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 Oct. 26, 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
367‑Y
Reimbursement for treatment in place and transportation to alternative health care settings
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

Accessed:
Oct. 26, 2024

Last modified:
Apr. 22, 2022

§ 364-M’s source at nysenate​.gov

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