Part 82 - Health Systems Agencies

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2904

SubPart 82-1 - Organization and Functions of Health Systems Agencies

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-1.1 - Definitions

Section 82-1.1 Definitions. As used in this subpart, the following words have the following meanings:

(a) "Commissioner" means the State Commissioner of Health.

(b) "Health facilities" shall include, but not be limited to hospitals as defined pursuant to section 2801(1) of the Public Health Law, facilities as defined pursuant to section 1.03(6) of the Mental Hygiene Law (other than community residences), certified home health agencies and long term home health care programs as defined pursuant to article 36 of the Public Health Law, hospices as defined pursuant to article 40 of the Public Health Law, and health maintenance organizations as defined pursuant to article 44 of the Public Health Law.

(c) "Health resources" shall include health services (including the provision of health care to individuals and the administration of health facilities), health professional personnel, and health facilities.

(d) "Provider of health care" means an individual: (1) who is a direct provider of health care (including but not limited to a physician, licensed midwife, dentist, nurse practitioner, licensed nurse, podiatrist, optometrist, physician's assistant, or ancillary personnel employed under the supervision of a physician) and whose primary current activity is the provision of health care to individuals or the administration (including trustees or members of boards of directors) of health facilities in which such care is provided; or (2) who holds a fiduciary position with, or has a fiduciary interest in, any entity which has as its primary purpose the delivery of health care, the conduct of research into or instruction for health professionals in the provision of health care, or the production of or supply of drugs or other articles for individuals or entities for use in the provision of or in research into or instruction in the provision of health care; or (3) who is a professional employee of a health professions school; or (4) who is the spouse of an individual described in paragraphs (1) or (2) or (3) of this subdivision.
 

Effective Date: 
Wednesday, May 31, 2000
Doc Status: 
Complete

Section 82-1.2 - Health service areas

82-1.2 Health service areas.

(a) Geographical description.Health service areas have been established for health systems agencies such that:

(1) the area is a geographic region appropriate for the effective planning and development of health services, determined on the basis of factors including population and the availability of resources to provide all necessary health services for residents of the area.

(2) the boundaries of health service areas have been determined so as to recognize the differences in health planning and health services development needs between metropolitan and nonmetropolitan areas.

(3) in order for a bi-state health service area to be designated, a bi-state planning agreement must be established. The bi-state planning agreement shall include but need not be limited to the following provisions: standards for equitable representation of board membership from each state; boundaries that are consistent with medical trade patterns; provisions for financial support from each state; and comparable policies and procedures to be implemented by the bi-state health systems agency in evaluating the availability and need for hospital or other health care facilities or services and governing the collection of data and statistics for health planning. Any such bi-state agreement shall be signed by the executives of each state.

(b) The geographical boundaries and territorial extent of the health services areas in New York State for health systems agencies are based on county groupings, approved by the governor, as described below:

Area 1: the counties of Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Orleans, Niagara and Wyoming.

Area 2: the counties of Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates.

Area 3: the counties of Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence and Tompkins.

Area 4: the counties of Broome, Chenango, Tioga, Bradford, Sullivan and Susquehanna provided a bi-state planning agreement with the State of Pennsylvania exists.

Area 5: the counties of Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Washington and Warren.

Area 6: the counties of Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester.

Area 7: the counties of Bronx, Kings, New York, Queens and Richmond.

Area 8: the counties of Nassau and Suffolk.

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-1.3 - Legal structure

82-1.3 Legal structure.

A health systems agency shall be a corporation organized pursuant to the not-for-profit corporation law which is incorporated in New York State, which is not a subsidiary of, or otherwise controlled by, any other private or public corporation or other legal entity, and which only engages in health planning and development activities and functions as defined in section 82-1.6 of this subpart.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-1.4 - Staffing

82-1.4 Staffing.

(a) A health systems agency shall have appropriate staff to fulfill health planning and development activities and functions as defined in section 82-1.6 of this subpart.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-1.5 - Governing body

82-1.5 Governing Body.

A health systems agency shall have a governing body which shall have exclusive authority to perform the health systems agency functions described in section 82-1.6 of this subpart. The "governing body" shall mean the board of directors of the health systems agency or a standing committee designated by the board of directors.

