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  4   NEW YORK STATE DEPARTMENT OF HEALTH
  5            HEAL NEW YORK UNIT
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  8                    90 Church Street
  9                    New York, New York
 10                    Friday, February 8, 2008
 11                    10:05 a.m.
 12   
 13   
 14       CHRISTOPHER DELKER, Moderator
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00002
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  2   PANEL:
  3   Tracy Raleigh
  4   Robert Schmidt
  5   Larry Volk
  6   Christopher Delker
  7   Charles Abel
  8   James W. Clyne, Jr.
  9   Michael J. Barbaro
 10   Jay Laudato
 11   Cynthia Miner
 12   Marybeth Hefner
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00003
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  2                  P R O C E E D I N G S
  3              MR. DELKER:  Good morning.
  4              Thank you for coming.  Everybody should
  5   have picked up one of these agendas outside with
  6   the slides attached.  We will be showing the slides
  7   on this wall; if you in the back want to see the
  8   slides, feel free to stand over in the lengthy
  9   space.  We will only be using those in the first
 10   several minutes of the presentation, or you can
 11   remain where you are if you wish.
 12              Sir, you can move there later when we
 13   turn them off.  There's a seat here in the front.
 14   Thank you.
 15              I'd just like to quickly give a preview
 16   of the agenda.  We're going to go through the
 17   agenda first and then leave the rest of the time
 18   for questions.  We'll be first introducing Jim
 19   Clyne, who is Director of the Office of Health
 20   Systems Management, who will talk about this RGA
 21   and the support for primary care and how that fits
 22   into the other efforts of restructuring that have
 23   been going on for the last couple of years in the
 24   State.
 25              Then we'll talk about the eligible

00004
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  2   activities of cost.  What this RGA will and won't
  3   pay for.  What you can and cannot ask for and
  4   expect to get funded.  Then, we'll talk about the
  5   factors involved in making the awards; the scoring
  6   criteria and the team reviews and the consideration
  7   of regional distributions.
  8              Then, we'll walk you briefly through the
  9   application process.  As you're probably aware,
 10   there are two main parts to the application:  A
 11   technical application and a financial one, and
 12   we'll talk about the differences between that.
 13              Then, the submission of the
 14   applications, which, in this high-tech age can be
 15   done, not electronically, but with some
 16   electronically readable media, like flash drives
 17   and things I don't understand.
 18              Then, the final part is the question and
 19   answer session, and that's the main reason why
 20   we're here.  So we're going to go through our
 21   agenda quickly.  We ask you to hold your questions
 22   until the question and answer session.  You will
 23   get a chance to ask a question coming to the
 24   microphone in the center, and we'll explain the
 25   ground rules for that when we get to that section.

00005
  1   
  2              So, with that said, I think we'll
  3   introduce ourselves.  I'm Christopher Delker,
  4   Division of Health Facilities Planning, the
  5   Department of Health.
  6              MR. SCHMIDT:  Bob Schmidt, Facilities
  7   Implementation Team.
  8              MR. LAUDATO:  Jay Laudato, the Office of
  9   Health Insurance Programs, the Department of
 10   Health.
 11              MR. CLYNE:  I'm the Deputy Commissioner
 12   for the Office of Health Systems Management.
 13              MR. ABEL:  Charlie Abel, Health
 14   Facilities Planning.
 15              MR. VOLK:  Larry Volk, Dormitory
 16   Authority.
 17              MS. RALEIGH:  Tracey Raleigh, Dormitory
 18   Authority.
 19              MR. BARBARO:  Michael Barbaro, Division
 20   of Legal Affairs, Department of Health.
 21              MR. DELKER:  Those of you who couldn't
 22   hear, Michael Barbaro, Division of Labor Affairs.
 23   I was going to refer to him as anonymous counsel,
 24   but he is here.  Through an oversight, we didn't
 25   have a name card for him, but he is here to protect

00006
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  2   us legally and to give comments on the legislative
  3   intent and things like that, if that comes up.
  4              It may have occurred to some of you why
  5   we have representatives from the Dormitory
  6   Authority here.  The majority of HEAL funding is
  7   bondable funds issued by the Dormitory Authority,
  8   so they're here for their financial expertise, as
  9   well as the program expertise and years of
 10   experience in helping to fund health care
 11   activities.
 12              Okay.  With that, I'll introduce Jim
 13   Clyne and ask him to comment on how this fits with
 14   a lot of other things that are going on in health
 15   care restructuring right now.
 16              MR. CLYNE:  Thank you.  Welcome.
 17              Obviously, there's a lot of interest in
 18   this RGA, I think.  It's a testament to two things:
 19   One, the need to do something for primary care
 20   development, but also for the substantial
 21   commitment that we're making to try to make that
 22   happen.  This RGA supports the Governor's
 23   commitment to reforming the State's health care
 24   system and complements previous HEAL offerings that
 25   have gone out over the past two years.  The intent

00007
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  2   is to -- the overall intent of the restructuring is
  3   to reduce the inpatient beds and the needs for
  4   those beds in both hospitals an nursing homes.
  5              Opening up HEAL to the non-institutional
  6   care, especially primary and preventive care, is
  7   key to making this a reality.  It supports the
  8   recommendations of the Berger Commission, to
  9   strengthen primary care and improve the
 10   infrastructure in New York State.  The investment
 11   also works with a recently proposed budget where a
 12   number of proposals to restructure Medicaid
 13   payments provide greater support for primary care
 14   and ambulatory care, which Jay Laudato will
 15   address.
 16              We're also starting some new initiatives
 17   in the area of planning.  We talked about this in a
 18   number of different venues who are creating a web-
 19   based resource for people that should be out in the
 20   next couple of weeks that will show PQI data by zip
 21   code, and will also show the same data by hospital
 22   discharge.  This is the type of data that we're
 23   going to be looking at to show the need for primary
 24   care in particular areas, and also to show how any
 25   given proposal will address the primary care needs

00008
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  2   and the ability of primary care to affect
  3   unnecessary inpatient admissions.
  4              As primary providers, you are uniquely
  5   positioned to help us with this realignment.  In
  6   some areas of the State, we all want better access
  7   to primary care.  It is just a matter of setting up
  8   a new site of care, a new client, and this RGA can
  9   support that type of initiative.  Better access to
 10   primary care doesn't always mean more clinics.  As
 11   a matter of fact, in some of our need
 12   methodologies, we show that there are plenty of
 13   clinics in some areas, yet the care that's being
 14   provided, based on the data that we see, is still
 15   lacking.  So better access to primary care also
 16   means making existing clinics better, more
 17   efficient, better able to serve people, better able
 18   to serve new populations, and this RGA can support
 19   that type of initiative also.  Better access can
 20   also mean connecting clinics, existing clinics that
 21   face barriers for accessing care, and we believe
 22   that this initiative can also address that.
 23              So we encourage you to be innovative,
 24   resourceful, and we're looking forward to seeing
 25   some new and different ideas as a way of improving

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  2   access to primary care in New York.  Thanks.
  3              MR. DELKER:  There's a slight
  4   substitution in the agenda.  Neil Benjamin was not
  5   able to be here today, but as Jim alluded to, there
  6   are some changes going on in reimbursement to help
  7   encourage more appropriate community-based care.
  8   Jay Laudato of the Office of Health Insurance
  9   Programs will talk about some of that briefly.
 10              MR. LAUDATO:  Thank you.
 11              On behalf of Deborah Bachrach, the
 12   Deputy Commissioner for the office of Health
 13   Insurance Programs and the State's Medicaid
 14   Director, I want to welcome you to this RGA
 15   meeting.  Sorry, I'll start again.
 16              On behalf of Deborah Bachrach, Deputy
 17   Commissioner for the Office of Health Insurance
 18   Programs and the State's Medicaid Director, I want
 19   to thank the Office of Health Systems Management
 20   for including us in this RGA and welcome you today.
 21              As Jim alluded to, New York State is
 22   taking an aggressive perform agenda in terms of
 23   Medicaid, and primary care is the centerpiece of
 24   that reform agenda, both in terms of policy and
 25   fiscal.  This year in the budget it is proposed

00010
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  2   that we will change ambulatory care reimbursement
  3   to adequately and appropriately reimburse for the
  4   time and resources needed to deliver quality
  5   primary care and other outpatient services.  The
  6   new methodology will remove any disincentives to
  7   treating medically complex patients by reimbursing
  8   for the full scope of care and all services
  9   provided within a patient visit.
 10              The Department also recognizes the vital
 11   importance of patient education, particularly as it
 12   responds to chronic diseases and adherence to
 13   treatment regimens.  Accordingly, there are
 14   proposed budget initiatives that will reimburse for
 15   the education of diabetics and asthmatics, and
 16   demonstration projects for medications therapy
 17   management.  Further, to improve access, there are
 18   proposals to increase reimbursement for evening and
 19   weekend hours.
 20              We are very pleased to be here today.
 21   We are grateful for the opportunity to combine
 22   ongoing reimbursement with target grant funds to
 23   improve the health of all New Yorkers.  Thank you.
 24              MR. DELKER:  Okay.  A couple of more
 25   things:  I neglected to introduce some other people

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  2   who are here with us, although they are not seated
  3   with us; that is Mary Beth Hefner and Cynthia
  4   Miner, from the Office of Fiscal Management, who
  5   are here to advise us and you on things as they
  6   pertain to ultimate approval of contracts by the
  7   Office of the State Comptroller, and also to help
  8   with advising about some of the eligible costs.
  9              Okay.  Let's keep this moving so we can
 10   get to the questions.
 11              We'll have to talk about this.  This is
 12   a competitive procurement and it's governed by the
 13   State Finance Law, and that was part of the initial
 14   HEAL legislation.  We bring this up because there
 15   are certain rules and protocols we have to follow.
 16              Most of you are probably familiar with
 17   grants and aid or recipients of grants and aid,
 18   categorical grants, things like that.  This is
 19   different.  There are some very strict provisions
 20   governing imparting information.  Information about
 21   this grant or eligible costs or the things like
 22   that that we're talking about here today cannot be
 23   imparted except simultaneously, at the same time
 24   available to everybody.  So that's why we're having
 25   these public gatherings here and in Albany.  That's

