissioner;
    (d)  The  adequacy  of  an  ACO's network of participating health care
  providers, including primary care health care providers;

 S. 6228--A                          4

    (e) Mechanisms by which an ACO will provide,  manage,  and  coordinate
  quality health care for its patients [and provide] INCLUDING WHERE PRAC-
  TICABLE  ELEVATING THE SERVICES OF PRIMARY CARE HEALTH CARE PROVIDERS TO
  MEET PATIENT-CENTERED MEDICAL HOME STANDARDS, COORDINATING SERVICES  FOR
  COMPLEX  HIGH-NEED PATIENTS, AND PROVIDING access to health care provid-
  ers that are not participants in the ACO;
    (f) Mechanisms by which the ACO shall receive and distribute  payments
  to  its participating health care providers, which may include incentive
  payments (WHICH MAY INCLUDE MEDICAL HOME  PAYMENTS)  or  mechanisms  for
  pooling  payments  received  by participating health care providers from
  third-party payers and patients;
    (g) Mechanisms and criteria for accepting  health  care  providers  to
  participate  in  the  ACO  that  are related to the needs of the patient
  population to be served and needs and purposes of the ACO, and  prevent-
  ing unreasonable discrimination;
    (h)  Mechanisms  for  quality  assurance  and grievance procedures for
  patients or health care providers where appropriate, AND PROCEDURES  FOR
  REVIEWING AND APPEALING PATIENT CARE DECISIONS;
    (i)  Mechanisms  that  promote  evidence-based  health  care,  patient
  engagement, coordination of care, electronic health  records,  including
  participation  in  health  information  exchanges,  [and] other enabling
  technologies  AND  INTEGRATED,  EFFICIENT  AND  EFFECTIVE  HEALTH   CARE
  SERVICES;
    (j) Performance standards for, and measures to assess, the quality and
  utilization of care provided by an ACO;
    (k)  Appropriate  requirements for ACOs to promote compliance with the
  purposes of this article;
    (l) Posting on the department's website information  about  ACOs  that
  would be useful to health care providers and patients, INCLUDING SIMILAR
  METRICS  AS  THE  COMMISSIONER PUBLISHES FOR OTHER ORGANIZATIONS SUCH AS
  MEDICAID MANAGED CARE PROVIDERS UNDER SECTION THREE HUNDRED SIXTY-FOUR-J
  OF THE SOCIAL SERVICES LAW AND HEALTH HOMES UNDER SECTION THREE  HUNDRED
  SIXTY-FIVE-L OF THE SOCIAL SERVICES LAW;
    (m)  Requirements  for  the submission of information and data by ACOs
  and their participating and affiliated health care providers  as  neces-
  sary  for  the  evaluation of the success of [the demonstration program]
  ACOS;
    (n) Protection of patient rights as appropriate;
    (o) The impact of the establishment and  operation  of  an  ACO  [on],
  INCLUDING PROVIDING THAT IT SHALL NOT DIMINISH access to any health care
  service FOR THE POPULATION SERVED AND in the area served; and
    (p) Establishment of standards, as appropriate, to promote the ability
  of an ACO to participate in applicable federal programs for ACOs.
    3.  (A)  THE  ACO  SHALL  PROVIDE  FOR MEANINGFUL PARTICIPATION IN THE
  COMPOSITION AND CONTROL OF THE ACO'S GOVERNING BODY FOR ACO PARTICIPANTS
  OR THEIR DESIGNATED REPRESENTATIVES.
    (B) THE ACO GOVERNING BODY SHALL INCLUDE AT LEAST  ONE  REPRESENTATIVE
  OF  EACH  OF  THE  FOLLOWING  GROUPS: (I) RECIPIENTS OF MEDICAID, FAMILY
  HEALTH PLUS, OR CHILD HEALTH PLUS; (II) PERSONS WITH OTHER HEALTH COVER-
  AGE; AND (III) PERSONS WHO DO NOT HAVE HEALTH COVERAGE.  SUCH  REPRESEN-
  TATIVES SHALL HAVE NO CONFLICT OF INTEREST WITH THE ACO AND NO IMMEDIATE
  FAMILY MEMBER WITH A CONFLICT OF INTEREST WITH THE ACO.
    (C)  AT LEAST SEVENTY-FIVE PERCENT CONTROL OF THE ACO'S GOVERNING BODY
  SHALL BE HELD BY ACO PARTICIPANTS.