(a) Responsibilities. The governing body shall be responsible for:

(1) appointing an executive director who shall be responsible for the internal affairs of the health systems agency including matters related to the staff of the agency and the agency's budget;

(2) the approval or disapproval of the agency's annual budget, health systems and other plans, reports, and products prepared by the agency as appropriate;

(3) issuing an annual report concerning the activities of the agency, and making the report readily available to the residents of the health service area and to the various communications media serving the area;

(4) performing any other duties and functions of the health systems agency required by law; and

(5) approving major planning initiatives not specifically required in section 82-1.6 of the subpart.

(b) Meetings. The governing body shall:

(1) meet at a minimum four times per calendar year;

(2) hold public meetings as if it were a public body to conduct the business of the agency;

(3) give adequate notice to the public of such meetings;

(4) provide an opportunity for parties directly affected by a decision of the agency to request a public meeting and, when good cause is shown, to conduct a public meeting for the purpose of considering additional information provided by the affected party(ies); and

(5) act by vote of at least a majority of the members of the governing body present at the time of the vote, provided a quorum is present at such time. (A quorum for the governing body shall be not less than a majority of its members.)

(c) Composition. Each health systems agency shall establish a process for the selection of the members of its governing body which assures a rotation of membership and that the members are broadly representative of the residents of the health service area and that the participation of such residents is encouraged and facilitated. A member of the governing body shall serve no more than two consecutive fixed terms of three years each in any period of twelve consecutive years or no more than a total of six years in any twelve-year period. Persons appointed as board members prior to March 1, 1990 shall be eligible to serve a full term subject to the conditions and limitations of section 2904 of the Public Health Law. Full compliance with this requirement shall be required as of March 1, 1993.

The membership of the board of directors of a health systems agency and any executive committee designated by the board of directors shall meet the following criteria:

(1) A majority (but not more than sixty percent of the members) shall be (i) residents of the health service area served by the agency who are consumers of health care, and (ii) broadly representative of the health service area and shall include individuals representing the principal social, economic, linguistic, handicapped, ethnic and racial populations and geographic areas of the health service area and major purchasers of health care, including labor organizations and business corporations, in the area. A consumer shall mean a person who is not a "provider of health care" as defined in accordance with section 82-1.1(d) of this subpart. Full compliance with this requirement shall be required as of March 1, 1993.

(2) The remainder of the members shall be residents of, or have their principal place of business in, the health service area served by the agency who are providers of health care and who, to the extent practicable, are representative of the variety of disciplines and interests of the health care system including (i) physicians, dentists, nurse practitioners, licensed midwives, licensed nurses, optometrists, podiatrists, physician's assistants, and other health professionals, (ii) health facilities, (iii) health care insurers, (iv) health professional schools, (v) the allied health professions, and (vi) other providers of health care.

Not less than one-half of the providers of health care of the governing body of a health systems agency shall be direct providers of health care and of such direct providers of health care, at least one shall be a person engaged in the administration of a health facility.

(3) At least sixty percent of board membership shall be nominated by local government, local provider organizations and local community organizations.

(4) The members shall (i) include public elected officials or other representatives of units of general purpose local government in the agency's health service area and representatives of public and private agencies in the area concerned with health, (ii) include persons who reside in nonmetropolitan areas within the health services area proportionate to the percentage of residents of the area who reside in nonmetropolitan areas, (iii) include persons who are knowledgeable about mental hygiene services, and (iv) if the agency serves an area in which there are one or more health maintenance organizations, include at least one member who is representative of such organizations. (5) To the extent practicable, all standing committees, subcommittees, and advisory groups appointed by the governing body of the health systems agency shall be appointed in such a manner as to provide broad representation in such a manner that a majority of the members shall be consumers of health care.

(d) Conflicts of interest.

(1) Annual statement. Each member of the governing body and staff shall submit annually to such governing body a written statement identifying all health facilities in which he or a member of his family has an interest, financial or otherwise, whether as owner, officer, director, fiduciary, employee or consultant, or supplier of goods or services where the health facility or health facilities represent a significant portion of the business of the supplier. For purposes of this subdivision, "family" shall, at a minimum, include a spouse and dependent children. Each health systems agency may expand the definition of family in their bylaws. The chair of the governing body shall distribute to each member and staff a copy of the annual statements submitted by all other members and staff.

