SubPart 47-2 - Obstetric and Pediatric Practitioner Incentive Demonstration Program

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Secs. 231, 232, 233, 2506

Section 47-2.1 - Definitions.

Section 47-2.1 Definitions.

(a) "Program" means the Obstetric and Pediatric Practitioner Incentive Demonstration Program, also known as the Obstetric and Pediatric Malpractice Insurance Subsidy Program, as administered by the New York State Department of Health.

(b) "Obstetric practitioner" means:

(1) a New York State licensed physician who is board certified or an active candidate for board certification in obstetrics;

(2) a New York State licensed physician who is board certified or eligible for board certification in family practice and who provides obstetrical services;

(3) a New York State Education Department licensed midwife or person certified to practice midwifery by the Department of Health; or

(4) a licensed registered nurse certified as an obstetric nurse practitioner by the New York State Education Department.

(c) "Pediatric practitioner" means:

(1) a New York State licensed physician who is board certified or eligible for board certification in Pediatrics; or

(2) a licensed registered nurse certified as a pediatric nurse practitioner by the New York State Education Department.

(d) "Obstetric Group Practice" means an obstetric practitioner with an arrangement to practice with one or more other obstetric practitioners whether by partnership agreement or by forming a professional corporation.

(e) "Covered services" means prenatal, delivery and post-partum services provided by an obstetric practitioner or pediatric services provided by a pediatric practitioner for children under the age of one in a private individual or group practice, or in a comprehensive diagnostic and treatment center (1) through the Prenatal Care Assistance Program, or the Medical Assistance Program under the Social Services Law; or (2) to women and children who are not covered for obstetric or pediatric services by the programs set forth in paragraph (1) of this subdivision, or by private health insurance; or (3) through a program approved by the commissioner pursuant to section 2506(4) of the Public Health Law, under which the services are provided as part of a program provided by a general hospital or a city or a county health department and without remuneration to the practitioner.

(f) "Target population" means pregnant women and children up to the age of one who (1) are eligible for the Prenatal Care Assistance Program or the Medical Assistance Program under the Social Services Law; or (2) are not covered for obstetric or pediatric services by the programs set forth in paragraph (1) of this subdivision or by private health insurance; or (3) are eligible for a program approved by the commissioner pursuant to Section 2506(4) of the Public Health Law under which the services are provided as part of a program provided by a general hospital or a city or a county health department and without remuneration to the practitioner.

(g) "Malpractice insurance premium" means the cost of professional liability insurance coverage for the contract period.

(h) "Contractor" means an eligible obstetric or pediatric practitioner or group practice who has contracted with the Department of Health for a subsidy.

(i) "Subsidy" means the amount of remuneration a contractor may receive through this Program for his/her malpractice insurance premium.

(j) "Designated pediatric area" means a Federally designated Health Professional Shortage Area or an area designated by New York State Board of Regents as a Regents Physician Loan Forgiveness Area.

(k) "New pediatric practitioner" means a pediatric practitioner who is proposing to begin practice, or began practice, six months before or after filing an application for a subsidy, in a designated pediatric area.

(l) "Additional service obstetric practitioner" means an obstetric practitioner or obstetric group practice that agrees to increase the number of the target population provided covered services.

(m) "Disproportionate share obstetric practitioner" means an obstetric practitioner or obstetric group practice that has in the past provided and agrees to continue to provide covered services to a high number of the target population.

(n) "High-number" means 1/3 the average number of deliveries performed per year per obstetrician, family practitioner, or nurse midwife, as determined by the Department of Health.

(o) "Full-time pediatric practice" means providing patient care services at least 37.5 hours per week during at least 46 weeks per year in a designated pediatric area. Up to 8 hours per week providing services to residents from the designated pediatric area in a hospital located outside the designated area may be counted towards those hours.

(p) "General pediatric services" means ambulatory health care services provided to children under the age of one.

(q) "Comprehensive obstetrical services" means prenatal, delivery and post-partum services.

(r) "Application" means an application for a contract submitted by an obstetric practitioner, obstetric group practice, or pediatric practitioner on forms prescribed by the Department. (s) "Average obstetrical malpractice premium (AOMP)" means the amount determined by the commissioner to reflect the average malpractice insurance premium per delivery for obstetricians in a geographic region.
 

Doc Status: 
Complete

Section 47-2.2 - Practice requirements/eligibility

47-2.2 Practice requirements/eligibility.

(a) A new pediatric practitioner may be eligible to contract with the Program if the practitioner:

(1) agrees to provide pediatric services full-time in a designated pediatric area;

(2) agrees that the ratio of the practice's target patient population to the total patient population will be equal to or greater than the ratio of the target population in the designated area to the total population in that designated area;

(3) agrees to provide medical care in accordance with accepted medical standards (for example, standards accepted by the American College of Pediatricians);

(4) has the education, training and access to health care facilities to provide pediatric services to the eligible population (or, for a pediatric nurse practitioner, a practice arrangement with a pediatric practitioner who meets such requirements) including:

(i) hospital admitting privileges;

(ii) arrangements for twenty-four hour backup coverage; and

(iii) has purchased medical malpractice insurance from a medical liability insurer; and

(5) is responsible for paying his/her own malpractice insurance premiums or is a member of a partnership or professional corporation which is responsible for paying his/her malpractice insurance premiums.

