§ 365-l. Health homes. 1. Notwithstanding any law, rule or regulation
to the contrary, the commissioner of health is authorized, in
consultation with the commissioners of the office of mental health,
office of alcoholism and substance abuse services, and office for people
with developmental disabilities, to (a) establish, in accordance with
applicable federal law and regulations, standards for the provision of
health home services to Medicaid enrollees with chronic conditions, (b)
establish payment methodologies for health home services based on
factors including but not limited to the complexity of the conditions
providers will be managing, the anticipated amount of patient contact
needed to manage such conditions, and the health care cost savings
realized by provision of health home services, (c) establish the
criteria under which a Medicaid enrollee will be designated as being an
eligible individual with chronic conditions for purposes of this
program, (d) assign any Medicaid enrollee designated as an eligible
individual with chronic conditions to a provider of health home
services.

2. In addition to payments made for health home services pursuant to
subdivision one of this section, the commissioner is authorized to pay
additional amounts to providers of health home services that meet
process or outcome standards specified by the commissioner. Such
additional amounts may be paid with state funds only if federal
financial participation for such payments is unavailable.

2-a. Up to fifteen million dollars in state funding may be used to
fund health home infrastructure development. Such funds shall be used to
develop enhanced systems to support Health Home operations including
assignments, workflow, and transmission of data. Funding will also be
disbursed pursuant to a formula established by the commissioner to be
designated health homes. Such formula may consider prior access to
similar funding opportunities, geographic and demographic factors,
including the population served, and prevalence of qualifying
conditions, connectivity to providers, and other criteria as established
by the commissioner.

2-b. The commissioner is authorized to make lump sum payments or
adjust rates of payment to providers up to a gross amount of five
million dollars, to establish coordination between the health homes and
the criminal justice system and for the integration of information of
health homes with state and local correctional facilities, to the extent
permitted by law. Such rate adjustments may be made to health homes
participating in a criminal justice pilot program with the purpose of
enrolling incarcerated individuals with serious mental illness, two or
more chronic conditions, including substance abuse disorders, or
HIV/AIDS, into such health home. Health homes receiving funds under this
subdivision shall be required to document and demonstrate the effective
use of funds distributed herein.

2-c. The commissioner is authorized to make grants up to a gross
amount of one million dollars for certified application counselors and
assistors to facilitate the enrollment of persons in high risk
populations, including but not limited to persons with mental health
and/or substance abuse conditions that have been recently discharged or
are pending release from state and local correctional facilities. Funds
allocated for certified application counselors and assistors shall be
expended through a request for proposal process.

2-d. The commissioner shall establish reasonable targets for health
home participation by enrollees of special needs managed care plans
designated pursuant to subdivision four of section three hundred
sixty-five-m of this title and by high-risk enrollees of other Medicaid
managed care plans operating pursuant to section three hundred
sixty-four-j of this title, and shall encourage both the managed care
providers and the health homes to work collaboratively with each other
to achieve such targets. The commissioner may assess penalties under
this subdivision in instances of failure to meet the participation
targets established pursuant to this subdivision, where the department
has determined that such failure reflected the absence of a good faith
and reasonable effort to achieve the participation targets, except that
managed care providers shall not be penalized for the failure of a
health home to work collaboratively toward meeting the participation
targets and a health home shall not be penalized for the failure of a
managed care provider to work collaboratively toward meeting the
participation targets.

3. Until such time as the commissioner obtains necessary waivers
and/or approvals of the federal social security act, Medicaid enrollees
assigned to providers of health home services will be allowed to opt out
of such services. In addition, upon enrollment, an enrollee shall be
offered an option of at least two providers of health home services, to
the extent practicable.

4. Payments authorized pursuant to this section will be made with
state funds only, to the extent that such funds are appropriated
therefore, until such time as federal financial participation in the
costs of such services is available.

5. The commissioner is authorized to submit amendments to the state
plan for medical assistance and/or submit one or more applications for
waivers of the federal social security act, to obtain federal financial
participation in the costs of health home services provided pursuant to
this section, and as provided in subdivision three of this section.

6. Notwithstanding any limitations imposed by section three hundred
sixty-four-l of this title on entities participating in demonstration
projects established pursuant to such section, the commissioner is
authorized to allow such entities which meet the requirements of this
section to provide health home services.

