S T A T E O F N E W Y O R K
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8582
I N S E N A T E
February 16, 2024
___________
Introduced by Sen. SKOUFIS -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to establishing a
pilot program in New York state for the establishment and operation of
certain rural health zones
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Legislative findings. The legislature finds that collab-
oration and innovation are needed to address significant gaps in health-
care in rural areas of the state. To provide rural populations with
better access to healthcare, the Rural Health Zone Pilot Program will
work to improve the health of the targeted zone populations to standards
consistent with quality, high levels of access to care and patient
outcomes that reflect a patient-centric approach to physical, behav-
ioral, and social well-being. A review of current practices in rural
communities is required to identify areas for improvement to local
health planning and infrastructure investment to improve access to care
and clinical outcomes. This healthcare review, coupled with capital
resources, programmatic support, and economic incentives, will create a
healthier population, revitalize the workforce, and create greater
opportunities for economic development within our rural communities.
Ultimately, the Rural Health Zone Pilot Program will establish an inno-
vative organizational replacement for a rural health care model that is
no longer viable.
§ 2. Article 29-A of the public health law is amended by adding a new
title 1-B to read as follows:
TITLE 1-B
RURAL HEALTH ZONE PILOT PROGRAM
SECTION 2958-B. RURAL HEALTH ZONE PILOT PROGRAM.
§ 2958-B. RURAL HEALTH ZONE PILOT PROGRAM. 1. THE COMMISSIONER SHALL,
WITHIN MONIES APPROPRIATED THEREFORE, ESTABLISH A RURAL HEALTH ZONE
PILOT PROGRAM. THE COMMISSIONER SHALL ESTABLISH PILOT RURAL HEALTH ZONES
IN:
(A) ORANGE, SULLIVAN, AND ULSTER COUNTIES;
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14489-01-4
S. 8582 2
(B) ORLEANS, GENESEE AND WYOMING COUNTIES AND CONTIGUOUS AREAS OF
EASTERN ERIE AND NIAGARA AND WESTERN MONROE COUNTIES;
(C) CORTLAND AND TOMPKINS COUNTIES; AND
(D) A ZONE TO BE DETERMINED BY THE GOVERNOR, THE TEMPORARY PRESIDENT
OF THE SENATE, AND THE SPEAKER OF THE ASSEMBLY NO LATER THAN THIRTY DAYS
AFTER THE EFFECTIVE DATE OF THIS ACT.
2. (A) THE COMMISSIONER SHALL ESTABLISH IN EACH PILOT RURAL HEALTH
ZONE A RURAL HEALTH ZONE BOARD. THE POWERS AND DUTIES OF EACH PILOT
RURAL HEALTH ZONE SHALL BE VESTED IN AND EXERCISED BY RURAL HEALTH ZONE
BOARDS ESTABLISHED FOR EACH ZONE CONSISTENT WITH THIS TITLE.
(B) EACH RURAL HEALTH ZONE BOARD SHALL BE COMPRISED OF AT LEAST EIGHT
MEMBERS, WHICH SHALL CONSIST OF:
(I) THE PUBLIC HEALTH COMMISSIONER FROM EACH COUNTY IN THE ZONE OR
SUCH OTHER PERSON APPOINTED BY THE LOCAL COUNTY EXECUTIVE;
(II) ONE REPRESENTATIVE OF THE DEPARTMENT, AS DESIGNATED BY THE
COMMISSIONER;
(III) TWO MEMBERS APPOINTED BY THE GOVERNOR; ONE MEMBER APPOINTED BY
THE TEMPORARY PRESIDENT OF THE SENATE; ONE MEMBER APPOINTED BY THE
SPEAKER OF THE ASSEMBLY; ONE MEMBER APPOINTED BY THE MINORITY LEADER OF
THE SENATE; AND ONE MEMBER APPOINTED BY THE MINORITY LEADER OF THE
ASSEMBLY. EACH BOARD MEMBER APPOINTED BY THE GOVERNOR, THE TEMPORARY
PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEAD-
ER OF THE SENATE AND MINORITY LEADER OF THE ASSEMBLY SHALL BE REPRESEN-
TATIVE OF BUSINESS, HEALTH SYSTEMS DELIVERY, HEALTH CARE FINANCING OR
THE PUBLIC.