(2) Pending matters. Each health systems agency shall adopt bylaws regarding disclosure and conflicts of interest which shall provide at a minimum:

(i) Disqualification. Where a member of the governing body and standing committees or his family has an interest, financial or otherwise, whether as owner, officer, director, fiduciary, employee or consultant of a health facility under consideration, or supplier of goods or services regarding a health facility under consideration where the health facility represents a significant portion of the business of the supplier, that member shall identify such interest and shall not participate in any vote on the matter.

(ii) Disclosure and possible disqualification. Where a member of the governing body and standing committees or his family has any of the aforesaid interests in a health facility, the status of which might reasonably be affected by another health facility under consideration before the body and which serves or is proposed to serve the same community or service areas as does the health facility in which the member of his family has an interest, or in any event where a member has an interest or association which might reasonably raise suspicion among the public that participation by him in the matter under consideration would be in violation of his trust, he shall, at the time of formal consideration of such matters before the body, disclose such interests or association so that the chair and, if necessary, the body can then determine whether his participation in the discussion of or vote on the matter would be proper.

(iii) Procedure. Prior to discussion or vote, all actual or potential conflicts shall be announced and, where appropriate, explained by the members holding such conflicts. In the case of disqualification, the members holding such conflicts shall absent themselves from the meeting during the period when the matter is under formal consideration unless the body, upon request of the member for good cause, by affirmative vote of the majority of those present determines to permit such member to remain. The minutes of each meeting of the body shall reflect all disclosures regarding conflicts of interest as well as the abstention from voting of the interested member.

(3) Advisory groups. Each health systems agency shall adopt conflicts of interest bylaws for advisory groups which advise the governing body or its standing committees.

(e) Records.

(1) The governing body of each health systems agency shall ensure that records and data of the agency are available, upon request, to the public, other than records or data that would not be subject to disclosure if the agency were a public agency subject to the Freedom of Information Law (article 6 of the Public Officers Law). Such records include, but are not limited to, applications and related documents concerning the establishment or construction of health facilities as defined in this subpart. Records, or portions thereof, which are not subject to disclosure shall be kept confidential.

(2) (i) Routine requests for access to records in which it appears clear that the requested information is disclosable shall be processed by the health systems agency.

(ii) Requests for access to records in which there is a question as to whether the information is subject to disclosure shall be forwarded to the Department of Health's records access officer, Corning Tower, Empire State Plaza, Albany, New York 12237 for a determination.

(3) A health systems agency may impose a reasonable charge for all inspections and copies, not exceeding the costs incurred by such agency. (f) Other requirements. Each health systems agency shall:

(1) submit a semi-annual report to the Senate and Assembly health committees, and the commissioner detailing the activities of each agency during that reporting period,

(2) annually submit a copy of its operating budget to the chairman of the Senate Finance Committee, the chairman of the Assembly Ways and Means Committee, the Director of the Budget and the Commissioner of Health. Such operating budget shall contain information detailing contributions received and the type and sources of contributions eligible for matching grants,

(3) provide for such fiscal control consistent with generally accepted accounting principles as the commissioner may require to assure proper disbursement of, and accounting for, funds received by the health systems agency from the state and other sources, and

(4) retain for a period of six years and permit the commissioner, the State Comptroller and the Attorney General, or their duly authorized representatives, to have access for the purpose of audit, inspection and copying to all books, documents, papers, accounts and records pertinent to the disposition of funds received by the health systems agency from the state and other sources.
 

Effective Date: 
Wednesday, May 31, 2000
Doc Status: 
Complete

Section 82-1.6 - Functions

82-1.6 Functions.

(a) Health systems agencies shall conduct regional health planning for the purposes of:

(1) improving the health of residents of a health service area,

(2) improving the availability, accessibility, continuity, quality, effectiveness and efficiency of the health services provided,

(3) controlling unnecessary increases in the cost of providing health services,

(4) preventing unnecessary duplication of health resources, and

(5) promoting of the development of health services, manpower, and facilities which meet identified needs, reduce inefficiencies, respond to local health planning priorities and implement the health plans of the agency.

