2807-M - Distribution of the professional education pools.

§  2807-m.  Distribution  of  the  professional  education  pools.  1.  Definitions. For purposes of this  section,  the  following  definitions  shall apply, unless the context clearly requires otherwise:    (a) "Clinical research" means patient-oriented research, epidemiologic  and  behavioral  studies,  or  outcomes  research  and  health  services  research that is approved by an institutional review board by  the  time  the clinical research position is filled.    (b) "Clinical research plan" means a plan submitted by a consortium or  teaching  general  hospital  for  a  clinical  research  position  which  demonstrates, in  a  form  to  be  provided  by  the  commissioner,  the  following:    (i)  financial  support for overhead, supervision, equipment and other  resources  equal  to  the  amount  of  funding  provided   pursuant   to  subparagraph  (i) of paragraph (b) of subdivision five-a of this section  by the teaching general hospital or consortium for the clinical research  position;    (ii) experience the sponsor-mentor and teaching general  hospital  has  in clinical research and the medical field of the study;    (iii)  methods, data collection and anticipated measurable outcomes of  the clinical research to be performed;    (iv) training goals, objectives and experience the researcher will  be  provided to assess a future career in clinical research;    (v)  scientific  relevance,  merit  and  health  implications  of  the  research to be performed;    (vi) information on potential  scientific  meetings  and  peer  review  journals where research results can be disseminated;    (vii)  clear  and  comprehensive  details  on  the  clinical  research  position;    (viii) qualifications necessary for the clinical research position and  strategy for recruitment;    (ix) non-duplication with other clinical research positions  from  the  same teaching general hospital or consortium;    (x)  methods  to  track the career of the clinical researcher once the  term of the position is complete; and    (xi) any other information required by the commissioner  to  implement  subparagraph (i) of paragraph (b) of subdivision five-a of this section.    (xii)  The  clinical  review  plan  submitted  in accordance with this  paragraph may be reviewed  by  the  commissioner  in  consultation  with  experts outside the department of health.    (c)  "Clinical  research  position"  means  a  post-graduate residency  position which:    (i) shall not be required in order for the researcher  to  complete  a  graduate medical education program;    (ii)  may  be reimbursed by other sources but only for costs in excess  of the funding  distributed  in  accordance  with  subparagraph  (i)  of  paragraph (b) of subdivision five-a of this section;    (iii)  shall  exceed  the  minimum  standards that are required by the  residency review committee in the specialty the researcher  has  trained  or is currently training;    (iv)  shall  not be previously funded by the teaching general hospital  or supported by another funding source at the teaching general  hospital  in  the  past  three  years  from the date the clinical research plan is  submitted to the commissioner;    (v) may supplement an existing research project;    (vi) shall be equivalent to a full-time position comprising of no less  than thirty-five hours per week for one or two years;(vii) shall provide, or be filled by a researcher who  has  formalized  instruction  in  clinical  research,  including  biostatistics, clinical  trial design, grant writing and research ethics;    (viii) shall be supervised by a sponsor-mentor who shall either (A) be  employed,  contracted  for  employment  or  paid  through  an affiliated  faculty practice plan by a teaching general hospital which has  received  at  least  one  research grant from the National Institutes of Health in  the past five  years  from  the  date  the  clinical  research  plan  is  submitted  to  the commissioner; (B) maintain a faculty appointment at a  medical, dental or podiatric school located in New York state  that  has  received  at  least  one  research grant from the National Institutes of  Health in the past five years from the date the clinical  research  plan  is  submitted  to  the  commissioner;  or  (C)  be  collaborating in the  clinical research plan with a researcher from another  institution  that  has received at least one research grant from the National Institutes of  Health  in  the past five years from the date the clinical research plan  is submitted to the commissioner; and    (ix) shall be filled by a  researcher  who  is  (A)  enrolled  or  has  completed  a graduate medical education program, as defined in paragraph  (i) of this subdivision; (B)  a  United  States  citizen,  national,  or  permanent  resident  of  the  United  States;  and  (C)  a graduate of a  medical, dental or  podiatric  school  located  in  New  York  state,  a  graduate or resident in a graduate medical education program, as defined  in  paragraph (i) of this subdivision, where the sponsoring institution,  as defined in paragraph (q) of this subdivision, is located in New  York  state,  or  resides  in New York state at the time the clinical research  plan is submitted to the commissioner.    (d) "Consortium" means an organization or association, approved by the  commissioner in consultation with  the  council,  of  general  hospitals  which  provide  graduate medical education, together with any affiliated  site; provided that such organization or association  may  also  include  other  providers  of  health  care  services, medical schools, payors or  consumers, and which meet other criteria pursuant to subdivision six  of  this section.    (e)  "Council"  means  the  New York state council on graduate medical  education.    (f) "Direct medical education" means the direct  costs  of  residents,  interns and supervising physicians.    (g)  "Distribution  period"  means  each  calendar  year  set forth in  subdivision two of this section.    (h) "Faculty" means persons who are employed by or under contract  for  employment  with  a  teaching  general  hospital  or  are paid through a  teaching  general  hospital's  affiliated  faculty  practice  plan   and  maintain  a  faculty appointment at a medical school. Such persons shall  not be limited to persons with a degree in medicine.    (i) "Graduate  medical  education  program"  means,  for  purposes  of  subparagraph (i) of paragraph (b) of subdivision five-a of this section,  a  post-graduate  medical education residency in the United States which  has received accreditation from a  nationally  recognized  accreditation  body  or  has  been approved by a nationally recognized organization for  medical, osteopathic, podiatric or dental residency programs  including,  but not limited to, specialty boards.    (j)  "Indirect  medical  education" means the estimate of costs, other  than direct costs, of educational activities in  teaching  hospitals  as  determined in accordance with the methodology applicable for purposes of  determining   an  estimate  of  indirect  medical  education  costs  for  reimbursement for inpatient hospital service pursuant to title XVIII  of  the federal social security act (medicare).(k)  "Medicare" means the methodology used for purposes of reimbursing  inpatient hospital services provided to beneficiaries of title XVIII  of  the federal social security act.    (l)   "Primary   care"  residents  specialties  shall  include  family  medicine,  general  pediatrics,  primary  care  internal  medicine,  and  primary  care  obstetrics  and  gynecology.  In  determining  whether  a  residency is in primary care, the commissioner shall  consult  with  the  council.    (m) "Regions", for purposes of this section, shall mean the regions as  defined  in paragraph (b) of subdivision sixteen of section twenty-eight  hundred seven-c of this article as in effect on June thirtieth, nineteen  hundred  ninety-six.  For  purposes   of   distributions   pursuant   to  subdivision  five-a  of  this  section,  except  distributions  made  in  accordance with paragraph (a) of subdivision  five-a  of  this  section,  "regions" shall be defined as New York city and the rest of the state.    (n) "Regional pool" means a professional education pool established on  a  regional  basis  by the commissioner from funds available pursuant to  sections twenty-eight hundred seven-s and twenty-eight  hundred  seven-t  of this article.    (o)  "Resident" means a person in a graduate medical education program  which  has  received  accreditation   from   a   nationally   recognized  accreditation  body  or  in  a  program approved by any other nationally  recognized organization for medical,  osteopathic  or  dental  residency  programs including, but not limited to, specialty boards.    (p)   "Shortage   specialty"  means  a  specialty  determined  by  the  commissioner, in consultation with the council, to be in short supply in  the state of New York.    (q) "Sponsoring institution" means the entity  that  has  the  overall  responsibility  for  a  program  of  graduate  medical  education.  Such  institutions shall include teaching general hospitals, medical  schools,  consortia and diagnostic and treatment centers.    (r)  "Weighted  resident  count"  means  a teaching general hospital's  total  number  of  residents  as  of  July   first,   nineteen   hundred  ninety-five,  including  residents in affiliated non-hospital ambulatory  settings, reported to  the  commissioner.  Such  resident  counts  shall  reflect the weights established in accordance with rules and regulations  adopted  by  the state hospital review and planning council and approved  by the commissioner for purposes of implementing subdivision twenty-five  of section twenty-eight hundred seven-c of this article and in effect on  July first, nineteen hundred ninety-five.  Such  weights  shall  not  be  applied  to  specialty  hospitals,  specified by the commissioner, whose  primary care mission is to engage in  research,  training  and  clinical  care  in  specialty  eye  and  ear,  special  surgery, orthopedic, joint  disease, cancer, chronic care or rehabilitative services.    (s) "Adjustment amount" means an amount determined for  each  teaching  hospital for periods prior to January first, two thousand nine by:    (i)  determining the difference between (A) a calculation of what each  teaching general hospital would have been paid if payments made pursuant  to paragraph (a-3) of subdivision one of  section  twenty-eight  hundred  seven-c   of  this  article  between  January  first,  nineteen  hundred  ninety-six and December thirty-first,  two  thousand  three  were  based  solely  on the case mix of persons eligible for medical assistance under  the medical assistance program pursuant to title eleven of article  five  of  the  social  services  law  who  are  enrolled in health maintenance  organizations and persons paid for under the family health plus  program  enrolled in approved organizations pursuant to title eleven-D of article  five  of  the social services law during those years, and (B) the actual  payments  to  each  such  hospital  pursuant  to  paragraph   (a-3)   ofsubdivision  one of section twenty-eight hundred seven-c of this article  between  January  first,  nineteen  hundred  ninety-six   and   December  thirty-first, two thousand three.    (ii)  reducing  proportionally  each  of  the  amounts  determined  in  subparagraph (i) of this paragraph so that the sum of all  such  amounts  totals no more than one hundred million dollars;    (iii)  further reducing each of the amounts determined in subparagraph  (ii) of this paragraph by the amount received  by  each  hospital  as  a  distribution  from funds designated in paragraph (a) of subdivision five  of this section attributable to the period January first,  two  thousand  three  through December thirty-first, two thousand three, except that if  such amount was  provided  to  a  consortium  then  the  amount  of  the  reduction  for  each  hospital  in the consortium shall be determined by  applying the proportion  of  each  hospital's  amount  determined  under  subparagraph  (i)  of this paragraph to the total of such amounts of all  hospitals in such consortium to the consortium award;    (iv) further reducing each of the amounts determined  in  subparagraph  (iii)  of  this  paragraph  by the amounts specified in paragraph (t) of  this subdivision; and    (v) dividing each of the amounts determined in subparagraph  (iii)  of  this paragraph by seven.    (t)  "Extra  reduction  amount"  shall mean an amount determined for a  teaching hospital for which an adjustment amount is calculated  pursuant  to   paragraph   (s)   of   this  subdivision  that  is  the  hospital's  proportionate share of the sum of the amounts specified in paragraph (u)  of this subdivision determined based upon a comparison of the hospital's  remaining  liability  calculated  pursuant  to  paragraph  (s)  of  this  subdivision to the sum of all such hospital's remaining liabilities.    (u)  "Allotment  amount"  shall mean an amount determined for teaching  hospitals as follows:    (i) for  a  hospital  for  which  an  adjustment  amount  pursuant  to  paragraph (s) of this subdivision does not apply, the amount received by  the  hospital  pursuant  to  paragraph  (a)  of subdivision five of this  section attributable to the period January  first,  two  thousand  three  through December thirty-first, two thousand three, or    (ii)  for  a  hospital  for  which  an  adjustment  amount pursuant to  paragraph  (s)  of  this  subdivision  applies  and  which  received   a  distribution  pursuant  to  paragraph  (a)  of  subdivision five of this  section attributable to the period January  first,  two  thousand  three  through  December  thirty-first, two thousand three that is greater than  the  hospital's  adjustment   amount,   the   difference   between   the  distribution amount and the adjustment amount.    