3. ALL APPOINTEES OF EACH RURAL HEALTH ZONE BOARD SHALL BE MADE NO
LATER THAN SIXTY DAYS AFTER THE EFFECTIVE DATE OF THIS TITLE. EACH BOARD
SHALL MEET AS FREQUENTLY AS DEEMED NECESSARY BUT AT LEAST FOUR TIMES IN
EACH CALENDAR YEAR. MEMBERS OF EACH BOARD SHALL DESIGNATE ONE OF ITS
MEMBERS AS ITS CHAIR. EACH BOARD SHALL ENACT AND FROM TIME TO TIME MAY
AMEND BY-LAWS IN RELATION TO ITS MEETINGS AND THE TRANSACTIONS OF ITS
BUSINESS. EACH APPOINTMENT SHALL BE MADE FOR THE DURATION OF THE PILOT
PROGRAM. ANY VACANCY SHALL BE FILLED BY THE APPOINTING AUTHORITY WITHIN
SIXTY DAYS. THE MEMBERS OF EACH BOARD SHALL SERVE WITHOUT COMPENSATION,
EXCEPT THAT MEMBERS SHALL BE ALLOWED THEIR NECESSARY AND ACTUAL EXPENSES
INCURRED IN THE PERFORMANCE OF THEIR DUTIES UNDER THIS SECTION. THE
DEPARTMENT OF HEALTH AND THE EMPIRE STATE DEVELOPMENT CORPORATION SHALL
PROVIDE EACH BOARD WITH SUCH FACILITIES, ASSISTANCE, AND DATA AS WILL
ENABLE EACH BOARD TO CARRY OUT ITS POWERS AND DUTIES WITHIN REASON. EACH
BOARD SHALL HAVE THE POWER TO RETAIN LEGAL COUNSEL AND CONSULTANTS
DEEMED NECESSARY BY EACH BOARD TO CARRY OUT ITS POWERS AND DUTIES. THE
MEMBERS OF EACH BOARD SHALL RECUSE THEMSELVES FROM DISCUSSIONS AND
ACTIONS WHERE A CONFLICT OF INTEREST MAY EXIST AND SHALL NOT RECEIVE
CONFIDENTIAL INFORMATION, DATA OR MATERIAL RELATED TO AN ENTITY WHERE A
CONFLICT OF INTEREST MAY EXIST. EACH BOARD WILL HAVE THE AUTHORITY TO
DETERMINE THE GEOGRAPHIC SCOPE OF THE ZONE CONSISTENT WITH THE AUTHORIZ-
ING STATUTE AND SUBJECT TO REVIEW AND CONFIRMATION BY THE COMMISSIONER.
4. EACH RURAL HEALTH ZONE BOARD SHALL REVIEW CURRENT COMMUNITY HEALTH-
CARE NEEDS, INFRASTRUCTURE, AND BARRIERS TO CARE WITHIN THE PILOT RURAL
HEALTH ZONE AND DEVELOP A RURAL HEALTH ZONE TRANSFORMATION PLAN. IN
CONNECTION WITH THE DEVELOPMENT OF THE RURAL HEALTH ZONE TRANSFORMATION
PLAN, EACH HOSPITAL, RURAL HEALTH CLINIC AND FEDERALLY QUALIFIED HEALTH
CENTER WITHIN THE ZONE, AND OTHER SAFETY NET PROVIDERS, MANAGED CARE
ORGANIZATIONS AND HEALTHCARE SERVICES PROVIDERS AS IDENTIFIED BY EACH
BOARD, SHALL SUBMIT A PROPOSED RURAL HEALTH TRANSFORMATION PLAN FOR SUCH
FACILITY OR CLINIC THAT THE ORGANIZATION PROPOSES TO IMPLEMENT UPON
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APPROVAL BY THE BOARD AND RECEIPT OF NECESSARY FUNDING. EACH BOARD SHALL
HOLD AT LEAST ONE PUBLIC HEARING WITH A PUBLIC COMMENT PERIOD IN EACH OF
THE COUNTIES COMPRISING THE ZONE ON ITS RURAL HEALTH ZONE TRANSFORMATION
PLAN UPON AT LEAST THIRTY DAYS NOTICE TO THE PUBLIC.
