senate Bill S2606C

Signed by Governor Amended

Enacts into law major components of legislation necessary to implement the state health mental hygiene budget for the 2013-2014 state fiscal year

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed by Governor
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actions

  • 22 / Jan / 2013
    • REFERRED TO FINANCE
  • 13 / Feb / 2013
    • AMEND AND RECOMMIT TO FINANCE
  • 13 / Feb / 2013
    • PRINT NUMBER 2606A
  • 22 / Feb / 2013
    • AMEND (T) AND RECOMMIT TO FINANCE
  • 22 / Feb / 2013
    • PRINT NUMBER 2606B
  • 10 / Mar / 2013
    • AMEND (T) AND RECOMMIT TO FINANCE
  • 10 / Mar / 2013
    • PRINT NUMBER 2606C
  • 23 / Mar / 2013
    • AMEND (T) AND RECOMMIT TO FINANCE
  • 23 / Mar / 2013
    • PRINT NUMBER 2606D
  • 26 / Mar / 2013
    • ORDERED TO THIRD READING CAL.276
  • 26 / Mar / 2013
    • PASSED SENATE
  • 26 / Mar / 2013
    • DELIVERED TO ASSEMBLY
  • 27 / Mar / 2013
    • REFERRED TO WAYS AND MEANS
  • 28 / Mar / 2013
    • SUBSTITUTED FOR A3006D
  • 28 / Mar / 2013
    • ORDERED TO THIRD READING RULES CAL.45
  • 28 / Mar / 2013
    • MOTION TO AMEND LOST
  • 28 / Mar / 2013
    • MOTION TO AMEND LOST
  • 28 / Mar / 2013
    • PASSED ASSEMBLY
  • 28 / Mar / 2013
    • RETURNED TO SENATE
  • 28 / Mar / 2013
    • DELIVERED TO GOVERNOR
  • 28 / Mar / 2013
    • SIGNED CHAP.56

Summary

Relates to the cap on local Medicaid expenditures; relates to the determination of rates of payments by certain state governmental agencies; relates to the medical assistance information and payment system; relates to managed care programs and managed long term care plans; relates to participation in the state health insurance exchange; relates to liability for certain acts under the false claims act; relates to civil actions pursuant to the false claims act; relates to the delay of certain administrative costs; relates to the preferred drug program; relates to antipsychotic therapeutic drugs; authorizes the commissioner of health to implement an incontinence supply utilization management program; relates to the funding of health home infrastructure development; relates to general hospital inpatient reimbursement; relates to managed care programs; relates to rates of payment for residential health care facilities and rates of reimbursement for inpatient detoxification and withdrawal services; relates to hospital inpatient base years; relates to the Medicaid managed care inpatient psychiatric care default rate; relates to the Medicaid managed care default rate; moves rate setting for child health plus to the department of health; requires the use of an enrollment broker for counties that are mandated Medicaid managed care and managed long term care; repeals the twentieth day of the month enrollment cut-off for managed long term care enrollees; relates to the nursing home financially disadvantaged program; eliminates the recruitment and retention attestation requirement for certain certified home health agencies; extends the office of the Medicaid inspector general's power to audit rebasing rates; relates to rebasing transition payments; relates to payment of claims; establishes the home and community-based care work group; relates to critical access hospitals; eliminates the bed hold requirement; relates to eligibility for Medicaid; relates to treatment of income and resources of institutionalized persons; relates to the people; repeals certain provisions of law relating to the pharmacy and therapeutics committee; relates to payments to hospital assessments; relates to the effectiveness of eligibility for medical assistance and the family health plus program; extends various plans and programs; relates to rates of payment by state governmental agencies; relates to reports on chronic illness demonstration projects and reports by the commissioner of health on health homes; relates to rates of payment for long term home health care programs; extends a demonstration program for physicians suffering from alcoholism, drug abuse or mental illness; relates to indigent care; relates to permitting online and telephone Medicaid applications; allows administrative renewals and self-attestation of residency; ends applications for family health plus; establishes a methodology for modified adjusted gross income; centralizes child health plus eligibility determinations; requires audit standards for eligibility; relates to residency and income attestation and verification for child health plus; eliminates temporary enrollment in child health plus; expands the child health plus social security number requirement to lawfully residing children; requires a status report on the health benefit exchange; relates to health benefit exchange navigators and clarifies the identity of persons to whom insurance licensing requirements apply; relates to coverage limitations requirements and student accident and health insurance; relates to standardization of individual enrollee direct payment contracts; ensures that group and individual insurance policy provisions conform to applicable requirements of federal law; relates to the general public health work program; consolidates the excess medical malpractice liability coverage pool; relates to the addition to the methadone registry of dosage and such other information as is necessary to facilitate disaster management; relates to state aid funding authorization of services funded by the office of alcoholism and substance abuse services; vests all authority to appoint and remove officers and employees of the office of mental health; creates mental health incident review panels; relates to psychiatric emergency programs; relates to foregoing a cost-of-living adjustment during the 2013-2014 state fiscal year; authorizes the actions necessary to manage the loss of federal revenue and create the mental hygiene stabilization fund; provides medical assistance to certain retirees of the New York city off-track betting corporation; and relates to funding to SUNY Downstate Medical Center and directing the restructuring of the hospital.

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Bill Details

Versions:
S2606
S2606A
S2606B
S2606C
S2606D
Legislative Cycle:
2013-2014
Law Section:
Budget Bills
Laws Affected:
Amd Various Laws, generally
view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2606--C

                            I N  S E N A T E

                            January 22, 2013
                               ___________

A  BUDGET  BILL,  submitted by the Governor pursuant to article seven of
  the Constitution -- read twice and ordered printed, and  when  printed
  to  be  committed to the Committee on Finance -- committee discharged,
  bill amended, ordered reprinted as amended  and  recommitted  to  said
  committee  -- committee discharged, bill amended, ordered reprinted as
  amended and recommitted to said  committee  --  committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee

AN ACT to amend chapter 59 of the laws  of  2011,  amending  the  public
  health  law  and other laws relating to general hospital reimbursement
  for annual rates, in relation to the cap on  local  Medicaid  expendi-
  tures;  to  amend  the social services law, in relation to the medical
  assistance information and payment system; to amend the state  finance
  law,  in relation to liability for certain acts under the false claims
  act; to amend the state finance law,  in  relation  to  civil  actions
  pursuant  to  the false claims act; to amend the public health law, in
  relation to the preferred drug program; to  amend  the  public  health
  law,  in  relation  to  antipsychotic  therapeutic drugs; to amend the
  social services law, in relation to  reducing  pharmacy  reimbursement
  for name brand drugs; to amend the social services law, in relation to
  managed  care  coverage  of  certain drugs; to amend the public health
  law, in relation to eliminating the summary  posting  requirement  for
  the  pharmacy  and therapeutic committee; to amend the social services
  law, in relation to early refill of prescriptions; to amend the social
  services law, in relation to authorizing the commissioner of health to
  implement an incontinence supply utilization  management  program;  to
  amend  part C of chapter 58 of the laws of 2005, relating to authoriz-
  ing reimbursements for expenditures made by or  on  behalf  of  social
  services  districts  for  medical assistance for needy persons and the
  administration thereof, in relation to the effectiveness  thereof;  to
  amend the public health law, in relation to general hospital inpatient
  reimbursement;  to  amend  the  social  services  law,  in relation to
  managed care programs; to amend section 2 of part H of chapter 111  of
  the  laws of 2010, relating to increasing Medicaid payments to provid-
  ers through managed care organizations and providing  equivalent  fees
  through  an  ambulatory  patient group methodology, in relation to the
  effectiveness thereof; to amend the public health law, in relation  to

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD12571-10-3

S. 2606--C                          2

  rates  of payment for residential health care facilities; to amend the
  public health law, in relation to hospital inpatient  base  years;  to
  amend  the public health law, in relation to the Medicaid managed care
  inpatient  psychiatric  care  default rate; to amend the public health
  law, in relation to the Medicaid managed care default rate;  to  amend
  the  public  health  law, in relation to moving rate setting for child
  health plus to the department of health; to amend the social  services
  law  and the public health law, in relation to requiring the use of an
  enrollment broker for counties that are mandated Medicaid managed care
  and managed long term  care;  to  amend  the  state  finance  law,  in
  relation  to  the  federal-state  health  reform  partnership  program
  account; to amend the public health law, in relation to repealing  the
  twentieth  day  of  the month enrollment cut-off for managed long term
  care enrollees; to amend the public health law,  in  relation  to  the
  nursing  home  financially  disadvantaged program; to amend the public
  health law, in relation to eliminating the recruitment  and  retention
  attestation requirement for certain certified home health agencies; to
  amend  the  public  health law, in relation to extending the office of
  the Medicaid inspector general's power to  audit  rebasing  rates;  to
  amend  the  public  health  law,  in  relation  to rebasing transition
  payments; to amend the public health law, in relation to capital  cost
  reimbursement  for  nursing  homes; to amend the public health law, in
  relation to eliminating the bed hold requirement; to amend the  public
  health  law,  in  relation  to  authorizing  upper  payment limits for
  certain nursing homes; to amend the public health law, in relation  to
  rates  for  specialty nursing homes; to amend the social services law,
  in relation to eliminating spousal refusal of medical care;  to  amend
  the  social  services  law,  in  relation  to  treatment of income and
  resources of institutionalized persons; to  amend  the  public  health
  law,  in  relation  to certain payments for certain home care agencies
  and services; to amend the social services law, in relation  to  Medi-
  caid  eligibility;  to amend part H of chapter 59 of the laws of 2011,
  amending the public health law and  other  laws  relating  to  general
  hospital  inpatient  reimbursement,  in  relation to the effectiveness
  thereof; to amend part H of chapter 59 of the laws of  2011,  amending
  the  public  health law and other laws relating to known and projected
  department of health state funds Medicaid expenditures, in relation to
  the effectiveness thereof; in relation to  eliminating  the  2013-2014
  trend  factor  and  thereafter;  to  repeal  certain provisions of the
  social services law and the public health law relating to managed care
  programs; and to repeal certain provisions of the  public  health  law
  and  the social services law relating to the pharmacy and therapeutics
  committee; providing for the repeal of certain provisions upon expira-
  tion thereof (Part A); to amend the public health law, in relation  to
  payments to hospital assessments; to amend part C of chapter 58 of the
  laws  of  2009  amending  the public health law relating to payment by
  governmental agencies for  general  hospital  inpatient  services,  in
  relation  to  the  effectiveness of eligibility for medical assistance
  and the family health plus program; to amend chapter 474 of  the  laws
  of  1996,  amending the education law and other laws relating to rates
  for residential healthcare facilities, in relation to  reimbursements;
  to  amend  chapter 884 of the laws of 1990, amending the public health
  law relating to authorizing bad debt and charity care  allowances  for
  certified home health agencies, in relation to the effectiveness ther-
  eof;  to amend the long term care integration and finance act of 1997,
  in relation to extending the expiration  of  operating  demonstrations

S. 2606--C                          3

  operating  a  managed  long term care plan; to amend chapter 81 of the
  laws of 1995, amending the public health law and other  laws  relating
  to medical reimbursement and welfare reform, in relation to reimburse-
  ments  and  the effectiveness thereof; to amend the public health law,
  in relation to capital related inpatient expenses; to amend part C  of
  chapter  58  of the laws of 2007, amending the social services law and
  other laws relating to enacting the major  components  of  legislation
  necessary  to  implement  the health and mental hygiene budget for the
  2007-2008 state fiscal year, in relation to rates of payment by  state
  governmental  agencies  and the effectiveness of certain provisions of
  such chapter; to amend the social services law, in relation to reports
  on chronic illness demonstration projects and reports by  the  commis-
  sioner  of health on health homes; to amend chapter 451 of the laws of
  2007, amending the public health law, the social services law and  the
  insurance  law,  relating  to providing enhanced consumer and provider
  protections, in relation to extending  the  effectiveness  of  certain
  provisions  thereof;  to  amend  the public health law, in relation to
  rates of payment for long term home health  care  programs;  to  amend
  chapter 426 of the laws of 1983, amending the public health law relat-
  ing to professional misconduct proceedings and chapter 582 of the laws
  of  1984, amending the public health law relating to regulating activ-
  ities of physicians, in  relation  to  the  effectiveness  of  certain
  provisions  thereof;  to  amend  the public health law, in relation to
  extending a demonstration program for physicians suffering from  alco-
  holism,  drug  abuse or mental illness; to amend part X2 of chapter 62
  of the laws of 2003 amending the public health law relating to  allow-
  ing the use of funds of the office of professional medical conduct for
  activities  of  the patient health information and quality improvement
  act of 2000, in relation to the effectiveness  of  certain  provisions
  thereof (Part B); to amend the public health law, in relation to indi-
  gent  care  (Part C); to amend the social services law, in relation to
  eligibility  conditions,  permitting  online  and  telephone  Medicaid
  applications, allowing administrative renewals and self-attestation of
  residency,  ending  applications  for  family health plus and modified
  adjusted gross income and Medicaid eligibility groups;  to  amend  the
  public  health  law, in relation to establishing methodology for modi-
  fied adjusted gross income, centralizing child health plus eligibility
  determinations, requiring audit standards for  eligibility,  residency
  and  income attestation and verification for child health plus, elimi-
  nating temporary enrollment in child health plus, expanding the  child
  health  plus  social  security number requirement to lawfully residing
  children, modified adjusted gross income under child health  plus  and
  personal  interviews  under  child health plus; to amend the insurance
  law and the public health law, in relation to clarifying the  identity
  of  persons  to whom insurance licensing requirements apply, insurance
  brokers and agents,  coverage  limitations  requirements  and  student
  accident and health insurance and standardization of individual enrol-
  lee  direct payment contracts; to repeal sections 369-ee and 369-ff of
  the social services law, relating to the family health  plus  program;
  to repeal certain other provisions of the social services law relating
  thereto;  to  repeal  certain provisions of the insurance law relating
  thereto; and providing for the repeal of certain provisions upon expi-
  ration thereof (Part D); to amend the public health law,  in  relation
  to the general public health work program; to amend chapter 577 of the
  laws  of  2008  amending  the public health law, relating to expedited
  partner therapy for persons infected with  chlamydia  trachomatis,  in

S. 2606--C                          4

  relation  to  the  effectiveness  of such chapter; to amend the public
  health law and the mental hygiene law, in  relation  to  consolidating
  the  excess  medical malpractice liability coverage pool; to amend the
  education  law,  in  relation  to medical malpractice reform; to amend
  part S of chapter 56 of the  laws  of  2012  relating  to  the  excess
  medical malpractice liability coverage pool, in relation to the appli-
  cation  of coverage for physicians and dentists; and to repeal certain
  provisions of the public health law relating to state aid for  certain
  public health programs and provisions relating to sexually transmitted
  diseases;  to  amend  the  public  health  law, in relation to medical
  assistance recoupment and reductions; to amend the public health  law,
  in  relation  to  enacting the "home care stabilization act"; to amend
  the insurance law, the public health law and  the  financial  services
  law,  in  relation  to  establishing  protections  to prevent surprise
  medical  bills  including   network   adequacy   requirements,   claim
  submission requirements, adequacy of and access to out-of-network care
  and  prohibition  of  excessive emergency charges; to amend the social
  services law, in relation to coverage of mail order  prescriptions  by
  managed care providers; to provide for the rates of payment to general
  hospitals  for total hip or knee joint replacement cases; to amend the
  public health law, in relation to directing the commissioner of health
  to report to the legislature on the progress and preparedness  of  the
  health  benefit  exchange; to amend the public health law, in relation
  to directing the commissioner of health to report to  the  legislature
  on the department of health's annual activities, mission and goals; to
  amend  chapter  56 of the laws of 2012, amending the public health law
  relating to evaluations  or  services  under  the  early  intervention
  program for infants and toddlers with disabilities and their families,
  in  relation  to  the  effectiveness of certain provisions thereof; to
  amend the public health law, in relation to establishing  the  broads-
  cale  systems  integration  demonstration program; to amend the public
  health law, in relation to requiring adrenoleukodystrophy screening of
  newborns; to amend the public health law, in relation to  payments  to
  rural  hospitals designated as critical access hospitals; to amend the
  state finance law, in relation to the monies of the spinal cord injury
  research trust fund; and to amend the social services law, in relation
  to a health technology  assessment  committee;  to  amend  the  social
  services  law,  in  relation  to  creating  incentives for counties to
  investigate and prosecute medicaid fraud; to amend the  public  health
  law, in relation to establishing the Medicaid identification and anti-
  fraud  biometric  technology program; and to amend the social services
  law, in relation to conforming medical assistance identification  with
  the   Medicaid  identification  and  anti-fraud  biometric  technology
  program; to amend the state finance law, in relation  to  establishing
  the  health care efficiency and affordability law of New Yorkers (HEAL
  NY) account; to repeal section 365-d of the social services law relat-
  ing to early and periodic screening diagnosis and  treatment  outreach
  demonstration  projects;  to  repeal section 2818 of the public health
  law, relating to the health care efficiency and affordability  law  of
  New  Yorkers  (HEAL  NY)  capital grant program; and providing for the
  repeal of certain provisions upon  expiration  thereof  (Part  E);  to
  amend  the  mental  hygiene  law,  in  relation to the addition to the
  methadone registry of dosage and such other information as  is  neces-
  sary  to  facilitate disaster management (Part F); to amend the mental
  hygiene law,  in  relation  to  state  aid  funding  authorization  of
  services  funded  by  the  office  of  alcoholism  and substance abuse

S. 2606--C                          5

  services; to repeal article 26 of such law relating thereto (Part  G);
  to  amend the mental hygiene law, in relation to inpatient facilities;
  to amend chapter 62 of the laws of 2003, amending the  mental  hygiene
  law  and the state finance law relating to the community mental health
  support and workforce reinvestment program, the membership of  subcom-
  mittees  for mental health of community services boards and the duties
  of such subcommittees and creating the  community  mental  health  and
  workforce   reinvestment   account,  in  relation  to  extending  such
  provisions relating thereto (Part H); to amend the mental hygiene law,
  in relation to the recovery of exempt income by the office  of  mental
  health for community residential programs and providing for the repeal
  of  such  provisions  upon  expiration thereof (Part I); intentionally
  omitted (Part J); to amend the mental hygiene law, in relation  to  an
  annual  examination  and  notice  of rights provided to respondent sex
  offenders who are confined in a secure treatment facility (Part K); to
  amend the mental hygiene law and the education  law,  in  relation  to
  creating  mental  health incident review panels (Part L); to amend the
  mental hygiene law, in relation to statewide  comprehensive  plans  of
  service  for  persons  with mental disabilities; and to repeal certain
  provisions of the mental hygiene law and certain provisions of chapter
  723 of the laws of 1989, amending the mental  hygiene  law  and  other
  laws  relating to the establishment of comprehensive psychiatric emer-
  gency programs, relating to eliminating  the  annual  reports  on  the
  comprehensive  psychiatric  emergency  program;  family  care; and the
  confinement, care and treatment of persons with developmental disabil-
  ities (Part M); to amend chapter 57 of the laws of 2006,  relating  to
  establishing a cost of living adjustment for designated human services
  programs,   in  relation  to  foregoing  such  adjustment  during  the
  2013-2014 state fiscal year (Part N); to authorize the actions  neces-
  sary  to  manage  the  loss  of  federal revenue and create the Mental
  Hygiene Stabilization fund (Part O); and in relation  to  adult  homes
  (Part P)

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. This act enacts into law major  components  of  legislation
which are necessary to implement the state fiscal plan for the 2013-2014
state  fiscal  year.  Each  component  is wholly contained within a Part
identified as Parts A through P. The effective date for each  particular
provision contained within such Part is set forth in the last section of
such Part. Any provision in any section contained within a Part, includ-
ing the effective date of the Part, which makes a reference to a section
"of  this  act", when used in connection with that particular component,
shall be deemed to mean and refer to the corresponding  section  of  the
Part  in  which  it  is  found. Section three of this act sets forth the
general effective date of this act.

                                 PART A

  Section 1. Subdivision (a) of section 90 of part H of  chapter  59  of
the  laws of 2011, amending the public health law and other laws, relat-
ing to general hospital inpatient reimbursement  for  annual  rates,  is
amended to read as follows:

S. 2606--C                          6

  (a)  Notwithstanding  any  other provision of law to the contrary, for
the state fiscal years beginning April 1, 2011 and ending on [March  31,
2013]  FEBRUARY  15,  2014 AND FOR THE RATE PERIOD APRIL 1, 2013 THROUGH
DECEMBER 31, 2013, all Medicaid payments made for services  provided  on
and  after  April  1,  2011,  shall,  except as hereinafter provided, be
subject to a uniform two percent reduction and such reduction  shall  be
applied,  to  the extent practicable, in equal amounts during the fiscal
year, provided, however, that an alternative method may be considered at
the discretion of the commissioner of health and  the  director  of  the
budget  based  upon consultation with the health care industry including
but not limited to, a uniform reduction in Medicaid rates of payments or
other reductions provided  that  any  method  selected  achieves  up  to
$345,000,000  in Medicaid state share savings in state fiscal year 2011-
12 [and], up to $357,000,000 in state fiscal year  2012-13,  AND  UP  TO
$311,000,000  FOR  THE  PERIOD  APRIL  1, 2013 THROUGH DECEMBER 31, 2013
except as hereinafter provided, for services provided on and after April
1, 2011 through [March] DECEMBER 31, 2013. Any  alternative  methods  to
achieve  the  reduction  must  be provided in writing and shall be filed
with the senate finance  committee  and  the  assembly  ways  and  means
committee not less than thirty days before the date on which implementa-
tion  is  expected  to begin. Nothing in this section shall be deemed to
prevent all or part of  such  alternative  reduction  plan  from  taking
effect retroactively, to the extent permitted by the federal centers for
medicare and medicaid services.
  S  2.  Subdivision 1 of section 91 of part H of chapter 59 of the laws
of 2011, amending the public health  law  and  other  laws  relating  to
general hospital reimbursement for annual rates, as amended by section 5
of  part  F  of  chapter  56  of the laws of 2012, is amended to read as
follows:
  1. Notwithstanding any inconsistent provision of state  law,  rule  or
regulation  to  the  contrary,  subject to federal approval, the year to
year rate of growth of department of health state funds Medicaid  spend-
ing  shall not exceed the ten year rolling average of the medical compo-
nent of the consumer price index  as  published  by  the  United  States
department  of  labor, bureau of labor statistics, for the preceding ten
years[.]; PROVIDED, HOWEVER, THAT FOR STATE FISCAL YEAR 2013-14 AND  FOR
EACH  FISCAL  YEAR  THEREAFTER, THE MAXIMUM ALLOWABLE ANNUAL INCREASE IN
THE AMOUNT OF DEPARTMENT OF HEALTH STATE FUNDS MEDICAID  SPENDING  SHALL
BE  CALCULATED BY MULTIPLYING THE DEPARTMENT OF HEALTH STATE FUNDS MEDI-
CAID SPENDING FOR THE PREVIOUS YEAR, MINUS THE AMOUNT OF ANY  DEPARTMENT
OF  HEALTH  STATE OPERATIONS SPENDING INCLUDED THEREIN, BY SUCH TEN YEAR
ROLLING AVERAGE.
  S 3. Section 92 of part H of chapter 59 of the laws of 2011,  amending
the  public  health  law  and other laws relating to known and projected
department of health state funds Medicaid expenditures, subdivision 1 as
amended by section 57 of part D of chapter 56 of the laws  of  2012,  is
amended to read as follows:
  S  92.  1. For state fiscal years 2011-12 through [2013-14] 2014-2015,
the director of the budget, in consultation  with  the  commissioner  of
health  referenced as "commissioner" for purposes of this section, shall
assess on a monthly basis, as reflected in monthly reports  pursuant  to
subdivision  five  of  this  section  known  and projected department of
health state funds medicaid expenditures by category of service  and  by
geographic  regions, as defined by the commissioner, and if the director
of the budget determines that such expenditures are  expected  to  cause
medicaid  disbursements  for such period to exceed the projected depart-

S. 2606--C                          7

ment of health medicaid state funds disbursements in the enacted  budget
financial  plan  pursuant  to  subdivision  3 of section 23 of the state
finance law, the commissioner of health, in consultation with the direc-
tor  of  the budget, shall develop a medicaid savings allocation plan to
limit such spending to  the  aggregate  limit  level  specified  in  the
enacted  budget  financial plan, provided, however, such projections may
be adjusted by the director of the budget to account for any changes  in
the  New  York state federal medical assistance percentage amount estab-
lished pursuant to the federal social security act, changes in  provider
revenues,  reductions  to local social services district medical assist-
ance administration, and beginning April 1, 2012 the  operational  costs
of  the  New  York  state  medical indemnity fund; AND PROVIDED FURTHER,
HOWEVER, THAT SUCH PROJECTIONS SHALL BE ADJUSTED BY THE DIRECTOR OF  THE
BUDGET  TO ACCOUNT FOR INCREASED OR EXPEDITED DEPARTMENT OF HEALTH STATE
FUNDS MEDICAID EXPENDITURES AS A RESULT OF A NATURAL OR  OTHER  TYPE  OF
DISASTER,   INCLUDING  A  GOVERNMENTAL  DECLARATION  OF  EMERGENCY;  AND
PROVIDED FURTHER, HOWEVER, THAT BEGINNING APRIL 1, 2013 SUCH PROJECTIONS
SHALL BE ADJUSTED BY THE DIRECTOR OF  THE  BUDGET  TO  ACCOUNT  FOR  NEW
DEPARTMENT  OF  HEALTH  STATE FUNDS MEDICAID EXPENDITURES RELATED TO ANY
MEDICAID WAIVER APPROVED BY THE FEDERAL CENTERS FOR MEDICARE  AND  MEDI-
CAID SERVICES.
  2.  Such medicaid savings allocation plan shall be designed, to reduce
the disbursements authorized by the appropriations herein in  compliance
with  the  following guidelines: (1) reductions shall be made in compli-
ance with applicable  federal  law,  including  the  provisions  of  the
Patient  Protection and Affordable Care Act, Public Law No. 111-148, and
the Health Care and Education Reconciliation Act of 2010, Public Law No.
111-152 (collectively "Affordable Care Act") and any  subsequent  amend-
ments  thereto  or  regulations  promulgated  thereunder; (2) reductions
shall be made in a manner that complies with  the  state  Medicaid  plan
approved  by  the  federal  centers  for medicare and medicaid services,
provided, however, that the commissioner  of  health  is  authorized  to
submit  any state plan amendment or seek other federal approval, includ-
ing waiver authority,  to  implement  the  provisions  of  the  medicaid
savings  allocation plan that meets the other criteria set forth herein;
(3) reductions shall be made in a manner that maximizes  federal  finan-
cial  participation,  to  the  extent practicable, including any federal
financial participation that is available or is reasonably  expected  to
become available, in the discretion of the commissioner of health, under
the  Affordable  Care  Act; (4) reductions shall be made uniformly among
categories of services and geographic  regions  of  the  state,  to  the
extent  practicable,  and  shall  be made uniformly within a category of
service, to the extent practicable, except  where  the  commissioner  of
health  determines that there are sufficient grounds for non-uniformity,
including but not limited to: the extent to which specific categories of
services contributed to department of health medicaid state funds spend-
ing in excess of the limits specified herein; the need to maintain safe-
ty net services in underserved communities; or the potential benefits of
pursuing innovative payment models contemplated by the  Affordable  Care
Act,  in  which  case  such  grounds  shall be set forth in the medicaid
savings allocation plan; and (5) reductions shall be made  in  a  manner
that  does  not  unnecessarily create administrative burdens to Medicaid
applicants and recipients or providers.
  3. (a) The commissioner of health shall seek the input of the legisla-
ture, as well  as  organizations  representing  health  care  providers,
consumers,  businesses,  workers, health insurers, and others with rele-

S. 2606--C                          8

vant expertise, in developing such medicaid savings allocation plan[, to
the extent that all or part of such  plan,  in  the  discretion  of  the
commissioner,  is  likely to have a material impact on the overall medi-
caid  program, particular categories of service or particular geographic
regions of the states].
  (b)[(i)] THE MEDICAID SAVINGS ALLOCATION PLAN SHALL  BE  SUBMITTED  TO
THE  LEGISLATURE FOR THEIR CONSIDERATION AND APPROVAL PRIOR TO IMPLEMEN-
TATION OF THE PLAN.
  (C) The commissioner  of  health  shall  post  the  APPROVED  medicaid
savings allocation plan on the department of health's website [and shall
provide  written copies of such plan to the chairs of the senate finance
and the assembly ways and means committees] at least 30 days before  the
date on which implementation is expected to begin.
  [(ii) The commissioner of health may revise the medicaid savings allo-
cation plan subsequent to the provision of notice and prior to implemen-
tation  but  need  provide  a new notice pursuant to subparagraph (i) of
this paragraph only if  the  commissioner  determines,  in  his  or  her
discretion, that such revisions materially alter the plan.
  (c)]  (D)  Notwithstanding  the provisions of paragraphs (a) and [(b)]
(C) of this subdivision, the commissioner of health need  not  seek  the
input  described  in paragraph (a) of this subdivision or provide notice
pursuant to paragraph [(b)] (C) of this [paragraph] SUBDIVISION  if,  in
the  discretion of the commissioner, expedited development and implemen-
tation of a medicaid savings allocation  plan  is  necessary  due  to  a
public  health  emergency.    IF THE COMMISSIONER DECIDES THAT EXPEDITED
DEVELOPMENT AND IMPLEMENTATION OF A MEDICAID SAVINGS ALLOCATION PLAN  IS
NECESSARY,  THE  COMMISSIONER  SHALL  NOTIFY THE GOVERNOR, THE TEMPORARY
PRESIDENT OF THE SENATE AND THE  SPEAKER  OF  THE  ASSEMBLY  SEVENTY-TWO
HOURS PRIOR TO TAKING ANY ACTION.
  For purposes of this section, a public health emergency is defined as:
(i)  a  disaster, natural or otherwise, that significantly increases the
immediate need for health care personnel in an area of the  state;  (ii)
an  event  or  condition that creates a widespread risk of exposure to a
serious communicable disease, or the potential for such widespread  risk
of  exposure;  or  (iii)  any other event or condition determined by the
commissioner to constitute an imminent threat to public health.
  [(d)] (E) Nothing in this paragraph shall be deemed to prevent all  or
part of such medical savings allocation plan from taking effect retroac-
tively  to  the extent permitted by the federal centers for medicare and
medicaid services.
  4. In accordance  with  the  medicaid  savings  allocation  plan,  the
commissioner  of  the  department  of  health shall reduce department of
health state funds medicaid disbursements by the amount of the projected
overspending through, actions including, but not limited to modifying or
suspending reimbursement methods, including but not limited to all fees,
premium levels and rates of payment, notwithstanding  any  provision  of
law  that sets a specific amount or methodology for any such payments or
rates of payment;  modifying  Medicaid  program  benefits;  seeking  all
necessary  Federal  approvals,  including,  but  not limited to waivers,
waiver amendments; and suspending time frames for  notice,  approval  or
certification  of  rate  requirements,  notwithstanding any provision of
law, rule or regulation to the contrary, including but  not  limited  to
sections 2807 and 3614 of the public health law, section 18 of chapter 2
of the laws of 1988, and 18 NYCRR 505.14(h).
  5.   The department of health shall prepare a monthly report that sets
forth:  (a) known and projected department of health  medicaid  expendi-

S. 2606--C                          9

tures  as  described  in  subdivision one of this section, DETAILING THE
SPECIFIC MEDICAID EXPENDITURES INCLUDED IN THE REPORT THAT  ARE  SUBJECT
TO  THE  AGGREGATE LIMIT LEVEL SPECIFIED IN THE ENACTED BUDGET FINANCIAL
PLAN AND ANY MEDICAID EXPENDITURES THAT ARE NOT SUBJECT TO THE AGGREGATE
LIMIT  LEVEL SPECIFIED IN THE ENACTED BUDGET FINANCIAL PLAN; and (b) the
actions taken to implement any medicaid savings allocation  plan  imple-
mented  pursuant to subdivision four of this section, including informa-
tion concerning the impact of such actions on each category  of  service
and  each geographic region of the state. Each such monthly report shall
be provided to the chairs of the senate finance and  the  assembly  ways
and  means  committees and shall be posted on the department of health's
website in a timely manner.
  6. ON OR BEFORE DECEMBER 31, 2013, THE  DIRECTOR  OF  THE  BUDGET,  IN
CONSULTATION WITH THE CHAIRS OF THE SENATE FINANCE AND ASSEMBLY WAYS AND
MEANS  COMMITTEES  SHALL PROVIDE A REPORT TO THE GOVERNOR, THE TEMPORARY
PRESIDENT OF THE SENATE AND  THE  SPEAKER  OF  THE  ASSEMBLY  CONTAINING
RECOMMENDATIONS FOR INCLUSION IN THE 2014-2015 EXECUTIVE BUDGET ON MODI-
FYING,  CONTINUING  OR DISCONTINUING SECTION NINETY-ONE OF THIS PART AND
THIS SECTION. IN PREPARING SUCH RECOMMENDATIONS, THE FOLLOWING SHALL  BE
ANALYZED: (A) THE ADEQUACY OF THE YEAR TO YEAR RATE OF GROWTH IN DEPART-
MENT  OF  HEALTH  STATE  FUNDS MEDICAID SPENDING PROVIDED FOR IN SECTION
NINETY-ONE OF THIS PART, (B) THE TYPES OF EXPENDITURES TO  BE  INCLUDED,
AND  THE  FACTORS THAT MUST BE ACCOUNTED FOR, IN DETERMINING THE DEPART-
MENT OF HEALTH STATE FUNDS MEDICAID AGGREGATE LIMIT LEVEL  SPECIFIED  IN
THE  ENACTED  BUDGET  FINANCIAL  PLAN, THE PROCESS FOR ASSESSING MONTHLY
EXPENDITURE LEVELS AND  ESTABLISHING  THE  MEDICAID  SAVINGS  ALLOCATION
PLAN,  AND  THE  ADEQUACY  OF  THE MONTHLY REPORT ON KNOWN AND PROJECTED
DEPARTMENT OF HEALTH STATE FUNDS MEDICAID EXPENDITURES,  AND  (C)  OTHER
RELEVANT  ISSUES  AS  AGREED  TO  BY  THE DIRECTOR OF THE BUDGET AND THE
CHAIRS OF THE SENATE FINANCE AND ASSEMBLY WAYS AND MEANS COMMITTEES.  IN
PREPARING  SUCH REPORT, THE DIRECTOR OF THE BUDGET AND THE CHAIRS OF THE
SENATE FINANCE AND ASSEMBLY WAYS AND MEANS  COMMITTEES  SHALL  SEEK  THE
INPUT  OF  ORGANIZATIONS  REPRESENTING HEALTH CARE PROVIDERS, CONSUMERS,
BUSINESSES, WORKERS, HEALTH INSURERS, AND OTHERS WITH  RELEVANT  EXPERI-
ENCE.
  S  4.  Section 2 of part H of chapter 59 of the laws of 2011; amending
the public health law  and  other  laws  relating  to  general  hospital
reimbursement for annual rates, is amended to read as follows:
  S 2. Notwithstanding paragraph (c) of subdivision 10 of section 2807-c
of  the  public health law, section 21 of chapter 1 of the laws of 1999,
or any other contrary provision of law, in determining rates of payments
by state governmental agencies effective for services  provided  on  and
after  January  1, 2013 through March 31, [2013] 2014, for inpatient and
outpatient  services  provided  by  general  hospitals,  for   inpatient
services and adult day health care outpatient services provided by resi-
dential  health  care  facilities  pursuant  to article 28 of the public
health law, except for residential health care facilities  or  units  of
such  facilities that provide services primarily to children under twen-
ty-one years of age, for home health care services provided pursuant  to
article  36 of the public health law, by certified home health agencies,
long term home health care programs and AIDS home care programs, and for
personal care services provided pursuant to section 365-a of the  social
services  law,  the  commissioner  of health shall apply no greater than
zero trend factors attributable to the  [2013]  2014  calendar  year  in
accordance with paragraph (c) of subdivision 10 of section 2807-c of the
public  health  law,  provided,  however, that such no greater than zero

S. 2606--C                         10

trend factors for such [2013] 2014 calendar year shall also  be  applied
to  rates  of payment for personal care services provided in those local
social service districts,  including  New  York  city,  whose  rates  of
payment  for  such services are established by such local social service
districts pursuant to a rate-setting exemption issued by the commission-
er of health to such local social service districts in  accordance  with
applicable regulations, and provided further, however, that for rates of
payment for assisted living program services provided on and after Janu-
ary 1, 2013 through March 31, [2013] 2014, trend factors attributable to
the  [2013]  2014  calendar year shall be established at no greater than
zero percent.
  S 5. Paragraph (a) of subdivision 8 of section  367-b  of  the  social
services  law, as amended by chapter 109 of the laws of 2007, is amended
to read as follows:
  (a) For the purpose  of  orderly  and  timely  implementation  of  the
medical  assistance  information  and  payment system, the department is
hereby authorized to enter into agreements with fiscal intermediaries or
fiscal agents for the design,  development,  implementation,  operation,
processing,  auditing  and  making  of payments, subject to audits being
conducted by the state in accordance with the terms of such  agreements,
for medical assistance claims under the system described by this section
in  any  social  services  district.  Such agreements shall specifically
provide that the state shall have complete oversight responsibility  for
the  fiscal  intermediaries'  or fiscal agents' performance and shall be
solely responsible for establishing eligibility requirements for recipi-
ents,  provider  qualifications,  rates  of  payment,  investigation  of
suspected  fraud and abuse, issuance of identification cards, establish-
ing and maintaining recipient eligibility files, provider profiles,  and
conducting  state  audits  of  the  fiscal intermediaries' or agents' at
least once annually. The system described in this subdivision  shall  be
operated  by  [a]  ONE  OR  MORE fiscal [intermediary] INTERMEDIARIES or
fiscal [agent] AGENTS in accordance with  this  subdivision  unless  the
department  is  otherwise  authorized by a law enacted subsequent to the
effective date of this subdivision to  operate  the  system  in  another
manner.  In  no  event  shall  such intermediary or agent be a political
subdivision of the state or any other  governmental  agency  or  entity.
NOTWITHSTANDING  THE  FOREGOING,  THE  DEPARTMENT MAY MAKE PAYMENTS TO A
PROVIDER UPON THE COMMISSIONER'S  DETERMINATION  THAT  THE  PROVIDER  IS
TEMPORARILY  UNABLE  TO COMPLY WITH BILLING REQUIREMENTS. The department
shall consult with the office of Medicaid  inspector  general  regarding
any  activities undertaken by the fiscal intermediaries or fiscal agents
regarding investigation of suspected fraud and abuse.
  S 6. Intentionally omitted.
  S 7. Intentionally omitted.
  S 8. Paragraph (g) of subdivision  1  of  section  189  of  the  state
finance  law,  as amended by chapter 379 of the laws of 2010, is amended
to read as follows:
  (g) knowingly makes, uses, or causes to  be  made  or  used,  a  false
record  or  statement material to an obligation to pay or transmit money
or property to the state or a local government, OR KNOWINGLY CONCEALS OR
KNOWINGLY AND IMPROPERLY AVOIDS OR DECREASES AN  OBLIGATION  TO  PAY  OR
TRANSMIT  MONEY OR PROPERTY TO THE STATE OR A LOCAL GOVERNMENT, shall be
liable to the state or a local government, as applicable,  for  a  civil
penalty  of  not less than six thousand dollars and not more than twelve
thousand dollars, plus three times the amount of all damages,  including

S. 2606--C                         11

consequential  damages,  which  the  state  or local government sustains
because of the act of that person.
  S  9. Subparagraphs (d) and (e) of subdivision 2 of section 190 of the
state finance law, paragraph (d) as amended by chapter 379 of  the  laws
of 2010, paragraph (e) as added by section 39 of part C of chapter 58 of
the laws of 2007, are amended to read as follows:
  (d)  If  the  state  notifies  the  court  that  it  intends to file a
complaint against the defendant and thereby be substituted as the plain-
tiff in the action, or to permit a  local  government  to  do  so,  such
complaint,  WHETHER  FILED  SEPARATELY OR AS AN AMENDMENT TO THE QUI TAM
PLAINTIFF'S COMPLAINT, must  be  filed  within  thirty  days  after  the
notification to the court. For statute of limitations purposes, any such
complaint  filed by the state or a local government shall relate back to
the filing date of the complaint of the qui tam plaintiff, to the extent
that the cause of action of the state or local government arises out  of
the  conduct, transactions, or occurrences set forth, or attempted to be
set forth, in the [prior] complaint of the qui tam plaintiff.
  (e) If the state notifies the court that it intends  to  intervene  in
the  action,  or to permit a local government to do so, then such motion
[for intervention] TO INTERVENE,  WHETHER  FILED  SEPARATELY  OR  AS  AN
AMENDMENT  TO  THE  QUI TAM PLAINTIFF'S COMPLAINT, shall be filed within
thirty days after the notification to the court. FOR STATUTE OF  LIMITA-
TIONS  PURPOSES, ANY COMPLAINT FILED BY THE STATE OR A LOCAL GOVERNMENT,
WHETHER FILED SEPARATELY OR AS AN AMENDMENT TO THE QUI  TAM  PLAINTIFF'S
COMPLAINT,  SHALL RELATE BACK TO THE FILING DATE OF THE COMPLAINT OF THE
QUI TAM PLAINTIFF, TO THE EXTENT THAT THE CAUSE OF ACTION OF  THE  STATE
OR  LOCAL  GOVERNMENT ARISES OUT OF THE CONDUCT, TRANSACTIONS, OR OCCUR-
RENCES SET FORTH, OR ATTEMPTED TO BE SET FORTH, IN THE COMPLAINT OF  THE
QUI TAM PLAINTIFF.
  S 9-a. Subdivision 4 of section 190 of the state finance law, as added
by section 39 of part C of chapter 58 of the laws of 2007, is amended to
read as follows:
  4.  Related  actions. When a person brings a qui tam action under this
section, no person other than the attorney general, or a  local  govern-
ment  attorney  acting  pursuant  to  subdivision one of this section or
paragraph (b) of subdivision two of this section, may intervene or bring
a related civil action based  upon  the  facts  underlying  the  pending
action[,  unless  such other person has first obtained the permission of
the attorney general to intervene or  to  bring  such  related  action];
provided,  however,  that nothing in this subdivision shall be deemed to
deny persons the right, upon leave of court, to file briefs amicus curi-
ae.
  S 9-b. Subdivisions 6 and 7 of section 190 of the state  finance  law,
as  added by section 39 of part C of chapter 58 of the laws of 2007, are
amended and a new subdivision 11 is added to read as follows:
  6. Awards to qui tam plaintiff. (a) If the attorney general elects  to
convert  the  qui  tam civil action into an attorney general enforcement
action, or to permit a local government to convert  the  action  into  a
civil  enforcement  action  by such local government, or if the attorney
general or a local government elects to intervene in the qui  tam  civil
action,  then  the  person  or  persons  who initiated the qui tam civil
action collectively shall be entitled to  receive  between  fifteen  and
twenty-five  percent  of  the  proceeds  recovered  in  the action or in
settlement of the action. The court shall determine  the  percentage  of
the  proceeds  to  which  a  person commencing a qui tam civil action is
entitled, by considering the extent to which the plaintiff substantially

S. 2606--C                         12

contributed to the prosecution of the action. Where the court finds that
the action was based primarily on disclosures  of  specific  information
(other  than  information  provided  by  the person bringing the action)
relating to allegations or transactions in a criminal, civil or adminis-
trative  hearing,  in  a  legislative or administrative report, hearing,
audit or investigation, or from the news media, the court may award such
sums as it considers appropriate, but in no case more than  ten  percent
of the proceeds, taking into account the significance of the information
and  the  role of the person or persons bringing the action in advancing
the case to litigation.  ANY SUCH PERSON SHALL ALSO  RECEIVE  AN  AMOUNT
FOR  REASONABLE  EXPENSES  THAT THE COURT FINDS TO HAVE BEEN NECESSARILY
INCURRED, REASONABLE ATTORNEYS' FEES,  AND  COSTS  PURSUANT  TO  ARTICLE
EIGHTY-ONE OF THE CIVIL PRACTICE LAW AND RULES. ALL SUCH EXPENSES, FEES,
AND COSTS SHALL BE AWARDED AGAINST THE DEFENDANT.
  (b)  If  the  attorney general or a local government does not elect to
intervene or convert the action, and the action is successful, then  the
person  or  persons  who  initiated  the  qui  tam  action which obtains
proceeds shall be entitled to receive  between  twenty-five  and  thirty
percent  of  the  proceeds  recovered in the action or settlement of the
action. The court shall determine the  percentage  of  the  proceeds  to
which a person commencing a qui tam civil action is entitled, by consid-
ering the extent to which the plaintiff substantially contributed to the
prosecution of the action.  SUCH PERSON SHALL ALSO RECEIVE AN AMOUNT FOR
REASONABLE  EXPENSES  WHICH  THE  COURT  FINDS  TO HAVE BEEN NECESSARILY
INCURRED, REASONABLE ATTORNEYS' FEES,  AND  COSTS  PURSUANT  TO  ARTICLE
EIGHTY-ONE OF THE CIVIL PRACTICE LAW AND RULES. ALL SUCH EXPENSES, FEES,
AND COSTS SHALL BE AWARDED AGAINST THE DEFENDANT.
  (c)  With  the exception of a court award of costs, expenses or attor-
neys' fees, any payment to a person pursuant to this paragraph shall  be
made from the proceeds.
  (D)  IF  THE  ATTORNEY  GENERAL OR A LOCAL GOVERNMENT DOES NOT PROCEED
WITH THE ACTION AND THE PERSON BRINGING THE ACTION CONDUCTS THE  ACTION,
THE  COURT MAY AWARD TO THE DEFENDANT ITS REASONABLE ATTORNEYS' FEES AND
EXPENSES IF THE DEFENDANT PREVAILS IN THE ACTION  AND  THE  COURT  FINDS
THAT  THE CLAIM OF THE PERSON BRINGING THE ACTION WAS CLEARLY FRIVOLOUS,
CLEARLY VEXATIOUS, OR BROUGHT PRIMARILY FOR PURPOSES OF HARASSMENT.
  7. Costs, expenses, disbursements and attorneys' fees. In  any  action
brought  pursuant  to  this  article,  the court may award [the attorney
general, on behalf of the people of the state  of  New  York,  and]  any
local  government  that  participates as a party in the action[, and any
person who is a qui tam plaintiff,] an amount  for  reasonable  expenses
which the court finds to have been necessarily incurred, plus reasonable
attorneys'  fees, plus costs pursuant to article eighty-one of the civil
practice law and rules. All such  expenses,  fees  and  costs  shall  be
awarded directly against the defendant and shall not be charged from the
proceeds, but shall only be awarded if [the state or] a local government
[or the qui tam civil action plaintiff] prevails in the action.
  11.  FEES  AND EXPENSES TO PREVAILING DEFENDANT. IF, IN A CIVIL ACTION
BROUGHT BY THE ATTORNEY GENERAL, THE DEMAND BY THE ATTORNEY  GENERAL  IS
SUBSTANTIALLY IN EXCESS OF THE JUDGMENT FINALLY OBTAINED BY THE ATTORNEY
GENERAL  AND IS UNREASONABLE WHEN COMPARED WITH SUCH JUDGMENT, UNDER THE
FACTS AND CIRCUMSTANCES OF THE CASE, THE COURT SHALL AWARD TO THE  PARTY
THE  FEES  AND OTHER EXPENSES RELATED TO DEFENDING AGAINST THE EXCESSIVE
DEMAND, UNLESS THE PARTY HAS COMMITTED A WILLFUL  VIOLATION  OF  LAW  OR
OTHERWISE  ACTED  IN  BAD  FAITH, OR SPECIAL CIRCUMSTANCES MAKE AN AWARD
UNJUST.

S. 2606--C                         13

  S 10. Intentionally omitted.
  S 11. Intentionally omitted.
  S 11-a.  Section 364-j of the social services law is amended by adding
a new subdivision 27 to read as follows:
  27. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, MANAGED CARE
PROVIDERS,  INCLUDING A SPECIAL NEEDS MANAGED CARE PLAN OR COMPREHENSIVE
HIV SPECIAL NEEDS PLAN, SHALL  COVER  MEDICALLY  NECESSARY  PRESCRIPTION
DRUGS, INCLUDING NON-FORMULARY DRUGS, UPON DEMONSTRATION BY THE PRESCRI-
BER,  AFTER  CONSULTING WITH THE MANAGED CARE PROVIDER, THAT SUCH DRUGS,
IN THE PRESCRIBER'S  REASONABLE  PROFESSIONAL  JUDGMENT,  ARE  MEDICALLY
NECESSARY AND WARRANTED.
  S  12. Paragraph (g-1) of subdivision 2 of section 365-a of the social
services law, as amended by section 23 of part H of chapter  59  of  the
laws of 2011, is amended to read as follows:
  (g-1)  drugs provided on an in-patient basis, those drugs contained on
the list established by regulation of the commissioner of health  pursu-
ant  to  subdivision four of this section, and those drugs which may not
be dispensed without a prescription as required by  section  sixty-eight
hundred  ten  of  the education law and which the commissioner of health
shall determine to be reimbursable based upon such factors as the avail-
ability of such drugs or alternatives at low  cost  if  purchased  by  a
medicaid  recipient,  or the essential nature of such drugs as described
by such commissioner in regulations, provided, however, that such drugs,
exclusive of long-term maintenance drugs, shall be dispensed in  quanti-
ties no greater than a thirty day supply or one hundred doses, whichever
is  greater; provided further that the commissioner of health is author-
ized to require prior authorization for any  refill  of  a  prescription
when  [less than seventy-five percent of the previously dispensed amount
per fill should have been used] MORE THAN A SIX DAY SUPPLY OF THE PREVI-
OUSLY DISPENSED AMOUNT SHOULD REMAIN were the product used  as  normally
indicated;  provided  further that the commissioner of health is author-
ized to require prior authorization of prescriptions of opioid  analges-
ics in excess of four prescriptions in a thirty-day period in accordance
with section two hundred seventy-three of the public health law, medical
assistance  shall  not include any drug provided on other than an in-pa-
tient basis for which a recipient is charged or a claim is made  in  the
case  of  a  prescription  drug,  in  excess of the maximum reimbursable
amounts to be established by department regulations in  accordance  with
standards  established  by the secretary of the United States department
of health and human services, or, in the case of a drug not requiring  a
prescription,  in  excess of the maximum reimbursable amount established
by the commissioner of health pursuant to paragraph (a)  of  subdivision
four of this section;
  S 13. Intentionally omitted.
  S 14. Section 271 of the public health law is REPEALED.
  S  15.  Subdivision  3  of  section  270  of  the public health law is
REPEALED, subdivision 2 is renumbered subdivision 3 and a  new  subdivi-
sion 2 is added to read as follows:
  2.  "BOARD"  SHALL  MEAN  THE DRUG UTILIZATION REVIEW BOARD CREATED BY
SECTION THREE HUNDRED SIXTY-NINE-BB OF THE SOCIAL SERVICES LAW.
  S 15-a. Subdivision 12 of section 270 of the  public  health  law,  as
added  by  section  10  of  part C of chapter 58 of the laws of 2005, is
amended to read as follows:
  12. "Supplemental rebate" means a supplemental rebate  under  subdivi-
sion [ten] ELEVEN of section two hundred seventy-two of this article.

S. 2606--C                         14

  S  16. Section 272 of the public health law, as added by section 10 of
part C of chapter 58 of the laws of 2005, subdivision 4  as  amended  by
section 30 of part A of chapter 58 of the laws of 2008, subdivision 8 as
amended by section 5 of part B of chapter 109 of the laws of 2010, para-
graph  (d) of subdivision 10 as added by section 17 of part H of chapter
59 of the laws of 2011, subdivision 11 as amended by section 36 of  part
C  of chapter 58 of the laws of 2009, paragraph (b) of subdivision 11 as
amended by section 9 of part H of chapter 59 of the  laws  of  2011,  is
amended to read as follows:
  S  272.  Preferred  drug  program.  1.  There  is hereby established a
preferred  drug  program  to  promote  access  to  the  most   effective
prescription  drugs  while  reducing  the cost of prescription drugs for
persons in state public health plans.
  2. When a prescriber prescribes a  non-preferred  drug,  state  public
health  plan reimbursement shall be denied unless prior authorization is
obtained, unless no prior authorization is required under this article.
  3. The commissioner shall  establish  performance  standards  for  the
program  that,  at a minimum, ensure that the preferred drug program and
the clinical drug review program provide  sufficient  technical  support
and timely responses to consumers, prescribers and pharmacists.
  4.  Notwithstanding  any  other  provision  of law to the contrary, no
preferred  drug  program  or   prior   authorization   requirement   for
prescription  drugs,  except as created by this article, paragraph (a-1)
or (a-2) of subdivision four of section three  hundred  sixty-five-a  of
the  social  services  law,  paragraph (g) of subdivision two of section
three hundred sixty-five-a of the social services law,  subdivision  one
of section two hundred forty-one of the elder law and shall apply to the
state public health plans.
  5.  The  [pharmacy and therapeutics committee] DRUG UTILIZATION REVIEW
BOARD shall consider and make recommendations to  the  commissioner  for
the  adoption  of  a  preferred  drug  program.  (a)  In  developing the
preferred drug program, the [committee] BOARD shall, without limitation:
(i) identify  therapeutic  classes  or  drugs  to  be  included  in  the
preferred  drug  program;  (ii)  identify preferred drugs in each of the
chosen therapeutic classes; (iii) evaluate  the  clinical  effectiveness
and  safety  of  drugs considering the latest peer-reviewed research and
may consider studies submitted to the federal  food  and  drug  adminis-
tration  in  connection with its drug approval system; (iv) consider the
potential impact on patient care and the potential  fiscal  impact  that
may result from making such a therapeutic class subject to prior author-
ization;  [and]  (v) consider the potential impact of the preferred drug
program on public health and safety by the use of drug-specific delivery
system to reduce illegal or unauthorized use or  diversion  of  opioids;
and  (vi) consider the potential impact of the preferred drug program on
the health of special populations such as  children,  the  elderly,  the
chronically  ill,  persons  with HIV/AIDS and persons with mental health
conditions.
  (b) In developing the preferred drug program,  the  [committee]  BOARD
may consider preferred drug programs or evidence based research operated
or  conducted by or for other state governments, the federal government,
or multi-state coalitions. Notwithstanding any inconsistent provision of
section one hundred twelve or article eleven of the state finance law or
section one hundred forty-two of the economic  development  law  or  any
other law, the department may enter into contractual agreements with the
Oregon  Health  and Science University Drug Effectiveness Review Project
to provide technical and clinical support to the [committee]  BOARD  and

S. 2606--C                         15

the department in researching and recommending drugs to be placed on the
preferred drug list.
  (c) The [committee] BOARD shall from time to time review all therapeu-
tic  classes  included  in the preferred drug program, and may recommend
that the commissioner add or delete drugs or classes of drugs to or from
the preferred drug program, subject to this subdivision.
  (d) The [committee]  BOARD  shall  establish  procedures  to  promptly
review  prescription  drugs  newly approved by the federal food and drug
administration.
  6. The [committee] BOARD shall recommend a procedure and criteria  for
the  approval  of non-preferred drugs as part of the prior authorization
process. In developing  these  criteria,  the  [committee]  BOARD  shall
include consideration of the following:
  (a) the preferred drug has been tried by the patient and has failed to
produce the desired health outcomes;
  (b) the patient has tried the preferred drug and has experienced unac-
ceptable side effects;
  (c)  the patient has been stabilized on a non-preferred drug and tran-
sition to the preferred drug would be medically contraindicated; and
  (d) other clinical indications for the use of the non-preferred  drug,
which  shall include consideration of the medical needs of special popu-
lations, including children, the elderly, the chronically  ill,  persons
with mental health conditions, and persons affected by HIV/AIDS.
  7.  The  commissioner  shall  provide thirty days public notice on the
department's website prior to any meeting of the  [committee]  BOARD  to
develop  recommendations  concerning  the  preferred  drug program. Such
notice regarding meetings of  the  [committee]  BOARD  shall  include  a
description  of the proposed therapeutic class to be reviewed, a listing
of drug products in the therapeutic  class,  and  the  proposals  to  be
considered  by the [committee] BOARD.  The [committee] BOARD shall allow
interested parties a reasonable opportunity to make an oral presentation
to the [committee] BOARD related to the prior authorization of the ther-
apeutic class to be reviewed. The [committee] BOARD shall  consider  any
information provided by any interested party, including, but not limited
to,  prescribers,  dispensers,  patients, consumers and manufacturers of
the drug in developing their recommendations.
  8. The commissioner shall provide notice of any recommendations devel-
oped by the [committee] BOARD regarding the preferred drug  program,  at
least  five  days before any final determination by the commissioner, by
making such information available  on  the  department's  website.  Such
public  notice  shall  include:  a  summary  of the deliberations of the
[committee] BOARD; a summary of the positions  of  those  making  public
comments  at  meetings  of  the  [committee]  BOARD; the response of the
[committee] BOARD to those comments, if any; and the findings and recom-
mendations of the  [committee]  BOARD.    THE  COMMISSIONER  SHALL  ALSO
PROVIDE  SUCH NOTICE OF THE BOARD'S RECOMMENDATIONS BY MAKING A VIDEO OR
AUDIO OF THE BOARD'S MEETINGS AVAILABLE ON THE DEPARTMENT'S  WEBSITE  AT
LEAST FIVE DAYS BEFORE ANY FINAL DETERMINATION BY THE COMMISSIONER.
  9.  Within  ten  days of a final determination regarding the preferred
drug program, the  commissioner  shall  provide  public  notice  on  the
department's  website  of  such determinations, including: the nature of
the determination; and analysis of  the  impact  of  the  commissioner's
determination on state public health plan populations and providers; and
the  projected fiscal impact to the state public health plan programs of
the commissioner's determination.