00012
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  2   also why you can send in questions to our website.
  3   That information is in the RGA.  So that means you
  4   can not plan to call us later on and follow up with
  5   something, because we won't be able to respond.  It
  6   also means that after this gathering is over, you
  7   cannot come up to us here or out in the hall, and
  8   ask, "Oh, I wanted ask some more about this," or "I
  9   didn't quite understand about that."  We will have
 10   to be rude and pretend we didn't hear you.
 11              The questions and answers for the
 12   website can still be submitted for a couple of
 13   weeks yet, so if anything occurs to you that, you
 14   know, you still need answered, send it in there and
 15   we will get those answers out.  We will also be
 16   publishing a transcript of this proceeding, as well
 17   as the one we held in Albany on Monday on our
 18   website, and we will -- you can then read through
 19   it again, if you need further clarification.
 20              We will also be issuing any corrections
 21   or clarifications at that time.  It's in the nature
 22   of these presentations that everything we say here
 23   is considered preliminary.  We are confident that
 24   we can answer most of your questions fully and
 25   accurately, but we do reserve the right to make

00013
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  2   corrections later.  When we publish the transcript
  3   on the website, then this will be final, and at
  4   that time we will include any corrections or
  5   clarifications that we need to include.  So just
  6   keep that in mind.
  7              I'm going to move to Bob Schmidt now.
  8   As he said, he is the director of the HEAL Unit.
  9   He is the one who is truly out there in front on
 10   the HEAL program in connection with contracts and
 11   RGA's and everything else.  I'll let him start
 12   walking us through some of the particulars in the
 13   application.
 14              MR. SCHMIDT:  I just have one last
 15   introduction, Janice Dee (ph), and she works in the
 16   HEAL Unit and she is at the registration desk.  We
 17   work together to do two in one week, so actually,
 18   four.  We have different RGA's this afternoon.  I
 19   just wanted to acknowledge that.
 20              We're going to talk about now the nuts
 21   and bolts in the application process. I'm hoping
 22   you all read the RGA and this is going to kind of
 23   give you a walk through in how to complete your
 24   application, how the evaluation process takes
 25   place, and how we get to the eventual awards.

00014
  1   
  2              The goals in Phase 6, as everyone
  3   discussed earlier, is to complement downsizing,
  4   supported by earlier HEAL New York funding, help
  5   align, help their resources with community needs,
  6   and improve health status through expanded access
  7   to primary care.  So we're going to be using those
  8   types of goals when we develop our review criteria:
  9   Eligible applicants, established diagnostic and
 10   treatment centers, hospital extension clinics and
 11   outpatient departments, and I'll let Chris say a
 12   few words on eligible applicants.
 13              MR. DELKER:  The eligible applicants are
 14   established diagnosis and treatment centers.
 15   Probably most of you are operators of those kinds
 16   of facilities, D&T centers.  They can be free
 17   standing independent or they can be operated by
 18   hospitals.  This is also -- also eligible are
 19   entities that think they are able to meet the
 20   certificate of need in operational requirements to
 21   become a D&T center, and those requirements are
 22   listed in New York State Health Department
 23   regulations, Part 710 and 750, and the succeeding
 24   ones in the 750 series.  So if your organization is
 25   not yet a D&T center but you feel like you could

00015
  1   
  2   provide that in your community, you would be
  3   eligible to apply under this RGA.
  4              This is for primary care, and this is
  5   the definition that's in the RGA -- you see it on
  6   the slide there.  Now we recognize there's not a
  7   statutory or regulatory definition of primary care,
  8   it's more a term of art.  There are as many ways to
  9   define it as there are providers in the field or
 10   advocates for it, but we feel this is a good
 11   working definition of it that we came with, in
 12   consultation with our colleagues in the Department.
 13   So activities that fit this are eligible under the
 14   RGA, and I think that those of you who are out
 15   there actually doing primary care probably can
 16   discern things in there that are compatible with
 17   what you're doing and would be eligible for
 18   funding.
 19              Now there is something on Article 28:
 20   To be a D&T center, you have to be certified under
 21   Article 28 of the Public Health Law.  The statutory
 22   definition of an Article 28 provider is a facility
 23   or institution engaged principally in providing
 24   services by or under the supervision of a physician
 25   or a dentist.  So this means several things:  The

00016
  1   
  2   word "principally," we have interpreted that over
  3   the years to mean:  The majority of visits would be
  4   those that would be provided or services would be
  5   provided by a physician or under the supervision of
  6   a physician or a dentist.  So that would leave out
  7   facilities or programs of the type that are
  8   primarily some other type of intervention, physical
  9   therapy or some other, you know, perhaps done by
 10   licensed professionals, but not medical
 11   professionals.  Those would not qualify as Article
 12   28 providers, nor would they qualify as applicants
 13   under this RGA.
 14              The supervision of a physician or a
 15   dentist so that means, yes, dental clinics,
 16   dedicated dental clinics are eligible to apply
 17   under this RGA.  They are considered primary care
 18   by the Department, they long have been.  This
 19   question came up Monday in Albany, "What about
 20   family planning?"  Family planning is primary care.
 21   The Department has long recognized that.  So those
 22   family planning D&T Article 28 facilities would be
 23   eligible to apply under this RGA.
 24              MR. SCHMIDT:   I'm going to talk about
 25   eligible costs.  Section 1.3.3 of the RGA lists all

00017
  1   
  2   of the eligible costs.  We consider this a capital
  3   program and the capital costs include construction,
  4   new construction, renovation, upgrading and
  5   equipment purchasing.  That also includes
  6   supportive services, staff training, system
  7   changes, translation services, but the one thing
  8   that we're not going to consider is administrative
  9   or back-room operations.  So that's pretty clear
 10   and that's stated in the RGA; so administrative
 11   costs cannot be included in this.
 12              Okay, basis of awards.  Chris mentioned
 13   earlier that there's two applications, there's a
 14   technical application and a financial application.
 15   In the technical application, overall we're talking
 16   about improving access to primary care.  On the
 17   financial side, we're looking to see projects that
 18   are reasonable, cost effective and financially
 19   feasible.  So, basically, we're going to be
 20   awarding up to 100 million dollars.  The award
 21   pools are broken out into the Berger Commission
 22   regions, and they're basically based on census.
 23   There's a New York City region, Long Island region,
 24   Hudson Valley, a northern, a central, and a western
 25   region.

00018
  1   
  2              The first category is a small project
  3   category and, basically, those are projects that
  4   will not be larger than $500,000, and 20 million
  5   dollars is set aside for small projects.  The small
  6   projects will be awarded out of the regional pools,
  7   and then the remaining pools will be awarded.
  8   Basically, we're calling it Category 2, which is
  9   just a general regional project.
 10              It's also important to know that the
 11   maximum award for all hospitals will be 20 percent
 12   of the awarded amount, so all the money that is
 13   awarded is 20 million dollars -- up to, I should
 14   say.
 15              Okay, the basis of awards:  In the
 16   scoring criteria, we're valuing the technical
 17   application at 75 percent of the score and the
 18   financial application is 25 percent.  This is --
 19   they're going to be evaluated using uniform scoring
 20   criteria.  Just to give you an idea of the stages
 21   of scoring, there's a Stage 1 review, which is a
 22   completeness review.  You have to make sure, if
 23   something is required to be included in your
 24   application, the RGA, you should be sure to include
 25   it because that becomes the first screen.  Before

00019
  1   
  2   applications can go forward, they have to be
  3   complete application.
  4              The second stage is an eligibility
  5   review, so this is where we determine whether the
  6   applicant is an eligible applicant.  You have to
  7   make it clear that you're an eligible applicant and
  8   that you fit the criteria mentioned in the RGA, and
  9   you should provide a substantiation that you are
 10   what you say you are.
 11              Then, Stage 3 is where the application
 12   takes, you know, a dual course, through a financial
 13   review and a technical review.
 14              Application:  The Executive Summary
 15   should be brief.  I mean, we mean brief.  It should
 16   be really no more than two pages.  The executive
 17   Summary has a number of functions in the process.
 18   Don't think it should be three pages or five pages.
 19   I mean, it should be two pages, but you can have a
 20   more detailed program description, that's -- you
 21   can look in the technical application; there's an
 22   opportunity to write more about the project, but
 23   you're going to have to keep your Executive Summary
 24   short.
 25              Community need:  We're looking to see a

00020
  1   
  2   documented community need, not an anecdotal or, you
  3   know, a vague kind of description of need.  We're
  4   looking for demographic data, age, gender, et
  5   cetera; health status information, morbidity and
  6   mortality indicators, prevalence of chronic disease
  7   management.  You should know your insurance
  8   coverage in your area.  If you have a high level of
  9   uninsured, are you able to document that?  The
 10   number of your Medicaid portions, et cetera, and
 11   then --
 12              I don't know if you want to talk about
 13   PQI at this stage or not?
 14              MR. DELKER:  Yes.
 15              The Department is working on a mapping
 16   of the entire State by zip code, according to PQI's
 17   prevention quality indicators and with interrelated
 18   variables regarding various risk factors, regarding
 19   demographic data, insurance data and so on.  We
 20   have engaged an outside consultant firms to do
 21   that, and I believe the first run was last week.
 22   There are some glitches and bugs, as to be
 23   expected.  We're trying to work those out now.  We
 24   hope in the next few weeks that that will be out;
 25   by that I mean available through the website.  So

00021
  1   
  2   that may help in identifying need in your area.  So
  3   just keep checking the Department of Health website
  4   periodically to see when that will be available.
  5              I think the point to be made here about
  6   the community need is that you have to show us that
  7   you know your communities and where the need is and
  8   you would know the other providers in your area and
  9   what they are, perhaps, not doing or why they are
 10   not accessible or where your efforts could
 11   compliment what they're doing.  I think that's what
 12   we're going to be looking here for.  As Jim said in
 13   his introduction, we're looking for connections;
 14   are you able to partner or collaborate with other
 15   entities in your area?
 16              MR. SCHMIDT:  The next section is the
 17   objectives and the time line.  So you need to
 18   identify and outline your process objectives, which
 19   is basically the sequence of your actual project
 20   and your outcome objectives, what your baseline
 21   data was and, then, how health quality improvements
 22   change that at the end of the process.
 23              For your project time line, I'd like to
 24   see the time line in quarterly increments.  It's
 25   something that you'd have quarterly milestones,

00022
  1   
  2   something that would work in conjunction with a
  3   budget that's developed in quarterly intervals.  I
  4   mean that RGA states that we will not pay a voucher
  5   more than monthly, but we're looking to have
  6   quarterly submissions.  So that's something to just
  7   keep in mind.
  8              Your monitoring plan:  I have to say
  9   historically, with our earlier HEAL phases, the
 10   monitoring plan has always been the weakest
 11   component in the application.  It's got to do a
 12   little bit more than say, yes, you will monitor the
 13   project.  You're going to have to describe your
 14   methodology.  I mean, if it does say
 15   "construction," it's one thing to monitor the
 16   construction process, but we also want to see
 17   monitoring of the program, of phases, so, you know,
 18   if you weren't reaching the goals that you
 19   originally stated, what mechanisms do you have in
 20   place to change or adjust the process to make sure
 21   your outcome meets what your original intentions
 22   were.
 23              Also, it's important to just note that
 24   progress reports are required for three years after
 25   completion of the grant project; so we're still

00023
  1   
  2   going to look for measures on the success of your
  3   implementation.
  4              The project budget:  I have two slides
  5   on project budget and project fund sources that tie
  6   into the two financial documents in the RGA, but
  7   I'm going to defer that to Charlie and Larry.
  8              MR. ABEL:  Just to summarize the high
  9   point now, give you some perspective, we expect to
 10   award 100 million dollars to new initiatives that
 11   will improve the health care of residents in New
 12   York State.  We're going to do this through an
 13   assessment, competitive assessment of your
 14   projects, your initiatives, and from a qualitative
 15   perspective and a financial perspective.  We want
 16   to make sure that 100 million dollars, which is a
 17   lot of money, but we expect to get far in excess of
 18   100 million dollars in requests.  We want to make
 19   sure that that money is invested wisely so that we
 20   can maximize the return on that investment.
 21              So, from a financial perspective, we
 22   need to see a plan that is necessary, reasonable,
 23   and in the public interest, and we'll be measuring
 24   your application against others with respect to
 25   those principals.