(b) A health systems agency shall perform the following functions on behalf of the state based upon available resources:

(1) assess the health status and health service needs of the population in the health service area, with attention to variations by location, socio-economic category, ethnicity, environment, age and disability and prepare and submit to the commissioner a comprehensive regional health plan which identifies priorities, goals, and implementation strategies for the health care system of the health service area;

(2) convene multiprovider and consumer planning groups for the purpose of identifying unmet needs affecting health status and to examine, at the community level, and report to the appropriate state agency, ways to develop primary and preventive services to meet those needs;

(3) assess health facility construction needs and submit to the commissioner, in a mutually agreed upon format and time frame, priority rankings of the capital expenditure and health service needs identified in its health service area;

(4) convene multifacility planning groups for the purpose of health facilities planning pursuant to Part 710 of Subchapter C of Chapter V of this Title in order to assist the commissioner to identify excess capacity, duplications, and unmet needs for health facilities, equipment, and services;

(5) convene providers of health care for the purpose of developing and implementing plans subject to approval by the appropriate state agency which respond to unmet needs and/or improve the allocation and distribution of health care services;

(6) assist appropriate state agencies, the Public Health Council, the State Hospital Review and Planning Council and appropriate councils under the Mental Hygiene Law in the development of standards and guidelines to determine public need for hospital and other health, including mental health services;

(7) coordinate its activities with other appropriate general or special purpose regional health and human services planning or administrative agencies including area agencies on aging, local and regional alcohol abuse, drug abuse, and mental health planning agencies, social services agencies, county public health departments, and local health officers. The health systems agency shall, as appropriate, obtain data from such other agencies for use in the health systems agency's planning and development activities, enter into agreements with such other agencies, and to the extent practicable, provide technical assistance to such other agencies;

(8) review and comment on the standards, criteria, findings, and recommendations proposed by the Department of Health concerning the appropriateness of selected health services in the health service area;

(9) conduct public hearings related to applications for the establishment or construction of a hospital as defined in Article 28 of the Public Health Law, the certification of home health agencies and the authorization to provide a long term home health care program as defined in Article 36 of the Public Health Law, the establishment or construction of a hospice as defined in Article 40 of the Public Health Law, and the establishment or construction of mental hygiene services and facilities other than community residences as defined in section 1.03(6) and pursuant to Article 31 of the Mental Hygiene Law;

(10) recommend to the commissioner and to the Public Health Council as appropriate approval or disapproval of applications for the establishment or construction of a hospital as defined in Article 28 of the Public Health Law, the certification of home health agencies and the authorization to provide a long term home health care program as defined in Article 36 of the Public Health Law, the establishment or construction of a hospice as defined in Article 40 of the Public Health Law;

(11) recommend to the appropriate state agency approval or disapproval of applications for the establishment or construction of mental hygiene services and facilities other than community residences as defined in section 1.03(6) and pursuant to Article 31 of the Mental Hygiene Law; (12) perform and issue special reports and engage in other planning and implementation activities at the request of the commissioner (or other appropriate state agency); such reports may be related to:

(i) the health status (and its determinants) of the residents of the health service area;

(ii) the status of the health care delivery system in the area and the use of that system by the residents of the area;

(iii) the effect the area's health care delivery system has on the health of the residents of the area;

(iv) the number, type, and location of the area's health resources including health services, manpower, and facilities; and

(v) the patterns of utilization of the area's health resources.

(c) The commissioner shall, in consultation with the health systems agencies, determine what specialized plans and reports are required as well as the time frame and format for the development of such plans and reports.

(d) In addition to the functions described in section 82-1.6(b) of this subpart, a health systems agency, to carry out its purposes, functions, and activities as described in section 82-1.6(a) of this subpart, may enter into agreements or contracts with and receive grant funds, contributions or donations from various entities interested in fostering the health planning goals and objectives of this subsection. A health systems agency may enter into agreements and contracts with and receive grant funds, contributions or donations from such entities as: (i) local, county, and state government; (ii) not-for-profit organizations exempt from taxation pursuant to section 501(c)(3) of Title 26 of the United States Code, private industry, insurers of health services, and other organizations, excluding, however, any such entities that are providers of health care operating facilities licensed or certified pursuant to the Public Health Law or Mental Hygiene Law except as may be authorized in accordance with paragraph (1) of subdivision (e) of this section; and (iii) associations of health facilities or associations of providers of health care.

(e) (1) A health systems agency shall not engage in any fee for service activity with a provider or potential provider of health care services except local government without prior approval of the State Hospital Review and Planning Council. Approval shall be issued or denied in a timely manner.

