Section 1003.3 - Certificate of Authority

1003.3 Certificate of Authority

(a) The Commissioner may issue a certificate of authority if the applicant has met the requirements of Article 29-E of the Public Health Law and this Part, except that a Medicare-only ACO need not meet such requirements except as provided in section 2999-r of the Public Health Law and specifically in this Part. The Commissioner shall evaluate an ACO application based on the information contained in and submitted with the application and any other relevant information known to the Commissioner. The Commissioner will notify an applicant if the application is incomplete and provide the applicant an opportunity to submit the required information to complete the application. An application that remains incomplete 90 days after receiving a request from the Commissioner for additional information may be denied.

(b) The following conditions must be satisfied in order for the Commissioner to approve an application:

(1) The ACO must demonstrate the capability to provide, manage and coordinate health care (including primary care) for a defined population including, where practicable, elevating the services of primary care health care providers to meet patient centered medical home standards, coordinating services for complex high need patients and providing access to health care providers that are not part of the ACO;

(2) There is participation

of clinically integrated health care providers and other ACO participants that are accountable for the quality, cost and delivery of health care to the ACO’s defined population;

(3) There is a governance, leadership and management structure which is reasonably and equitably representative of the ACO participants and its patients; and

(4) There is documentation of satisfactory character and competence required to conduct the affairs of the ACO in its best interests and in the public interest and so as to provide proper services for the patients to be served.

Effective Date: 
Wednesday, December 31, 2014
Doc Status: 
Complete