00024
  1   
  2              Within the RGA is a document that heads
  3   up the financial packet and specifies very clearly
  4   what we will be rating your application on, from a
  5   financial perspective.  The first element is the
  6   project budget.  It must very be clearly detailed
  7   with respect to what are the line items that are
  8   requested be funded, what are those elements; why
  9   are these elements important for your initiative?
 10   It ties into the effectiveness and the clarity of
 11   your Executive Summary.  We will be comparing that
 12   document, that part of your submission specified in
 13   your initiative with what you're asking for funding
 14   for.
 15              We don't expect that the HEAL dollars,
 16   the HEAL and F Sharp-funded awards program, we
 17   don't expect that those are the only dollars to
 18   fund this initiative.  They may be.  They may be,
 19   but what we do expect, in most cases, is that you
 20   will have some of your own money at risk.  From our
 21   historical perspective in awarding grants, it just
 22   makes sense that these dollars, these HEAL dollars,
 23   are basically the dollars that are part of
 24   initiative funding that is to fill any gap between
 25   what's you, as to your particular entity, any

00025
  1   
  2   related entities to your organization who can also
  3   participate in the funding, those sources of
  4   funding, borrowed funds as well, and in combination
  5   with these HEAL and F Sharp dollars, to really
  6   leverage those avenues for funding, to bring out --
  7   to propose a fund, the best possible initiative.
  8              So list in your budget all of your
  9   underlying assumptions.  Make sure that they are
 10   very clearly there for the reviewer.  We want to
 11   make sure that the project fund sources are
 12   detailed, specifically where you're proposing to
 13   get the funding for this program.  You will have a
 14   line for grant funding from us; you will have a
 15   line for other sources of funding.  Please be very
 16   clear and detailed how the availability of those
 17   other sources are funded.  If you're proposing to
 18   borrow funds for part of this project, a letter of
 19   interest from a lending institution would be very
 20   helpful.  The cost effectiveness, why are these
 21   costs reasonable?  Clearly, it will not help you to
 22   ask for more than what is needed.  It will look
 23   like your budget is inflated.  It will score
 24   poorly.
 25              The project funding viability -- the

00026
  1   
  2   project's financial viability, I should say:  This
  3   is not, this project, this initiative is not
  4   designed to be a -- it's not designed to fund an
  5   initiative that will not be able to survive beyond
  6   the grant funding, period.  So we're not interested
  7   in funding any project that has had a two-year
  8   duration.  We want to be able to see from your
  9   documents submitted that this is necessary to start
 10   this initiative, and you will be able to perpetuate
 11   this project beyond the two year funding period.
 12              The final element that you will be rated
 13   on is the applicant's financial stability.  So to
 14   the extent that you and your other stakeholders who
 15   are involved in submitting this initiative and part
 16   of the project have a demonstrated ability to be
 17   financially stable now and into the future, you
 18   need to be able to show us that in the application.
 19              We'll be able to take additional
 20   questions related to these later on.
 21              MR. SCHMIDT:  Just also, again, Chris
 22   mentioned this earlier, this is a competitive
 23   procurement, which mean s no negotiations or
 24   adjustments prior to the project once it's
 25   submitted.  So, basically, we have our deadline for

00027
  1   
  2   submission.  There's no advantage to submitting
  3   this earlier.  You have to submit it by the
  4   deadline and, then, once it's submitted, there's no
  5   -- you can't call us an say, "I forgot a piece," or
  6   say, "I want to replace Appendix D."  There's no
  7   changes that you can do.  Once it's in, it's in.
  8              Application submission:  This slide
  9   might be a little confusing.  It generated a couple
 10   of questions on Monday.  There are separate
 11   technical and financial applications; you have to
 12   submit two originals, two original technical and
 13   two original financial -- two originals with
 14   signatures, because basically one, it's said, is
 15   retained by the Department; one is retained by the
 16   Dormitory Authority.  The four hard copies become
 17   our working copies, and then six CD's.  We prefer
 18   flash drives that have complete copies of, you
 19   know, the application package with Appendix, any
 20   attachments and additional submissions complete on
 21   those flash drives, and basically we're using the
 22   electronic system for storing and reviewing
 23   applications, so that helps us out.  That's a
 24   requirement.
 25              The applications are due by 3:00 p.m. on

00028
  1   
  2   April 17th, 2008, and our Q and A's are due in by
  3   February 22nd.  So, if you have a question that is
  4   not answered today, or you come across something
  5   that you want to ask, e-mail it into our -- we have
  6   a dedicated e-mail address, and you probably all
  7   used it when you registered, but it's
  8   HEALNewYorkprimarycare@health.state.NY.US.  We will
  9   post these, we're hoping, two weeks after the
 10   February 22nd due date, but you will have to watch
 11   the website because it may go close, but...  so
 12   just keep that in mind.
 13              I'll turn it over to Chris, and he will
 14   lay out some ground rules for the Q and A session.
 15              MR. DELKER:  Okay.  You can see the
 16   numbers of people we have here.  We have to end by
 17   12:00, maybe a few minutes afterwards since we
 18   started a few minutes late, because there are
 19   posted times and we have to adhere to the rules.
 20   There are a lot of you here.  In terms of fairness
 21   to everybody, you will be allowed to ask one
 22   question and, if necessary, one related follow-up.
 23   So don't plan to come to the microphone to ask
 24   multiple questions.  Ask one and if, after
 25   everybody has a chance to ask a first question

00029
  1   
  2   there's still time available, we can go back to
  3   people and offer them an opportunity to ask their
  4   second question.
  5              When you want to ask a question, come up
  6   to the microphone here in the forward part of the
  7   room.  These microphones only work if it's very
  8   close to your mouth like it is to mine right now.
  9   So lean into it.  The stenographer has to hear all
 10   your questions and everybody here has to hear the
 11   questions and answers because, as I said at the
 12   beginning, information has to be available to
 13   everybody at the same time.
 14              So I would suggest that you begin coming
 15   forward and actually line up.  It will probably
 16   save time, instead of waiting for the other person
 17   and then coming up.  So who wants to go first?
 18   There's never a shortage of people in the City.
 19   Please state your name and your organization, and
 20   at the end of the session, if you can leave your
 21   business card with the stenographer, if you've
 22   asked a question, it will help her in the
 23   transcript.
 24              MR. OSBORNE:  Mike Osborne, Catholic
 25   Health System, Buffalo, New York.

00030
  1   
  2              My question relates to the 20 percent
  3   for hospitals.  If a hospital were to spin off an
  4   extension clinic, I assume that extension clinic is
  5   considered a hospital, if you spin it off into a
  6   D&T, if that wasn't done at the time of the
  7   application, would you fall into that larger bucket
  8   of money or do you get --
  9              MR. DELKER:  No, if the hospital is the
 10   applicant, you're governed by that ceiling.
 11              MR. OSBORNE:  Even if the application
 12   was submitted into a separate organization.
 13              MR. DELKER:  If you're connected, it's
 14   not going to work.
 15               (Laughter.)
 16              MS. SWAIN:  Hi, I'm Elizabeth Swain.
 17   I'm the CEO of the Community Healthcare Association
 18   in New York State, CHANY.
 19              My question has to do with eligible
 20   grant expenditures.  Are expenditures related to
 21   reorganizing the way care is delivered, including
 22   the way HIT is integrated into the care delivery
 23   process to enhance capacity improved clinical
 24   outcomes eligible for coverage?  And if yes, is
 25   this an eligible stand-alone user, or must it be in

00031
  1   
  2   conjunction with a facility improvement project?
  3              MR. ABEL:  The basic answer is, yes.  We
  4   want to qualify that a little bit by saying that
  5   there are other HIT initiatives that the Department
  6   is supporting; so we want to make sure that, to the
  7   extent that the goals of this procurement are
  8   achieved, and it may be that it's more appropriate
  9   to submit under the HIT initiatives, that's a
 10   baseline assessment we're going to have to do when
 11   we review the application, if it's submitted under
 12   this, in this manner.
 13              However, this grant does not disqualify
 14   an HIT-based initiative.  It should, as we
 15   discussed earlier.  You have to be sure that you
 16   are hitting this program with goals of expanding
 17   and enhancing the care, with results that can be
 18   demonstrated and tested.  Thank you.
 19              MR. CLYNE:  That is going to be the key
 20   to any of these proposals that you're asking if
 21   these can be funded.  We tried to be somewhat
 22   flexible in allowing costs to be funded, but we're
 23   going to be very tough, to hold anything that comes
 24   forward to:  How is this going to improve and
 25   expand primary care, as opposed to maybe just being

00032
  1   
  2   a financial benefit to the organization.
  3              MR. DELKER:  Bear in mind, these are
  4   competitive applications and if the past is any
  5   guide, we're going to get four to five times the
  6   number of requests that we can fund.  So think very
  7   carefully about what Jim just said and what Charlie
  8   just said.
  9              MR. IRELAND:  Hi, Daniel Ireland, from
 10   United Memorial Medical Center of the State of New
 11   York.
 12              My question involves what Mr. Able
 13   stated, related to costs and expenditures,
 14   understanding that there's no requirement for a
 15   match, but you indicated that it always is good to
 16   show that the hospital is contributing, as well as
 17   what they're requesting from the HEAL funding.  Are
 18   you including staff salaries that would be utilized
 19   to implement, let's say if there was an IT and
 20   there's dedicated IT staff for a period of time to
 21   get the implementation off that ground; is that
 22   recognized by the OH as an expenditure, as far as
 23   the hospital's commitment towards the project, even
 24   if it isn't reimbursed by the HEAL grant?
 25              MR. ABEL:  Start-up costs of an

