HLT-15-10-00012-P Palliative Care Certified Medical Schools and Residency Programs

4/14/10 N.Y. St. Reg. HLT-15-10-00012-P

NEW YORK STATE REGISTER

VOLUME XXXII, ISSUE 15

April 14, 2010

RULE MAKING ACTIVITIES

DEPARTMENT OF HEALTH

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. HLT-15-10-00012-P

Palliative Care Certified Medical Schools and Residency Programs

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed Action:

Addition of Part 48 to Title 10 NYCRR.

Statutory authority:

Public Health Law, section 2807-n

Subject:

Palliative Care Certified Medical Schools and Residency Programs.

Purpose:

Defines palliative care certified medical schools & residency programs to award grants according to PHL, section 2807-n.

Text of proposed rule:

Pursuant to the authority vested in the Commissioner of Health by Section 2807-n of the Public Health Law, a new Part 48 is hereby added to Title 10 (Health) of the Official Compilation of Codes, Rules and Regulations of the State of New York, effective upon publication of a Notice of Adoption in the New York State Register, to read as follows:

PART 48

Palliative Care Certified Medical Schools and Residency Programs

48.10 Definitions

(a) Palliative care shall mean the active, interdisciplinary care of patients with serious, life-threatening, advanced, or life limiting illness, focusing on relief of distressing physical and psychosocial symptoms and meeting spiritual needs. Its goal is achievement of the best quality of life for patients and families.

(b) Palliative care certified medical school shall be a Liaison Committee on Medical Education (LCME) or American Osteopathic Association (AOA) accredited medical school in New York State which is an institution granting a degree of doctor of medicine or of osteopathic medicine in accordance with regulations by the Commissioner of Education under subdivision two of section sixty-five hundred twenty-four of the education law, and which meets the following criteria:

(1) one or more faculty does clinical work or teaching relevant to palliative care; and/or

(2) contains an element of the preclinical or clinical curriculum relevant to palliative care; and

(3) is certified by the Commissioner or his or her designee in conformance with Subdivision (a) of Section 48.20 of this Part.

Relevant work, teaching, or curriculum may include, but is not limited to, didactic coursework or training related to one of the following eight domains of quality palliative care relating to populations with serious or life-threatening illnesses: (1) structure and process of care, (2) physical aspects of care, (3) psychological and psychiatric aspects of care, (4) social aspects of care, (5) spiritual, religious, and existential aspects of care, (6) cultural aspects of care, (7) care of the imminently dying patient, and (8) ethical and legal aspects of care.

(c) Palliative care certified residency program shall be a graduate medical education program in New York State accredited and in good standing by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA), and which meets the following criteria:

(1) is sponsored by one of the following specialties that have incorporated Hospice and Palliative Medicine (HPM) as a subspecialty:

(i) anesthesiology;

(ii) emergency medicine;

(iii) family medicine;

(iv) internal medicine;

(v) pediatrics;

(vi) physical medicine and rehabilitation;

(vii) psychiatry and neurology;

(viii) radiology;

(ix) surgery; or

(x) obstetrics and gynecology; and

(2) contains an element of the teaching curriculum is identified as relevant to palliative care; and

(3) is certified by the Commissioner or his or her designee in conformance with Subdivision (b) of Section 48.20 of this Part.

Relevant work, teaching, or curriculum may include, but is not limited to, didactic coursework or training related to one of the following eight domains of quality palliative care, relating to populations with serious or life-threatening illnesses: (1) structure and process of care, (2) physical aspects of care, (3) psychological and psychiatric aspects of care, (4) social aspects of care, (5) spiritual, religious, and existential aspects of care, (6) cultural aspects of care, (7) care of the imminently dying patient, and (8) ethical and legal aspects of care.

48.20 Certification

(a) Any medical school which has submitted an application with documentation acceptable to the department and which has been determined by the Commissioner or his or her designee to have met the definition of a palliative care certified medical school as set forth in subdivision (b) of Section 48.10 of this Part shall be certified until such time as the medical school receives written notice of termination from the Commissioner of Health, who, in his/she sole discretion, may terminate when continuation of such certification no longer benefits public health or satisfies the definitional requirements. Medical schools are eligible during the period of certification to apply for grants for undergraduate medical education in palliative care within amounts appropriated for such purpose to enhance the study of palliative care, increase the opportunities for undergraduate medical education in palliative care and encourage the education of physicians in palliative care.