 S. 6228--A                          5

    (D) MEMBERS OF THE ACO GOVERNING BODY SHALL HAVE A FIDUCIARY RELATION-
  SHIP WITH THE ACO AND SHALL BE SUBJECT TO CONFLICT OF INTEREST  REQUIRE-
  MENTS ADOPTED BY THE ACO AND IN REGULATIONS OF THE COMMISSIONER.
    (E)  THE ACO'S FINANCES, INCLUDING DIVIDENDS AND OTHER RETURN ON CAPI-
  TAL, DEBT STRUCTURE, EXECUTIVE COMPENSATION, AND ACO PARTICIPANT COMPEN-
  SATION, SHALL BE ARRANGED AND CONDUCTED TO MAXIMIZE THE  ACHIEVEMENT  OF
  THE PURPOSES OF THIS ARTICLE.
    4.  (A) AN ACO SHALL USE ITS BEST EFFORTS TO INCLUDE AMONG ITS PARTIC-
  IPANTS, ON REASONABLE  TERMS  AND  CONDITIONS,  ANY  FEDERALLY-QUALIFIED
  HEALTH  CENTER  THAT  IS WILLING TO BE A PARTICIPANT AND THAT SERVES THE
  AREA AND POPULATION SERVED BY THE ACO.
    (B) AN ACO MAY SEEK TO FOCUS ON  PROVIDING  HEALTH  CARE  SERVICES  TO
  PATIENTS  WITH ONE OR MORE CHRONIC CONDITIONS OR SPECIAL NEEDS. HOWEVER,
  AN ACO MAY NOT OTHERWISE, ON THE BASIS OF A PERSON'S  MEDICAL  OR  DEMO-
  GRAPHIC  CHARACTERISTICS,  DISCRIMINATE  FOR OR AGAINST OR DISCOURAGE OR
  ENCOURAGE ANY PERSON OR PERSON WITH RESPECT TO ENROLLING OR  PARTICIPAT-
  ING IN THE ACO.
    (C)  AN ACO SHALL NOT, BY INCENTIVES OR OTHERWISE, DISCOURAGE A HEALTH
  CARE PROVIDER FROM PROVIDING OR AN  ENROLLEE  OR  PATIENT  FROM  SEEKING
  APPROPRIATE HEALTH CARE SERVICES.
    (D) AN ACO SHALL NOT DISCRIMINATE AGAINST OR DISADVANTAGE A PATIENT OR
  PATIENT'S REPRESENTATIVE FOR THE EXERCISE OF PATIENT AUTONOMY.
    (E) AN ACO MAY NOT LIMIT OR RESTRICT BENEFICIARIES TO USE OF PROVIDERS
  CONTRACTED  OR AFFILIATED WITH THE ACO. AN ACO MAY NOT REQUIRE A PATIENT
  TO OBTAIN THE PRIOR APPROVAL, FROM A PRIMARY CARE GATEKEEPER  OR  OTHER-
  WISE,  BEFORE  UTILIZING THE SERVICES OF OTHER PROVIDERS. AN ACO MAY NOT
  MAKE ADVERSE DETERMINATIONS AS DEFINED IN  ARTICLE  FORTY-NINE  OF  THIS
  CHAPTER.
    5.    AN  ACO  MAY  PROVIDE  CARE  COORDINATION  FOR ITS PARTICIPATING
  PATIENTS, WHICH (A) SHALL INCLUDE BUT NOT BE LIMITED TO MANAGING, REFER-
  RING TO, LOCATING, COORDINATING, AND MONITORING HEALTH CARE SERVICES FOR
  THE MEMBER TO ASSURE THAT ALL MEDICALLY NECESSARY HEALTH  CARE  SERVICES
  ARE MADE AVAILABLE TO AND ARE EFFECTIVELY USED BY THE MEMBER IN A TIMELY
  MANNER,  CONSISTENT  WITH PATIENT AUTONOMY; AND (B) IS NOT A REQUIREMENT
  FOR PRIOR AUTHORIZATION FOR HEALTH CARE SERVICES, AND REFERRAL SHALL NOT
  BE REQUIRED FOR A MEMBER TO RECEIVE A HEALTH CARE SERVICE.
    6. (a) Subject to regulations of the  commissioner:  (i)  an  ACO  may
  enter  into arrangements with one or more third-party health care payers
  to establish payment methodologies for  health  care  services  for  the
  third-party  health  care  payer's  enrollees provided by the ACO or for
  which the ACO is responsible, such as  full  or  partial  capitation  or
  other arrangements; (ii) such arrangements may include provision for the
  ACO to receive and distribute payments to the ACO's participating health
  care  providers,  including  incentive  payments and payments for health
  care services from third-party health  care  payers  and  patients;  and
  (iii)  an  ACO  may  include mechanisms for pooling payments received by
  participating  health  care  providers  from  third-party   payers   and
  patients.
    (b)  Subject  to regulations of the commissioner, the commissioner, in
  consultation with the superintendent of financial services, may  author-
  ize  a third-party health care payer to participate in payment methodol-
  ogies with an ACO under this subdivision, notwithstanding  any  contrary
  provision  of  this chapter, the insurance law, the social services law,
  or the elder law, on finding that the payment methodology is  consistent
  with the purposes of this article.