00033
  1   
  2   initiative are eligible.  Obviously, to the extent
  3   that you can fund those, that would be desirable,
  4   but HEAL dollars are available for start-up costs
  5   as well.
  6              MR. IRELAND:  Thank you.
  7              MS. REGAN:  Good morning.  I'm Blossom
  8   Regan from South Nassau Community Hospital in
  9   Oceanside.
 10              I have a question with regard to
 11   eligibility of costs and activities.  Under
 12   supportive services, would operating expenses be
 13   allowable for personal services, any costs related
 14   to screening and referral activities?
 15              MR. ABEL:  Well, two points that that
 16   question brings up:  One, this initiative is not
 17   really designed to sustain a program that is
 18   already in place.  If you have something that's out
 19   there and the project is under way, or it has been
 20   approved by the Department of some other initiative
 21   or some other CON and you have all your funding
 22   already described and available, then this is not
 23   the place to come to try to have the grant fund
 24   supplement or supplant those other funding sources.
 25              It is, as it has been said, it's

00034
  1   
  2   primarily a capital project, but we do recognize
  3   that there are going to be the operational expenses
  4   as part of these initiatives that would be eligible
  5   for funding.  So, some operating expenses we expect
  6   to be able to be in these initiatives, and perhaps
  7   it could be funded by grant funds, but I'll let
  8   Larry add to that.
  9              MR. VOLK:  The one comment that I wanted
 10   to make was that it's more of an example than
 11   anything else.  An example of the type of operating
 12   costs that would make a lot of sense under this
 13   program is if you are starting to deliver a new
 14   service, but there will be a period of time while
 15   that service is ramping up where the revenues
 16   produced by the volume that you're generating will
 17   not match your cost.  That is the type of start-up
 18   expense, operating expense, that this program
 19   clearly entails and envisions.
 20              MS. REGAN:  And outreach related to an
 21   existing service?
 22              MR. VOLK:  I think that would be
 23   similar, which is that if your outreach is aimed at
 24   drawing in initially a group that is going to make
 25   a sustainable program, then, sure.  If the outreach

00035
  1   
  2   is part of an ongoing program, that that is, in
  3   fact, your program to reach the community, then
  4   that's probably not where this is intended.
  5              MR. CLYNE:  Right.  If you're moving to
  6   a new zip code or serving a new sub population or
  7   starting a whole different line of service which
  8   will allow you to reach out to a different
  9   population and you need some jump-start funds,
 10   that's what this is for.  The sustainable dollars
 11   will come at least from the State, from the
 12   Medicaid side, and I think that Jay is working on
 13   it to redo the ambulatory care reimbursement
 14   methodology.
 15              MS. REGAN:  Thank you.
 16              MS. ROUSSO:  Hi, Harilyn Rousso.  I
 17   think I know the answer, I just wanted to clarify
 18   something regarding the definition of "primary
 19   care."  For person populations, for example, people
 20   with disabilities, certain kinds of care, like
 21   urology, has a very preventive basis, and certain
 22   Article 28 definitions you put up there, but it
 23   doesn't expectly fit the first definition of care.
 24   I'm wondering whether such services would fit into
 25   your definition of primary care.

00036
  1   
  2              MR. LAUDATO:  One of the things the
  3   definition doesn't include is who is the entity who
  4   is delivering the primary care and, so, it could be
  5   that a urologist is playing a continuity care role.
  6   One of the things that I would just be very clear
  7   about is the concepts of primary care are to have
  8   an ongoing relationship with the patient,
  9   holistically managing their needs.  If that
 10   includes specialty care, or if that includes
 11   diagnostic procedures and part of what is necessary
 12   to deliver quality primary care appropriate to a
 13   population is adding those services, then that's a
 14   good idea.  But it is not, for example, appropriate
 15   to say, "We need a urology program."  "We need a
 16   dialysis unit."  Rather, it is about primary care
 17   and the ongoing continuity, holistically treating
 18   patients.
 19              MR. CLYNE:   We got a number of
 20   questions about this at the previous conference
 21   also, and we did state then, also, that part of
 22   this is going to be when we see the applications,
 23   we can judge them and see their impact on primary
 24   care, because it's hard for us to see and guess
 25   every combination that could exist between primary

00037
  1   
  2   care providers and specialists or how specialists
  3   are going to be brought into an existing
  4   arrangement to determine whether that would expand
  5   access to primary care.  But we are -- we're open
  6   to seeing those applications.
  7              MS. CORRIGAN:  Ann Corrigan from
  8   Medicine Health Network, and I'm asking about
  9   eligible projects.  The intent, obviously, is for
 10   more capital focus on your part, but you've also
 11   listed other examples of eligible initiatives.  If
 12   a project was multi-prong and included advancing
 13   quality of care and scope of services in a variety
 14   of different ways, is that project cluster
 15   eligible, even if it didn't have a capital
 16   component?
 17              MR. ABEL:  It could be.  Again, the
 18   emphasis is on expanding care to address a targeted
 19   need for care in the community.  So, you know, you
 20   may have, from a facility perspective, you've got
 21   an idea on where you want to go, you want to expand
 22   services.  I'm going to sound a little cynical now,
 23   but maybe you wanted to expand your hospital's
 24   primary care network into an area that may be good
 25   for your hospital, but it may be covered by some

00038
  1   
  2   other facility.  We want to make sure that you've
  3   identified in your application what that need is,
  4   clear community need and, clearly, how your
  5   initiative is going to meet that need.
  6              MS. CORRIGAN:   Are you disadvantaging
  7   yourself because the preponderance of funds are the
  8   DASNY funds, which only fund capital, if you were
  9   to apply for mainly non-capital expansions and
 10   improvements?
 11              MR. ABEL:  In past HEAL awards, we've
 12   been able to be pretty flexible with the definition
 13   of "capital."  There's still are threshold
 14   boundaries that we need to adhere to when we start
 15   assigning different expenses to capital versus non-
 16   capital items, and this one clearly has the
 17   emphasis, 75 percent of the dollars here, in the
 18   overall HEAL, and the initiative must be capital
 19   dollars because there is going to be bonding for
 20   this, so it must fit that definition.
 21              But we recognize that there may be very
 22   good projects out there that may not have any
 23   capital component to that.  We want to fund the
 24   best projects.
 25              MR. VOLK:  Let me just expand on that,

00039
  1   
  2   just a touch.
  3              There are really three different sources
  4   of funds for this:  There's Authority bonds,
  5   there's State hard-dollar appropriations, and there
  6   are some Federal funds as well.  Each of those
  7   groups of money has its own set of rules, and the
  8   rules in many ways are very complex and we have not
  9   asked you to be responsible for figuring out which
 10   of those rules you're under, but we have to figure
 11   it out as we make the allocation.  So the largest
 12   chunk of the cash is actually available from
 13   Authority bonding.  Authority bonding has the
 14   strictest rules of a capital nature of the
 15   expenditure, and then the other programs are
 16   slightly more flexible.
 17              So as we go through the applications,
 18   not only do we score them and keep track of them
 19   that way, we also keep track of what type of fund
 20   each individual component within the applications
 21   is entailing, so that we all can keep track of
 22   whether we've got enough money when we get all done
 23   to fund all of the applications.
 24              So it's extraordinarily complex.  I
 25   don't keep track of it; Marybeth and her unit do

00040
  1   
  2   keep track of a lot of that, but to the extent that
  3   you are making what all of us would think of as
  4   real capital expenditures, and the budget does call
  5   for you to identify those items that you see as
  6   being capital expenditures, to that extent, those
  7   have somewhat more flexibility when we get to the
  8   final analysis.  But your project, the quality of
  9   what you are proposing to do and what you are
 10   proposing to spend money on from here to there, has
 11   all got to score highly to ever get to the point
 12   where those considerations are taken into account.
 13              MS. CORRIGAN:  Thank you.
 14              MR. CLYNE:  Our best advice is, don't
 15   send in an application trying to guess which way,
 16   just send in the best applications and we'll try
 17   and sort that out, because you never know how the
 18   applications are going to come in.  If there's lots
 19   of people apply for lots of, you know, bondable
 20   projects, then maybe that's more competitive than
 21   the other side.  So, really, the best advice is to
 22   send in the best projects.
 23              MR. SWEENEY:  Joe Sweeney, Heart Share
 24   Human Services, Brooklyn, New York.
 25              Will you consider projects that are

00041
  1   
  2   currently under way, capital expansion projects
  3   that are currently being financed through debt?
  4              MR. ABEL:  If all your funding sources
  5   are available and not threatened in any way, there
  6   is no further need for grant funds.
  7              MR. SWEENEY:  Excuse me?
  8              MR. ABEL:   There is no further need for
  9   grant funds, from our perspective.  The clear --  I
 10   don't know if it's even in the RGA.  An underlying
 11   tenent of this RGA funding is that HEAL funds may
 12   not be used to supplant or substitute for other
 13   sources of funds already available to the
 14   applicant.
 15              MR. CLYNE:  In other words, if we've
 16   already said that you're financially feasible
 17   because we have approved the CON, we cannot then go
 18   back and say you're not financially feasible and
 19   give you a HEAL award.
 20              MR. SWEENEY:  Thank you.
 21              MS. WEXLER:  Judy Wexler, Commissioner
 22   of the Public Health System.
 23              I'm not an applicant, but I'm concerned
 24   about whether these grant requests are going to
 25   require information about the history of the

00042
  1   
  2   facility in providing care for the uninsured and
  3   people with public insurance, as well as cultural
  4   competence in any commitments to continue and
  5   guarantee that services will be provided to those
  6   populations and in a manner that's cut really
  7   palpable.
  8              MR. DELKER:  I think we would look at
  9   that in how the applicant identifies need in their
 10   community, and if they're responding to an
 11   identified public health need.  These are 24-month
 12   contracts and, you know, there will not be funding
 13   available after that.  We do, in the review, as Bob
 14   said when he walked through the application, we do
 15   look for viability of the project after the
 16   contract period has ended.  To the extent that
 17   those things pertain to that project, it would be
 18   considered.
 19              MS. WEXLER:  So community need can be
 20   narrowed and limited?
 21              MR. DELKER:  It can be narrowed, but
 22   bear in mind what we said earlier; these are
 23   competitive applications and, you know, the more
 24   narrowly focused an application, frankly, it's not
 25   going to score as high unless you have an

