§ 2111. Disease management demonstration programs. 1. The department\nmay establish disease management demonstration programs through a\nrequest for proposals process to enhance the quality and\ncost-effectiveness of care rendered to medicaid-eligible persons with\nchronic health problems whose care and treatment, because of one or more\nhospitalizations, multiple disabling conditions requiring residential\ntreatment or other health care requirements, results in high medicaid\nexpenditures. In order to be eligible to sponsor and to undertake a\ndisease management demonstration program, the proposed sponsor may be a\nnot-for-profit, for-profit or local government organization that has\ndemonstrated expertise in the management or coordination of care to\npersons with chronic diseases or that has the experience of providing\ncost-effective community-based care to such patients, or in the case of\na local government organization, has expressed a strong willingness to\nsponsor such a program. The department may also approve disease\nmanagement demonstration programs which include, but are not limited to,\nthe promotion of adherence to evidence-based guidelines, improvement of\nprovider and patient communication and provide information on provider\nand beneficiary utilization of services. The department shall grant no\nfewer than six demonstration programs, no more than one-third of such\nprograms shall be selected to provide these services in any single\nsocial services district; provided further, where the department grants\nless than six demonstration programs, no more than one such program\nshall be selected to provide these services in any single social\nservices district. The department shall approve disease management\ndemonstration programs which are geographically diverse and\nrepresentative of both urban and rural social services districts. The\nprogram sponsor must establish, to the satisfaction of the department,\nits capacity to enroll and serve sufficient numbers of enrollees to\ndemonstrate the cost-effectiveness of the demonstration program.\n 2. The department shall establish the criteria by which individuals\nwill be identified as eligible for enrollment in the demonstration\nprograms. Persons eligible for enrollment in the disease management\ndemonstration program shall be limited to individuals who: receive\nmedical assistance pursuant to title eleven of article five of the\nsocial services law and may be eligible for benefits pursuant to title\n18 of the social security act (Medicare); are not enrolled in a Medicaid\nmanaged care plan, including individuals who are not required or not\neligible to participate in Medicaid managed care programs pursuant to\nsection three hundred sixty-four-j of the social services law; are\ndiagnosed with chronic health problems as may be specified by the entity\nundertaking the demonstration program, including, but not limited to one\nor more of the following: congestive heart failure, chronic obstructive\npulmonary disease, asthma, diabetes or other chronic health conditions\nas may be specified by the department; or have experienced or are likely\nto experience one or more hospitalizations or are otherwise expected to\nincur excessive costs and high utilization of health care services.\n 3. Enrollment in a demonstration program shall be voluntary. A\nparticipating individual may discontinue his or her enrollment at any\ntime without cause. The commissioner shall review and approve all\nenrollment and marketing materials for a demonstration program.\n 4. The demonstration program shall offer evidence-based services and\ninterventions designed to ensure that the enrollees receive high\nquality, preventative and cost-effective care, aimed at reducing the\nnecessity for hospitalization or emergency room care or at reducing\nlengths of stay when hospitalization is necessary. The demonstration\nprogram may include screening of eligible enrollees, developing an\nindividualized car
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.