5. (A) THE COMMISSIONER SHALL ESTABLISH A RURAL HEALTH ZONE FUND FOR
EACH ZONE FOR THE PURPOSES OF ASSISTING THE BOARD IN CARRYING OUT ITS
POWERS AND DUTIES UNDER THIS TITLE. THE COMMISSIONER SHALL, ON AN ANNUAL
BASIS, SPECIFY FUNDS FOR EACH ZONE TO THE RESPECTIVE FUND, AND SHALL BE
ADMINISTERED AND DISBURSED IN ACCORDANCE WITH THIS TITLE.
(B) CONSISTENT WITH BUDGETED APPROPRIATIONS TO EACH FUND AND THE
PROVISIONS OF THIS TITLE, EACH BOARD SHALL HAVE FULL AUTHORITY TO ESTAB-
LISH, EVALUATE AND AWARD GRANTS, CONTRACTS, LOANS, INCLUDING FORGIVABLE
LOANS, AND PROVIDE STATE INCOME AND OTHER TAX CREDITS AND ABATEMENTS FOR
PERSONS AND ENTITIES THAT ARE PROVIDING OR SUPPORTING THE DELIVERY OF
HEALTH CARE SERVICES AND RELATED INFRASTRUCTURE IN EACH ZONE. EACH ZONE
MAY AWARD ECONOMIC BENEFITS TO QUALIFIED PERSONS OR ENTITIES WHO ARE
PROVIDING OR SUPPORTING THE PROVISION OF HEALTHCARE SERVICES TO INDIVID-
UALS WHO WORK OR RESIDE IN THE ZONE SUCH ECONOMIC BENEFITS AS DESCRIBED
IN ARTICLE 18-B OF THE GENERAL MUNICIPAL LAW OR REFERRED BY SECTION NINE
HUNDRED SIXTY-SIX OF THE GENERAL MUNICIPAL LAW. EACH ZONE MAY PROVIDE
GRANTS, CONTRACTS OR OTHER BUDGETARY SUPPORT TO HOSPITALS AND HEALTH
SYSTEMS THAT ARE PRIMARILY LOCATED OUTSIDE THE ZONE BUT THAT AFFILIATE
WITH, PROVIDE SERVICE TO, OR HAVE HOSPITAL OR CLINIC SITES IN THE ZONE.
6. IN ADDITION TO THE OBLIGATION AND AUTHORITY OF EACH BOARD TO ESTAB-
LISH AND IMPLEMENT A RURAL HEALTH ZONE TRANSFORMATION PLAN, EACH ZONE
SHALL EVALUATE THE POTENTIAL FOR ESTABLISHING A GLOBAL MEDICAL BUDGET
FOR THE SAFETY NET PROVIDERS, INCLUDING HOSPITALS, RURAL HEALTH CLINICS
AND FEDERALLY QUALIFIED HEALTH CENTERS. THE GLOBAL MEDICAL BUDGETS MAY
INCLUDE VOLUNTARY PARTICIPATION OF PRIVATE THIRD-PARTY PAYORS FOR
PROPORTIONAL FUNDING OF SUCH BUDGETS BASED ON THEIR RELATIVE ENROLLMENT
IN SUCH ZONE. IN THE EVENT THAT A BOARD DETERMINES THAT A GLOBAL MEDICAL
BUDGET IS NOT WARRANTED OR RECOMMENDED FOR SAFETY NET PROVIDERS, THE
BOARD SHALL EVALUATE AND IDENTIFY ANY ALTERNATIVE THIRD-PARTY PAYOR
REIMBURSEMENT MODELS OR CHANGES THAT MAY BE WARRANTED TO ACHIEVE A MORE
STABLE AND SUSTAINABLE FORM AND AMOUNT OF COMPENSATION TO THE SAFETY NET
PROVIDERS FOR THEIR SERVICES TO THE ZONE POPULATION. EACH BOARD SHALL
