* 2999-e. Demonstration projects. 1. Notwithstanding any inconsistent regulation of the department, the commissioner is authorized and shall select up to five demonstration projects throughout the state, pursuant to a competitive bid or request for proposal process, which have been determined by the commissioner to encompass one or more of the following elements:
(a) use of the workgroup metrics to measure and reward physician, clinic and hospital performance;
(b) involvement of multiple payers, including government programs, multiple providers and multiple communities voluntarily agreeing to employ the workgroup metrics to reward physician, clinic and hospital performance for quality improvement;
(c) use of information technology to share patient information among providers to improve coordination of patient care;
(d) targeted improvement in care coordination through the participation of multiple stakeholders;
(e) collection, analysis and public reporting on the risk-adjusted measures, incentives and processes utilized, and outcomes; and
(f) programs to enhance patient self-management through adherence to treatment plans.
2. In evaluating proposed demonstration projects, the commissioner shall consider the degree to which a proposed project reflects the elements listed above including demonstrated commitments on the part of all practitioners, providers and payors to participate.
3. (a) There shall be no more than five demonstration projects under this title.
(b) Where any demonstration project involves recipients of Medicaid, family health plus, or child health plus, those recipients shall not constitute more than half the individuals covered by the demonstration project and their health care, measured in the amount of annual reimbursement, shall not cover more than half of the health care covered by the demonstration project.
(c) No demonstration project shall limit the scope or terms of coverage or limit the grounds or procedural rights for appealing a denial of reimbursement for a health care service, for any consumer, enrollee, or recipient subject to the demonstration project.
* NB Expired April 1, 2011
Last modified: February 3, 2019