N.Y. Social Services Law Section 364-M
Statewide patient centered medical home program

1.

The commissioner of health is authorized to certify certain clinicians and clinics as health care homes in order to improve health outcomes and efficiency through patient care continuity and coordination of health services. These providers will be eligible for enhanced payments for services provided to: recipients eligible for Medicaid fee-for-service; enrollees eligible for Medicaid managed care; enrollees eligible for and enrolled in Family Health Plus organizations pursuant to title eleven-D of this article (“Family Health Plus”); and enrollees eligible for and enrolled in Child Health Plus. As used in this section “clinic” means a general hospital providing outpatient care or a diagnostic and treatment center, licensed under article twenty-eight of the public health law.

2.

By December first, two thousand nine, the commissioner of health shall develop and implement standards of certification for patient centered medical homes for Medicaid fee-for-service and Medicaid managed care, Family Health Plus and Child Health Plus programs. In developing such standards, the commissioner of health shall:

(a)

consider existing standards developed by national accrediting and professional organizations; and

(b)

consult with national and local organizations working on medical home models, physicians, hospitals, clinics, health plans and consumers and their representatives.

3.

To maintain their certification, patient centered medical homes must:

(a)

renew their certification at a frequency determined by the commissioner of health; and

(b)

provide data to the department of health and to health plans in which the patient is enrolled to permit the commissioner of health to evaluate the impact of patient centered medical homes on quality, outcomes and cost.

4.

Subject to the availability of funding and federal financial participation, the commissioner of health is authorized:

(a)

To pay enhanced rates of payment to clinics and clinicians that are certified as patient centered medical homes under this section. Such enhancements may be tiered based on the level of standard achieved by the clinician or clinic; and

(b)

To pay additional amounts for patient centered medical homes that meet specific process or outcome standards specified by the commissioner of health.

5.

By December thirty-first, two thousand twelve, the commissioner of health shall report to the governor and the legislature on the impact of the statewide patient centered medical home program on quality, cost and outcomes for enrollees in Medicaid fee-for-service, Medicaid managed care, Family Health Plus and Child Health Plus. * NB Repealed April 1, 2025

Source: Section 364-M — Statewide patient centered medical home program, https://www.­nysenate.­gov/legislation/laws/SOS/364-M (updated Apr. 22, 2022; accessed May 4, 2024).

363
Declaration of objects 363‑A
Federal aid 363‑B
Agreements for federal determination of eligibility of aged, blind and disabled persons for medical assistance 363‑C
Medicaid management 363‑D
Provider compliance program 363‑E
Medicaid plan, applications for waivers and plan amendments 363‑F
Electronic visit verification for personal care and home health providers 364
Responsibility for standards 364‑A
Cooperation of state departments 364‑B
Residential and medical care placement demonstration projects 364‑C
National long term care channeling demonstration project 364‑D
Medical assistance research and demonstration projects 364‑E
Aid to families with dependent children homemaker/home health aide demonstration projects 364‑F
Primary care case management programs 364‑G
Medical assistance capitation rate demonstration project 364‑H
Foster family care demonstration programs for elderly or disabled persons 364‑I
Medical assistance presumptive eligibility program 364‑J
Managed care programs 364‑J‑2
Transitional supplemental payments 364‑JJ
Special advisory review panel on Medicaid managed care 364‑KK
Condition of Participation 364‑M
Statewide patient centered medical home program 364‑N
Diabetes and chronic disease self-management pilot program 365
Responsibility for assistance 365‑A
Character and adequacy of assistance 365‑B
Local medical plans: professional directors 365‑C
Medical advisory committee 365‑D
Medicaid evidence based benefit review advisory committee 365‑E
Optional or continued membership in entities offering comprehensive health services plans 365‑F
Consumer directed personal assistance program 365‑G
Utilization review for certain care, services and supplies 365‑H
Provision and reimbursement of transportation costs 365‑J
Advisory opinions 365‑K
Provision of prenatal care services 365‑L
Health homes 365‑M
Administration and management of behavioral health services 365‑N
Department of health assumption of program administration 365‑O
Provision and coverage of services for living organ donors 365‑P
Doulas for Medicaid 366
Eligibility 366‑A
Applications for assistance 366‑B
Penalties for fraudulent practices 366‑C
Treatment of income and resources of institutionalized persons 366‑D
Medical assistance provider 366‑E
Certified home health agency medicare billing 366‑F
Persons acting in concert with a medical assistance provider 366‑G
Newborn enrollment for medical assistance 366‑H
Automated system 366‑I
Long-term care financing demonstration program 367
Authorization for hospital care 367‑A
Payments 367‑B
Medical assistance information and payment system 367‑C
Payment for long term home health care programs 367‑D
Personal care need determination 367‑E
Payment for AIDS home care programs 367‑F
Partnership for long term care program 367‑G
Authorization and provision of personal emergency response services 367‑H
Payment for assisted living programs 367‑I
Personal care services provider assessments 367‑O
Health insurance demonstration programs 367‑P
Responsibilities of local districts for personal care services, home care services and private duty nursing 367‑P*2
Payment for limited home care services agencies 367‑Q
Personal care services worker recruitment and retention program 367‑R
Private duty nursing services worker recruitment and retention program 367‑S
Long term care demonstration program 367‑S*2
Emergency medical transportation services 367‑T
Payment for emergency physician services 367‑U
Payment for home telehealth services 367‑V
County long-term care financing demonstration program 367‑W
Health care and mental hygiene worker bonuses 367‑X
Payment for violence prevention programs 368
Quarterly estimates 368‑A
State reimbursement 368‑B
State reimbursement to local health districts 368‑C
Audit of state rates of payment to providers of health care services 368‑D
Reimbursement to public school districts and state operated/state supported schools which operate pursuant to article eighty-five, eighty... 368‑E
Reimbursement to counties for pre-school children with handicapping conditions 368‑F
Reimbursement of costs under the early intervention program 369
Application of other provisions
Green check means up to date. Up to date

Accessed:
May 4, 2024

Last modified:
Apr. 22, 2022

§ 364-M’s source at nysenate​.gov

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