7. Notwithstanding any law, rule, or regulation to the contrary, the
commissioners of the department of health, the office of mental health,
the office for people with developmental disabilities, and the office of
alcoholism and substance abuse services are authorized to jointly
establish a single set of operating and reporting requirements and a
single set of construction and survey requirements for entities that:

(a) can demonstrate experience in the delivery of health, and mental
health and/or alcohol and substance abuse services and/or services to
persons with developmental disabilities, and the capacity to offer
integrated delivery of such services in each location approved by the
commissioner; and

(b) meet the standards established pursuant to subdivision one of this
section for providing and receiving payment for health home services;
provided, however, that an entity meeting the standards established
pursuant to subdivision one of this section shall not be required to be
an integrated service provider pursuant to this subdivision.

In establishing a single set of operating and reporting requirements
and a single set of construction and survey requirements for entities
described in this subdivision, the commissioners of the department of
health, the office of mental health, the office for people with
developmental disabilities, and the office of alcoholism and substance
abuse services are authorized to waive any regulatory requirements as
are necessary to avoid duplication of requirements and to allow the
integrated delivery of services in a rational and efficient manner.

8. (a) The commissioner of health is authorized to contract with one
or more entities to assist the state in implementing the provisions of
this section. Such entity or entities shall be the same entity or
entities chosen to assist in the implementation of the multipayor
patient centered medical home program pursuant to section twenty-nine
hundred fifty-nine-a of the public health law. Responsibilities of the
contractor shall include but not be limited to: developing
recommendations with respect to program policy, reimbursement, system
requirements, reporting requirements, evaluation protocols, and provider
and patient enrollment; providing technical assistance to potential
medical home and health home providers; data collection; data sharing;
program evaluation, and preparation of reports.

(b) Notwithstanding any inconsistent provision of sections one hundred
twelve and one hundred sixty-three of the state finance law, or section
one hundred forty-two of the economic development law, or any other law,
the commissioner of health is authorized to enter into a contract or
contracts under paragraph (a) of this subdivision without a competitive
bid or request for proposal process, provided, however, that:

(i) The department of health shall post on its website, for a period
of no less than thirty days:

(1) A description of the proposed services to be provided pursuant to
the contract or contracts;

(2) The criteria for selection of a contractor or contractors;

(3) The period of time during which a prospective contractor may seek
selection, which shall be no less than thirty days after such
information is first posted on the website; and

(4) The manner by which a prospective contractor may seek such
selection, which may include submission by electronic means;

(ii) All reasonable and responsive submissions that are received from
prospective contractors in timely fashion shall be reviewed by the
commissioner of health; and

(iii) The commissioner of health shall select such contractor or
contractors that, in his or her discretion, are best suited to serve the
purposes of this section.

9. The contract entered into by the commissioner of health prior to
January first, two thousand thirteen pursuant to subdivision eight of
this section may be amended or modified without the need for a
competitive bid or request for proposal process, and without regard to
the provisions of sections one hundred twelve and one hundred
sixty-three of the state finance law, section one hundred forty-two of
the economic development law, or any other provision of law, excepting
the responsible vendor requirements of the state finance law, including,
but not limited to, sections one hundred sixty-three and one hundred
thirty-nine-k of the state finance law, to allow the purchase of
additional personnel and services, subject to available funding, for the
limited purpose of assisting the department of health with implementing
the Balancing Incentive Program, the Fully Integrated Duals Advantage
Program, the Vital Access Provider Program, the Medicaid waiver
amendment associated with the public hospital transformation, the
addition of behavioral health services as a managed care plan benefit,
the delivery system reform incentive payment plan, activities to
facilitate the transition of vulnerable populations to managed care
and/or any workgroups required to be established by the chapter of the
laws of two thousand thirteen that added this subdivision. The
department is authorized to extend such contract for a period of one
year, without a competitive bid or request for proposal process, upon
determination that the existing contractor is qualified to continue to
provide such services; provided, however, that the department of health
shall submit a request for applications for such contract during the
time period specified in this subdivision and may terminate the contract
identified herein prior to expiration of the extension authorized by
this subdivision.