S. 2606--C                         16

  10. The commissioner shall adopt a preferred drug program  and  amend-
ments  after  considering the recommendations from the [committee] BOARD
and  any  comments  received  from  prescribers,  dispensers,  patients,
consumers and manufacturers of the drug.
  (a)  The  preferred drug list in any therapeutic class included in the
preferred drug program shall be developed based initially on  an  evalu-
ation  of  the  clinical  effectiveness,  safety  and  patient outcomes,
followed by consideration of the cost-effectiveness of the drugs.
  (b) In each therapeutic class included in the preferred drug  program,
the [committee] BOARD shall determine whether there is one drug which is
significantly more clinically effective and safe, and that drug shall be
included  on  the preferred drug list without consideration of cost. If,
among two or more drugs in a therapeutic class, the difference in  clin-
ical  effectiveness  and safety is not clinically significant, then cost
effectiveness (including price and supplemental  rebates)  may  also  be
considered  in  determining which drug or drugs shall be included on the
preferred drug list.
  (c) In addition to drugs selected under paragraph (b) of this subdivi-
sion, any prescription drug in the therapeutic class, whose cost to  the
state public health plans (including net price and supplemental rebates)
is  equal  to  or  less than the cost of another drug in the therapeutic
class that is on the preferred drug list under  paragraph  (b)  of  this
subdivision,  may be selected to be on the preferred drug list, based on
clinical effectiveness, safety and cost-effectiveness.
  (d) Notwithstanding any provision of this section to the contrary, the
commissioner may  designate  therapeutic  classes  of  drugs,  including
classes  with  only  one drug, as all preferred prior to any review that
may be conducted by the [committee] BOARD pursuant to this section.
  11. (a) The commissioner shall provide an opportunity  for  pharmaceu-
tical  manufacturers to provide supplemental rebates to the state public
health plans for drugs within a  therapeutic  class;  such  supplemental
rebates  shall  be taken into consideration by the [committee] BOARD and
the commissioner in determining the cost-effectiveness of drugs within a
therapeutic class under the state public health plans.
  (b) The commissioner may designate a  pharmaceutical  manufacturer  as
one  with  whom  the  commissioner  is  negotiating  or has negotiated a
manufacturer agreement, and all of the drugs it manufactures or  markets
shall  be  included  in the preferred drug program. The commissioner may
negotiate directly with a pharmaceutical manufacturer for rebates relat-
ing to any or all of the drugs it manufactures or markets. A manufactur-
er agreement shall designate any or all of  the  drugs  manufactured  or
marketed  by  the  pharmaceutical manufacturer as being preferred or non
preferred drugs. When a pharmaceutical manufacturer has been  designated
by  the  commissioner  under this paragraph but the commissioner has not
reached a manufacturer agreement with the  pharmaceutical  manufacturer,
then  the  commissioner  may designate some or all of the drugs manufac-
tured or marketed by the pharmaceutical manufacturer  as  non  preferred
drugs.  However,  notwithstanding  this  paragraph,  any  drug  that  is
selected to be on the preferred drug list under paragraph (b) of  subdi-
vision  ten  of  this  section  on grounds that it is significantly more
clinically effective and safer than other drugs in its therapeutic class
shall be a preferred drug.
  (c) Supplemental rebates under this subdivision shall be  in  addition
to  those  required  by  applicable federal law and subdivision seven of
section three hundred sixty-seven-a of the social services law. In order
to be considered in connection with the  preferred  drug  program,  such

S. 2606--C                         17

supplemental  rebates  shall  apply to the drug products dispensed under
the Medicaid program and the EPIC program. The commissioner is prohibit-
ed  from  approving  alternative  rebate  demonstrations,  value   added
programs  or guaranteed savings from other program benefits as a substi-
tution for supplemental rebates.
  13. The commissioner may implement all or a portion of  the  preferred
drug  program  through  contracts  with administrators with expertise in
management of pharmacy services, subject to applicable laws.
  14. For a period of eighteen  months,  commencing  with  the  date  of
enactment  of  this  article,  and  without regard to the preferred drug
program or the clinical drug review program requirements of  this  arti-
cle,  the  commissioner is authorized to implement, or continue, a prior
authorization requirement for a drug which may not be dispensed  without
a  prescription  as  required  by section sixty-eight hundred ten of the
education law, for which there is a non-prescription version within  the
same  drug  class,  or  for which there is a comparable non-prescription
version of the same drug. Any such prior authorization requirement shall
be implemented in a manner that is consistent with the process  employed
by  the  commissioner for such authorizations as of one day prior to the
date of enactment of this article. At the  conclusion  of  the  eighteen
month  period,  any  such  drug  or  drug  class shall be subject to the
preferred drug program requirements of this article; provided,  however,
that the commissioner is authorized to immediately subject any such drug
to  prior authorization without regard to the provisions of subdivisions
five through eleven of this section.
  S 17. Subdivisions 4, 5 and 6 of section 274 of the public health law,
as added by section 10 of part C of chapter 58 of the laws of 2005,  are
amended to read as follows:
  4.  The  commissioner  shall  obtain  an evaluation of the factors set
forth in subdivision three of this section and a  recommendation  as  to
the  establishment of a prior authorization requirement for a drug under
the clinical drug review program from  the  [pharmacy  and  therapeutics
committee]  DRUG UTILIZATION REVIEW BOARD. For this purpose, the commis-
sioner and the [committee] BOARD, as applicable, shall comply  with  the
following meeting and notice processes established by this article:
  (a) the open meetings law and freedom of information law provisions of
subdivision six of section two hundred seventy-one of this article; and
  (b)  the public notice and interested party provisions of subdivisions
seven, eight and nine of section two hundred seventy-two of  this  arti-
cle.
  5.  The [committee] BOARD shall recommend a procedure and criteria for
the approval of drugs subject to prior authorization under the  clinical
drug  review  program. Such criteria shall include the specific approved
clinical indications for use of the drug.
  6. The commissioner shall identify a drug  for  which  prior  authori-
zation  is required, as well as the procedures and criteria for approval
of use of the drug, under the clinical drug review program after consid-
ering the recommendations from the [committee] BOARD  and  any  comments
received  from  prescribers,  dispensers, consumers and manufacturers of
the drug. In  no  event  shall  the  prior  authorization  criteria  for
approval  pursuant  to  this  subdivision  result in denial of the prior
authorization request based on the relative cost of the drug subject  to
prior authorization.
  S  18. Section 277 of the public health law, as added by section 10 of
part C of chapter 58 of the laws of 2005, is amended to read as follows:

S. 2606--C                         18

  S 277. Review and reports. 1. The commissioner, in  consultation  with
the [pharmacy and therapeutics committee] DRUG UTILIZATION REVIEW BOARD,
shall  undertake  periodic  reviews, at least annually, of the preferred
drug program which shall include consideration of:
  (a)  the  volume of prior authorizations being handled, including data
on the number and characteristics of prior  authorization  requests  for
particular prescription drugs;
  (b) the quality of the program's responsiveness, including the quality
of the administrator's responsiveness;
  (c) complaints received from patients and providers;
  (d)  the savings attributable to the state, and to each county and the
city of New York, due to the provisions of this article;
  (e) the aggregate amount  of  supplemental  rebates  received  in  the
previous  fiscal  year and in the current fiscal year, to date; and such
amounts are to be broken out by fiscal year and by month;
  (f) the education and outreach  program  established  by  section  two
hundred seventy-six of this article.
  2. The commissioner and the [panel] BOARD shall, beginning March thir-
ty-first,  two  thousand six and annually thereafter, submit a report to
the governor and the legislature concerning each of the items subject to
periodic review under subdivision one of this section.
  3. The commissioner and the [panel] BOARD shall, [beginning  with  the
commencement  of  the  preferred  drug  program and monthly thereafter,]
submit a MONTHLY report to the governor and the  legislature  concerning
the  amount  of  supplemental  rebates  AND  REBATES  UNDER  FEDERAL LAW
received.
  S 19. Subdivision 5 of section 369-bb of the social  services  law  is
REPEALED and a new subdivision 5 is added to read as follows:
  5.  (A)  THE  FUNCTIONS,  POWERS AND DUTIES OF THE FORMER PHARMACY AND
THERAPEUTICS COMMITTEE AS ESTABLISHED IN ARTICLE  TWO-A  OF  THE  PUBLIC
HEALTH  LAW  SHALL  NOW BE CONSIDERED A FUNCTION OF THE DRUG UTILIZATION
REVIEW BOARD, INCLUDING BUT NOT LIMITED TO:
  (I) CONDUCTING AN EXECUTIVE SESSION FOR THE PURPOSE OF  RECEIVING  AND
EVALUATING  DRUG PRICING INFORMATION RELATED TO SUPPLEMENTAL REBATES, OR
RECEIVING AND EVALUATING TRADE SECRETS, OR OTHER INFORMATION  WHICH,  IF
DISCLOSED, WOULD CAUSE SUBSTANTIAL INJURY TO THE COMPETITIVE POSITION OF
THE MANUFACTURER; AND
  (II)  EVALUATING  AND PROVIDING RECOMMENDATIONS TO THE COMMISSIONER OF
HEALTH ON OTHER ISSUES RELATING TO PHARMACY SERVICES UNDER  MEDICAID  OR
EPIC,  INCLUDING,  BUT NOT LIMITED TO: THERAPEUTIC COMPARISONS; ENHANCED
USE OF GENERIC DRUG PRODUCTS; ENHANCED TARGETING OF PHYSICIAN  PRESCRIB-
ING PATTERNS; AND
  (III)  COLLABORATING  WITH  MANAGED CARE ORGANIZATIONS TO ADDRESS DRUG
UTILIZATION CONCERNS AND TO IMPLEMENT CONSISTENT  MANAGEMENT  STRATEGIES
ACROSS THE FEE-FOR-SERVICE AND MANAGED CARE PHARMACY BENEFITS.
  (B)  ANY BUSINESS OR OTHER MATTER UNDERTAKEN OR COMMENCED BY THE PHAR-
MACY AND THERAPEUTICS COMMITTEE PERTAINING  TO  OR  CONNECTED  WITH  THE
FUNCTIONS,  POWERS,  OBLIGATIONS  AND  DUTIES ARE HEREBY TRANSFERRED AND
ASSIGNED TO THE DRUG UTILIZATION REVIEW BOARD AND PENDING ON THE  EFFEC-
TIVE  DATE  OF  THIS  SUBDIVISION, MAY BE CONDUCTED AND COMPLETED BY THE
DRUG UTILIZATION REVIEW BOARD IN THE SAME  MANNER  AND  UNDER  THE  SAME
TERMS  AND  CONDITIONS  AND  WITH  THE  SAME  EFFECT AS IF CONDUCTED AND
COMPLETED BY THE PHARMACY AND THERAPEUTICS COMMITTEE. ALL BOOKS, PAPERS,
AND PROPERTY OF THE PHARMACY AND THERAPEUTICS COMMITTEE  SHALL  CONTINUE
TO BE MAINTAINED BY THE DRUG UTILIZATION REVIEW BOARD.

S. 2606--C                         19

  (C)  ALL  RULES,  REGULATIONS, ACTS, ORDERS, DETERMINATIONS, AND DECI-
SIONS OF THE PHARMACY AND THERAPEUTICS COMMITTEE PERTAINING TO THE FUNC-
TIONS AND POWERS HEREIN TRANSFERRED AND ASSIGNED, IN FORCE AT  THE  TIME
OF SUCH TRANSFER AND ASSUMPTION, SHALL CONTINUE IN FULL FORCE AND EFFECT
AS RULES, REGULATIONS, ACTS, ORDERS, DETERMINATIONS AND DECISIONS OF THE
DRUG  UTILIZATION  REVIEW  BOARD UNTIL DULY MODIFIED OR ABROGATED BY THE
COMMISSIONER OF HEALTH.
  S 20. Subdivisions 1 and 2 of section 369-bb of  the  social  services
law,  as  added  by  chapter  632  of the laws of 1992, paragraph (a) of
subdivision 2 as amended by chapter 843 of the laws of 1992, is  amended
to read as follows:
  1.  [A  thirteen-member]  AN  EIGHTEEN  MEMBER drug utilization review
board is hereby created in the department.  [The]  IN  ADDITION  TO  THE
RESPONSIBILITIES  UNDER  SECTION  TWO  HUNDRED SEVENTY-TWO OF THE PUBLIC
HEALTH LAW, THE board is responsible for the establishment and implemen-
tation of medical standards  and  criteria  for  the  retrospective  and
prospective DUR program.
  2. The members of the DUR board shall be appointed by the commissioner
and  shall serve a three-year term.  Members may be reappointed upon the
completion of other terms.   The membership shall be  comprised  of  the
following:
  (a)  [Five]  SIX persons licensed and actively engaged in the practice
of medicine in the state, [at least one of whom shall have expertise  in
the area of mental health, who shall be selected from a list of nominees
provided  by  the  medical  society  of  the state of New York and other
medical associations] WITH EXPERTISE IN  THE  AREAS  OF  MENTAL  HEALTH,
HIV/AIDS,  GERIATRICS,  PEDIATRICS  OR  INTERNAL MEDICINE AND WHO MAY BE
SELECTED BASED ON INPUT FROM PROFESSIONAL ASSOCIATIONS  AND/OR  ADVOCACY
GROUPS IN NEW YORK STATE.
  (b) [Five] SIX persons licensed and actively practicing in [community]
pharmacy  in the state who [shall] MAY be selected [from a list of nomi-
nees provided by  pharmaceutical  societies/associations  of]  BASED  ON
INPUT  FROM PROFESSIONAL ASSOCIATIONS AND/OR ADVOCACY GROUPS IN New York
state.
  (c) Two persons with expertise in  drug  utilization  review  who  are
[either]  health  care  professionals  licensed  under Title VIII of the
education law [or who are pharmacologists] AT LEAST ONE  OF  WHOM  IS  A
PHARMACOLOGIST.
  (d)  [One  person from the department of social services (commissioner
or designee).] TWO PERSONS THAT  ARE  CONSUMERS  OR  CONSUMER  REPRESEN-
TATIVES  OF  ORGANIZATIONS WITH A REGIONAL OR STATEWIDE CONSTITUENCY AND
WHO HAVE BEEN INVOLVED IN ACTIVITIES RELATED  TO  HEALTH  CARE  CONSUMER
ADVOCACY, INCLUDING ISSUES AFFECTING MEDICAID OR EPIC RECIPIENTS.
  (E) ONE PERSON LICENSED AND ACTIVELY PRACTICING AS A NURSE PRACTITION-
ER OR MIDWIFE.
  (F)  THE  COMMISSIONER SHALL DESIGNATE A PERSON FROM THE DEPARTMENT TO
SERVE AS CHAIRPERSON OF THE BOARD.
  S 21. Paragraph (g) of subdivision 2 of section 365-a  of  the  social
services  law,  as  amended  by section 7 of part D of chapter 56 of the
laws of 2012, is amended to read as follows:
  (g) sickroom supplies, eyeglasses, prosthetic  appliances  and  dental
prosthetic  appliances  furnished  in accordance with the regulations of
the department; provided further that: (i) the commissioner of health is
authorized to implement a preferred diabetic supply program wherein  the
department  of  health  will  receive  enhanced  rebates  from preferred
manufacturers of glucometers and test strips, and may  subject  non-pre-

S. 2606--C                         20

ferred manufacturers' glucometers and test strips to prior authorization
under  section  two hundred seventy-three of the public health law; (ii)
enteral formula therapy  and  nutritional  supplements  are  limited  to
coverage only for nasogastric, jejunostomy, or gastrostomy tube feeding,
for  treatment of an inborn metabolic disorder, or to address growth and
development problems in children, or, subject to  standards  established
by the commissioner, for persons with a diagnosis of HIV infection, AIDS
or   HIV-related   illness  or  other  diseases  and  conditions;  (iii)
prescription footwear and inserts are limited to coverage only when used
as an integral part of a lower limb orthotic appliance,  as  part  of  a
diabetic  treatment  plan, or to address growth and development problems
in children; [and] (iv) compression and support stockings are limited to
coverage only for pregnancy or treatment of venous  stasis  ulcers;  AND
(V)  THE  COMMISSIONER  OF HEALTH IS AUTHORIZED TO IMPLEMENT AN INCONTI-
NENCE SUPPLY UTILIZATION MANAGEMENT  PROGRAM  TO  REDUCE  COSTS  WITHOUT
LIMITING ACCESS THROUGH THE EXISTING PROVIDER NETWORK, INCLUDING BUT NOT
LIMITED  TO SINGLE OR MULTIPLE SOURCE CONTRACTS OR, A PREFERRED INCONTI-
NENCE SUPPLY PROGRAM WHEREIN  THE  DEPARTMENT  OF  HEALTH  WILL  RECEIVE
ENHANCED  REBATES FROM PREFERRED MANUFACTURERS OF INCONTINENCE SUPPLIES,
AND MAY SUBJECT NON-PREFERRED MANUFACTURERS'  INCONTINENCE  SUPPLIES  TO
PRIOR  APPROVAL  PURSUANT TO REGULATIONS OF THE DEPARTMENT, PROVIDED ANY
NECESSARY APPROVALS UNDER FEDERAL LAW  HAVE  BEEN  OBTAINED  TO  RECEIVE
FEDERAL  FINANCIAL  PARTICIPATION  IN THE COSTS OF INCONTINENCE SUPPLIES
PROVIDED PURSUANT TO THIS SUBPARAGRAPH;
  S 22. Intentionally omitted.
  S 23. Intentionally omitted.
  S 24. Intentionally omitted.
  S 25. Intentionally omitted.
  S 26. Paragraph (c) of subdivision 35 of section 2807-c of the  public
health law, as added by section 2 of part C of chapter 58 of the laws of
2009, is amended to read as follows:
  (c)  The  base period reported costs and statistics used for rate-set-
ting for operating cost components, including the  weights  assigned  to
diagnostic  related  groups,  shall  be  updated no less frequently than
every four years and the new base period shall  be  no  more  than  four
years  prior  to the first applicable rate period that utilizes such new
base period PROVIDED, HOWEVER, THAT THE FIRST UPDATED BASE PERIOD  SHALL
BEGIN ON JANUARY FIRST, TWO THOUSAND FOURTEEN.
  S 27. Intentionally omitted.
  S 28. Intentionally omitted.
  S 29. Intentionally omitted.
  S 30. Intentionally omitted.
  S 31. Intentionally omitted.
  S 32. Intentionally omitted.
  S 33. Intentionally omitted.
  S  33-a. Subparagraphs (ii) and (x) of paragraph (b) of subdivision 35
of section 2807-c of the public health law, as added  by  section  2  of
part  C  of  chapter  58  of  the  laws  of 2009, are amended to read as
follows:
  (ii) Only those two thousand five base year costs which relate to  the
cost  of  services provided to Medicaid inpatients, as determined by the
applicable ratio of costs to charges methodology, shall be utilized  for
rate-setting  purposes,  PROVIDED,  HOWEVER,  THAT  THE COMMISSIONER MAY
UTILIZE UPDATED MEDICAID INPATIENT RELATED BASE YEAR COSTS  AND  STATIS-
TICS  AS  NECESSARY  TO ADJUST INPATIENT RATES IN ACCORDANCE WITH CLAUSE
(C) OF SUBPARAGRAPH (X) OF THIS PARAGRAPH;

S. 2606--C                         21

  (x) Such regulations shall provide for  administrative  rate  appeals,
but  only  with regard to: (A) the correction of computational errors or
omissions of data, including with regard to the hospital specific compu-
tations pertaining to  graduate  medical  education,  wage  equalization
factor  adjustments,  [and]  (B)  capital  cost  reimbursement, AND, (C)
CHANGES TO THE BASE YEAR STATISTICS AND  COSTS  USED  TO  DETERMINE  THE
DIRECT  AND  INDIRECT GRADUATE MEDICAL EDUCATION COMPONENTS OF THE RATES
AS A RESULT OF NEW TEACHING PROGRAMS AT NEW TEACHING HOSPITALS AND/OR AS
A RESULT OF RESIDENTS DISPLACED AND TRANSFERRED AS A RESULT OF  TEACHING
HOSPITAL CLOSURES;
  S  34. Section 364-i of the social services law is amended by adding a
new subdivision 7 to read as follows:
  7. NOTWITHSTANDING THE PROVISIONS OF SECTION ONE HUNDRED  THIRTY-THREE
OF  THIS  CHAPTER  OR ANY LAW TO THE CONTRARY, NO MEDICAL ASSISTANCE, AS
DEFINED IN SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS  TITLE,  SHALL  BE
AUTHORIZED  OR  REQUIRED  TO  BE FURNISHED TO AN INDIVIDUAL PRIOR TO THE
DATE THE INDIVIDUAL IS DETERMINED ELIGIBLE  FOR  ASSISTANCE  UNDER  THIS
TITLE,  EXCEPT  AS PROVIDED FOR IN THIS SECTION OR PURSUANT TO THE REGU-
LATIONS OF THE DEPARTMENT.
  S 35. Intentionally Omitted
  S 35-a. Subparagraph (i) of paragraph (b) of subdivision 1 of  section
364-j  of the social services law, as amended by chapter 433 of the laws
of 1997, is amended to read as follows:
  (i) is authorized to operate under article forty-four  of  the  public
health  law  or article forty-three of the insurance law and provides or
arranges, directly or indirectly (including  by  referral)  for  covered
comprehensive  health  services  on a full capitation basis, INCLUDING A
SPECIAL NEEDS MANAGED CARE PLAN OR COMPREHENSIVE HIV SPECIAL NEEDS PLAN;
or
  S 36. Paragraphs (c), (m) and (p) of subdivision 1 of section 364-j of
the social services law, paragraph (c) as amended by section 12 of  part
C of chapter 58 of the laws of 2004, paragraph (m) as amended by section
42-b  of  part H of chapter 59 of the laws of 2011, and paragraph (p) as
amended by chapter 649 of the laws of 1996, are amended and a new  para-
graph (z) is added to read as follows:
  (c)  "Managed  care  program".  A  statewide  program in which medical
assistance recipients enroll  on  a  voluntary  or  mandatory  basis  to
receive medical assistance services, including case management, directly
and  indirectly  (including  by  referral) from a managed care provider,
[and] INCLUDING as applicable, a  [mental  health  special  needs  plan]
SPECIAL  NEEDS  MANAGED  CARE  PLAN or a comprehensive HIV special needs
plan, under this section.
  (m) "Special needs managed care plan" [and "specialized  managed  care
plan"]  shall have the same meaning as in section forty-four hundred one
of the public health law.
  (p) "Grievance". Any complaint presented by a participant or a partic-
ipant's representative for resolution through the grievance process of a
managed care provider[, comprehensive HIV special needs plan or a mental
health special needs plan].
  (Z) "CREDENTIALED ALCOHOLISM AND SUBSTANCE ABUSE  COUNSELOR  (CASAC)".
AN  INDIVIDUAL  CREDENTIALED  BY  THE OFFICE OF ALCOHOLISM AND SUBSTANCE
ABUSE SERVICES IN ACCORDANCE WITH APPLICABLE REGULATIONS OF THE  COMMIS-
SIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
  S  37.  Paragraph  (c) of subdivision 2 of section 364-j of the social
services law, as added by section 42-c of part H of chapter  59  of  the
laws of 2011, is amended to read as follows:

S. 2606--C                         22

  (c)  The  commissioner  of  health,  jointly  with the commissioner of
mental health and the commissioner of  alcoholism  and  substance  abuse
services  shall  be  authorized  to establish special needs managed care
[and specialized managed  care]  plans,  under  the  medical  assistance
program,  in accordance with applicable federal law and regulations. The
commissioner of health,  in  cooperation  with  such  commissioners,  is
authorized,  subject  to the approval of the director of the division of
the budget, to apply for federal  waivers  when  such  action  would  be
necessary  to  assist in promoting the objectives of this section.  WITH
REGARD TO SUCH SPECIAL NEEDS  MANAGED  CARE  PLANS,  SUCH  COMMISSIONERS
SHALL JOINTLY ESTABLISH STANDARDS AND REQUIREMENTS TO:
  (I)  ENSURE  THAT  ANY  SPECIAL  NEEDS MANAGED CARE PLAN SHALL HAVE AN
ADEQUATE NETWORK OF PROVIDERS TO MEET THE BEHAVIORAL HEALTH  AND  HEALTH
NEEDS  OF  ENROLLEES, AND SHALL REVIEW THE ADEQUACY PRIOR TO APPROVAL OF
ANY SPECIAL NEEDS MANAGED CARE PLAN, AND UPON CONTRACT RENEWAL OR EXPAN-
SION. TO THE EXTENT THAT THE NETWORK HAS BEEN DETERMINED TO MEET  STAND-
ARDS SET FORTH IN SUBDIVISION FIVE OF SECTION FOUR THOUSAND FOUR HUNDRED
THREE OF THE PUBLIC HEALTH LAW, SUCH NETWORK SHALL BE DEEMED ADEQUATE.
  (II)  ENSURE THAT ANY SPECIAL NEEDS MANAGED CARE PLAN SHALL MAKE LEVEL
OF CARE AND COVERAGE DETERMINATIONS UTILIZING  EVIDENCE-BASED  TOOLS  OR
GUIDELINES DESIGNED TO ADDRESS THE BEHAVIORAL HEALTH NEEDS OF ENROLLEES.
  (III)  ENSURE  SUFFICIENT  ACCESS  TO  BEHAVIORAL  HEALTH  AND  HEALTH
SERVICES FOR ELIGIBLE ENROLLEES BY  ESTABLISHING  AND  MONITORING  PENE-
TRATION RATES OF SPECIAL NEEDS MANAGED CARE PLANS.
  (IV)  ESTABLISH  STANDARDS  TO ENCOURAGE THE USE OF SERVICES, PRODUCTS
AND CARE RECOMMENDED, ORDERED OR PRESCRIBED BY A PROVIDER TO SUFFICIENT-
LY ADDRESS THE BEHAVIORAL HEALTH AND HEALTH SERVICES NEEDS OF ENROLLEES;
AND MONITOR THE APPLICATION OF SUCH STANDARDS TO ENSURE THAT THEY SUFFI-
CIENTLY ADDRESS THE BEHAVIORAL  HEALTH  AND  HEALTH  SERVICES  NEEDS  OF
ENROLLEES.
  S  37-a.   Paragraphs (b) and (c) of subdivision 3 of section 364-j of
the social services law are REPEALED.
  S 38.  Paragraphs (a), (d) and (e) of subdivision 3 of  section  364-j
of  the  social  services law, paragraph (a) as amended by section 13 of
part C of chapter 58 of the laws of 2004, paragraph (d)  as  amended  by
chapter  648  of  the  laws  of 1999 and as relettered by section 77 and
paragraph (e) as amended by section 77-a of part H of chapter 59 of  the
laws of 2011, are amended to read as follows:
  (a)  Every  person  eligible for or receiving medical assistance under
this article, who  resides  in  a  social  services  district  providing
medical  assistance,  which  has  implemented  the  state's managed care
program shall participate in the program  authorized  by  this  section.
Provided,  however,  that  participation  in a comprehensive HIV special
needs plan also shall be in accordance with article  forty-four  of  the
public  health  law and participation in a [mental health special needs]
SPECIAL NEEDS MANAGED CARE plan shall also be in accordance with article
forty-four of the public health law and article thirty-one of the mental
hygiene law.
  (d) [The] UNTIL SUCH TIME AS PROGRAM FEATURES AND REIMBURSEMENT  RATES
ARE  APPROVED  BY  THE  COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE
COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH, THE OFFICE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES, THE OFFICE OF CHILDREN AND FAMILY  SERVICES,
AND  THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, AS APPROPRI-
ATE, THE following services shall not be provided to medical  assistance
recipients  through  managed  care programs established pursuant to this

S. 2606--C                         23

section, and shall continue to  be  provided  outside  of  managed  care
programs and in accordance with applicable reimbursement methodologies:
  (i)  day treatment services provided to individuals with developmental
disabilities;
  (ii) comprehensive medicaid case management services provided to indi-
viduals with developmental disabilities;
  (iii) services provided pursuant to title two-A of article twenty-five
of the public health law;
  (iv) services provided pursuant to article eighty-nine of  the  educa-
tion law;
  (v)  mental  health  services  provided by a certified voluntary free-
standing day treatment program  where  such  services  are  provided  in
conjunction  with  educational  services authorized in an individualized
education program in accordance with regulations promulgated pursuant to
article eighty-nine of the education law;
  (vi) long term services as determined by the  commissioner  of  mental
retardation and developmental disabilities, provided to individuals with
developmental  disabilities  at  facilities licensed pursuant to article
sixteen of the mental hygiene law or clinics  serving  individuals  with
developmental  disabilities  at  facilities licensed pursuant to article
twenty-eight of the public health law;
  (vii) TB directly observed therapy;
  (viii) AIDS adult day health care;
  (ix) HIV COBRA case management; and
  (x) other services as determined by the commissioner of health.
  (e) The following categories of individuals may be required to  enroll
with  a  managed  care  program  when program features and reimbursement
rates are approved by the commissioner of health  and,  as  appropriate,
the  commissioners  of  the  [department]  OFFICE  of mental health, the
office for [persons] PEOPLE with developmental disabilities, the  office
of  children and family services, and the office of [alcohol] ALCOHOLISM
and substance abuse services:
  (i) an individual dually eligible for medical assistance and  benefits
under  the  federal Medicare program [and enrolled in a Medicare managed
care plan offered by an entity that is also  a  managed  care  provider;
provided that (notwithstanding paragraph (g) of subdivision four of this
section):];  PROVIDED, HOWEVER, NOTHING HEREIN SHALL REQUIRE AN INDIVID-
UAL ENROLLED IN A MANAGED LONG  TERM  CARE  PLAN,  PURSUANT  TO  SECTION
FORTY-FOUR  HUNDRED  THREE-F OF THE PUBLIC HEALTH LAW, TO DISENROLL FROM
SUCH PROGRAM;
  [(a) if the individual changes his or her Medicare managed  care  plan
as  authorized  by  title  XVIII of the federal social security act, and
enrolls in another Medicare managed care plan that  is  also  a  managed
care  provider, the individual shall be (if required by the commissioner
under this paragraph) enrolled in that managed care provider;
  (b) if the individual changes his or her Medicare managed care plan as
authorized by title XVIII  of  the  federal  social  security  act,  but
enrolls in another Medicare managed care plan that is not also a managed
care provider, the individual shall be disenrolled from the managed care
provider  in  which he or she was enrolled and withdraw from the managed
care program;
  (c) if the individual disenrolls from his or her Medicare managed care
plan as authorized by title XVIII of the federal  social  security  act,
and  does not enroll in another Medicare managed care plan, the individ-
ual shall be disenrolled from the managed care provider in which  he  or
she was enrolled and withdraw from the managed care program;

S. 2606--C                         24

  (d)  nothing  herein shall require an individual enrolled in a managed
long term care plan, pursuant to section forty-four hundred  three-f  of
the public health law, to disenroll from such program.]
  (ii) an individual eligible for supplemental security income;
  (iii) HIV positive individuals;
  (iv)  persons with serious mental illness and children and adolescents
with serious emotional disturbances, as defined  in  section  forty-four
hundred one of the public health law;
  (v)  a  person receiving services provided by a residential alcohol or
substance abuse program or facility for the [mentally retarded] DEVELOP-
MENTALLY DISABLED;
  (vi) a person receiving services  provided  by  an  intermediate  care
facility for the [mentally retarded] DEVELOPMENTALLY DISABLED or who has
characteristics and needs similar to such persons;
  (vii)  a  person  with  a  developmental  or  physical  disability who
receives home and  community-based  services  or  care-at-home  services
through  existing  waivers under section nineteen hundred fifteen (c) of
the federal social security act or who  has  characteristics  and  needs
similar to such persons;
  (viii)  a  person  who  is eligible for medical assistance pursuant to
subparagraph twelve or subparagraph thirteen of paragraph (a) of  subdi-
vision one of section three hundred sixty-six of this title;
  (ix)  a  person receiving services provided by a long term home health
care program, or a person receiving inpatient services in a  state-oper-
ated  psychiatric facility or a residential treatment facility for chil-
dren and youth;
  (x) certified blind or disabled children  living  or  expected  to  be
living separate and apart from the parent for thirty days or more;
  (xi) residents of nursing facilities;
  (xii)  a foster child in the placement of a voluntary agency or in the
direct care of the local social services district;
  (xiii) a person or family that is homeless; [and]
  (xiv) individuals for whom a managed care provider  is  not  geograph-
ically  accessible so as to reasonably provide services to the person. A
managed care provider is not geographically  accessible  if  the  person
cannot  access  the  provider's  services  in  a  timely  fashion due to
distance or travel time[.];
  (XV) A PERSON ELIGIBLE  FOR  MEDICARE  PARTICIPATING  IN  A  CAPITATED
DEMONSTRATION PROGRAM FOR LONG TERM CARE;
  (XVI) AN INFANT LIVING WITH AN INCARCERATED MOTHER IN A STATE OR LOCAL
CORRECTIONAL FACILITY AS DEFINED IN SECTION TWO OF THE CORRECTION LAW;
  (XVII)  A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE
FOR LESS THAN SIX MONTHS;
  (XVIII) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS  ONLY
WITH RESPECT TO TUBERCULOSIS-RELATED SERVICES;
  (XIX) INDIVIDUALS RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;
  (XX)  A  PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAIL-
ABLE FROM OR UNDER A  THIRD-PARTY  PAYOR  WHICH  MAY  BE  MAINTAINED  BY
PAYMENT,  OR  PART PAYMENT, OF THE PREMIUM OR COST SHARING AMOUNTS, WHEN
PAYMENT OF SUCH PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE,
AS DETERMINED BY THE LOCAL SOCIAL SERVICES DISTRICT;
  (XXI) A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
GRAPH ELEVEN OF PARAGRAPH  (A)  OF  SUBDIVISION  ONE  OF  SECTION  THREE
HUNDRED SIXTY-SIX OF THIS TITLE;

S. 2606--C                         25

  (XXII)  A  PERSON  WHO  IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
PARAGRAPH (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX  OF
THIS TITLE;
  (XXIII)  A  PERSON WHO IS MEDICARE/MEDICAID DUALLY ELIGIBLE AND WHO IS
NOT ENROLLED IN A MEDICARE MANAGED CARE PLAN;
  (XXIV) INDIVIDUALS WITH A CHRONIC  MEDICAL  CONDITION  WHO  ARE  BEING
TREATED  BY A SPECIALIST PHYSICIAN THAT IS NOT ASSOCIATED WITH A MANAGED
CARE PROVIDER IN THE INDIVIDUAL'S SOCIAL SERVICES DISTRICT; AND
  (XXV) NATIVE AMERICANS.
  S 39. Subparagraphs (ii), (iv) and (vii) of  paragraph  (e),  subpara-
graphs  (i)  and (v) of paragraph (f) and paragraphs (g), (h), (i), (o),
(p), (q) and (r) of  subdivision  4  of  section  364-j  of  the  social
services  law,  subparagraphs  (ii),  (iv)  and  (vii) of paragraph (e),
subparagraph (v) of paragraph  (f)  and  paragraph  (g)  as  amended  by
section 14 of part C of chapter 58 of the laws of 2004, subparagraph (i)
of paragraph (f) as amended by section 79 of part H of chapter 59 of the
laws  of  2011,  paragraph  (h) as amended by chapter 433 of the laws of
1997, and paragraphs (i), (o), (p), (q) and (r) as  amended  by  chapter
649 of the laws of 1996, are amended and a new paragraph (v) is added to
read as follows:
  (ii) In any social services district which has implemented a mandatory
managed  care program pursuant to this section, the requirements of this
subparagraph shall apply to the extent consistent with federal  law  and
regulations.  The  department  of  health, may contract with one or more
independent organizations to provide enrollment counseling  and  enroll-
ment  services,  for  participants  required  to  enroll in managed care
programs, for each social services district requesting the  services  of
an  enrollment  broker.  To select such organizations, the department of
health shall  issue  a  request  for  proposals  (RFP),  shall  evaluate
proposals  submitted  in response to such RFP and, pursuant to such RFP,
shall award a contract to one or more qualified and responsive organiza-
tions. Such organizations shall not be owned, operated, or controlled by
any governmental  agency,  managed  care  provider,  [comprehensive  HIV
special  needs  plan,  mental  health  special  needs  plan,] or medical
services provider.
  (iv) Local  social  services  districts  or  enrollment  organizations
through  their enrollment counselors shall provide participants with the
opportunity for face to face counseling including individual  counseling
upon  request  of  the  participant.  Local social services districts or
enrollment organizations through their enrollment counselors shall  also
provide participants with information in a culturally and linguistically
appropriate  and  understandable  manner,  in light of the participant's
needs, circumstances and language proficiency, sufficient to enable  the
participant  to  make  an informed selection of a managed care provider.
Such information shall include, but shall not  be  limited  to:  how  to
access  care within the program; a description of the medical assistance
services that can be obtained other than through a managed care  provid-
er[, mental health special needs plan or comprehensive HIV special needs
plan];  the  available  managed  care  providers[, mental health special
needs plans and comprehensive HIV special needs plans] and the scope  of
services  covered  by  each; a listing of the medical services providers
associated with each managed care  provider;  the  participants'  rights
within  the  managed  care  program;  and  how  to exercise such rights.
Enrollment counselors shall inquire  into  each  participant's  existing
relationships  with  medical  services providers and explain whether and
how such  relationships  may  be  maintained  within  the  managed  care

S. 2606--C                         26

program.  For  enrollments  made  during face to face counseling, if the
participant has a preference for particular medical services  providers,
enrollment  counselors  shall verify with the medical services providers
that  such  medical  services  providers  whom  the  participant prefers
participate in the managed care provider's network and are available  to
serve the participant.
  (vii)  Any  marketing materials developed by a managed care provider[,
comprehensive HIV special needs plan  or  mental  health  special  needs
plan]  shall be approved by the department of health or the local social
services district, and the commissioner of mental health AND THE COMMIS-
SIONER OF ALCOHOLISM AND SUBSTANCE ABUSE  SERVICES,  where  appropriate,
within sixty days prior to distribution to recipients of medical assist-
ance.  All  marketing  materials  shall be reviewed within sixty days of
submission.
  (i) Participants shall choose a managed care provider at the  time  of
application  for  medical assistance; if the participant does not choose
such a provider the commissioner shall  assign  such  participant  to  a
managed care provider in accordance with subparagraphs (ii), (iii), (iv)
and  (v)  of  this paragraph. Participants already in receipt of medical
assistance shall have no less than thirty days from the date selected by
the district to enroll in the managed care program to select  a  managed
care provider[, and as appropriate, a mental health special needs plan,]
and shall be provided with information to make an informed choice. Where
a participant has not selected such a provider [or mental health special
needs plan,] the commissioner of health shall assign such participant to
a  managed  care provider[, and] WHICH, IF as appropriate, [to] MAY BE a
[mental health special needs plan]  SPECIAL  NEEDS  MANAGED  CARE  PLAN,
taking  into account capacity and geographic accessibility.  The commis-
sioner may after the period of time established in subparagraph (ii)  of
this  paragraph  assign  participants  to a managed care provider taking
into account quality performance criteria and cost.   Provided  however,
cost  criteria  shall  not  be of greater value than quality criteria in
assigning participants.
  (v) The commissioner  shall  assign  all  participants  not  otherwise
assigned  to  a  managed care plan pursuant to subparagraphs (ii), (iii)
and (iv) of this paragraph  equally  among  each  of  the  managed  care
providers that meet the criteria established in subparagraph (i) of this
paragraph;  PROVIDED,  HOWEVER, THAT THE COMMISSIONER SHALL ASSIGN INDI-
VIDUALS MEETING THE CRITERIA FOR ENROLLMENT IN A SPECIAL  NEEDS  MANAGED
CARE PLAN TO SUCH PLAN OR PLANS WHERE AVAILABLE.
  (g)  If  another  managed  care provider[, mental health special needs
plan or comprehensive HIV special needs plan] is available, participants
may change such provider or plan without cause  within  thirty  days  of
notification of enrollment or the effective date of enrollment, whichev-
er  is  later with a managed care provider[, mental health special needs
plan or comprehensive HIV special needs plan] by making a request of the
local social services district except that such period shall  be  forty-
five  days  for participants who have been assigned to a provider by the
commissioner of health. However, after such  thirty  or  forty-five  day
period,  whichever  is  applicable, a participant may be prohibited from
changing managed care providers more frequently than once  every  twelve
months,  as permitted by federal law except for good cause as determined
by the commissioner of health through regulations.
  (h) If another medical services provider is available,  a  participant
may  change  his  or her provider of medical services (including primary
care practitioners) without cause within  thirty  days  of  the  partic-

S. 2606--C                         27

ipant's  first  appointment with a medical services provider by making a
request of the managed care provider[, mental health special needs  plan
or comprehensive HIV special needs plan]. However, after that thirty day
period,  no participant shall be permitted to change his or her provider
of medical services other than once every six  months  except  for  good
cause as determined by the commissioner through regulations.
  (i)  A  managed  care provider[, mental health special needs plan, and
comprehensive HIV special needs plan] requesting a  disenrollment  shall
not  disenroll  a  participant  without  the prior approval of the local
social services district in which the participant resides, provided that
disenrollment from a [mental health special needs  plan]  SPECIAL  NEEDS
MANAGED  CARE PLAN must comply with the standards of the commissioner of
health, THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, and
the commissioner of mental health.  A  managed  care  provider[,  mental
health special needs plan or comprehensive HIV special needs plan] shall
not  request  disenrollment  of  a  participant  based on any diagnosis,
condition, or perceived  diagnosis  or  condition,  or  a  participant's
efforts  to  exercise  his  or  her  rights  under  a grievance process,
provided however, that a managed  care  provider  may,  where  medically
appropriate,  request  permission  to  refer  participants  to a [mental
health special needs plan] MANAGED CARE PROVIDER THAT IS A SPECIAL NEEDS
MANAGED CARE PLAN or  a  comprehensive  HIV  special  needs  plan  after
consulting  with  such participant and upon obtaining his/her consent to
such referral, and[,] provided further that  a  [mental  health  special
needs plan] SPECIAL NEEDS MANAGED CARE PLAN may, where clinically appro-
priate,  disenroll  individuals  who  no  longer  require  the  level of
services provided by a [mental health special needs plan] SPECIAL  NEEDS
MANAGED CARE PLAN.
  (o)  A  managed  care  provider  shall provide or arrange, directly or
indirectly, (including by  referral)  for  the  full  range  of  covered
services to all participants, notwithstanding that such participants may
be  eligible to be enrolled in a comprehensive HIV special needs plan or
[mental health special needs plan] SPECIAL NEEDS MANAGED CARE PLAN.
  (p) A managed care provider[, comprehensive HIV special needs plan and
mental health special needs plan] shall implement procedures to communi-
cate appropriately with participants who have  difficulty  communicating
in  English  and to communicate appropriately with visually-impaired and
hearing-impaired participants.
  (q) A managed care provider[, comprehensive HIV special needs plan and
mental health special needs plan] shall comply with applicable state and
federal law provisions prohibiting discrimination on the basis of  disa-
bility.
  (r) A managed care provider[, comprehensive HIV special needs plan and
mental health special needs plan] shall provide services to participants
pursuant  to  an  order  of  a court of competent jurisdiction, provided
however, that such services shall be within such  provider's  or  plan's
benefit  package  and  are  reimbursable  under title xix of the federal
social security act.
  (V) A MANAGED CARE PROVIDER MUST ALLOW ENROLLEES  TO  ACCESS  CHEMICAL
DEPENDENCE TREATMENT SERVICES FROM FACILITIES CERTIFIED BY THE OFFICE OF
ALCOHOLISM  AND  SUBSTANCE  ABUSE  SERVICES,  EVEN  IF SUCH SERVICES ARE
RENDERED BY A PRACTITIONER WHO WOULD NOT OTHERWISE BE  SEPARATELY  REIM-
BURSED,  INCLUDING  BUT  NOT  LIMITED  TO  A CREDENTIALED ALCOHOLISM AND
SUBSTANCE ABUSE COUNSELOR (CASAC).

S. 2606--C                         28

  S 40. Paragraph (a) of subdivision 5 of section 364-j  of  the  social
services  law,  as  amended by section 15 of part C of chapter 58 of the
laws of 2004, is amended to read as follows:
  (a) The managed care program shall provide for the selection of quali-
fied  managed  care  providers  by  the  commissioner of health [and, as
appropriate, mental health special needs  plans  and  comprehensive  HIV
special needs plans] to participate in the program, INCLUDING COMPREHEN-
SIVE  HIV  SPECIAL  NEEDS  PLANS AND SPECIAL NEEDS MANAGED CARE PLANS IN
ACCORDANCE WITH THE PROVISIONS OF SECTION THREE HUNDRED SIXTY-FIVE-M  OF
THIS  TITLE;  provided,  however,  that  the  commissioner of health may
contract directly with comprehensive HIV special needs plans  consistent
with standards set forth in this section, and assure that such providers
are  accessible  taking into account the needs of persons with disabili-
ties and the differences between rural, suburban,  and  urban  settings,
and in sufficient numbers to meet the health care needs of participants,
and  shall  consider  the  extent  to  which  major public hospitals are
included within such providers' networks.
  S 41. The opening paragraph of subdivision 6 of section 364-j  of  the
social  services  law,  as  added by chapter 649 of the laws of 1996, is
amended to read as follows:
  6. A managed care provider[,  mental  health  special  needs  plan  or
comprehensive  HIV  special needs plan provider] shall not engage in the
following practices:
  S 42. Subdivision 17 of section 364-j of the social services  law,  as
amended  by  section 94 of part B of chapter 436 of the laws of 1997, is
amended to read as follows:
  17. (A) The provisions of  this  section  regarding  participation  of
persons  receiving family assistance and supplemental security income in
managed care programs shall be effective if, and  as  long  as,  federal
financial  participation  is  available  for  expenditures  for services
provided pursuant to this section.
  (B) THE PROVISIONS OF THIS SECTION REGARDING THE FURNISHING OF  HEALTH
AND BEHAVIORAL HEALTH SERVICES THROUGH A SPECIAL NEEDS MANAGED CARE PLAN
SHALL  BE  EFFECTIVE IF, AND AS LONG AS, FEDERAL FINANCIAL PARTICIPATION
IS AVAILABLE FOR EXPENDITURES FOR SERVICES PROVIDED BY SUCH PLANS PURSU-
ANT TO THIS SECTION.
  S 43. Subdivision 20 of section 364-j of the social services  law,  as
added by chapter 649 of the laws of 1996, is amended to read as follows:
  20. Upon a determination that a participant appears to be suitable for
admission  to a comprehensive HIV special needs plan or a [mental health
special needs plan] SPECIAL NEEDS MANAGED  CARE  PLAN,  a  managed  care
provider shall inform the participant of the availability of such plans,
where available and appropriate.
  S  44.  Paragraph (a) of subdivision 23 of section 364-j of the social
services law, as added by section 65 of part A of chapter 57 of the laws
of 2006, is amended to read as follows:
  (a) As a means of protecting the health, safety and welfare of recipi-
ents, in addition to any  other  sanctions  that  may  be  imposed,  the
commissioner,  IN  CONSULTATION  WITH THE COMMISSIONERS OF THE OFFICE OF
MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES,
WHERE APPROPRIATE, shall appoint temporary management of a managed  care
provider  upon determining that the managed care provider has repeatedly
failed to meet the substantive requirements of sections 1903(m) and 1932
of the federal Social Security Act and regulations. A hearing shall  not
be required prior to the appointment of temporary management.

S. 2606--C                         29

  S  45.  The opening paragraph of subdivision 4 of section 365-m of the
social services law, as added by section 42-d of part H of chapter 59 of
the laws of 2011, is amended to read as follows:
  The  commissioners of the office of mental health, the office of alco-
holism and substance abuse services and the department of health,  shall
have  the  responsibility  for  jointly designating on a regional basis,
after consultation with the local social  services  district  and  local
governmental unit, as such term is defined in the mental hygiene law, of
a  city with a population of over one million persons, and after consul-
tation of other affected counties,  a  limited  number  of  [specialized
managed  care  plans  under  section  three hundred sixty-four-j of this
title,] special [need] NEEDS managed  care  plans  under  section  three
hundred  sixty-four-j  of  this  title[,  and/or integrated physical and
behavioral health provider systems certified under article twenty-nine-E
of the public health law] capable of managing the behavioral  and  phys-
ical  health  needs  of  medical  assistance  enrollees with significant
behavioral health needs. Initial designations of such plans [or provider
systems] should be made no later than April first, two  thousand  [thir-
teen] FOURTEEN, provided, however, such designations shall be contingent
upon a determination by such state commissioners that the entities to be
designated  have  the capacity and financial ability to provide services
in such plans [or provider systems], and that the region  has  a  suffi-
cient  population  and service base to support such plans [and systems].
Once designated, the commissioner of health shall make  arrangements  to
enroll such enrollees in such plans [or integrated provider systems] and
to pay such plans [or provider systems] on a capitated or other basis to
manage,  coordinate,  and pay for behavioral and physical health medical
assistance services for such enrollees. Notwithstanding any inconsistent
provision of section one hundred twelve and one hundred  sixty-three  of
the state finance law, and section one hundred forty-two of the economic
development  law,  or any other law to the contrary, the designations of
such plans [and provider systems], and any resulting contracts with such
plans[,] OR providers [or provider systems] are authorized to be entered
into by such state commissioners without a competitive  bid  or  request
for proposal process, provided however that:
  S  45-a.  Paragraph  c of subdivision 3 of section 365-m of the social
services law, as added by section 42-d of part H of chapter  59  of  the
laws of 2011, is amended to read as follows:
  (c) the commissioners of the office of mental health and the office of
alcoholism  and  substance  abuse  services,  in  consultation  with the
commissioner of health and the impacted local governmental units,  shall
select  such  contractor  or contractors that, in their discretion, have
demonstrated the ability to effectively, efficiently,  and  economically
integrate  behavioral  health  and  health  services; have the requisite
expertise and financial resources; have demonstrated that  their  direc-
tors, sponsors, members, managers, partners or operators have the requi-
site  character,  competence and standing in the community, and are best
suited to serve the  purposes  of  this  section.    IN  SELECTING  SUCH
CONTRACTOR OR CONTRACTORS, THE COMMISSIONERS SHALL:
  (I)  ENSURE  THAT  ANY SUCH CONTRACTOR OR CONTRACTORS HAVE AN ADEQUATE
NETWORK OF PROVIDERS TO MEET THE BEHAVIORAL HEALTH AND HEALTH  NEEDS  OF
ENROLLEES,  AND  SHALL REVIEW THE ADEQUACY PRIOR TO APPROVAL OF ANY SUCH
CONTRACT OR CONTRACTS, AND UPON CONTRACT RENEWAL OR  EXPANSION.  TO  THE
EXTENT  THAT THE NETWORK HAS BEEN DETERMINED TO MEET STANDARDS SET FORTH
IN SUBDIVISION FIVE OF SECTION FOUR THOUSAND FOUR HUNDRED THREE  OF  THE
PUBLIC HEALTH LAW, SUCH NETWORK SHALL BE DEEMED ADEQUATE.