(b) Any residency program which has submitted an application with documentation acceptable to the department and which has been determined by the Commissioner or his or her designee to have met the definition of a palliative care certified residency program as set forth in subdivision (c) of Section 48.10 shall be certified until such time as the residency program receives written notice of termination from the Commissioner of Health, who, in his/she sole discretion, may terminate when continuation of such certification no longer benefits public health or satisfies the definitional requirements. Residency programs are eligible during the period of certification to apply for grants for graduate medical education in palliative care, within amounts appropriated for such purpose.

Text of proposed rule and any required statements and analyses may be obtained from:

Katherine Ceroalo, DOH, Bureau of House Counsel, Regulatory Affairs Unit, Room 2438, ESP, Tower Building, Albany, NY 12237, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Regulatory Impact Statement

Statutory Authority:

The authority for the promulgation of these regulations is contained in section 2807-n of the Public Health Law (PHL). Hospice and Palliative Medicine (HPM) has recently become a recognized subspecialty reflecting the increased importance of palliative care and the desire to incorporate it into existing medical training. The purpose for certifying palliative care medical schools and residency programs is to award grants as set forth in PHL section 2807-n to appropriate schools and programs that will best utilize such funds to increase and enhance palliative care professional education, and training.

Legislative Objectives:

Despite the formal recognition of HPM within mainstream medicine, the challenge continues to be the lack of professional education and knowledge on end of life care. There is a continued need for faculty leaders in the field of palliative medicine to direct education and research programs in medical schools and residency training programs. The legislative objective is to ensure that physicians are educated about palliative care so that the residents of the State will receive such services of the highest quality when the need arises.

Needs and Benefits:

There has been a growing call to advance the integration of palliative care into the American healthcare system in order to meet the healthcare needs of the chronically ill and aging population and their families. The World Health Organization (WHO) defines palliative care as an approach which improves quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.

Hospice and Palliative Medicine (HPM) has recently become a subspecialty recognized by both the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME), reflecting the increased importance of palliative care and the desire to incorporate it into existing medical training infrastructure. Despite the formal recognition within mainstream medicine, two of the field’s most challenging issues continue to be the lack of professional education and knowledge on end-of–life care and the need to develop and expand hospice and palliative care services into hospitals and nursing homes, where the majority of Americans die. Faculty leaders in the field of palliative medicine are needed to direct education and research programs in medical schools and residency training programs. State support for training and education programs is critical to addressing this need. The National Consensus Projects have established domain of quality palliative care relating to populations with serious or life-threatening illness which will be helpful in targeting training and education.

Costs for the Implementation of and Continuing Compliance with these Regulations to the Regulated Entity:

None. This regulation merely defines a “palliative care certified medical school” and a “palliative care residency program,” as the initial step for a medical school or residency program, to be eligible for grants set forth in PHL section 2807-n. It will require submission of paperwork periodically to the Department, which can be easily done by current medical school or residency program administrative staff.

Cost to State and Local Government:

None.

Cost to the Department of Health:

None. Determinations under the regulation will be made by existing Department staff.

Local Government Mandates:

None.

Paperwork:

Any medical school or residency program that would like to be palliative care certified will have to apply via the grant application process to the Department. The Department will receive grant applications and requests for certification from such schools and residency programs and will make the ultimate determination of what schools and residency programs are certified.

Duplication:

This regulation does not duplicate any other state or federal law or regulation.

Alternative Approaches:

This regulation will determine which medical schools and residency programs are certified for palliative care. Only such medical schools and residency programs may apply for funding through the Palliative Care Education and Training program. There are no other alternatives given statutory language.

Federal Requirements:

This regulatory amendment does not exceed any minimum standards of the federal government for the same or similar subject areas.

Compliance Schedule:

This proposal will go into effect upon a Notice of Adoption in the New York State Register.

Regulatory Flexibility Analysis

No Regulatory Flexibility Analysis for Small Businesses and Local Governments is required, pursuant to section 202-b of the State Administrative Procedure Act (SAPA). The proposed regulation only applies to medical schools and residency programs, none of which meet the definition of a small business or are operated by local governments.

Rural Area Flexibility Analysis

No rural area flexibility analysis is required pursuant to section 202-bb(4)(a) of the State Administrative Procedure Act (SAPA). The proposed regulation does not impose an adverse impact on facilities in rural areas, and they do not impose reporting, record keeping or other compliance requirements on facilities in rural areas.

Job Impact Statement

No Job Impact Statement is required pursuant to section 201-a(2)(a) of the State Administrative Procedure Act. It is apparent, from the nature of the proposed regulation, that it will not have a substantial adverse impact on jobs and employment opportunities.