Title: Section 408.2 - Network Operational Plans (NOP)
408.2 Network Operational Plans (NOP)
(a) "Network operational plan" shall mean a written plan, including periodic updates of such a plan, prepared by a CSFRHN, with the involvement of consumers unaffiliated with health care providers, describing the steps to be taken by such network and its participating providers to enhance access, by residents of the affected rural area, including special populations, to necessary health care services while promoting cost efficiencies in the provision of services.
(b) The commissioner shall not approve a network operational plan until he/she has considered the recommendations of the HSA(s) having jurisdiction in the region in which the network intends to operate and is satisfied that the plan complies with the provisions of section 2957 of the Public Health Law, and meets the following requirements:
(1) establishes an organizational structure that includes a decision making structure representative of participating providers and consumers, mission statement, goals, operating principles, and written agreements between the network and all affiliated providers, copies of which shall be submitted with a proposed plan;
(2) provides for the delivery of at least acute care, comprehensive primary care, and emergency medical care;
(3) ensures the provision of appropriate high quality health care services in accordance with prevailing standards of care and practice. At a minimum the plan shall demonstrate that:
(i) the roles and responsibilities of the network and its participating providers in quality assurance/improvement activities are identified. Quality assurance/improvement activities conducted by the network on behalf of one or more of its participating providers shall be specifically delineated;
(ii) a strategy for monitoring, coordinating and assuring that the quality assurance/improvement programs of network participants comply with existing criteria and standards applicable to participants. At a minimum this strategy shall assure that:
(a) both process and outcome based measures are included in network provider quality assessment programs;
(b) a network-wide communication and information system, or plans for such system, is available and contains the capacity to track patients throughout the system and provide network providers with the necessary information to enhance continuity of care; and
(c) procedures will be in place that delineate the duties and responsibilities of medical/professional and ancillary support staff necessary to ensure the provision of high quality services by network providers;
(4) ensures that all potential patients in the network service area have access to necessary services. At a minimum the plan shall provide assurances that:
(i) residents of the network service area shall be provided with information sufficient to make them aware of available services;
(ii) providers of the three required minimum services are located so as to ensure reasonable access to services by all residents of the area served by the network as determined by the commissioner; and
(iii) on-call systems are in place to provide 24-hour a day coverage within the network for at least the three required minimum services in settings appropriate to patient needs;
(5) provides for the efficient and effective coordination of affiliated network providers in planning and evaluating both the integration and provision of services. At a minimum this element of a network operational plan shall include:
(i) an organizational structure, or plans for such structure, for ensuring coordination among network members and other appropriate agencies involved in planning for health and health related services in the network's service area; and
(ii) a coordinated system for developing and using community service plans, county municipal health plans, and other appropriate existing or proposed health plans such as those of appropriate state and regional agencies including the HSAs;
(6) provides for the pooling and sharing of existing resources to facilitate greater system efficiencies; and
(7) establishes terms and conditions to ensure that no hospital, physician or other licensed or certified health care provider operating in good standing, serving the network service area, and willing to meet the terms and conditions of the network as defined in the network operational plan, shall be denied the ability to participate therein. Such terms and conditions may include, but need not be limited to, a prospective participant's ability to deliver services in accordance with prevailing standards of care and/or practice and a participant's willingness to participate in coordinated network quality assurance and improvement programs, peer review programs, credentialing systems, utilization review programs, medical record systems, consultation services, specialty services, communications systems and data collection systems. Such terms and conditions may also include provisions for the payment and reimbursement of services provided by network participants. (c) Periodic updates and revisions of network operational plans. The governing board of a central services facility rural health network shall annually review the network's operational plan, and amend it as necessary subject to the prior approval of the commissioner.
(1) When an operational plan is proposed to be amended, the network shall simultaneously notify the commissioner and the Health Systems Agency (HSA) having geographical jurisdiction in the region in which the network operates or intends to operate regarding all such proposed amendments. The network shall also provide reasonable prior notification to the public, by publication in a newspaper of general circulation in the service area, and through such other media as the network deems appropriate, of all significant amendments as described below.
(2) If, upon review, the commissioner finds that such amendment(s) are significant, he shall not issue a determination concerning such amendment(s) until he has received the recommendations of the health systems agency having jurisdiction. Significant amendments shall include but need not be limited to those materially affecting any of the criteria set forth in subdivision (3) of section 2957 of the Public Health Law, additions or deletions of network participants and changes in the geographic area being served by the network. In the event that a significant overlap in the service areas of two or more CSFRHNs is proposed, the commissioner may require one or more of the CSFRHNs to amend its defined service area.
(d) Upon request of a CSFRHN, through its proposed network operational plan, or a proposed amendment thereto, the commissioner may permit the network to make application for, or fulfill regulatory requirements on behalf of, network participating providers for purposes including, but not necessarily limited to, certificate of need, quality assurance, reimbursement, and professional credentialing and privileging.
(e) All amendments shall be described in an annual report which shall be submitted to the commissioner no later than March 31st of the following year. Such report shall describe in detail the manner and extent to which a network and its affiliated providers have achieved the efficiencies proposed in the network operational plan and have effected increased access to necessary health care services.
(f) No CSFRHN shall discontinue operation or implementation of a network operational plan unless it has first received the Commissioner's approval of a plan of closure pursuant to subdivisions (g) through (j) of Section 401.3 of this Title.
VOLUME C (Title 10)