S. 2606--C                         30

  (II)  ENSURE  THAT  SUCH CONTRACTOR OR CONTRACTORS SHALL MAKE LEVEL OF
CARE AND  COVERAGE  DETERMINATIONS  UTILIZING  EVIDENCE-BASED  TOOLS  OR
GUIDELINES  DESIGNATED  TO ADDRESS THE BEHAVIORAL HEALTH NEEDS OF ENROL-
LEES.
  (III)  ENSURE  SUFFICIENT  ACCESS  TO  BEHAVIORAL  HEALTH  AND  HEALTH
SERVICES FOR ELIGIBLE ENROLLEES BY  ESTABLISHING  AND  MONITORING  PENE-
TRATION RATES OF ANY SUCH CONTRACTOR OR CONTRACTORS.
  (IV)  ESTABLISH  STANDARDS  TO ENCOURAGE THE USE OF SERVICES, PRODUCTS
AND CARE RECOMMENDED, ORDERED OR PRESCRIBED BY A PROVIDER TO SUFFICIENT-
LY ADDRESS THE BEHAVIORAL HEALTH AND HEALTH SERVICES NEEDS OF ENROLLEES;
AND MONITOR THE APPLICATION OF SUCH STANDARDS TO ENSURE THAT THEY SUFFI-
CIENTLY ADDRESS THE BEHAVIORAL  HEALTH  AND  HEALTH  SERVICES  NEEDS  OF
ENROLLEES.
  S  45-b. Paragraph (c) of subdivision 4 of section 365-m of the social
services, as added by section 42-d of part H of chapters 59 of the  laws
of 2011, is amended to read as follows:
  (c) the commissioners of the office of mental health and the office of
alcoholism  and  substance  abuse  services,  in  consultation  with the
commissioner of health, shall select such  plans  or  systems  that,  in
their  discretion,  have  demonstrated the ability to effectively, effi-
ciently, and economically manage  the  behavioral  and  physical  health
needs of medical assistance enrollees with significant behavioral health
needs; have the requisite expertise and financial resources; have demon-
strated  that  their directors, sponsors, members, managers, partners or
operators have the requisite character, competence and standing  in  the
community,  and  are  best suited to serve the purposes of this section.
Oversight of such contracts  with  such  plans,  providers  or  provider
systems  shall  be the joint responsibility of such state commissioners,
and for contracts affecting a city with a population of over one million
persons, also with the city's local social services district  and  local
governmental  unit,  as  such term is defined in the mental hygiene law.
IN SELECTING SUCH PLANS OR SYSTEMS, THE COMMISSIONERS SHALL:
  (I) ENSURE THAT ANY SUCH PLANS OR SYSTEMS HAVE AN ADEQUATE NETWORK  OF
PROVIDERS  TO  MEET THE BEHAVIORAL HEALTH AND HEALTH NEEDS OF ENROLLEES,
AND SHALL REVIEW THE ADEQUACY PRIOR TO APPROVAL OF  ANY  SUCH  PLANS  OR
SYSTEMS,  AND UPON CONTRACT RENEWAL OR EXPANSION. TO THE EXTENT THAT THE
NETWORK HAS BEEN DETERMINED TO MEET STANDARDS SET FORTH  IN  SUBDIVISION
FIVE  OF  SECTION  FOUR THOUSAND FOUR HUNDRED THREE OF THE PUBLIC HEALTH
LAW, SUCH NETWORK SHALL BE DEEMED ADEQUATE.
  (II) ENSURE THAT SUCH PLANS OR SYSTEMS SHALL MAKE LEVEL  OF  CARE  AND
COVERAGE  DETERMINATIONS  UTILIZING  EVIDENCE-BASED  TOOLS OR GUIDELINES
DESIGNED TO ADDRESS THE BEHAVIORAL HEALTH NEEDS OF ENROLLEES.
  (III)  ENSURE  SUFFICIENT  ACCESS  TO  BEHAVIORAL  HEALTH  AND  HEALTH
SERVICES  FOR  ELIGIBLE  ENROLLEES  BY ESTABLISHING AND MONITORING PENE-
TRATION RATES OF ANY SUCH PLANS OR SYSTEMS.
  (IV) ESTABLISH STANDARDS TO ENCOURAGE THE USE  OF  SERVICES,  PRODUCTS
AND CARE RECOMMENDED, ORDERED OR PRESCRIBED BY A PROVIDER TO SUFFICIENT-
LY ADDRESS THE BEHAVIORAL HEALTH AND HEALTH SERVICES NEEDS OF ENROLLEES;
AND MONITOR THE APPLICATION OF SUCH STANDARDS TO ENSURE THAT THEY SUFFI-
CIENTLY  ADDRESS  THE  BEHAVIORAL  HEALTH  AND  HEALTH SERVICES NEEDS OF
ENROLLEES.
  S 45-c. Section 365-m of the social services law is amended by  adding
a new subdivision 5 to read as follows:
  5.  ON OR BEFORE JUNE THIRTIETH, TWO THOUSAND SIXTEEN, THE COMMISSION-
ERS OF THE OFFICE OF MENTAL HEALTH AND  THE  OFFICE  OF  ALCOHOLISM  AND
SUBSTANCE  ABUSE  SERVICES,  IN  CONSULTATION  WITH  THE COMMISSIONER OF

S. 2606--C                         31

HEALTH, SHALL PREPARE A REPORT ON THE EXTENT TO WHICH  ENTITIES  COVERED
UNDER THIS SECTION MEET THE REQUIREMENTS SET FORTH IN SUBPARAGRAPHS (I),
(II), (III), AND (IV) OF PARAGRAPH (C) OF SUBDIVISION THREE AND SUBPARA-
GRAPHS  (I),  (II), (III), AND (IV) OF PARAGRAPH (C) OF SUBDIVISION FOUR
OF THIS SECTION AND ENTITIES COVERED UNDER PARAGRAPH (C) OF  SUBDIVISION
2  OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE MEET THE REQUIRE-
MENTS OF SUBPARAGRAPHS (I), (II), (III), AND (IV) OF SUCH PARAGRAPH. THE
REPORT SHALL BE DELIVERED TO THE TEMPORARY PRESIDENT OF THE SENATE,  THE
SPEAKER  OF  THE  ASSEMBLY,  THE  MINORITY LEADER OF THE SENATE, AND THE
MINORITY LEADER OF THE ASSEMBLY ON OR BEFORE JUNE THIRTIETH,  TWO  THOU-
SAND SIXTEEN.
  S 46. Subdivision 8 of section 4401 of the public health law, as added
by section 42 of part H of chapter 59 of the laws of 2011, is amended to
read as follows:
  8.  "Special  needs  managed  care plan" [or "specialized managed care
plan"] shall mean a combination of persons natural or corporate, or  any
groups  of  such  persons,  or  a  county or counties, who enter into an
arrangement, agreement or plan, or combination of  arrangements,  agree-
ments  or  plans,  to  provide  health and behavioral health services to
enrollees with significant behavioral health needs.
  S 47. Section 4403-d of the public health law,  as  added  by  section
42-a  of part H of chapter 59 of the laws of 2011, is amended to read as
follows:
  S 4403-d. Special needs managed care plans  [and  specialized  managed
care plans]. No person, group of persons, county or counties may operate
a  special  needs  managed  care plan [or specialized managed care plan]
without first obtaining a certificate of authority from the  commission-
er,  issued jointly with the commissioner of the office of mental health
and the commissioner of the office of  alcoholism  and  substance  abuse
services.
  S  47-a.  Subparagraphs (iii) and (iv) of paragraph (b) of subdivision
7 of section 4403-f of the public health law are REPEALED.
  S 48. Subparagraph (v) of paragraph (b) of subdivision  7  of  section
4403-f of the public health law, as amended by section 41-b of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
  (v)  The following medical assistance recipients shall not be eligible
to participate in a managed long term care program or other care coordi-
nation model  established  pursuant  to  this  paragraph  until  program
features  and  reimbursement rates are approved by the commissioner and,
as applicable, the commissioner of developmental disabilities:
  (1) a person enrolled in a managed care plan pursuant to section three
hundred sixty-four-j of the social services law;
  (2) a participant in the traumatic brain injury waiver program;
  (3) a participant in the nursing home transition and diversion  waiver
program;
  (4) a person enrolled in the assisted living program;
  (5)  a  person  enrolled  in  home and community based waiver programs
administered   by   the   office   for   people    with    developmental
disabilities[.];
  (6) A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE FOR
LESS  THAN SIX MONTHS, FOR A REASON OTHER THAN THAT THE PERSON IS ELIGI-
BLE FOR MEDICAL ASSISTANCE ONLY THROUGH THE APPLICATION OF EXCESS INCOME
TOWARD THE COST OF MEDICAL CARE AND SERVICES;
  (7) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS ONLY WITH
RESPECT TO TUBERCULOSIS-RELATED SERVICES;
  (8) A PERSON RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;

S. 2606--C                         32

  (9) A PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAILABLE
FROM OR UNDER A THIRD-PARTY PAYOR WHICH MAY BE MAINTAINED BY PAYMENT, OR
PART PAYMENT, OF THE PREMIUM OR COST SHARING AMOUNTS,  WHEN  PAYMENT  OF
SUCH  PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE, AS DETER-
MINED BY THE SOCIAL SERVICES DISTRICT;
  (10)  A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
GRAPH ELEVEN OF PARAGRAPH  (A)  OF  SUBDIVISION  ONE  OF  SECTION  THREE
HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES LAW;
  (11) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO PARA-
GRAPH  (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX OF THE
SOCIAL SERVICES LAW; AND
  (12) NATIVE AMERICANS.
  S 48-a. Notwithstanding any contrary provision of law, the commission-
er of alcoholism and substance abuse services is authorized, subject  to
the  approval  of the director of the budget, to transfer to the commis-
sioner of health state funds to be utilized as the state share  for  the
purpose  of  increasing  payments  under the medicaid program to managed
care organizations licensed under article 44 of the public health law or
under article 43 of the insurance law. Such managed  care  organizations
shall  utilize  such funds for the purpose of reimbursing hospital-based
and free-standing chemical dependence outpatient  and  opioid  treatment
clinics  licensed  pursuant  to  article  28 of the public health law or
article 32 of the mental hygiene law for chemical  dependency  services,
as  determined  by  the commissioner of health, in consultation with the
commissioner of alcoholism and substance  abuse  services,  provided  to
medicaid  eligible  outpatients. Such reimbursement shall be in the form
of fees for such services which are equivalent to  the  payments  estab-
lished  for such services under the ambulatory patient group (APG) rate-
setting methodology as utilized by the department of health  or  by  the
office  of  alcoholism  and  substance  abuse  services for rate-setting
purposes; provided, however, that the increase to such fees  that  shall
result  from  the provisions of this section shall not, in the aggregate
and as determined by the commissioner of health,  in  consultation  with
the  commissioner of alcoholism and substance abuse services, be greater
than the increased funds made available pursuant to  this  section.  The
commissioner  of  health  may,  in consultation with the commissioner of
alcoholism and substance abuse services, promulgate regulations, includ-
ing emergency regulations, as are necessary to implement the  provisions
of this section.
  S  49. Section 2 of part H of chapter 111 of the laws of 2010 relating
to increasing Medicaid payments to providers through managed care organ-
izations and providing equivalent fees  through  an  ambulatory  patient
group methodology, is amended to read as follows:
  S  2.  This  act  shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2010, AND SHALL
EXPIRE ON MARCH 31, 2017.
  S 50. Paragraph (e) of subdivision 8 of section  2511  of  the  public
health  law,  as  added  by section 21-a of part B of chapter 109 of the
laws of 2010, is amended to read as follows:
  (e) The commissioner shall adjust subsidy payments to approved  organ-
izations  made  on and after April first, two thousand ten THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, so that the  amount  of  each  such
payment,  as  otherwise  calculated  pursuant  to  this  subdivision, is
reduced by twenty-eight percent of the amount by which  such  calculated
payment  exceeds  the statewide average subsidy payment for all approved
organizations in effect on April first, two thousand ten. Such statewide

S. 2606--C                         33

average subsidy payment shall be  calculated  by  the  commissioner  and
shall not reflect adjustments made pursuant to this paragraph.
  S 51. Intentionally Omitted.
  S 52. Intentionally Omitted.
  S 53. Intentionally Omitted.
  S  53-a. Subdivision (c-1) of section 1 of part C of chapter 58 of the
laws of 2005, relating to as added by section 1 of part F of chapter  56
of  the laws of 2012, authorizing reimbursement for expenditures made by
or on behalf of social services districts  for  medical  assistance  for
needy  persons  and  the  administration  thereof, is amended to read as
follows:
  (c-1) Notwithstanding  any  provisions  of  subdivision  (c)  of  this
section  to  the  contrary,  [effective  April  1, 2013,] for the period
[January] APRIL 1, 2013 through December 31, 2013 and for each  calendar
year  thereafter,  the  medical  assistance  expenditure  amount for the
social services district for such period shall be equal to the  previous
calendar year's medical assistance expenditure amount, except that[:
  (1)] for the period [January] APRIL 1, 2013 through December 31, 2013,
the previous calendar year medical assistance expenditure amount will be
increased by [2%;] 1%.
  [(2)  for  the  period  January 1, 2014 through December 31, 2014, the
previous calendar year medical assistance  expenditure  amount  will  be
increased by 1%.]
  S  54. Subparagraph (iii) of paragraph (g) of subdivision 7 of section
4403-f of the public health law, as amended by section 41-b of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
  (iii) The enrollment application shall be  submitted  by  the  managed
long  term  care  plan  or demonstration to the entity designated by the
department prior to the commencement of services under the managed  long
term  care  plan or demonstration. [For purposes of reimbursement of the
managed long term care plan or demonstration, if the enrollment applica-
tion is submitted on or before the  twentieth  day  of  the  month,  the
enrollment  shall  commence  on the first day of the month following the
completion and submission and if the enrollment application is submitted
after the twentieth day of the month, the enrollment shall  commence  on
the  first  day  of  the second month following submission.] Enrollments
conducted by a plan or demonstration shall  be  subject  to  review  and
audit  by  the department or a contractor selected pursuant to paragraph
(d) of this subdivision.
  S 55. Paragraph (a) of subdivision 8 of section  3614  of  the  public
health  law,  as added by section 54 of part J of chapter 82 of the laws
of 2002, is amended to read as follows:
  (a) Notwithstanding any inconsistent provision of law, rule  or  regu-
lation  and  subject to the provisions of paragraph (b) of this subdivi-
sion and to the availability of  federal  financial  participation,  the
commissioner  shall  adjust  medical  assistance  rates  of  payment for
services provided by certified home health agencies  FOR  SUCH  SERVICES
PROVIDED  TO  CHILDREN  UNDER  EIGHTEEN  YEARS  OF  AGE AND FOR SERVICES
PROVIDED TO A SPECIAL NEEDS POPULATION OF MEDICALLY COMPLEX AND  FRAGILE
CHILDREN,  ADOLESCENTS  AND  YOUNG  DISABLED  ADULTS BY A CHHA OPERATING
UNDER A PILOT PROGRAM APPROVED BY THE DEPARTMENT, long term home  health
care  programs and AIDS home care programs in accordance with this para-
graph and paragraph (b) of this subdivision for  purposes  of  improving
recruitment  and retention of non-supervisory home care services workers
or any worker with direct patient care responsibility in  the  following

S. 2606--C                         34

amounts  for services provided on and after December first, two thousand
two.
  (i)  rates  of  payment  by  governmental  agencies for certified home
health agency services FOR SUCH  SERVICES  PROVIDED  TO  CHILDREN  UNDER
EIGHTEEN YEARS OF AGE AND FOR SERVICES PROVIDED TO A SPECIAL NEEDS POPU-
LATION  OF MEDICALLY COMPLEX AND FRAGILE CHILDREN, ADOLESCENTS AND YOUNG
DISABLED ADULTS BY A CHHA OPERATING UNDER A PILOT  PROGRAM  APPROVED  BY
THE  DEPARTMENT  (including  services  provided  through  contracts with
licensed home care  services  agencies)  shall  be  increased  by  three
percent;
  (ii)  rates  of  payment  by  governmental agencies for long term home
health  care  program  services  (including  services  provided  through
contracts  with licensed home care services agencies) shall be increased
by three percent; and
  (iii) rates of payment by governmental agencies  for  AIDS  home  care
programs  (including  services  provided through contracts with licensed
home care services agencies) shall be increased by three percent.
  S 56. The opening paragraph of subdivision 9 of section  3614  of  the
public  health  law, as amended by section 5 of part C of chapter 109 of
the laws of 2006, is amended to read as follows:
  Notwithstanding any law  to  the  contrary,  the  commissioner  shall,
subject  to  the availability of federal financial participation, adjust
medical assistance rates of payment for certified home  health  agencies
FOR  SUCH  SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND
FOR SERVICES PROVIDED TO A SPECIAL NEEDS POPULATION OF MEDICALLY COMPLEX
AND FRAGILE CHILDREN, ADOLESCENTS AND YOUNG DISABLED ADULTS  BY  A  CHHA
OPERATING  UNDER  A  PILOT PROGRAM APPROVED BY THE DEPARTMENT, long term
home health care programs, AIDS home care programs established  pursuant
to  this  article,  hospice  programs established under article forty of
this chapter and for managed long term care plans and  approved  managed
long term care operating demonstrations as defined in section forty-four
hundred  three-f of this chapter. Such adjustments shall be for purposes
of improving recruitment, training and retention of home health aides or
other personnel with direct patient care responsibility in the following
aggregate amounts for the following periods:
  S 57. Paragraph (a) of subdivision 10 of section 3614  of  the  public
health law, as amended by section 24 of part C of chapter 59 of the laws
of 2011, is amended to read as follows:
  (a)  Such  adjustments to rates of payments shall be allocated propor-
tionally based on each certified home  health  [agency's]  AGENCY,  long
term home health care program, AIDS home care and hospice program's home
health  aide or other direct care services total annual hours of service
provided to medicaid patients, as reported in each  such  agency's  most
recently available cost report as submitted to the department or for the
purpose of the managed long term care program a suitable proxy developed
by  the department in consultation with the interested parties. Payments
made pursuant to this section shall not be subject to subsequent adjust-
ment or reconciliation; PROVIDED  THAT  SUCH  ADJUSTMENTS  TO  RATES  OF
PAYMENTS  TO  CERTIFIED  HOME  HEALTH  AGENCIES  SHALL  ONLY BE FOR THAT
PORTION OF SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND
FOR SERVICES PROVIDED TO A SPECIAL NEEDS POPULATION OF MEDICALLY COMPLEX
AND FRAGILE CHILDREN, ADOLESCENTS AND YOUNG DISABLED ADULTS  BY  A  CHHA
OPERATING UNDER A PILOT PROGRAM APPROVED BY THE DEPARTMENT.
  S 58. Intentionally omitted.

S. 2606--C                         35

  S  59.  Paragraph (d) of subdivision 2-b of section 2808 of the public
health law, as added by section 47 of part C of chapter 109 of the  laws
of 2006, is amended to read as follows:
  (d)  Cost  reports submitted by residential health care facilities for
the two thousand two calendar year or any part thereof  shall,  notwith-
standing  any  contrary  provision  of  law, be subject to audit through
December thirty-first, two thousand [fourteen] EIGHTEEN  and  facilities
shall  retain  for the purpose of such audits all fiscal and statistical
records relevant to such cost reports, provided, however, that any  such
audit  commenced on or before December thirty-first, two thousand [four-
teen] EIGHTEEN, may be completed and used for the purpose  of  adjusting
any Medicaid rates which utilize such costs.
  S 60. Subparagraph (ii) of paragraph (a) of subdivision 2-b of section
2808 of the public health law, as added by section 47 of part C of chap-
ter 109 of the laws of 2006, is amended to read as follows:
  (ii)  Rates  for the periods two thousand seven and two thousand eight
shall be further adjusted by a per diem add-on amount, as determined  by
the  commissioner, reflecting the proportional amount of each facility's
projected Medicaid benefit to the total projected Medicaid  benefit  for
all  facilities  of  the imputed use of the rate-setting methodology set
forth in paragraph (b) of this subdivision, provided, however, that  for
those facilities that do not receive a per diem add-on adjustment pursu-
ant to this subparagraph, rates shall be further adjusted to include the
proportionate benefit, as determined by the commissioner, of the expira-
tion  of  the opening paragraph and paragraph (a) of subdivision sixteen
of this section and of paragraph (a) of  subdivision  fourteen  of  this
section,  provided,  further,  however,  that the aggregate total of the
rate adjustments made pursuant to this subparagraph shall not exceed one
hundred thirty-seven million five hundred thousand dollars for  the  two
thousand  seven  rate  period  and  one hundred sixty-seven million five
hundred thousand dollars for the two  thousand  eight  rate  period  AND
PROVIDED  FURTHER,  HOWEVER, THAT SUCH RATE ADJUSTMENTS AS MADE PURSUANT
TO THIS SUBPARAGRAPH PRIOR TO TWO THOUSAND TWELVE SHALL NOT  BE  SUBJECT
TO SUBSEQUENT ADJUSTMENT OR RECONCILIATION.
  S  61. Subparagraph (i) of paragraph (b) of subdivision 2-b of section
2808 of the public health law, as amended by section 94  of  part  H  of
chapter 59 of the laws of 2011, is amended to read as follows:
  (i)  (A) Subject to the provisions of subparagraphs (ii) through (xiv)
of this paragraph, for periods on and after April  first,  two  thousand
nine  the  operating  cost  component  of rates of payment shall reflect
allowable operating costs as reported in each facility's cost report for
the two thousand two calendar year, as  adjusted  for  inflation  on  an
annual  basis  in accordance with the methodology set forth in paragraph
(c) of subdivision ten of section twenty-eight hundred seven-c  of  this
article,  provided,  however,  that  for  those facilities which [do not
receive a per diem add-on adjustment pursuant to  subparagraph  (ii)  of
paragraph (a) of this subdivision] ARE DETERMINED BY THE COMMISSIONER TO
BE QUALIFYING FACILITIES IN ACCORDANCE WITH THE PROVISIONS OF CLAUSE (B)
OF  THIS  SUBPARAGRAPH,  rates  shall be further adjusted to include the
proportionate benefit, as determined by the commissioner, of the expira-
tion of the opening paragraph and paragraph (a) of  subdivision  sixteen
of  this  section  and  of paragraph (a) of subdivision fourteen of this
section, and provided further that the operating cost component of rates
of payment for those facilities  which  [did  not  receive  a  per  diem
adjustment in accordance with subparagraph (ii) of paragraph (a) of this
subdivision] ARE DETERMINED BY THE COMMISSIONER TO BE QUALIFYING FACILI-

S. 2606--C                         36

TIES  IN  ACCORDANCE  WITH THE PROVISIONS OF CLAUSE (B) OF THIS SUBPARA-
GRAPH shall not be less than the  operating  component  such  facilities
received  in  the  two  thousand  eight  rate  period,  as  adjusted for
inflation  on  an  annual  basis  in accordance with the methodology set
forth in paragraph  (c)  of  subdivision  ten  of  section  twenty-eight
hundred  seven-c  of  this  article  and further provided, however, that
rates for facilities whose operating cost component reflects  base  year
costs  subsequent  to  January  first, two thousand two shall have rates
computed in accordance with this paragraph, utilizing allowable  operat-
ing  costs  as reported in such subsequent base year period, and trended
forward to  the  rate  year  in  accordance  with  applicable  inflation
factors.
  (B)  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH QUALIFYING FACILITIES ARE
THOSE FACILITIES  FOR  WHICH  THE  COMMISSIONER  DETERMINES  THAT  THEIR
REPORTED TWO THOUSAND TWO BASE YEAR OPERATING COST COMPONENT, AS DEFINED
IN  ACCORDANCE WITH THE REGULATIONS OF THE DEPARTMENT AS SET FORTH IN 10
NYCRR 86-2.10(A)(7); IS LESS THAN THE OPERATING COMPONENT  SUCH  FACILI-
TIES  RECEIVED  IN  THE  TWO  THOUSAND EIGHT RATE PERIOD, AS ADJUSTED BY
APPLICABLE TREND FACTORS.
  S 62. Intentionally omitted.
  S 63. Paragraph (e-1) of subdivision 12 of section 2808 of the  public
health  law, as amended by section 1 of part D of chapter 59 of the laws
of 2011, is amended to read as follows:
  (e-1) Notwithstanding any inconsistent provision of law or regulation,
the commissioner shall provide,  in  addition  to  payments  established
pursuant  to  this  article  prior to application of this section, addi-
tional payments under the medical assistance program pursuant  to  title
eleven of article five of the social services law for non-state operated
public  residential health care facilities, including public residential
health care facilities located in the county of Nassau,  the  county  of
Westchester  and  the  county  of Erie, but excluding public residential
health care facilities operated by a town or city within  a  county,  in
aggregate  annual  amounts of up to one hundred fifty million dollars in
additional payments for the state fiscal year beginning April first, two
thousand six and for the state fiscal year beginning  April  first,  two
thousand  seven and for the state fiscal year beginning April first, two
thousand eight and of up to three hundred million dollars in such aggre-
gate annual additional payments for  the  state  fiscal  year  beginning
April  first, two thousand nine, and for the state fiscal year beginning
April first, two thousand ten and for the state  fiscal  year  beginning
April  first, two thousand eleven, and for the state fiscal years begin-
ning April first, two thousand twelve  and  April  first,  two  thousand
thirteen.  The  amount  allocated  to  each  eligible public residential
health care facility for this period shall  be  computed  in  accordance
with  the  provisions  of  paragraph  (f) of this subdivision, provided,
however, that patient  days  shall  be  utilized  for  such  computation
reflecting  actual  reported data for two thousand three and each repre-
sentative succeeding year as applicable, AND PROVIDED FURTHER,  HOWEVER,
THAT,  IN  CONSULTATION  WITH IMPACTED PROVIDERS, OF THE FUNDS ALLOCATED
FOR DISTRIBUTION IN THE STATE FISCAL YEAR  BEGINNING  APRIL  FIRST,  TWO
THOUSAND  THIRTEEN, UP TO THIRTY-TWO MILLION DOLLARS MAY BE ALLOCATED IN
ACCORDANCE WITH PARAGRAPH (F-1) OF THIS SUBDIVISION.
  S 64. Subdivision 12 of section 2808  of  the  public  health  law  is
amended by adding a new paragraph (f-1) to read as follows:
  (F-1)  FUNDS  ALLOCATED  BY  THE PROVISIONS OF PARAGRAPH (E-1) OF THIS
SUBDIVISION FOR DISTRIBUTION PURSUANT TO THIS PARAGRAPH, SHALL BE  ALLO-

S. 2606--C                         37

CATED  PROPORTIONALLY TO THOSE PUBLIC RESIDENTIAL HEALTH CARE FACILITIES
WHICH WERE SUBJECT TO RETROACTIVE REDUCTIONS IN PAYMENTS  MADE  PURSUANT
TO THIS SUBDIVISION FOR STATE FISCAL YEAR PERIODS BEGINNING APRIL FIRST,
TWO THOUSAND SIX.
  S 65. Intentionally omitted.
  S  66.  Paragraph (c) of subdivision 2-c of section 2808 of the public
health law, as added by section 95 of part H of chapter 59 of  the  laws
of 2011, is amended to read as follows:
  (c) The non-capital component of the rates for: (i) AIDS facilities or
discrete AIDS units within facilities; (ii) discrete units for residents
receiving care in a long-term inpatient rehabilitation program for trau-
matic  brain injured persons; (iii) discrete units providing specialized
programs for residents requiring behavioral interventions; (iv) discrete
units for long-term ventilator dependent residents; and  (v)  facilities
or  discrete  units  within  facilities  that provide extensive nursing,
medical, psychological and counseling support services solely  to  chil-
dren  shall  reflect  the rates in effect for such facilities on January
first, two thousand nine, as adjusted for inflation and rate appeals  in
accordance  with applicable statutes, provided, however, that such rates
for facilities described in subparagraph (i)  of  this  paragraph  shall
reflect the application of the provisions of section twelve of part D of
chapter  fifty-eight  of  the  laws  of  two thousand nine, and provided
further, however, that insofar as such rates reflect  trend  adjustments
for  trend  factors attributable to the two thousand eight and two thou-
sand nine calendar years the  aggregate  amount  of  such  trend  factor
adjustments  shall be subject to the provisions of section two of part D
of chapter fifty-eight of the laws of two thousand nine, as amended; AND
PROVIDED  FURTHER,  HOWEVER,  THAT  NOTWITHSTANDING   ANY   INCONSISTENT
PROVISIONS OF THIS SUBDIVISION AND SUBJECT TO THE AVAILABILITY OF FEDER-
AL  FINANCIAL  PARTICIPATION,  FOR  ALL  RATE PERIODS ON AND AFTER APRIL
FIRST, TWO THOUSAND FOURTEEN, RATES CONSISTENT WITH PARAGRAPHS  (A)  AND
(B)  OF  THIS  SUBDIVISION  FOR  FACILITIES DESCRIBED IN THIS PARAGRAPH,
INCLUDING A  PATIENT  ACUITY  ADJUSTMENT  FOR  FACILITIES  DESCRIBED  IN
SUBPARAGRAPH  (V) OF THIS PARAGRAPH, SHALL BE ESTABLISHED BY THE COMMIS-
SIONER BY REGULATION AS AUTHORIZED BY PARAGRAPH (D) OF THIS  SUBDIVISION
AND IN CONSULTATION WITH AFFECTED PROVIDERS.
  S 67. Intentionally omitted.
  S  68.  Paragraph  (a) of subdivision 2 of section 366-c of the social
services law, as added by chapter 558 of the laws of 1989, is amended to
read as follows:
  (a) For purposes of this section an "institutionalized  spouse"  is  a
person  (I) WHO IS in a medical institution or nursing facility [(i) who
is] AND expected to remain in such facility or institution for at  least
thirty  consecutive days[,]; or (II) WHO is receiving care, services and
supplies pursuant to a waiver pursuant  to  subsection  (c)  of  section
nineteen  hundred  fifteen  of  the  federal  social  security act OR IS
RECEIVING CARE, SERVICES AND SUPPLIES IN A MANAGED LONG-TERM  CARE  PLAN
PURSUANT  TO  SECTION ELEVEN HUNDRED FIFTEEN OF THE SOCIAL SECURITY ACT;
and [(ii)] (III) who is married to a person who  is  not  in  a  medical
institution  or  nursing  facility  or  is not receiving WAIVER services
[pursuant to a waiver pursuant to subsection  (c)  of  section  nineteen
hundred fifteen of the federal social security act] DESCRIBED IN SUBPAR-
AGRAPH  (II)  OF THIS PARAGRAPH; PROVIDED, HOWEVER, THAT MEDICAL ASSIST-
ANCE SHALL BE FURNISHED PURSUANT TO THIS PARAGRAPH ONLY IF, FOR SO  LONG
AS,  AND TO THE EXTENT THAT FEDERAL FINANCIAL PARTICIPATION IS AVAILABLE
THEREFOR. THE COMMISSIONER OF HEALTH SHALL MAKE ANY  AMENDMENTS  TO  THE

S. 2606--C                         38

STATE  PLAN  FOR MEDICAL ASSISTANCE, OR APPLY FOR ANY WAIVER OR APPROVAL
UNDER THE FEDERAL SOCIAL SECURITY ACT THAT ARE NECESSARY  TO  CARRY  OUT
THE PROVISIONS OF THIS PARAGRAPH.
  S  69.  Paragraph  (b)  of subdivision 6 of section 3614 of the public
health law, as added by chapter 645 of the laws of 2003, is  amended  to
read as follows:
  (b)   For   purposes   of  this  subdivision,  real  property  capital
construction costs shall only  be  included  in  rates  of  payment  for
assisted  living  programs  if: THE FACILITY HOUSES EXCLUSIVELY ASSISTED
LIVING PROGRAM BEDS AUTHORIZED PURSUANT TO PARAGRAPH (J) OF  SUBDIVISION
THREE  OF SECTION FOUR HUNDRED SIXTY-ONE-L OF THE SOCIAL SERVICES LAW OR
(i) the facility is operated by a not-for-profit corporation;  (ii)  the
facility  commenced operation after nineteen hundred ninety-eight and at
least ninety-five percent of the certified approved beds are provided to
residents who are subject to the assisted living program; and (iii)  the
assisted living program is in a county with a population of no less than
two  hundred eighty thousand persons.  The methodology used to calculate
the rate for such capital construction costs shall be the same methodol-
ogy used to calculate the  capital  construction  costs  at  residential
health  care  facilities  for such costs, PROVIDED THAT THE COMMISSIONER
MAY ADOPT RULES AND REGULATIONS WHICH ESTABLISH A CAP ON  REAL  PROPERTY
CAPITAL  CONSTRUCTION  COSTS FOR THOSE FACILITIES THAT HOUSE EXCLUSIVELY
ASSISTED LIVING PROGRAM BEDS AUTHORIZED PURSUANT  TO  PARAGRAPH  (J)  OF
SUBDIVISION  THREE  OF  SECTION  FOUR  HUNDRED SIXTY-ONE-L OF THE SOCIAL
SERVICES LAW.
  S 70. Subdivision 3 of section 461-l of the  social  services  law  is
amended by adding a new paragraph (j) to read as follows:
  (J)  THE  COMMISSIONER OF HEALTH IS AUTHORIZED TO ADD UP TO FOUR THOU-
SAND FIVE HUNDRED ASSISTED LIVING PROGRAM BEDS TO THE  GROSS  NUMBER  OF
ASSISTED  LIVING  PROGRAM BEDS HAVING BEEN DETERMINED TO BE AVAILABLE AS
OF APRIL FIRST, TWO THOUSAND TWELVE.  APPLICANTS ELIGIBLE TO  SUBMIT  AN
APPLICATION  UNDER THIS PARAGRAPH SHALL BE LIMITED TO ADULT HOMES ESTAB-
LISHED PURSUANT TO SECTION FOUR  HUNDRED  SIXTY-ONE-B  OF  THIS  ARTICLE
WITH,  AS  OF SEPTEMBER FIRST, TWO THOUSAND TWELVE, A CERTIFIED CAPACITY
OF EIGHTY BEDS OR MORE IN WHICH TWENTY-FIVE PERCENT OR MORE OF THE RESI-
DENT POPULATION ARE PERSONS WITH SERIOUS MENTAL ILLNESS  AS  DEFINED  IN
REGULATIONS  PROMULGATED BY THE COMMISSIONER OF HEALTH. THE COMMISSIONER
OF HEALTH SHALL NOT BE REQUIRED TO REVIEW ON A COMPARATIVE BASIS  APPLI-
CATIONS  SUBMITTED FOR ASSISTED LIVING PROGRAM BEDS MADE AVAILABLE UNDER
THIS PARAGRAPH.
  S 71. Subdivision 14 of section 366 of the  social  services  law,  as
added  by  section  74  of  part H of chapter 59 of the laws of 2011, is
amended to read as follows:
  14. The commissioner of health may make any  available  amendments  to
the  state  plan  for  medical  assistance submitted pursuant to section
three hundred sixty-three-a of this title, or, if an  amendment  is  not
possible,  develop  and submit an application for any waiver or approval
under the federal social security act that may be necessary to disregard
or exempt an amount of income, for the purpose of assisting with housing
costs, for individuals receiving coverage of nursing  facility  services
under this title, OTHER THAN SHORT-TERM REHABILITATION SERVICES, AND FOR
INDIVIDUALS  IN RECEIPT OF MEDICAL ASSISTANCE WHILE IN AN ADULT HOME, AS
DEFINED IN SUBDIVISION TWENTY-FIVE OF SECTION TWO OF THIS  CHAPTER,  who
[are]:  ARE (i) discharged [from the nursing facility] to the community;
AND (ii) IF ELIGIBLE, enrolled in a plan certified pursuant  to  section
forty-four hundred three-f of the public health law; and (iii) [while so

S. 2606--C                         39

enrolled,  not]  DO  NOT MEET THE CRITERIA TO BE considered an "institu-
tionalized spouse" for purposes of section three hundred sixty-six-c  of
this title.
  S  71-a.  Section  97-eeee  of  the  state  finance law, as amended by
section 10 of part B of chapter 58 of the laws of 2007,  is  amended  to
read as follows:
  S 97-eeee. Federal-state health reform partnership program account. 1.
There  is  hereby  established  in  the joint custody of the state comp-
troller and the commissioner of taxation  and  finance  a  miscellaneous
special  revenue account to be known as the "federal-state health reform
partnership program account".
  2. The account shall consist of [those] ALL monies received  from  the
federal  government  for  additional  medical  assistance revenues [or],
savings achieved  under  the  federal-state  health  reform  partnership
program  [or],  monies earned by the state and received from the federal
government to support expenditures under the federal-state health reform
partnership program and/or successor program pursuant to section 1115 of
the federal social security act.
  3. Notwithstanding any provision of law to the contrary, where and  to
the  extent  that  federal  revenues or savings under subdivision two of
this section made available to the state under any such New  York  State
section 1115 waiver or amendment thereto, such revenues or savings shall
be deposited in the account.
  4.  [All]  NOTWITHSTANDING  ANY  PROVISION OF LAW TO THE CONTRARY, ALL
monies shall remain in such account unless otherwise disbursed  pursuant
to appropriation by the legislature.
  S  72. Section 364-j of the social services law is amended by adding a
new subdivision 27 to read as follows:
  27. (A) THE CENTERS FOR MEDICARE AND MEDICAID SERVICES HAS ESTABLISHED
AN INITIATIVE TO ALIGN INCENTIVES BETWEEN  MEDICARE  AND  MEDICAID.  THE
GOAL  OF  THE  INITIATIVE  IS  TO  INCREASE  ACCESS TO SEAMLESS, QUALITY
PROGRAMS THAT INTEGRATE SERVICES FOR THE DUALLY ELIGIBLE BENEFICIARY  AS
WELL AS TO ACHIEVE BOTH STATE AND FEDERAL HEALTH CARE SAVINGS BY IMPROV-
ING  HEALTH  CARE DELIVERY AND ENCOURAGING HIGH-QUALITY, EFFICIENT CARE.
IN FURTHERANCE OF THIS GOAL, THE LEGISLATURE AUTHORIZES THE COMMISSIONER
OF HEALTH  TO  ESTABLISH  A  FULLY  INTEGRATED  DUALS  ADVANTAGE  (FIDA)
PROGRAM.
  (B)   THE   FIDA   PROGRAM   SHALL  PROVIDE  TARGETED  POPULATIONS  OF
MEDICARE/MEDICAID DUALLY  ELIGIBLE  PERSONS  WITH  COMPREHENSIVE  HEALTH
SERVICES  THAT  INCLUDE  THE FULL RANGE OF MEDICARE AND MEDICAID COVERED
SERVICES,  INCLUDING  BUT  NOT  LIMITED  TO  PRIMARY  AND  ACUTE   CARE,
PRESCRIPTION   DRUGS,  BEHAVIORAL  HEALTH  SERVICES,  CARE  COORDINATION
SERVICES,  AND  LONG-TERM  SUPPORTS  AND  SERVICES,  AS  WELL  AS  OTHER
SERVICES,  THROUGH MANAGED CARE PROVIDERS, AS DEFINED IN SUBDIVISION ONE
OF THIS SECTION, INCLUDING MANAGED LONG TERM CARE PLANS CERTIFIED PURSU-
ANT TO SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW.
  (C) UNDER THE FIDA PROGRAM ESTABLISHED PURSUANT TO  THIS  SUBDIVISION,
UP TO THREE MANAGED LONG TERM CARE PLANS MAY BE AUTHORIZED TO EXCLUSIVE-
LY  ENROLL  INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, AS SUCH TERM IS
DEFINED IN SECTION 1.03 OF THE MENTAL HYGIENE LAW. THE  COMMISSIONER  OF
HEALTH  MAY WAIVE ANY OF THE DEPARTMENT'S REGULATIONS AS THE COMMISSION-
ER, IN CONSULTATION WITH THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES,
DEEMS NECESSARY TO ALLOW SUCH MANAGED LONG TERM CARE PLANS TO PROVIDE OR
ARRANGE FOR SERVICES FOR  INDIVIDUALS  WITH  DEVELOPMENTAL  DISABILITIES
THAT  ARE ADEQUATE AND APPROPRIATE TO MEET THE NEEDS OF SUCH INDIVIDUALS
AND THAT WILL ENSURE THEIR HEALTH AND SAFETY. THE COMMISSIONER OF DEVEL-

S. 2606--C                         40

OPMENTAL DISABILITIES MAY WAIVE ANY OF THE OFFICE FOR PEOPLE WITH DEVEL-
OPMENTAL DISABILITIES' REGULATIONS AS SUCH COMMISSIONER, IN CONSULTATION
WITH THE COMMISSIONER OF HEALTH, DEEMS NECESSARY TO ALLOW  SUCH  MANAGED
LONG  TERM CARE PLANS TO PROVIDE OR ARRANGE FOR SERVICES FOR INDIVIDUALS
WITH DEVELOPMENTAL DISABILITIES THAT ARE  ADEQUATE  AND  APPROPRIATE  TO
MEET THE NEEDS OF SUCH INDIVIDUALS AND THAT WILL ENSURE THEIR HEALTH AND
SAFETY.
  (D)  THE  PROVISIONS  OF  THIS  SUBDIVISION SHALL NOT APPLY UNLESS ALL
NECESSARY APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN  OBTAINED
TO  RECEIVE  FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF HEALTH CARE
SERVICES PROVIDED PURSUANT TO THIS SUBDIVISION.
  (E) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO SUBMIT  AMENDMENTS  TO
THE STATE PLAN FOR MEDICAL ASSISTANCE AND/OR SUBMIT ONE OR MORE APPLICA-
TIONS FOR WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT AS MAY BE NECESSARY
TO OBTAIN THE FEDERAL APPROVALS NECESSARY TO IMPLEMENT THIS SUBDIVISION.
  (F)  THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE COMMISSIONER
OF DEVELOPMENTAL DISABILITIES, AS APPROPRIATE, MAY CONTRACT WITH MANAGED
CARE PLANS APPROVED TO PARTICIPATE IN THE FIDA PROGRAM WITHOUT THE  NEED
FOR  A  COMPETITIVE  BID  OR  REQUEST  FOR PROPOSAL PROCESS, AND WITHOUT
REGARD TO THE PROVISIONS OF SECTIONS ONE HUNDRED TWELVE AND ONE  HUNDRED
SIXTY-THREE  OF  THE STATE FINANCE LAW, SECTION ONE HUNDRED FORTY-TWO OF
THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER PROVISION OF LAW.
  S 73. The public health law is amended by adding a new section  4403-g
to read as follows:
  S 4403-G. DEVELOPMENTAL DISABILITY INDIVIDUAL SUPPORT AND CARE COORDI-
NATION ORGANIZATIONS.  1. DEFINITIONS. AS USED IN THIS SECTION:
  (A) "DEVELOPMENTAL DISABILITY INDIVIDUAL SUPPORT AND CARE COORDINATION
ORGANIZATION" OR "DISCO" MEANS AN ENTITY THAT HAS RECEIVED A CERTIFICATE
OF AUTHORITY PURSUANT TO THIS SECTION TO PROVIDE, OR ARRANGE FOR, HEALTH
AND  LONG  TERM CARE SERVICES, AS DETERMINED BY THE COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES,  ON  A  CAPITATED  BASIS  IN
ACCORDANCE  WITH  THIS  SECTION,  FOR  A  POPULATION OF INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES, AS SUCH TERM IS DEFINED IN SECTION  1.03  OF
THE MENTAL HYGIENE LAW, WHICH THE ORGANIZATION IS AUTHORIZED TO ENROLL.
  (B)  "ELIGIBLE  APPLICANT"  MEANS  AN ENTITY CONTROLLED BY ONE OR MORE
NON-PROFIT ORGANIZATIONS WHICH HAVE A HISTORY OF PROVIDING OR COORDINAT-
ING HEALTH AND LONG TERM CARE SERVICES  TO  PERSONS  WITH  DEVELOPMENTAL
DISABILITIES.
  (C)  "HABILITATION SERVICES" MEANS SERVICES, INCLUDING BUT NOT LIMITED
TO LONG TERM HOME AND COMMUNITY BASED SERVICES, DESIGNED TO ASSIST INDI-
VIDUALS IN ACQUIRING, RETAINING, AND IMPROVING THE SELF-HELP, SOCIALIZA-
TION, AND ADAPTIVE SKILLS NECESSARY TO RESIDE SUCCESSFULLY IN  HOME  AND
COMMUNITY  BASED  SETTINGS,  INCLUDING  PREVOCATIONAL,  EDUCATIONAL, AND
SUPPORTED EMPLOYMENT SERVICES, BUT NOT INCLUDING SPECIAL  EDUCATION  AND
RELATED  SERVICES THAT OTHERWISE ARE AVAILABLE TO THE INDIVIDUAL THROUGH
A LOCAL EDUCATIONAL AGENCY, OR VOCATIONAL REHABILITATION  SERVICES  THAT
OTHERWISE ARE AVAILABLE TO THE INDIVIDUAL THROUGH A PROGRAM FUNDED UNDER
SECTION  ONE  HUNDRED  TEN OF THE REHABILITATION ACT OF NINETEEN HUNDRED
SEVENTY-THREE;
  (D) "HEALTH AND LONG TERM CARE SERVICES" MEANS SERVICES INCLUDING, BUT
NOT LIMITED TO, HABILITATION SERVICES, OTHER  HOME  AND  COMMUNITY-BASED
AND  INSTITUTION-BASED  LONG  TERM CARE SERVICES, AND ANCILLARY SERVICES
(THAT SHALL INCLUDE MEDICAL SUPPLIES AND NUTRITIONAL  SUPPLEMENTS)  THAT
ARE  NECESSARY  TO MEET THE NEEDS OF PERSONS WHOM THE PLAN IS AUTHORIZED
TO ENROLL, AND MAY INCLUDE PRIMARY CARE AND ACUTE CARE IF THE  DISCO  IS
AUTHORIZED  TO  PROVIDE  OR  ARRANGE  FOR  SUCH  SERVICES.   EACH PERSON

S. 2606--C                         41

ENROLLED IN A DISCO SHALL RECEIVE THE HABILITATION  AND  OTHER  SERVICES
NECESSARY  TO  ACHIEVE  PERSON-CENTERED GOALS, TO LIVE IN THE MOST INTE-
GRATED SETTING APPROPRIATE TO THAT PERSON'S NEEDS, AND  TO  ENABLE  THAT
PERSON TO INTERACT WITH NONDISABLED PERSONS TO THE FULLEST EXTENT POSSI-
BLE,  PROVIDED  THAT ALL SUCH SERVICES ARE CONSISTENT WITH SUCH PERSON'S
WISHES TO THE EXTENT SUCH WISHES ARE KNOWN.
  2. APPROVAL AUTHORITY.  AN APPLICANT SHALL BE ISSUED A CERTIFICATE  OF
AUTHORITY  AS  A  DISCO UPON A DETERMINATION BY THE COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES THAT THE  APPLICANT  COMPLIES
WITH THE OPERATING REQUIREMENTS FOR A DISCO UNDER THIS SECTION.
  3.  APPLICATION  FOR CERTIFICATE OF AUTHORITY; FORM.  THE COMMISSIONER
AND THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES SHALL JOINTLY DEVELOP
APPLICATION FORMS FOR A CERTIFICATE OF AUTHORITY TO OPERATE A DISCO.  AN
ELIGIBLE APPLICANT SHALL SUBMIT AN  APPLICATION  FOR  A  CERTIFICATE  OF
AUTHORITY  TO  OPERATE A DISCO UPON FORMS PRESCRIBED BY SUCH COMMISSION-
ERS. SUCH ELIGIBLE APPLICANT SHALL SUBMIT INFORMATION AND  DOCUMENTATION
TO THE COMMISSIONER WHICH SHALL INCLUDE, BUT NOT BE LIMITED TO:
  (A)  A  DESCRIPTION  OF  THE SERVICE AREA PROPOSED TO BE SERVED BY THE
DISCO WITH PROJECTIONS OF ENROLLMENT THAT  WILL  RESULT  IN  A  FISCALLY
SOUND PLAN;
  (B) A DESCRIPTION OF THE SERVICES TO BE COVERED BY SUCH DISCO;
  (C)  A  DESCRIPTION  OF THE PROPOSED MARKETING PLAN, AND HOW MARKETING
MATERIALS WILL BE PRESENTED TO INDIVIDUALS WITH DEVELOPMENTAL  DISABILI-
TIES,  OR THEIR AUTHORIZED SURROGATES, FOR THE PURPOSES OF ENABLING THEM
TO MAKE AN INFORMED CHOICE;
  (D) THE NAMES OF THE PROVIDERS PROPOSED TO BE IN THE DISCO'S NETWORK;
  (E) EVIDENCE OF  THE  CHARACTER  AND  COMPETENCE  OF  THE  APPLICANT'S
PROPOSED OPERATORS;
  (F) ADEQUATE DOCUMENTATION OF THE APPROPRIATE LICENSES, CERTIFICATIONS
OR  APPROVALS TO PROVIDE CARE AS PLANNED, INCLUDING AFFILIATE AGREEMENTS
OR PROPOSED CONTRACTS WITH SUCH PROVIDERS AS MAY BE NECESSARY TO PROVIDE
THE FULL COMPLEMENT OF SERVICES  REQUIRED  TO  BE  PROVIDED  UNDER  THIS
SECTION;
  (G) A DESCRIPTION OF THE PROPOSED QUALITY-ASSURANCE MECHANISMS, GRIEV-
ANCE  PROCEDURES, MECHANISMS TO PROTECT THE RIGHTS OF ENROLLEES AND CARE
COORDINATION SERVICES TO ENSURE CONTINUITY, QUALITY, APPROPRIATENESS AND
COORDINATION OF CARE;
  (H) A DESCRIPTION OF THE PROPOSED QUALITY ASSESSMENT  AND  PERFORMANCE
IMPROVEMENT  PROGRAM THAT INCLUDES PERFORMANCE AND OUTCOME BASED QUALITY
STANDARDS  FOR  ENROLLEE  HEALTH  STATUS  AND  SATISFACTION,  AND   DATA
COLLECTION AND REPORTING FOR STANDARD PERFORMANCE MEASURES;
  (I)  A  DESCRIPTION  OF  THE MANAGEMENT SYSTEMS AND SYSTEMS TO PROCESS
PAYMENT FOR COVERED SERVICES;
  (J) A DESCRIPTION  OF  HOW  ACHIEVING  OF  PERSON-CENTERED  GOALS,  AS
DEFINED  BY  THE  COMMISSIONER  OF  DEVELOPMENTAL  DISABILITIES, WILL BE
ASSESSED; AS WELL AS A DESCRIPTION OF HOW HABILITATION SERVICES, INCLUD-
ING LONG TERM CARE SERVICES, WILL MEET SUCH GOALS;
  (K) A DESCRIPTION OF THE MECHANISM TO MAXIMIZE  REIMBURSEMENT  OF  AND
COORDINATE  SERVICES  REIMBURSED  PURSUANT TO TITLE XVIII OF THE FEDERAL
SOCIAL SECURITY ACT AND ALL OTHER APPLICABLE BENEFITS, WITH SUCH BENEFIT
COORDINATION INCLUDING, BUT NOT LIMITED TO, MEASURES  TO  SUPPORT  SOUND
CLINICAL  DECISIONS, REDUCE ADMINISTRATIVE COMPLEXITY, COORDINATE ACCESS
TO SERVICES, MAXIMIZE BENEFITS AVAILABLE  PURSUANT  TO  SUCH  TITLE  AND
ENSURE THAT NECESSARY CARE IS PROVIDED;
  (L)  A  DESCRIPTION  OF  THE  SYSTEMS FOR SECURING AND INTEGRATING ANY
POTENTIAL SOURCES OF FUNDING FOR SERVICES PROVIDED  BY  OR  THROUGH  THE

S. 2606--C                         42

ORGANIZATION,  INCLUDING,  BUT  NOT  LIMITED TO, FUNDING AVAILABLE UNDER
TITLES XVI, XVIII, XIX AND XX OF THE FEDERAL SOCIAL SECURITY ACT AND ALL
OTHER AVAILABLE SOURCES OF FUNDING;
  (M) A DESCRIPTION OF THE PROPOSED CONTRACTUAL ARRANGEMENTS FOR PROVID-
ERS OF HEALTH AND LONG TERM CARE SERVICES IN THE BENEFIT PACKAGE; AND
  (N) INFORMATION RELATED TO THE FINANCIAL CONDITION OF THE APPLICANT.
  4.  CERTIFICATE  OF  AUTHORITY  APPROVAL.   THE COMMISSIONER SHALL NOT
APPROVE AN APPLICATION FOR A CERTIFICATE OF AUTHORITY UNLESS THE  APPLI-
CANT  DEMONSTRATES  TO  THE  SATISFACTION  OF  THE  COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES:
  (A) THAT IT WILL HAVE IN  PLACE  ACCEPTABLE  QUALITY  ASSURANCE  MECH-
ANISMS,  GRIEVANCE  PROCEDURES  AND  MECHANISMS TO PROTECT THE RIGHTS OF
ENROLLEES AND CARE COORDINATION SERVICES TO ENSURE CONTINUITY,  QUALITY,
APPROPRIATENESS AND COORDINATION OF CARE;
  (B)  THAT  IT  WILL  HAVE IN PLACE A MECHANISM OR MEANS TO ASSURE THAT
INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES CAN MAKE  INFORMED  CHOICES,
EITHER INDEPENDENTLY OR THROUGH AN AUTHORIZED SURROGATE, ON ALL  MATTERS
PERTINENT  TO  A PERSON-CENTERED PLAN, AS DEFINED BY THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES, AND WITH RESPECT TO RELATED GOALS, SERVICES,
AND OBJECTIVES;
  (C) THAT  IT  HAS  DEVELOPED  A  QUALITY  ASSESSMENT  AND  PERFORMANCE
IMPROVEMENT  PROGRAM THAT INCLUDES PERFORMANCE AND OUTCOME BASED QUALITY
STANDARDS FOR ENROLLEE HEALTH STATUS AND SATISFACTION,  WHICH  SHALL  BE
REVIEWED BY THE COMMISSIONER AND THE COMMISSIONER OF DEVELOPMENTAL DISA-
BILITIES.  THE  PROGRAM  SHALL INCLUDE DATA COLLECTION AND REPORTING FOR
STANDARD PERFORMANCE MEASURES AS REQUIRED BY THE  COMMISSIONER  AND  THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES;
  (D)  THAT  AN  OTHERWISE  ELIGIBLE ENROLLEE SHALL NOT BE INVOLUNTARILY
DISENROLLED WITHOUT THE PRIOR APPROVAL OF THE COMMISSIONER  OF  DEVELOP-
MENTAL DISABILITIES;
  (E)  THAT  THE APPLICANT SHALL NOT USE DECEPTIVE OR COERCIVE MARKETING
METHODS TO ENCOURAGE PARTICIPANTS TO ENROLL AND THAT THE APPLICANT SHALL
NOT DISTRIBUTE MARKETING MATERIALS TO POTENTIAL  ENROLLEES  BEFORE  SUCH
MATERIALS HAVE BEEN APPROVED BY THE COMMISSIONER AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES;
  (F)  SATISFACTORY  EVIDENCE  OF  THE  CHARACTER  AND COMPETENCE OF THE
APPLICANT'S PROPOSED OPERATORS;
  (G) REASONABLE ASSURANCE THAT THE APPLICANT WILL PROVIDE HIGH  QUALITY
SERVICES  TO  AN  ENROLLED  POPULATION,  THAT THE APPLICANT'S NETWORK OF
PROVIDERS IS ADEQUATE AND THAT SUCH PROVIDERS HAVE  DEMONSTRATED  SUFFI-
CIENT  COMPETENCY TO DELIVER HIGH QUALITY SERVICES TO THE ENROLLED POPU-
LATION AND THAT POLICIES AND PROCEDURES WILL BE IN PLACE TO ADDRESS  THE
CULTURAL AND LINGUISTIC NEEDS OF THE ENROLLED POPULATION;
  (H) SUFFICIENT MANAGEMENT SYSTEMS CAPACITY TO MEET THE REQUIREMENTS OF
THIS  SECTION AND THE ABILITY TO EFFICIENTLY PROCESS PAYMENT FOR COVERED
SERVICES;
  (I) READINESS AND CAPABILITY TO MAXIMIZE REIMBURSEMENT OF AND  COORDI-
NATE  SERVICES  REIMBURSED PURSUANT TO TITLE XVIII OF THE FEDERAL SOCIAL
SECURITY ACT AND ALL OTHER APPLICABLE BENEFITS, WITH SUCH BENEFIT  COOR-
DINATION  INCLUDING, BUT NOT LIMITED TO, MEASURES TO SUPPORT SOUND CLIN-
ICAL DECISIONS, REDUCE ADMINISTRATIVE COMPLEXITY, COORDINATE  ACCESS  TO
SERVICES,  MAXIMIZE BENEFITS AVAILABLE PURSUANT TO SUCH TITLE AND ENSURE
THAT NECESSARY CARE IS PROVIDED;
  (J) READINESS AND CAPABILITY TO ARRANGE AND MANAGE COVERED SERVICES;
  (K) WILLINGNESS AND CAPABILITY OF TAKING, OR COOPERATING IN, ALL STEPS
NECESSARY TO SECURE AND INTEGRATE ANY POTENTIAL SOURCES OF  FUNDING  FOR

