TheNew York State Department of Health is the department of theNew York state government responsible forpublic health. It promotes the prevention and control of disease, environmental health, healthy lifestyles, and emergency preparedness and response; supervises local health boards; oversees reporting and vital records; conducts surveillance of hospitals; does research at theWadsworth Center; and administers several other health insurance programs and institutions.[1] Its regulations are compiled in title 10 of theNew York Codes, Rules and Regulations.
New York State relies on a county-based system for delivery of public health services.[1] 58 local health departments offer core services including assessing community health, disease control and prevention, family health, and health education; 37 localities provide environmental health services, while the other 21 rely on the state's Department of Health.[1]
At the local level, public health workers are found not only in local health agencies but also in private and nonprofit organizations concerned with the public's health.[2] The most common professional disciplines are physicians, nurses, environmental specialists, laboratorians, health educators, disease investigators, outreach workers, and managers, as well as otherallied health professions.[2] Nurses represented 22% of the localities' workforce (and 42% offull-time equivalent workers in rural localities), scientific/investigative staff represented 22%–27% of the workforce, support staff represented 28%, education/outreach staff represented 10%, and physicians represented 1%.[1] In 2018 the Department of Health had over 3300 personnel in its central office, three regional offices, three field offices and nine district health offices, and an additional 1400 personnel in its five healthcare institutions.[3]
The New York State Department of Health, through the Public Health Law and State Sanitary Code, supervises and enforces statewide standards for communicable disease control, nuisance abatement, sanitation, and emergency response, exercising reserve police powers and regulatory authority while overseeing local health officers and coordinating with federal agencies to preserve and protect public health.[4]
The commissioner is the executive enforcement authority overArticle 28 healthcare facilities—conducting inspections, determining Medicaid necessity/appropriateness, administering patient-rights and public reporting systems, promulgating specified regulations, and imposing penalties and other compliance actions.[5] Subject to the commissioner's approval, thePublic Health and Health Planning Council (PHHPC) is a quasi-legislative authority that adopts and amends the State Sanitary Code, promulgates Article 28 regulations establishing operating-certificate standards, reporting and accounting systems, hospital classification and cost-finding methodologies, reimbursement and rate-setting frameworks, and penalty systems for residential health care facilities, and also exercises authority over the certificate of need process.[5][6][7]
Thecertificate of need (CON) process is a regulatory mechanism used to oversee the establishment, construction, renovation, and major equipment acquisition of healthcare facilities.[8][9] The CON process aims to controlhealth care costs and prevent duplicative services by ensuring new investments meet a community need.[10][11] New York's CON requirements are among the most extensive in the nation, covering all six major categories of health services: hospital beds, non-hospital beds, medical equipment, new facilities, new services, and even emergency medical transport, and New York is unique in applying CON laws to dentists' offices.[12]
The department enforcesnurse staffing transparency and planning by requiring Article 28 hospitals and nursing homes to disclose unit-level staffing and nursing-sensitive outcome metrics on request, while general hospitals must maintain nurse-led clinical-staffing committees that annually file and implement unit- and shift-specific staffing plans, incorporating acuity, skill-mix and service-specific minimums (e.g., ICU/CCU, OR, perinatal, burn, PICU, transplant), including a 1:2 RN-to-patient minimum in ICU/critical care.[13]
To help offset financial losses from serving Medicaid and uninsured patients,disproportionate share hospital (DSH) payments are distributed through multiple mechanisms.[14][15] These include theHealth Care Reform Act (HCRA)-funded Indigent Care Pool and adjustments for hospitals, DSH intergovernmental transfers for public hospitals, and DSH payments to Institutes for Mental Disease (IMDs). The Indigent Care Pool (ICP) is intended to help cover hospitals' costs from providingcharity care and from unpaid bills classified asbad debt, in addition to their Medicaid shortfalls.[16][17] Hospitals receive ICP reimbursements for debt even as they collect the same debt from patients, since nothing in the law requires them to credit patient accounts.[18] As of 2018, hospitals received about $1.1 billion per year in ICP funds.[15][17]
State directed payments (SDPs) allow states to require Medicaid managed care plans to pay providers at specific rates or using defined methods — such as uniform payment increases, minimum fee schedules, or value-based payment models — in addition to the base payment rates negotiated between plans and providers.[19][20] New York's Directed Payment Template programs (DPTs) includevalue-based payment initiatives such as population-based payments forpatient-centered medical home providers.[21] They also include enhanced reimbursements forsafety net,critical access, and sole community facilities, as well as forNYC Health + Hospitals' outpatient services.[22][23][24][25][26] These payments are delivered through highercapitation rates paid to managed care plans, with the nonfederal share financed by state general funds,HCRA provider taxes, and intergovernmental transfers.
The Health Department'sState Board for Professional Medical Conduct and Office of Professional Medical Conduct are responsible for investigating and adjudicating complaints againstphysicians,physician assistants, and specialist assistants.[27][28] The Education Department'sState Board for Medicine advises on licensing, practice standards, and professional conduct for physicians and physician assistants.[29] The Health Department licenses the practice of radiography, radiation therapy, and nuclear medicine technology.[30] It also certifies first responders, EMTs, advanced EMTs, and ambulance services.[31] And it licenses the manufacture, distribution, import, export, institutional dispensing, institutional dispensing limited, conducting of research, instructional activities, or chemical analysis of or with controlled substances.[32] Otherunlicensed assistive personnel such as certified nurse aides, feeding assistants, personal care aides, and home health aides are not licensed but are governed through department–approved training, competency evaluation, and registry frameworks. TheEducation Department and its boards regulate the otherallied health professions.