2. Regional pools. (a) The commissioner shall establish regional pools  for  each  of  the  periods January first, nineteen hundred ninety-seven  through December thirty-first, nineteen  hundred  ninety-seven,  January  first,  nineteen  hundred  ninety-eight  through  December thirty-first,  nineteen hundred  ninety-eight,  and  January  first,  nineteen  hundred  ninety-nine  through December thirty-first, nineteen hundred ninety-nine  and on and after  January  first,  two  thousand  from  funds  available  pursuant  to  sections  twenty-eight  hundred  seven-s  and twenty-eight  hundred seven-t of this article.    (b) For periods prior  to  January  first,  two  thousand  nine,  each  regional  pool  shall  be  distributed  on  a  monthly basis to teaching  general hospitals for costs associated with graduate  medical  education  provided  by  such  teaching  general  hospitals  in accordance with the  distribution methodology set forth in subdivision three of this section;  provided however, teaching general hospitals with a  resident  count  of  zero  as  of  July  first  of the year preceding the distribution periodshall not be  eligible  for  distributions  pursuant  to  this  section.  General  hospitals may elect to have their distribution paid through the  consortium.    3. Regional pool distributions.  (a) Distributions to teaching general  hospitals shall be made from the regional pools described in subdivision  two of this section for each period prior to January first, two thousand  nine,  less  amounts  set  aside  pursuant  to  subdivision five of this  section. To be eligible to participate in distributions pursuant to this  section,  a  teaching  general  hospital  and  consortium  must  be   in  compliance  with  graduate  medical education reporting requirements set  forth in subdivision four of this section.    (b) For periods prior  to  January  first,  two  thousand  nine,  each  teaching  general hospital in a region shall have a proxy calculated for  its graduate medical education costs as follows:    (i) The direct medical education portion of the  proxy  shall  be  the  product  of:  the  teaching  general  hospital's medicare direct medical  education payment amount per resident for federal fiscal  year  nineteen  hundred  ninety-five--ninety-six  and  the  teaching  general hospital's  weighted resident count as of July first, nineteen  hundred  ninety-five  and  the teaching general hospital's inpatient percentage of total costs  and percentage of inpatient days, excluding medicare days, patient  days  eligible  for payments by governmental agencies, the comprehensive motor  vehicle insurance reparations act, workers' compensation law,  volunteer  firefighters'  benefit law, volunteer ambulance workers' benefit law and  self-pay patient days, to total days as such costs and days are reported  in the institutional cost report for periods ending March  thirty-first,  nineteen   hundred   ninety-five,   June   thirtieth,  nineteen  hundred  ninety-five or  December  thirty-first,  nineteen  hundred  ninety-five,  whichever is applicable. The teaching general hospital's medicare direct  medical  education payment amount for purposes of this calculation shall  not exceed one  hundred  fifty  percent  of  the  regional  average  per  resident amount for the region in which the teaching general hospital is  located.    (ii)  The  indirect  medical  education  portion  of  the  proxy for a  teaching  general  hospital  shall  be  calculated  using  the  medicare  resident  per  bed  formula  in  existence  on  June thirtieth, nineteen  hundred ninety-six, except  the  teaching  general  hospital's  weighted  resident count as of July first, nineteen hundred ninety-five and number  of  certified  acute  care  beds  as  of January first, nineteen hundred  ninety-five shall be used in the application of the formula. The formula  result shall be applied to the teaching  general  hospital's  applicable  case mix neutral and wage adjusted medicare standardized rate amount for  federal fiscal year nineteen hundred ninety-five--ninety-six. The result  of  this  application  shall  be  multiplied  by  the  teaching  general  hospital's total number of discharges as reported in  the  institutional  cost  report  for  periods  ending  March thirty-first, nineteen hundred  ninety-five, June thirtieth, nineteen hundred  ninety-five  or  December  thirty-first,  nineteen  hundred  ninety-five,  whichever is applicable,  excluding  discharges  relating  to  patients  eligible  for   medicare,  payments   by   governmental   agencies,   payments   pursuant   to  the  comprehensive motor vehicle insurance reparations act, payments pursuant  to the workers' compensation law, the  volunteer  firefighters'  benefit  law,   the  volunteer  ambulance  workers'  benefit  law,  and  self-pay  patients, and applicable weighting factors developed in accordance  with  subdivision  three  of  section  twenty-eight  hundred  seven-c  of this  article as in effect  in  nineteen  hundred  ninety-five.  For  teaching  general hospitals which are specialty hospitals reimbursed on a per diem  basis,  the  applicable  case  mix  neutral  and  wage adjusted medicarestandardized rate amount for purposes of this calculation shall  be  the  amount  determined for the majority of teaching general hospitals within  a region.    (iii) The teaching general hospital's graduate medical education proxy  shall  equal  the sum of its direct medical education proxy and indirect  medical education proxy.    (c)  For  periods  prior  to  January  first,  two  thousand  nine,  a  distribution   amount  for  each  teaching  general  hospital  shall  be  calculated from the applicable regional pool  described  in  subdivision  two  of  this  section  as  adjusted  pursuant  to paragraph (d) of this  subdivision based upon its percentage  of  the  regional  total  of  the  graduate  medical  education  proxies,  except that for purposes of this  paragraph the statewide amount used to compute such distribution amounts  shall be four hundred ninety million dollars on an annual basis for  the  periods  January  first, two thousand through December thirty-first, two  thousand two and two hundred forty-five million dollars for  the  period  January  first,  two thousand three through June thirtieth, two thousand  three, less amounts set aside each period pursuant to subdivision  seven  of this section.    (d)  For  periods  prior  to  January  first,  two thousand nine, each  teaching  general  hospital  shall  receive  a  distribution  from   the  applicable  regional  pool  based  on its distribution amount determined  under paragraph (c) of this subdivision adjusted by a  reduction  amount  that is determined as follows:    (i)  the  commissioner  shall  establish  a  reduction  percentage  by  dividing twenty-seven million dollars each year for the  period  January  first,  two thousand through December thirty-first, two thousand ten and  six million seven hundred fifty thousand dollars for the period  January  first,  two  thousand  eleven  through  March thirty-first, two thousand  eleven, by the sum of initial hospital distribution  amounts  calculated  pursuant to paragraph (c) of this subdivision;    (ii)  the  commissioner shall multiply the reduction percentage by the  amount calculated pursuant to paragraph (c) of this subdivision for each  teaching general hospital;    (iii)  each  teaching  general  hospital  shall   have   its   initial  distribution  amount  as  determined  pursuant  to paragraph (c) of this  subdivision reduced by an amount up to the amount calculated pursuant to  subparagraph (ii) of this paragraph and subject to the  requirements  of  subparagraph  (iv) of this paragraph, provided, however, that if the sum  of reduction amounts for all facilities thus  calculated  is  less  than  twenty-seven  million  dollars  on  a  statewide basis each year for the  period January first, two thousand through  December  thirty-first,  two  thousand  ten  and  six million seven hundred fifty thousand dollars for  the  period  January  first,   two   thousand   eleven   through   March  thirty-first,  two  thousand  eleven,  the commissioner may increase the  reduction percentage subject to the provisions of subparagraph  (iv)  of  this  paragraph  so  that  the  sum  of  the  reduction  amounts for all  facilities is twenty-seven million dollars  each  year  for  the  period  January  first, two thousand through December thirty-first, two thousand  ten and six million seven hundred fifty thousand dollars for the  period  January  first,  two  thousand  eleven  through  March thirty-first, two  thousand eleven.    (iv) for distribution periods prior to  January  first,  two  thousand  eleven,  an  individual hospital's reduction amount shall not exceed the  hospital's projected losses for treating medicaid and uninsured patients  after all  other  projected  medical  assistance,  including  all  other  projected  disproportionate  share  payments  for the applicable period.Such cap on the reduction amount shall also not be reconciled to reflect  actual medicaid and uninsured losses for the applicable period.    (e)   Effective  April  first,  two  thousand  four  through  December  thirty-first, two thousand eight,  the  distribution  amount  calculated  pursuant  to  paragraphs  (c)  and  (d)  of  this  subdivision  for each  non-public teaching general hospital shall  be  reduced  by  the  amount  calculated   and   included  in  rates  pursuant  to  paragraph  (d)  of  subdivision twenty-five of section twenty-eight hundred seven-c of  this  article.    (f)  Effective  January  first,  two  thousand  five  through December  thirty-first, two thousand eight, each teaching general  hospital  shall  receive  a  distribution  from the applicable regional pool based on its  distribution amount determined under paragraphs (c), (d) and (e) of this  subdivision and reduced by its adjustment amount calculated pursuant  to  paragraph  (s) of subdivision one of this section and, for distributions  for the  period  January  first,  two  thousand  five  through  December  thirty-first,  two thousand five, further reduced by its extra reduction  amount calculated pursuant to paragraph (t) of subdivision one  of  this  section.    4.   Reporting   requirements.  Each  teaching  general  hospital  and  consortium shall furnish to the department such reports and  information  as  may be required by the commissioner to implement this section and to  assess the cost, quality and health system needs  for  graduate  medical  education, including, but not limited to:    (a)  each  teaching  general  hospital  and  site other than a general  hospital at which residents receive training shall describe annually its  graduate medical education program or programs and report the number  of  residents in each program; and    (b)  each  consortium  shall  provide  annually a list of the teaching  general hospitals and  sites  other  than  general  hospitals  at  which  residents  receive  training  participating in the consortium as members  and an implementation report relating to achievement of  the  goals  and  objectives of the consortium plan; and    (c)  each  teaching  general hospital and sponsoring institution shall  jointly prepare and submit to the commissioner on  an  annual  basis  an  institutional  graduate  medical education budget reflecting all sources  of graduate medical education revenue and expenditures  for  a  calendar  year.  In  a  form  and manner to be specified by the commissioner, such  budget shall be prepared and reviewed by the residency training director  and certified  by  the  chief  executive  officer  as  to  accuracy  and  completeness  prior to submission to the commissioner. Such budget shall  be submitted to the commissioner by February first,  two  thousand  nine  for  the  two  thousand  nine  calendar  year  and  each February first,  thereafter.    5. Supplemental distributions. (a) Up to  thirty-one  million  dollars  annually  for  the  periods January first, two thousand through December  thirty-first, two thousand three, and up to twenty-five million  dollars  plus  the  sum  of the amounts specified in paragraph (n) of subdivision  one of this section for the period  January  first,  two  thousand  five  through  December  thirty-first, two thousand five, and up to thirty-one  million dollars annually for the period January first, two thousand  six  through  December  thirty-first,  two thousand seven, shall be set aside  and reserved by the commissioner from  the  regional  pools  established  pursuant   to   subdivision   two   of  this  section  for  supplemental  distributions in each such region to be  made  by  the  commissioner  to  consortia   and   teaching   general  hospitals  in  accordance  with  a  distribution methodology developed in consultation with the council  and  specified in rules and regulations adopted by the commissioner.(b)  Funds  available  shall  be distributed to consortia and teaching  general hospitals that substantially meet the following  training  goals  and objectives:    (i)  reducing the number of graduate medical education programs and/or  the number of residents in such programs;    (ii) increasing the number of residents training in underserved areas;    (iii) increasing the number of residents training in  ambulatory  care  facilities;    (iv) improving the quality of training programs;    (v) increasing training of minorities; and    (vi)  such  other factors as may be specified in rules and regulations  adopted by the commissioner in consultation with the council.    