00043
  1   
  2   over-arching demonstration of a really strong unmet
  3   need.
  4              MR. CLYNE:  An unmet need and your
  5   ability to serve it versus others that might put in
  6   an application for the same area.  That's what we
  7   don't know.  There can be more than one application
  8   coming in for service in a given population or a
  9   given area, and we will obviously look at, then,
 10   who can do the best job to serve that population.
 11              MR. HOWARD:  Dewey Howard from the
 12   Institute for Community Living in New York.
 13              Page 23 of the RGA speaks to non-
 14   competitive grants for physical reasons, basically.
 15   Would an applicant be precluded from applying for
 16   those that are listed under Subsection 2?  Would
 17   they be precluded from applying under Subsection 1
 18   on the competitive side, if they apply under
 19   Subsection 2?  That's page 23.
 20              MR. ABEL:  Our pagination may be
 21   different from yours.
 22              MS. RALEIGH:  Is it a small project
 23   versus the rest?
 24              MR. HOWARD:  There would be two
 25   projects.  What I'm envisioning is two projects:

00044
  1   
  2   One for the financial health of the organization,
  3   that's addressed under Subsection 2, and one for a
  4   capital grant; it's addressed as a competitive bid.
  5              It's under, you know, the law, the HEAL
  6   law, Subsection 2 of the HEAL law.
  7              MR. DELKER:  That covers all phases of
  8   HEAL allocations.  Overall, the Department and
  9   DASNY have that discretion, but that is not part of
 10   this iteration.  All applications under this
 11   iteration will be evaluated on a competitive basis.
 12              MR. HOWARD:  So Subsection 2 does not
 13   have a time line for applications?
 14              MR. DELKER:  That statute, that doesn't
 15   govern the application process.  That goes with
 16   this RGA.  This RGA is a solicitation authorized
 17   under the HEAL legislation which you're citing, but
 18   in this solicitation it is being issued completely
 19   on a competitive basis.
 20              MR. HOWARD:  Under Subsection 1 of the
 21   HEAL law.
 22              MR. DELKER:  Whatever.  Yeah, we have
 23   statutory authorization for it.
 24              MR. HOWARD:  Thank you.
 25              MR. HIRSCH:  Jerry Hirsch, North

00045
  1   
  2   Shore-LIJ Health System.
  3              If you're looking to relocate
  4   hospital-based clinics from the hospital out to the
  5   community and expand services -- I assume that
  6   would be something that would be looked at; it
  7   addresses the primary care and the capital
  8   component of this -- do you need to have site
  9   control of the facility at the time you make the
 10   application or can you guarantee that you can have
 11   site control by the time you're granted the award?
 12              MR. ABEL:  Well, that application
 13   specifically would require a certificate-of-need
 14   application.  It's at that point that we review
 15   site control as being documented.  Clearly,
 16   especially in the City, the site of your clinic, it
 17   would, I would expect, be critical to you being
 18   able to satisfy and address that community need.
 19   So you should be as specific as possible in your
 20   application, but we would not require evidence of
 21   site control.
 22              MR. HIRSCH:  Thank you very much.
 23              MR. NICKY (ph):  Martin Nicky, Lifetime
 24   Healthcare, Rochester.
 25              Referring to page 4, under "Eligible

00046
  1   
  2   Costs," under Section I, you have "Staff training
  3   and system changes in quality assurance to enable
  4   the facility," and so on.  This includes cost
  5   associated with preparation for recognition by the
  6   national quality assurance programs and CQA; off of
  7   that, are you meaning the Bridges to Excellence
  8   Program -- other people call it Advanced Medical
  9   Home Chronic Care -- and if so, can it apply in
 10   regards to demonstrating a need, really, and what
 11   those programs will demonstrate is an increase in
 12   quality and reduction in cost, but they will not
 13   necessarily answer a need for expanded care or
 14   access to care by the end insured?  So what I'm
 15   wondering is, if there's an application for a
 16   demonstration project to be able to implement that,
 17   would that qualify, even though it's not a capital
 18   project?
 19              MR. LAUDATO:  We are thinking about that
 20   program in particular.  That was the example, the
 21   Medical Home Bridges to Excellence.  We are
 22   thinking about that specific program as the
 23   example.  However, again, I would put this in the
 24   context of an expansion enhancement of primary
 25   care.  What we want, when we expand and enhance

00047
  1   
  2   primary care, is appropriate quality care.  So,
  3   again, I think it's going to be, again, a
  4   thoughtful analysis of community need, supported by
  5   data.
  6              MR. NICKY:  So the need could be
  7   improving quality and decreasing costs for the
  8   community, which will overall enhance care?
  9              MR. CLYNE:  Yes, but you really ought to
 10   look at expanding because, again, just because a
 11   cost is eligible and it's something that we can
 12   fund, it's got to be competitive.  So if we're
 13   looking at a grant that says we're going to improve
 14   quality of care by funding this but we get other
 15   applications that come in and say, "We're going to
 16   do that and we're going to serve 10,000 more
 17   Medicaid recipients," you can imagine which one is
 18   going to score higher.
 19              So you have to remember, it's
 20   competitive.  We think there's going to be a lot of
 21   applications, and the focus is on expanding the
 22   access to care, but wanting to include a cost like
 23   that so that you can wrap it into an overall
 24   program of care.
 25              MR. NICKY:  Thank you.

00048
  1   
  2              MS. SIEGEL (ph):  Ann Siegel, New York
  3   City Department of Health and Mental Hygiene,
  4   Primary Care Information Project.
  5              My question is really related to
  6   eligible applicants and costs.  You've listed
  7   public health departments as an eligible applicant,
  8   and they must apply under the Article 28
  9   facilities, and we were wondering if that also
 10   means expenses must be spent under the Article 28
 11   facilities?
 12              MR. ABEL:  Are you saying would we fund
 13   costs that are under the scope of this primary care
 14   initiative?
 15              MS. SIEGEL:  No.  We would be applying
 16   as a health department, under Article 28
 17   facilities, but can costs and expenses also be paid
 18   under facilities that are not under the Article 28
 19   license?
 20              MR. ABEL:  I guess I'm having
 21   difficulty --
 22              MR. CLYNE:  You mean funded under a
 23   public health program like home visiting, it's not
 24   under your 28?
 25              MS. SIEGEL:  Private practices, sole

00049
  1   
  2   practitioners, some of the other applicants that
  3   not eligible?
  4              MR. ABEL:  No.
  5              MR. DELKER:  The purpose of putting the
  6   Article 28 stipulation in there was to, you know,
  7   local health departments, you know, they can
  8   deliver care under other articles of the Public
  9   Health Law, but we want it to be clear that they
 10   will be applying as a D&T center, operated by a
 11   municipality or county.  So tacking on those other
 12   things you described would not fit them.
 13              MS. SIEGEL:  Okay.  Thank you.
 14              MR. RIALAS:  Hi, Christos Rialas, New
 15   York State Dental and Medical Centers.
 16              Given the RGA refers to Article 28
 17   facilities and dental equipment, I take it that
 18   dental schools, specifically Article 28 part of the
 19   schools, the dental clinics, are eligible to apply.
 20   So my question is whether the five academic dental
 21   centers in New York State can apply as a consultant
 22   or should they apply as five individual entities?
 23              MR. DELKER:  Five individual entities,
 24   because, you know, Article 28 operators and
 25   consortia are those very vague things that they may

00050
  1   
  2   be an incorporated organization, but they're not
  3   really the operator of the health care facility.
  4              MR. VOLK:  One of the institutions,
  5   however, could apply on behalf of the consortium on
  6   all four, but the applicant itself would be the
  7   actual Article 28.
  8              MR. RIALAS:  In that case, will there be
  9   a limit on the maximum amount of the grant asked or
 10   would it be, let's say, a maximum of five, if --
 11               MR. VOLK:  Yes, it would be limited by
 12   the maximum grant.
 13              MR. RIALAS:  Okay.  Thank you.
 14              MS. GOLUB:  Hi, I'm Maxine Golub of the
 15   Institute for Family Health.  This is a two-part
 16   question.  One is:  Will you consider mental health
 17   as a primary care service in order to facilitate
 18   the co-location of mental health services in
 19   primary care settings; and the second part is, if
 20   your Article 28 network extends more than one of
 21   the regions you have described, if you have to
 22   submit two separate applications and will they both
 23   be considered?
 24              MR. LAUDATO:  This is about primary care
 25   and, so, if mental health is delivered within the

00051
  1   
  2   context of primary care and supports primary care
  3   objectives, then it would be an appropriate
  4   request.  But, again, it's about Article 28 and
  5   Article 28 licensure.
  6              I'll leave the second question.
  7              MR. CLYNE:  Just to stress it, it would
  8   also have to be focused on how you're expanding
  9   care.  This means by doing this that you're going
 10   to be able to open up care to X number of people
 11   because they have a co-condition of a mental health
 12   issue, then, yes, that would be eligible.  If it's
 13   just to tack on the service to serve the existing
 14   population it, again, is not going to score high.
 15              MS. GOLUB:  Unless you consider that an
 16   enhancement that will allow your existing
 17   population to expand from primary care.
 18              MR. CLYNE:  Again, you can make that
 19   case, but as we sit here and look at and judge the
 20   application against all the other applications
 21   coming in, if you wanted to, you could go out and
 22   stick that on your Article 28 license right now, if
 23   you thought that was a better way of providing
 24   services.  There's nothing that prevents you from
 25   doing that.

00052
  1   
  2              MR. LAUDATO:  The idea that this is a
  3   grant that's a start-up grant for a two-year
  4   period, and not necessarily something that is
  5   focused on the addition of a service under an
  6   operating certificate.
  7              MS. GOLUB:  I was specifically thinking
  8   about the capital need related to expanding your
  9   space in order to expand those services.
 10              MR. CLYNE:  Again, it might be, until we
 11   see them and can judge them and see what else comes
 12   in, it's hard to speculate on it, but it would be
 13   eligible.  But, again, you always have to think
 14   about how you expand these services.
 15              MS. GOLUB:  On the second part of that
 16   question, about if your Article 28 extension was in
 17   more than one of the regions we identified, would
 18   you have to submit those as two separate
 19   applications?
 20              MR. DELKER:  No.  We do say that we do
 21   reserve the right to distribute the regional funds
 22   to meet the needs; so, no, you would not need two
 23   separate applications, but be careful how you use
 24   the term "network," because I'm not sure what you
 25   mean there.