S. 2606--C                         43

SERVICES  PROVIDED  BY  OR THROUGH THE DISCO, INCLUDING, BUT NOT LIMITED
TO, FUNDING AVAILABLE UNDER TITLES XVI, XVIII, XIX AND XX OF THE FEDERAL
SOCIAL SECURITY ACT AND ALL OTHER AVAILABLE SOURCES OF FUNDING;
  (L) THAT THE CONTRACTUAL ARRANGEMENTS FOR PROVIDERS OF HEALTH AND LONG
TERM  CARE  SERVICES IN THE BENEFIT PACKAGE ARE SUFFICIENT TO ENSURE THE
AVAILABILITY AND ACCESSIBILITY OF SUCH SERVICES TO THE PROPOSED ENROLLED
POPULATION CONSISTENT WITH GUIDELINES ESTABLISHED  BY  THE  COMMISSIONER
AND THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES; AND
  (M)  THAT  THE  APPLICANT  IS  FINANCIALLY  RESPONSIBLE  AND  SHALL BE
EXPECTED TO MEET ITS OBLIGATIONS TO ITS ENROLLED MEMBERS.
  5. ENROLLMENT.  (A) ONLY PERSONS WITH DEVELOPMENTAL  DISABILITIES,  AS
DETERMINED  BY  THE  OFFICE  FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES,
SHALL BE ELIGIBLE TO ENROLL IN DISCOS.
  (B) THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES  OR  ITS
DESIGNEE  SHALL  ENROLL AN ELIGIBLE PERSON IN THE DISCO CHOSEN BY HIM OR
HER, HIS OR HER GUARDIAN OR OTHER LEGAL  REPRESENTATIVE,  PROVIDED  THAT
SUCH DISCO IS AUTHORIZED TO ENROLL SUCH PERSON.
  (C)  NO  PERSON  WITH  A  DEVELOPMENTAL DISABILITY WHO IS RECEIVING OR
APPLYING FOR MEDICAL ASSISTANCE AND WHO IS  RECEIVING,  OR  ELIGIBLE  TO
RECEIVE,  SERVICES  FUNDED,  CERTIFIED,  AUTHORIZED  OR  APPROVED BY THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL BE  REQUIRED  TO
ENROLL  IN  A  DISCO  IN  ORDER  TO  RECEIVE SUCH SERVICES UNTIL PROGRAM
FEATURES AND REIMBURSEMENT RATES ARE APPROVED BY  THE  COMMISSIONER  AND
THE  COMMISSIONER  OF DEVELOPMENTAL DISABILITIES, AND UNTIL SUCH COMMIS-
SIONERS DETERMINE THAT THERE ARE A SUFFICIENT NUMBER OF PLANS AUTHORIZED
TO COORDINATE  CARE  FOR  INDIVIDUALS  WITH  DEVELOPMENTAL  DISABILITIES
PURSUANT  TO  THIS ARTICLE OPERATING IN THE PERSON'S COUNTY OF RESIDENCE
TO MEET THE NEEDS OF PERSONS WITH DEVELOPMENTAL DISABILITIES,  AND  THAT
SUCH DISCOS MEET THE STANDARDS OF THIS SECTION.
  (D)  PERSONS  REQUIRED  TO  ENROLL  IN A DISCO SHALL HAVE NO LESS THAN
SIXTY DAYS TO SELECT A DISCO, AND SUCH PERSONS AND  THEIR  GUARDIANS  OR
OTHER  LEGAL  REPRESENTATIVES SHALL BE PROVIDED WITH INFORMATION TO MAKE
AN INFORMED CHOICE. WHERE A PERSON, GUARDIAN OR  OTHER  LEGAL  REPRESEN-
TATIVE HAS NOT SELECTED A DISCO, THE COMMISSIONER OF DEVELOPMENTAL DISA-
BILITIES  OR  ITS DESIGNEE SHALL ENROLL SUCH PERSON IN A DISCO CHOSEN BY
SUCH COMMISSIONER, TAKING INTO ACCOUNT QUALITY, CAPACITY AND  GEOGRAPHIC
ACCESSIBILITY.  THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES OR
ITS DESIGNEE SHALL AUTOMATICALLY RE-ENROLL A PERSON WITH THE SAME  DISCO
IF THERE IS A LOSS OF MEDICAID ELIGIBILITY OF TWO MONTHS OR LESS.
  (E)  ENROLLED  PERSONS MAY CHANGE THEIR ENROLLMENT AT ANY TIME WITHOUT
CAUSE, PROVIDED, HOWEVER, THAT A PERSON REQUIRED TO ENROLL IN A DISCO IN
ORDER TO RECEIVE SERVICES FUNDED, LICENSED, AUTHORIZED  OR  APPROVED  BY
THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES MAY ONLY DISENROLL
FROM  A DISCO IF HE OR SHE ENROLLS IN ANOTHER DISCO AUTHORIZED TO ENROLL
HIM OR HER.  SUCH DISENROLLMENT SHALL BE EFFECTIVE  NO  LATER  THAN  THE
FIRST DAY OF THE SECOND MONTH FOLLOWING THE REQUEST.
  (F)  A  DISCO MAY REQUEST THE INVOLUNTARY DISENROLLMENT OF AN ENROLLED
PERSON IN WRITING TO THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL  DISABILI-
TIES.  SUCH  DISENROLLMENT  SHALL  NOT BE EFFECTIVE UNTIL THE REQUEST IS
REVIEWED AND APPROVED BY SUCH OFFICE. THE DEPARTMENT AND THE OFFICE  FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL ADOPT RULES AND REGULATIONS
GOVERNING THIS PROCESS.
  6.  ASSESSMENTS.    THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILI-
TIES, OR ITS DESIGNEE, SHALL COMPLETE A  COMPREHENSIVE  ASSESSMENT  THAT
SHALL  INCLUDE,  BUT  NOT  BE  LIMITED TO, AN EVALUATION OF THE MEDICAL,
SOCIAL, HABILITATIVE AND ENVIRONMENTAL NEEDS OF EACH PROSPECTIVE  ENROL-

S. 2606--C                         44

LEE  IN A DISCO AS SUCH NEEDS RELATE TO EACH INDIVIDUAL'S HEALTH, SAFETY
AND ABILITY TO LIVE IN THE MOST INTEGRATED SETTING APPROPRIATE  TO  THAT
PERSON'S  NEEDS.   THIS ASSESSMENT SHALL ALSO SERVE AS THE BASIS FOR THE
DEVELOPMENT  AND PROVISION OF AN APPROPRIATE PLAN OF CARE FOR THE ENROL-
LEE.   SUCH PLAN  OF  CARE  SHALL  BE  FOCUSED  ON  THE  ACHIEVEMENT  OF
PERSON-CENTERED GOALS AND SHALL BE CONSISTENT WITH, AND HELP INFORM, ANY
OTHER PERSON-CENTERED PLAN REQUIRED FOR THE ENROLLEE BY THE COMMISSIONER
OF DEVELOPMENTAL DISABILITIES.  THE ASSESSMENT SHALL BE COMPLETED BY THE
OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL DISABILITIES OR ITS DESIGNEE IN
CONSULTATION WITH THE PROSPECTIVE ENROLLEE'S HEALTH CARE PRACTITIONER AS
NECESSARY.  THE  COMMISSIONER  OF   DEVELOPMENTAL   DISABILITIES   SHALL
PRESCRIBE  THE  FORMS  ON WHICH THE ASSESSMENT SHALL BE MADE. THE OFFICE
FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES MAY DESIGNATE  THE  DISCO  TO
PERFORM SUCH ASSESSMENTS.
  7. PROGRAM OVERSIGHT AND ADMINISTRATION.  (A) THE COMMISSIONER AND THE
COMMISSIONER  OF  DEVELOPMENTAL  DISABILITIES  SHALL  JOINTLY PROMULGATE
REGULATIONS TO IMPLEMENT THIS  SECTION,  TO  PROVIDE  FOR  OVERSIGHT  OF
DISCOS,  INCLUDING ON SITE REVIEWS, AND TO ENSURE THE QUALITY, APPROPRI-
ATENESS AND COST-EFFECTIVENESS OF THE SERVICES PROVIDED BY DISCOS.
  (B) THE COMMISSIONER AND THE COMMISSIONER OF  DEVELOPMENTAL  DISABILI-
TIES  MAY  WAIVE RULES AND REGULATIONS OF THEIR RESPECTIVE DEPARTMENT OR
OFFICE, INCLUDING BUT NOT LIMITED TO, THOSE  PERTAINING  TO  DUPLICATIVE
REQUIREMENTS  CONCERNING  RECORD  KEEPING, BOARDS OF DIRECTORS, STAFFING
AND REPORTING, WHEN SUCH WAIVER WILL PROMOTE THE EFFICIENT  DELIVERY  OF
APPROPRIATE, QUALITY, COST-EFFECTIVE SERVICES AND WHEN THE HEALTH, SAFE-
TY  AND  GENERAL  WELFARE  OF  DISCO ENROLLEES WILL NOT BE IMPAIRED AS A
RESULT OF SUCH WAIVER.  THE COMMISSIONERS WILL REPORT  ANNUALLY  TO  THE
LEGISLATURE,  AND  TO THE JOINT ADVISORY COUNCIL ESTABLISHED PURSUANT TO
PARAGRAPH F OF THIS SUBDIVISION, ON ALL  RULES  AND  REGULATIONS  WAIVED
PURSUANT TO THIS PARAGRAPH, AND ON THE ESTIMATED COST SAVINGS AND QUALI-
TY  IMPROVEMENTS  THAT  THE  WAIVER  OF  SUCH  RULES AND REGULATIONS ARE
EXPECTED TO PRODUCE.  IN ORDER TO ACHIEVE DISCO SYSTEM EFFICIENCIES  AND
COORDINATION  AND  TO PROMOTE THE OBJECTIVES OF HIGH QUALITY, INTEGRATED
AND COST EFFECTIVE CARE, THE  COMMISSIONERS  SHALL  ESTABLISH  A  SINGLE
COORDINATED  SURVEILLANCE  PROCESS,  ALLOW  FOR  A COMPREHENSIVE QUALITY
IMPROVEMENT AND REVIEW PROCESS TO MEET COMPONENT  QUALITY  REQUIREMENTS,
AND  REQUIRE  A  UNIFORM  COST REPORT.   THE COMMISSIONERS SHALL REQUIRE
DISCOS TO UTILIZE QUALITY IMPROVEMENT MEASURES, BASED ON THE ACHIEVEMENT
OF PERSONAL OUTCOMES AND QUALITY OF  LIFE,  HEALTH  OUTCOMES  DATA,  AND
ASSESSMENTS  OF  CONSUMERS AND FAMILY SATISFACTION, FOR INTERNAL QUALITY
ASSESSMENT PROCESSES AND MAY UTILIZE SUCH MEASURES AS PART OF THE SINGLE
COORDINATED SURVEILLANCE PROCESS.
  (B-1) THE COMMISSIONER AND THE COMMISSIONER OF THE OFFICE OF  DEVELOP-
MENTAL  DISABILITIES,  IN  CONSULTATION  WITH THE JOINT ADVISORY COUNCIL
ESTABLISHED PURSUANT TO PARAGRAPH F OF THIS SUBDIVISION, SHALL  IDENTIFY
A  VALID AND RELIABLE QUALITY ASSURANCE INSTRUMENT THAT INCLUDES ASSESS-
MENTS OF CONSUMER AND FAMILY SATISFACTION, PROVISION  OF  SERVICES,  AND
PERSONAL  OUTCOMES.  THE INSTRUMENT SHALL INCLUDE OUTCOME-BASED MEASURES
SUCH AS HEALTH, SAFETY,  WELL-BEING,  RELATIONSHIPS,  INTERACTIONS  WITH
PEOPLE  WHO DO NOT HAVE A DISABILITY, EMPLOYMENT, QUALITY OF LIFE, INTE-
GRATION, CHOICE, SERVICE AND CONSUMER SATISFACTION.
  (C) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THE SOCIAL  SERVICES
LAW  TO  THE CONTRARY, THE COMMISSIONER IN CONSULTATION WITH THE COMMIS-
SIONER OF DEVELOPMENTAL  DISABILITIES  SHALL,  PURSUANT  TO  REGULATION,
DETERMINE  WHETHER  AND THE EXTENT TO WHICH THE APPLICABLE PROVISIONS OF
THE SOCIAL SERVICES LAW OR REGULATIONS RELATING TO APPROVALS AND AUTHOR-

S. 2606--C                         45

IZATIONS OF, AND UTILIZATION LIMITATIONS ON, HEALTH AND LONG  TERM  CARE
SERVICES REIMBURSED PURSUANT TO TITLE XIX OF THE FEDERAL SOCIAL SECURITY
ACT  ARE  INCONSISTENT  WITH THE FLEXIBILITY NECESSARY FOR THE EFFICIENT
ADMINISTRATION  OF  DISCOS, AND SUCH REGULATIONS SHALL PROVIDE THAT SUCH
PROVISIONS SHALL NOT BE APPLICABLE TO ENROLLEES OF DISCOS, PROVIDED THAT
SUCH DETERMINATIONS ARE CONSISTENT WITH APPLICABLE FEDERAL LAW AND REGU-
LATION.
  (D) THE COMMISSIONER AND THE COMMISSIONER OF  DEVELOPMENTAL  DISABILI-
TIES SHALL ENSURE, THROUGH PERIODIC REVIEWS OF DISCOS, THAT ORGANIZATION
SERVICES  ARE  PROMPTLY  AVAILABLE  TO  ENROLLEES WHEN APPROPRIATE. SUCH
PERIODIC REVIEWS SHALL BE MADE ACCORDING TO STANDARDS AS  DETERMINED  BY
THE COMMISSIONERS IN REGULATIONS.
  (E)  THE  COMMISSIONER AND THE COMMISSIONER OF DEVELOPMENTAL DISABILI-
TIES SHALL HAVE THE AUTHORITY TO CONDUCT  BOTH  ON  SITE  AND  OFF  SITE
REVIEWS OF DISCOS.  SUCH REVIEWS MAY INCLUDE, BUT NOT BE LIMITED TO, THE
FOLLOWING   COMPONENTS:  GOVERNANCE;  FISCAL  AND  FINANCIAL  REPORTING;
RECORDKEEPING; INTERNAL CONTROLS;  MARKETING;  NETWORK  CONTRACTING  AND
ADEQUACY;  PROGRAM  INTEGRITY ASSURANCES; UTILIZATION CONTROL AND REVIEW
SYSTEMS; GRIEVANCE AND APPEALS SYSTEMS; QUALITY ASSESSMENT AND ASSURANCE
SYSTEMS;  CARE  MANAGEMENT;  ENROLLMENT  AND  DISENROLLMENT;  MANAGEMENT
INFORMATION SYSTEMS, AND OTHER OPERATIONAL AND MANAGEMENT COMPONENTS.
  (F)  JOINT  ADVISORY  COUNCIL. THERE SHALL BE A JOINT ADVISORY COUNCIL
CHAIRED BY THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES  COMPRISED  OF
TWELVE  MEMBERS,  INCLUDING  FAMILY MEMBERS OF PEOPLE WITH DEVELOPMENTAL
DISABILITIES, DEVELOPMENTAL DISABILITIES  PROVIDERS,  AND  DEVELOPMENTAL
DISABILITIES  ADVOCATES,  INCLUDING  SELF  ADVOCATES. THE JOINT ADVISORY
COUNCIL SHALL MEET MONTHLY TO REVIEW ALL MANAGED CARE  OPTIONS  PROVIDED
TO  INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES CONCERNING: THE ADEQUACY
OF HABILITATION SERVICES OFFERED; THE RECORD OF COMPLIANCE WITH  PERSON-
CENTERED  CARE  PLANS;  THE ADEQUACY OF RATES; THE STATUS OF PERSON-CEN-
TERED SERVICES AND COMMUNITY INTEGRATION; THE STATUS OF  THE  TRANSITION
OF  SERVICES  OVERSEEN BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISA-
BILITIES TO MANAGED CARE; AND ALL OTHER MATTERS  OF  IMPORTANCE  TO  THE
QUALITY OF LIFE, HEALTH, SAFETY AND COMMUNITY INTEGRATION OF INDIVIDUALS
WITH  DEVELOPMENTAL  DISABILITIES  ENROLLED IN MANAGED CARE.   THE JOINT
ADVISORY COUNCIL SHALL SUBMIT QUARTERLY REPORTS ON ITS FINDINGS, CONCLU-
SIONS,  RECOMMENDATIONS,  AND  ANY  PROPOSED  AMENDMENTS  TO   PERTINENT
SECTIONS  OF THE LAW TO THE GOVERNOR, SENATE MAJORITY LEADER AND SPEAKER
OF THE ASSEMBLY.
  8. SOLVENCY.  (A) THE COMMISSIONER, IN CONSULTATION WITH  THE  COMMIS-
SIONER  OF DEVELOPMENTAL DISABILITIES, SHALL BE RESPONSIBLE FOR EVALUAT-
ING, APPROVING AND REGULATING ALL MATTERS RELATING TO  FISCAL  SOLVENCY,
INCLUDING  RESERVES,  SURPLUS  AND  PROVIDER CONTRACTS. THE COMMISSIONER
SHALL PROMULGATE REGULATIONS TO IMPLEMENT THIS SECTION. THE  COMMISSION-
ER, IN THE ADMINISTRATION OF THIS SUBDIVISION:
  (I)  SHALL  BE GUIDED BY THE STANDARDS THAT GOVERN THE FISCAL SOLVENCY
OF A  HEALTH  MAINTENANCE  ORGANIZATION,  PROVIDED,  HOWEVER,  THAT  THE
COMMISSIONER  SHALL  RECOGNIZE  THE SPECIFIC DELIVERY COMPONENTS, OPERA-
TIONAL CAPACITY AND FINANCIAL CAPABILITY OF THE ELIGIBLE APPLICANT FOR A
CERTIFICATE OF AUTHORITY;
  (II) SHALL NOT APPLY FINANCIAL SOLVENCY STANDARDS  THAT  EXCEED  THOSE
REQUIRED FOR A HEALTH MAINTENANCE ORGANIZATION; AND
  (III) SHALL ESTABLISH REASONABLE CAPITALIZATION AND CONTINGENT RESERVE
REQUIREMENTS.
  (B)  STANDARDS  ESTABLISHED  PURSUANT  TO  THIS  SUBDIVISION  SHALL BE
ADEQUATE TO PROTECT THE INTERESTS OF ENROLLEES IN THE DISCO. THE COMMIS-

S. 2606--C                         46

SIONER SHALL BE SATISFIED THAT THE  ELIGIBLE  APPLICANT  IS  FINANCIALLY
SOUND, AND HAS MADE ADEQUATE PROVISIONS TO PAY FOR QUALITY SERVICES THAT
ARE  COST  EFFECTIVE  AND APPROPRIATE TO NEEDS AND THE PROTECTION OF THE
HEALTH, SAFETY, WELFARE AND SATISFACTION OF THOSE SERVED.
  9.  ROLE  OF THE SUPERINTENDENT OF FINANCIAL SERVICES.  (A) THE SUPER-
INTENDENT OF FINANCIAL SERVICES SHALL DETERMINE AND APPROVE PREMIUMS  IN
ACCORDANCE  WITH  THE INSURANCE LAW WHENEVER ANY POPULATION OF ENROLLEES
NOT ELIGIBLE UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT IS TO BE
COVERED. THE DETERMINATION AND APPROVAL OF THE SUPERINTENDENT OF  FINAN-
CIAL  SERVICES  SHALL  RELATE  TO PREMIUMS CHARGED TO SUCH ENROLLEES NOT
ELIGIBLE UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT.
  (B) THE  SUPERINTENDENT  OF  FINANCIAL  SERVICES  SHALL  EVALUATE  AND
APPROVE  ANY  ENROLLEE CONTRACTS WHENEVER SUCH ENROLLEE CONTRACTS ARE TO
COVER ANY POPULATION OF ENROLLEES NOT ELIGIBLE UNDER TITLE  XIX  OF  THE
FEDERAL SOCIAL SECURITY ACT.
  10. PAYMENT RATES FOR DISCO ENROLLEES ELIGIBLE FOR MEDICAL ASSISTANCE.
THE  COMMISSIONER SHALL ESTABLISH PAYMENT RATES FOR SERVICES PROVIDED TO
ENROLLEES ELIGIBLE UNDER TITLE XIX OF THE FEDERAL SOCIAL  SECURITY  ACT.
SUCH  PAYMENT  RATES SHALL BE SUBJECT TO APPROVAL BY THE DIRECTOR OF THE
DIVISION OF THE BUDGET.  PAYMENT RATES SHALL BE  RISK-ADJUSTED  TO  TAKE
INTO  ACCOUNT  THE  CHARACTERISTICS OF ENROLLEES, OR PROPOSED ENROLLEES,
INCLUDING, BUT NOT LIMITED TO:   FRAILTY, DISABILITY LEVEL,  HEALTH  AND
FUNCTIONAL  STATUS, AGE, GENDER, THE NATURE OF SERVICES PROVIDED TO SUCH
ENROLLEES, AND OTHER FACTORS AS DETERMINED BY THE COMMISSIONER  AND  THE
COMMISSIONER  OF  DEVELOPMENTAL DISABILITIES. THE RISK ADJUSTED PREMIUMS
MAY ALSO BE COMBINED WITH  DISINCENTIVES  OR  REQUIREMENTS  DESIGNED  TO
MITIGATE ANY INCENTIVES TO OBTAIN HIGHER PAYMENT CATEGORIES.
  11.  CONTINUATION  OF  CERTIFICATE  OF  AUTHORITY.   CONTINUATION OF A
CERTIFICATE OF AUTHORITY ISSUED UNDER THIS SECTION SHALL  BE  CONTINGENT
UPON  COMPLIANCE BY THE DISCO WITH APPLICABLE PROVISIONS OF THIS SECTION
AND RULES AND REGULATIONS PROMULGATED THEREUNDER; THE CONTINUING  FISCAL
SOLVENCY  OF  THE DISCO; AND FEDERAL FINANCIAL PARTICIPATION IN PAYMENTS
ON BEHALF OF ENROLLEES WHO ARE ELIGIBLE TO RECEIVE SERVICES UNDER  TITLE
XIX OF THE FEDERAL SOCIAL SECURITY ACT.
  12.  PROTECTION  OF  ENROLLEES.    THE COMMISSIONER MAY, IN HIS OR HER
DISCRETION AND WITH THE CONCURRENCE OF THE COMMISSIONER OF DEVELOPMENTAL
DISABILITIES, FOR THE PURPOSE OF THE  PROTECTION  OF  ENROLLEES,  IMPOSE
MEASURES INCLUDING, BUT NOT LIMITED TO BANS ON FURTHER ENROLLMENTS UNTIL
ANY  IDENTIFIED PROBLEMS ARE RESOLVED TO THE SATISFACTION OF THE COMMIS-
SIONER, OR FINES UPON A FINDING THAT THE DISCO HAS FAILED TO COMPLY WITH
THE PROVISIONS OF ANY APPLICABLE STATUTE, RULE OR REGULATION.
  13. INFORMATION SHARING.   THE COMMISSIONER AND  THE  COMMISSIONER  OF
DEVELOPMENTAL  DISABILITIES  SHALL,  AS  NECESSARY  AND  CONSISTENT WITH
FEDERAL REGULATIONS PROMULGATED PURSUANT TO THE HEALTH INSURANCE  PORTA-
BILITY  AND ACCOUNTABILITY ACT, SHARE WITH SUCH DISCO THE FOLLOWING DATA
IF IT IS AVAILABLE:
  (A) INFORMATION CONCERNING UTILIZATION OF SERVICES  AND  PROVIDERS  BY
EACH OF ITS ENROLLEES PRIOR TO AND DURING ENROLLMENT.
  (B)  AGGREGATE DATA CONCERNING UTILIZATION AND COSTS FOR ENROLLEES AND
FOR COMPARABLE  COHORTS  SERVED  THROUGH  THE  MEDICAID  FEE-FOR-SERVICE
PROGRAM.
  14.  CONTRACTS.    NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS
SECTION AND SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED  SIXTY-THREE  OF
THE  STATE  FINANCE  LAW,  THE  COMMISSIONER,  IN  CONSULTATION WITH THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES,  MAY  CONTRACT  WITH  DISCOS
APPROVED  UNDER  THIS  SECTION  WITHOUT A COMPETITIVE BID OR REQUEST FOR

S. 2606--C                         47

PROPOSAL PROCESS, TO PROVIDE COVERAGE FOR  ENROLLEES  PURSUANT  TO  THIS
SECTION. NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS SECTION AND
SECTION  ONE  HUNDRED  FORTY-THREE  OF  THE ECONOMIC DEVELOPMENT LAW, NO
NOTICE IN THE PROCUREMENT OPPORTUNITIES NEWSLETTER SHALL BE REQUIRED FOR
CONTRACTS  AWARDED  BY  THE COMMISSIONER TO QUALIFIED DISCOS PURSUANT TO
THIS SECTION.
  15. APPLICABILITY OF OTHER LAWS.   DISCOS  SHALL  BE  SUBJECT  TO  THE
PROVISIONS  OF  THE  INSURANCE  LAW AND REGULATIONS APPLICABLE TO HEALTH
MAINTENANCE ORGANIZATIONS,  THIS  ARTICLE  AND  REGULATIONS  PROMULGATED
THEREUNDER. TO THE EXTENT THAT THE PROVISIONS OF THIS SECTION ARE INCON-
SISTENT  WITH  THE  PROVISIONS  OF THIS CHAPTER OR THE PROVISIONS OF THE
INSURANCE LAW, THE PROVISIONS OF THIS SECTION SHALL PREVAIL.
  16. EFFECTIVENESS. THE PROVISIONS OF THIS SECTION SHALL ONLY BE EFFEC-
TIVE IF, FOR SO LONG AS,  AND  TO  THE  EXTENT  THAT  FEDERAL  FINANCIAL
PARTICIPATION  IS  AVAILABLE  FOR  THE COSTS OF SERVICES PROVIDED BY THE
DISCOS TO ENROLLEES WHO ARE RECIPIENTS OF MEDICAL ASSISTANCE PURSUANT TO
TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. THE COMMISSION-
ER SHALL MAKE ANY NECESSARY AMENDMENTS TO THE  STATE  PLAN  FOR  MEDICAL
ASSISTANCE  SUBMITTED PURSUANT TO SECTION THREE HUNDRED SIXTY-THREE-A OF
THE SOCIAL SERVICES LAW, IN  ORDER  TO  ENSURE  SUCH  FEDERAL  FINANCIAL
PARTICIPATION.
  S 74. Section 4403 of the public health law is amended by adding a new
subdivision 8 to read as follows:
  8.  NOTWITHSTANDING  ANY  PROVISION  OF  LAW TO THE CONTRARY, A HEALTH
MAINTENANCE ORGANIZATION MAY EXPAND ITS  COMPREHENSIVE  HEALTH  SERVICES
PLAN  TO  INCLUDE  SERVICES  OPERATED,  CERTIFIED, FUNDED, AUTHORIZED OR
APPROVED BY THE  OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES,
INCLUDING  HABILITATION SERVICES AS DEFINED IN PARAGRAPH (C) OF SUBDIVI-
SION ONE OF SECTION FORTY-FOUR HUNDRED THREE-G OF THIS CHAPTER, AND  MAY
OFFER  SUCH  EXPANDED PLAN TO A POPULATION OF PERSONS WITH DEVELOPMENTAL
DISABILITIES, AS SUCH TERM IS DEFINED IN THE MENTAL HYGIENE LAW, SUBJECT
TO THE FOLLOWING:
  (A) SUCH ORGANIZATION SHALL HAVE THE ABILITY TO PROVIDE OR  COORDINATE
SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, AS DEMONSTRATED BY
CRITERIA  TO  BE  DETERMINED BY THE COMMISSIONER AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES;
  (B) THE PROVISION BY SUCH ORGANIZATION OF  SERVICES  OPERATED,  CERTI-
FIED,  FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE OFFICE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES SHALL BE SUBJECT TO THE JOINT  OVERSIGHT  AND
REVIEW  OF  BOTH  THE DEPARTMENT AND THE OFFICE FOR PEOPLE WITH DEVELOP-
MENTAL DISABILITIES;
  (C) SUCH ORGANIZATION SHALL NOT PROVIDE OR ARRANGE FOR SERVICES  OPER-
ATED, CERTIFIED, FUNDED, AUTHORIZED OR APPROVED BY THE OFFICE FOR PEOPLE
WITH  DEVELOPMENTAL DISABILITIES UNTIL THE COMMISSIONER AND COMMISSIONER
OF DEVELOPMENTAL DISABILITIES APPROVE PROGRAM FEATURES  AND  RATES  THAT
INCLUDE  SUCH  SERVICES,  AND DETERMINE THAT SUCH ORGANIZATION MEETS THE
REQUIREMENTS OF THIS PARAGRAPH;
  (D) AN OTHERWISE ELIGIBLE ENROLLEE RECEIVING SERVICES THROUGH THE PLAN
THAT ARE OPERATED, CERTIFIED, FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT BE INVOLUN-
TARILY DISENROLLED FROM SUCH PLAN WITHOUT  THE  PRIOR  APPROVAL  OF  THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES;
  (E) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL DETER-
MINE  THE ELIGIBILITY OF INDIVIDUALS RECEIVING SERVICES OPERATED, CERTI-
FIED, FUNDED, AUTHORIZED OR APPROVED BY SUCH OFFICE TO ENROLL IN SUCH  A

S. 2606--C                         48

PLAN  AND  SHALL  ENROLL  INDIVIDUALS IT DETERMINES ELIGIBLE IN THE PLAN
CHOSEN BY SUCH INDIVIDUAL, GUARDIAN OR OTHER LEGAL REPRESENTATIVE;
  (F) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, OR IF IT SO
DESIGNATES, THE HEALTH MAINTENANCE ORGANIZATION OR OTHER DESIGNEE, SHALL
COMPLETE  A COMPREHENSIVE ASSESSMENT FOR ENROLLEES THAT RECEIVE SERVICES
OPERATED, CERTIFIED, FUNDED, AUTHORIZED  OR  APPROVED  BY  SUCH  OFFICE.
THIS  ASSESSMENT  SHALL INCLUDE, BUT NOT BE LIMITED TO, AN EVALUATION OF
THE MEDICAL, SOCIAL,  HEALTH,  SAFETY,  ENVIRONMENTAL  AND  HABILITATIVE
NEEDS  OF EACH PROSPECTIVE ENROLLEE. THIS ASSESSMENT SHALL ALSO SERVE AS
THE BASIS FOR THE DEVELOPMENT AND PROVISION OF AN  APPROPRIATE  PLAN  OF
CARE FOR THE ENROLLEE.  THE ASSESSMENT SHALL BE COMPLETED BY SUCH OFFICE
OR  ITS DESIGNEE, IN CONSULTATION WITH THE PROSPECTIVE ENROLLEE'S HEALTH
CARE PRACTITIONER AS NECESSARY.  THE COMMISSIONER OF DEVELOPMENTAL DISA-
BILITIES SHALL PRESCRIBE THE FORMS ON  WHICH  THE  ASSESSMENT  SHALL  BE
MADE;
  (G)  NO  PERSON  WITH  A DEVELOPMENTAL DISABILITY SHALL BE REQUIRED TO
ENROLL IN A COMPREHENSIVE HEALTH SERVICES PLAN AS A CONDITION OF RECEIV-
ING MEDICAL ASSISTANCE AND SERVICES OPERATED, CERTIFIED, FUNDED, AUTHOR-
IZED OR APPROVED BY THE OFFICE FOR PEOPLE WITH  DEVELOPMENTAL  DISABILI-
TIES  UNTIL PROGRAM FEATURES AND REIMBURSEMENT RATES ARE APPROVED BY THE
COMMISSIONER AND THE  COMMISSIONER  OF  DEVELOPMENTAL  DISABILITIES  AND
UNTIL SUCH COMMISSIONERS DETERMINE THAT THERE ARE A SUFFICIENT NUMBER OF
PLANS  AUTHORIZED  TO COORDINATE CARE FOR INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES PURSUANT TO THIS ARTICLE OPERATING IN THE  PERSON'S  COUNTY
OF  RESIDENCE  TO MEET THE NEEDS OF PERSONS WITH DEVELOPMENTAL DISABILI-
TIES, AND THAT SUCH PLANS MEET THE STANDARDS OF THIS SECTION; AND
  (H) THE PROVISIONS OF THIS SUBDIVISION SHALL ONLY BE EFFECTIVE IF, FOR
SO LONG AS, AND TO THE EXTENT THAT FEDERAL  FINANCIAL  PARTICIPATION  IS
AVAILABLE  FOR THE COSTS OF SERVICES PROVIDED HEREUNDER TO RECIPIENTS OF
MEDICAL ASSISTANCE PURSUANT TO TITLE  ELEVEN  OF  ARTICLE  FIVE  OF  THE
SOCIAL  SERVICES  LAW.  THE COMMISSIONER SHALL MAKE ANY NECESSARY AMEND-
MENTS TO THE STATE PLAN FOR MEDICAL  ASSISTANCE  SUBMITTED  PURSUANT  TO
SECTION  THREE  HUNDRED SIXTY-THREE-A OF THE SOCIAL SERVICES LAW, AND/OR
SUBMIT ONE OR MORE APPLICATIONS FOR WAIVERS OF THE FEDERAL SOCIAL  SECU-
RITY  ACT,  AS MAY BE NECESSARY TO ENSURE SUCH FEDERAL FINANCIAL PARTIC-
IPATION. TO THE EXTENT THAT  THE  PROVISIONS  OF  THIS  SUBDIVISION  ARE
INCONSISTENT   WITH  OTHER  PROVISIONS  OF  THIS  ARTICLE  OR  WITH  THE
PROVISIONS OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL  SERVICES
LAW, THE PROVISIONS OF THIS SUBDIVISION SHALL PREVAIL.
  S  75.  The  opening  paragraph  of  paragraph (h) of subdivision 7 of
section 4403-f of the public health law, as amended by section  41-b  of
part H of chapter 59 of the laws of 2011, is amended to read as follows:
  The commissioner AND, IN THE CASE OF A PLAN ARRANGING FOR OR PROVIDING
SERVICES  OPERATED,  CERTIFIED,  FUNDED,  AUTHORIZED  OR APPROVED BY THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, THE  COMMISSIONER  OF
DEVELOPMENTAL  DISABILITIES,  shall, upon request by a managed long term
care plan or operating demonstration, and consistent with federal  regu-
lations  promulgated  pursuant  to  the Health Insurance Portability and
Accountability Act, share with such plan or demonstration the  following
data if it is available:
  S  76.  Section  4403-f  of the public health law is amended by adding
three new subdivisions 12, 13 and 14 to read as follows:
  12. NOTWITHSTANDING ANY PROVISION TO THE CONTRARY, A MANAGED LONG TERM
CARE PLAN MAY EXPAND THE SERVICES IT PROVIDES OR ARRANGES FOR TO INCLUDE
SERVICES OPERATED, CERTIFIED, FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR  PEOPLE  WITH DEVELOPMENTAL DISABILITIES FOR A POPULATION OF

S. 2606--C                         49

PERSONS WITH DEVELOPMENTAL DISABILITIES, AS SUCH TERM IS DEFINED IN  THE
MENTAL  HYGIENE LAW, INCLUDING HABILITATIVE SERVICES AS DEFINED IN PARA-
GRAPH (C) OF SUBDIVISION ONE OF SECTION FORTY-FOUR  HUNDRED  THREE-G  OF
THIS CHAPTER, SUBJECT TO THE FOLLOWING:
  (A) SUCH PLAN SHALL HAVE THE ABILITY TO PROVIDE OR COORDINATE SERVICES
FOR  PERSONS WITH DEVELOPMENTAL DISABILITIES AS DEMONSTRATED BY CRITERIA
TO BE DETERMINED BY THE COMMISSIONER AND THE  COMMISSIONER  OF  DEVELOP-
MENTAL DISABILITIES;
  (B)  THE PROVISION BY SUCH PLAN OF SERVICES OPERATED, CERTIFIED, FUND-
ED, AUTHORIZED OR APPROVED BY THE OFFICE FOR PEOPLE  WITH  DEVELOPMENTAL
DISABILITIES  SHALL BE SUBJECT TO THE JOINT OVERSIGHT AND REVIEW OF BOTH
THE DEPARTMENT AND THE OFFICE FOR PEOPLE  WITH  DEVELOPMENTAL  DISABILI-
TIES;
  (C)  SUCH  PLAN  SHALL  NOT  PROVIDE OR ARRANGE FOR SERVICES OPERATED,
CERTIFIED, FUNDED, AUTHORIZED OR APPROVED BY THE OFFICE FOR PEOPLE  WITH
DEVELOPMENTAL  DISABILITIES  UNTIL  THE COMMISSIONER AND COMMISSIONER OF
DEVELOPMENTAL DISABILITIES  APPROVE  PROGRAM  FEATURES  AND  RATES  THAT
INCLUDE  SUCH  SERVICES,  AND DETERMINE THAT SUCH ORGANIZATION MEETS THE
REQUIREMENTS OF THIS SUBDIVISION;
  (D) AN OTHERWISE ELIGIBLE ENROLLEE RECEIVING SERVICES THROUGH THE PLAN
THAT ARE OPERATED, CERTIFIED, FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT BE INVOLUN-
TARILY DISENROLLED FROM SUCH PLAN WITHOUT  THE  PRIOR  APPROVAL  OF  THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES;
  (E) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL DETER-
MINE  THE ELIGIBILITY OF INDIVIDUALS RECEIVING SERVICES OPERATED, CERTI-
FIED, FUNDED, AUTHORIZED OR APPROVED BY SUCH OFFICE TO ENROLL IN SUCH  A
PLAN.  SUCH  OFFICE OR ITS DESIGNEE SHALL ENROLL ELIGIBLE INDIVIDUALS IT
DETERMINES ELIGIBLE IN A PLAN CHOSEN BY  SUCH  INDIVIDUAL,  GUARDIAN  OR
OTHER LEGAL REPRESENTATIVE;
  (F) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, OR IF IT SO
DESIGNATES,  A  PLAN  OR  OTHER DESIGNEE, SHALL COMPLETE A COMPREHENSIVE
ASSESSMENT FOR ENROLLEES WHO RECEIVE SERVICES OPERATED, CERTIFIED, FUND-
ED, AUTHORIZED OR APPROVED  BY  SUCH  OFFICE.    THIS  ASSESSMENT  SHALL
INCLUDE,  BUT  NOT  BE LIMITED TO, AN EVALUATION OF THE MEDICAL, SOCIAL,
HABILITATIVE AND ENVIRONMENTAL NEEDS OF EACH PROSPECTIVE ENROLLEE.  THIS
ASSESSMENT SHALL ALSO  SERVE  AS  THE  BASIS  FOR  THE  DEVELOPMENT  AND
PROVISION  OF AN APPROPRIATE PLAN OF CARE FOR THE ENROLLEE.  THE COMMIS-
SIONER OF DEVELOPMENTAL DISABILITIES SHALL PRESCRIBE THE FORMS ON  WHICH
THE ASSESSMENT SHALL BE MADE; AND
  (G)  NO  PERSON  WITH  A DEVELOPMENTAL DISABILITY SHALL BE REQUIRED TO
ENROLL IN A MANAGED LONG TERM CARE PLAN  AS  A  CONDITION  OF  RECEIVING
MEDICAL  ASSISTANCE AND SERVICES OPERATED, CERTIFIED, FUNDED, AUTHORIZED
OR APPROVED BY THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES
UNTIL  PROGRAM  FEATURES  AND  REIMBURSEMENT  RATES  ARE APPROVED BY THE
COMMISSIONER AND THE  COMMISSIONER  OF  DEVELOPMENTAL  DISABILITIES  AND
UNTIL SUCH COMMISSIONERS DETERMINE THAT THERE ARE A SUFFICIENT NUMBER OF
PLANS  AUTHORIZED  TO COORDINATE CARE FOR INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES PURSUANT TO THIS ARTICLE OPERATING IN THE  PERSON'S  COUNTY
OF  RESIDENCE  TO MEET THE NEEDS OF PERSONS WITH DEVELOPMENTAL DISABILI-
TIES, AND THAT SUCH PLANS MEET THE STANDARDS OF THIS SECTION.
  13. NOTWITHSTANDING ANY INCONSISTENT PROVISION TO  THE  CONTRARY,  THE
COMMISSIONER  MAY ISSUE A CERTIFICATE OF AUTHORITY TO NO MORE THAN THREE
ELIGIBLE APPLICANTS TO OPERATE MANAGED LONG TERM PLANS THAT ARE  AUTHOR-
IZED  TO EXCLUSIVELY ENROLL INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES,
AS SUCH TERM IS DEFINED IN SECTION 1.03 OF THE MENTAL HYGIENE  LAW.  THE

S. 2606--C                         50

COMMISSIONER  MAY  ONLY ISSUE CERTIFICATES OF AUTHORITY PURSUANT TO THIS
SUBDIVISION IF, AND TO THE EXTENT  THAT,  THE  DEPARTMENT  HAS  RECEIVED
FEDERAL  APPROVAL  TO OPERATE A FULLY INTEGRATED DUALS ADVANTAGE PROGRAM
FOR  THE  INTEGRATION  OF  SERVICES FOR PERSONS ENROLLED IN MEDICARE AND
MEDICAID.   THE COMMISSIONER MAY WAIVE ANY  OF  THE  DEPARTMENT'S  REGU-
LATIONS  AS  THE  COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES, DEEMS NECESSARY TO ALLOW SUCH  MANAGED  LONG
TERM  PLANS  TO  PROVIDE  OR  ARRANGE  FOR SERVICES FOR INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES THAT ARE ADEQUATE AND APPROPRIATE TO MEET THE
NEEDS OF SUCH INDIVIDUALS AND THAT WILL ENSURE THEIR HEALTH AND SAFETY.
  14. THE PROVISIONS OF SUBDIVISIONS TWELVE AND THIRTEEN OF THIS SECTION
SHALL ONLY BE EFFECTIVE IF, FOR SO LONG  AS,  AND  TO  THE  EXTENT  THAT
FEDERAL  FINANCIAL  PARTICIPATION IS AVAILABLE FOR THE COSTS OF SERVICES
PROVIDED THEREUNDER TO RECIPIENTS  OF  MEDICAL  ASSISTANCE  PURSUANT  TO
TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. THE COMMISSION-
ER  SHALL  MAKE  ANY  NECESSARY AMENDMENTS TO THE STATE PLAN FOR MEDICAL
ASSISTANCE SUBMITTED PURSUANT TO SECTION THREE HUNDRED SIXTY-THREE-A  OF
THE  SOCIAL  SERVICES  LAW,  AND/OR  SUBMIT ONE OR MORE APPLICATIONS FOR
WAIVERS OF THE FEDERAL SOCIAL SECURITY  ACT,  AS  MAY  BE  NECESSARY  TO
ENSURE  SUCH  FEDERAL  FINANCIAL  PARTICIPATION.  TO THE EXTENT THAT THE
PROVISIONS OF SUBDIVISIONS TWELVE  AND  THIRTEEN  OF  THIS  SECTION  ARE
INCONSISTENT   WITH  OTHER  PROVISIONS  OF  THIS  ARTICLE  OR  WITH  THE
PROVISIONS OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL  SERVICES
LAW, THE PROVISIONS OF THIS SUBDIVISION SHALL PREVAIL.
  S  77.  Subparagraph (ii) of paragraph (b) of subdivision 1 of section
364-j of the social services law, as amended by chapter 433 of the  laws
of  1997,  is  amended  and a new subparagraph (iii) is added to read as
follows:
  (ii) is authorized  as  a  partially  capitated  program  pursuant  to
section  three  hundred sixty-four-f of this title or section forty-four
hundred three-e of the public health law or section 1915b of the  social
security act[.]; OR
  (III)  IS  AUTHORIZED  TO  OPERATE  UNDER  SECTION  FORTY-FOUR HUNDRED
THREE-G OF THE PUBLIC HEALTH LAW.
  S 78. Section 364-j of the social services law is amended by adding  a
new subdivision 28 to read as follows:
  28.  TO  THE EXTENT THAT ANY PROVISION OF THIS SECTION IS INCONSISTENT
WITH ANY PROVISION OF SECTION FORTY-FOUR HUNDRED THREE-G OF  THE  PUBLIC
HEALTH  LAW, SUCH PROVISION OF THIS SECTION SHALL NOT APPLY TO AN ENTITY
AUTHORIZED TO OPERATE PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-G  OF
THE PUBLIC HEALTH LAW.
  S  79.  Subdivision  2  of section 365-a of the social services law is
amended by adding a new paragraph (aa) to read as follows:
  (AA) CARE AND SERVICES FURNISHED BY A DEVELOPMENTAL  DISABILITY  INDI-
VIDUAL  SUPPORT  AND  CARE  COORDINATION  ORGANIZATION  (DISCO) THAT HAS
RECEIVED A CERTIFICATE  OF  AUTHORITY  PURSUANT  TO  SECTION  FORTY-FOUR
HUNDRED  THREE-G OF THE PUBLIC HEALTH LAW TO ELIGIBLE INDIVIDUALS RESID-
ING IN THE GEOGRAPHIC AREA SERVED BY SUCH ENTITY, WHEN SUCH SERVICES ARE
FURNISHED IN ACCORDANCE WITH AN AGREEMENT APPROVED BY THE DEPARTMENT  OF
HEALTH WHICH MEETS THE REQUIREMENTS OF FEDERAL LAW AND REGULATIONS.
  S  80.  The  commissioner  of  health  shall, to the extent necessary,
submit the appropriate waivers, including, but  not  limited  to,  those
authorized  pursuant  to  sections  eleven  hundred fifteen and nineteen
hundred fifteen  of  the  federal  social  security  act,  or  successor
provisions,  and  any other waivers necessary to achieve the purposes of
high quality, integrated and cost effective care and  integrated  finan-

S. 2606--C                         51

cial eligibility policies under the medical assistance program or pursu-
ant  to  title  XVIII  of the federal social security act and to require
medical  assistance  recipients  with  developmental  disabilities   who
require  home  and community-based services, as specified by the commis-
sioner, to receive  such  services  through  an  available  organization
certified  pursuant  to  article  44 of the public health law. Copies of
such original  waiver  applications  and  amendments  thereto  shall  be
provided  to  the  chairs  of the senate finance committee, the assembly
ways and means committee and the senate and assembly  health  committees
simultaneously with their submission to the federal government.
  S 81. Notwithstanding any inconsistent provision of law, rule or regu-
lation, for purposes of implementing the provisions of the public health
law and the social services law, references to titles XIX and XXI of the
federal  social  security  act  in  the public health law and the social
services law shall be deemed to include and also to mean  any  successor
titles thereto under the federal social security act.
  S 82. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the effectiveness of the provisions of sections 2807 and 3614 of
the  public health law, section 18 of chapter 2 of the laws of 1988, and
18 NYCRR 505.14(h), as they relate to time frames for  notice,  approval
or  certification  of rates of payment, are hereby suspended and without
force or effect for purposes of implementing the provisions of this act.
  S 83. Severability clause. If any clause, sentence, paragraph,  subdi-
vision,  section  or  part of this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment  shall  not  affect,
impair or invalidate the remainder thereof, but shall be confined in its
operation  to  the  clause, sentence, paragraph, subdivision, section or
part thereof directly involved in the controversy in which such judgment
shall have been rendered. It is hereby declared to be the intent of  the
legislature  that  this act would have been enacted even if such invalid
provisions had not been included herein.
  S 84. This act shall take effect immediately and shall  be  deemed  to
have  been  in full force and effect on and after April 1, 2013 provided
that:
  1. the amendments to subdivision 10 of section 2807-c  of  the  public
health law, made by section four of this act, shall not affect the expi-
ration of such subdivision and shall be deemed repealed therewith;
  1-a.  the amendments to section 364-j of the social services law, made
by section eleven-a of this act, shall not  affect  the  expiration  and
repeal of such section and shall be deemed repealed therewith;
  1-b. Section twelve of this act shall take effect July 1, 2013;
  1-c.  section  thirty-three-a of this act shall take effect January 1,
2014;
  2. any rules or regulations necessary to implement the  provisions  of
this  act  may be promulgated and any procedures, forms, or instructions
necessary for such implementation may be adopted and issued on or  after
the date this act shall have become a law;
  3. this act shall not be construed to alter, change, affect, impair or
defeat any rights, obligations, duties or interests accrued, incurred or
conferred prior to the effective date of this act;
  4.  the  commissioner  of  health  and the superintendent of financial
services and any appropriate council may take  any  steps  necessary  to
implement this act prior to its effective date;
  5. notwithstanding any inconsistent provision of the state administra-
tive  procedure  act  or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of financial  services

S. 2606--C                         52

and  any  appropriate council is authorized to adopt or amend or promul-
gate on an emergency basis any regulation he  or  she  or  such  council
determines  necessary  to  implement  any  provision  of this act on its
effective date;
  6.  the  provisions of this act shall become effective notwithstanding
the failure of the commissioner  of  health  or  the  superintendent  of
financial  services or any council to adopt or amend or promulgate regu-
lations implementing this act;
  7. the amendments to section 364-j of the social services law made  by
sections  thirty-five-a, thirty-six, thirty-seven, thirty-eight, thirty-
nine, forty, forty-one, forty-two, forty-three,  forty-four,  fifty-two,
seventy-two,  seventy-seven  and  seventy-eight  of  this  act shall not
affect the repeal of such section and shall be  deemed  repealed  there-
with;
  8.  section  forty-eight-a  of  this  act  shall  expire and be deemed
repealed March 31, 2017;
  9. the amendments to paragraph (b) of subdivision 7 of section  4403-f
of  the  public health law made by section forty-eight of this act shall
not affect the expiration of such paragraph and repeal of  such  section
and shall be deemed expired and repealed therewith.
  10.  the amendments to section 4403-f of the public health law made by
sections fifty-four, seventy-five and seventy-six of this act shall  not
affect  the  repeal  of such section and shall be deemed repealed there-
with; and
  11. the provisions of this act shall apply to  any  pending  cause  of
action  brought  pursuant  to  article  13 of the state finance law, and
shall further apply to claims, records, statements  or  obligations,  as
defined  by  section 188 of the state finance law, that were made, used,
or existing prior to, on or after April 1, 2007.
  12. the amendments to paragraph (c)  of  subdivision  2-c  of  section
4403-f  of  the  public health law made by section sixty-six of this act
shall expire and be deemed repealed April 1, 2016.
  13. Sections thirty-seven, forty-five-a, forty-five-b and forty-five-c
of this act shall take effect on April first, two thousand fourteen.
  14. the amendments made by subdivision c-1 of section 1 of part  C  of
chapter  58 of the laws of 2005, authorizing reimbursements for expendi-
tures made by or on behalf of  social  services  districts  for  medical
assistance  for needy persons and the administration thereof, shall take
effect on the same date and in the same manner as section 1 of part F of
chapter 56 of the laws of 2012 takes effect.

                                 PART B

  Section 1. Subdivision (f) of section 129 of part C of chapter  58  of
the  laws of 2009, amending the public health law relating to payment by
governmental  agencies  for  general  hospital  inpatient  services,  is
amended to read as follows:
  (f)  section  twenty-five  of  this  act  shall  expire  and be deemed
repealed April 1, [2013] 2016;
  S 2. Paragraph (a) of subdivision 1 of section 212 of chapter  474  of
the  laws of 1996, amending the education law and other laws relating to
rates for residential healthcare facilities, as amended by section 2  of
part D of chapter 59 of the laws of 2011, is amended to read as follows:
  (a) Notwithstanding any inconsistent provision of law or regulation to
the  contrary,  effective beginning August 1, 1996, for the period April
1, 1997 through March 31, 1998, April 1, 1998 for the  period  April  1,

S. 2606--C                         53

1998  through  March  31,  1999, August 1, 1999, for the period April 1,
1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
through March 31, 2001, April 1, 2001, for  the  period  April  1,  2001
through  March  31,  2002,  April  1, 2002, for the period April 1, 2002
through March 31, 2003, and for the state fiscal year beginning April 1,
2005 through March 31, 2006, and for the  state  fiscal  year  beginning
April  1,  2006  through  March  31, 2007, and for the state fiscal year
beginning April 1, 2007 through March 31, 2008, and for the state fiscal
year beginning April 1, 2008 through March 31, 2009, and for  the  state
fiscal  year beginning April 1, 2009 through March 31, 2010, and for the
state fiscal year beginning April 1, 2010 through March 31, [2013] 2016,
the department of health is authorized to pay public general  hospitals,
as  defined  in subdivision 10 of section 2801 of the public health law,
operated by the state of New York or by the state university of New York
or by a county, which shall not include a city with a population of over
one million, of the state of New York, and those public  general  hospi-
tals  located  in  the  county of Westchester, the county of Erie or the
county of Nassau, additional payments for inpatient hospital services as
medical assistance payments pursuant to title 11 of  article  5  of  the
social  services law for patients eligible for federal financial partic-
ipation under title XIX of the federal social security  act  in  medical
assistance  pursuant  to  the  federal  laws  and  regulations governing
disproportionate share payments to hospitals up to one  hundred  percent
of  each such public general hospital's medical assistance and uninsured
patient losses after all other medical assistance, including  dispropor-
tionate  share  payments to such public general hospital for 1996, 1997,
1998, and 1999, based initially for 1996  on  reported  1994  reconciled
data  as further reconciled to actual reported 1996 reconciled data, and
for 1997 based initially on reported 1995  reconciled  data  as  further
reconciled  to  actual  reported  1997  reconciled  data, for 1998 based
initially on reported 1995 reconciled  data  as  further  reconciled  to
actual  reported  1998  reconciled  data,  for  1999  based initially on
reported 1995 reconciled data as further reconciled to  actual  reported
1999  reconciled  data, for 2000 based initially on reported 1995 recon-
ciled data as further reconciled to actual reported 2000 data, for  2001
based  initially  on reported 1995 reconciled data as further reconciled
to actual reported 2001 data, for 2002 based initially on reported  2000
reconciled  data as further reconciled to actual reported 2002 data, and
for state fiscal years beginning on April 1, 2005,  based  initially  on
reported  2000  reconciled data as further reconciled to actual reported
data for 2005, and for state fiscal years beginning on  April  1,  2006,
based  initially  on reported 2000 reconciled data as further reconciled
to actual reported data for 2006, for state fiscal  years  beginning  on
and  after  April  1,  2007  through  March 31, 2009, based initially on
reported 2000 reconciled data as further reconciled to  actual  reported
data  for  2007 and 2008, respectively, for state fiscal years beginning
on and after April 1, 2009, based initially on reported 2007  reconciled
data,  adjusted  for  authorized Medicaid rate changes applicable to the
state fiscal year, and as further reconciled to actual reported data for
2009, for state fiscal years beginning on and after April 1, 2010, based
initially on reported reconciled data from the base year two years prior
to the payment year,  adjusted  for  authorized  Medicaid  rate  changes
applicable  to  the  state fiscal year, and further reconciled to actual
reported data from such payment year, and to actual  reported  data  for
each  respective succeeding year.  The payments may be added to rates of

S. 2606--C                         54

payment or made as aggregate payments  to  an  eligible  public  general
hospital.
  S  3.  Section  11  of  chapter  884 of the laws of 1990, amending the
public health law relating to authorizing  bad  debt  and  charity  care
allowances  for  certified home health agencies, as amended by section 3
of part D of chapter 59 of the laws of  2011,  is  amended  to  read  as
follows:
  S 11. This act shall take effect immediately and:
  (a) sections one and three shall expire on December 31, 1996,
  (b)  sections  four  through ten shall expire on June 30, [2013] 2015,
and
  (c) provided that the amendment to section 2807-b of the public health
law by section two of this act shall not affect the expiration  of  such
section  2807-b  as  otherwise  provided  by  law and shall be deemed to
expire therewith.
  S 4. Subdivision 2 of section 246 of chapter 81 of the laws  of  1995,
amending  the  public  health  law  and  other  laws relating to medical
reimbursement and welfare reform, as amended by section 4 of part  D  of
chapter 59 of the laws of 2011, is amended to read as follows:
  2.  Sections  five,  seven  through nine, twelve through fourteen, and
eighteen of this act shall be deemed to have  been  in  full  force  and
effect  on  and  after  April  1, 1995 through March 31, 1999 and on and
after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
through March 31, 2003 and on and after April 1, 2003 through March  31,
2006  and  on  and after April 1, 2006 through March 31, 2007 and on and
after April 1, 2007 through March 31, 2009 and on  and  after  April  1,
2009  through  March 31, 2011 and sections twelve, thirteen and fourteen
of this act shall be deemed to be in full force and effect on and  after
April 1, 2011 through March 31, [2013] 2015;
  S  5.  Subparagraph  (vi) of paragraph (b) of subdivision 2 of section
2807-d of the public health law, as amended by section 102 of part H  of
chapter 59 of the laws of 2011, is amended to read as follows:
  (vi)  Notwithstanding  any contrary provision of this paragraph or any
other provision of law or regulation to the  contrary,  for  residential
health care facilities the assessment shall be six percent of each resi-
dential  health care facility's gross receipts received from all patient
care services and other operating income on a cash basis for the  period
April  first,  two thousand two through March thirty-first, two thousand
three for hospital  or  health-related  services,  including  adult  day
services;  provided,  however,  that residential health care facilities'
gross receipts attributable to payments received pursuant to title XVIII
of the federal social security act (medicare) shall be excluded from the
assessment; provided, however, that for all such gross receipts received
on or after April first, two thousand three through March  thirty-first,
two  thousand  five,  such assessment shall be five percent, and further
provided that for all such gross receipts received  on  or  after  April
first,  two thousand five through March thirty-first, two thousand nine,
and on or after April first, two thousand  nine  through  March  thirty-
first,  two  thousand  eleven  such assessment shall be six percent, and
further provided that for all such gross receipts received on  or  after
April  first,  two thousand eleven through March thirty-first, two thou-
sand thirteen such assessment shall be six percent, AND FURTHER PROVIDED
THAT FOR ALL SUCH GROSS RECEIPTS RECEIVED ON OR AFTER APRIL  FIRST,  TWO
THOUSAND  THIRTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FIFTEEN SUCH
ASSESSMENT SHALL BE SIX PERCENT.