The distribution of funds pursuant to this subdivision  shall  not  be  conditioned  on  a  consortia  or teaching general hospital reducing the  number of graduate medical  education  programs  and/or  the  number  of  residents in such program.    (c)  In  the event that funds available under this subdivision are not  distributed to consortia or teaching  general  hospitals  in  accordance  with  this  subdivision,  such  funds  shall  be distributed to teaching  general hospitals  in  accordance  with  the  methodology  described  in  subdivision three of this section.    (d)  Notwithstanding any other provision of law or regulation, for the  period January first, two thousand five through  December  thirty-first,  two  thousand  five,  the  commissioner shall distribute as supplemental  payments the allotment specified in paragraph (n) of subdivision one  of  this section.    5-a.  Graduate  medical  education  innovations pool. (a) Supplemental  distributions. (i) Thirty-one million dollars  for  the  period  January  first,  two  thousand  eight through December thirty-first, two thousand  eight, shall be set aside and reserved  by  the  commissioner  from  the  regional  pools  established pursuant to subdivision two of this section  and shall be available for distributions pursuant to subdivision five of  this section and in accordance with section 86-1.89 of title 10  of  the  codes,  rules  and  regulations of the state of New York as in effect on  January first, two thousand eight; provided, however,  for  purposes  of  funding  the  empire  clinical research investigation program (ECRIP) in  accordance with paragraph eight of subdivision (e) and paragraph two  of  subdivision  (f)  of section 86-1.89 of title 10 of the codes, rules and  regulations of the state of New York, distributions shall be made  using  two  regions  defined as New York city and the rest of the state and the  dollar amount  set  forth  in  subparagraph  (i)  of  paragraph  two  of  subdivision  (f)  of section 86-1.89 of title 10 of the codes, rules and  regulations of the state of New  York  shall  be  increased  from  sixty  thousand dollars to seventy-five thousand dollars.    (ii)  For  periods  on  and  after  January  first, two thousand nine,  supplemental distributions pursuant to subdivision five of this  section  and  in  accordance with section 86-1.89 of title 10 of the codes, rules  and regulations of the state of New York shall no longer be made and the  provisions of section 86-1.89 of  title  10  of  the  codes,  rules  and  regulations of the state of New York shall be null and void.    (b)  Empire  clinical  research  investigator  program  (ECRIP).  Nine  million one hundred twenty thousand  dollars  annually  for  the  period  January  first,  two  thousand  nine  through December thirty-first, two  thousand ten, and two million two hundred eighty  thousand  dollars  for  the   period   January   first,   two   thousand  eleven  through  March  thirty-first, two thousand eleven, shall be set aside  and  reserved  by  the  commissioner  from  the  regional  pools  established  pursuant  to  subdivision  two  of  this  section  to  be  allocated  regionally  withtwo-thirds of the available funding going to New York city and one-third  of  the  available  funding  going to the rest of the state and shall be  available for distribution as follows:    Distributions  shall  first  be made to consortia and teaching general  hospitals for the empire clinical research investigator program  (ECRIP)  to  help  secure federal funding for biomedical research, train clinical  researchers, recruit national leaders as faculty to act as mentors,  and  train  residents  and  fellows  in  biomedical  research skills based on  hospital-specific data submitted to the commissioner  by  consortia  and  teaching  general  hospitals  in  accordance  with  clause  (G)  of this  subparagraph. Such distributions shall be made in  accordance  with  the  following methodology:    (A)  The  greatest  number  of clinical research positions for which a  consortium or teaching general hospital may be funded pursuant  to  this  subparagraph  shall  be  one  percent  of  the total number of residents  training at the consortium or teaching general hospital on  July  first,  two  thousand  eight  for  the  period  January first, two thousand nine  through December thirty-first, two  thousand  nine  rounded  up  to  the  nearest one position.    (B)  Distributions  made  to a consortium or teaching general hospital  shall equal the  product  of  the  total  number  of  clinical  research  positions  submitted  by  a  consortium or teaching general hospital and  accepted by the commissioner  as  meeting  the  criteria  set  forth  in  paragraph  (b)  of  subdivision  one  of  this  section,  subject to the  reduction calculation set forth in  clause  (C)  of  this  subparagraph,  times one hundred ten thousand dollars.    (C)  If  the  dollar  amount for the total number of clinical research  positions in the region  calculated  pursuant  to  clause  (B)  of  this  subparagraph exceeds thirty percent of the funding available pursuant to  this  paragraph,  or an amount equal to the sum of one clinical research  position per teaching general  hospital  in  the  region,  whichever  is  greater,  including  clinical  research positions that continue from and  were funded  in  prior  distribution  periods,  the  commissioner  shall  eliminate  one-half of the clinical research positions submitted by each  consortium or teaching general hospital rounded down to the nearest  one  position.  Such  reduction shall be repeated until the dollar amount for  the total number of clinical research positions in the region  does  not  exceed  thirty  percent  of the regional pool, or an amount equal to the  sum of one clinical research position per teaching general  hospital  in  the  region,  whichever  is greater. No clinical research positions that  continue from and were funded in prior  distribution  periods  shall  be  eliminated by such reduction.    (D)  Each  consortium or teaching general hospital shall receive fifty  percent of its annual distribution amount calculated  pursuant  to  this  subparagraph  once  the  requirements  set  forth  in clause (G) of this  subparagraph have been met. The remaining distribution amount  shall  be  disbursed  subsequent to the submission of information required pursuant  to clause (G) of this subparagraph.    (E)  Each  consortium   or   teaching   general   hospital   receiving  distributions  pursuant  to this subparagraph shall reserve seventy-five  thousand dollars to primarily fund salary and  fringe  benefits  of  the  clinical  research  position  with  the  remainder  going  to  fund  the  development of faculty who are involved in biomedical research, training  and clinical care.    (F)  Undistributed  or  returned  funds  available  to  fund  clinical  research  positions pursuant to this paragraph for a distribution period  shall be available to fund clinical research positions in  a  subsequent  distribution period.