It created a State Commission in Lunacy having "exclusive jurisdiction over all institutions for the care and treatment of the insane, epileptics and idiots".
The Commission consisted of three commissioners appointed by the Governor of New York for terms of six years, with the exception of New York State Medical Commissioner, who served based on his "good behavior".
By chapter 32 of the Laws of 1909, the Commission was given supervision over the expenditures of all New York State hospitals for the insane: "no disbursements for any purpose can be made by these institutions except upon quarterly estimates, which must be submitted to the Commission for revision and approval.
All vouchers for the maintenance and building improvements account of the State hospitals are paid through the office of the Commission."
There was also a Bureau of Deportation which acted under the direction of the Commission to return nonresident insane persons to their place of origin.