New York fundsgraduate medical education (GME) through the department with hospital rate add-ons,HCRA-based GME and professional education pool supplemental payments, and administering programs like Empire Clinical Research Investigator Program (ECRIP) and Doctors Across New York (DANY).[33][34][35][36] New York accounted for nearly half of the nation's total state Medicaid GME spending—$1.82 billion of the total $3.87 billion in 2012—and more than 10 times any other state.[37]
The All-Payer Database (APD) is the state all-payer claims database administered by the department.[38][39]All-payer claims databases (APCDs) are large state databases that includemedical billing claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers to advance the goal of improvinghealth care affordability, efficiency, and cost transparency.[40]
The Health Commerce System (HCS) is theweb portal that serves as the primary communications, reporting, and credentialing platform between the department and health facilities, providers, and local public health authorities. It includes a number ofapplications, such as the Health Emergency Response Data System (HERDS) for emergency and routine data collection, the Integrated Health Alerting and Notification System (IHANS) for urgent alerts and guidelines, the New York State Immunization Information System (NYSIIS) for vaccine records, and eCLEP forWadsworth Center lab reporting.
In 1866, the state legislature passed theMetropolitan Health Law and established the NYCMetropolitan Board of Health, and in 1870 the legislature replaced it with the NYC Department of Health.[41][42] The State Board of Health was created 18 May 1880 by the103rd Legislature.[43] The State Department of Health and its commissioner were created by an act of 19 February 1901 of the124th Legislature, superseding the board.[44]
The earliest New York state laws regarding public health were quarantine laws for the port of New York, first passed by theNew York General Assembly in 1758.[45][46] The1793 Philadelphia yellow fever epidemic precipitated the 1799–1800 creation of the New York Marine Hospital, and in 1801 its resident physician and the health officers of the port were constituted as the New York City board of health.[47][48][49] The1826–1837 cholera pandemic precipitated further legislation. In 1847 a law mandatedcivil registration ofvital events (births, marriages, and deaths). The1881–1896 cholera pandemic further caused an expansion of its powers to compel reporting and to perform the duties of local boards of health.[50]
Thecertificate of need (CON) requirement was created by New York in 1964.[51][10][52] In 1965 the department was given central responsibility over hospitals and related facilities.[53][54] 2010 state budget legislation abolished the Public Health Council and the State Hospital Review and Planning Council and consolidated their functions into the newly createdPublic Health and Health Planning Council (PHHPC).[55] The Nursing Care Quality Protection Act was amended in 2021 requiring general hospitals to establish clinical staffing committees to develop and oversee clinical staffing plans, to include specific nurse-to-patient ratios for each unit and work shift.[56][57]
The state implementedMedicaid in 1966 and designated the stateDepartment of Social Services (DSS) as the "single state agency" but required it to contract with the Health Department.[58][59] The Social Services Department and local social districts were responsible for eligibility determinations and paying claims, while the Health Department and local health districts were responsible for settings standards (including fees schedules) and supervising and surveilling providers.[59] Oversight of adult homes, enriched housing programs, residences for adults, assisted living programs, and public homes (other than shelters for adults) were transferred from DSS by the Welfare Reform Act of 1997.[60] In 2012, the Health Department started assuming administrative responsibilities for Medicaid from the counties.[61][62][63][64]
By 1970 the state began to regulate health insurance reimbursement rates, in 1983 beganall-payer rate setting, and by 1986-1988 had moved to acase-based system.[65] In 1982–1983 the state overhauled the hospital reimbursement system by imposing revenue caps, creating regional bad debt and charity care pools, and shifting all payors into a uniform prospective payment methodology (NYPHRM I).[66][67][68] In 1987 the New York State Council on Graduate Medical Education was created by executive order.[69][70] In 1988 the state established a mandatoryDRG-based case payment system for all payors, continued bad debt and charity pools through payor add-ons and revenue assessments, provided direct and indirect cost reimbursements forgraduate medical education, added quality protections and HMO negotiation authority, and aimed to curb hospital cost growth (NYPHRM III).[71][72] In 1996 these were replaced by the currentHealth Care Reform Act (HCRA), allowing negotiated reimbursement rates and establishing tax funding for public goods like graduate medical education,charity care, and public health.[73][74][75] The Health Care Reform Act of 2000 (HCRA 2000) was a major extension and modification that made significant changes to how New York State funded hospitals, subsidized care for the uninsured, and managed health insurance programs.[76][77] In 2006 the Hospital Financial Assistance Law (HFAL or Manny's Law) was enacted requiring hospitals to adopt and publicize uniform financial assistance policies, including income-based limits on charges, sliding-scale discounts, reasonable payment terms, and restrictions on aggressive collections, as a condition for receiving ICP payments.[78][79]
^Committee on the Governance and Financing of Graduate Medical Education; Board on Health Care Services; Institute of Medicine (24 October 2014),"GME Financing",Graduate Medical Education That Meets the Nation's Health Needs,PMID25340242,WikidataQ95619477
^"The Welfare Reform Act of 1997".Laws of the State of New York Passed at the Sessions of the Legislature.220th sess.: III:2806–2961. 1997.hdl:2027/nyp.33433017532999.ISSN0892-287X. Chapter 436, enacted 20 August 1997, effective immediately with provisos. § 122(e) at p. 2923: "The functions, powers, duties and obligations of the former department of social services concerning adult homes, enriched housing programs, residences for adults, assisted living programs and public homes other than those that are shelters for adults, the medicaid audit function pursuant to sections 364 and 368-c of the social services law, and the prevention of medicaid fraud and abuse pursuant to sections 145-a and 145-b of the social services law are transferred to the New York state department of health."
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