 S. 6228--A                          6

    [4.]  (C)  AN ACO MAY CONTRACT WITH A THIRD-PARTY HEALTH CARE PAYER TO
  SERVE AS ALL OR PART OF THE THIRD-PARTY  HEALTH  CARE  PAYER'S  PROVIDER
  NETWORK  OR CARE COORDINATION AGENT, PROVIDED IN THAT CASE THE ACO SHALL
  BE SUBJECT TO ALL PROVISIONS OF THIS CHAPTER OR THE INSURANCE LAW  WHICH
  ARE  APPLICABLE  TO  THE PROVIDER NETWORK OF THE THIRD-PARTY HEALTH CARE
  PAYER.
    7. The provision of health care services directly or indirectly by  an
  ACO  through  health care providers shall not be considered the practice
  of a profession under title eight of the education law by the ACO.
    S 2999-r. Other laws. 1. (a) It is the policy of the state  to  permit
  and  encourage  cooperative,  collaborative and integrative arrangements
  among third-party health care payers and health care providers who might
  otherwise be competitors under the active supervision of the commission-
  er. To the extent that it is necessary to  accomplish  the  purposes  of
  this  article,  competition  may be supplanted and the state may provide
  state action immunity under state and federal antitrust laws  to  payors
  and health care providers.
    (b)  The  commissioner  [may]  SHALL  engage  in  state supervision to
  promote state action immunity under state and federal antitrust laws and
  may inspect, require, or request additional documentation and take other
  actions under this article to verify and make sure that this article  is
  implemented in accordance with its intent and purpose.
    2.  With  respect  to  the  planning, implementation, and operation of
  ACOs, the commissioner, by regulation, [may] SHALL specifically  deline-
  ate  safe harbors that exempt ACOs from the application of the following
  statutes:

    (a) article  twenty-two  of  the  general  business  law  relating  to
  arrangements and agreements in restraint of trade;
    (b)  article one hundred thirty-one-A of the education law relating to
  fee-splitting arrangements; and
    (c) title two-D of article two of this chapter relating to health care
  practitioner referrals.
    3. For the purposes of this article, an ACO shall be deemed  to  be  a
  hospital  for  purposes of sections twenty-eight hundred five-j, twenty-
  eight hundred  five-k,  twenty-eight  hundred  five-l  and  twenty-eight
  hundred  five-m  of  this  chapter  and  subdivisions  three and five of
  section sixty-five hundred twenty-seven of the education law.
    4.  THE COMMISSIONER IS AUTHORIZED TO SEEK FEDERAL GRANTS,  APPROVALS,
  AND  WAIVERS  TO  IMPLEMENT  THIS  ARTICLE,  INCLUDING FEDERAL FINANCIAL
  PARTICIPATION UNDER  PUBLIC  HEALTH  COVERAGE.  THE  COMMISSIONER  SHALL
  PROVIDE  COPIES  OF  APPLICATIONS AND OTHER DOCUMENTS, INCLUDING DRAFTS,
  SUBMITTED  TO  THE  FEDERAL  GOVERNMENT  SEEKING  SUCH  FEDERAL  GRANTS,
  APPROVALS,  AND  WAIVERS  TO THE CHAIRS OF THE SENATE FINANCE COMMITTEE,
  THE ASSEMBLY WAYS AND MEANS  COMMITTEE,  AND  THE  SENATE  AND  ASSEMBLY
  HEALTH  COMMITTEES  SIMULTANEOUSLY  WITH THEIR SUBMISSION TO THE FEDERAL
  GOVERNMENT.
    5. THE COMMISSIONER MAY DIRECTLY, OR BY CONTRACT  WITH  NOT-FOR-PROFIT
  ORGANIZATIONS, PROVIDE:

    (A)  CONSUMER  ASSISTANCE  TO  PATIENTS SERVED BY AN ACO AS TO MATTERS
  RELATING TO ACOS;
    (B) TECHNICAL AND OTHER ASSISTANCE TO HEALTH  CARE  PROVIDERS  PARTIC-
  IPATING IN AN ACO AS TO MATTERS RELATING TO THE ACO;
    (C)  ASSISTANCE  TO  ACOS TO PROMOTE THEIR FORMATION AND IMPROVE THEIR
  OPERATION, INCLUDING ASSISTANCE UNDER SECTION TWENTY-EIGHT HUNDRED EIGH-
  TEEN OF THIS CHAPTER; AND

 S. 6228--A                          7

    (D) INFORMATION SHARING AND OTHER ASSISTANCE AMONG ACOS TO IMPROVE THE
  OPERATION OF ACOS.
    S 2. The commissioner of health shall convene a workgroup to develop a
  proposal  whereby an ACO may serve, in place of a managed care plan: (a)
  Medicaid enrollees otherwise required to participate  in  managed  care,
  care  management, or care coordination under section 364-j of the social
  services law, section 4403-f of the public health law, or other law; and
  (b) enrollees in family health plus  under  section  369-ee  or  section
  369-ff  of  the  social services law and the child health insurance plan
  under title 1-A of article 25 of the public health  law.  The  workgroup
  shall  include,  but  not be limited to, representatives of: accountable
  care organizations or entities  seeking  to  form  an  accountable  care
  organization  under  article  29-E of the public health law; health care
  providers serving Medicaid enrollees; Medicaid, family health plus,  and
  child  health insurance plan enrollees; and the senate and the assembly.
  The workgroup shall report its recommendations for regulatory or  statu-
  tory actions to the governor, the commissioner of health, and the legis-
  lature.
    S  3. Section 2818 of the public health law is amended by adding a new
  subdivision 7 to read as follows:

    7. NOTWITHSTANDING SUBDIVISIONS ONE AND TWO OF THIS SECTION,  SECTIONS
  ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW,
  OR  ANY  OTHER INCONSISTENT PROVISION OF LAW, OF THE FUNDS AVAILABLE FOR
  EXPENDITURE PURSUANT TO THIS SECTION, THE COMMISSIONER MAY ALLOCATE  AND
  DISTRIBUTE,  WITHOUT  A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS,
  GRANTS TO ACCOUNTABLE CARE ORGANIZATIONS UNDER ARTICLE TWENTY-NINE-E  OF
  THIS  CHAPTER FOR THE PURPOSE OF PROMOTING THEIR FORMATION AND IMPROVING
  THEIR OPERATION.   CONSIDERATION RELIED  UPON  BY  THE  COMMISSIONER  IN
  DETERMINING  THE  ALLOCATION  AND  DISTRIBUTION  OF  THESE  FUNDS  SHALL
  INCLUDE, BUT NOT BE LIMITED  TO,  THE  NEED  FOR  AND  CAPACITY  OF  THE
  ACCOUNTABLE  CARE  ORGANIZATION  TO  ACCOMPLISH  THE PURPOSES OF ARTICLE
  TWENTY-NINE-E OF THIS CHAPTER IN THE AREA TO BE SERVED.
    S 4. This act shall take effect immediately.