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Care Coordination/Care Management in New York

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Patients and residents in assisted living and adult care facilities have significant authority to make decisions regarding their health care treatment.1 In particular, (1) New York grants such individuals the right to receive all information necessary to consent to treatment, the right to refuse treatment, and the right to participate in all treatment and discharge decisions;2 (2) residents of assisted living facilities and in-patient mental health facilities must work with their facility to create a personalized treatment plan;3 and (3) patients must give their informed consent to genetic testing4 and HIV testing5 while voluntary and informal patients must consent to their continued admission for mental health services every 120 days.6

New York also authorizes surrogates and health care agents to make medical decisions on behalf of, respectively, an incapacitated patient or principle.7

New York has established a managed care program to provide “comprehensive and coordinated health care [that is] delivered in a cost effective manner.”8 New York will use regional entities to coordinate the provision of behavioral health services to medical assistance beneficiaries if the beneficiary is either (1) not enrolled in managed care or (2) does not receive behavioral health services through their managed care provider.9

New York has authorized the implementation and testing of various health care models to improve the coordination of health care services.10 For example, the commissioner may certify providers as patient centered medical homes11 and may provide funding for demonstration projects that focus on the care of Medicaid beneficiaries with comorbidities that are ineligible for managed care.12

 

Footnotes

  • 1. NY PUB HEALTH § 4660; NY SOC SERV § 461-d; N.Y. COMP. CODES R. & REGS. TIT. 10, § 405.7(B); N.Y. COMP. CODES R. & REGS. TIT. 10, § 405.7(C).
  • 2. NY PUB HEALTH § 4660; NY SOC SERV § 461-d; N.Y. COMP. CODES R. & REGS. TIT. 10, § 405.7(B); N.Y. COMP. CODES R. & REGS. TIT. 10, § 405.7(C).
  • 3. NY MENT HYG § 29.13; NY PUB HEALTH § 4659.
  • 4. N.Y. Ins. Law § 2615.
  • 5. NY PUB HEALTH § 2786.
  • 6. NY MENT HYG § 9.19.
  • 7. NY PUB HEALTH § 2994-d; NY PUB HEALTH § 2982.
  • 8. NY SOC SERV § 364-j.
  • 9. NY SOC SERV § 365-m.
  • 10. NY PUB HEALTH § 206.
  • 11. NY SOC SERV § 364-m.
  • 12. NY SOC SERV § 364-l.

 

Care Coordination/Care Management in New York

Subtopic Statute/Regulation Description
Treatment planning when using interdisciplinary team (including assessments, plan of care, discharge/transfer planning Administration and Management of Behavioral Health Services – N.Y. Soc. Serv. Law § 365-m Regional entities will approve and coordinate behavioral health services for medical assistance beneficiaries that are not enrolled in managed care...
Establishment of a Client Service Report System – N.Y. Mental Hyg. Law § 29.13 The commissioner must create a “client service report system” in order provide patients, patient representatives, and community and...
N.Y. Pub. Health Law § 4659 - Requirements for an Individualized Service Plan Upon admission to an assisted living facility, a resident, their representative, and the facility operator must develop an individualized service...
Licensure laws requiring or recommending care coordination or care management activities (Cross reference with private insurance/Medicaid/Medicare data requirements) Establishment and Requirements of Chronic illness Demonstration Projects – N.Y. Soc. Serv. Law § 364-l The commissioner of health may develop, subject to funding, demonstration projects to (1) improve the coordination of care delivered to Medicaid...
Powers and Duties of the Commissioner – N.Y. Pub. Health Law § 206 The Commissioner’s powers and duties include: Collecting and maintaining “information relating to marriage, birth, mortality, disease...
Requirements for Health Homes and Medicaid Beneficiaries – N.Y. Soc. Serv. Law § 365-l The commissioner of health has discretion to establish health homes to provide services to Medicaid beneficiaries that have chronic conditions. If...
Requirements for Managed Care Programs – N.Y. Soc. Serv. Law § 364-j New York’s managed care program must provide “comprehensive and coordinated health care delivered in a cost effective manner.”...
Requirements for Treatment Plans for Patients in In-Patient Facilities – N.Y. Mental Hyg. Law § 29.13 In-patient facility directors must develop a written treatment plan for each patient. The plan must identify the goals of treatment, the programs,...
New coordinated systems of care (ACOs, Patient Centered Medical Homes/Health homes) (Cross reference with Quality Measurement) Establishment of a Statewide Patient Centered Medical Home Program – N.Y. Soc. Serv. Law § 364-m The commissioner of health may “certify certain clinicians and clinics as health care homes in order to improve health outcomes and efficiency...
Informed consent requirements (If the information is going beyond the patient and provider Informed Consent Requirements – N.Y. Pub. Health Law § 2442 Informed Consent Requirements for Human Subjects in Medical Research Projects  Article 24 A (§2440-46) of the New York Public Health Law...
N.Y. Comp. Codes R. & Regs. tit. 10, § 405.7(b) - Patient Rights in Hospitals Hospitals must afford to each patient the right to: Exercise these rights regardless of the patient's language or impairment of hearing or vision...
Patients’ Bill of Rights – N.Y. Comp. Codes R. & Regs. tit. 10, § 405.7(c) As a patient in a hospital in New York State, you have the right, consistent with law, to: Understand and use these rights. If for any reason you...
Requirements for Voluntary and Informal Admissions and Notices Regarding Hospitalization – N.Y. Mental Hyg. Law § 9.19 Requirements for Voluntary and Informal Admissions and Notices Regarding Hospitalization New York’s Mental Hygiene Law allows directors of...
Rights of Residents in Adult Care Facilities – N.Y. Soc. Serv. Law § 461-d The rights of adult care facility residents include the following: “[T]he right to independent personal decisions and knowledge…...
Patient authorization requirements (to provide health information to another individual) N.Y. Pub. Health Law § 2994-d - Requirements for Health Care Decisions Made for Adult Patients by Surrogates Surrogate decision makers have “the right to receive medical information and medical records necessary to make informed decisions about the...
Discharge instructions/Required follow-up. Provider Requirements – N.Y. Comp. Codes R. & Regs. tit. 14, § 815.4 Requirements for Providers of Chemical Dependency Services The law protects the rights of patients seeking chemical dependency services by...
Treatment of Minors – N.Y. Mental Hyg. Law § 22.11 Treatment of minors seeking treatment for chemical dependency This law addresses the treatment of minors (defined as unmarried persons under 18 years...
Care Coordination/Care Management Requirements and Duties of Providers of Services to the Mentally Disabled – N.Y. Mental Hyg. Law § 31.11 Every provider of services to the mentally disabled must comply with the following requirements: Notify the district attorney or other...
Rights and Duties of Health Care Agents – N.Y. Pub. Health Law § 2982 Rights and Duties of Health Care Agents A health care agent is an adult who has been given the authority to make health care decisions on behalf of...
Disease management Rules and regulations for Forms and Reports for HIV Testing and Information – N.Y. Pub. Health Law § 2786 The commissioner must (1) establish regulations to implement the HIV and Aids laws contained in Article 27-F; (2) create informed consent forms for...
Click on the individual state law in the table above to see our summary of the individual law.


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