S. 2606--C                         55

  S 6. Section 88 of chapter 659 of the laws of 1997,  constituting  the
long  term care integration and finance act of 1997, as amended by chap-
ter 446 of the laws of 2011, is amended to read as follows:
  S  88. Notwithstanding any provision of law to the contrary, all oper-
ating demonstrations, as such term is defined in paragraph (c) of subdi-
vision 1 of section 4403-f of the public health law as added by  section
eighty-two  of this act, due to expire prior to January 1, 2001 shall be
deemed to expire on December 31, [2013] 2015.
  S 7. Subparagraph (v) of paragraph (b) of subdivision  35  of  section
2807-c  of  the  public health law, as amended by section 2 of part G of
chapter 56 of the laws of 2012, is amended to read as follows:
  (v) such  regulations  shall  incorporate  quality  related  measures,
including,  but  not  limited  to, potentially preventable re-admissions
(PPRs) and provide for rate adjustments or payment disallowances related
to PPRs and other potentially  preventable  negative  outcomes  (PPNOs),
which shall be calculated in accordance with methodologies as determined
by the commissioner, provided, however, that such methodologies shall be
based on a comparison of the actual and risk adjusted expected number of
PPRs and other PPNOs in a given hospital and with benchmarks established
by  the  commissioner and provided further that such rate adjustments or
payment disallowances shall result in an aggregate reduction in Medicaid
payments of no less than thirty-five million dollars for the period July
first, two thousand ten through March thirty-first, two thousand  eleven
and  no less than fifty-one million dollars for annual periods beginning
April first, two thousand eleven through March thirty-first,  two  thou-
sand   [thirteen]   FOURTEEN,   provided  further  that  such  aggregate
reductions shall be offset by Medicaid payment reductions occurring as a
result of decreased PPRs during the period July first, two thousand  ten
through  March  thirty-first,  two  thousand eleven and the period April
first, two thousand eleven  through  March  thirty-first,  two  thousand
[thirteen] FOURTEEN and as a result of decreased PPNOs during the period
April  first,  two thousand eleven through March thirty-first, two thou-
sand [thirteen] FOURTEEN; and provided further that for the period  July
first,  two thousand ten through March thirty-first, two thousand [thir-
teen] FOURTEEN, such rate adjustments or payment disallowances shall not
apply to behavioral health PPRs; or to readmissions  that  occur  on  or
after fifteen days following an initial admission. By no later than July
first,  two  thousand eleven the commissioner shall enter into consulta-
tions with representatives of the health care facilities subject to this
section regarding potential prospective revisions to applicable  method-
ologies  and benchmarks set forth in regulations issued pursuant to this
subparagraph;
  S 8.  Subdivision 2 of section 93 of part C of chapter 58 of the  laws
of  2007  amending  the  social  services law and other laws relating to
enacting the major components of legislation necessary to implement  the
health  and  mental  hygiene  budget  for  the 2007-2008 fiscal year, as
amended by section 10 of part B of chapter 58 of the laws  of  2009,  is
amended to read as follows:
  2.  section  two  of  this  act shall expire and be deemed repealed on
March 31, [2013] 2014;
  S 8-a. Subdivision 8 of section 364-l of the social services  law,  as
added  by  section  2  of  part  C of chapter 58 of the laws of 2007, is
amended to read as follows:
  8. The commissioner of health shall provide a report to  the  governor
and  the  legislature  no later than January first, two thousand ten. ON
AND AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN SUCH  COMMISSIONER  SHALL

S. 2606--C                         56

PROVIDE  A  REPORT  ANNUALLY  TO  THE  GOVERNOR AND THE LEGISLATURE. The
report shall include findings as to the demonstration  projects'  effec-
tiveness  in managing the care needs and improving the health of program
participants,  an  evaluation  as to the programs' cost-effectiveness as
measured against traditional medicaid care models,  and  recommendations
as  to whether the programs should be extended, modified, eliminated, or
made permanent.
  S 9. Section 194 of chapter 474 of the  laws  of  1996,  amending  the
education  law  and  other laws relating to rates for residential health
care facilities, as amended by section 9 of part D of chapter 59 of  the
laws of 2011, is amended to read as follows:
  S  194.  1. Notwithstanding any inconsistent provision of law or regu-
lation, the trend factors used to project reimbursable  operating  costs
to the rate period for purposes of determining rates of payment pursuant
to  article  28  of  the  public  health law for residential health care
facilities for reimbursement of inpatient services provided to  patients
eligible  for  payments made by state governmental agencies on and after
April 1, 1996 through March 31, 1999 and for payments made on and  after
July  1,  1999  through  March  31,  2000 and on and after April 1, 2000
through March 31, 2003 and on and after April 1, 2003 through March  31,
2007  and  on  and after April 1, 2007 through March 31, 2009 and on and
after April 1, 2009 through March 31, 2011 and on  and  after  April  1,
2011 through March 31, 2013 AND ON AND AFTER APRIL 1, 2013 THROUGH MARCH
31,  2015  shall  reflect no trend factor projections or adjustments for
the period April 1, 1996, through March 31, 1997.
  2. The commissioner of health shall adjust such rates  of  payment  to
reflect  the  exclusion pursuant to this section of such specified trend
factor projections or adjustments.
  S 10. Subdivision 1 of section 89-a of part C of  chapter  58  of  the
laws  of  2007, amending the social services law and other laws relating
to enacting the major components of legislation necessary  to  implement
the  health  and  mental  hygiene  budget for the 2007-2008 state fiscal
year, as amended by section 10 of part D of chapter 59 of  the  laws  of
2011, is amended to read as follows:
  1.  Notwithstanding  paragraph (c) of subdivision 10 of section 2807-c
of the public health law and section 21 of chapter  1  of  the  laws  of
1999,  as  amended, and any other inconsistent provision of law or regu-
lation to the contrary,  in  determining  rates  of  payments  by  state
governmental agencies effective for services provided beginning April 1,
2006,  through  March  31,  2009, and on and after April 1, 2009 through
March 31, 2011, and on and after April 1, 2011 through March  31,  2013,
AND  ON AND AFTER APRIL 1, 2013 THROUGH MARCH 31, 2015 for inpatient and
outpatient services provided by  general  hospitals  and  for  inpatient
services and outpatient adult day health care services provided by resi-
dential  health  care  facilities  pursuant  to article 28 of the public
health law, the commissioner  of  health  shall  apply  a  trend  factor
projection of two and twenty-five hundredths percent attributable to the
period January 1, 2006 through December 31, 2006, and on and after Janu-
ary  1,  2007,  provided,  however, that on reconciliation of such trend
factor for the period January 1, 2006 through December 31, 2006 pursuant
to paragraph (c) of subdivision 10  of  section  2807-c  of  the  public
health law, such trend factor shall be the final US Consumer Price Index
(CPI)  for  all  urban  consumers,  as published by the US Department of
Labor, Bureau of Labor  Statistics  less  twenty-five  hundredths  of  a
percentage point.

S. 2606--C                         57

  S  11.  Paragraph  (f) of subdivision 1 of section 64 of chapter 81 of
the laws of 1995, amending the public health law and other laws relating
to medical reimbursement and welfare reform, as amended by section 11 of
part D of chapter 59 of the laws of 2011, is amended to read as follows:
  (f)  Prior  to  February  1, 2001, February 1, 2002, February 1, 2003,
February 1, 2004, February 1, 2005, February 1, 2006, February 1,  2007,
February  1, 2008, February 1, 2009, February 1, 2010, February 1, 2011,
February 1, 2012, [and] February 1, 2013 AND FEBRUARY 1, 2014 AND FEBRU-
ARY 1, 2015 the commissioner of health shall calculate the result of the
statewide total  of  residential  health  care  facility  days  of  care
provided  to beneficiaries of title XVIII of the federal social security
act (medicare), divided by the sum of such days of  care  plus  days  of
care provided to residents eligible for payments pursuant to title 11 of
article  5  of the social services law minus the number of days provided
to residents receiving hospice care, expressed as a percentage, for  the
period  commencing  January  1,  through  November 30, of the prior year
respectively, based on such data for such period. This  value  shall  be
called  the  2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009,
2010, 2011, 2012, [and] 2013, 2014 AND 2015 statewide target  percentage
respectively.
  S  12.  Subparagraph (ii) of paragraph (b) of subdivision 3 of section
64 of chapter 81 of the laws of 1995, amending the public health law and
other laws relating to medical  reimbursement  and  welfare  reform,  as
amended  by  section  12 of part D of chapter 59 of the laws of 2011, is
amended to read as follows:
  (ii) If the 1997, 1998, 2000, 2001,  2002,  2003,  2004,  2005,  2006,
2007,  2008, 2009, 2010, 2011, 2012, [and] 2013, 2014 AND 2015 statewide
target percentages are not for  each  year  at  least  three  percentage
points  higher  than  the statewide base percentage, the commissioner of
health shall determine the percentage  by  which  the  statewide  target
percentage  for each year is not at least three percentage points higher
than the statewide base percentage. The percentage  calculated  pursuant
to  this  paragraph  shall  be  called the 1997, 1998, 2000, 2001, 2002,
2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, [and]  2013,
2014  AND 2015 statewide reduction percentage respectively. If the 1997,
1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009,  2010,
2011,  2012,  [and]  2013; 2014 AND 2015 statewide target percentage for
the respective year is at least three percentage points higher than  the
statewide  base  percentage,  the statewide reduction percentage for the
respective year shall be zero.
  S 13.  Subparagraph (iii) of paragraph (b) of subdivision 4 of section
64 of chapter 81 of the laws of 1995, amending the public health law and
other laws relating to medical  reimbursement  and  welfare  reform,  as
amended  by  section  13 of part D of chapter 59 of the laws of 2011, is
amended to read as follows:
  (iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,  2008,
2009,  2010,  2011,  2012, [and] 2013, 2014 AND 2015 statewide reduction
percentage shall be  multiplied  by  one  hundred  two  million  dollars
respectively  to determine the 1998, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008, 2009, 2010, 2011, 2012,  [and]  2013,  2014  AND  2015
statewide  aggregate  reduction  amount. If the 1998 and the 2000, 2001,
2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012,  [and]
2013, 2014 AND 2015 statewide reduction percentage shall be zero respec-
tively,  there  shall  be  no  1998, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008, 2009, 2010, 2011, 2012,  [and]  2013,  2014  AND  2015
reduction amount.

S. 2606--C                         58

  S  14.  Paragraph  (b) of subdivision 5 of section 64 of chapter 81 of
the laws of 1995, amending the public health law and other laws relating
to medical reimbursement and welfare reform, as amended by section 14 of
part D of chapter 59 of the laws of 2011, is amended to read as follows:
  (b)  The  1996,  1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008, 2009, 2010, 2011, 2012,  [and]  2013,  2014  AND  2015
statewide  aggregate  reduction amounts shall for each year be allocated
by the commissioner of health among residential health  care  facilities
that are eligible to provide services to beneficiaries of title XVIII of
the  federal  social  security act (medicare) and residents eligible for
payments pursuant to title 11 of article 5 of the social services law on
the basis of the extent of each facility's  failure  to  achieve  a  two
percentage  points  increase  in  the  1996  target  percentage, a three
percentage point increase in the 1997, 1998,  2000,  2001,  2002,  2003,
2004,  2005,  2006, 2007, 2008, 2009, 2010, 2011, 2012, [and] 2013, 2014
AND 2015 target percentage and a two and  one-quarter  percentage  point
increase  in  the  1999 target percentage for each year, compared to the
base percentage, calculated  on  a  facility  specific  basis  for  this
purpose,  compared  to the statewide total of the extent of each facili-
ty's failure to achieve a two percentage points increase in the 1996 and
a three percentage point increase in the 1997  and  a  three  percentage
point  increase  in  the 1998 and a two and one-quarter percentage point
increase in the 1999 target percentage  and  a  three  percentage  point
increase  in  the  2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,
2009, 2010, 2011, 2012, [and] 2013,  2014  AND  2015  target  percentage
compared to the base percentage. These amounts shall be called the 1996,
1997,  1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,
2009, 2010, 2011, 2012, [and] 2013,  2014  AND  2015  facility  specific
reduction amounts respectively.
  S  14-a.  Section 228 of chapter 474 of the laws of 1996, amending the
education law and other laws relating to rates  for  residential  health
care  facilities,  as amended by section 14-a of part D of chapter 59 of
the laws of 2011, is amended to read as follows:
  S 228. 1. Definitions. (a) Regions,  for  purposes  of  this  section,
shall  mean  a downstate region to consist of Kings, New York, Richmond,
Queens, Bronx, Nassau and Suffolk counties  and  an  upstate  region  to
consist  of  all  other New York state counties. A certified home health
agency or long term home health care program shall  be  located  in  the
same county utilized by the commissioner of health for the establishment
of rates pursuant to article 36 of the public health law.
  (b)  Certified  home  health  agency  (CHHA)  shall  mean such term as
defined in section 3602 of the public health law.
  (c) Long term home health care program (LTHHCP) shall mean  such  term
as defined in subdivision 8 of section 3602 of the public health law.
  (d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
ly, located within a region.
  (e)  Medicaid  revenue percentage, for purposes of this section, shall
mean CHHA and LTHHCP  revenues  attributable  to  services  provided  to
persons  eligible  for payments pursuant to title 11 of article 5 of the
social services law divided by such revenues plus CHHA and LTHHCP reven-
ues attributable to services provided to beneficiaries of Title XVIII of
the federal social security act (medicare).
  (f) Base period, for purposes of this  section,  shall  mean  calendar
year 1995.
  (g) Target period. For purposes of this section, the 1996 target peri-
od  shall  mean  August  1, 1996 through March 31, 1997, the 1997 target

S. 2606--C                         59

period shall mean January 1, 1997 through November 30,  1997,  the  1998
target  period shall mean January 1, 1998 through November 30, 1998, the
1999 target period shall mean January 1, 1999 through November 30, 1999,
the  2000  target period shall mean January 1, 2000 through November 30,
2000, the 2001 target period shall mean January 1, 2001 through November
30, 2001, the 2002 target period shall  mean  January  1,  2002  through
November  30,  2002,  the  2003 target period shall mean January 1, 2003
through November 30, 2003, the 2004 target period shall mean January  1,
2004  through  November  30, 2004, and the 2005 target period shall mean
January 1, 2005 through November 30, 2005, the 2006 target period  shall
mean  January  1,  2006  through  November 30, 2006, and the 2007 target
period shall mean January 1, 2007 through November 30, 2007 and the 2008
target period shall mean January 1, 2008 through November 30, 2008,  and
the  2009  target period shall mean January 1, 2009 through November 30,
2009 and the 2010 target period  shall  mean  January  1,  2010  through
November  30, 2010 and the 2011 target period shall mean January 1, 2011
through November 30, 2011 and the 2012 target period shall mean  January
1,  2012 through November 30, 2012 and the 2013 target period shall mean
January 1, 2013 through November 30, 2013, AND THE  2014  TARGET  PERIOD
SHALL MEAN JANUARY 1, 2014 THROUGH NOVEMBER 30, 2014 AND THE 2015 TARGET
PERIOD SHALL MEAN JANUARY 1, 2015 THROUGH NOVEMBER 30, 2015.
  2.  (a) Prior to February 1, 1997, for each regional group the commis-
sioner of health shall calculate the 1996 medicaid  revenue  percentages
for the period commencing August 1, 1996 to the last date for which such
data is available and reasonably accurate.
  (b)  Prior  to  February  1, 1998, prior to February 1, 1999, prior to
February 1, 2000, prior to February 1, 2001, prior to February 1,  2002,
prior  to February 1, 2003, prior to February 1, 2004, prior to February
1, 2005, prior to February 1, 2006, prior to February 1, 2007, prior  to
February  1, 2008, prior to February 1, 2009, prior to February 1, 2010,
prior to February 1, 2011, prior to February 1,  2012  [and],  prior  to
February  1,  2013,  PRIOR  TO FEBRUARY 1, 2014 AND PRIOR TO FEBRUARY 1,
2015 for each regional group the commissioner of health shall  calculate
the  prior year's medicaid revenue percentages for the period commencing
January 1 through November 30 of such prior year.
  3. By September 15, 1996, for each regional group the commissioner  of
health shall calculate the base period medicaid revenue percentage.
  4.  (a)  For  each  regional  group,  the 1996 target medicaid revenue
percentage shall be calculated by subtracting the 1996 medicaid  revenue
reduction percentages from the base period medicaid revenue percentages.
The  1996  medicaid  revenue  reduction  percentage, taking into account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
  (i) one and one-tenth percentage points for CHHAs located  within  the
downstate region;
  (ii)  six-tenths  of one percentage point for CHHAs located within the
upstate region;
  (iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
  (iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
  (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004,  2005,  2006,  2007,
2008,  2009,  2010,  2011,  2012,  [and]  2013,  2014  AND 2015 for each
regional group, the target medicaid revenue percentage for  the  respec-
tive year shall be calculated by subtracting the respective year's medi-
caid  revenue reduction percentage from the base period medicaid revenue

S. 2606--C                         60

percentage. The medicaid revenue reduction percentages for  1997,  1998,
2000,  2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011,
2012, [and] 2013, 2014 AND 2015 taking into account regional and program
differences  in  utilization  of medicaid and medicare services, for the
following regional groups shall be equal to for each such year:
  (i) one and one-tenth percentage points for CHHAs located  within  the
downstate region;
  (ii)  six-tenths  of one percentage point for CHHAs located within the
upstate region;
  (iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
  (iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
  (c) For each regional group, the 1999 target medicaid revenue percent-
age shall  be  calculated  by  subtracting  the  1999  medicaid  revenue
reduction  percentage  from the base period medicaid revenue percentage.
The 1999 medicaid revenue reduction  percentages,  taking  into  account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
  (i)  eight  hundred  twenty-five  thousandths (.825) of one percentage
point for CHHAs located within the downstate region;
  (ii) forty-five hundredths (.45) of one  percentage  point  for  CHHAs
located within the upstate region;
  (iii)  one  and  thirty-five  hundredths  percentage points (1.35) for
LTHHCPs located within the downstate region; and
  (iv) one and two hundred seventy-five  thousandths  percentage  points
(1.275) for LTHHCPs located within the upstate region.
  5.  (a) For each regional group, if the 1996 medicaid revenue percent-
age is not equal to or  less  than  the  1996  target  medicaid  revenue
percentage,  the  commissioner of health shall compare the 1996 medicaid
revenue percentage to the 1996 target  medicaid  revenue  percentage  to
determine  the  amount  of the shortfall which, when divided by the 1996
medicaid  revenue  reduction  percentage,  shall  be  called  the   1996
reduction  factor.  These  amounts, expressed as a percentage, shall not
exceed one hundred percent. If the 1996 medicaid revenue  percentage  is
equal  to  or less than the 1996 target medicaid revenue percentage, the
1996 reduction factor shall be zero.
  (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003,  2004,  2005,  2006,
2007,  2008,  2009, 2010, 2011, 2012, [and] 2013, 2014 AND 2015 for each
regional group, if the medicaid revenue percentage  for  the  respective
year is not equal to or less than the target medicaid revenue percentage
for  such respective year, the commissioner of health shall compare such
respective year's medicaid revenue percentage to such respective  year's
target medicaid revenue percentage to determine the amount of the short-
fall  which,  when  divided  by  the  respective year's medicaid revenue
reduction percentage, shall be called  the  reduction  factor  for  such
respective  year.  These  amounts,  expressed as a percentage, shall not
exceed one hundred percent. If the medicaid  revenue  percentage  for  a
particular  year  is  equal  to or less than the target medicaid revenue
percentage for that year, the reduction factor for that  year  shall  be
zero.
  6.  (a)  For  each  regional group, the 1996 reduction factor shall be
multiplied by the following amounts to determine each  regional  group's
applicable 1996 state share reduction amount:
  (i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;

S. 2606--C                         61

  (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
  (iii)  one  million  two hundred seventy thousand dollars ($1,270,000)
for LTHHCPs located within the downstate region; and
  (iv) five hundred  ninety  thousand  dollars  ($590,000)  for  LTHHCPs
located within the upstate region.
  For  each regional group reduction, if the 1996 reduction factor shall
be zero, there shall be no 1996 state share reduction amount.
  (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004,  2005,  2006,  2007,
2008,  2009,  2010,  2011,  2012,  [and]  2013,  2014  AND 2015 for each
regional group, the reduction factor for the respective  year  shall  be
multiplied  by  the following amounts to determine each regional group's
applicable state share reduction amount for such respective year:
  (i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;
  (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
  (iii) one million two hundred seventy  thousand  dollars  ($1,270,000)
for LTHHCPs located within the downstate region; and
  (iv)  five  hundred  ninety  thousand  dollars  ($590,000) for LTHHCPs
located within the upstate region.
  For each regional group reduction,  if  the  reduction  factor  for  a
particular  year  shall be zero, there shall be no state share reduction
amount for such year.
  (c) For each regional group, the 1999 reduction factor shall be multi-
plied by the following amounts to determine each regional group's appli-
cable 1999 state share reduction amount:
  (i) one million seven hundred ninety-two thousand five hundred dollars
($1,792,500) for CHHAs located within the downstate region;
  (ii) five hundred sixty-two thousand five hundred  dollars  ($562,500)
for CHHAs located within the upstate region;
  (iii)  nine hundred fifty-two thousand five hundred dollars ($952,500)
for LTHHCPs located within the downstate region; and
  (iv) four hundred forty-two thousand five hundred  dollars  ($442,500)
for LTHHCPs located within the upstate region.
  For  each regional group reduction, if the 1999 reduction factor shall
be zero, there shall be no 1999 state share reduction amount.
  7. (a) For each regional group, the 1996 state share reduction  amount
shall be allocated by the commissioner of health among CHHAs and LTHHCPs
on  the  basis  of  the  extent  of  each CHHA's and LTHHCP's failure to
achieve the 1996 target medicaid revenue  percentage,  calculated  on  a
provider  specific  basis utilizing revenues for this purpose, expressed
as a proportion of the total of each  CHHA's  and  LTHHCP's  failure  to
achieve  the 1996 target medicaid revenue percentage within the applica-
ble regional group. This proportion shall be multiplied by the  applica-
ble  1996 state share reduction amount calculation pursuant to paragraph
(a) of subdivision 6 of this section. This amount shall  be  called  the
1996 provider specific state share reduction amount.
  (b)  For  1997,  1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008, 2009, 2010, 2011, 2012, [and] 2013, 2014 AND 2015  for  each
regional group, the state share reduction amount for the respective year
shall be allocated by the commissioner of health among CHHAs and LTHHCPs
on  the  basis  of  the  extent  of  each CHHA's and LTHHCP's failure to
achieve the target medicaid revenue percentage for the applicable  year,
calculated  on  a  provider  specific  basis utilizing revenues for this
purpose, expressed as a proportion of  the  total  of  each  CHHA's  and

S. 2606--C                         62

LTHHCP's  failure  to achieve the target medicaid revenue percentage for
the applicable year within the applicable regional group.  This  propor-
tion  shall be multiplied by the applicable year's state share reduction
amount  calculation pursuant to paragraph (b) or (c) of subdivision 6 of
this section. This amount shall be called the  provider  specific  state
share reduction amount for the applicable year.
  8.  (a)  The 1996 provider specific state share reduction amount shall
be due to the state from each CHHA and LTHHCP and may be recouped by the
state by March 31, 1997 in a lump sum amount or  amounts  from  payments
due  to  the  CHHA  and  LTHHCP pursuant to title 11 of article 5 of the
social services law.
  (b) The provider specific state share reduction amount for 1997, 1998,
1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009,  2010,
2011,  2012, [and] 2013, 2014 AND 2015 respectively, shall be due to the
state from each CHHA and LTHHCP and each year the amount  due  for  such
year may be recouped by the state by March 31 of the following year in a
lump  sum  amount  or  amounts  from payments due to the CHHA and LTHHCP
pursuant to title 11 of article 5 of the social services law.
  9. CHHAs and LTHHCPs shall submit such data and  information  at  such
times  as  the  commissioner  of health may require for purposes of this
section. The commissioner of health may use data available  from  third-
party payors.
  10. On or about June 1, 1997, for each regional group the commissioner
of  health  shall  calculate for the period August 1, 1996 through March
31, 1997 a medicaid revenue percentage,  a  reduction  factor,  a  state
share  reduction  amount,  and a provider specific state share reduction
amount in accordance with the methodology provided in paragraph  (a)  of
subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
sion  6 and paragraph (a) of subdivision 7 of this section. The provider
specific state share reduction amount calculated in accordance with this
subdivision shall be compared to the 1996 provider specific state  share
reduction amount calculated in accordance with paragraph (a) of subdivi-
sion 7 of this section. Any amount in excess of the amount determined in
accordance  with paragraph (a) of subdivision 7 of this section shall be
due to the state from each CHHA  and  LTHHCP  and  may  be  recouped  in
accordance  with  paragraph (a) of subdivision 8 of this section. If the
amount is less than the amount determined in accordance  with  paragraph
(a)  of  subdivision 7 of this section, the difference shall be refunded
to the CHHA and LTHHCP by the state no later than July 15,  1997.  CHHAs
and  LTHHCPs  shall  submit  data  for the period August 1, 1996 through
March 31, 1997 to the commissioner of health by April 15, 1997.
  11. If a CHHA or LTHHCP  fails  to  submit  data  and  information  as
required for purposes of this section:
  (a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
caid  revenue  percentage  between  the  applicable  base period and the
applicable target period for purposes of the  calculations  pursuant  to
this section; and
  (b)  the  commissioner of health shall reduce the current rate paid to
such CHHA and such LTHHCP by state  governmental  agencies  pursuant  to
article  36  of the public health law by one percent for a period begin-
ning on the first day of the calendar month following the applicable due
date as established by the commissioner of health and  continuing  until
the last day of the calendar month in which the required data and infor-
mation are submitted.
  12. The commissioner of health shall inform in writing the director of
the  budget  and the chair of the senate finance committee and the chair

S. 2606--C                         63

of the assembly ways and means committee of the results  of  the  calcu-
lations pursuant to this section.
  S  15.  Subdivision  5-a  of  section 246 of chapter 81 of the laws of
1995, amending the public health law and other laws relating to  medical
reimbursement  and welfare reform, as amended by section 15 of part D of
chapter 59 of the laws of 2011, is amended to read as follows:
  5-a. Section sixty-four-a of this act shall be deemed to have been  in
full  force and effect on and after April 1, 1995 through March 31, 1999
and on and after July 1, 1999 through March 31, 2000 and  on  and  after
April  1,  2000  through  March  31, 2003 and on and after April 1, 2003
through March 31, 2007, and on and after April 1, 2007 through March 31,
2009, and on and after April 1, 2009 through March 31, 2011, and on  and
after  April  1,  2011 through March 31, 2013, AND ON AND AFTER APRIL 1,
2013 THROUGH MARCH 31, 2015;
  S 16. Section 64-b of chapter 81 of the laws  of  1995,  amending  the
public  health  law and other laws relating to medical reimbursement and
welfare reform, as amended by section 16 of part D of chapter 59 of  the
laws of 2011, is amended to read as follows:
  S  64-b.  Notwithstanding  any  inconsistent  provision  of  law,  the
provisions of subdivision 7 of section 3614 of the public health law, as
amended, shall remain and be in full force and effect on April  1,  1995
through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
and after April 1, 2000 through March 31, 2003 and on and after April 1,
2003  through  March  31,  2007,  and on and after April 1, 2007 through
March 31, 2009, and on and after April 1, 2009 through March  31,  2011,
and  on and after April 1, 2011 through March 31, 2013, AND ON AND AFTER
APRIL 1, 2013 THROUGH MARCH 31, 2015.
  S 17. Subdivision 1 of section 20 of chapter 451 of the laws of  2007,
amending  the  public health law, the social services law and the insur-
ance  law,  relating  to  providing  enhanced  consumer   and   provider
protections,  as  amended  by  section 17 of part D of chapter 59 of the
laws of 2011, is amended to read as follows:
  1. sections four, eleven and thirteen  of this act shall  take  effect
immediately  and  shall  expire  and  be deemed repealed June 30, [2013]
2015;
  S 18. The opening paragraph of subdivision 7-a of section 3614 of  the
public  health  law, as amended by section 18 of part D of chapter 59 of
the laws of 2011, is amended to read as follows:
  Notwithstanding any inconsistent provision of law or  regulation,  for
the  purposes  of establishing rates of payment by governmental agencies
for long term home health care programs for the period April first,  two
thousand five, through December thirty-first, two thousand five, and for
the  period  January first, two thousand six through March thirty-first,
two thousand seven, and on and after April  first,  two  thousand  seven
through  March  thirty-first,  two thousand nine, and on and after April
first, two thousand nine through March thirty-first, two thousand  elev-
en,  and  on  and  after  April first, two thousand eleven through March
thirty-first, two thousand thirteen AND ON AND AFTER  APRIL  FIRST,  TWO
THOUSAND  THIRTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FIFTEEN, the
reimbursable base year administrative and general costs of a provider of
services shall not exceed the statewide average  of  total  reimbursable
base  year  administrative  and  general  costs  of  such  providers  of
services.
  S 19. Intentionally omitted.
  S 20.  Subdivision 6-a of section 93 of part C of chapter  58  of  the
laws  of 2007 amending the social services law and the public health law

S. 2606--C                         64

relating to adjustments of rates, as amended by section 40 of part D  of
chapter 58 of the laws of 2009, is amended to read as follows:
  6-a.  section  fifty-seven  of  this  act  shall  expire and be deemed
repealed on December 31, [2013] 2018; provided that the amendments  made
by such section to subdivision 4 of section 366-c of the social services
law  shall  apply  with  respect  to  determining initial and continuing
eligibility for medical assistance, including the continued  eligibility
of recipients originally determined eligible prior to the effective date
of  this  act, and provided further that such amendments shall not apply
to any person or group of persons if it is  subsequently  determined  by
the  Centers  for Medicare and Medicaid services or by a court of compe-
tent jurisdiction that medical assistance with federal financial partic-
ipation is available for the costs of services provided to  such  person
or persons under the provisions of subdivision 4 of section 366-c of the
social services law in effect immediately prior to the effective date of
this act.
  S 21. Subdivision 12 of section 246 of chapter 81 of the laws of 1995,
amending  the  public  health  law  and  other  laws relating to medical
reimbursement and welfare reform, as amended by section 23 of part D  of
chapter 59 of the laws of 2011, is amended to read as follows:
  12. Sections one hundred five-b through one hundred five-f of this act
shall expire March 31, [2013] 2015.
  S  22.  Section  5  of  chapter  426 of the laws of 1983, amending the
public health law relating to professional  misconduct  proceedings,  as
amended  by  chapter  36  of  the  laws  of  2008, is amended to read as
follows:
  S 5. This act shall take effect June 1, 1983 and shall remain in  full
force and effect until March 31, [2013] 2018.
  S  23.  Section  5  of  chapter  582 of the laws of 1984, amending the
public health law relating to regulating activities  of  physicians,  as
amended  by  chapter  36  of  the  laws  of  2008, is amended to read as
follows:
  S 5. This act shall take effect immediately, provided however that the
provisions of this act shall remain in full force and effect until March
31, [2013] 2018 at which time the provisions of this act shall be deemed
to be repealed.
  S 24. Subparagraph (ii) of paragraph (c) of subdivision 11 of  section
230  of  the  public health law, as amended by chapter 36 of the laws of
2008, is amended to read as follows:
  (ii) Participation and membership during a  three  year  demonstration
period  in  a physician committee of the Medical Society of the State of
New York or the New York State Osteopathic Society whose purpose  is  to
confront and refer to treatment physicians who are thought to be suffer-
ing  from  alcoholism,  drug abuse or mental illness. Such demonstration
period shall commence on April first, nineteen hundred eighty and termi-
nate on May thirty-first, nineteen hundred eighty-three.  An  additional
demonstration  period  shall  commence  on  June first, nineteen hundred
eighty-three and  terminate  on  March  thirty-first,  nineteen  hundred
eighty-six.  An  additional demonstration period shall commence on April
first, nineteen hundred eighty-six and terminate on March  thirty-first,
nineteen  hundred  eighty-nine. An additional demonstration period shall
commence April first, nineteen hundred eighty-nine and  terminate  March
thirty-first,  nineteen  hundred ninety-two. An additional demonstration
period shall commence  April  first,  nineteen  hundred  ninety-two  and
terminate  March  thirty-first,  nineteen  hundred ninety-five. An addi-
tional demonstration period shall  commence  on  April  first,  nineteen

S. 2606--C                         65

hundred  ninety-five  and  terminate  on  March  thirty-first,  nineteen
hundred ninety-eight. An additional demonstration period shall  commence
on  April  first,  nineteen  hundred ninety-eight and terminate on March
thirty-first,  two  thousand  three.  An additional demonstration period
shall commence on April first, two thousand three and terminate on March
thirty-first, two  thousand  thirteen[;].  AN  ADDITIONAL  DEMONSTRATION
PERIOD  SHALL  COMMENCE APRIL FIRST, TWO THOUSAND THIRTEEN AND TERMINATE
ON MARCH THIRTY-FIRST, TWO THOUSAND EIGHTEEN provided, however, that the
commissioner may prescribe requirements for  the  continuation  of  such
demonstration  program,  including periodic reviews of such programs and
submission of any reports and data necessary  to  permit  such  reviews.
During  these  additional  periods,  the provisions of this subparagraph
shall also apply to a physician committee of a county medical society.
  S 25. Section 4 of part X2 of chapter 62 of the laws of 2003, amending
the public health law relating to allowing for the use of funds  of  the
office  of  professional  medical  conduct for activities of the patient
health information and quality improvement act of 2000,  as  amended  by
section  27  of  part A of chapter 59 of the laws of 2011, is amended to
read as follows:
  S 4. This  act  shall  take  effect  immediately;  provided  that  the
provisions  of  section  one of this act shall be deemed to have been in
full force and effect on and after April 1, 2003, and shall expire March
31, [2013] 2015 when upon such date the provisions of such section shall
be deemed repealed.
  S 26. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the effectiveness of the provisions of sections 2807 and 3614 of
the public health law, section 18 of chapter 2 of the laws of 1988,  and
18  NYCRR  505.14(h), as they relate to time frames for notice, approval
or certification of rates of payment, are hereby suspended  and  without
force or effect for purposes of implementing the provisions of this act.
  S  27. Severability clause. If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair or invalidate the remainder thereof, but shall be confined in its
operation to the clause, sentence, paragraph,  subdivision,  section  or
part  thereof  directly involved in the controversy in which such judge-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  28.  This  act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2013;  provided
that the amendments to subparagraph (ii) of paragraph (c) of subdivision
11  of  section 230 of the public health law made by section twenty-four
of this act shall not affect the expiration  of  such  subparagraph  and
shall expire therewith.

                                 PART C

  Section  1.  Section  2807-k  of  the  public health law is amended by
adding a new subdivision 5-d to read as follows:
  5-D. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF  THIS  SECTION,
SECTION  TWENTY-EIGHT  HUNDRED  SEVEN-W  OF  THIS  ARTICLE  OR ANY OTHER
CONTRARY PROVISION OF LAW, AND SUBJECT TO THE  AVAILABILITY  OF  FEDERAL
FINANCIAL  PARTICIPATION,  FOR  PERIODS  ON AND AFTER JANUARY FIRST, TWO
THOUSAND THIRTEEN, THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND  FIFTEEN,
ALL  FUNDS  AVAILABLE  FOR DISTRIBUTION PURSUANT TO THIS SECTION, EXCEPT

S. 2606--C                         66

FOR FUNDS DISTRIBUTED PURSUANT TO SUBPARAGRAPH (V) OF PARAGRAPH  (B)  OF
SUBDIVISION FIVE-B OF THIS SECTION, AND ALL FUNDS AVAILABLE FOR DISTRIB-
UTION  PURSUANT TO SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE,
SHALL  BE  RESERVED AND SET ASIDE AND DISTRIBUTED IN ACCORDANCE WITH THE
PROVISIONS OF THIS SUBDIVISION.
  (B) THE COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY  PROMULGATE
EMERGENCY  REGULATIONS,  ESTABLISHING METHODOLOGIES FOR THE DISTRIBUTION
OF FUNDS AS DESCRIBED IN PARAGRAPH (A)  OF  THIS  SUBDIVISION  AND  SUCH
REGULATIONS SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING:
  (I)  SUCH  REGULATIONS  SHALL  ESTABLISH METHODOLOGIES FOR DETERMINING
EACH FACILITY'S RELATIVE UNCOMPENSATED CARE NEED AMOUNT BASED  ON  UNIN-
SURED  INPATIENT AND OUTPATIENT UNITS OF SERVICE FROM THE COST REPORTING
YEAR TWO YEARS PRIOR TO THE DISTRIBUTION YEAR, MULTIPLIED BY THE  APPLI-
CABLE  MEDICAID  RATES IN EFFECT JANUARY FIRST OF THE DISTRIBUTION YEAR,
AS SUMMED AND ADJUSTED BY A STATEWIDE COST ADJUSTMENT FACTOR AND REDUCED
BY THE  SUM  OF  ALL  PAYMENT  AMOUNTS  COLLECTED  FROM  SUCH  UNINSURED
PATIENTS,  AND  AS  FURTHER  ADJUSTED  BY  APPLICATION OF A NOMINAL NEED
COMPUTATION THAT SHALL TAKE INTO ACCOUNT EACH FACILITY'S MEDICAID  INPA-
TIENT SHARE.
  (II)  ANNUAL  DISTRIBUTIONS  PURSUANT  TO SUCH REGULATIONS FOR THE TWO
THOUSAND THIRTEEN THROUGH TWO THOUSAND FIFTEEN CALENDAR YEARS  SHALL  BE
IN ACCORD WITH THE FOLLOWING:
  (A)  ONE  HUNDRED  THIRTY-NINE  MILLION  FOUR HUNDRED THOUSAND DOLLARS
SHALL BE DISTRIBUTED AS MEDICAID DISPROPORTIONATE SHARE HOSPITAL ("DSH")
PAYMENTS TO MAJOR PUBLIC GENERAL HOSPITALS; AND
  (B) NINE HUNDRED NINETY-FOUR MILLION NINE HUNDRED THOUSAND DOLLARS  AS
MEDICAID  DSH  PAYMENTS  TO ELIGIBLE GENERAL HOSPITALS, OTHER THAN MAJOR
PUBLIC GENERAL HOSPITALS.
  (III)(A) SUCH REGULATIONS SHALL ESTABLISH  TRANSITION  ADJUSTMENTS  TO
THE  DISTRIBUTIONS  MADE PURSUANT TO CLAUSES (A) AND (B) OF SUBPARAGRAPH
(II) OF THIS PARAGRAPH SUCH THAT NO FACILITY EXPERIENCES A REDUCTION  IN
INDIGENT CARE POOL PAYMENTS PURSUANT TO THIS SUBDIVISION THAT IS GREATER
THAN  THE  PERCENTAGES, AS SPECIFIED IN CLAUSE (C) OF THIS SUBPARAGRAPH,
AS COMPARED TO THE AVERAGE DISTRIBUTION THAT EACH SUCH FACILITY RECEIVED
FOR THE THREE CALENDAR YEARS PRIOR TO TWO THOUSAND THIRTEEN PURSUANT  TO
THIS  SECTION  AND SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE;
PROVIDED, HOWEVER,  THAT  SUCH  REGULATIONS  ESTABLISH  ADJUSTMENTS  FOR
VOLUNTARY  TEACHING  HOSPITALS THAT RECEIVED PAYMENTS FROM THE VOLUNTARY
TEACHING HOSPITAL POOL FOR STATE FISCAL YEARS TWO THOUSAND TEN-TWO THOU-
SAND TWELVE, BASED ON THE DIFFERENCE BETWEEN  WHAT  THE  HOSPITAL  WOULD
HAVE RECEIVED FROM SUCH POOL HAD THE REGIONAL ALLOCATION METHODOLOGY NOT
INCLUDED DATA FROM PUBLIC TEACHING HOSPITALS AND WHAT THE HOSPITAL ACTU-
ALLY RECEIVED, PROVIDED SUCH HOSPITAL APPEALED THIS ISSUE TO THE DEPART-
MENT OF HEALTH BEFORE NOVEMBER EIGHTH, TWO THOUSAND TWELVE.
  (B)  SUCH  REGULATIONS  SHALL  ALSO ESTABLISH ADJUSTMENTS LIMITING THE
INCREASES IN INDIGENT  CARE  POOL  PAYMENTS  EXPERIENCED  BY  FACILITIES
PURSUANT TO THIS SUBDIVISION BY AN AMOUNT THAT WILL BE, AS DETERMINED BY
THE  COMMISSIONER  AND  IN CONJUNCTION WITH SUCH OTHER FUNDING AS MAY BE
AVAILABLE FOR THIS PURPOSE, SUFFICIENT TO ENSURE FULL  FUNDING  FOR  THE
TRANSITION ADJUSTMENT PAYMENTS AUTHORIZED BY CLAUSE (A) OF THIS SUBPARA-
GRAPH.
  (C)  NO  FACILITY  SHALL  EXPERIENCE A REDUCTION IN INDIGENT CARE POOL
PAYMENTS PURSUANT TO THIS SUBDIVISION THAT: FOR THE CALENDAR YEAR BEGIN-
NING JANUARY FIRST, TWO THOUSAND THIRTEEN, IS GREATER THAN TWO AND  ONE-
HALF  PERCENT;  FOR THE CALENDAR YEAR BEGINNING JANUARY FIRST, TWO THOU-
SAND FOURTEEN, IS GREATER THAN FIVE PERCENT; AND, FOR THE CALENDAR  YEAR

S. 2606--C                         67

BEGINNING  ON JANUARY FIRST, TWO THOUSAND FIFTEEN, IS GREATER THAN SEVEN
AND ONE-HALF PERCENT.
  (IV) SUCH REGULATIONS SHALL RESERVE ONE PERCENT OF THE FUNDS AVAILABLE
FOR  DISTRIBUTION  IN THE TWO THOUSAND FOURTEEN AND TWO THOUSAND FIFTEEN
CALENDAR YEARS PURSUANT TO THIS SUBDIVISION, SUBDIVISION  FOURTEEN-F  OF
SECTION  TWENTY-EIGHT  HUNDRED SEVEN-C OF THIS ARTICLE, AND SECTIONS TWO
HUNDRED  ELEVEN  AND  TWO  HUNDRED  TWELVE  OF  CHAPTER   FOUR   HUNDRED
SEVENTY-FOUR OF THE LAWS OF NINETEEN HUNDRED NINETY-SIX, IN A "FINANCIAL
ASSISTANCE  COMPLIANCE  POOL"  AND SHALL ESTABLISH METHODOLOGIES FOR THE
DISTRIBUTION OF SUCH POOL FUNDS TO FACILITIES BASED ON  THEIR  LEVEL  OF
COMPLIANCE,  AS  DETERMINED  BY THE COMMISSIONER, WITH THE PROVISIONS OF
SUBDIVISION NINE-A OF THIS SECTION.
  S 2. Subdivision 14-f of section 2807-c of the public health  law,  as
amended by chapter 1 of the laws of 1999, is amended to read as follows:
  14-f.  Public general hospital indigent care adjustment. Notwithstand-
ing any inconsistent provision of this section AND SUBJECT TO THE AVAIL-
ABILITY OF FEDERAL FINANCIAL PARTICIPATION, payment for inpatient hospi-
tal  services  for  persons  eligible  for  payments   made   by   state
governmental  agencies  for  the  period January first, nineteen hundred
ninety-seven through December thirty-first, nineteen hundred ninety-nine
and periods on and after  January  first,  two  thousand  applicable  to
patients eligible for federal financial participation under title XIX of
the  federal social security act in medical assistance provided pursuant
to title eleven of article five of the social services law determined in
accordance with this section shall include for eligible  public  general
hospitals  a  public  general hospital indigent care adjustment equal to
the aggregate amount of the adjustments provided for such public general
hospital for the  period  January  first,  nineteen  hundred  ninety-six
through  December  thirty-first, nineteen hundred ninety-six pursuant to
subdivisions fourteen-a and fourteen-d of this section on an  annualized
basis,  [provided  all  federal  approvals  necessary by federal law and
regulation for federal financial  participation  in  payments  made  for
beneficiaries  eligible  for  medical  assistance under title XIX of the
federal social security act based upon the adjustment provided herein as
a component of such payments are granted] PROVIDED,  HOWEVER,  THAT  FOR
PERIODS  ON  AND  AFTER  JANUARY  FIRST, TWO THOUSAND THIRTEEN AN ANNUAL
AMOUNT OF FOUR HUNDRED TWELVE MILLION  DOLLARS  SHALL  BE  ALLOCATED  TO
ELIGIBLE  MAJOR  PUBLIC HOSPITALS BASED ON EACH HOSPITAL'S PROPORTIONATE
SHARE OF MEDICAID AND UNINSURED LOSSES TO TOTAL MEDICAID  AND  UNINSURED
LOSSES  FOR  ALL  ELIGIBLE MAJOR PUBLIC HOSPITALS, NET OF ANY DISPROPOR-
TIONATE  SHARE  HOSPITAL  PAYMENTS   RECEIVED   PURSUANT   TO   SECTIONS
TWENTY-EIGHT  HUNDRED  SEVEN-K  AND TWENTY-EIGHT HUNDRED SEVEN-W OF THIS
ARTICLE. The adjustment may be made to rates of payment or as  aggregate
payments to an eligible hospital.
  S  3.  Paragraph  (i) of subdivision 2-a of section 2807 of the public
health law, as amended by section 16 of part C of chapter 58 of the laws
of 2009, is amended to read as follows:
  (i) Notwithstanding any provision of law to  the  contrary,  rates  of
payment   by  governmental  agencies  for  general  hospital  outpatient
services, general hospital emergency services  and  ambulatory  surgical
services  provided  by  a general hospital established pursuant to para-
graphs (a), (c) and (d) of this subdivision shall result in an aggregate
increase in such rates of payment of fifty-six million dollars  for  the
period  December  first,  two thousand eight through March thirty-first,
two thousand nine and one  hundred  seventy-eight  million  dollars  for
periods   after   April   first,   two   thousand  nine,  THROUGH  MARCH

S. 2606--C                         68

THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND ONE HUNDRED FIFTY-THREE MILLION
DOLLARS FOR STATE FISCAL YEAR PERIODS ON  AND  AFTER  APRIL  FIRST,  TWO
THOUSAND  THIRTEEN,  provided,  however,  that  for periods on and after
April  first, two thousand nine, such amounts may be adjusted to reflect
projected decreases in fee-for-service Medicaid utilization and  changes
in  case-mix  with  regard  to such services from the two thousand seven
calendar year to the applicable rate year, and provided further,  howev-
er,  that  funds made available as a result of any such decreases may be
utilized by the commissioner to increase capitation rates paid to  Medi-
caid  managed care plans and family health plus plans to cover increased
payments to health care providers for ambulatory care  services  and  to
increase  such  other  ambulatory care payment rates as the commissioner
determines necessary to facilitate access  to  quality  ambulatory  care
services.
  S  4.  The  opening  paragraph of subparagraph (i) of paragraph (i) of
subdivision 35 of section 2807-c of the public health law, as  added  by
section  3-a of part B of chapter 109 of the laws of 2010, is amended to
read as follows:
  Notwithstanding any inconsistent provision of this subdivision or  any
other  contrary  provision  of  law  and  subject to the availability of
federal financial participation, for the period July first, two thousand
ten through March thirty-first, two  thousand  eleven,  and  each  state
fiscal  year  period  thereafter, the commissioner shall make additional
inpatient hospital payments up to the aggregate upper payment limit  for
inpatient hospital services after all other medical assistance payments,
but  not to exceed two hundred thirty-five million five hundred thousand
dollars for the period July first, two thousand ten through March  thir-
ty-first,  two  thousand  eleven  [and],  three hundred fourteen million
dollars for each state fiscal year BEGINNING APRIL FIRST,  TWO  THOUSAND
ELEVEN,  THROUGH  MARCH THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND NO LESS
THAN THREE HUNDRED THIRTY-NINE MILLION DOLLARS  FOR  EACH  STATE  FISCAL
YEAR  thereafter,  to general hospitals, other than major public general
hospitals, providing emergency room services and  including  safety  net
hospitals, which shall, for the purpose of this paragraph, be defined as
having  either:  a Medicaid share of total inpatient hospital discharges
of at least thirty-five  percent,  including  both  fee-for-service  and
managed  care  discharges  for  acute and exempt services; or a Medicaid
share of total discharges of at least  thirty  percent,  including  both
fee-for-service  and  managed  care  discharges  for  acute  and  exempt
services,  and  also  providing  obstetrical  services.  Eligibility  to
receive  such additional payments shall be based on data from the period
two years prior to the rate year, as reported on the institutional  cost
report submitted to the department as of October first of the prior rate
year.  Such  payments  shall  be made as medical assistance payments for
fee-for-service inpatient hospital services pursuant to title eleven  of
article five of the social services law for patients eligible for feder-
al financial participation under title XIX of the federal social securi-
ty act and in accordance with the following:
  S  5.  This  act  shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1,  2013  provided
that:
  a. sections one, two and four of this act shall be deemed to have been
in full force and effect on and after January 1, 2013; and
  b.  the amendments to subdivision 14-f of section 2807-c of the public
health law made by section two of this act shall not affect the  expira-
tion of such subdivision and shall be deemed to expire therewith.