00053
  1   
  2              MS. GOLUB:  Do you want me to clarify?
  3              MR. DELKER:  There is a definition of
  4   "network" under the Public Health Law, and to be
  5   established as a network operator.  So, I don't
  6   know if you're referring to D&T's that have the
  7   same operator, it happens to be different regions?
  8              MS. GOLUB:  Yes, the same operator.
  9              MR. DELKER:  Yes.  All right.
 10              MS. GOLUB:  Thank you.
 11              MR. PALAMINAS (ph):  Hello.  My name is
 12   John Palaminas, and I'm from Cayuga Medical Center
 13   in Ithaca.
 14              My question relates to section 1.3.3 and
 15   Subsection H.  It states there that you can
 16   possibly fund information technology that
 17   integrates clinical information from outside the
 18   applicant's setting, but it also says that Rios and
 19   others interfaced with a state are excluded.  So if
 20   you want to pull information into the Article 28
 21   from outside of it, is it okay to have a community-
 22   wide information sharing network to enhance the
 23   primary care?
 24              MR. SCHMIDT:  I think I can answer this
 25   one.

00054
  1   
  2              The reason why this was included as an
  3   eligible cost is because the two earlier health IT
  4   phases of HEAL did not allow for an individual
  5   applicant, like a D&T state to submit an
  6   application and get EMR.  So this is allowing you
  7   to do this on your own, without having to be
  8   connected to a Rio or a community based health
  9   network.  But what we are requiring is that the
 10   system -- if that was to become one of the costs
 11   included in your grant, that the system has to be
 12   interoperable, the software has to be approved by
 13   HA, and you have to be set up so that you can, at
 14   some point, become part of a Rio or a community
 15   based health network.
 16              We're not going to pay for the hook-up
 17   costs to get from an individual system to an
 18   interoperable larger system, because the other two
 19   phases of HEAL are doing that right now.
 20              MR. PALAMINAS:  Thank you.
 21              MS. TOMPKINS:  Hello.  Kathleen Tompkins
 22   from Kaiser Health in Buffalo.  I have a question
 23   also on eligible cost with age.
 24              On Information Systems and Technology
 25   you say:  "...including but not limited to age are

00055
  1   
  2   the integrated results from outside the applicant's
  3   setting."  My question is:  Is the EHR from outside
  4   of the applicant's setting, is that the primary
  5   interest for funding or would other types of
  6   information and technology be eligible?  Not
  7   necessarily EHR.
  8              MR. SCHMIDT:  We will have to get back
  9   to you on that, I guess.  We will have to discuss
 10   it.
 11              MS. RALEIGH:  I was going to make the
 12   point that to be competitive, the project has to
 13   really link the IT initiative back to, you know,
 14   enhancing access to primary care.
 15              MS. TOMPKINS:  Right.
 16              MR. ABEL:  If you can write down your
 17   question and submit that to the staff, we will be
 18   able to answer that on the question and answer.
 19              MS. TOMPKINS:  Okay, very good.
 20              MR. DELKER:  Submit it to the website in
 21   the Q and A.  When we say "We'll get back to you,"
 22   that's what we mean, because we can't get back to
 23   you one on one.
 24              MS. TOMPKINS:  All right.  I will do
 25   that.  Thank you.

00056
  1   
  2              MS. CAMERA:  Hi.  Joan Camera,
  3   Management Associates.
  4              With regard to diagnostic and treatment
  5   centers, there are some out there that have limited
  6   life, three years, five years.  I just wanted to
  7   make sure that this grant is available to them.
  8              MR. ABEL:  It should be.  They're
  9   eligible.  They are certified as Article 28 right
 10   now.  If their life happens to be expiring, their
 11   limited life happens to be expiring within the next
 12   two years or three years, I think we need to, to
 13   somehow assess on parallel tracks the likelihood
 14   that that Article 28 would be eligible for extended
 15   life for the period of this grant, contracted from
 16   the perspective that we're looking for project
 17   sustainability in the future.
 18              MS. CAMERA:  Thank you.
 19              MR. DELKER:  Excuse me, you have already
 20   asked a question and some people haven't yet.
 21   Thank you.
 22              MR. CICERO:  Frank Cicero, Cicero
 23   Consulting.
 24              May a single Article 28 operator submit
 25   two separate, distinct applications for different

00057
  1   
  2   purposes, one in the 500 and under category and one
  3   in the over 500 category?
  4              MR. SCHMIDT:  Yes.  You can do that, but
  5   it has to be separate projects.
  6              MR. CICERO:  Understood.
  7              MR. ABEL:  Can I just add to that,
  8   because I'm hopeful that we were able to drive this
  9   point home.  You should not be submitting the same
 10   project for multiple categories, and for that
 11   matter, if you submit more than one project, they
 12   should not be dependent upon one another.  We have
 13   to be able to score these applications
 14   competitively, and if you submit more than one
 15   project and one is dependent on the other, one that
 16   can score very highly, we will not be able to fund
 17   the second project.
 18              MR. CLYNE:  And the other question that
 19   has come up in other places is, don't submit for
 20   previously submitted HEAL applications.  If there
 21   was an award made from HEAL 2 or from 4, don't come
 22   in looking for the piece of that project that was
 23   denied.  Whatever we did on those previous grants,
 24   that's completed, so it would, again, have to be a
 25   new project that stands on its own.

00058
  1   
  2              MR. ABEL:  Jim, if I can just tack on to
  3   that, because this question has come up as well,
  4   let's say we funded an initiative, partially funded
  5   an initiative through an earlier HEAL project, the
  6   question of the HEAL funding that we have awarded
  7   doesn't cover the whole request or the whole
  8   project, but what we've required of those
  9   applicants in the past is that they can accomplish
 10   the project in its entirety with the award that was
 11   given.  So there's assumed to be no shortfall in
 12   carrying out that initiative to be funded with this
 13   effort.
 14              MS. ESPOSITO:  Hi, Marybeth Esposito,
 15   Mather Hospital.
 16              Would ongoing care for a chronically ill
 17   population health care center manage to fit with
 18   this RGA?
 19              MR. LAUDATO:  Again, I think that this
 20   program is very specifically targeted to the
 21   expansion and --
 22              MR. DELKER:  They can't hear you.
 23              MR. LAUDATO:  I'm sorry.  I'm not
 24   getting it.  Some of these funds will be used to
 25   buy new microphones, only about 50 million of it,

00059
  1   
  2   but it's all bondable.
  3               (Laughter.)
  4              The program is for the expansion of
  5   primary care.  Chronically ill people obviously fit
  6   within the context of that, but this is a limited
  7   program of two years and so, again, it has to be
  8   some sort of change to either the expansion of your
  9   capacity or the enhancement of your services that
 10   is time limited and discrete and that is ongoing
 11   and has ongoing support for it.
 12              Conversely, there are several RFP's
 13   coming up, one that is currently out.  There's a 20
 14   million dollar RFP for chronic illness
 15   demonstration projects.  It's on the website now
 16   and that has funding for chronic disease management
 17   and demonstration projects that will allow
 18   facilities to really look at and explore ways to
 19   support their patients with chronic disease.  In
 20   addition, we expect to release an RFP on disease
 21   management after the budget that will enable
 22   facilities to provide disease management services
 23   to patients.
 24              MR. CLYNE:  It keeps coming back to how
 25   it is going to be constructed.  Again, if you can

00060
  1   
  2   show that primary care will be eligible to a new
  3   population by making some link or connection, then
  4   that could be funded.
  5              MS. GAETA:  Nancy Gaeta, The Gaeta
  6   Company.
  7              My question has to do with the resulting
  8   operating costs for DTC.  We all know there are
  9   corridors of operating costs.  You put in a new
 10   program and it changes those corridors.  I'll
 11   assume that a CON would be entertained to change
 12   those corridors in a subsequent rate, if you have,
 13   as a result of an expansion of the service, a new
 14   program, additional ancillary costs, new
 15   pharmaceutical costs, all related to the delivery
 16   of the additional --
 17              MR. ABEL:  Are you referring to D&T's
 18   reimbursable corridor costs?
 19              MS. GAETA:  Yes, the operating side on
 20   it.
 21              MR. ABEL:  This is independent of any
 22   changes to the operating rates for D&T's.
 23              MS. GAETA:  I understand that, but there
 24   would be an impact on the operating cost structure
 25   and will the Department of Health entertain a CON

00061
  1   
  2   or a rate appeal because it would change that,
  3   subsequently.
  4              MR. ABEL:  Typically the changes to a
  5   D&TC that could trigger the D&TC falling into a
  6   different reimbursable corridor have a couple of
  7   characteristics:  One, a certificate-of-need
  8   application would have to be submitted, and the
  9   chain or the initiative that's being contemplated
 10   must be of such magnitude that it changes the
 11   character of the full D&T, such that we could
 12   defend upon CON review that this D&TC should be
 13   considered for a new reimbursable category.
 14              The details are much more than I can go
 15   into here and every project is reviewed on its own
 16   merits in that regard.
 17              MS. GAETA:  Thank you.
 18              MR. LAUDATO:  I would just add that,
 19   again, proposed in the budget for this year is a
 20   change in ambulatory care reimbursement, moving
 21   from the threshold visit methodology to a bundled
 22   methodology that will allow for multiple services
 23   to be delivered, but will also change the cost
 24   structure of -- not the cost structure, but will
 25   reimburse in a different manner than a fixed per-

00062
  1   
  2   visit rate.
  3              MS. DAVIDSON:  Nadia Davidson --
  4   Community Health Center.
  5              I just have two quick questions about
  6   the application.  Is there a page limit?  No.
  7              Then, with the submission, you said two
  8   originals for each one; are there also four hard
  9   copies for each one?  It's 6, so it's 12 and 8?
 10              MR. SCHMIDT:   Yes.
 11              MS. DAVIDSON:  8 and 12.  That's good,
 12   thank you.  That was a "yes," right?
 13              MR. SCHMIDT:  Yes, two original
 14   technical, two original financials, and four copies
 15   of each of the technical and four copies of the
 16   financial.  So it's four and eight, actually.
 17   That's why that slide was confusing on Monday.
 18              MS. JACOBELLIS:  Teresa Jacobellis,
 19   Huntington Hospital.
 20              We're a hospital that's open to free-
 21   standing D&T under it's own Article 28 certificate;
 22   do we apply as the D&T on its own or as a hospital?
 23              MR. DELKER:  Who is the operator's name
 24   on the certificate, is it Huntington Hospital?
 25              MS. JACOBELLIS:  No, the primary care