(b) An additional service obstetric practitioner may be eligible to contract with the Program if the practitioner:

(1) agrees to increase the number of the target population provided comprehensive obstetrical services over the number served preceding the application;

(2) agrees to provide medical care in accordance with accepted medical standards (for example, standards accepted by the American College of Obstetricians and Gynecologists, the American Academy of Family Practitioners, or the American College of Nurse- Midwives);

(3) has the education, training and access to health care facilities to provide obstetric services to the eligible population (or, for obstetric nurse practitioners, a practice arrangement with an obstetric practitioner who meets such requirements) including:

(i) hospital admitting and delivery privileges in a hospital with maternity services or practice privileges in a birth center; and

(ii) arrangements for twenty-four hour backup coverage; and

(iii) has purchased medical malpractice insurance from a medical liability insurer; and

(4) is responsible for paying his/her/their own malpractice insurance premiums or is a member of a partnership or professional corporation which is responsible for paying his/her malpractice insurance premiums.

(c) A disproportionate share obstetric practitioner may be eligible to contract with the Program if the practitioner:

(1) agrees to maintain his/her/their current high number of the target population provided comprehensive obstetrical services: the number of deliveries required to be performed to be considered a group providing a disproportionate share of services is the sum of those required for each individual to be a disproportionate share provider;

(2) agrees to provide medical care in accordance with accepted medical standards (for example, standards accepted by the American College of Obstetricians and Gynecologists, the American Academy of Family Practitioners, or the American College of Nurse- Midwives);

(3) has the education, training and access to health care facilities to provide obstetric services to the eligible population (or for obstetric nurse practitioners, a practice arrangement with an obstetric practitioner who meets such requirements) including:

(i) hospital admitting and delivery privileges in a hospital with maternity services or practice privileges in a birth center;

(ii) arrangements for twenty-four hour backup coverage; and

(iii) has purchased medical malpractice insurance from a medical liability insurer; and

(4) is responsible for paying his/her/their own malpractice insurance premiums or is a member of a partnership or professional corporation which is responsible for paying his/her/their malpractice insurance premiums.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-2.3 - Amount of subsidy

47-2.3 Amount of subsidy.

(a) A new pediatric practitioner may receive a subsidy in an amount equal to his/her malpractice insurance premium for the contract period up to a maximum of $10,000.

(b) An additional service obstetric practitioner may receive a subsidy equal to the AOMP for each delivery to a member of the target population during the contract period above the number of deliveries of the target population performed during the calendar year prior to the date of original application, proportioned to the contract period. A maximum of $30,000 per year is allowed per obstetric practitioner in a solo or group practice who qualifies under section 47-2.2(b) which will be prorated for shorter contract periods. The number of deliveries performed by a group practice will be based on the total number performed by all practitioners in the group.

(c) A disproportionate share obstetric practitioner may receive a subsidy equal to the AOMP for each member of the target population delivered during the contract period over the minimum number of deliveries of the target population considered a disproportionate share, proportioned to the contract period. A maximum subsidy of $10,000 per year will be allowed per obstetric practitioner in a solo or group practice who qualifies under section 47-1.2(c) which will be prorated for shorter contract periods. The number of deliveries performed by a group practice will be based on the total number performed by all practitioners in the group.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-2.4 - Payment of subsidy

47-2.4 Payment of subsidy.

If a practitioner is a solo practitioner responsible for payment of his/her malpractice insurance premium, such subsidy will be paid directly to the practitioner. If the practitioner is a member of a partnership or professional corporation which is responsible for payment of his/her malpractice insurance premiums, such subsidy will be paid to the partnership or professional corporation.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete

Section 47-2.5 - Selection of contractors

47-2.5 Selection of contractors.

(a) Process. Contractors shall be selected based on the criteria described in subdivisions (b) and (c) of this section to the extent funds are available for contracts; however, a practitioner who is not eligible to enroll in the medical assistance program as a Medicaid provider or who is under suspension, exclusion or involuntary withdrawal from participation in the medical assistance program shall not be eligible for a contract under this Part.

(b) Preference. Preference shall be given to practitioners in the following categories in the order of listing:

(1) An additional service obstetric practitioner who has had a contract, satisfactorily met the contract's terms and conditions, and is requesting a second contract.

(2) A new pediatric practitioner who has a new pediatric practitioner contract, satisfactorily met the contract's terms and conditions, and is requesting a second contract.

(3) An additional service obstetric practitioner applying for an initial contract.

(4) A new pediatric practitioner applying for an initial contract.

(5) A disproportionate share obstetric practitioner applying for an initial or additional contract.

(c) Selection criteria. If funds available for the program are not sufficient to cover all eligible applicants within a category listed in subdivision (b) above, then applicants within that category shall be reviewed competitively using the following criteria:

(1) the extent of the practitioner's potential contribution towards increasing covered services available to the target population;

(2) the need for covered services to the target population in the designated area or location;

(3) in the case of an obstetric practitioner, the extent of participation in the New York State Department of Health Prenatal Care Assistance Program;

(4) the extent of participation in a Medicaid managed care program if there is a New York State Department of Social Services approved program in the social services district; and

(5) the demonstrated commitment of the applicant to serve the target population and the education, training or other experience of the applicant to provide obstetric or pediatric services to the target population.
 

Doc Status: 
Complete

Section 47-2.6 - Program administration and process.

47-2.6 Program administration and process.

(a) Applicants shall apply to the New York State Department of Health on such forms and provide such information as the Department determines is necessary to administer the program.

(b) Applicants who are practitioners in an obstetric group practice must submit an application as a group.

(c) To obtain a subsidy, applicants who are selected and approved must enter into a contract with the Department. The contract will include the minimum level of services to be provided, recording requirements, payment schedule and other requirements.
 

Effective Date: 
Wednesday, October 13, 1993
Doc Status: 
Complete