(G)  In  order  to  be  eligible  for  distributions  pursuant to this  subparagraph,  each  consortium  and  teaching  general  hospital  shall  provide  to  the commissioner by July first of each distribution period,  the following data and information on a  hospital-specific  basis.  Such  data  and information shall be certified as to accuracy and completeness  by the chief executive officer, chief financial officer or chair of  the  consortium  governing  body  of  each  consortium  or  teaching  general  hospital and shall be maintained by each consortium and teaching general  hospital for five years from the date of submission:    (I) For each clinical research  position,  information  on  the  type,  scope,  training  objectives,  institutional  support, clinical research  experience of the sponsor-mentor, plans for submitting research outcomes  to peer reviewed  journals  and  at  scientific  meetings,  including  a  meeting  sponsored  by  the  department, the name of a principal contact  person responsible for tracking the career  development  of  researchers  placed  in  clinical  research positions, as defined in paragraph (c) of  subdivision one of this section, and who is authorized to certify to the  commissioner that all the requirements of the clinical research training  objectives  set  forth  in  this  subparagraph  shall   be   met.   Such  certification  shall  be  provided  by  July  first of each distribution  period;    (II) For each clinical research position,  information  on  the  name,  citizenship  status, medical education and training, and medical license  number of the researcher, if applicable, shall be provided  by  December  thirty-first of the calendar year following the distribution period;    (III)  Information  on  the  status  of  the  clinical  research plan,  accomplishments,  changes  in   research   activities,   progress,   and  performance  of  the  researcher  shall be provided six months after the  clinical research position has commenced and every six months thereafter  for a full-time position and for a half-time position,  one  year  after  the clinical research position has commenced and every year thereafter;    (IV)  A  final report detailing training experiences, accomplishments,  activities  and  performance  of  the  clinical  researcher,  and  data,  methods,  results  and  analyses  of the clinical research plan shall be  provided three months after the clinical research position ends; and    (V) Any other data or information  required  by  the  commissioner  to  implement this subparagraph.    (c)  Ambulatory  care  training.  Four  million  nine hundred thousand  dollars for  the  period  January  first,  two  thousand  eight  through  December  thirty-first,  two  thousand  eight, four million nine hundred  thousand dollars for the period January first, two thousand nine through  December thirty-first, two thousand  nine,  four  million  nine  hundred  thousand  dollars for the period January first, two thousand ten through  December thirty-first, two thousand ten, and  one  million  two  hundred  twenty-five  thousand dollars for the period January first, two thousand  eleven through March thirty-first, two thousand  eleven,  shall  be  set  aside   and  reserved  by  the  commissioner  from  the  regional  pools  established pursuant to subdivision two of this  section  and  shall  be  available for distributions to sponsoring institutions to be directed to  support   clinical   training  of  medical  students  and  residents  in  free-standing  ambulatory  care  settings,  including  community  health  centers   and   private  practices.  Such  funding  shall  be  allocated  regionally with two-thirds of the available funding going  to  New  York  city  and  one-third  of  the available funding going to the rest of the  state and shall be distributed to sponsoring institutions in each region  pursuant to a request for application or request  for  proposal  process  with  preference  being  given  to sponsoring institutions which providetraining in sites located in underserved rural or inner-city  areas  and  those that include medical students in such training.    (d)  Physician loan repayment program.  One million nine hundred sixty  thousand dollars for  the  period  January  first,  two  thousand  eight  through  December  thirty-first,  two  thousand  eight, one million nine  hundred sixty  thousand  dollars  for  the  period  January  first,  two  thousand  nine  through  December  thirty-first,  two thousand nine, one  million nine hundred sixty  thousand  dollars  for  the  period  January  first, two thousand ten through December thirty-first, two thousand ten,  and  four  hundred ninety thousand dollars for the period January first,  two thousand eleven through March  thirty-first,  two  thousand  eleven,  shall  be  set  aside and reserved by the commissioner from the regional  pools established pursuant to subdivision two of this section and  shall  be available for purposes of physician loan repayment in accordance with  subdivision  ten  of  this  section.  Such  funding  shall  be allocated  regionally with one-third of available funds going to New York city  and  two-thirds  of  available funds going to the rest of the state and shall  be distributed in a manner to  be  determined  by  the  commissioner  as  follows:    (i) Funding shall first be awarded to repay loans of up to twenty-five  physicians  who  train  in  primary care or specialty tracks in teaching  general hospitals, and who enter and remain in primary care or specialty  practices in underserved communities, as determined by the commissioner.    (ii) After distributions in accordance with subparagraph (i)  of  this  paragraph,  all  remaining  funds  shall  be  awarded  to repay loans of  physicians who enter and remain in primary care or  specialty  practices  in underserved communities, as determined by the commissioner, including  but  not  limited  to  physicians working in general hospitals, or other  health care facilities.    (iii) In no case shall less than fifty percent of the funds  available  pursuant   to   this   paragraph   be  distributed  in  accordance  with  subparagraphs (i) and (ii) of this paragraph to physicians identified by  general hospitals.    (e) Physician practice support.   