00063
  1   
  2   center has its own certificate in its own name.
  3              MR. DELKER:  So it's a separate
  4   corporation.  Then, that's the applicant.  I mean,
  5   you could apply -- well, no, you couldn't.
  6              MR. ABEL:  Whichever entity is
  7   controlling the initiative.
  8              MS. JACOBELLIS:  Okay.  Can you define a
  9   "regional project"?  Is it just budget that defines
 10   that?  Is there a geographic reach?  Is there a
 11   number of people that need to be reached or how is
 12   that defined?
 13              MR. DELKER:  The regions are based on
 14   the original commission breakdowns.  So how you
 15   decide what region you're in is where you're
 16   operating the certificate.  It's where you're
 17   operating from.
 18              MS. JACOBELLIS:  I'm sorry.  I meant
 19   whether we're a small project or a regional project
 20   in terms of that $500,000 budget, is that the only
 21   cut off or is there a broader --
 22              MR. SCHMIDT:  The only cutoff, whether
 23   you're small or regional, is the $500,000, that's
 24   the limit.  So there's no placing application
 25   that's specified, you know, "I want to be in a

00064
  1   
  2   small project pool," "I want to be in the large
  3   project pool."  It's basically, we're using the
  4   dollar value as the cutoff point.  So when the
  5   awards are made, the dollars, the small project
  6   dollars will come out of the regional pools.
  7              MR. VALLET:  Jean-Paul Vallet, Orange
  8   Regional Medical Center.
  9              With regard to eligible costs, would
 10   those include also any cost associated with
 11   recruitment, placement and, perhaps, even
 12   employment of primary care physicians by the
 13   Article 28?
 14              MR. ABEL:  It could.
 15              MR. VALLET:  It could?
 16              MR. CLYNE:  Again, it's hard to see how
 17   an application will come in with just that in it.
 18   Again, it's understanding what's eligible costs but
 19   what's going to be a project that scores.
 20              MR. VALLET:  It could appear as a
 21   line-item cost?
 22              MR. CLYNE:  A line item cost is part of
 23   starting out a new initiative, a new outreach to an
 24   under served area; that could be an eligible cause
 25   included there, but just having that on it saying,

00065
  1   
  2   "We're going to recruit doctors for this place,"
  3   again, is not the kind of application we're looking
  4   for.
  5              MR. VALLET:  I didn't see it in the RGA.
  6   Thank you.
  7              MR. DELKER:  The list of eligible costs,
  8   bear in mind, has includes but not limited to in
  9   the RGA.  So, you know, there are other things.  If
 10   you can fit them in with primary care, the purpose
 11   of this RGA as has been described, then we will
 12   consider it.
 13              MR. BRANSBOKER (Ph):  Michael
 14   Bransboker, ODA, Brooklyn.
 15              Are you going to consider costs that are
 16   in place before this program starts as eligible, or
 17   costs for extensions that are incurred -- if we're
 18   financing from our reserves?
 19              MR. ABEL:  There's going to be an
 20   established -- what is the established contract
 21   period?
 22              MR. SCHMIDT:  In the RGA it states that
 23   we plan to start contracting in August, but we
 24   haven't actually determined an incurred cost start
 25   date, at this point.  It's going to have to be

00066
  1   
  2   August, because in some phases it was earlier than
  3   the start date.
  4              MR. ABEL:  I believe you mentioned that
  5   you financed those costs, so they're taken care of.
  6              MR. BRANSBOKER:  From our reserves.
  7              MR. ABEL:  Good.  Then they're paid for.
  8   Thank you for your contribution.
  9              MS. ROSA:  Marcy Rosa, MHRA.  In the
 10   context of expanding primary care and trying to
 11   enhance it while you're expanding it, would you
 12   entertain capital costs associated with the
 13   enhancement, i.e., a home visiting program that
 14   needs a new facility in order to reach its
 15   capacity?
 16              MR. LAUDATO:  I'm not understanding your
 17   question.
 18              MS. ROSA:  I have an Article 28 in a
 19   community that can expand, definitely expand
 20   primary care, both medical or family practice and
 21   pediatrics, if we wanted to do that; and we have a
 22   home visiting component in the same community that
 23   work very closely.  The home visiting program is in
 24   a facility that's not large enough for it to staff
 25   up to its capacity.  Could we charge capital

00067
  1   
  2   expenses for that facility, in addition to whatever
  3   we need to do in the facility where the primary
  4   care is delivered?
  5              MR. CLYNE:  Yeah.  Sure.
  6              MR. LAUDATO:  Yes.
  7              MS. ROSA:  Thank you.
  8              MS. DAVIS:  Hi, Edith Davis from
  9   Bellevue Hospital Center, New York City Health and
 10   Hospitals Corporation.
 11              We were contemplating a project that
 12   might span more than one of the facilities that HHC
 13   operates.  So my question is whether the
 14   corporation, as an entity spanning the various
 15   institutions, would be eligible as the applicant,
 16   or would we have to apply from an individual
 17   facility?  I believe the corporation is the legal
 18   operator of all the facilities.
 19              MR. DELKER:  Yes.  It's HHC that's on
 20   the operating certificate, so they could apply
 21   either way; either as the individual facilities or
 22   the corporation itself could apply.
 23              MS. DAVIS:  Thank you.
 24              MS. SWEENEY:  Hi, I'm Maura Sweeney from
 25   the Catholic Health Care System in New York.

00068
  1   
  2              I understand from previous questions
  3   that if a new program is being funded through debt,
  4   they're considered viable and, therefore, wouldn't
  5   be eligible, but would a faster expansion of that
  6   program, you know, a broader expansion sooner, be
  7   eligible for a grant, so that we might move to a
  8   second or third site sooner than we would have
  9   under, you know, debt?
 10              MR. ABEL:  Well, if I would expect the
 11   focus of your application would be on getting
 12   additional sites beyond the scope of the work
 13   you've already planned, with HEAL dollars included.
 14   It could be, that could be.  That sounds to me like
 15   it could be an application that could be eligible.
 16   You know, again, if it's already within the scope
 17   of your initiative and your more distant goal, in
 18   terms of time frame, this would speed it up, you
 19   know, it would be competitively reviewed.  I don't
 20   think we would toss it out.  I don't think we'd
 21   toss it out.
 22              MS. SWEENEY:  Okay.  Thanks.
 23              MS. LAGER:  Hi, Nancy Lager from Primary
 24   Care Develop ment Corporation.  I just wanted to
 25   clarify what you were talking about, in terms of

00069
  1   
  2   the time period for expenditures, and I just have a
  3   follow up to that.
  4              You're saying that if somebody has
  5   already been starting to plan their project, maybe
  6   haven't gotten to the CON stage, but have hired an
  7   architect and expended funds, that those funds or
  8   any funds they spend between now and the award of
  9   the grant, those are not eligible for grant
 10   funding?
 11              MR. SCHMIDT:   Well, in this phase,
 12   actually in 2008 -- maybe Marybeth will say a word
 13   or two on this -- our contracting rules have
 14   changed somewhat.  We are not going to be
 15   reimbursing costs prior to the start of the
 16   contract period.
 17              MS. HEFNER:  In the past we've done some
 18   matching funds, but we're not interested in the
 19   matching.  So reimbursement has to be during the
 20   period of the contract.
 21              MR. SCHMIDT:   That's true.  We have no
 22   matching in this procurement.
 23              MS. LAGER:  Can you repeat the answer,
 24   please, we didn't hear it.  Thank you.
 25              MR. SCHMIDT:   Yes.  Costs are

00070
  1   
  2   reimbursable from the start of the contract period,
  3   which we anticipate will be August.  If it's later,
  4   then the costs could be possibly, you know, later
  5   than August, maybe September, you know.  When the
  6   contract period begins, that's when you can start
  7   reimbursement for costs.
  8              When we mentioned, you know, in some of
  9   the earlier phases, we allowed coverage of matching
 10   costs before the contract period, so when you had a
 11   50 percent matching in phase two, the start was
 12   much earlier than the beginning of the contract
 13   period.
 14              MS. LAGER:  And sort of a related
 15   question, but different:  Because you're only going
 16   to be reimbursed after you start -- if an applicant
 17   needs to borrow money, in essence to bridge those
 18   payments, especially during the course of
 19   construction, are those financing costs eligible?
 20              MR. SCHMIDT:  Yes, they are eligible.
 21   Actually, I should also mention, there's no
 22   advances in this phase.
 23              MR. DELKER:  Ann, hold on just a second.
 24   Is there anyone who has not yet asked a question
 25   who wants to?

00071
  1   
  2              (No response.)
  3              All right, we can go into second
  4   questions now.  Ann, you're first.
  5              MS. CORRIGAN:  Ann Corrigan again, from
  6   Medicine Health Network.  I just want to clarify
  7   that there really are two objectives, as stated in
  8   the RGA, one being to expand and one being to
  9   enhance, with all the subparts?  Because some of
 10   the answers I've heard to other questions gave the
 11   impression that when you were reviewing
 12   competitively, you would, of course, I think I even
 13   heard the words "of course," review to see those
 14   which were expanded as more competitive.  I just
 15   wanted to be clear about whether that is true or
 16   whether what I think I'm reading in the RGA is
 17   true?
 18              MR. ABEL:  I'll start off with a general
 19   comment.  I think from the Health Department's
 20   perspective -- I think the Governor has discussed
 21   this as well -- we have a lot of health care
 22   providers out in the community.  In some areas of
 23   the State, we seem to have a large number of
 24   providers available, but the healthcare outcomes
 25   are not all that good.  So it's not for lack of

00072
  1   
  2   having healthcare providers, but maybe it's for
  3   lack of having good health care coordination or
  4   targeted healthcare efforts to demonstrated
  5   healthcare needs.
  6              So, one aspect with respect to, you
  7   know, enhancement of healthcare services out there,
  8   I think, is to get at those deficiencies in the
  9   healthcare system that may exist right now, so that
 10   we can show that we are achieving better healthcare
 11   outcomes over time.
 12              MS. CORRIGAN:  So there is no better
 13   project stated?
 14              MR. CLYNE:  No, but I think the point
 15   that we keep trying to stress though is,
 16   particularly when people ask questions about, are
 17   specific things eligible to be funded, and we say,
 18   "yes," I just want to keep emphasizing that while
 19   you could do that, - electronic medical records is
 20   eligible, but an application only for that, which
 21   you can call, "this is going to enhance our care,"
 22   that's fine, but that's a fairly limited, fairly
 23   small enhancement to care, as opposed to another
 24   application that came in with other components to
 25   it.