PROVIDE THEIR REVIEW AND RECOMMENDATIONS TO THE COMMISSIONER WITHIN TWO
YEARS OF THE ESTABLISHMENT OF THE BOARD. IN MAKING ITS RECOMMENDATIONS,
EACH ZONE SHALL SEEK CONSULTATION AND COMMENT FROM ZONE SAFETY NET
PROVIDERS AND PRIVATE THIRD-PARTY PAYORS WHO PROVIDE COVERAGE TO EMPLOY-
ERS AND INDIVIDUALS THAT ARE LOCATED IN THE ZONE. A COPY OF THE RECOM-
MENDATIONS OF EACH BOARD REQUIRED BY THIS SECTION SHALL ALSO BE PROVIDED
TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF
THE ASSEMBLY, THE CHAIR OF THE SENATE STANDING COMMITTEE ON HEALTH, THE
CHAIR OF THE ASSEMBLY HEALTH COMMITTEE AND THE CHAIR OF THE LEGISLATIVE
COMMISSION ON THE DEVELOPMENT OF RURAL RESOURCES. EACH BOARD AND THE
DEPARTMENT SHALL NOT HAVE AUTHORITY TO ADOPT OR IMPLEMENT ANY GLOBAL
HEALTH BUDGETS FOR ANY SAFETY NET PROVIDERS ABSENT ENACTMENT OF FURTHER
LEGISLATION.
7. EACH BOARD WILL CONSULT WITH, AND PROVIDE RECOMMENDATIONS TO, THE
COMMISSIONER AND THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL REGARDING
NECESSARY CHANGES TO STATE REGULATORY CODES OR ESTABLISHMENT STANDARDS
FOR ENTITIES THAT ARE PROVIDING SERVICES IN THE RURAL HEALTH ZONES AND
IDENTIFY RECOMMENDED STATE LEGISLATIVE CHANGES. THE COMMISSIONER IS
AUTHORIZED TO WAIVE, MODIFY OR SUSPEND THE PROVISIONS OF RULES AND REGU-
LATIONS PROMULGATED PURSUANT TO THIS CHAPTER IF THE COMMISSIONER DETER-
S. 8582 4
MINES THAT SUCH WAIVER, MODIFICATION OR SUSPENSION IS NECESSARY FOR THE
SUCCESSFUL IMPLEMENTING OF THE PILOT PROGRAM AUTHORIZED PURSUANT TO THIS
TITLE AND PROVIDED THAT THE COMMISSIONER DETERMINES THAT THE HEALTH,
SAFETY AND GENERAL WELFARE OF PEOPLE RECEIVING HEALTH CARE UNDER SUCH
RURAL DENTISTRY PILOT PROGRAM WILL NOT BE IMPAIRED AS A RESULT OF SUCH
WAIVER, MODIFICATION, OR SUSPENSION.
8. THE COMMISSIONER SHALL APPLY FOR FUNDING AND TECHNICAL SUPPORT FOR
THE PROJECT FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES OFFICE
OF INNOVATIONS IN ACCORDANCE WITH SECTION 1115-A OF THE SOCIAL SECURITY
ACT, 42 U.S.C. 1315-A. THE COMMISSIONER AND EACH BOARD SHALL EVALUATE,
IN CONNECTION WITH SUCH APPLICATION, ANY POTENTIAL CHANGES TO ITS NEW
YORK STATE MEDICAID PLAN AND DEMONSTRATION PROJECT AND WAIVER THAT WOULD
APPLY IN THE ZONES DURING THE PERIOD OF THE PILOT PROGRAM.