Four million nine  hundred  thousand  dollars  for  the  period  January  first,  two  thousand  eight through  December thirty-first, two thousand eight,  four  million  nine  hundred  thousand  dollars  annually  for  the period January first, two thousand  nine through December thirty-first, two thousand ten,  and  one  million  two  hundred  twenty-five thousand dollars for the period January first,  two thousand eleven through March  thirty-first,  two  thousand  eleven,  shall  be  set  aside and reserved by the commissioner from the regional  pools established pursuant to subdivision two of this section and  shall  be  available  for  purposes of physician practice support. Such funding  shall be allocated regionally with one-third of available funds going to  New York city and two-thirds of available funds going to the rest of the  state and shall be distributed in a  manner  to  be  determined  by  the  commissioner as follows:    (i)  Preference in funding shall first be accorded to teaching general  hospitals for up to twenty-five awards, to  support  costs  incurred  by  physicians  trained  in  primary  or  specialty  tracks  who  thereafter  establish or join practices in underserved communities, as determined by  the commissioner.    (ii) After distributions in accordance with subparagraph (i)  of  this  paragraph, all remaining funds shall be awarded to physicians to support  the   cost   of   establishing   or  joining  practices  in  underserved  communities, as determined by the commissioner,  and  to  hospitals  and  other  health  care  providers  to  recruit  new  physicians  to provide  services in underserved communities, as determined by the commissioner.(iii) In no case shall less than fifty percent of the funds  available  pursuant  to  this  paragraph  be  distributed  to  general hospitals in  accordance with subparagraphs (i) and (ii) of this paragraph.    (f) Study on physician workforce. Five hundred ninety thousand dollars  annually  for  the  period  January  first,  two  thousand eight through  December thirty-first, two thousand ten,  and  one  hundred  forty-eight  thousand  dollars  for  the  period  January  first, two thousand eleven  through March thirty-first, two thousand eleven, shall be set aside  and  reserved  by  the  commissioner  from  the  regional  pools  established  pursuant to subdivision two of this section and shall  be  available  to  fund  a  study of physician workforce needs and solutions including, but  not  limited  to,  an  analysis  of  residency  programs  and  projected  physician  workforce  and  community needs. The commissioner shall enter  into agreements with one or more organizations  to  conduct  such  study  based on a request for proposal process.    (g)  Diversity in medicine/post-baccalaureate program. Notwithstanding  any inconsistent provision of section one hundred twelve or one  hundred  sixty-three  of the state finance law or any other law, one million nine  hundred sixty thousand dollars annually for the  period  January  first,  two  thousand eight through December thirty-first, two thousand ten, and  four hundred ninety thousand dollars for the period January  first,  two  thousand eleven through March thirty-first, two thousand eleven shall be  set  aside  and  reserved  by  the  commissioner from the regional pools  established pursuant to subdivision two of this  section  and  shall  be  available  for  distributions  to  the Associated Medical Schools of New  York  to  fund  its  diversity  program  including  existing   and   new  post-baccalaureate  programs for minority and economically disadvantaged  students and encourage participation from all  medical  schools  in  New  York.  The  associated  medical  schools of New York shall report to the  commissioner on an annual basis regarding the  use  of  funds  for  such  purpose in such form and manner as specified by the commissioner.    (h)  In  the  event  there are undistributed funds within amounts made  available for distributions pursuant to this subdivision, such funds may  be reallocated and distributed in  current  or  subsequent  distribution  periods  in  a manner determined by the commissioner for any purpose set  forth in this subdivision.    5-b. Other graduate medical education reforms. Any funds  specifically  appropriated  for the purposes of this subdivision shall be used to fund  innovative graduate medical education reforms to be  determined  by  the  commissioner  in  consultation  with  the  council,  including,  but not  limited to, (a) development of  primary  care  residency  and  specialty  position  training  tracks  for  graduates  to serve rural or inner-city  communities, (b) development  of  regional  pilot  network  programs  to  affiliate   major  academic  centers  with  community  teaching  general  hospitals, (c)  support  for  faculty  development  programs,  including  designating  faculty  to  mentor students and residents in primary care,  (d) support training in fields which serve the geriatric population; (e)  increase training  in  cultural  competence,  (f)  promote  training  of  physicians  who  will serve persons with developmental disabilities, and  (g) any other reforms necessary  to  improve  patient  care  management,  interdisciplinary  training,  or  quality  in graduate medical education  programs. Such funding shall be distributed to  consortia  and  teaching  general  hospitals  in  each region on a competitive basis pursuant to a  request for proposal process.    6. Consortia. (a) A consortium must:    (i) have a governing body and such  committees  as  appropriate  which  should  be responsible for the policy coordination and administration of  residency programs and which provides all members of the  consortium  anopportunity  to  participate  in  the establishment of consortium policy  goals and objectives;    (ii)  have  procedures  and  criteria  for  processing applications by  health care providers in the region for participation in the consortium;    (iii) establish policies to evaluate and to maintain and  improve  the  quality of training programs;    (iv)   have  a  mechanism  for  resolving  educational  and  financial  allocation disputes among participating members; and    (v) comply with such further  requirements  as  the  commissioner  may  reasonably  require for purposes of implementing this section to achieve  state policy goals and objectives regarding graduate medical education.    (b) Nothing in this section shall preclude a  consortium  from  having  members  from  different  regions  and  from  allocating  regional  pool  distributions among regions.    (c) To the extent  consortia  might  be  anti-competitive  within  the  meaning  and  intent  of the federal and state antitrust laws, it is the  intent of the legislature to supplant competition with such arrangements  to the extent necessary to accomplish the purposes of this section,  and  provide  state  action  immunity  under  the federal antitrust laws with  respect to the planning, implementation and operation of  consortia  and  participation  therein  by  hospitals,  other  providers  of health care  services, medical schools, payors and consumers.    (d) Each approved consortium shall  submit  a  plan  for  each  period  defined  in  subdivision  two  of  this  section  for  approval  by  the  commissioner, in consultation with the council, for allocation of  funds  collected pursuant to paragraph (c) of subdivision three of this section  to  participating  general  hospitals  which  provide  graduate  medical  education and sites other than  general  hospitals  at  which  residents  receive training.    