S. 2606--C                         69

                                 PART D

  Section  1. Subdivision 1 of section 366 of the social services law is
REPEALED and a new subdivision 1 is added to read as follows:
  1. (A) DEFINITIONS. FOR PURPOSES OF THIS SECTION:
  (1) "BENCHMARK COVERAGE" REFERS TO MEDICAL ASSISTANCE COVERAGE DEFINED
IN SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE;
  (2) "CARETAKER RELATIVE" MEANS A RELATIVE  OF  A  DEPENDENT  CHILD  BY
BLOOD,  ADOPTION, OR MARRIAGE WITH WHOM THE CHILD IS LIVING, WHO ASSUMES
PRIMARY RESPONSIBILITY FOR THE CHILD'S  CARE  AND  WHO  IS  ONE  OF  THE
FOLLOWING:
  (I)  THE  CHILD'S  FATHER,  MOTHER, GRANDFATHER, GRANDMOTHER, BROTHER,
SISTER, STEPFATHER, STEPMOTHER, STEPBROTHER,  STEPSISTER,  UNCLE,  AUNT,
FIRST COUSIN, NEPHEW, OR NIECE; OR
  (II) THE SPOUSE OF SUCH PARENT OR RELATIVE, EVEN AFTER THE MARRIAGE IS
TERMINATED BY DEATH OR DIVORCE;
  (3) "FAMILY SIZE" MEANS THE NUMBER OF PERSONS COUNTED AS MEMBERS OF AN
INDIVIDUAL'S HOUSEHOLD;
  (4) "FEDERAL POVERTY LINE" MEANS THE POVERTY LINE DEFINED AND ANNUALLY
REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES;
  (5) "HOUSEHOLD," FOR PURPOSES OF DETERMINING THE FINANCIAL ELIGIBILITY
OF  APPLICANTS  AND  RECIPIENTS OF BENEFITS UNDER THIS TITLE, SHALL MEAN
THE NUMBER OF INDIVIDUALS IN THE HOME WHO ACT AS A SINGLE ECONOMIC UNIT;
  (6) "MAGI" MEANS MODIFIED ADJUSTED GROSS INCOME;
  (7) "MAGI-BASED INCOME" MEANS INCOME CALCULATED USING THE SAME METHOD-
OLOGIES USED TO DETERMINE MAGI UNDER SECTION 36B(D)(2)(B) OF THE  INTER-
NAL  REVENUE  CODE,  WITH  THE   EXCEPTION OF LUMP SUM PAYMENTS, CERTAIN
EDUCATIONAL SCHOLARSHIPS, AND CERTAIN AMERICAN INDIAN AND ALASKA  NATIVE
INCOME,  AS  SPECIFIED  BY  THE  COMMISSIONER  OF HEALTH CONSISTENT WITH
FEDERAL REGULATION AT 42 CFR 435.603 OR ANY SUCCESSOR REGULATION;
  (8) "MAGI HOUSEHOLD INCOME" MEANS, WITH RESPECT TO AN INDIVIDUAL WHOSE
MEDICAL ASSISTANCE ELIGIBILITY  IS  BASED  ON  MODIFIED  ADJUSTED  GROSS
INCOME, THE SUM OF THE MAGI-BASED INCOME OF EVERY PERSON INCLUDED IN THE
INDIVIDUAL'S  MAGI HOUSEHOLD, EXCEPT THAT IT SHALL NOT INCLUDE THE MAGI-
BASED INCOME OF THE FOLLOWING PERSONS IF SUCH PERSONS ARE  NOT  EXPECTED
TO  BE REQUIRED TO FILE A TAX RETURN IN THE TAXABLE YEAR IN WHICH ELIGI-
BILITY FOR MEDICAL ASSISTANCE IS BEING DETERMINED:
  (I) A BIOLOGICAL, ADOPTED, OR STEP CHILD WHO IS INCLUDED IN THE  INDI-
VIDUAL'S MAGI HOUSEHOLD; OR
  (II)  A  PERSON, OTHER THAN A SPOUSE OR A BIOLOGICAL, ADOPTED, OR STEP
CHILD, WHO IS EXPECTED TO BE CLAIMED AS A TAX DEPENDENT BY THE  INDIVID-
UAL;
  (9)  "STANDARD COVERAGE" REFERS TO MEDICAL ASSISTANCE COVERAGE DEFINED
IN SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE.
  (B) MAGI ELIGIBILITY GROUPS. INDIVIDUALS LISTED IN THIS PARAGRAPH  ARE
ELIGIBLE FOR MEDICAL ASSISTANCE BASED ON MODIFIED ADJUSTED GROSS INCOME.
IN DETERMINING THE ELIGIBILITY OF AN INDIVIDUAL FOR THE MAGI ELIGIBILITY
GROUP  WITH  THE  HIGHEST INCOME STANDARD UNDER WHICH THE INDIVIDUAL MAY
QUALIFY, AN AMOUNT EQUIVALENT TO FIVE PERCENTAGE POINTS OF  THE  FEDERAL
POVERTY  LEVEL  FOR THE APPLICABLE FAMILY SIZE WILL BE DEDUCTED FROM THE
HOUSEHOLD INCOME.
  (1) AN INDIVIDUAL IS ELIGIBLE FOR BENCHMARK COVERAGE  IF  HIS  OR  HER
MAGI  HOUSEHOLD  INCOME DOES NOT EXCEED ONE HUNDRED THIRTY-THREE PERCENT
OF THE FEDERAL POVERTY LINE FOR THE APPLICABLE FAMILY SIZE AND HE OR SHE
IS:
  (I) AGE NINETEEN OR OLDER AND UNDER AGE SIXTY-FIVE; AND

S. 2606--C                         70

  (II) NOT PREGNANT; AND
  (III)  NOT  ENTITLED TO OR ENROLLED FOR BENEFITS UNDER PARTS A OR B OF
TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT; AND
  (IV) NOT OTHERWISE ELIGIBLE FOR AND RECEIVING COVERAGE UNDER  SUBPARA-
GRAPHS TWO AND THREE OF THIS PARAGRAPH; AND
  (V)  NOT  A  PARENT  OR  OTHER CARETAKER RELATIVE OF A DEPENDENT CHILD
UNDER TWENTY-ONE YEARS OF AGE AND LIVING WITH SUCH  CHILD,  UNLESS  SUCH
CHILD IS RECEIVING BENEFITS UNDER THIS TITLE OR UNDER TITLE 1-A OF ARTI-
CLE  TWENTY-FIVE  OF  THE PUBLIC HEALTH LAW, OR OTHERWISE IS ENROLLED IN
MINIMUM ESSENTIAL COVERAGE.
  (2) A PREGNANT WOMAN OR AN INFANT YOUNGER THAN  ONE  YEAR  OF  AGE  IS
ELIGIBLE  FOR STANDARD COVERAGE IF HIS OR HER MAGI HOUSEHOLD INCOME DOES
NOT EXCEED THE MAGI-EQUIVALENT OF TWO HUNDRED  PERCENT  OF  THE  FEDERAL
POVERTY  LINE  FOR THE APPLICABLE FAMILY SIZE, WHICH SHALL BE CALCULATED
IN ACCORDANCE WITH GUIDANCE ISSUED BY THE SECRETARY OF THE UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR AN INFANT YOUNGER  THAN  ONE
YEAR OF AGE WHO MEETS THE PRESUMPTIVE ELIGIBILITY REQUIREMENTS OF SUBDI-
VISION FOUR OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (3)  A CHILD WHO IS AT LEAST ONE YEAR OF AGE BUT YOUNGER THAN NINETEEN
YEARS OF AGE IS ELIGIBLE FOR STANDARD COVERAGE IF HIS OR HER MAGI HOUSE-
HOLD  INCOME  DOES  NOT  EXCEED  THE  MAGI-EQUIVALENT  OF  ONE   HUNDRED
THIRTY-THREE  PERCENT  OF  THE  FEDERAL  POVERTY LINE FOR THE APPLICABLE
FAMILY SIZE, WHICH SHALL  BE  CALCULATED  IN  ACCORDANCE  WITH  GUIDANCE
ISSUED  BY  THE  SECRETARY OF THE UNITED STATES DEPARTMENT OF HEALTH AND
HUMAN SERVICES, OR A CHILD WHO IS AT LEAST ONE YEAR OF AGE  BUT  YOUNGER
THAN  NINETEEN  YEARS  OF  AGE  WHO  MEETS  THE  PRESUMPTIVE ELIGIBILITY
REQUIREMENTS OF SUBDIVISION FOUR OF SECTION THREE  HUNDRED  SIXTY-FOUR-I
OF THIS TITLE.
  (4)  AN  INDIVIDUAL WHO IS A PREGNANT WOMAN OR IS A MEMBER OF A FAMILY
THAT CONTAINS A DEPENDENT CHILD LIVING WITH A PARENT OR OTHER  CARETAKER
RELATIVE  IS ELIGIBLE FOR STANDARD COVERAGE IF HIS OR HER MAGI HOUSEHOLD
INCOME DOES NOT EXCEED THE MAGI-EQUIVALENT OF ONE HUNDRED THIRTY PERCENT
OF THE HIGHEST AMOUNT THAT ORDINARILY WOULD HAVE BEEN PAID TO  A  PERSON
WITHOUT  ANY  INCOME OR RESOURCES UNDER THE FAMILY ASSISTANCE PROGRAM AS
IT EXISTED ON THE FIRST DAY OF NOVEMBER, NINETEEN HUNDRED  NINETY-SEVEN,
WHICH  SHALL  BE  CALCULATED  IN  ACCORDANCE WITH GUIDANCE ISSUED BY THE
SECRETARY OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN  SERVICES;
FOR  PURPOSES  OF  THIS  SUBPARAGRAPH,  THE TERM DEPENDENT CHILD MEANS A
PERSON WHO IS UNDER EIGHTEEN YEARS OF AGE, OR IS EIGHTEEN YEARS  OF  AGE
AND  A FULL-TIME STUDENT, WHO IS DEPRIVED OF PARENTAL SUPPORT OR CARE BY
REASON OF THE DEATH, CONTINUED ABSENCE, OR PHYSICAL OR MENTAL INCAPACITY
OF A PARENT, OR BY REASON OF THE UNEMPLOYMENT OF THE PARENT, AS  DEFINED
BY THE DEPARTMENT OF HEALTH.
  (5) A CHILD WHO IS UNDER TWENTY-ONE YEARS OF AGE AND WHO WAS IN FOSTER
CARE  UNDER  THE  RESPONSIBILITY  OF  THE STATE ON HIS OR HER EIGHTEENTH
BIRTHDAY  IS  ELIGIBLE  FOR  STANDARD  COVERAGE;   NOTWITHSTANDING   ANY
PROVISION  OF  LAW  TO THE CONTRARY, THE PROVISIONS OF THIS SUBPARAGRAPH
SHALL BE EFFECTIVE ONLY IF AND FOR SO LONG AS FEDERAL FINANCIAL  PARTIC-
IPATION  IS AVAILABLE IN THE COSTS OF MEDICAL ASSISTANCE FURNISHED HERE-
UNDER.
  (6) AN INDIVIDUAL WHO IS NOT OTHERWISE ELIGIBLE FOR MEDICAL ASSISTANCE
UNDER THIS SECTION IS ELIGIBLE FOR COVERAGE OF FAMILY PLANNING  SERVICES
REIMBURSED  BY  THE  FEDERAL GOVERNMENT AT A RATE OF NINETY PERCENT, AND
FOR COVERAGE OF THOSE SERVICES IDENTIFIED BY THE COMMISSIONER OF  HEALTH
AS  SERVICES  GENERALLY  PERFORMED  AS  PART  OF  OR AS A FOLLOW-UP TO A
SERVICE ELIGIBLE FOR SUCH NINETY PERCENT REIMBURSEMENT, INCLUDING TREAT-

S. 2606--C                         71

MENT FOR SEXUALLY TRANSMITTED DISEASES, IF HIS OR HER  INCOME  DOES  NOT
EXCEED THE MAGI-EQUIVALENT OF TWO HUNDRED PERCENT OF THE FEDERAL POVERTY
LINE  FOR  THE  APPLICABLE  FAMILY  SIZE,  WHICH  SHALL BE CALCULATED IN
ACCORDANCE  WITH  GUIDANCE  ISSUED BY THE SECRETARY OF THE UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES.
  (7) A CHILD WHO IS NINETEEN OR TWENTY YEARS OF AGE LIVING WITH HIS  OR
HER  PARENT  WILL  BE  ELIGIBLE  FOR STANDARD COVERAGE IF THE SUM OF THE
MAGI-BASED INCOME OF EVERY PERSON INCLUDED IN THE CHILD'S MAGI HOUSEHOLD
EXCEEDS ONE HUNDRED  THIRTY-THREE  PERCENT,  BUT  DOES  NOT  EXCEED  ONE
HUNDRED  FIFTY  PERCENT,  OF THE FEDERAL POVERTY LINE FOR THE APPLICABLE
FAMILY SIZE.
  (C) NON-MAGI ELIGIBILITY GROUPS. INDIVIDUALS LISTED IN THIS  PARAGRAPH
ARE ELIGIBLE FOR STANDARD COVERAGE. WHERE A FINANCIAL ELIGIBILITY DETER-
MINATION  MUST BE MADE BY THE MEDICAL ASSISTANCE PROGRAM FOR INDIVIDUALS
IN THESE GROUPS,  SUCH  FINANCIAL  ELIGIBILITY  WILL  BE  DETERMINED  IN
ACCORDANCE WITH SUBDIVISION TWO OF THIS SECTION.
  (1)  AN  INDIVIDUAL  RECEIVING  OR ELIGIBLE TO RECEIVE FEDERAL SUPPLE-
MENTAL SECURITY INCOME PAYMENTS AND/OR ADDITIONAL STATE PAYMENTS  PURSU-
ANT  TO  TITLE  SIX  OF THIS ARTICLE; ANY INCONSISTENT PROVISION OF THIS
CHAPTER OR OTHER LAW NOTWITHSTANDING, THE DEPARTMENT MAY  DESIGNATE  THE
OFFICE  OF TEMPORARY AND DISABILITY ASSISTANCE AS ITS AGENT TO DISCHARGE
ITS RESPONSIBILITY, OR SO MUCH OF ITS RESPONSIBILITY AS IS PERMITTED  BY
FEDERAL  LAW,  FOR  DETERMINING  ELIGIBILITY FOR MEDICAL ASSISTANCE WITH
RESPECT TO PERSONS WHO ARE NOT ELIGIBLE TO RECEIVE FEDERAL  SUPPLEMENTAL
SECURITY  INCOME  PAYMENTS  BUT  WHO  ARE RECEIVING A STATE ADMINISTERED
SUPPLEMENTARY PAYMENT OR MANDATORY MINIMUM SUPPLEMENT IN ACCORDANCE WITH
THE PROVISIONS OF SUBDIVISION ONE OF SECTION TWO HUNDRED TWELVE OF  THIS
ARTICLE.
  (2)  AN  INDIVIDUAL  WHO,  ALTHOUGH NOT RECEIVING PUBLIC ASSISTANCE OR
CARE FOR HIS OR HER MAINTENANCE UNDER OTHER PROVISIONS OF THIS  CHAPTER,
HAS  INCOME  AND RESOURCES, INCLUDING AVAILABLE SUPPORT FROM RESPONSIBLE
RELATIVES, THAT DOES NOT EXCEED THE AMOUNTS SET FORTH IN  PARAGRAPH  (A)
OF  SUBDIVISION  TWO OF THIS SECTION, AND IS (I) SIXTY-FIVE YEARS OF AGE
OR OLDER, OR CERTIFIED BLIND OR CERTIFIED DISABLED OR (II)  FOR  REASONS
OTHER  THAN  INCOME  OR  RESOURCES, IS ELIGIBLE FOR FEDERAL SUPPLEMENTAL
SECURITY INCOME BENEFITS AND/OR ADDITIONAL STATE PAYMENTS.
  (3) A CHILD IN FOSTER CARE, OR  A  CHILD  DESCRIBED  IN  SECTION  FOUR
HUNDRED FIFTY-FOUR OR FOUR HUNDRED FIFTY-EIGHT-D OF THIS CHAPTER.
  (4) A DISABLED INDIVIDUAL AT LEAST SIXTEEN YEARS OF AGE, BUT UNDER THE
AGE  OF  SIXTY-FIVE,  WHO:    WOULD  BE  ELIGIBLE FOR BENEFITS UNDER THE
SUPPLEMENTAL SECURITY INCOME PROGRAM BUT FOR EARNINGS IN EXCESS  OF  THE
ALLOWABLE  LIMIT;  HAS  NET  AVAILABLE  INCOME  THAT DOES NOT EXCEED TWO
HUNDRED FIFTY PERCENT OF THE APPLICABLE FEDERAL INCOME OFFICIAL  POVERTY
LINE,  AS  DEFINED AND UPDATED BY THE UNITED STATES DEPARTMENT OF HEALTH
AND HUMAN SERVICES, FOR A ONE-PERSON OR TWO-PERSON HOUSEHOLD, AS DEFINED
BY THE COMMISSIONER IN REGULATION; HAS HOUSEHOLD RESOURCES,  AS  DEFINED
IN PARAGRAPH (E) OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-SIX-C
OF THIS TITLE, OTHER THAN RETIREMENT ACCOUNTS, THAT DO NOT EXCEED TWENTY
THOUSAND  DOLLARS  FOR A ONE-PERSON HOUSEHOLD OR THIRTY THOUSAND DOLLARS
FOR A TWO-PERSON HOUSEHOLD, AS DEFINED  BY  THE  COMMISSIONER  IN  REGU-
LATION;  AND  CONTRIBUTES  TO  THE  COST  OF MEDICAL ASSISTANCE PROVIDED
PURSUANT TO THIS SUBPARAGRAPH IN ACCORDANCE WITH SUBDIVISION  TWELVE  OF
SECTION  THREE HUNDRED SIXTY-SEVEN-A OF THIS TITLE; FOR PURPOSES OF THIS
SUBPARAGRAPH, DISABLED MEANS HAVING A MEDICALLY DETERMINABLE  IMPAIRMENT
OF  SUFFICIENT  SEVERITY  AND  DURATION  TO  QUALIFY  FOR BENEFITS UNDER
SECTION 1902(A)(10)(A)(II)(XV) OF THE SOCIAL SECURITY ACT.

S. 2606--C                         72

  (5) AN INDIVIDUAL AT LEAST SIXTEEN YEARS OF AGE, BUT UNDER THE AGE  OF
SIXTY-FIVE, WHO: IS EMPLOYED; CEASES TO BE IN RECEIPT OF MEDICAL ASSIST-
ANCE  UNDER  SUBPARAGRAPH  FIVE OF THIS PARAGRAPH BECAUSE THE PERSON, BY
REASON OF MEDICAL IMPROVEMENT, IS DETERMINED AT THE TIME OF A  REGULARLY
SCHEDULED  CONTINUING  DISABILITY  REVIEW  TO  NO LONGER BE ELIGIBLE FOR
SUPPLEMENTAL SECURITY INCOME PROGRAM BENEFITS  OR  DISABILITY  INSURANCE
BENEFITS  UNDER  THE  SOCIAL  SECURITY  ACT;  CONTINUES TO HAVE A SEVERE
MEDICALLY DETERMINABLE IMPAIRMENT, TO BE DETERMINED IN  ACCORDANCE  WITH
APPLICABLE  FEDERAL  REGULATIONS; AND CONTRIBUTES TO THE COST OF MEDICAL
ASSISTANCE PROVIDED PURSUANT TO THIS  SUBPARAGRAPH  IN  ACCORDANCE  WITH
SUBDIVISION TWELVE OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS TITLE;
FOR PURPOSES OF THIS SUBPARAGRAPH, A PERSON IS CONSIDERED TO BE EMPLOYED
IF  THE  PERSON  IS  EARNING  AT LEAST THE APPLICABLE MINIMUM WAGE UNDER
SECTION SIX OF THE FEDERAL FAIR LABOR STANDARDS ACT AND WORKING AT LEAST
FORTY HOURS PER MONTH; OR
  (6) AN INDIVIDUAL RECEIVING TREATMENT FOR BREAST  OR  CERVICAL  CANCER
WHO  MEETS  THE ELIGIBILITY REQUIREMENTS OF PARAGRAPH (D) OF SUBDIVISION
FOUR OF THIS SECTION OR  THE  PRESUMPTIVE  ELIGIBILITY  REQUIREMENTS  OF
SUBDIVISION FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (7) AN INDIVIDUAL RECEIVING TREATMENT FOR COLON OR PROSTATE CANCER WHO
MEETS  THE ELIGIBILITY REQUIREMENTS OF PARAGRAPH (E) OF SUBDIVISION FOUR
OF THIS SECTION OR THE PRESUMPTIVE ELIGIBILITY REQUIREMENTS OF  SUBDIVI-
SION FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (8) AN INDIVIDUAL WHO:
  (I) IS UNDER TWENTY-SIX YEARS OF AGE; AND
  (II)  WAS  IN FOSTER CARE UNDER THE RESPONSIBILITY OF THE STATE ON HIS
OR HER EIGHTEENTH BIRTHDAY; AND
  (III) WAS IN RECEIPT OF MEDICAL ASSISTANCE UNDER THIS TITLE  WHILE  IN
FOSTER CARE; AND
  (IV)  IS  NOT  OTHERWISE  ELIGIBLE  FOR  MEDICAL ASSISTANCE UNDER THIS
TITLE.
  (9) A RESIDENT OF A HOME FOR ADULTS  OPERATED  BY  A  SOCIAL  SERVICES
DISTRICT, OR A RESIDENTIAL CARE CENTER FOR ADULTS OR COMMUNITY RESIDENCE
OPERATED  OR  CERTIFIED  BY  THE  OFFICE  OF MENTAL HEALTH, AND HAS NOT,
ACCORDING TO CRITERIA PROMULGATED BY THE DEPARTMENT CONSISTENT WITH THIS
TITLE, SUFFICIENT INCOME, OR IN THE CASE OF A PERSON SIXTY-FIVE YEARS OF
AGE OR OLDER, CERTIFIED BLIND, OR CERTIFIED DISABLED, SUFFICIENT  INCOME
AND  RESOURCES,  INCLUDING AVAILABLE SUPPORT FROM RESPONSIBLE RELATIVES,
TO MEET ALL THE COSTS OF REQUIRED MEDICAL CARE  AND  SERVICES  AVAILABLE
UNDER THIS TITLE.
  (D)  CONDITIONS  OF  ELIGIBILITY.  A  PERSON SHALL NOT BE ELIGIBLE FOR
MEDICAL ASSISTANCE UNDER THIS TITLE UNLESS HE OR SHE:
  (1) IS A RESIDENT OF THE STATE, OR, WHILE TEMPORARILY  IN  THE  STATE,
REQUIRES  IMMEDIATE  MEDICAL  CARE  WHICH  IS  NOT  OTHERWISE AVAILABLE,
PROVIDED THAT SUCH PERSON DID NOT ENTER THE STATE  FOR  THE  PURPOSE  OF
OBTAINING SUCH MEDICAL CARE; AND
  (2)  ASSIGNS  TO  THE  APPROPRIATE  SOCIAL SERVICES OFFICIAL OR TO THE
DEPARTMENT, IN ACCORDANCE WITH DEPARTMENT REGULATIONS: (I) ANY  BENEFITS
WHICH  ARE AVAILABLE TO HIM OR HER INDIVIDUALLY FROM ANY THIRD PARTY FOR
CARE OR OTHER MEDICAL BENEFITS AVAILABLE UNDER THIS TITLE AND WHICH  ARE
OTHERWISE  ASSIGNABLE  PURSUANT TO A CONTRACT OR ANY AGREEMENT WITH SUCH
THIRD PARTY; OR (II) ANY RIGHTS, OF  THE  INDIVIDUAL  OR  OF  ANY  OTHER
PERSON  WHO  IS  ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS TITLE AND ON
WHOSE BEHALF THE INDIVIDUAL  HAS  THE  LEGAL  AUTHORITY  TO  EXECUTE  AN
ASSIGNMENT  OF  SUCH  RIGHTS,  TO  SUPPORT  SPECIFIED AS SUPPORT FOR THE
PURPOSE OF MEDICAL CARE BY A COURT OR ADMINISTRATIVE ORDER; AND

S. 2606--C                         73

  (3) COOPERATES WITH THE APPROPRIATE SOCIAL SERVICES  OFFICIAL  OR  THE
DEPARTMENT  IN  ESTABLISHING PATERNITY OR IN ESTABLISHING, MODIFYING, OR
ENFORCING A SUPPORT ORDER WITH RESPECT TO HIS OR  HER  CHILD;  PROVIDED,
HOWEVER,  THAT  NOTHING HEREIN CONTAINED SHALL BE CONSTRUED TO REQUIRE A
PAYMENT  UNDER THIS TITLE FOR CARE OR SERVICES, THE COST OF WHICH MAY BE
MET IN WHOLE OR IN PART BY A THIRD PARTY; NOTWITHSTANDING THE FOREGOING,
A SOCIAL SERVICES OFFICIAL SHALL NOT REQUIRE  SUCH  COOPERATION  IF  THE
SOCIAL  SERVICES OFFICIAL OR THE DEPARTMENT DETERMINES THAT SUCH ACTIONS
WOULD BE DETRIMENTAL TO THE BEST INTEREST OF THE  CHILD,  APPLICANT,  OR
RECIPIENT, OR WITH RESPECT TO PREGNANT WOMEN DURING PREGNANCY AND DURING
THE  SIXTY-DAY PERIOD BEGINNING ON THE LAST DAY OF PREGNANCY, IN ACCORD-
ANCE WITH PROCEDURES AND CRITERIA  ESTABLISHED  BY  REGULATIONS  OF  THE
DEPARTMENT CONSISTENT WITH FEDERAL LAW; AND
  (4) APPLIES FOR AND UTILIZES GROUP HEALTH INSURANCE BENEFITS AVAILABLE
THROUGH  A  CURRENT  OR FORMER EMPLOYER, INCLUDING BENEFITS FOR A SPOUSE
AND DEPENDENT CHILDREN,  IN  ACCORDANCE  WITH  THE  REGULATIONS  OF  THE
DEPARTMENT.
  (E)  CONDITIONS OF COVERAGE. AN OTHERWISE ELIGIBLE PERSON SHALL NOT BE
ENTITLED TO MEDICAL ASSISTANCE COVERAGE OF CARE, SERVICES, AND  SUPPLIES
UNDER THIS TITLE WHILE HE OR SHE:
  (1)  IS  AN  INMATE  OR  PATIENT IN AN INSTITUTION OR FACILITY WHEREIN
MEDICAL ASSISTANCE MAY NOT BE PROVIDED  IN  ACCORDANCE  WITH  APPLICABLE
FEDERAL  OR STATE REQUIREMENTS, EXCEPT FOR PERSONS DESCRIBED IN SUBPARA-
GRAPH NINE OF PARAGRAPH (C) OF THIS SUBDIVISION OR SUBDIVISION ONE-A  OR
SUBDIVISION ONE-B OF THIS SECTION; OR
  (2)  IS  A  PATIENT IN A PUBLIC INSTITUTION OPERATED PRIMARILY FOR THE
TREATMENT OF TUBERCULOSIS OR CARE OF THE  MENTALLY  DISABLED,  WITH  THE
EXCEPTION  OF:  (I)  A  PERSON  SIXTY-FIVE  YEARS  OF AGE OR OLDER AND A
PATIENT IN ANY SUCH INSTITUTION; (II) A PERSON UNDER TWENTY-ONE YEARS OF
AGE AND RECEIVING IN-PATIENT PSYCHIATRIC SERVICES IN A  PUBLIC  INSTITU-
TION  OPERATED  PRIMARILY FOR THE CARE OF THE MENTALLY DISABLED; (III) A
PATIENT IN A PUBLIC INSTITUTION OPERATED PRIMARILY FOR THE CARE  OF  THE
MENTALLY  RETARDED  WHO  IS  RECEIVING MEDICAL CARE OR TREATMENT IN THAT
PART OF SUCH INSTITUTION THAT HAS BEEN APPROVED PURSUANT  TO  LAW  AS  A
HOSPITAL  OR  NURSING HOME; (IV) A PATIENT IN AN INSTITUTION OPERATED BY
THE STATE DEPARTMENT OF MENTAL HYGIENE, WHILE UNDER CARE IN  A  HOSPITAL
ON  RELEASE  FROM  SUCH INSTITUTION FOR THE PURPOSE OF RECEIVING CARE IN
SUCH HOSPITAL; OR (V) IS A PERSON RESIDING IN A COMMUNITY RESIDENCE OR A
RESIDENTIAL CARE CENTER FOR ADULTS.
  S 2. Subdivision 4 of section  366  of  the  social  services  law  is
REPEALED and a new subdivision 4 is added to read as follows:
  4. SPECIAL ELIGIBILITY PROVISIONS.
  (A) TRANSITIONAL MEDICAL ASSISTANCE.
  (1)  NOTWITHSTANDING ANY OTHER PROVISION OF LAW, EACH FAMILY WHICH WAS
ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO SUBPARAGRAPH FOUR  OF  PARA-
GRAPH  (B) OF SUBDIVISION ONE OF THIS SECTION IN AT LEAST ONE OF THE SIX
MONTHS IMMEDIATELY PRECEDING THE MONTH IN WHICH SUCH FAMILY BECAME INEL-
IGIBLE FOR SUCH ASSISTANCE BECAUSE OF INCOME FROM THE EMPLOYMENT OF  THE
CARETAKER  RELATIVE SHALL, WHILE SUCH FAMILY INCLUDES A DEPENDENT CHILD,
REMAIN ELIGIBLE FOR MEDICAL ASSISTANCE FOR TWELVE CALENDAR MONTHS  IMME-
DIATELY  FOLLOWING  THE  MONTH  IN  WHICH SUCH FAMILY WOULD OTHERWISE BE
DETERMINED TO BE INELIGIBLE  FOR  MEDICAL  ASSISTANCE  PURSUANT  TO  THE
PROVISIONS OF THIS TITLE AND THE REGULATIONS OF THE DEPARTMENT GOVERNING
INCOME  AND  RESOURCE LIMITATIONS RELATING TO ELIGIBILITY DETERMINATIONS
FOR FAMILIES DESCRIBED IN SUBPARAGRAPH FOUR OF PARAGRAPH (B) OF SUBDIVI-
SION ONE OF THIS SECTION.

S. 2606--C                         74

  (2) (I) UPON  GIVING  NOTICE  OF  TERMINATION  OF  MEDICAL  ASSISTANCE
PROVIDED  PURSUANT  TO SUBPARAGRAPH FOUR OF PARAGRAPH (B) OF SUBDIVISION
ONE OF THIS SECTION, THE DEPARTMENT SHALL NOTIFY EACH SUCH FAMILY OF ITS
RIGHTS TO EXTENDED BENEFITS UNDER SUBPARAGRAPH ONE OF THIS PARAGRAPH AND
DESCRIBE THE CONDITIONS UNDER WHICH SUCH EXTENSION MAY BE TERMINATED.
  (II)  THE  DEPARTMENT  SHALL  PROMULGATE  REGULATIONS IMPLEMENTING THE
REQUIREMENTS OF THIS SUBPARAGRAPH AND SUBPARAGRAPH ONE OF THIS PARAGRAPH
RELATING TO THE CONDITIONS UNDER WHICH EXTENDED COVERAGE  HEREUNDER  MAY
BE  TERMINATED,  THE  SCOPE  OF COVERAGE, AND THE CONDITIONS UNDER WHICH
COVERAGE MAY BE EXTENDED PENDING A REDETERMINATION OF ELIGIBILITY.  SUCH
REGULATIONS SHALL, AT A MINIMUM, PROVIDE FOR: TERMINATION OF SUCH COVER-
AGE  AT  THE  CLOSE  OF  THE  FIRST  MONTH IN WHICH THE FAMILY CEASES TO
INCLUDE A DEPENDENT CHILD; NOTICE OF TERMINATION PRIOR TO THE  EFFECTIVE
DATE  OF  ANY  TERMINATIONS;  COVERAGE  UNDER  EMPLOYEE HEALTH PLANS AND
HEALTH MAINTENANCE ORGANIZATIONS; AND DISQUALIFICATION  OF  PERSONS  FOR
EXTENDED COVERAGE BENEFITS UNDER THIS PARAGRAPH FOR FRAUD.
  (3)  NOTWITHSTANDING  ANY  INCONSISTENT  PROVISION OF LAW, EACH FAMILY
WHICH WAS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO SUBPARAGRAPH  FOUR
OF PARAGRAPH (B) OF SUBDIVISION ONE OF THIS SECTION IN AT LEAST THREE OF
THE  SIX  MONTHS  IMMEDIATELY  PRECEDING  THE MONTH IN WHICH SUCH FAMILY
BECAME INELIGIBLE FOR SUCH ASSISTANCE AS A RESULT, WHOLLY OR PARTLY,  OF
THE  COLLECTION  OR  INCREASED COLLECTION OF SPOUSAL SUPPORT PURSUANT TO
PART D OF TITLE IV OF  THE  FEDERAL  SOCIAL  SECURITY  ACT,  SHALL,  FOR
PURPOSES OF MEDICAL ASSISTANCE ELIGIBILITY, BE CONSIDERED TO BE ELIGIBLE
FOR MEDICAL ASSISTANCE PURSUANT TO SUBPARAGRAPH FOUR OF PARAGRAPH (B) OF
SUBDIVISION  ONE  OF THIS SECTION FOR AN ADDITIONAL FOUR CALENDAR MONTHS
BEGINNING WITH THE MONTH INELIGIBILITY FOR SUCH ASSISTANCE BEGINS.
  (B) PREGNANT WOMEN AND CHILDREN.
  (1) A PREGNANT WOMAN ELIGIBLE FOR MEDICAL  ASSISTANCE  UNDER  SUBPARA-
GRAPH TWO OR FOUR OF PARAGRAPH (B) OF SUBDIVISION ONE OF THIS SECTION ON
ANY  DAY OF HER PREGNANCY WILL CONTINUE TO BE ELIGIBLE FOR SUCH CARE AND
SERVICES THROUGH THE END OF THE MONTH IN WHICH THE SIXTIETH DAY  FOLLOW-
ING THE END OF THE PREGNANCY OCCURS, WITHOUT REGARD TO ANY CHANGE IN THE
INCOME  OF  THE  FAMILY  THAT  INCLUDES THE PREGNANT WOMAN, EVEN IF SUCH
CHANGE OTHERWISE WOULD HAVE RENDERED HER INELIGIBLE FOR MEDICAL  ASSIST-
ANCE.
  (2) A CHILD BORN TO A WOMAN ELIGIBLE FOR AND RECEIVING MEDICAL ASSIST-
ANCE  ON  THE  DATE OF THE CHILD'S BIRTH SHALL BE DEEMED TO HAVE APPLIED
FOR MEDICAL ASSISTANCE AND TO HAVE BEEN FOUND ELIGIBLE FOR SUCH  ASSIST-
ANCE  ON  THE DATE OF SUCH BIRTH AND TO REMAIN ELIGIBLE FOR SUCH ASSIST-
ANCE FOR A PERIOD OF ONE YEAR, SO LONG AS THE CHILD IS A MEMBER  OF  THE
WOMAN'S  HOUSEHOLD AND THE WOMAN REMAINS ELIGIBLE FOR SUCH ASSISTANCE OR
WOULD REMAIN ELIGIBLE FOR SUCH ASSISTANCE IF SHE WERE PREGNANT.
  (3) A CHILD UNDER THE AGE OF NINETEEN WHO IS DETERMINED  ELIGIBLE  FOR
MEDICAL ASSISTANCE UNDER THE PROVISIONS OF THIS SECTION, SHALL, CONSIST-
ENT  WITH  APPLICABLE  FEDERAL  REQUIREMENTS,  REMAIN  ELIGIBLE FOR SUCH
ASSISTANCE UNTIL THE EARLIER OF:
  (I) THE LAST DAY OF THE MONTH WHICH IS  TWELVE  MONTHS  FOLLOWING  THE
DETERMINATION OR REDETERMINATION OF ELIGIBILITY FOR SUCH ASSISTANCE; OR
  (II)  THE  LAST DAY OF THE MONTH IN WHICH THE CHILD REACHES THE AGE OF
NINETEEN.
  (4) AN INFANT ELIGIBLE UNDER SUBPARAGRAPH TWO OR FOUR OF PARAGRAPH (B)
OF SUBDIVISION ONE OF THIS SECTION WHO IS RECEIVING MEDICALLY  NECESSARY
IN-PATIENT SERVICES FOR WHICH MEDICAL ASSISTANCE IS PROVIDED ON THE DATE
THE  CHILD ATTAINS ONE YEAR OF AGE, AND WHO, BUT FOR ATTAINING SUCH AGE,
WOULD REMAIN ELIGIBLE FOR MEDICAL ASSISTANCE  UNDER  SUCH  SUBPARAGRAPH,

S. 2606--C                         75

SHALL  CONTINUE  TO  REMAIN ELIGIBLE UNTIL THE END OF THE STAY FOR WHICH
IN-PATIENT SERVICES ARE BEING FURNISHED.
  (5)  A  CHILD  ELIGIBLE  UNDER  SUBPARAGRAPH THREE OF PARAGRAPH (B) OF
SUBDIVISION ONE OF THIS SECTION WHO  IS  RECEIVING  MEDICALLY  NECESSARY
IN-PATIENT SERVICES FOR WHICH MEDICAL ASSISTANCE IS PROVIDED ON THE DATE
THE CHILD ATTAINS NINETEEN YEARS OF AGE, AND WHO, BUT FOR ATTAINING SUCH
AGE,  WOULD REMAIN ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS PARAGRAPH,
SHALL CONTINUE TO REMAIN ELIGIBLE UNTIL THE END OF THE  STAY  FOR  WHICH
IN-PATIENT SERVICES ARE BEING FURNISHED.
  (6)  A  WOMAN  WHO WAS PREGNANT WHILE IN RECEIPT OF MEDICAL ASSISTANCE
WHO SUBSEQUENTLY LOSES HER ELIGIBILITY FOR MEDICAL ASSISTANCE SHALL HAVE
HER ELIGIBILITY FOR MEDICAL ASSISTANCE CONTINUED FOR A PERIOD  OF  TWEN-
TY-FOUR  MONTHS  FROM  THE  END  OF  THE MONTH IN WHICH THE SIXTIETH DAY
FOLLOWING THE END OF HER PREGNANCY OCCURS, BUT ONLY FOR FEDERAL TITLE  X
SERVICES  WHICH ARE ELIGIBLE FOR REIMBURSEMENT BY THE FEDERAL GOVERNMENT
AT A RATE OF NINETY PERCENT; PROVIDED, HOWEVER, THAT SUCH NINETY PERCENT
LIMITATION SHALL NOT APPLY TO THOSE SERVICES IDENTIFIED BY  THE  COMMIS-
SIONER   AS  SERVICES,  INCLUDING  TREATMENT  FOR  SEXUALLY  TRANSMITTED
DISEASES, GENERALLY PERFORMED AS PART OF OR AS A FOLLOW-UP TO A  SERVICE
ELIGIBLE  FOR  SUCH  NINETY PERCENT REIMBURSEMENT; AND PROVIDED FURTHER,
HOWEVER, THAT NOTHING IN  THIS  PARAGRAPH  SHALL  BE  DEEMED  TO  AFFECT
PAYMENT  FOR SUCH TITLE X SERVICES IF FEDERAL FINANCIAL PARTICIPATION IS
NOT AVAILABLE FOR SUCH CARE, SERVICES AND SUPPLIES.
  (C) BREAST AND CERVICAL CANCER TREATMENT.
  (1) PERSONS WHO ARE NOT ELIGIBLE  FOR  MEDICAL  ASSISTANCE  UNDER  THE
TERMS  OF  SECTION  1902(A)(10)(A)(I) OF THE FEDERAL SOCIAL SECURITY ACT
ARE ELIGIBLE FOR MEDICAL ASSISTANCE COVERAGE  DURING  THE  TREATMENT  OF
BREAST OR CERVICAL CANCER, SUBJECT TO THE PROVISIONS OF THIS PARAGRAPH.
  (2)  (I)  MEDICAL  ASSISTANCE  IS  AVAILABLE  UNDER  THIS PARAGRAPH TO
PERSONS WHO ARE UNDER SIXTY-FIVE YEARS OF AGE, HAVE  BEEN  SCREENED  FOR
BREAST  AND/OR CERVICAL CANCER UNDER THE CENTERS FOR DISEASE CONTROL AND
PREVENTION BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM  AND  NEED
TREATMENT  FOR  BREAST OR CERVICAL CANCER, AND ARE NOT OTHERWISE COVERED
UNDER CREDITABLE COVERAGE  AS  DEFINED  IN  THE  FEDERAL  PUBLIC  HEALTH
SERVICE ACT; PROVIDED HOWEVER THAT MEDICAL ASSISTANCE SHALL BE FURNISHED
PURSUANT  TO THIS CLAUSE ONLY TO THE EXTENT PERMITTED UNDER FEDERAL LAW,
IF, FOR SO LONG AS, AND TO THE EXTENT  THAT  FEDERAL  FINANCIAL  PARTIC-
IPATION IS AVAILABLE THEREFOR.
  (II)  MEDICAL  ASSISTANCE IS AVAILABLE UNDER THIS PARAGRAPH TO PERSONS
WHO MEET THE REQUIREMENTS OF CLAUSE (I) OF  THIS  SUBPARAGRAPH  BUT  FOR
THEIR AGE AND/OR GENDER, WHO HAVE BEEN SCREENED FOR BREAST AND/OR CERVI-
CAL  CANCER  UNDER THE PROGRAM DESCRIBED IN TITLE ONE-A OF ARTICLE TWEN-
TY-FOUR OF THE PUBLIC HEALTH LAW AND NEED TREATMENT FOR BREAST OR CERVI-
CAL CANCER, AND ARE NOT OTHERWISE COVERED UNDER CREDITABLE  COVERAGE  AS
DEFINED  IN THE FEDERAL PUBLIC HEALTH SERVICE ACT; PROVIDED HOWEVER THAT
MEDICAL ASSISTANCE SHALL BE FURNISHED PURSUANT TO THIS  CLAUSE  ONLY  IF
AND FOR SO LONG AS THE PROVISIONS OF CLAUSE (I) OF THIS SUBPARAGRAPH ARE
IN EFFECT.
  (3) MEDICAL ASSISTANCE PROVIDED TO A PERSON UNDER THIS PARAGRAPH SHALL
BE  LIMITED  TO  THE  PERIOD IN WHICH SUCH PERSON REQUIRES TREATMENT FOR
BREAST OR CERVICAL CANCER.
  (4) (I) THE COMMISSIONER OF HEALTH SHALL PROMULGATE  SUCH  REGULATIONS
AS  MAY BE NECESSARY TO CARRY OUT THE PROVISIONS OF THIS PARAGRAPH. SUCH
REGULATIONS SHALL INCLUDE, BUT NOT BE LIMITED TO:  ELIGIBILITY  REQUIRE-
MENTS;  A  DESCRIPTION  OF THE MEDICAL SERVICES WHICH ARE COVERED; AND A
PROCESS FOR PROVIDING PRESUMPTIVE ELIGIBILITY WHEN A  QUALIFIED  ENTITY,

S. 2606--C                         76

AS  DEFINED  BY THE COMMISSIONER, DETERMINES ON THE BASIS OF PRELIMINARY
INFORMATION THAT A PERSON MEETS THE REQUIREMENTS FOR  ELIGIBILITY  UNDER
THIS PARAGRAPH.
  (II)  FOR  PURPOSES  OF DETERMINING ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER THIS PARAGRAPH, RESOURCES AVAILABLE TO SUCH INDIVIDUAL  SHALL  NOT
BE  CONSIDERED  NOR  REQUIRED  TO  BE APPLIED TOWARD THE PAYMENT OR PART
PAYMENT OF THE COST OF MEDICAL CARE,  SERVICES  AND  SUPPLIES  AVAILABLE
UNDER THIS PARAGRAPH.
  (III)  AN INDIVIDUAL SHALL BE ELIGIBLE FOR PRESUMPTIVE ELIGIBILITY FOR
MEDICAL ASSISTANCE UNDER THIS PARAGRAPH IN ACCORDANCE  WITH  SUBDIVISION
FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (5) THE COMMISSIONER OF HEALTH SHALL, CONSISTENT WITH THIS TITLE, MAKE
ANY  NECESSARY  AMENDMENTS  TO  THE  STATE  PLAN  FOR MEDICAL ASSISTANCE
SUBMITTED PURSUANT TO SECTION THREE HUNDRED SIXTY-THREE-A OF THIS TITLE,
IN ORDER TO ENSURE FEDERAL FINANCIAL PARTICIPATION IN EXPENDITURES UNDER
THIS PARAGRAPH. NOTWITHSTANDING ANY PROVISION OF LAW  TO  THE  CONTRARY,
THE PROVISIONS OF CLAUSE (I) OF SUBPARAGRAPH TWO OF THIS PARAGRAPH SHALL
BE  EFFECTIVE ONLY IF AND FOR SO LONG AS FEDERAL FINANCIAL PARTICIPATION
IS AVAILABLE IN THE COSTS OF MEDICAL ASSISTANCE FURNISHED THEREUNDER.
  (D) COLON AND PROSTATE CANCER TREATMENT.
  (1) NOTWITHSTANDING ANY OTHER PROVISION OF  LAW  TO  THE  CONTRARY,  A
PERSON  WHO  HAS  BEEN  SCREENED  OR REFERRED FOR SCREENING FOR COLON OR
PROSTATE CANCER BY THE CANCER SERVICES SCREENING  PROGRAM,  AS  ADMINIS-
TERED  BY THE DEPARTMENT OF HEALTH, AND HAS BEEN DIAGNOSED WITH COLON OR
PROSTATE CANCER IS ELIGIBLE FOR MEDICAL ASSISTANCE FOR THE  DURATION  OF
HIS OR HER TREATMENT FOR SUCH CANCER.
  (2) PERSONS ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS PARAGRAPH SHALL
HAVE  AN  INCOME  OF TWO HUNDRED FIFTY PERCENT OR LESS OF THE COMPARABLE
FEDERAL INCOME OFFICIAL POVERTY LINE AS DEFINED AND ANNUALLY REVISED  BY
THE FEDERAL OFFICE OF MANAGEMENT AND BUDGET.
  (3)  AN  INDIVIDUAL  SHALL BE ELIGIBLE FOR PRESUMPTIVE ELIGIBILITY FOR
MEDICAL ASSISTANCE UNDER THIS PARAGRAPH IN ACCORDANCE  WITH  SUBDIVISION
FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (4)  MEDICAL  ASSISTANCE  IS AVAILABLE UNDER THIS PARAGRAPH TO PERSONS
WHO ARE UNDER SIXTY-FIVE YEARS OF AGE, AND  ARE  NOT  OTHERWISE  COVERED
UNDER  CREDITABLE  COVERAGE  AS  DEFINED  IN  THE  FEDERAL PUBLIC HEALTH
SERVICE ACT.
  S 3. Paragraph (a) of subdivision 4 of section  364-i  of  the  social
services  law,  as  added by section 29-a of part A of chapter 58 of the
laws of 2007, is amended to read as follows:
  (a) Notwithstanding any inconsistent provision of law to the contrary,
a child shall be presumed to be eligible for  medical  assistance  under
this  title beginning on the date that a qualified entity, as defined in
paragraph (c) of this subdivision, determine, on the basis  of  prelimi-
nary information, that the [net] MAGI household income of the child does
not exceed the applicable level for eligibility as provided for pursuant
to  SUBPARAGRAPH  TWO  OR  THREE  OF  paragraph [(u)] (B) of subdivision
[four] ONE of section three hundred sixty-six of this title.
  S 4. Paragraph (a) of subdivision 5 of section  364-i  of  the  social
services law, as added by chapter 176 of the laws of 2006, is amended to
read as follows:
  (a) An individual shall be presumed to be eligible for medical assist-
ance  under this title beginning on the date that a qualified entity, as
defined in paragraph (c) of this subdivision, determines, on  the  basis
of  preliminary  information, that the individual meets the requirements

S. 2606--C                         77

of paragraph [(v) or (v-1)] (C) OR (D) of subdivision  four  of  section
three hundred sixty-six of this title.
  S  5.  Subdivision  6  of section 364-i of the social services law, as
added by chapter 484 of the laws of 2009 and paragraph (a-2) as added by
section 76 of part H of chapter 59 of the laws of 2011,  is  amended  to
read as follows:
  6. (a) A pregnant woman shall be presumed to be eligible for [coverage
of  services  described  in  paragraph  (c) of this subdivision] MEDICAL
ASSISTANCE UNDER THIS TITLE, EXCLUDING INPATIENT SERVICES  AND  INSTITU-
TIONAL  LONG  TERM  CARE,  beginning  on  the  date that a prenatal care
provider, licensed under article twenty-eight of the public  health  law
or  other  prenatal  care  provider approved by the department of health
determines, on the basis of preliminary information, that  the  pregnant
woman's  [family has: (i) subject to the approval of the federal Centers
for Medicare and Medicaid Services, gross income that  does  not  exceed
two  hundred  thirty percent of the federal poverty line (as defined and
annually revised by the United States department  of  health  and  human
services)  for a family of the same size, or (ii) in the absence of such
approval, net income that does not exceed two  hundred  percent  of  the
federal  poverty  line  (as  defined  and annually revised by the United
States department of health and human services) for a family of the same
size.] MAGI HOUSEHOLD INCOME DOES NOT EXCEED THE MAGI-EQUIVALENT OF  TWO
HUNDRED  PERCENT  OF  THE FEDERAL POVERTY LINE FOR THE APPLICABLE FAMILY
SIZE, AS DEFINED BY THIS CHAPTER.
  (a-2) At the time of application for presumptive eligibility  pursuant
to  this  subdivision, a pregnant woman who resides in a social services
district that has implemented the state's managed care program  pursuant
to  section  three  hundred  sixty-four-j  of  this  title must choose a
managed care provider. If a managed care provider is not chosen  at  the
time  of  application,  the pregnant woman will be assigned to a managed
care provider in accordance with subparagraphs (ii), (iii), (iv) and (v)
of paragraph (f) of subdivision four of  section  three  hundred  sixty-
four-j of this title.
  (b)  Such  presumptive  eligibility shall continue through the earlier
of:  the day on which eligibility is determined pursuant to this  title;
or  the  last day of the month following the month in which the provider
makes preliminary determination, in the case of  a  pregnant  woman  who
does  not  file  an application for medical assistance on or before such
day.
  (c) [A presumptively eligible pregnant woman is eligible for  coverage
of:
  (i)  all  medical  care,  services,  and  supplies available under the
medical assistance program, excluding inpatient  services  and  institu-
tional  long  term  care,  if the woman's family has: (A) subject to the
approval of the federal Centers  for  Medicare  and  Medicaid  Services,
gross  income  that  does  not  exceed one hundred twenty percent of the
federal poverty line (as defined and  annually  revised  by  the  United
States department of health and human services) for a family of the same
size,  or  (B) in the absence of such approval, net income that does not
exceed one hundred percent of the federal poverty line (as  defined  and
annually  revised  by  the  United States department of health and human
services) for a family of the same size; or
  (ii) prenatal care services as described in subparagraph four of para-
graph (o) of subdivision four of section three hundred sixty-six of this
title, if the woman's family has: (A) subject to  the  approval  of  the
federal  Centers  for  Medicare and Medicaid Services, gross income that

S. 2606--C                         78

exceeds one hundred twenty percent  of  the  federal  poverty  line  (as
defined  and  annually revised by the United States department of health
and human services) for families of the same size, but does  not  exceed
two  hundred  thirty percent of such federal poverty line, or (B) in the
absence of such approval, net income that exceeds  one  hundred  percent
but  does not exceed two hundred percent of the federal poverty line (as
defined and annually revised by the United States department  of  health
and human services) for a family of the same size.
  (d)]  The  department  of health shall provide prenatal care providers
licensed under article twenty-eight of the public health law  and  other
approved  prenatal care providers with such forms as are necessary for a
pregnant woman to apply and information on how to assist such  women  in
completing  and filing such forms. A qualified provider which determines
that a pregnant woman is presumptively eligible shall notify the  social
services  district  in  which the pregnant woman resides of the determi-
nation within five working days after the date on  which  such  determi-
nation  is made and shall inform the woman at the time the determination
is made that she is required to make application by the last day of  the
month following the month in which the determination is made.
  [(e)]  (D)  Notwithstanding  any  other provision of law, care that is
furnished to a pregnant woman pursuant  to  this  subdivision  during  a
presumptive eligibility period shall be deemed as medical assistance for
purposes of payment and state reimbursement.
  [(f)] (E) Facilities licensed under article twenty-eight of the public
health  law  providing  prenatal care services shall perform presumptive
eligibility determinations and assist women  in  submitting  appropriate
documentation to the social services district as required by the commis-
sioner; provided, however, that a facility may apply to the commissioner
for exemption from this requirement on the basis of undue hardship.
  [(g)] (F) All prenatal care providers enrolled in the medicaid program
must  provide  prenatal  care  services  to  eligible service recipients
determined presumptively eligible for medical  assistance  but  not  yet
enrolled  in the medical assistance program, and assist women in submit-
ting appropriate  documentation  to  the  social  services  district  as
required by the commissioner.
  S  6.  Subdivision  1  and  the  opening paragraph of subdivision 2 of
section 365-a of the social services law, subdivision 1  as  amended  by
chapter 110 of the laws of 1971 and the opening paragraph of subdivision
2  as  amended by chapter 41 of the laws of 1992, are amended to read as
follows:
  [1.] The amount, nature and manner of providing medical assistance for
needy persons shall be determined by the public  welfare  official  with
the advice of a physician and in accordance with the local medical plan,
this title, and the regulations of the department.
  1.  "BENCHMARK COVERAGE" SHALL MEAN PAYMENT OF PART OR ALL OF THE COST
OF MEDICALLY NECESSARY MEDICAL, DENTAL, AND REMEDIAL CARE, SERVICES, AND
SUPPLIES DESCRIBED IN SECTION FOUR THOUSAND THREE HUNDRED TWENTY-SIX  OF
THE  INSURANCE LAW - HEALTHY NY, AND TO THE EXTENT NOT INCLUDED THEREIN,
ANY ESSENTIAL BENEFITS AS DEFINED IN  42  U.S.C.  18022(B),  SUCH  CARE,
SERVICES AND SUPPLIES SHALL BE PROVIDED THROUGH A MANAGED CARE PROGRAM.
  ["Medical  assistance"] "STANDARD COVERAGE" shall mean payment of part
or all of the cost of medically necessary medical, dental  and  remedial
care,  services  and  supplies, as authorized in this title or the regu-
lations of the department, which are  necessary  to  prevent,  diagnose,
correct  or  cure  conditions  in the person that cause acute suffering,
endanger life, result in  illness  or  infirmity,  interfere  with  such

S. 2606--C                         79

person's  capacity  for  normal  activity,  or threaten some significant
handicap and which are furnished an eligible person in  accordance  with
this  title  and  the regulations of the department. Such care, services
and  supplies  shall  include  the  following medical care, services and
supplies,  together  with  such  medical  care,  services  and  supplies
provided  for  in subdivisions three, four and five of this section, and
such medical care, services and supplies as are authorized in the  regu-
lations of the department:
  S  7.  Subdivision  1  of section 366-a of the social services law, as
amended by section 60 of part C of chapter 58 of the laws  of  2009,  is
amended to read as follows:
  1.  Any  person  requesting  medical  assistance  may make application
therefor [in person, through another in his behalf  or  by  mail]  BY  A
WRITTEN APPLICATION to the social services official of the county[, city
or  town,  or  to  the service officer of the city or town] in which the
applicant resides or is found OR TO THE  DEPARTMENT  OF  HEALTH  OR  ITS
AGENT; A PHONE APPLICATION; OR AN ON-LINE APPLICATION.  [In addition, in
the  case  of  a person who is sixty-five years of age or older and is a
patient in a state hospital for tuberculosis or for the  mentally  disa-
bled, applications may be made to the department or to a social services
official designated as the agent of the department.] Notwithstanding any
provision  of  law  to the contrary, [a personal] AN IN-PERSON interview
with the applicant or with the person who made application on his or her
behalf shall not be required as part of a determination  of  initial  or
continuing eligibility pursuant to this title.
  S  8.  Paragraph  (a)  of subdivision 2 of section 366-a of the social
services law, as amended by section 60 of part C of chapter  58  of  the
laws of 2009, is amended to read as follows:
  (a)  Upon receipt of such application, the appropriate social services
official, or the department of health or its agent [when  the  applicant
is a patient in a state hospital for the mentally disabled,] shall veri-
fy the eligibility of such applicant. In accordance with the regulations
of  the  department  of  health,  it  shall be the responsibility of the
applicant to provide information and  documentation  necessary  for  the
determination of initial and ongoing eligibility for medical assistance.
If  an  applicant or recipient is unable to provide necessary documenta-
tion, the [public welfare] SOCIAL SERVICES official OR THE DEPARTMENT OF
HEALTH OR ITS AGENT shall promptly cause an investigation  to  be  made.
Where  an  investigation is necessary, sources of information other than
public records will be consulted only with permission of  the  applicant
or  recipient.  In  the event that such permission is not granted by the
applicant or recipient, or necessary documentation cannot  be  obtained,
the  social  services  official or the department of health or its agent
may suspend or deny medical assistance until such  time  as  it  may  be
satisfied as to the applicant's or recipient's eligibility therefor.
  S  9.  The  opening paragraph of subdivision 3 of section 366-a of the
social services law, as added by chapter 256 of the  laws  of  1966,  is
amended to read as follows:
  Upon  the receipt of such application, and after the completion of any
investigation that shall be deemed necessary,  the  appropriate  [public
welfare]  SOCIAL SERVICES official[,] or the department OF HEALTH or its
agent [when the applicant is a patient in a state hospital for  tubercu-
losis or for the mentally disabled,] shall
  S  10. Paragraphs (b) and (c) of subdivision 5 of section 366-a of the
social services law, as added by section 52 of part A of  chapter  1  of
the laws of 2002, are amended to read as follows:

S. 2606--C                         80

  (b)  The  commissioner  shall develop a simplified statewide recertif-
ication form for use in redetermining eligibility under this title.  The
form [shall] MAY include requests only for such information that is:
  (i)  reasonably  necessary  to  determine  continued  eligibility  for
medical assistance under this title; and
  (ii) subject to change since  the  date  of  the  recipient's  initial
application.
  (c)  [A  personal]  THE  REGULATIONS REQUIRED BY PARAGRAPH (A) OF THIS
SUBDIVISION SHALL PROVIDE THAT:
  (I) THE REDETERMINATION OF ELIGIBILITY WILL BE MADE BASED ON  RELIABLE
INFORMATION  POSSESSED  OR  AVAILABLE TO THE DEPARTMENT OF HEALTH OR ITS
AGENT, INCLUDING INFORMATION ACCESSED FROM DATABASES PURSUANT TO  SUBDI-
VISION EIGHT OF THIS SECTION;
  (II)  IF  THE  DEPARTMENT  OF  HEALTH  OR ITS AGENT IS UNABLE TO RENEW
ELIGIBILITY BASED  ON  AVAILABLE  INFORMATION,  THE  RECIPIENT  WILL  BE
REQUESTED  TO  SUPPLY  ANY SUCH INFORMATION AS IS NECESSARY TO DETERMINE
CONTINUED ELIGIBILITY FOR MEDICAL ASSISTANCE UNDER THIS TITLE; AND
  (III) FOR PERSONS WHOSE MEDICAL ASSISTANCE  ELIGIBILITY  IS  BASED  ON
MODIFIED  ADJUSTED  GROSS  INCOME,  ELIGIBILITY MUST BE RENEWED AT LEAST
ONCE EVERY TWELVE MONTHS, UNLESS THE DEPARTMENT OF HEALTH OR  ITS  AGENT
RECEIVES  INFORMATION ABOUT A CHANGE IN A RECIPIENT'S CIRCUMSTANCES THAT
MAY AFFECT ELIGIBILITY.
  (D) AN IN-PERSON interview with the recipient shall not  AUTOMATICALLY
be required as part of a redetermination of eligibility pursuant to this
subdivision UNLESS THE DEPARTMENT OF HEALTH DETERMINES OTHERWISE.
  S  11.  Paragraph  (d) of subdivision 5 of section 366-a of the social
services law is REPEALED.
  S 12. Paragraph (e) of subdivision 5 of section 366-a  of  the  social
services  law, as added by section 1 of part C of chapter 58 of the laws
of 2007, is amended to read as follows:
  (e) The commissioner of health shall verify the accuracy of the infor-
mation provided by [the] AN APPLICANT OR recipient  [pursuant  to  para-
graph  (d)  of  this  subdivision] by matching it against information to
which the commissioner of health has access, including under subdivision
eight of this section.  In the event there is an  inconsistency  between
the  information  reported by the recipient and any information obtained
by the commissioner of health from other sources and such  inconsistency
is  material  to  medical  assistance  eligibility,  the commissioner of
health shall request that the recipient provide  adequate  documentation
to  verify  his  or  her place of residence or income, as applicable. In
addition to the documentation of residence and income authorized by this
paragraph, the commissioner of  health  is  authorized  to  periodically
require  a  reasonable  sample of recipients to provide documentation of
residence and income at  recertification.  The  commissioner  of  health
shall  consult  with the medicaid inspector general regarding income and
residence verification practices and procedures  necessary  to  maintain
program integrity and deter fraud and abuse.
  S  13.  Subdivision  11 of section 364-j of the social services law is
REPEALED.
  S 14. Clause (D) of subparagraph (v) of paragraph (a) of subdivision 2
of section 369-ee of the social services law, as amended by  section  67
of  part  C  of  chapter  58  of the laws of 2009, is amended, and a new
subparagraph (vi) is added to read as follows:
  (D) is not described in clause (A), (B) or (C)  of  this  subparagraph
and has gross family income equal to or less than two hundred percent of
the  federal income official poverty line (as defined and updated by the