9. WITHIN SIX MONTHS FROM THE EFFECTIVE DATE OF THIS TITLE, THE
COMMISSIONER, IN CONSULTATION WITH EACH BOARD, SHALL ESTABLISH UNIFORM
DATA MEASUREMENT AND REPORTING TOOL FOR THE ZONES TO REVIEW AND EVALUATE
PROGRESS DURING THE PILOT PROGRAM, INCLUDING RELEVANT COSTS, COMMUNITY
HEALTH OUTCOMES AND SOCIAL DETERMINATES OF HEALTH, AND SHALL INCORPORATE
POPULATION HEALTH DATA THAT IS CURRENTLY BEING TRACKED AND REPORTED BY
THE STATE AT THE COUNTY AND REGIONAL LEVEL. NO LATER THAN TWELVE MONTHS
AFTER THE APPROVAL OF THE PILOT PROGRAM, AND ANNUALLY THEREAFTER, IN A
FORM THAT CONFORMS TO THE DATA MEASUREMENT AND REPORTING SYSTEM CREATED
BY THE COMMISSIONER, EACH BOARD SHALL REPORT TO THE COMMISSIONER ON THE
PROGRESS OF THE PROGRAM. SUCH REPORTS SHALL BE PUBLICLY AVAILABLE AND
SHALL BE PROVIDED TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE
SENATE, THE SPEAKER OF THE ASSEMBLY, THE CHAIR OF THE SENATE STANDING
COMMITTEE ON HEALTH, THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE AND THE
CHAIR OF THE LEGISLATIVE COMMISSION ON THE DEVELOPMENT OF RURAL
RESOURCES. THE COSTS FOR THE REPORTING REQUIREMENTS SET FORTH IN THIS
SECTION SHALL BE ALLOCATED FROM THE DEPARTMENT'S GENERAL OPERATING BUDG-
ET.
10. EACH ZONE MAY COLLABORATE AND COORDINATE THEIR PLANNING AND ACTIV-
ITIES WITH OTHER ZONES TO PROMOTE EFFICIENCY, SHARE BEST PRACTICES AND
AVOID UNNECESSARY DUPLICATION OF EFFORTS OR RESOURCES.
11. THE RURAL HEALTH ZONE PILOT PROGRAM SHALL HAVE A DURATION OF FIVE
YEARS FROM THE DATE OF THE FIRST ADOPTION OF A RURAL HEALTH ZONE TRANS-
FORMATION PLAN BY EACH BOARD. THE PILOT PROGRAM MAY BE EXTENDED FROM
TIME TO TIME BY FURTHER LEGISLATION OR BY THE COMMISSIONER AS REQUIRED
TO MEET THE REQUIREMENTS FOR ANY STATE INNOVATION GRANT RECEIVED FROM
CENTERS FOR MEDICARE AND MEDICAID SERVICES RELATED TO THE PILOT PROGRAM.
12. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, FOR GRANTS, CONTRACTS
AND ALLOCATIONS THAT ARE SET FORTH AND CONSISTENT WITH THE PLAN ADOPTED
BY THE ADMINISTRATIVE BOARD, EACH ZONE WILL NOT BE SUBJECT TO PROCURE-
MENT, GRANT AWARD OR COMPETITIVE BIDDING REQUIREMENTS.
13. THE ACTIVITIES OF THE ZONES, EACH BOARD AND HEALTHCARE PROVIDERS
AND PARTICIPANTS IN FURTHERANCE OF THE RURAL HEALTH ZONE PLANNING AND
IMPLEMENTATION AND OTHER EFFORTS DESCRIBED IN THIS TITLE SHALL BE EXEMPT
FROM THE PROVISIONS AND PENALTIES OF ARTICLE TWENTY-TWO OF THE GENERAL
BUSINESS LAW RESPECTING ARRANGEMENTS AND AGREEMENTS IN RESTRAINT OF
TRADE. TO THE GREATEST EXTENT POSSIBLE, SUCH ACTIVITIES SHALL BE SUBJECT
TO THE OVERSIGHT OF EACH BOARD, THE COMMISSIONER AND THE PUBLIC HEALTH
AND PLANNING COUNCIL TO PROVIDE STATE ACTION IMMUNITY UNDER STATE AND
FEDERAL ANTITRUST LAW.
§ 3. This act shall take effect immediately.