(2) The governing body of a health systems agency shall be responsible for developing and periodically revising policies and procedures, governing the agency's ability to sell resources and engage in fee-for- service activities or other contractual arrangements. Such policies and procedures shall be submitted to the State Hospital Review and Planning Council for review.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

SubPart 82-2 - State Funding for Health Systems Agencies

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-2.1 - Grants, general

Section 82-2.1 Grants, general. The Commissioner of Health, contingent upon appropriation by the legislature, shall annually make a grant to each health systems agency for health planning and development. A grant under this subpart shall be made on such conditions, including the submission of the agency's budget and annual programmatic and administrative plans, as the Commissioner of Health determines is necessary and appropriate, and shall be used by the health systems agency for compensation of health systems agency personnel, collection of data, planning, and the performance of the functions of the health systems agency.

A health systems agency may use grant funds to make payments under contracts with other entities to assist the health systems agency in the performance of its functions as defined in section 82-1.6 of subpart 82-1 of this part; but an agency may not use grant funds to make payments under a grant or contract with another entity for the development or delivery of health services or resources.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-2.2 - Computation of grants

82-2.2 Computation of grants. The amount of any grant made to a health systems agency pursuant to this subpart shall be determined by the Commissioner of Health, in accordance with appropriations made pursuant to law.

(a) Base support. The Commissioner of Health shall allocate at least $250,000, contingent upon appropriation level, as base support for each health systems agency and shall distribute any base support according to an equitable formula.

(b) Matching support. Matching support shall be provided based on the level of appropriation and shall be calculated based on a ratio of the appropriation and funds raised and received during the previous calendar year from other qualified sources including grants by local and county governments, interest income, and grants or contributions made by individuals or private entities excluding grants or contributions made by individuals, private entities, or health maintenance organizations having a financial, fiduciary, or other direct interest in the development, expansion, or support of health resources. The calendar year shall be applied to promote consistency and uniformity in measuring funds raised notwithstanding any overlap that may occur in the initial year in measuring funds raised on which state matching funds are calculated. For purposes of this paragraph, an individual or entity shall not be considered to have such an interest solely on the basis of (i) providing, directly or indirectly, health care for their employees, nor (ii) engaging in issuing any policy or contract of individual or group health insurance or hospital or medical service benefits. Further, for purposes of this paragraph, an association of health facilities or providers of health care shall not be considered to have such an interest. The funds raised and received from other qualified sources on which state matching funds are calculated and allocated shall be used solely for the purposes specified in section 82-1.6 of subpart 82-1 of this part.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-2.3 - Termination

82-2.3 Termination.

(a) A grant may be terminated by the Commissioner of Health before the expiration of the established funding period if (1) the health service area of the agency is revised during the funding period or (2) the Commissioner of Health determines that the health systems agency cannot effectively carry out the functions as defined in section 82-1.6 of subpart 82-1 of this part.

(b) Before the Commissioner of Health may terminate the funding of a health systems agency, the commissioner shall provide written notice of the reasons for termination and shall provide the health systems agency with an opportunity to meet with the Department of Health, present information and resolve the deficiencies.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-2.4 - Accounting

82-2.4 Accounting.

The health systems agency shall maintain full and complete books, records and accounts, consistent with generally accepted accounting principles, pertinent to the receipt and disposition of state grant funds and other funds. Such books, records and accounts shall be retained for a period of six years from the date of disbursement of such grant funds and other funds by the health systems agency and shall at all times be made available for audit, inspection and copying by the Commissioner of Health, the State Comptroller and the Attorney General, or by their duly authorized representatives.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete

Section 82-2.5 - Limitations on non-state sources of funding

82-2.5 Limitations on non-state sources of funding.

A health systems agency may enter into agreements and contracts with and receive grant funds, contributions or donations from such entities as: (i) local, county, and state governments; (ii) not-for-profit organizations exempt from taxation pursuant to section 501(c)(3) of Title 26 of the United States Code, private industry, insurers of health services, and other organizations, excluding, however, any such entities that are providers of health care operating facilities licensed or certified pursuant to the Public Health Law or Mental Hygiene Law except as may be authorized in accordance with section 82-1.6(e)(1) of subpart 82-1 of this part; and (iii) associations of health facilities or associations of providers of health care.
 

Effective Date: 
Wednesday, November 7, 1990
Doc Status: 
Complete