S. 2606--C                         81

United States Department of Health and Human Services) for a  family  of
the  same size; provided, however, that eligibility under this clause is
subject to sources of federal and non-federal funding for  such  purpose
described   in   section  sixty-seven-a  of  [the]  PART  C  OF  chapter
FIFTY-EIGHT of the laws of two thousand nine [that added this clause] or
as may be available under the waiver agreement  entered  into  with  the
federal  government  under section eleven hundred fifteen of the federal
social security act, as jointly determined by the commissioner  and  the
director  of the division of the budget. In no case shall state funds be
utilized to support the non-federal share of  expenditures  pursuant  to
this  subparagraph,  provided  however  that the commissioner may demon-
strate to the United States department of health and human services  the
existence of non-federally participating state expenditures as necessary
to secure federal funding under an eleven hundred fifteen waiver for the
purposes  herein. Eligibility under this clause may be provided to resi-
dents of all counties or, at the joint discretion  of  the  commissioner
and  the director of the division of the budget, a subset of counties of
the state[.]; AND
  (VI) CONTINGENT UPON THE REQUIREMENTS OF THE  PATIENT  PROTECTION  AND
AFFORDABLE  CARE ACT OF 2010 BEING FULLY IMPLEMENTED BY THE STATE AND AS
APPROVED BY  THE  SECRETARY  OF  THE  DEPARTMENT  OF  HEALTH  AND  HUMAN
SERVICES,  AND  CONTINGENT UPON FULL IMPLEMENTATION OF THE STATE ENROLL-
MENT CENTER, MAKES APPLICATION FOR BENEFITS PURSUANT TO THIS TITLE ON OR
BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND THIRTEEN.
  S 14-a. Subdivision 5 of section 369-ee of the social services law  is
amended by adding a new paragraph (d) to read as follows:
  (D)  NOTWITHSTANDING  THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
SION OR ANY OTHER PROVISION OF LAW, IN THE CASE OF  A  PERSON  RECEIVING
HEALTH  CARE SERVICES PURSUANT TO THIS TITLE ON JANUARY FIRST, TWO THOU-
SAND FOURTEEN, SUCH PERSON'S ELIGIBILITY SHALL BE RECERTIFIED AS SOON AS
PRACTICABLE THEREAFTER, AND SUCH  PERSON'S  COVERAGE  UNDER  THIS  TITLE
SHALL  END  ON THE EARLIEST OF: (I) THE DATE THE PERSON IS ENROLLED IN A
QUALIFIED HEALTH PLAN OFFERED THROUGH A HEALTH INSURANCE EXCHANGE ESTAB-
LISHED IN ACCORDANCE  WITH  THE  REQUIREMENTS  OF  THE  FEDERAL  PATIENT
PROTECTION  AND  AFFORDABLE  CARE  ACT (P.L. 111-148), AS AMENDED BY THE
FEDERAL HEALTH CARE AND EDUCATION  ACT  OF  2010  (P.L.  111-152);  (II)
DECEMBER THIRTY-FIRST, TWO THOUSAND FOURTEEN; OR (III) THE DATE ON WHICH
THE  DEPARTMENT  OF  HEALTH CEASES TO HAVE ALL NECESSARY APPROVALS UNDER
FEDERAL LAW AND REGULATION TO RECEIVE FEDERAL  FINANCIAL  PARTICIPATION,
UNDER  THE  PROGRAM  DESCRIBED  IN  TITLE ELEVEN OF THIS ARTICLE, IN THE
COSTS OF HEALTH SERVICES PROVIDED PURSUANT TO THIS SECTION, AND  CONTIN-
GENT UPON THE REQUIREMENTS OF THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT  OF 2010 BEING FULLY IMPLEMENTED BY THE STATE AND AS APPROVED BY THE
SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND CONTINGENT
UPON FULL IMPLEMENTATION OF THE STATE ENROLLMENT CENTER.
  S 15. Section 369-ee of the social services law is REPEALED.
  S 15-a. Section 369-ff of the social services law is REPEALED.
  S 16. Subdivision 3 of section 367-a of the  social  services  law  is
amended by adding a new paragraph (e) to read as follows:
  (E)  (1)  PAYMENT  OF  PREMIUMS FOR ENROLLING INDIVIDUALS IN QUALIFIED
HEALTH PLANS OFFERED THROUGH A  HEALTH  INSURANCE  EXCHANGE  ESTABLISHED
PURSUANT TO THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L.
111-148),  AS AMENDED BY THE FEDERAL HEALTH CARE AND EDUCATION RECONCIL-
IATION ACT OF 2010 (P.L. 111-152), TOGETHER WITH THE COSTS OF APPLICABLE
CO-INSURANCE, DEDUCTIBLE AMOUNTS, AND  OTHER  COST-SHARING  OBLIGATIONS,
SHALL BE AVAILABLE TO INDIVIDUALS WHO:

S. 2606--C                         82

  (I)  IMMEDIATELY PRIOR TO BEING ENROLLED IN THE QUALIFIED HEALTH PLAN,
OR TO THE EXPIRATION OR REPEAL OF THE FAMILY HEALTH PLUS  PROGRAM,  WERE
ELIGIBLE  UNDER  SUCH  PROGRAM AND ENROLLED IN A FAMILY HEALTH INSURANCE
PLAN AS A PARENT OR STEPPARENT OF A CHILD UNDER THE AGE  OF  TWENTY-ONE,
AND  WHOSE  MAGI  HOUSEHOLD  INCOME, AS DEFINED IN SUBPARAGRAPH EIGHT OF
PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION THREE HUNDRED  SIXTY-SIX  OF
THIS  TITLE,  EXCEEDS  ONE  HUNDRED  THIRTY-THREE PERCENT OF THE FEDERAL
POVERTY LINE FOR THE APPLICABLE FAMILY SIZE;
  (II) ARE NOT OTHERWISE ELIGIBLE  FOR  MEDICAL  ASSISTANCE  UNDER  THIS
TITLE; AND
  (III)  ARE  ENROLLED IN A STANDARD HEALTH PLAN IN THE SILVER LEVEL, AS
DEFINED IN 42 U.S.C. 18022.
  (2) CONTINGENT UPON  FULL  FEDERAL  FINANCIAL  PARTICIPATION,  PAYMENT
PURSUANT  TO THIS PARAGRAPH SHALL BE FOR PREMIUMS, CO-INSURANCE, DEDUCT-
IBLES, AND OTHER COST-SHARING OBLIGATIONS OF THE  INDIVIDUAL  UNDER  THE
QUALIFIED  HEALTH  PLAN  TO  THE EXTENT THAT THEY EXCEED THE AMOUNT THAT
WOULD HAVE BEEN THE INDIVIDUAL'S CO-PAYMENT OBLIGATION AMOUNT UNDER  THE
FAMILY  HEALTH  PLUS PROGRAM, AND SHALL CONTINUE ONLY IF AND FOR SO LONG
AS  THE  INDIVIDUAL'S  MAGI  HOUSEHOLD  INCOME   EXCEEDS   ONE   HUNDRED
THIRTY-THREE  PERCENT, BUT DOES NOT EXCEED ONE HUNDRED FIFTY PERCENT, OF
THE FEDERAL POVERTY LINE FOR THE APPLICABLE FAMILY SIZE.
  (3) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO SUBMIT  AMENDMENTS  TO
THE STATE PLAN FOR MEDICAL ASSISTANCE AND/OR SUBMIT ONE OR MORE APPLICA-
TIONS FOR WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT AS MAY BE NECESSARY
TO RECEIVE FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF PAYMENTS MADE
PURSUANT TO THIS PARAGRAPH.
  (4)  THIS  PARAGRAPH  SHALL BE CONTINGENT UPON THE REQUIREMENTS OF THE
PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010  BEING  FULLY  IMPLE-
MENTED  BY  THE STATE AND AS APPROVED BY THE SECRETARY OF THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES, AND CONTINGENT UPON FULL IMPLEMENTATION OF
THE STATE ENROLLMENT CENTER.
  S 17. Section 2510 of the public health law amended by  adding  a  new
subdivision 13 to read as follows:
  13.  "HOUSEHOLD  INCOME"  MEANS THE SUM OF THE MODIFIED ADJUSTED GROSS
INCOME OF EVERY INDIVIDUAL INCLUDED IN A CHILD'S HOUSEHOLD CALCULATED IN
ACCORDANCE WITH APPLICABLE  FEDERAL  LAW  AND  REGULATIONS,  AS  MAY  BE
AMENDED.  THIS DEFINITION SHALL BE EFFECTIVE ON JANUARY FIRST, TWO THOU-
SAND FOURTEEN OR A LATER DATE CONCOMITANT WITH THE  FULL  IMPLEMENTATION
OF  THE  PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 BY THE STATE
AND AS APPROVED BY THE SECRETARY OF THE DEPARTMENT OF HEALTH  AND  HUMAN
SERVICES.
  S  18.  Section 2510 of the public health law is amended by adding two
new subdivisions 14 and 15 to read as follows:
  14. "STATE ENROLLMENT CENTER" MEANS THE CENTRALIZED SYSTEM AND  OPERA-
TION  OF  ELIGIBILITY  DETERMINATIONS BY THE STATE OR ITS CONTRACTOR FOR
ALL INSURANCE AFFORDABILITY PROGRAMS, INCLUDING THE CHILD HEALTH  INSUR-
ANCE  PROGRAM  ESTABLISHED PURSUANT TO THIS TITLE.  THE STATE ENROLLMENT
CENTER SHALL BE SUBJECT TO THE PROVISIONS OF SECTION EIGHT OF THE  STATE
FINANCE LAW.
  15.  "INSURANCE AFFORDABILITY PROGRAMS" MEANS THOSE PROGRAMS SET FORTH
IN SECTION 435.4 OF TITLE 42 OF THE CODE OF FEDERAL REGULATIONS.
  S 19. Subparagraphs (iv) and (vi) of paragraph (f) of subdivision 2 of
section 2511 of the public health law, subparagraph  (iv)  as  added  by
section  44  of part A of chapter 1 of the laws of 2002 and subparagraph
(vi) as added by section 45-b of part C of chapter 58  of  the  laws  of
2008, are amended to read as follows:

S. 2606--C                         83

  (iv)  In  the  event a household does not provide income documentation
required by subparagraph (iii) of this paragraph within  two  months  of
the approved organization's OR STATE ENROLLMENT CENTER'S request, WHICH-
EVER IS APPLICABLE, the approved organization OR STATE ENROLLMENT CENTER
shall disenroll the child at the end of such two month period. Except as
provided  in  paragraph  (c)  of  subdivision  five-a  of  this section,
approved organizations shall not be obligated to repay subsidy  payments
made  by  the state on behalf of children enrolled during this two month
period.
  (vi) Any income verification response by the  department  of  taxation
and  finance  pursuant  to  subparagraphs (i) and (ii) of this paragraph
shall not be a public record and shall not be released  by  the  commis-
sioner,  the department of taxation and finance [or], an approved organ-
ization, OR THE STATE ENROLLMENT CENTER, except pursuant to  this  para-
graph. Information disclosed pursuant to this paragraph shall be limited
to  information  necessary  for  verification.  Information so disclosed
shall be kept confidential by the party receiving such information. Such
information shall be expunged within a reasonable time to be  determined
by the commissioner and the department of taxation and finance.
  S  20.  Paragraph  (j)  of subdivision 2 of section 2511 of the public
health law, as added by section 45 of part A of chapter 1 of the laws of
2002, is amended to read as follows:
  (j) Where an application for recertification of  coverage  under  this
title  contains  insufficient  information  for a final determination of
eligibility for continued coverage, a child shall be  presumed  eligible
for  a period not to exceed the earlier of two months beyond the preced-
ing period of eligibility or the date upon which a  final  determination
of  eligibility  is  made based on the submission of additional data. In
the event such additional information is not submitted within two months
of the approved organization's OR  STATE  ENROLLMENT  CENTER'S  request,
WHICHEVER  IS  APPLICABLE, the approved organization OR STATE ENROLLMENT
CENTER shall disenroll the child following the expiration  of  such  two
month  period. Except as provided in paragraph (c) of subdivision five-a
of this section, approved organizations shall not be obligated to  repay
subsidy payments received on behalf of children enrolled during this two
month period.
  S  21.  Subdivision  4  of  section  2511 of the public health law, as
amended by section 70 of part B of chapter 58 of the laws  of  2005,  is
amended to read as follows:
  4.  Households  shall  report  to  the  approved organization OR STATE
ENROLLMENT CENTER, WHICHEVER IS  APPLICABLE,  within  thirty  days,  any
changes in New York state residency or health care coverage under insur-
ance  that  may make a child ineligible for subsidy payments pursuant to
this section. Any individual who, with the intent  to  obtain  benefits,
willfully  misstates income or residence to establish eligibility pursu-
ant to subdivision two of this section or willfully fails to  notify  an
approved  organization  OR  STATE ENROLLMENT CENTER of a change in resi-
dence or health care coverage pursuant to this subdivision  shall  repay
such subsidy to the commissioner. Individuals seeking to enroll children
for coverage shall be informed that such willful misstatement or failure
to notify shall result in such liability.
  S  22.  The subdivision heading and paragraphs (a) and (b) of subdivi-
sion 5-a of section 2511 of the public health law, the subdivision head-
ing and paragraph (a) as added by chapter 170 of the laws  of  1994  and
paragraph  (b)  as  amended by section 71 of part B of chapter 58 of the
laws of 2005, are amended to read as follows:

S. 2606--C                         84

  Obligations of approved organizations OR THE STATE ENROLLMENT  CENTER.
(a)  An  approved  organization OR STATE ENROLLMENT CENTER, WHICHEVER IS
APPLICABLE, shall have the obligation to review all information provided
pursuant to subdivision two of this section and  shall  not  certify  or
recertify  a  child  as  eligible for a subsidy payment unless the child
meets the eligibility criteria.
  (b) An approved organization OR STATE ENROLLMENT CENTER, WHICHEVER  IS
APPLICABLE,  shall  promptly review all information relating to a poten-
tial change in eligibility based on  information  provided  pursuant  to
subdivision  four  of  this  section.  Within at least thirty days after
receipt of such information, the approved organization OR STATE  ENROLL-
MENT CENTER shall make a determination whether the child is still eligi-
ble for a subsidy payment and shall notify the household and the commis-
sioner if it determines the child is not eligible for a subsidy payment.
  S  23.  Paragraph  (a) of subdivision 11 of section 2511 of the public
health law, as amended by section 37 of part A of chapter 58 of the laws
of 2007, is amended to read as follows:
  (a) An approved organization shall submit required reports and  infor-
mation to the commissioner in such form and at times, at least annually,
as  may  be  required by the commissioner and specified in contracts and
official department of health administrative guidance, in order to eval-
uate the operations and results of the program and quality of care being
provided by such  organizations.  Such  reports  and  information  shall
include,  but  not be limited to, enrollee demographics (APPLICABLE ONLY
UNTIL THE STATE ENROLLMENT CENTER IS IMPLEMENTED),  program  utilization
and expense, patient care outcomes and patient specific medical informa-
tion,  including  encounter  data maintained by an approved organization
for purposes of quality assurance and oversight.    Any  information  or
data  collected pursuant to this paragraph shall be kept confidential in
accordance with Title XXI of the federal  social  security  act  or  any
other applicable state or federal law.
  S  24.  Subdivision  12  of  section 2511 of the public health law, as
amended by chapter 2 of the laws of 1998, is amended to read as follows:
  12. The commissioner shall, in consultation with  the  superintendent,
establish  procedures to coordinate the child health insurance plan with
the medical assistance program, including but not limited to, procedures
to maximize enrollment of eligible  children  under  those  programs  by
identification  and  transfer of children who are eligible or who become
eligible to receive medical  assistance  and  procedures  to  facilitate
changes  in enrollment status for children who are ineligible for subsi-
dies under this section and for children who are no longer eligible  for
medical  assistance  in  order  to  facilitate  and ensure continuity of
coverage. The commissioner shall review, on an annual basis, the  eligi-
bility verification and recertification procedures of approved organiza-
tions under this title to insure the appropriate enrollment of children.
Such  review shall include, but not be limited to, an audit of a statis-
tically representative sample of cases from among all approved organiza-
tions AND SHALL BE APPLICABLE TO ANY PERIOD  DURING  WHICH  AN  APPROVED
ORGANIZATION'S RESPONSIBILITIES INCLUDE DETERMINING ELIGIBILITY.  In the
event  such  review and audit reveals cases which do not meet the eligi-
bility criteria for coverage set forth in this section, that information
shall be forwarded to the approved organization and the commissioner for
appropriate action.
  S 25. Paragraph (e) of subdivision 12-a of section 2511 of the  public
health  law, as added by chapter 2 of the laws of 1998, is amended and a
new paragraph (f) is added to read as follows:

S. 2606--C                         85

  (e) standards and procedures  for  the  imposition  of  penalties  for
substantial  noncompliance,  which  may  include, but not be limited to,
financial penalties in addition to penalties set forth in section twelve
of this chapter and consistent with  applicable  federal  standards,  as
specified in contracts, and contract termination[.]; PROVIDED HOWEVER
  (F)  AUDIT  STANDARDS  AND  PROCEDURES  ESTABLISHED  PURSUANT  TO THIS
SECTION, INCLUDING PENALTIES, SHALL BE APPLICABLE TO ELIGIBILITY  DETER-
MINATIONS  MADE  BY APPROVED ORGANIZATIONS ONLY FOR PERIODS DURING WHICH
AN APPROVED ORGANIZATION'S RESPONSIBILITIES INCLUDE MAKING  SUCH  ELIGI-
BILITY DETERMINATIONS.
  S  26.  Paragraph  (e)  and  subparagraphs (i), (ii), (iii) and (v) of
paragraph (f) of subdivision 2 of section 2511 of the public health law,
paragraph (e) as added by chapter 170 of the laws of 1994 and relettered
by chapter 2 of the laws of 1998, and  subparagraphs  (i)  and  (ii)  of
paragraph  (f)  as  amended  by section 6 of part B of chapter 58 of the
laws of 2010, subparagraph (iii) of paragraph (f) as amended by  chapter
535  of  the  laws  of  2010,  and  subparagraph (v) of paragraph (f) as
amended by section 7 of part J of chapter 82 of the laws  of  2002,  are
amended to read as follows:
  (e)  is  a resident of New York state. Such residency shall be [demon-
strated by] ATTESTED TO BY THE APPLICANT FOR INSURANCE, PROVIDED  HOWEV-
ER, THE COMMISSIONER SHALL REQUIRE adequate proof[, as determined by the
commissioner,]  of  a New York state street address IN ANY CIRCUMSTANCES
WHEN THERE IS AN INCONSISTENCY WITH  RESIDENCY  INFORMATION  FROM  OTHER
DATA  SOURCES.  [If  the  child  has  no  street address, such proof may
include, but not be limited to, school records  or  other  documentation
determined by the commissioner.]
  (i) In order to establish income eligibility under this subdivision at
initial application, a household shall provide [such documentation spec-
ified  in  subparagraph (iii) of this paragraph, as necessary and suffi-
cient to determine a child's financial eligibility for a subsidy payment
under this title] THE SOCIAL SECURITY NUMBERS FOR EACH PARENT AND LEGAL-
LY RESPONSIBLE ADULT WHO IS  A  MEMBER  OF  THE  HOUSEHOLD,  SUBJECT  TO
SUBPARAGRAPH  (V)  OF  THIS  PARAGRAPH. The commissioner [may verify the
accuracy of such income information provided by the household by  match-
ing  it against] SHALL DETERMINE ELIGIBILITY BASED ON income information
contained in databases to which the commissioner has  access,  including
the  state's  wage  reporting  system  pursuant  to  subdivision five of
section one hundred seventy-one-a of the tax law  and  by  means  of  an
income  verification  performed pursuant to a cooperative agreement with
the department of taxation and finance pursuant to subdivision  four  of
section  one  hundred  seventy-one-b  of the tax law.   THE COMMISSIONER
SHALL REQUIRE AN ATTESTATION BY THE HOUSEHOLD THAT THE  INCOME  INFORMA-
TION OBTAINED FROM ELECTRONIC DATA SOURCES IS ACCURATE. SUCH ATTESTATION
SHALL  INCLUDE  ANY OTHER HOUSEHOLD INCOME INFORMATION NOT OBTAINED FROM
AN ELECTRONIC DATA SOURCE THAT  IS  NECESSARY  TO  DETERMINE  A  CHILD'S
FINANCIAL  ELIGIBILITY  FOR  A SUBSIDY PAYMENT UNDER THIS TITLE.  IF THE
ATTESTATION IS INCONSISTENT WITH  INFORMATION  OBTAINED  FROM  AVAILABLE
DATA  SOURCES,  DOCUMENTATION SHALL BE REQUIRED AS SPECIFIED IN SUBPARA-
GRAPH (III) OF THIS PARAGRAPH.
  (ii) In order to establish income eligibility under  this  subdivision
at  recertification, a household shall attest to all information regard-
ing the household's income that is necessary and sufficient to determine
a child's financial eligibility for a subsidy payment under  this  title
and shall provide the social security numbers for each parent and legal-
ly  responsible  adult who is a member of the household and whose income

S. 2606--C                         86

is available to the child, subject to subparagraph  (v)  of  this  para-
graph.  The commissioner may verify the accuracy of such income informa-
tion provided by the household by matching it against income information
contained  in  databases to which the commissioner has access, including
the state's wage reporting system and by means of an income verification
performed pursuant to a cooperative agreement  with  the  department  of
taxation and finance pursuant to subdivision four of section one hundred
seventy-one-b  of  the tax law, AND MAY MAKE A REDETERMINATION OF ELIGI-
BILITY BASED ON RELIABLE INFORMATION CONTAINED IN DATABASES TO WHICH THE
COMMISSIONER HAS ACCESS.  THE COMMISSIONER SHALL REQUIRE AN  ATTESTATION
BY THE HOUSEHOLD THAT THE INCOME INFORMATION CONTAINED IN THE ENROLLMENT
FILE OR OBTAINED FROM ELECTRONIC DATA SOURCES IS ACCURATE. SUCH ATTESTA-
TION  SHALL  INCLUDE ANY OTHER HOUSEHOLD INCOME INFORMATION NOT OBTAINED
FROM AN ELECTRONIC DATA SOURCE. In the event that there is an inconsist-
ency between the income information attested to by the household and any
information obtained by the commissioner from other sources pursuant  to
this subparagraph, and such inconsistency is material to the household's
eligibility  for  a  subsidy  payment under this title, the commissioner
shall require the [approved organization to obtain] HOUSEHOLD TO PROVIDE
income documentation [from the household] as specified  in  subparagraph
(iii) of this paragraph.
  (iii) IF THE ATTESTATION OF HOUSEHOLD INCOME REQUIRED BY SUBPARAGRAPHS
(I)  AND (II) OF THIS PARAGRAPH IS IN ANY WAY INCONSISTENT WITH INFORMA-
TION  OBTAINED  FROM  DATA  SOURCES,  FURTHER  DOCUMENTATION  SHALL   BE
REQUIRED. Income documentation shall include, but not be limited to, one
or  more  of the following for each parent and legally responsible adult
who is a member of the household and whose income is  available  to  the
child;
  (A) current annual income tax returns;
  (B) paycheck stubs;
  (C) written documentation of income from all employers; or
  (D) written documentation of income eligibility of a child for free or
reduced  breakfast or lunch through the school meal program certified by
the child's school, provided that:
  (I) the commissioner  may  verify  the  accuracy  of  the  information
provided in the same manner and way as provided for in subparagraph (ii)
of this paragraph; and
  (II)  such  documentation  may  not be suitable proof of income in the
event of a material inconsistency in income after the  commissioner  has
performed  verification pursuant to subparagraph (ii) of this paragraph;
or
  (E) other documentation of income (earned or unearned)  as  determined
by  the  commissioner,  provided,  however, such documentation shall set
forth the source of such income.
  (v) In the event a household chooses not to provide the social securi-
ty numbers required by [subparagraph] SUBPARAGRAPHS (I) AND (ii) of this
paragraph, such household shall provide income  documentation  specified
in  subparagraph  (iii)  of this paragraph as a condition of the child's
enrollment. Nothing in this paragraph shall be construed as obligating a
household to provide social  security  numbers  of  parents  or  legally
responsible adults as a condition of a child's enrollment or eligibility
for a subsidy payment under this title.
  S  27.  Subparagraph (ii) of paragraph (g) of subdivision 2 of section
2511 of the public health law, as amended by section 29  of  part  A  of
chapter 58 of the laws of 2007, is amended to read as follows:

S. 2606--C                         87

  (ii) Effective September first two thousand seven, THROUGH MARCH THIR-
TY-FIRST,  TWO  THOUSAND  FOURTEEN  OR A LATER DATE CONCOMITANT WITH THE
FULL IMPLEMENTATION OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF
2010 BY THE DATE AND AS APPROVED BY THE SECRETARY OF THE  DEPARTMENT  OF
HEALTH AND HUMAN SERVICES, temporary enrollment pursuant to subparagraph
(i)  of  this paragraph shall be provided only to children who apply for
recertification of coverage under this title who appear to  be  eligible
for  medical assistance under title eleven of article five of the social
services law.
  S 28. Paragraph (a) of subdivision 2-b of section 2511 of  the  public
health law, as added by section 5 of part B of chapter 58 of the laws of
2010, is amended to read as follows:
  (a)  Effective October first, two thousand ten, for purposes of claim-
ing federal financial participation under paragraph nine  of  subsection
(c)  of  section  twenty-one hundred five of the federal social security
act[,] for individuals declaring to be citizens at initial  application,
AND,  EFFECTIVE  JANUARY FIRST, TWO THOUSAND FOURTEEN OR A LATER DATE TO
BE DETERMINED BY THE COMMISSIONER CONTINGENT UPON  THE  REQUIREMENTS  OF
THE  PATIENT  PROTECTION  AND  AFFORDABLE  CARE  ACT OF 2010 BEING FULLY
IMPLEMENTED BY THE STATE AND AS APPROVED BY THE SECRETARY OF THE DEPART-
MENT OF HEALTH AND HUMAN SERVICES, a household shall provide:
  (i) the social security number for the applicant to be verified by the
commissioner in accordance with a  process  established  by  the  social
security administration pursuant to federal law, or
  (ii)  documentation  of  citizenship  and  identity  of  the applicant
consistent with requirements under the medical  assistance  program,  as
specified by the commissioner on the initial application.
  S  29.  Paragraph  (d)  of subdivision 9 of section 2510 of the public
health law, as added by section 72-a of part C of chapter 58 of the laws
of 2009, is amended to read as follows:
  (d) for periods on or after July first, two thousand nine, amounts  as
follows:
  (i)  no  payments  are  required  for  eligible  children whose family
[gross] household income is less than one hundred sixty percent  of  the
non-farm  federal poverty level and for eligible children who are Ameri-
can Indians or Alaskan Natives, as defined by  the  U.S.  Department  of
Health and Human Services, whose family [gross] household income is less
than  two  hundred  fifty-one  percent  of  the non-farm federal poverty
level; and
  (ii) nine dollars per month  for  each  eligible  child  whose  family
[gross]  household  income  is between one hundred sixty percent and two
hundred twenty-two percent of the non-farm federal poverty level, but no
more than twenty-seven dollars per month per family; and
  (iii) fifteen dollars per month for each eligible child  whose  family
[gross] household income is between two hundred twenty-three percent and
two  hundred fifty percent of the non-farm federal poverty level, but no
more than forty-five dollars per month per family; and
  (iv) thirty dollars per month for each  eligible  child  whose  family
[gross]  household  income  is between two hundred fifty-one percent and
three hundred percent of the non-farm federal poverty level, but no more
than ninety dollars per month per family;
  (v) forty-five dollars per month for each eligible child whose  family
[gross]  household income is between three hundred one percent and three
hundred fifty percent of the non-farm federal poverty level, but no more
than one hundred thirty-five dollars per month per family; and

S. 2606--C                         88

  (vi) sixty dollars per month for  each  eligible  child  whose  family
[gross]  household income is between three hundred fifty-one percent and
four hundred percent of the non-farm federal poverty level, but no  more
than one hundred eighty dollars per month per family.
  S  30. Subparagraph (iii) of paragraph (a) of subdivision 2 of section
2511 of the public health law, as amended by section 32  of  part  B  of
chapter 58 of the laws of 2008, is amended to read as follows:
  (iii)  effective  September  first,  two  thousand eight, resides in a
household having a [gross] household income at  or  below  four  hundred
percent of the non-farm federal poverty level (as defined and updated by
the United States department of health and human services);
  S  31.  Subparagraph (ii) of paragraph (d) of subdivision 2 of section
2511 of the public health law, as amended by section 33  of  part  A  of
chapter  58  of  the laws of 2007, clause (B) as amended by section 3 of
part OO of chapter 57 of the  laws  of  2008,  is  amended  to  read  as
follows:
  (ii)  (A) The implementation of this paragraph for a child residing in
a household having a [gross] household income at or  below  two  hundred
fifty  percent  of  the  non-farm  federal poverty level (as defined and
updated by the United States department of health  and  human  services)
shall  take  effect  only upon the commissioner's finding that insurance
provided under this title  is  substituting  for  coverage  under  group
health plans in excess of a percentage specified by the secretary of the
federal  department of health and human services. The commissioner shall
notify the legislature prior to implementation of this paragraph.
  (B) The implementation of clauses (A), (B), (C), (D),  (E),  (F),  (G)
and  (I) of subparagraph (i) of this paragraph for a child residing in a
household having a [gross] household income between two  hundred  fifty-
one  and  four hundred percent of the non-farm federal poverty level (as
defined and updated by the United States department of health and  human
services)  shall  take  effect  September  first,  two  thousand  eight;
provided however, the entirety of subparagraph  (i)  of  this  paragraph
shall  take  effect  and be applied to such children on the date federal
financial participation becomes available for such population in accord-
ance with the state's Title XXI  child  health  plan.  The  commissioner
shall  monitor  the  number  of  children who are subject to the waiting
period established pursuant to this clause.
  S 32. Clauses (A) and (B) of subparagraph  (i)  of  paragraph  (b)  of
subdivision  18  of  section  2511 of the public health law, as added by
section 31 of part A of chapter 58 of the laws of 2007, are  amended  to
read as follows:
  (A)  participation  in the program for a child who resides in a house-
hold having a [gross] household income at or  below  two  hundred  fifty
percent of the non-farm federal poverty level (as defined and updated by
the  United  States  department  of  health and human services) shall be
voluntary and an eligible child may disenroll from the  premium  assist-
ance  program  at  any time and enroll in individual coverage under this
title; and
  (B) participation in the program for a child who resides in  a  house-
hold having a [gross] household income between two hundred fifty-one and
four  hundred  percent of the non-farm federal poverty level (as defined
and updated  by  the  United  States  department  of  health  and  human
services)  and  meets certain eligibility criteria shall be mandatory. A
child in this income group who meets the criteria for enrollment in  the
premium assistance program shall not be eligible for individual coverage
under this title;

S. 2606--C                         89

  S 33. Subparagraph (iv) of paragraph (b) and paragraph (d) of subdivi-
sion  9  of section 2511 of the public health law, as amended by section
18-a of chapter 2 of the laws of 1998, are amended to read as follows:
  (iv) outstationing of persons who are authorized to provide assistance
to  families in completing the enrollment application process under this
title and title eleven of article  five  of  the  social  services  law,
[including  the conduct of personal interviews pursuant to section three
hundred sixty-six-a of the social services law and  personal  interviews
required  upon recertification under such section of the social services
law,] in locations, such as community settings, which are geographically
accessible to large numbers of children who may be eligible for benefits
under such titles, and at times, including evenings and  weekends,  when
large  numbers  of  children who may be eligible for benefits under such
titles are likely to be encountered. Persons outstationed in  accordance
with  this  subparagraph  shall  be authorized to make determinations of
presumptive eligibility in accordance with paragraph (g) of  subdivision
two of section two thousand five hundred and eleven of this title; and
  (d)  Subject  to the availability of funds therefor, training shall be
provided for outstationed persons and employees  of  approved  organiza-
tions  to  enable  them  to  disseminate information, AND facilitate the
completion of the  application  process  under  this  subdivision[,  and
conduct   personal   interviews   required   by  section  three  hundred
sixty-six-a of the social services law and personal interviews  required
upon recertification under such section of the social services law].
  S  33-a.  Subdivision  1  of  section  206 of the public health law is
amended by adding a new paragraph (s) to read as follows:
  (S) ISSUE A READINESS REPORT TO THE LEGISLATURE, DETAILING THE  STATUS
OF  THE  STATEWIDE HEALTH BENEFIT EXCHANGE, STATE ENROLLMENT CENTER, AND
STATE MEDICAID  ENROLLMENT  CENTER  ESTABLISHED  UNDER  EXECUTIVE  ORDER
NUMBER  FORTY-TWO OF TWO THOUSAND TWELVE, BY AUGUST THIRTIETH, TWO THOU-
SAND THIRTEEN. THE READINESS REPORT MAY BE PROVIDED IN ELECTRONIC FORMAT
AND SHALL BE DISTRIBUTED TO THE TEMPORARY PRESIDENT OF THE  SENATE,  THE
SPEAKER  OF  THE ASSEMBLY, THE CHAIR OF THE SENATE STANDING COMMITTEE ON
HEALTH, AND THE CHAIR OF THE ASSEMBLY HEALTH  COMMITTEE.  THE  READINESS
REPORT SHALL OUTLINE THE PROGRESS AND PREPAREDNESS OF THE HEALTH BENEFIT
EXCHANGE,  STATE ENROLLMENT CENTER, AND STATE MEDICAID ENROLLMENT CENTER
AND DETAIL HOW THE EXCHANGE, STATE ENROLLMENT CENTER, AND STATE MEDICAID
ENROLLMENT CENTER WILL CARRY OUT THEIR  RESPECTIVE  FUNCTIONS  INCLUDING
BUT NOT LIMITED TO:
  (I) THE PROCESS BY WHICH THE HEALTH BENEFIT EXCHANGE, STATE ENROLLMENT
CENTER, AND STATE MEDICAID ENROLLMENT CENTER WILL BEGIN ACCEPTING APPLI-
CATIONS ON OCTOBER FIRST, TWO THOUSAND THIRTEEN;
  (II)  THE  PROCESS BY WHICH THE HEALTH BENEFIT EXCHANGE, STATE ENROLL-
MENT CENTER, AND STATE MEDICAID ENROLLMENT CENTER WILL CERTIFY QUALIFIED
HEALTH PLANS;
  (III) THE ANTICIPATED COST OF INDIVIDUAL AND SMALL GROUP  PLANS  BEING
OFFERED IN THE HEALTH BENEFIT EXCHANGE;
  (IV) THE NUMBER OF NAVIGATORS APPROVED;
  (V)  THE  PLAN FOR FULL OPERATION BY JANUARY FIRST, TWO THOUSAND FOUR-
TEEN; AND
  (VI) THE PLAN TO BECOME FISCALLY SELF-SUSTAINING BY JANUARY FIRST, TWO
THOUSAND FIFTEEN.
  S 34. Paragraphs 9 and 10 of subsection (a) of  section  2101  of  the
insurance  law, as added by chapter 687 of the laws of 2003, are amended
and a new paragraph 11 is added to read as follows:

S. 2606--C                         90

  (9) a person who is not a resident of this state who  sells,  solicits
or  negotiates  a contract of insurance for commercial property/casualty
risks to an insured with risks located in more than  one  state  insured
under  that contract, provided that such person is otherwise licensed as
an  insurance  producer  to sell, solicit or negotiate that insurance in
the state where the insured maintains its principal  place  of  business
and the contract of insurance insures risks located in that state; [or]
  (10)  any  salaried  full-time employee who counsels or advises his or
her employer relative to the insurance interests of the employer  or  of
the  subsidiaries  or  business affiliates of the employer provided that
the employee does not sell or solicit insurance  or  receive  a  commis-
sion[.]; OR
  (11)  ANY  PERSON WHO HAS RECEIVED A GRANT FROM AND HAS BEEN CERTIFIED
BY THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION  1311  OF
THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S 18031, TO ACT AS A NAVIGATOR,
INCLUDING ANY PERSON EMPLOYED BY A CERTIFIED  NAVIGATOR,  PROVIDED  THAT
THE  PERSON  HAS  COMPLETED  THE TRAINING REQUIRED BY THE HEALTH BENEFIT
EXCHANGE, AND PROVIDED THE PERSON DOES NOT SELL, SOLICIT,  OR  NEGOTIATE
INSURANCE.
  S  35.  Paragraphs  8  and  9 of subsection (c) of section 2101 of the
insurance law, paragraph 8 as  amended  and  paragraph  9  as  added  by
section 5 of part I of chapter 61 of the laws of 2011, are amended and a
new paragraph 10 is added to read as follows:
  (8)  a  person who is not a resident of this state who sells, solicits
or negotiates a contract for commercial property/casualty  risks  to  an
insured  with  risks  located  in more than one state insured under that
contract, provided that such person is otherwise licensed as  an  insur-
ance  producer to sell, solicit or negotiate that insurance in the state
where the insured maintains its principal  place  of  business  and  the
contract of insurance insures risks located in that state; [or]
  (9)  a  person who is not a resident of this state who sells, solicits
or negotiates a contract of property/casualty insurance, as  defined  in
paragraph  six  of  subsection  (x)  of  this section, of an insurer not
authorized to  do  business  in  this  state,  provided  that:  (A)  the
insured's  home  state  is  a  state other than this state; and (B) such
person is otherwise licensed to sell, solicit or negotiate  excess  line
insurance in the insured's home state[.]; OR
  (10)  ANY  PERSON WHO HAS RECEIVED A GRANT FROM AND HAS BEEN CERTIFIED
BY THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION  1311  OF
THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S 18031, TO ACT AS A NAVIGATOR,
INCLUDING ANY PERSON EMPLOYED BY A CERTIFIED  NAVIGATOR,  PROVIDED  THAT
THE  PERSON  HAS  COMPLETED  THE TRAINING REQUIRED BY THE HEALTH BENEFIT
EXCHANGE, AND PROVIDED THE PERSON DOES NOT SELL, SOLICIT,  OR  NEGOTIATE
INSURANCE.
  S  36.  Paragraphs  10 and 11 of subsection (k) of section 2101 of the
insurance law, paragraph 10 as amended and  paragraph  11  as  added  by
section 6 of part I of chapter 61 of the laws of 2011, are amended and a
new paragraph 12 is added to read as follows:
  (10)  any  salaried  full-time employee who counsels or advises his or
her employer relative to the insurance interests of the employer  or  of
the  subsidiaries  or business affiliates of the employer, provided that
the employee does not sell or solicit insurance or receive a commission;
[or]
  (11) a person who is not a resident of this state who sells,  solicits
or  negotiates  a contract of property/casualty insurance, as defined in
paragraph six of subsection (x) of  this  section,  of  an  insurer  not

S. 2606--C                         91

authorized  to  do  business  in  this  state,  provided  that:  (A) the
insured's home state is a state other than  this  state;  and  (B)  such
person  is  otherwise licensed to sell, solicit or negotiate excess line
insurance in the insured's home state[.]; OR
  (12)  ANY  PERSON WHO HAS RECEIVED A GRANT FROM AND HAS BEEN CERTIFIED
BY THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION  1311  OF
THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S  18031 TO ACT AS A NAVIGATOR,
INCLUDING ANY PERSON EMPLOYED BY A CERTIFIED  NAVIGATOR,  PROVIDED  THAT
THE  PERSON  HAS  COMPLETED  THE TRAINING REQUIRED BY THE HEALTH BENEFIT
EXCHANGE, AND PROVIDED THE PERSON DOES NOT SELL, SOLICIT,  OR  NEGOTIATE
INSURANCE.
  S 37.  Intentionally omitted.
  S  37-a.  The  section  heading and subsections (a) and (c) of section
2120 of the insurance law is amended to read as follows:
  Fiduciary capacity of insurance agents, insurance brokers,  NAVIGATORS
and  reinsurance  intermediaries.    (a) Every insurance agent and every
insurance broker acting as such in this state AND  ANY  PERSON  WHO  HAS
RECEIVED  A  GRANT  FROM  AND  HAS  BEEN CERTIFIED BY THE HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO SECTION 1311  OF  THE  AFFORDABLE  CARE
ACT,  42 U.S.C. S 18031, TO ACT AS A NAVIGATOR shall be responsible in a
fiduciary capacity for all funds  received  or  collected  as  insurance
agent  [or],  insurance  broker, OR NAVIGATOR and shall not, without the
express consent of his or its principal, mingle any such funds with  his
or its own funds or with funds held by him or it in any other capacity.
  (c)  This  section shall not require any such agent, broker, NAVIGATOR
or reinsurance intermediary to maintain a separate bank deposit for  the
funds  of  each  such principal, if and as long as the funds so held for
each such principal are  reasonably  ascertainable  from  the  books  of
account  and  records of such agent, broker or reinsurance intermediary,
as the case may be.
  S 37-b. Subsections (a) and (d) of section 2123 of the insurance  law,
as amended by chapter 540 of the laws of 1996, paragraph 3 of subsection
(a)  as  added by chapter 616 of the laws of 1997, the opening paragraph
of paragraph 3 of subsection (a) as amended by chapter 13 of the laws of
2002, are amended to read as follows:
  (a) (1) No agent or representative of any insurer  or  health  mainte-
nance  organization  authorized  to  transact  life,  accident or health
insurance or health maintenance organization business in this state  and
no  insurance  broker,  and no other person, firm, association or corpo-
ration, INCLUDING, BUT NOT LIMITED TO, ANY PERSON  WHO  HAS  RECEIVED  A
GRANT  FROM AND HAS BEEN CERTIFIED BY THE HEALTH BENEFIT EXCHANGE ESTAB-
LISHED PURSUANT TO SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C.  S
18031,  TO  ACT  AS  A  NAVIGATOR,  shall issue or circulate or cause or
permit to be issued or circulated, any illustration, circular, statement
or memorandum misrepresenting the terms, benefits or advantages  of  any
policy  or  contract  of life, accident or health insurance, any annuity
contract or any health maintenance organization contract,  delivered  or
issued  for  delivery or to be delivered or issued for delivery, in this
state, or shall make any misleading estimate  as  to  the  dividends  or
share  of  surplus or additional amounts to be received in the future on
such policy or contract, or shall make any false or misleading statement
as to the dividends or share of surplus or additional amounts previously
paid by any such insurer or health maintenance organization  on  similar
policies  or  contracts, or shall make any misleading representation, or
any misrepresentation, as to the financial condition of any such insurer

S. 2606--C                         92

or health maintenance organization, or as to the  legal  reserve  system
upon which such insurer or health maintenance organization operates.
  (2) No such person, firm, association or corporation shall make to any
person  or  persons  any  incomplete  comparison of any such policies or
contracts of any insurer, insurers, or health maintenance  organization,
for  the  purpose  of  inducing,  or  tending  to induce, such person or
persons to lapse, forfeit or surrender any insurance  policy  or  health
maintenance organization contract.
  (3)  Any replacement of individual life insurance policies or individ-
ual annuity contracts of an insurer by an agent, representative  of  the
same  or  different insurer or broker shall conform to standards promul-
gated by regulation by the superintendent. Such regulation shall:
  (A) specify what constitutes the replacement of a life insurance poli-
cy or annuity contract and the proper disclosure and notification proce-
dures to replace a policy or contract;
  (B) require notification of the proposed replacement  to  the  insurer
whose policies or contracts are intended to be replaced;
  (C)  require  the timely exchange of illustrative and cost information
required by section three thousand two hundred nine of this chapter  and
necessary  for  completion  of a comparison of the proposed and replaced
coverage; and
  (D) provide for a sixty-day period following issuance of the  replace-
ment policies or contracts during which the policy or contract owner may
return  the policies or contracts and reinstate the replaced policies or
contracts.
  (d) Any agent or representative of an insurer  or  health  maintenance
organization,  any  insurance broker and any other person, firm, associ-
ation or corporation INCLUDING, BUT NOT LIMITED TO, ANY PERSON  WHO  HAS
RECEIVED  A  GRANT  FROM  AND  HAS  BEEN CERTIFIED BY THE HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO SECTION 1311  OF  THE  AFFORDABLE  CARE
ACT,  42  U.S.C.  S  18031,  TO ACT AS A NAVIGATOR, who, or which, shall
violate any of the  provisions  of  this  section  and  shall  knowingly
receive  any compensation or commission for the sale OR PLACEMENT of any
insurance policy, health maintenance organization  or  annuity  contract
induced  by a violation of this section shall also be liable for a civil
penalty in the amount received  by  such  violator  as  compensation  or
commission,  which penalty may be sued for and recovered for his own use
and benefit by any person  induced  to  purchase  an  insurance  policy,
health  maintenance  organization or annuity contract by such violation.
In addition, such agent, representative, broker, person,  firm,  associ-
ation  or corporation violating this section shall be liable for a civil
penalty in the amount of any compensation  or  commission  lost  by  any
agent,  representative  or  broker  as  a  result of a violation of this
section or the making of  such  false  or  misleading  statement,  which
penalty  may  be  sued  for and recovered for his own use and benefit by
such agent, representative or broker.
  S 38. Subparagraph (B) of paragraph 25 of subsection  (i)  of  section
3216  of  the  insurance  law,  as amended by chapter 596 of the laws of
2011, is amended to read as follows:
  (B) Every policy [which] THAT provides  physician  services,  medical,
major  medical  or  similar  comprehensive-type  coverage  shall provide
coverage for the screening, diagnosis and treatment of  autism  spectrum
disorder  in accordance with this paragraph and shall not exclude cover-
age for the screening, diagnosis  or  treatment  of  medical  conditions
otherwise covered by the policy because the individual is diagnosed with
autism spectrum disorder. Such coverage may be subject to annual deduct-

S. 2606--C                         93

ibles,  copayments  and  coinsurance as may be deemed appropriate by the
superintendent and shall be consistent with those imposed on other bene-
fits under the policy. Coverage for applied behavior analysis  shall  be
subject  to  a  maximum  benefit  of  [forty-five  thousand dollars] SIX
HUNDRED EIGHTY HOURS OF  TREATMENT  per  POLICY  OR  CALENDAR  year  per
covered individual [and such maximum annual benefit will increase by the
amount  calculated from the average ten year rolling average increase of
the medical component of the consumer price index]. This paragraph shall
not be construed as limiting the benefits that are  otherwise  available
to  an  individual  under  the policy, provided however that such policy
shall not contain any limitations on visits that are solely  applied  to
the  treatment  of  autism spectrum disorder. No insurer shall terminate
coverage or refuse to deliver, execute, issue, amend, adjust,  or  renew
coverage  to  an  individual  solely because the individual is diagnosed
with autism spectrum disorder or has received treatment for autism spec-
trum disorder. Coverage shall  be  subject  to  utilization  review  and
external  appeals of health care services pursuant to article forty-nine
of this chapter as well as, case  management,  and  other  managed  care
provisions.
  S  39.  Subparagraph  (B) of paragraph 17 of subsection (1) of section
3221 of the insurance law, as amended by chapter  596  of  the  laws  of
2011, is amended to read as follows:
  (B)  Every  group  or  blanket  policy [which] THAT provides physician
services, medical, major medical or similar comprehensive-type  coverage
shall  provide  coverage  for  the screening, diagnosis and treatment of
autism spectrum disorder in accordance with this paragraph and shall not
exclude coverage for the screening, diagnosis or  treatment  of  medical
conditions  otherwise  covered  by  the policy because the individual is
diagnosed with autism spectrum disorder. Such coverage may be subject to
annual deductibles, copayments and coinsurance as may be  deemed  appro-
priate  by the superintendent and shall be consistent with those imposed
on other benefits under  the  group  or  blanket  policy.  Coverage  for
applied  behavior  analysis  shall  be  subject  to a maximum benefit of
[forty-five thousand dollars] SIX HUNDRED EIGHTY HOURS OF TREATMENT  per
POLICY  OR CALENDAR year per covered individual [and such maximum annual
benefit will increase by the amount calculated from the average ten year
rolling average increase of the medical component of the consumer  price
index].  This  paragraph shall not be construed as limiting the benefits
that are otherwise available to an individual under the group or blanket
policy, provided however that such policy shall not contain any  limita-
tions on visits that are solely applied to the treatment of autism spec-
trum disorder. No insurer shall terminate coverage or refuse to deliver,
execute, issue, amend, adjust, or renew coverage to an individual solely
because the individual is diagnosed with autism spectrum disorder or has
received  treatment  for  autism  spectrum  disorder.  Coverage shall be
subject to utilization  review  and  external  appeals  of  health  care
services pursuant to article forty-nine of this chapter as well as, case
management, and other managed care provisions.
  S  40. Paragraph 2 of subsection (ee) of section 4303 of the insurance
law, as amended by chapter 596 of the laws of 2011, is amended  to  read
as follows:
  (2)  Every contract [which] THAT provides physician services, medical,
major medical  or  similar  comprehensive-type  coverage  shall  provide
coverage  for  the screening, diagnosis and treatment of autism spectrum
disorder in accordance with this [subsection] PARAGRAPH  and  shall  not
exclude  coverage  for  the screening, diagnosis or treatment of medical

S. 2606--C                         94

conditions otherwise covered by the contract because the  individual  is
diagnosed with autism spectrum disorder. Such coverage may be subject to
annual  deductibles,  copayments and coinsurance as may be deemed appro-
priate  by the superintendent and shall be consistent with those imposed
on other benefits under the  contract.  Coverage  for  applied  behavior
analysis  shall  be subject to a maximum benefit of [forty-five thousand
dollars] SIX HUNDRED EIGHTY HOURS OF TREATMENT per CONTRACT OR  CALENDAR
year  per  covered  individual  [and  such  maximum  annual benefit will
increase by the amount calculated from  the  average  ten  year  rolling
average  increase of the medical component of the consumer price index].
This paragraph shall not be construed as limiting the benefits that  are
otherwise available to an individual under the contract, provided howev-
er  that  such contract shall not contain any limitations on visits that
are solely applied to the treatment  of  autism  spectrum  disorder.  No
insurer  shall  terminate coverage or refuse to deliver, execute, issue,
amend, adjust, or renew coverage to an  individual  solely  because  the
individual  is  diagnosed  with autism spectrum disorder or has received
treatment for autism spectrum disorder. Coverage  shall  be  subject  to
utilization review and external appeals of health care services pursuant
to  article  forty-nine of this chapter as well as, case management, and
other managed care provisions.
  S 40-a. Paragraph 1 of subsection (d) of section 3221 of the insurance
law is amended to read as follows:
  (1) The superintendent may approve  any  form  of  certificate  to  be
issued  under  a blanket accident and health insurance policy as defined
in section four thousand two hundred thirty-seven of this chapter, which
omits or modifies any of the provisions hereinbefore required,  if  [he]
THE  SUPERINTENDENT deems such omission or modification suitable for the
character of such insurance and not unjust to the persons insured there-
under.  CERTIFICATES ISSUED UNDER A POLICY OR CONTRACT OF STUDENT  ACCI-
DENT  AND  HEALTH  INSURANCE  AS  DEFINED  IN SECTION THREE THOUSAND TWO
HUNDRED FORTY OF THIS ARTICLE SHALL COMPLY WITH SUCH SECTION.
  S 41. The insurance law is amended by adding a  new  section  3240  to
read as follows:
  S 3240. STUDENT ACCIDENT AND HEALTH INSURANCE.  (A) IN THIS SECTION:
  (1) "STUDENT ACCIDENT AND HEALTH INSURANCE" MEANS A POLICY OR CONTRACT
OF  HOSPITAL, MEDICAL, OR SURGICAL EXPENSE INSURANCE DELIVERED OR ISSUED
FOR DELIVERY IN THIS STATE ON OR AFTER  JANUARY  FIRST,  TWO    THOUSAND
FOURTEEN,  BY  AN  INSURER OR A CORPORATION, TO AN INSTITUTION OF HIGHER
EDUCATION  COVERING  STUDENTS  ENROLLED  IN  THE  INSTITUTION  AND   THE
STUDENTS' DEPENDENTS.
  (2)  "INSTITUTION OF HIGHER EDUCATION" OR "INSTITUTION" SHALL HAVE THE
MEANING SET FORTH IN THE HIGHER EDUCATION ACT OF 1965, 20 U.S.C. S 1001.
  (3) "INSURER" MEANS AN INSURER LICENSED TO WRITE ACCIDENT  AND  HEALTH
INSURANCE PURSUANT TO THIS CHAPTER.
  (4)  "CORPORATION"  MEANS  A  CORPORATION ORGANIZED IN ACCORDANCE WITH
ARTICLE FORTY-THREE OF THIS CHAPTER.
  (B) AN INSURER OR CORPORATION SHALL NOT IMPOSE ANY PRE-EXISTING CONDI-
TION EXCLUSION IN A STUDENT   ACCIDENT AND HEALTH  INSURANCE  POLICY  OR
CONTRACT.    AN INSURER OR CORPORATION SHALL NOT CONDITION  ELIGIBILITY,
INCLUDING CONTINUED ELIGIBILITY,  FOR  A  STUDENT  ACCIDENT  AND  HEALTH
INSURANCE  POLICY  OR  CONTRACT  ON  HEALTH  STATUS,  MEDICAL CONDITION,
INCLUDING BOTH PHYSICAL AND MENTAL ILLNESSES, CLAIMS EXPERIENCE, RECEIPT
OF HEALTH CARE, MEDICAL HISTORY, GENETIC INFORMATION, EVIDENCE OF INSUR-
ABILITY, INCLUDING CONDITIONS ARISING OUT OF ACTS OF DOMESTIC  VIOLENCE,
OR DISABILITY.

