§ 2999-q. Accountable care organizations; requirements. 1. The\ncommissioner shall make regulations establishing criteria for\ncertificates of authority, quality standards for ACOs, reporting\nrequirements and other matters deemed to be appropriate and necessary in\nthe operation and evaluation of ACOs under this article. In making such\nregulations, the commissioner shall consult with the superintendent of\nfinancial services, health care providers, third-party health care\npayers, advocates representing patients, and other appropriate parties.\nSuch regulations shall be consistent, to the extent practical and\nconsistent with this article, with CMS regulations for accountable care\norganizations under the Medicare program.\n 2. Such regulations may, and shall as necessary for purposes of this\narticle, address matters including but not limited to:\n (a) The governance, leadership and management structure of the ACO\nthat reasonably and equitably represents the ACO's participants and the\nACO's patients, including the manner in which clinical and\nadministrative systems and clinical participation will be managed;\n (b) Definition of the population proposed to be served by the ACO,\nwhich may include reference to a geographical area and patient\ncharacteristics;\n (c) The character, competence and fiscal responsibility and soundness\nof an ACO and its principals, if and to the extent deemed appropriate by\nthe commissioner;\n (d) The adequacy of an ACO's network of participating health care\nproviders, including primary care health care providers;\n (e) Mechanisms by which an ACO will provide, manage, and coordinate\nquality health care for its patients including where practicable\nelevating the services of primary care health care providers to meet\npatient-centered medical home standards, coordinating services for\ncomplex high-need patients, and providing access to health care\nproviders that are not participants in the ACO;\n (f) Mechanisms by which the ACO shall receive and distribute payments\nto its participating health care providers, which may include incentive\npayments (which may include medical home payments) or mechanisms for\npooling payments received by participating health care providers from\nthird-party payers and patients;\n (g) Mechanisms and criteria for accepting health care providers to\nparticipate in the ACO that are related to the needs of the patient\npopulation to be served and needs and purposes of the ACO, and\npreventing unreasonable discrimination;\n (h) Mechanisms for quality assurance and grievance procedures for\npatients or health care providers where appropriate, and procedures for\nreviewing and appealing patient care decisions;\n (i) Mechanisms that promote evidence-based health care, patient\nengagement, coordination of care, electronic health records, including\nparticipation in health information exchanges, other enabling\ntechnologies and integrated, efficient and effective health care\nservices;\n (j) Performance standards for, and measures to assess, the quality and\nutilization of care provided by an ACO;\n (k) Appropriate requirements for ACOs to promote compliance with the\npurposes of this article;\n (l) Posting on the department's website information about ACOs that\nwould be useful to health care providers and patients, including similar\nmetrics as the commissioner publishes for other organizations such as\nMedicaid managed care providers under section three hundred sixty-four-j\nof the social services law and health homes under section three hundred\nsixty-five-l of the social services law;\n (m) Requirements for the submission of information and data by ACOs\nand their participating and affiliated health care providers as\nnecessary for the evaluation of the success of ACOs;\n (n) Protection of patient rights as appropriate;\n (o) The impact of the establishment and operation of an ACO, including\nproviding that it shall not diminish access to any health car
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