7.  Notwithstanding  any inconsistent provision of section one hundred  twelve or one hundred sixty-three of the state finance law or any  other  law,  up  to  one  million  dollars  for  the  period January first, two  thousand through December thirty-first, two thousand,  one  million  six  hundred  thousand  dollars  annually  for the periods January first, two  thousand one through December  thirty-first,  two  thousand  eight,  one  million  five  hundred thousand dollars annually for the periods January  first, two thousand nine through  December  thirty-first,  two  thousand  ten,  and  three  hundred  seventy-five  thousand dollars for the period  January first, two  thousand  eleven  through  March  thirty-first,  two  thousand  eleven,  shall  be  set aside and reserved by the commissioner  from the regional pools established pursuant to subdivision two of  this  section  and  shall be available for distributions to the New York state  area health education  center  program  for  the  purpose  of  expanding  community-based  training  of medical students. In addition, one million  dollars annually for  the  period  January  first,  two  thousand  eight  through  December  thirty-first, two thousand ten, and two hundred fifty  thousand dollars for the  period  January  first,  two  thousand  eleven  through  March thirty-first, two thousand eleven, shall be set aside and  reserved  by  the  commissioner  from  the  regional  pools  established  pursuant  to  subdivision two of this section and shall be available for  distributions to the New York state area health education center program  for the purpose of post-secondary training of health care  professionals  who  will  achieve  specific  program outcomes within the New York state  area health education center program. The New  York  state  area  health  education  center  program shall report to the commissioner on an annual  basis regarding the use of funds for  each  purpose  in  such  form  and  manner as specified by the commissioner.8.  Revenue  from  distributions  pursuant  to  this  section shall be  included in gross revenue  received  for  purposes  of  the  assessments  pursuant to subdivision eighteen of section twenty-eight hundred seven-c  of  this article and for purposes of the assessments pursuant to section  twenty-eight hundred seven-d of this article.    10.  Physician  loan repayment program.   (a) Beginning January first,  two thousand eight,  the  commissioner  is  authorized,  within  amounts  available  pursuant  to subdivision five-a of this section, to make loan  repayment  awards  to  primary  care  physicians  or   other   physician  specialties  determined  by  the  commissioner  to  be  in short supply,  licensed to practice medicine in New York state, who agree  to  practice  for  at  least  five  years in an underserved area, as determined by the  commissioner. Such physician shall be  eligible  for  a  loan  repayment  award  of  up  to  one  hundred  fifty thousand dollars over a five year  period distributed as follows: fifteen percent of total loan debt not to  exceed twenty thousand dollars for the first year;  fifteen  percent  of  total  loan  debt  not  to  exceed  twenty-five thousand dollars for the  second year; twenty percent of total loan debt not to exceed thirty-five  thousand dollars for the third year; and twenty-five  percent  of  total  loan  debt  not  to exceed thirty-five thousand dollars per year for the  fourth year; and any unpaid balance of the total loan debt not to exceed  the maximum award amount for the fifth year of practice in such area.    (b) Loan repayment awards made to a physician  pursuant  to  paragraph  (a)   of   this  subdivision  shall  not  exceed  the  total  qualifying  outstanding debt of the physician from student loans  to  cover  tuition  and  other  related  educational  expenses, made by or guaranteed by the  federal or state  government,  or  made  by  a  lending  or  educational  institution approved under title IV of the federal higher education act.  Loan  repayment  awards  shall  be used solely to repay such outstanding  debt.    (c) In the event that a five-year commitment pursuant to the agreement  referenced in paragraph (a) of this subdivision is  not  fulfilled,  the  recipient  shall  be responsible for repayment in amounts which shall be  calculated in accordance with the formula set forth in  subdivision  (b)  of  section  two  hundred  fifty-four-o of title forty-two of the United  States Code, as amended.    (d) The commissioner is authorized to apply any  funds  available  for  purposes  of paragraph (a) of this subdivision for use as matching funds  for federal grants for the purpose of assisting states in operating loan  repayment programs pursuant to section three hundred thirty-eight  I  of  the public health service act.    (e)  The  commissioner  may  postpone,  change  or  waive  the service  obligation and repayment amounts set forth in paragraphs  (a)  and  (c),  respectively of this subdivision in individual circumstances where there  is compelling need or hardship.    (f)(i)  When  a physician is not actually practicing in an underserved  area, he or she shall be deemed to be practicing in an underserved  area  if  he  or  she  practices  in  a  facility  or  physician's office that  primarily  serves  an  underserved  population  as  determined  by   the  commissioner,  without  regard to whether the population or the facility  or physician's office is located in an underserved area.    (ii) In making criteria and determinations as to whether an area is an  underserved area or whether a facility or physician's  office  primarily  serves  an  underserved  population,  the commissioner may make separate  criteria and determinations for different specialties.    11. The commissioner shall  conduct  a  study  of  (i)  the  need  for  expansion  of the physician loan repayment program under subdivision ten  of this section to include dentists, midwives, nurse practitioners,  andphysician  assistants;  (ii)  the  level of funding appropriate for that  expansion; and (iii) appropriate sources of funding for  the  future  of  the  program  and  the  expansion.  The study may include examination of  possible  expansion  of other programs to recruit people to enter health  care professions and serve in underserved areas. The commissioner  shall  conduct  the  study in consultation with representatives of the affected  professions, educational institutions and training programs that educate  and  train  people  for  those  professions,  appropriate  health   care  providers,  affected  communities  and  other  interested  parties.  The  commissioner shall report to the governor and  the  legislature  on  the  findings  of  the  study  and  recommendations  by  December  first, two  thousand eight.