00073
  1   
  2              Again, we're going to also be looking at
  3   the area that you're attempting to serve and the
  4   population that you're attempting to serve.  As
  5   Charlie indicated, we've definitely run into
  6   situations where we see areas that have, under our
  7   need methodology, a sufficient number of providers
  8   but poor outcomes.  In areas that have poor
  9   outcomes, where people come in with a way that they
 10   believe and we believe they can actually enhance
 11   care and enhance outcomes and decrease
 12   hospitalizations, that's going to be something that
 13   obviously is an enhancement that's a much better
 14   enhancement than a single shot that we're going to
 15   have with an electronic medical record.
 16              Now not all enhancements are created
 17   equal, and I think the point we're trying to make
 18   is that the single-shot individual, "This would be
 19   better for my clinic," is not going to be scored as
 20   high as a more complete project that shows how
 21   you're really going to change care in your
 22   community.  The only thing we have to note is, we
 23   have not finalized the scoring criteria, so we're
 24   going to have to come up with the scoring criteria
 25   and we'll treat everybody equally.

00074
  1   
  2              MS. CORRIGAN:   Thank you.
  3              MS. ROUSSO:  You were mentioning how
  4   long you're going to supply data.  I'm wondering
  5   whether you're going to do it for a particular
  6   population?  Aside from the geographic, I'm
  7   particularly interested in people with
  8   disabilities; they'll also range in gender and
  9   various other breakdowns.  Will that be part of
 10   what you'll have?
 11              MR. CLYNE:  The PQI data that's going to
 12   be posted is based on the census data and discharge
 13   data and a myriad of those two.  So we will have
 14   racial and ethnic breakdowns, gender and income.
 15   This is only the beginning of our efforts to try
 16   and roll out the data that we have and make it
 17   useful for people.  So we're open to lots of other
 18   ideas about how to create data, but the stuff we
 19   have is a myriad of discharge data, the PQI data,
 20   and the census data to create this package that
 21   will be available shortly.
 22              MS. LAGER:  Nancy Lager, again.
 23              What if you applied for, again, for
 24   consulting services to reorganize the way you
 25   provide care, in order to expand the capacity

00075
  1   
  2   within an existing facility, without there being a
  3   specific facility improvement component to that
  4   application; does that qualify?
  5              It will be a bigger return on
  6   investment.  The State will get more use out of an
  7   existing facility, better productivity out of the
  8   physicians, without actually spending capital
  9   dollars on the physical facility.
 10              MR. CLYNE:  It would be eligible, but
 11   again, it's hard to know until we see exactly what
 12   it is.  We're not looking for people to spend, you
 13   know, capital dollar that they don't really have,
 14   just so they can, you know, get into this
 15   procurement and then be able to add back a bunch of
 16   other costs on it.  So if there's a reasonable
 17   proposal to be able to expand your capacity within
 18   your existing four walls, we are certainly open to
 19   that.
 20              MR. DELKER:  I think seeing a budget
 21   item with only consulting fee in an application and
 22   nothing else would make me look askance as a
 23   reviewer.
 24              MR. ABEL:  I wanted to expand on that as
 25   well.

00076
  1   
  2              If it's only consulting services or a
  3   large component of it is consulting services,
  4   you're once removed from improving healthcare, and
  5   that makes it very difficult because we're then
  6   relying upon the entity that contracts with you to
  7   do its share, and I'm not sure you're going to be
  8   able to -- well, you're going to have to be able to
  9   demonstrate in your application how your consulting
 10   services directly impacts on improved cared and how
 11   can we test that?
 12              MR. LAUDATO:  I would just also add that
 13   this has to be tied back to data on community need.
 14   It is not about the improvement of an individual
 15   facility's administration.
 16              MR. PALAMINAS:  Hi, this is John
 17   Palaminas, again, from Cayuga Medical Center in
 18   Ithaca.
 19              I have a question about how specific the
 20   application needs to be in describing the project.
 21   Let's say that you identified a need and you think
 22   that you can prove the outcomes, but you need a
 23   certain software package, but there's two or three
 24   vendors, A, B, and C that you could use.  Now, do
 25   you have to decide which one you want to use to put

00077
  1   
  2   that into your application or can you describe the
  3   general features of what you want to do and then
  4   purchase it or, you know, figure out six months
  5   later, after the application is completed, what
  6   you're going to buy?
  7              MR. ABEL:  It's going to take some time
  8   and technology changes over time, prices change,
  9   but you're caught between, I guess, two things:
 10   One, the more detailed and specific your budget is,
 11   the highest in score and, obviously, the more
 12   relevant it is to your initiative.  Then, you want
 13   to be able to provide some -- on the other hand,
 14   you want to be able to provide some flexibility for
 15   a change over time.  So I think I would look to
 16   describe the project in as much detail as you can,
 17   with as much specifics that you have available to
 18   you at the time of that application.
 19              If you are saying you're going to get a
 20   Seaman's project to give you this functionality and
 21   then we award you a contract, you then, at the time
 22   of the contract, realize, "Well, G.E. puts out a
 23   better project, a better product for the same exact
 24   functionality," we're not going to criticize you,
 25   we're not going to pull that award away for that

00078
  1   
  2   kind of a change.
  3              MR. PALAMINAS:  Thank you.
  4              MR. STERN:  Barry Stern, Lomeed (ph)
  5   Medical Center.
  6              I think, Charlie, you had answered this
  7   earlier.  We received a HEAL award for HEAL 4.  One
  8   of the sources of funding was in a -- capital
  9   grant, and we recently learned that because of site
 10   control issues, the underlying collateral has to be
 11   unique and separate and apart from the entire
 12   project for it to be issued; can we ask in this
 13   HEAL 6 award for that money to be funded?
 14              MR. ABEL:  I don't think so.  I think
 15   that those HEAL dollars were awarded with the
 16   assumption that you were going to be able to pull
 17   together the necessary resources for that full
 18   initiative and, you know, if you're not able to
 19   secure one of your funding sources because of some
 20   technicality, then I think the expectation is
 21   you're going to derive that from somewhere other
 22   than HEAL.  As an alternative, in the event that
 23   you're not able to go forward with a particular
 24   part of that initiative, then I think we are going
 25   to have to work through that on a contractual

00079
  1   
  2   basis.  You know, potentially, depending upon which
  3   HEAL iteration we're talking about, it could
  4   jeopardize the HEAL funding for that initiative.
  5              MR. IRELAND:   Dan Ireland, United
  6   Memorial.  One other question on the Rio comment
  7   that was made earlier; I just want to clarify:
  8   There is no requirement to get a sign-off from the
  9   Rio if you're doing an EMR project in your primary
 10   care, it just needs to be able to communicate with
 11   it sometime in the future; is that correct?
 12              MR. SCHMIDT:  Right.  You don't have to
 13   become a member of a Rio at the sign-off if you
 14   will be in the Rio, but you have to have software
 15   that's certified and interoperable, that will be
 16   capable of joining at some point in the future.
 17              MR. IRELAND:  So simply HL-7, if you're
 18   software is HL-7 compatible, that's a standardized
 19   compatibility.
 20              MR. SCHMIDT:  No, it has to be
 21   certified.  There's a standard that comes out every
 22   year and certain packages have a certification
 23   awarded to them every year and, like, for example,
 24   I forget, Phase 5 had the most recent year's
 25   certification.  But your software vendors will be

00080
  1   
  2   able to tell you and you can make that
  3   determination.
  4              MR. IRELAND:  Thank you.
  5              MS. ROUSSO:  One more question:  To
  6   build the facility for primary care, is that the
  7   only thing you can do in that area?  I mean, if the
  8   primary focus is on primary care, but then you use
  9   some space for something else, is that
 10   inappropriate?
 11              MR. ABEL:  I mean, we can allocate, you
 12   know, there's a process of allocation.  If you're
 13   going to build a larger facility and a portion of
 14   it is going to be used for the primary care
 15   initiatives and that becomes the focus, an
 16   allocation of the overall project cost is for this
 17   primary care initiative, that could be eligible for
 18   expense.  So I guess the answer is, yes, you could,
 19   but I don't think -- we may not be able to fund the
 20   portion of the expansion for these other services.
 21              MS. LAGER:  Hi, Nancy Lager, again.
 22              If you were in a pace program, and the
 23   pace program is setting up an adult day health
 24   program with a primary care component, can or
 25   should the applicant apply under both HEAL 6 and

00081
  1   
  2   HEAL 7 for funding?  Do pieces of that apply under
  3   one or the other?
  4              MR. ABEL:  The initiatives for HEAL 6
  5   and HEAL 7 have to be separate and distinct and
  6   cannot depend upon both projects being funded.  I
  7   don't know the specifics.  I don't think you want
  8   to give me --
  9              MS. LAGER:  It would be one facility
 10   and, so, could components of the one facility that
 11   encompasses both primary care and adult day health
 12   seek funding for the pieces of that facility that
 13   relate to those two programmatic functions?
 14              MR. ABEL:  I don't want to get into the
 15   specifics of a given application.  Let's just say
 16   that if you submit an application under HEAL 6, and
 17   it includes not only a request line for HEAL 6
 18   funds, but also for HEAL 7 at some future HEAL
 19   iteration, that is going to create problems for us
 20   with respect to granting this application.  I don't
 21   know if it will make it ineligible, but it will
 22   certainly limit the ability for us to score this
 23   high.
 24              MR. VOLK:  I think you also create
 25   issues of feasibility.  Since you have to treat

00082
  1   
  2   each half or each portion as independent, if having
  3   both portions is required, then in one of your
  4   applications, you're going to have to establish
  5   that you have funding available to cover the other
  6   half, and to do that both ways you don't need any
  7   money.
  8              (Laughter.)
  9              MR. DELKER:  Any further questions?
 10              (No response.)
 11              All right.  Thank you all for coming.
 12   As we said, if any further questions occur to you,
 13   you still have a couple of week to submit them to
 14   the website.  We will be submitting a transcript
 15   with any corrections or clarifications.
 16              Leave your business cards with the
 17   stenographer if you asked a question.
 18              (TIME NOTED:  11:50 A.M.)
 19   
 20   
 21   
 22   
 23   
 24   
 25   

00083
  1   
  2   
  3                C E R T I F I C A T I O N
  4   
  5                   I, SHANASIA ILGNER, a Shorthand
  6   Reporter and Notary Public, within and for the
  7   State of New York, do hereby certify that I
  8   reported the proceedings in the within-entitled
  9   matter, on February 8, 2008, at 90 Church Street,
 10   New York, New York, and that to the best of my
 11   ability, the above proceedings are an accurate
 12   transcription of what transpired at that time and
 13   place.
 14                   IN WITNESS WHEREOF, I have hereunto
 15   set my hand this       day of                  ,
 16   2008.
 17   
 18   
 19                            SHANASIA ILGNER,
 20                            Shorthand Reporter
 21   
 22   
 23   
 24   
 25