S. 2606--C                         95

  (C)  AN  INSURER  OR CORPORATION SHALL CONDITION ELIGIBILITY INCLUDING
CONTINUING ELIGIBILITY, ON THE COVERED INDIVIDUAL BEING  ENROLLED  AS  A
STUDENT IN AN INSTITUTION OF HIGHER EDUCATION TO WHICH THE STUDENT ACCI-
DENT AND HEALTH INSURANCE POLICY OR CONTRACT IS ISSUED.
  (D)  A  STUDENT ACCIDENT AND HEALTH INSURANCE POLICY OR CONTRACT SHALL
PROVIDE COVERAGE FOR ESSENTIAL HEALTH BENEFITS  AS  DEFINED  IN  SECTION
1302(B) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(B).
  (E)  AN  INSURER OR CORPORATION SHALL NOT REFUSE TO RENEW OR OTHERWISE
TERMINATE A STUDENT ACCIDENT AND HEALTH  INSURANCE  POLICY  OR  CONTRACT
EXCEPT FOR ONE OR MORE OF THE REASONS SET FORTH IN:
  (1)  SUBPARAGRAPHS (A), (B), (D) OR (G) OF PARAGRAPH TWO OF SUBSECTION
(P) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS ARTICLE; OR
  (2) SUBPARAGRAPHS (A), (B), (D) OR (G) OF PARAGRAPH TWO OF  SUBSECTION
(J) OF SECTION FOUR THOUSAND THREE HUNDRED FIVE OF THIS CHAPTER.
  (F)  THIS  SECTION  SHALL NOT APPLY TO COVERAGE UNDER A STUDENT HEALTH
PLAN ISSUED PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR  OF
THIS CHAPTER.
  (G)  THE  RATIO  OF  BENEFITS  TO  PREMIUMS  SHALL  BE  NOT  LESS THAN
EIGHTY-TWO PERCENT AS CALCULATED IN A MANNER TO  BE  DETERMINED  BY  THE
SUPERINTENDENT.
  S 42. Intentionally omitted.
  S 43. Intentionally omitted.
  S  43-a. Item (i) of subparagraph (C) of paragraph 2 of subsection (c)
of section 4304 of the insurance law, as amended by section 9 of part  A
of chapter 1 of the laws of 2002, is amended to read as follows:
  (i)  Discontinuance  of  a  class  of contract upon not less than five
months' prior written notice[, except  for  subscribers  to  direct  pay
major  medical or similar comprehensive-type coverage issued by a corpo-
ration organized pursuant to this article, or any successor  corporation
organized  through  a  conversion  pursuant to subsection (j) of section
four thousand three hundred one of this article, and in effect prior  to
January  first,  nineteen  hundred  ninety-six  who  are  ineligible  to
purchase policies offered after such date pursuant to section four thou-
sand three hundred twenty-one or four thousand three hundred  twenty-two
of  this  article due to the provisions of 42 U.S.C. 1395ss in effect on
the effective date of this  item.  In  the  event  any  such  subscriber
becomes  eligible  to purchase policies offered pursuant to section four
thousand three hundred twenty-one or four thousand three  hundred  twen-
ty-two  of  this  article, then such subscriber may be discontinued upon
not less than five months' prior  written  notice].  In  exercising  the
option  to  discontinue  coverage pursuant to this item, the corporation
must act uniformly without regard to any health status-related factor of
enrolled individuals or individuals who may  become  eligible  for  such
coverage and must offer to subscribers or group remitting agents, as may
be  appropriate,  the  option  to  purchase  all other individual health
insurance coverage currently being offered by the corporation to  appli-
cants in that market.
  S  44.  The  section heading and subsection (a) of section 4321 of the
insurance law, the section heading as added by chapter 504 of  the  laws
of  1995  and  subsection  (a)  as amended by chapter 342 of the laws of
2004, are amended to read as follows:
  Standardization  of  individual  enrollee  direct  payment   contracts
offered  by health maintenance organizations PRIOR TO OCTOBER FIRST, TWO
THOUSAND THIRTEEN. (a) On and  after  January  first,  nineteen  hundred
ninety-six,  AND  UNTIL  SEPTEMBER  THIRTIETH, TWO THOUSAND THIRTEEN all
health maintenance organizations issued a certificate of authority under

S. 2606--C                         96

article forty-four of the public health law or licensed under this arti-
cle shall offer a standardized individual enrollee contract on  an  open
enrollment  basis as prescribed by section forty-three hundred seventeen
of  this article and section forty-four hundred six of the public health
law, and regulations promulgated  thereunder,  provided,  however,  that
such  requirements  shall not apply to a health maintenance organization
exclusively serving individuals enrolled pursuant  to  title  eleven  of
article  five of the social services law, title eleven-D of article five
of the social services law, title one-A of article  twenty-five  of  the
public health law or title eighteen of the federal Social Security Act[,
and,  further  provided, that such health maintenance organization shall
not discontinue a contract for an  individual  receiving  comprehensive-
type coverage in effect prior to January first, two thousand four who is
ineligible to purchase policies offered after such date pursuant to this
section  or section four thousand three hundred twenty-two of this arti-
cle due to the provision of 42 U.S.C. 1395ss in effect prior to  January
first,  two thousand four]. On and after January first, nineteen hundred
ninety-six, AND UNTIL SEPTEMBER THIRTIETH, TWO  THOUSAND  THIRTEEN,  the
enrollee  contracts  issued  pursuant  to  this section and section four
thousand three hundred twenty-two of this  article  shall  be  the  only
contracts  offered  by  health maintenance organizations to individuals.
The enrollee contracts issued by a health maintenance organization under
this section and section four thousand three hundred twenty-two of  this
article  shall  also  be the only contracts issued by health maintenance
organizations for purposes of conversion pursuant to sections four thou-
sand three hundred four and four thousand three  hundred  five  of  this
article.  However,  nothing  in  this section shall be deemed to require
health maintenance organizations to terminate individual direct  payment
contracts  issued prior to January first, nineteen hundred ninety-six or
prevent health maintenance  organizations  from  terminating  individual
direct payment contracts issued prior to January first, nineteen hundred
ninety-six.
  S  45.  The  section heading and subsection (a) of section 4322 of the
insurance law, the section heading as added by chapter 504 of  the  laws
of  1995  and  subsection  (a)  as amended by chapter 342 of the laws of
2004, are amended to read as follows:
  Standardization  of  individual  enrollee  direct  payment   contracts
offered  by  health  maintenance organizations which provide out-of-plan
benefits PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN. (a) On and after
January first, nineteen hundred ninety-six, AND UNTIL SEPTEMBER  THIRTI-
ETH,  TWO THOUSAND THIRTEEN, all health maintenance organizations issued
a certificate of authority under article forty-four of the public health
law or licensed under this article shall offer to individuals, in  addi-
tion  to  the  standardized  contract  required by section four thousand
three hundred twenty-one of  this  article,  a  standardized  individual
enrollee  direct  payment  contract  on  an  open  enrollment  basis  as
prescribed by section four thousand  three  hundred  seventeen  of  this
article  and section four thousand four hundred six of the public health
law, and regulations promulgated thereunder, with an out-of-plan benefit
system, provided, however, that such requirements shall not apply  to  a
health maintenance organization exclusively serving individuals enrolled
pursuant  to  title  eleven  of article five of the social services law,
title eleven-D of article five of the social services law,  title  one-A
of article twenty-five of the public health law or title eighteen of the
federal  Social  Security  Act[, and, further provided, that such health
maintenance organization shall not discontinue a contract for  an  indi-

S. 2606--C                         97

vidual  receiving comprehensive-type coverage in effect prior to January
first, two thousand four who is ineligible to purchase policies  offered
after  such date pursuant to this section or section four thousand three
hundred  twenty-two  of  this  article due to the provision of 42 U.S.C.
1395ss in effect prior to January first, two thousand four]. The out-of-
plan benefit system shall either be provided by the  health  maintenance
organization  pursuant  to subdivision two of section four thousand four
hundred six of the public health law or through an  accompanying  insur-
ance contract providing out-of-plan benefits offered by a company appro-
priately  licensed pursuant to this chapter. On and after January first,
nineteen hundred ninety-six, AND UNTIL SEPTEMBER THIRTIETH, TWO THOUSAND
THIRTEEN, the contracts issued pursuant to this section and section four
thousand three hundred twenty-one of this  article  shall  be  the  only
contracts  offered  by  health maintenance organizations to individuals.
The enrollee contracts issued by a health maintenance organization under
this section and section four thousand three hundred twenty-one of  this
article  shall  also  be the only contracts issued by the health mainte-
nance organization for purposes of conversion pursuant to sections  four
thousand three hundred four and four thousand three hundred five of this
article.  However,  nothing  in  this section shall be deemed to require
health maintenance organizations to terminate individual direct  payment
contracts  issued prior to January first, nineteen hundred ninety-six or
prohibit health maintenance organizations  from  terminating  individual
direct payment contracts issued prior to January first, nineteen hundred
ninety-six.
  S  46.  The  insurance  law is amended by adding a new section 4328 to
read as follows:
  S 4328. INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACTS OFFERED BY HEALTH
MAINTENANCE ORGANIZATION ON AND AFTER OCTOBER FIRST, TWO THOUSAND  THIR-
TEEN.  (A)  ON  AND  AFTER  OCTOBER  FIRST, TWO THOUSAND THIRTEEN, EVERY
HEALTH MAINTENANCE ORGANIZATION ISSUED A CERTIFICATE OF AUTHORITY  UNDER
ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR LICENSED UNDER THIS ARTI-
CLE,  OR  AN AFFILIATED INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL
OFFER AN INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT IN ACCORDANCE  WITH
THE  REQUIREMENTS OF THIS SECTION; PROVIDED, HOWEVER, THAT THIS REQUIRE-
MENT SHALL NOT APPLY TO A HOLDER OF A  SPECIAL  PURPOSE  CERTIFICATE  OF
AUTHORITY  ISSUED PURSUANT TO SECTION FOUR THOUSAND FOUR HUNDRED THREE-A
OF THE PUBLIC HEALTH LAW, EXCEPT AS OTHERWISE REQUIRED UNDER  SUBSECTION
(L)  OF  SECTION  FOUR THOUSAND THREE HUNDRED FOUR OF THIS ARTICLE, OR A
HEALTH MAINTENANCE ORGANIZATION EXCLUSIVELY SERVING INDIVIDUALS ENROLLED
PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF  THE  SOCIAL  SERVICES  LAW,
TITLE  ELEVEN-D  OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW, TITLE ONE-A
OF ARTICLE TWENTY-FIVE OF THE PUBLIC HEALTH LAW OR TITLE EIGHTEEN OF THE
FEDERAL SOCIAL SECURITY ACT. THE ENROLLEE CONTRACTS ISSUED  BY A  HEALTH
MAINTENANCE  ORGANIZATION  UNDER  THIS  SECTION  ALSO  SHALL BE THE ONLY
CONTRACTS ISSUED BY THE HEALTH MAINTENANCE ORGANIZATION FOR PURPOSES  OF
CONVERSION  PURSUANT  TO  SECTIONS  FOUR THOUSAND THREE HUNDRED FOUR AND
FOUR THOUSAND THREE HUNDRED FIVE OF THIS ARTICLE.
  (B) (1) WITHIN THE HEALTH BENEFIT  EXCHANGE  ESTABLISHED  PURSUANT  TO
SECTION  1311  OF  THE  AFFORDABLE CARE ACT, 42 U.S.C. S 18031, A HEALTH
MAINTENANCE ORGANIZATION MAY OFFER AN INDIVIDUAL ENROLLEE DIRECT PAYMENT
CONTRACT THAT IS A  CATASTROPHIC  HEALTH  PLAN  AS  DEFINED  IN  SECTION
1302(E)  OF  THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(E), OR ANY REGU-
LATIONS PROMULGATED THEREUNDER.
  (2) THE INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT  OFFERED  PURSUANT
TO  THIS  SECTION  SHALL  HAVE  THE  SAME  ENROLLMENT PERIODS, INCLUDING

S. 2606--C                         98

SPECIAL  ENROLLMENT  PERIODS,  AS  REQUIRED  FOR  AN  INDIVIDUAL  DIRECT
PAYMENT  CONTRACT OFFERED WITHIN THE HEALTH BENEFIT EXCHANGE ESTABLISHED
PURSUANT TO SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S  18031,
OR ANY REGULATIONS PROMULGATED THEREUNDER.
  (3)  THE  INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT OFFERED PURSUANT
TO THIS SECTION SHALL BE ISSUED WITHOUT REGARD TO EVIDENCE OF INSURABIL-
ITY AND WITHOUT AN EXCLUSION FOR PRE-EXISTING CONDITIONS.
  (4) A HEALTH MAINTENANCE ORGANIZATION OFFERING AN INDIVIDUAL  ENROLLEE
DIRECT  PAYMENT  CONTRACT  PURSUANT  TO THIS SECTION SHALL NOT ESTABLISH
RULES FOR ELIGIBILITY, INCLUDING CONTINUED ELIGIBILITY, OF ANY  INDIVID-
UAL OR DEPENDENT OF THE INDIVIDUAL TO ENROLL UNDER THE CONTRACT BASED ON
ANY OF THE FOLLOWING HEALTH STATUS-RELATED FACTORS:
  (A) HEALTH STATUS;
  (B) MEDICAL CONDITION, INCLUDING BOTH PHYSICAL AND MENTAL ILLNESSES;
  (C) CLAIMS EXPERIENCE;
  (D) RECEIPT OF HEALTH CARE;
  (E) MEDICAL HISTORY;
  (F) GENETIC INFORMATION;
  (G) EVIDENCE OF INSURABILITY, INCLUDING CONDITIONS ARISING OUT OF ACTS
OF DOMESTIC VIOLENCE; OR
  (H) DISABILITY.
  (5)  THE  INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT OFFERED PURSUANT
TO THIS SECTION SHALL BE COMMUNITY RATED. FOR  PURPOSES  OF  THIS  PARA-
GRAPH, "COMMUNITY RATED" MEANS A RATING METHODOLOGY IN WHICH THE PREMIUM
FOR  ALL  PERSONS  COVERED  BY A CONTRACT FORM IS THE SAME, BASED ON THE
EXPERIENCE OF THE ENTIRE POOL OF RISKS,  WITHOUT  REGARD  TO  AGE,  SEX,
HEALTH STATUS, TOBACCO USAGE, OR OCCUPATION.
  (C)  IN  ADDITION  TO  OR  IN  LIEU  OF THE INDIVIDUAL ENROLLEE DIRECT
PAYMENT CONTRACTS REQUIRED UNDER THIS SECTION,  ALL  HEALTH  MAINTENANCE
ORGANIZATIONS ISSUED A CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR
OF  THE PUBLIC HEALTH LAW OR LICENSED UNDER THIS ARTICLE MAY OFFER INDI-
VIDUAL ENROLLEE DIRECT  PAYMENT  CONTRACTS  WITHIN  THE  HEALTH  BENEFIT
EXCHANGE  ESTABLISHED  PURSUANT  TO  SECTION 1311 OF THE AFFORDABLE CARE
ACT, 42 U.S.C. S 18031, OR ANY REGULATIONS PROMULGATED THEREUNDER.
  (D)(1) NOTHING IN THIS SECTION SHALL BE DEEMED TO REQUIRE HEALTH MAIN-
TENANCE ORGANIZATIONS TO DISCONTINUE INDIVIDUAL DIRECT PAYMENT CONTRACTS
ISSUED PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN OR  PREVENT  HEALTH
MAINTENANCE  ORGANIZATIONS  FROM DISCONTINUING INDIVIDUAL DIRECT PAYMENT
CONTRACTS ISSUED PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN.    IF  A
HEALTH  MAINTENANCE  ORGANIZATION DISCONTINUES INDIVIDUAL DIRECT PAYMENT
CONTRACTS ISSUED PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN,  REGARD-
LESS OF WHETHER IT IS A GRANDFATHERED HEALTH PLAN, THEN THE HEALTH MAIN-
TENANCE  ORGANIZATION  SHALL COMPLY WITH  THE REQUIREMENTS OF SUBSECTION
(C) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR OF THIS ARTICLE.
  (2) FOR PURPOSES OF THIS SUBSECTION, "GRANDFATHERED HEALTH PLAN" MEANS
COVERAGE PROVIDED BY A CORPORATION IN WHICH AN INDIVIDUAL  WAS  ENROLLED
ON  MARCH  TWENTY-THIRD,  TWO  THOUSAND  TEN FOR AS LONG AS THE COVERAGE
MAINTAINS GRANDFATHERED STATUS IN ACCORDANCE WITH SECTION 1251(E) OF THE
AFFORDABLE CARE ACT, 42 U.S.C. S 18011(E).
  S 46-a. Paragraph 5 of subsection (c) of section 3216 of the insurance
law is amended to read as follows:
  (5) (A) Any family  policy  providing  hospital  or  surgical  expense
insurance  (but  not  including such insurance against accidental injury
only) shall provide that, in the event such  insurance  on  any  person,
other  than  the  policyholder,  is  terminated because the person is no
longer within the definition of the family as set forth  in  the  policy

S. 2606--C                         99

but before such person has attained the limiting age, if any, for cover-
age  of adults specified in the policy, such person shall be entitled to
have issued to [him] THAT PERSON by the  insurer,  without  evidence  of
insurability,  upon application therefor and payment of the first premi-
um, within thirty-one days after such insurance shall  have  terminated,
an individual conversion policy. The conversion privilege afforded here-
in shall also be available upon the divorce or annulment of the marriage
of the policyholder to the former spouse of such policyholder.
  (B)  Written  notice  of  entitlement  to a conversion policy shall be
given by the insurer to the policyholder at least fifteen and  not  more
than  sixty days prior to the termination of coverage due to the initial
limiting age of the covered dependent.  Such  notice  shall  include  an
explanation  of  the  rights  of the dependent with respect to [his] THE
DEPENDENT being enrolled in an accredited institution of learning or his
incapacity for self-sustaining employment by reason of  mental  illness,
developmental  disability or mental retardation as defined in the mental
hygiene law or physical handicap.
  (C) Such individual conversion policy shall be subject to the  follow-
ing terms and conditions:
  (i)  The  premium  shall  be  that applicable to the [class of risk to
which such person belongs, to the age of such person and  to  the]  form
and amount of insurance therefor.
  (ii)  [Such  policy  shall provide, on a basis specified in the family
policy, the same or substantially the same benefits as those provided in
the family policy or such benefits as are provided in a  policy  specif-
ically  approved  as  an individual conversion policy by the superinten-
dent.
  (iii)] The benefits provided under such policy shall become  effective
upon  the  date that such person was no longer eligible under the family
policy.
  [(iv) The policy may exclude any  condition  excluded  by  the  family
policy  for  such person at the time of the termination of his insurance
thereunder. The policy shall not exclude any other  pre-existing  condi-
tions,  but  the  benefits  paid under such policy may be reduced by the
amount of any such benefits payable under the family  policy  after  the
termination  of such person's insurance thereunder and, during the first
policy year of the conversion policy, the  benefits  payable  under  the
policy may be reduced so that they are not in excess of those that would
have  been  payable  had such person's insurance under the family policy
remained in force and effect.
  (v)] (III) No insurer shall be required to issue a  conversion  policy
if  it  appears  that  the person applying for such policy shall have at
that time in force another  insurance  policy  or  hospital  service  or
medical  expense  indemnity  contract  providing  similar benefits or is
covered by or is eligible for coverage by a group  insurance  policy  or
contract providing similar benefits or shall be covered by similar bene-
fits required by any statute or provided by any welfare plan or program,
which together with the conversion policy would result in over insurance
or  duplication  of  benefits  according  to  standards on file with the
superintendent relating to individual policies.
  [(vi)] (IV) The policy may include a provision whereby the insurer may
request information at any premium due date of the policy of the  person
covered thereunder as to whether he is then covered by another policy or
hospital  service  or  medical  expense indemnity corporation subscriber
contract providing similar benefits  or  is  then  covered  by  a  group
contract  or  policy providing similar benefits or is then provided with

S. 2606--C                         100

similar benefits required by any statute or provided by any welfare plan
or program. If any such person is so covered or so provided and fails to
furnish the details of such coverage when requested, the benefits  paya-
ble under the conversion policy may be based on the hospital surgical or
medical  expenses  actually  incurred  after  excluding  expenses to the
extent they are payable under such other coverage or provided under such
statute, plan, or program.
  S 46-b. Subdivision 1 of section 4406 of the  public  health  law,  as
amended  by  chapter  342  of  the  laws  of 2004, is amended to read as
follows:
  1.   The contract between a health  maintenance  organization  and  an
enrollee  shall  be subject to regulation by the superintendent as if it
were a health insurance subscriber contract, and shall include, but  not
be  limited to, all mandated benefits required by article forty-three of
the insurance law. Such contract shall fully and clearly state the bene-
fits and limitations therein provided or imposed, so  as  to  facilitate
understanding  and  comparisons,  and to exclude provisions which may be
misleading or unreasonably confusing. Such contract shall be  issued  to
any individual and dependents of such individual [and any group of fifty
or  fewer  employees or members, exclusive of spouses and dependents, or
any employee or member of the group, including dependents,] applying for
such contract at any time throughout the year, and may include a pre-ex-
isting condition provision as provided  for  in  section  four  thousand
three  hundred  eighteen of the insurance law, provided, however, [that]
THE OBLIGATION OF THE HEALTH MAINTENANCE ORGANIZATION  SHALL  BE  DEEMED
SATISFIED IF such COVERAGE IS OFFERED BY AN AFFILIATE OR SUBSIDIARY. THE
requirements shall not apply to a health maintenance organization exclu-
sively  serving individuals enrolled pursuant to title eleven of article
five of the social services law, title eleven-D of article five  of  the
social  services  law,  title one-A of article twenty-five of the public
health law or title eighteen of the federal Social  Security  Act,  and,
further  provided,  that  such health maintenance organization shall not
discontinue a contract for an  individual  receiving  comprehensive-type
coverage  in  effect  prior  to  January first, two thousand four who is
ineligible to purchase policies offered after such date pursuant to this
section or section four thousand three hundred twenty-two of [this arti-
cle] THE INSURANCE LAW due to the provision of  42  U.S.C.    1395ss  in
effect prior to January first, two thousand four. Subject to the credit-
able  coverage  requirements  of subsection (a) of section four thousand
three hundred eighteen of the insurance law, the organization may, as an
alternative to the use of a pre-existing condition provision,  elect  to
offer  contracts  without  a  pre-existing  condition provision to [such
groups] INDIVIDUALS but may  require  that  coverage  shall  not  become
effective  until  after  a specified affiliation period of not more than
sixty days after the application for coverage is submitted.  The  organ-
ization  is  not  required  to  provide health care services or benefits
during such period and no premium shall  be  charged  for  any  coverage
during  the  period.   After January first, nineteen hundred ninety-six,
all individual direct payment contracts shall be issued only pursuant to
sections four thousand three hundred twenty-one and four thousand  three
hundred  twenty-two  of  the insurance law. Such contracts may not, with
respect to an eligible individual (as defined in section 2741(b) of  the
federal  Public  Health Service Act, 42 U.S.C. S 300gg-41(b), impose any
pre-existing condition exclusion.
  S 47. Paragraphs 4, 6, 9 and 10 of subsection (e) of section  3221  of
the insurance law are REPEALED, paragraphs 5, 7, 8, 11 and 12 are renum-

S. 2606--C                         101

bered paragraphs 4, 5, 6, 7 and 8 and paragraph 1, as amended by chapter
306 of the laws of 1987, is amended to read as follows:
  (1)  A  group  policy  providing hospital, MEDICAL or surgical expense
insurance for other than  specific  diseases  or  accident  only,  shall
provide that if the insurance on an employee or member insured under the
group policy ceases because of termination of [(I)] (A) employment or of
membership in the class or classes eligible for coverage under the poli-
cy or [(II)] (B) the policy, for any reason whatsoever, unless the poli-
cyholder  has  replaced  the  group  policy  with similar and continuous
coverage for the  same  group  whether  insured  or  self-insured,  such
employee  or  member who has been insured under the group policy [for at
least three months] shall be  entitled  to  have  issued  to  [him]  THE
INSURED by the insurer without evidence of insurability upon application
made  to  the insurer within forty-five days after such termination, and
payment of the quarterly, or, at the option of the employee or member, a
less frequent premium applicable to the [class  of  risk  to  which  the
person  belongs,  the  age  of  such person, and the] form and amount of
insurance, an individual policy of insurance. The insurer  may,  at  its
option  elect  to provide the insurance coverage under a group insurance
policy, delivered in this state, in lieu of the issuance of a  converted
individual policy of insurance. Such individual policy, or group policy,
as the case may be is hereafter referred to as the converted policy. The
benefits  provided under the converted policy shall be those required by
subsection (f)[, (g), (h) or (i) hereof] OF THIS SECTION, [whichever  is
applicable  and,]  in  the  event  of termination of the converted group
policy of insurance, each insured  thereunder  shall  have  a  right  of
conversion to a converted individual policy of insurance.
  S  48.  Paragraph 3 of subsection (e) of section 3221 of the insurance
law, as separately amended by chapters 370 and 869 of the laws of  1984,
is amended to read as follows:
  (3)  The  converted  policy  shall,  at  the option of the employee or
member, provide identical coverage for the dependents of  such  employee
or  member  who  were covered under the group policy. Provided, however,
that if the employee or member chooses the option of dependent  coverage
then  dependents  acquired after the permitted time to convert stated in
paragraph one of this subsection shall be added to the converted  family
policy  in  accordance  with the provisions of subsection (c) of section
thirty-two hundred sixteen of this article and any  regulations  promul-
gated  or  guidelines issued by the superintendent. The converted policy
need not provide benefits in excess of those provided for  such  persons
under  the  group  policy from which conversion is made [and may contain
any exclusion or benefit limitation contained in  the  group  policy  or
customarily  used  in  individual  policies].  The effective date of the
individual's coverage under the converted policy shall be  the  date  of
the  termination of the individual's insurance under the group policy as
to those persons covered under the group policy.
  S 49. Subsections (f) and (g) of section 3221 of the insurance law are
REPEALED and a new subsection (f) is added to read as follows:
  (F) IF THE GROUP INSURANCE POLICY INSURES THE EMPLOYEE OR  MEMBER  FOR
HOSPITAL,  MEDICAL OR SURGICAL EXPENSE INSURANCE, OR IF THE GROUP INSUR-
ANCE POLICY INSURES THE EMPLOYEE OR MEMBER FOR MAJOR MEDICAL OR  SIMILAR
COMPREHENSIVE-TYPE COVERAGE, THEN THE CONVERSION PRIVILEGE SHALL ENTITLE
THE  EMPLOYEE  OR  MEMBER  TO  OBTAIN  COVERAGE UNDER A CONVERTED POLICY
PROVIDING, AT THE INSURED'S OPTION,  COVERAGE  ON  AN  EXPENSE  INCURRED
BASIS.

S. 2606--C                         102

  S  50.  Subparagraph  (D)  of paragraph 4 of subsection (l) of section
3221 of the insurance law, as amended by chapter  230  of  the  laws  of
2004, is amended to read as follows:
  (D)  In addition to the requirements of subparagraph (A) of this para-
graph, every insurer issuing a group policy for delivery in  this  state
[which]  WHERE THE policy provides reimbursement to insureds for psychi-
atric or psychological services or for the diagnosis  and  treatment  of
mental,  nervous or emotional disorders and ailments, however defined in
such policy, by physicians, psychiatrists or psychologists, [must] SHALL
provide the same coverage to insureds for such services  when  performed
by  a licensed clinical social worker, within the lawful scope of his or
her practice, who is licensed pursuant to  subdivision  two  of  section
seven  thousand  seven hundred four of the education law and in addition
shall have either: (i) three or  more  additional  years  experience  in
psychotherapy,  which  for  the purposes of this subparagraph shall mean
the use of verbal methods in interpersonal relationships with the intent
of assisting a person  or  persons  to  modify  attitudes  and  behavior
[which]  THAT  are  intellectually, socially or emotionally maladaptive,
under supervision, satisfactory to the state board for social work, in a
facility,  licensed  or  incorporated  by  an  appropriate  governmental
department,  providing  services  for  diagnosis or treatment of mental,
nervous or emotional disorders or ailments[, or];  (ii)  three  or  more
additional  years  experience  in  psychotherapy  under the supervision,
satisfactory to the state board for social work, of  a  psychiatrist,  a
licensed and registered psychologist or a licensed clinical social work-
er  qualified for reimbursement pursuant to subsection [(h)] (E) of this
section, or (iii) a combination of the experience specified in items (i)
and (ii) OF THIS SUBPARAGRAPH totaling three years, satisfactory to  the
state board for social work.
  (E)  The  state  board  for  social  work shall maintain a list of all
licensed clinical  social  workers  qualified  for  reimbursement  under
[this] subparagraph (D) OF THIS PARAGRAPH.
  S  51.  Paragraph 3 of subsection (e) of section 4304 of the insurance
law is REPEALED and paragraphs 4 and 5 are renumbered paragraphs  3  and
4, and paragraphs 1 and 2 of such subsection (e), paragraph 1 as amended
by  chapter  661  of the laws of 1997, and as further amended by section
104 of part A of chapter 62 of the laws of 2011, are amended to read  as
follows:
  (1)  If  any  such  contract  is  terminated  in  accordance  with the
provisions of paragraph one of subsection (c) [hereof] OF THIS  SECTION,
or any such contract is terminated because of a default by the remitting
agent  in  the payment of premiums not cured within the grace period and
the remitting agent has not  replaced  the  contract  with  similar  and
continuous  coverage for the same group whether insured or self-insured,
or any such contract is terminated in accordance with the provisions  of
subparagraph  (E)  of  paragraph  two of subsection (c) [hereof] OF THIS
SECTION, or if an individual other than the contract holder is no longer
covered under a "family contract" because  [he]  THE  INDIVIDUAL  is  no
longer  within  the definition set forth in the contract, or a spouse is
no longer covered  under  the  contract  because  of  divorce  from  the
contract  holder  or  annulment of the marriage, or any such contract is
terminated because of the death of the contract holder, then such  indi-
vidual, former spouse, or in the case of the death of the contract hold-
er  the  surviving  spouse  or other dependents of the deceased contract
holder covered under the contract, as the case may be, shall be entitled
to convert, without evidence of insurability, upon application  therefor

S. 2606--C                         103

and  the  making  of the first payment thereunder within thirty-one days
after the date of termination of such contract, to a contract [of a type
which provides coverage most nearly comparable to the type  of  coverage
under  the  contract from which the individual converted, which coverage
shall be no less than the minimum standards for  basic  hospital,  basic
medical,  or  major  medical  as provided for in department of financial
services regulation; provided, however, that if the corporation does not
issue such a major medical contract, then to a comprehensive or compara-
ble type of coverage which is most commonly being sold to  group  remit-
ting  agents.  Notwithstanding  the previous sentence, a corporation may
elect to issue a standardized individual enrollee contract  pursuant  to
section  four  thousand three hundred twenty-two of this article in lieu
of a major medical contract, comprehensive or comparable type of  cover-
age  required  to be offered upon conversion from an indemnity contract]
THAT CONTAINS THE BENEFITS DESCRIBED IN PARAGRAPH ONE OF SUBSECTION  (B)
OF  SECTION  FOUR  THOUSAND  THREE HUNDRED TWENTY-EIGHT OF THIS ARTICLE.
The effective date of the coverage  provided  by  the  converted  direct
payment  contract shall be the date of the termination of coverage under
the contract from which conversion was made.
  (2) The corporation shall not be required to issue any such  converted
individual direct payment contract if its issuance would result in over-
insurance or duplication of benefits according to standards on file with
the  superintendent and approved by [him] THE SUPERINTENDENT with regard
to such contracts. The individual direct payment contract may include  a
provision  whereby  the  corporation  may  request  information when any
payment is due under the contract of the person covered thereunder as to
whether he is then covered  by  another  individual  contract  providing
similar benefits or is then covered by a group contract policy providing
similar  benefits  or is then provided with similar benefits required by
any statute or provided by any welfare plan or  program  which  together
with  the  converted  individual direct payment contract would result in
overinsurance or duplication of benefits according to the  standards  on
file  with  the  superintendent relating to individual contracts. If any
such person is so covered or  so  provided  and  fails  to  furnish  the
details of such coverage when requested, the benefits provided under the
converted  individual direct payment contract may be based on the hospi-
tal, surgical or medical  expenses  actually  incurred  after  excluding
expenses  to  the  extent  they are payable under such other coverage or
provided under such statute, plan or program.
  S 52. Paragraphs 1 and 2 of subsection (d)  of  section  4305  of  the
insurance law, paragraph 1 as amended by chapter 504 of the laws of 1995
and  paragraphs  1  and 2 as further amended by section 104 of part A of
chapter 62 of the laws of 2011, are amended to read as follows:
  (1) (A) A group contract issued pursuant to this section shall contain
a provision to the effect that in case  of  a  termination  of  coverage
under  such  contract  of  any  member of the group because of [(I)] (I)
termination for any reason whatsoever of [his] THE  MEMBER'S  employment
or  membership,  [if he has been covered under the group contract for at
least three months,] or [(II)] (II) termination for any reason whatsoev-
er of the group contract itself unless the  group  contract  holder  has
replaced the group contract with similar and continuous coverage for the
same  group  whether  insured  or self-insured, [he] THE MEMBER shall be
entitled to have issued to [him] THE MEMBER by the corporation,  without
evidence  of  insurability, upon application therefor and payment of the
first premium made to  the  corporation  within  forty-five  days  after
termination  of  the  coverage,  an  individual direct payment contract,

S. 2606--C                         104

covering such member and [his] THE MEMBER'S eligible dependents who were
covered by the group contract,  which  provides  coverage  [most  nearly
comparable  to  the  type  of  coverage  under the group contract, which
coverage shall be no less than the minimum standards for basic hospital,
basic  medical, or major medical as provided for in department of finan-
cial services regulation; provided, however,  that  if  the  corporation
does not issue such a major medical contract, then to a comprehensive or
comparable  type  of coverage which is most commonly being sold to group
remitting agents. Notwithstanding the previous sentence,  a  corporation
may  elect to issue a standardized individual enrollee contract pursuant
to section four thousand three hundred twenty two  of  this  article  in
lieu  of  a  major medical contract, comprehensive or comparable type of
coverage required to  be  offered  upon  conversion  from  an  indemnity
contract]  THAT  CONTAINS  THE  BENEFITS  DESCRIBED  IN PARAGRAPH ONE OF
SUBSECTION (B) OF SECTION FOUR THOUSAND THREE  HUNDRED  TWENTY-EIGHT  OF
THIS ARTICLE.
  (B) The conversion privilege afforded [herein] IN THIS PARAGRAPH shall
also  be  available:  [(A)]  (I)  upon  the  divorce or annulment of the
marriage of a member, to the divorced spouse or former  spouse  of  such
member[,  (B)];  (II)  upon  the  death  of the member, to the surviving
spouse and other dependents covered under  the  contract[,];  and  [(C)]
(III) to a dependent if no longer within the definition in the contract.
  (2)  The  effective  date  of  the coverage provided by the individual
direct payment contract shall be the date  of  the  termination  of  the
individual's  coverage  under the group contract. [The individual direct
payment converted contract may exclude any  condition  excluded  by  the
group contract. The individual direct payment contract shall not exclude
any  other  pre-existing  conditions but the benefits provided under the
individual direct payment converted  contract  may  be  reduced  by  the
amount  of any such benefits provided under the group contract after the
termination of the individual's coverage thereunder and during the first
contract year of such individual direct payment converted  contract  the
benefits provided under the contract may be reduced so that they are not
in  excess  of  those that would have been provided had the individual's
contract under the group contract remained in  force  and  effect.]  The
corporation  shall  not  be  required  to  issue  such individual direct
payment converted contract covering any person if it appears  that  such
person  shall  then  be covered by another individual contract providing
similar coverage or if it shall appear that such person is covered by or
eligible to be covered by a group contract or policy  providing  similar
benefits or is provided with similar benefits required by any statute or
provided  by  any welfare plan or program, which together with the indi-
vidual direct payment converted contract would result in  over-insurance
or  duplication  of  benefits  according  to  standards on file with the
superintendent of financial services relating to  individual  contracts.
The individual direct payment converted contract may include a provision
whereby  the corporation may request information when any payment is due
under the contract of any person covered thereunder as to whether he  is
then  covered by another contract or by a policy providing similar bene-
fits or is then covered by a group contract or policy providing  similar
benefits or is then provided with similar benefits required by any stat-
ute or provided by any welfare plan or program. If any such person is so
covered or so provided and fails to furnish the details of such coverage
when requested, the benefits payable under the individual direct payment
converted  contract  may  be  based on the hospital, surgical or medical
expenses actually incurred after excluding expenses to the  extent  they

S. 2606--C                         105

are  payable  under  such other coverage or provided under such statute,
plan or program.
  In  the  event the benefits provided or payable are reduced in accord-
ance with the provisions of this subsection the corporation shall return
such portion of the premium paid as shall exceed the pro rata portion of
the benefits thus determined.
  S 53. Intentionally omitted.
  S 54. Intentionally omitted.
  S 55. Intentionally omitted.
  S 56. Section 4326 of the insurance law, as added by chapter 1 of  the
laws  of  1999,  subsection (b) as amended by chapter 342 of the laws of
2004, subparagraph (A) of paragraph 1 and subparagraph (C) of  paragraph
3 of subsection (c) as amended by chapter 419 of the laws of 2000, para-
graphs 13 and 14 of subsection (d), paragraphs 6 and 7 of subsection (e)
and  subsection  (k)  as  amended  and paragraph 15 of subsection (d) as
added by chapter 219 of the laws of 2011 and  subsections  (d-1),  (d-2)
and  (d-3)  as  added  by chapter 645 of the laws of 2005, is amended to
read as follows:
  S 4326. Standardized health insurance contracts for  qualifying  small
employers  and  individuals. (a) A program is hereby established for the
purpose of making standardized health insurance contracts  available  to
qualifying  small  employers  [and qualifying individuals] as defined in
this section. Such program is designed to encourage small  employers  to
offer  health  insurance  coverage  to their employees [and to also make
coverage available to uninsured employees whose employers do not provide
group health insurance].
  (b) Participation in the  program  established  by  this  section  and
section  four  thousand  three  hundred  twenty-seven of this article is
limited to corporations or insurers organized  or  licensed  under  this
article  or  article  forty-two  of  this chapter and health maintenance
organizations issued a certificate of authority under article forty-four
of the public health law or licensed under this  article.  Participation
by all health maintenance organizations is mandatory, provided, however,
that  such requirements shall not apply to a HOLDER OF A SPECIAL PURPOSE
CERTIFICATE OF AUTHORITY ISSUED PURSUANT TO SECTION FOUR  THOUSAND  FOUR
HUNDRED  THREE-A OF THE PUBLIC HEALTH LAW OR A health maintenance organ-
ization exclusively serving individuals enrolled pursuant to title elev-
en of article five of the social services law, title eleven-D of article
five of the social services law, title one-A of article  twenty-five  of
the  public  health law or title eighteen of the federal Social Security
Act[, and, further provided, that such health  maintenance  organization
shall  not discontinue a contract for an individual receiving comprehen-
sive-type coverage in effect prior to January first, two  thousand  four
who  is ineligible to purchase policies offered after such date pursuant
to this section or section four thousand  three  hundred  twenty-two  of
this article due to the provision of 42 U.S.C. 1395ss in effect prior to
January first, two thousand four]. On and after January first, two thou-
sand  one,  all  health maintenance organizations shall offer qualifying
group health  insurance  contracts  [and  qualifying  individual  health
insurance  contracts]  as  defined  in this section. For the purposes of
this section and section four thousand  three  hundred  twenty-seven  of
this  article,  article  forty-three  corporations  or article forty-two
insurers which voluntarily participate in compliance with  the  require-
ments  of this program shall be eligible for reimbursement from the stop
loss funds created pursuant to section four thousand three hundred twen-

S. 2606--C                         106

ty-seven of this article under the same terms and conditions  as  health
maintenance organizations.
  (c)  The  following  definitions  shall be applicable to the insurance
contracts offered under the program established by this section:
  (1) (A) A qualifying small employer is [an employer that is either:
  (A) An individual proprietor who is the only employee of the business:
  (i) without health insurance which provides  benefits  on  an  expense
reimbursed  or  prepaid  basis  in effect during the twelve month period
prior to application for a qualifying group  health  insurance  contract
under the program established by this section; and
  (ii)  resides in a household having a net household income at or below
two hundred eight percent of the  non-farm  federal  poverty  level  (as
defined  and  updated  by  the  federal  department  of health and human
services) or the gross equivalent of such net income;
  (iii) except that the requirements set  forth  in  item  (i)  of  this
subparagraph  shall not be applicable where an individual proprietor had
health insurance coverage during the previous  twelve  months  and  such
coverage  terminated  due  to  one of the reasons set forth in items (i)
through (viii) of subparagraph (C) of paragraph three of subsection  (c)
of this section; or
  (B) An] AN employer with:
  (i) not more than fifty eligible employees;
  (ii)  no  group  health insurance [which] THAT provides benefits on an
expense reimbursed or prepaid basis covering employees in effect  during
the  twelve  month  period  prior  to application for a qualifying group
health insurance contract under the program established by this section;
and
  (iii) at least thirty percent  of  its  eligible  employees  receiving
annual  wages  from the employer at a level equal to or less than thirty
thousand dollars. The thirty thousand dollar figure  shall  be  adjusted
periodically pursuant to subparagraph [(F)] (D) of this paragraph.
  [(C)  The  requirements  set  forth in item (i) of subparagraph (A) of
this paragraph and in item (ii) of subparagraph (B)  of  this  paragraph
shall  not  be  applicable where an individual proprietor or employer is
transferring from a health insurance contract issued pursuant to the New
York state small business health insurance  partnership  program  estab-
lished  by  section  nine hundred twenty-two of the public health law or
from health care coverage issued pursuant to a  regional  pilot  project
for  the uninsured established by section one thousand one hundred eigh-
teen of this chapter.
  (D)] (B) The twelve month period set forth [in item  (i)  of  subpara-
graph  (A) of this paragraph and] in item (ii) of subparagraph [(B)] (A)
of this paragraph may be adjusted  by  the  superintendent  from  twelve
months  to eighteen months if he determines that the twelve month period
is insufficient to prevent inappropriate substitution of  [other  health
insurance contracts for] qualifying group health insurance contracts FOR
OTHER HEALTH INSURANCE CONTRACTS.
  [(E)]  (C)  An [individual proprietor or] employer shall cease to be a
qualifying small employer if any health insurance [which] THAT  provides
benefits  on  an expense reimbursed or prepaid basis covering [the indi-
vidual proprietor or] an employer's  employees,  other  than  qualifying
group  health insurance purchased pursuant to this section, is purchased
or otherwise takes effect subsequent to  purchase  of  qualifying  group
health insurance under the program established by this section.
  [(F)]  (D)  The wage levels utilized in subparagraph [(B)] (A) of this
paragraph shall be adjusted annually, beginning in two thousand two. The

S. 2606--C                         107

adjustment shall take effect on July first of each year. For July first,
two thousand two, the adjustment shall be a  percentage  of  the  annual
wage  figure  specified in subparagraph [(B)] (A) of this paragraph. For
subsequent  years,  the  adjustment  shall be a percentage of the annual
wage figure [which] THAT took effect on July first of  the  prior  year.
The  percentage  adjustment  shall  be  the same percentage by which the
current year's non-farm federal poverty level, as defined and updated by
the federal department of health and human services, for a  family  unit
of  four  persons  for the forty-eight contiguous states and Washington,
D.C., changed from the same level established for the prior year.
  (2) A qualifying group health insurance contract is a  group  contract
purchased from a health maintenance organization, corporation or insurer
by  a  qualifying  small employer [which] THAT provides the benefits set
forth in subsection (d) of this section. The contract  must  insure  not
less than fifty percent of the employees [eligible for coverage].
  [(3)(A) A qualifying individual is an employed person:
  (i)  who  does not have and has not had health insurance with benefits
on an expense reimbursed or prepaid basis during the twelve month period
prior to the individual's application for  health  insurance  under  the
program established by this section;
  (ii)  whose  employer  does not provide group health insurance and has
not provided group health insurance with benefits on  an  expense  reim-
bursed  or  prepaid basis covering employees in effect during the twelve
month period prior to the individual's application for health  insurance
under the program established by this section;
  (iii) resides in a household having a net household income at or below
two  hundred  eight  percent  of  the non-farm federal poverty level (as
defined and updated by  the  federal  department  of  health  and  human
services) or the gross equivalent of such net income; and
  (iv) is ineligible for Medicare.
  (B)  The  requirements set forth in items (i) and (ii) of subparagraph
(A) of this paragraph shall not be applicable  where  an  individual  is
transferring  from  a  health  insurance contract issued pursuant to the
voucher insurance  program  established  by  section  one  thousand  one
hundred  twenty-one  of this chapter, a health insurance contract issued
pursuant to the New York state small business health insurance  partner-
ship  program  established  by  section  nine  hundred twenty-two of the
public health law or health care coverage issued pursuant to a  regional
pilot  project for the uninsured established by section one thousand one
hundred eighteen of this chapter.
  (C) The requirements set forth in items (i) and (ii)  of  subparagraph
(A)  of  this  paragraph shall not be applicable where an individual had
health insurance coverage during the previous  twelve  months  and  such
coverage terminated due to:
  (i) loss of employment due to factors other than voluntary separation;
  (ii) death of a family member which results in termination of coverage
under a health insurance contract under which the individual is covered;
  (iii)  change  to  a  new  employer that does not provide group health
insurance with benefits on an expense reimbursed or prepaid basis;
  (iv) change of residence so that no  employer-based  health  insurance
with benefits on an expense reimbursed or prepaid basis is available;
  (v) discontinuation of a group health insurance contract with benefits
on  an expense reimbursed or prepaid basis covering the qualifying indi-
vidual as an employee or dependent;
  (vi) expiration of the coverage periods established by  the  continua-
tion  provisions  of  the  Employee  Retirement  Income Security Act, 29

S. 2606--C                         108

U.S.C.   section 1161 et seq. and the  Public  Health  Service  Act,  42
U.S.C.   section 300bb-1 et seq. established by the Consolidated Omnibus
Budget Reconciliation Act of  1985,  as  amended,  or  the  continuation
provisions of subsection (m) of section three thousand two hundred twen-
ty-one,  subsection  (k) of section four thousand three hundred four and
subsection (e) of section four thousand three hundred five of this chap-
ter;
  (vii) legal separation, divorce or annulment which results  in  termi-
nation  of  coverage  under  a health insurance contract under which the
individual is covered; or
  (viii) loss of eligibility under a group health plan.
  (D) The twelve month period set forth in items (i) and (ii) of subpar-
agraph (A) of this paragraph may be adjusted by the superintendent  from
twelve  months to eighteen months if he determines that the twelve month
period is insufficient to prevent inappropriate  substitution  of  other
health  insurance  contracts  for qualifying individual health insurance
contracts.
  (4) A qualifying individual health insurance contract is an individual
contract issued directly to a qualifying individual and  which  provides
the  benefits set forth in subsection (d) of this section. At the option
of the qualifying individual, such contract  may  include  coverage  for
dependents of the qualifying individual.]
  (d)  [The  contracts issued pursuant to this section by health mainte-
nance organizations, corporations or insurers and approved by the super-
intendent shall only provide in-plan benefits, except for emergency care
or where services are not available through a plan  provider.    Covered
services shall include only the following:
  (1)  inpatient  hospital  services consisting of daily room and board,
general nursing care, special diets and miscellaneous hospital  services
and supplies;
  (2)  outpatient  hospital services consisting of diagnostic and treat-
ment services;
  (3)  physician  services  consisting  of  diagnostic   and   treatment
services, consultant and referral services, surgical services (including
breast  reconstruction surgery after a mastectomy), anesthesia services,
second surgical opinion, and a second opinion for cancer treatment;
  (4) outpatient surgical facility charges related to a covered surgical
procedure;
  (5) preadmission testing;
  (6) maternity care;
  (7) adult preventive health services consisting of mammography screen-
ing; cervical cytology screening; periodic physical examinations no more
than once every three years; and adult immunizations;
  (8) preventive and primary health care services for dependent children
including routine well-child visits and necessary immunizations;
  (9) equipment, supplies and self-management education for  the  treat-
ment of diabetes;
  (10) diagnostic x-ray and laboratory services;
  (11) emergency services;
  (12)  therapeutic services consisting of radiologic services, chemoth-
erapy and hemodialysis;
  (13) blood and blood products furnished in connection with surgery  or
inpatient hospital services;
  (14) prescription drugs obtained at a participating pharmacy. In addi-
tion  to  providing coverage at a participating pharmacy, health mainte-
nance organizations may utilize a mail order prescription drug  program.

S. 2606--C                         109

Health maintenance organizations may provide prescription drugs pursuant
to  a  drug  formulary;  however,  health maintenance organizations must
implement  an  appeals  process  so  that  the  use   of   non-formulary
prescription drugs may be requested by a physician; and
  (15)  for  a  contract  that  is  not a grandfathered health plan, the
following additional preventive health services:
  (A) evidence-based items or services that have in effect a  rating  of
'A'  or  'B' in the current recommendations of the United States preven-
tive services task force;
  (B) immunizations that have in effect a recommendation from the  advi-
sory  committee  on  immunization  practices  of the centers for disease
control and prevention with respect to the individual involved;
  (C) with respect  to  children,  including  infants  and  adolescents,
evidence-informed  preventive  care  and  screenings provided for in the
comprehensive guidelines supported by the health resources and  services
administration; and
  (D) with respect to women, such additional preventive care and screen-
ings not described in subparagraph (A) of this paragraph as provided for
in  comprehensive  guidelines  supported  by  the  health  resources and
services administration.
  (E) For purposes of this paragraph, "grandfathered health plan"  means
coverage  provided  by a corporation in which an individual was enrolled
on March twenty-third, two thousand ten for  as  long  as  the  coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable  Care  Act,  42  U.S.C. S 18011(e)] A QUALIFYING GROUP HEALTH
INSURANCE CONTRACT SHALL PROVIDE COVERAGE FOR THE ESSENTIAL HEALTH BENE-
FIT PACKAGE AS REQUIRED IN SECTION 2707(A) OF THE PUBLIC HEALTH  SERVICE
ACT,  42 U.S.C. S 300GG-6(A). FOR PURPOSES OF THIS SUBSECTION "ESSENTIAL
HEALTH BENEFITS PACKAGE" SHALL HAVE THE MEANING  SET  FORTH  IN  SECTION
1302(A) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(A).
  (d-1)  Covered  services  shall  not  include  drugs,  procedures  and
supplies for the treatment of erectile dysfunction when provided to,  or
prescribed  for  use  by,  a person who is required to register as a sex
offender pursuant to article six-C of the correction law, provided that:
(1) any denial of coverage pursuant to this subsection shall provide the
enrollee with the means of obtaining additional  information  concerning
both the denial and the means of challenging such denial; (2) all drugs,
procedures and supplies for the treatment of erectile dysfunction may be
subject to prior authorization by corporations, insurers or health main-
tenance  organizations for the purposes of implementing this subsection;
and (3) the superintendent shall promulgate regulations to implement the
denial of coverage pursuant to this subsection giving health maintenance
organizations, corporations and insurers at least sixty  days  following
promulgation  of  the  regulations  to implement their denial procedures
pursuant to this subsection.
  (d-2) No person or entity authorized to provide  coverage  under  this
section  shall be subject to any civil or criminal liability for damages
for any decision or action pursuant to subsection (d-1) of this section,
made in the ordinary course of business if  that  authorized  person  or
entity  acted reasonably and in good faith with respect to such informa-
tion.
  (d-3) Notwithstanding any other provision of law, if the  commissioner
of  health  makes  a  finding  pursuant  to  subdivision twenty-three of
section two hundred six of the public health law, the superintendent  is
authorized  to  remove  a  drug,  procedure  or supply from the services
covered by the standardized health  insurance  contract  established  by

S. 2606--C                         110

this  section  for  those  persons required to register as sex offenders
pursuant to article six-C of the correction law.
  (e)  [The  benefits  provided in the contracts described in subsection
(d) of this section shall be subject to the  following  deductibles  and
copayments:
  (1)  in-patient  hospital  services  shall  have a five hundred dollar
copayment for each continuous hospital confinement;
  (2) surgical services shall be subject to a copayment of the lesser of
twenty percent of the cost of such services or two hundred  dollars  per
occurrence;
  (3) outpatient surgical facility charges shall be subject to a facili-
ty copayment charge of seventy-five dollars per occurrence;
  (4)  emergency services shall have a fifty dollar copayment which must
be waived if hospital admission results from the emergency room visit;
  (5) prescription drugs shall have a one hundred dollar  calendar  year
deductible per individual. After the deductible is satisfied, each thir-
ty-four  day  supply  of a prescription drug will be subject to a copay-
ment. The copayment will be ten dollars if  the  drug  is  generic.  The
copayment  for a brand name drug will be twenty dollars plus the differ-
ence in cost between the brand name  drug  and  the  equivalent  generic
drug.  If  a mail order drug program is utilized, a twenty dollar copay-
ment shall be imposed on a ninety day  supply  of  generic  prescription
drugs.  A forty dollar copayment plus the difference in cost between the
brand name drug and the equivalent generic drug shall be  imposed  on  a
ninety  day  supply  of brand name prescription drugs. In no event shall
the copayment exceed the cost of the prescribed drug;
  (6) (A) the maximum coverage for prescription drugs in  an  individual
contract  that  is  a  grandfathered health plan shall be three thousand
dollars per individual in a calendar year; and
  (B) the maximum dollar amount on coverage for prescription drugs in an
individual contract that is not a grandfathered health plan  or  in  any
group  contract  shall  be  consistent  with  section 2711 of the Public
Health Service Act, 42 U.S.C. S 300gg-11 or any regulations thereunder.
  (C) For purposes of this paragraph, "grandfathered health plan"  means
coverage  provided  by a corporation in which an individual was enrolled
on March twenty-third, two thousand ten for  as  long  as  the  coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e); and
  (7)  all  other services shall have a twenty dollar copayment with the
exception of prenatal care which shall have a ten  dollar  copayment  or
preventive  health  services  provided  pursuant to paragraph fifteen of
subsection (d) of this section, for which no copayment  shall  apply]  A
QUALIFYING  GROUP HEALTH INSURANCE CONTRACT ISSUED TO A QUALIFYING SMALL
EMPLOYER PRIOR TO JANUARY FIRST, TWO THOUSAND  FOURTEEN  THAT  DOES  NOT
INCLUDE  ALL  ESSENTIAL  HEALTH  BENEFITS  REQUIRED  PURSUANT TO SECTION
2707(A) OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-6(A),  SHALL
BE  DISCONTINUED. A QUALIFYING SMALL EMPLOYER SHALL BE TRANSITIONED TO A
PLAN THAT PROVIDES: (1) A LEVEL OF COVERAGE THAT IS DESIGNED TO  PROVIDE
BENEFITS  THAT  ARE ACTUARIALLY EQUIVALENT TO EIGHTY PERCENT OF THE FULL
ACTUARIAL VALUE OF THE BENEFITS PROVIDED UNDER THE PLAN; AND (2)  COVER-
AGE  FOR  THE  ESSENTIAL  HEALTH  BENEFIT PACKAGE AS REQUIRED IN SECTION
2707(A) OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C.  S  300GG-6(A).  THE
SUPERINTENDENT  SHALL  STANDARDIZE  THE BENEFIT PACKAGE AND COST SHARING
REQUIREMENTS OF QUALIFIED GROUP HEALTH  INSURANCE  CONTRACTS  CONSISTENT
WITH  COVERAGE  OFFERED  THROUGH THE HEALTH BENEFIT EXCHANGE ESTABLISHED
PURSUANT TO SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18031.

S. 2606--C                         111

  (f) [Except as included in the list of covered services in  subsection
(d)  of  this section, the] THE mandated and make-available benefits set
forth in sections [three thousand two hundred sixteen,]  three  thousand
two  hundred  twenty-one of this chapter and four thousand three hundred
three  of  this  article shall not be applicable to the contracts issued
pursuant to this section. [Mandated benefits included in such  contracts
shall  be  subject  to  the  deductibles  and  copayments  set  forth in
subsection (e) of this section.]
  (g) [The superintendent shall be authorized to modify, by  regulation,
the  copayment  and  deductible amounts described in this section if the
superintendent determines such amendments are  necessary  to  facilitate
implementation  of this section. On or after January first, two thousand
two, the superintendent shall be authorized to establish, by regulation,
one or more additional standardized health insurance benefit packages if
the superintendent determines additional benefit packages with different
levels of benefits are necessary to meet the needs of the public.
  (h)] A health maintenance organization, corporation  or  insurer  must
offer the benefit package without change or additional benefits. [Quali-
fying] A QUALIFYING small [employers] EMPLOYER shall be issued the bene-
fit package in a qualifying group health insurance contract. [Qualifying
individuals shall be issued the benefit package in a qualifying individ-
ual health insurance contract.
  (i)]  (H)  A  health  maintenance organization, corporation or insurer
shall obtain from the employer [or individual] written certification  at
the  time  of  initial  application  and annually thereafter ninety days
prior to the contract renewal date that such  employer  [or  individual]
meets  the  requirements of a qualifying small employer [or a qualifying
individual] pursuant to this section. A health maintenance organization,
corporation  or  insurer  may  require  the  submission  of  appropriate
documentation in support of the certification.
  [(j)] (I) Applications for qualifying group health insurance contracts
[and  qualifying individual health insurance contracts] must be accepted
from [any qualifying individual and] any qualifying  small  employer  at
all  times  throughout  the year. The superintendent, by regulation, may
require health maintenance organizations, corporations  or  insurers  to
give  preference  to qualifying small employers whose eligible employees
have the lowest average salaries.
  [(k) (1) All  coverage  under  a  qualifying  group  health  insurance
contract  or  a  qualifying individual health insurance contract must be
subject to a pre-existing condition limitation provision as set forth in
sections three thousand two hundred thirty-two of this chapter and  four
thousand three hundred eighteen of this article, including the crediting
requirements  thereunder.  The  underwriting  of  such contracts may not
involve more than the imposition of a pre-existing condition limitation.
However, as provided in sections three thousand two  hundred  thirty-two
of  this  chapter and four thousand three hundred eighteen of this arti-
cle, a corporation shall not impose a pre-existing condition  limitation
provision  on  any  person  under age nineteen, except may impose such a
limitation on those persons covered by a  qualifying  individual  health
insurance contract that is a grandfathered health plan.
  (2)]  (J)  Beginning January first, two thousand fourteen, pursuant to
section 2704 of the Public Health Service Act, 42 U.S.C.  S  300gg-3,  a
corporation  shall not impose any pre-existing condition limitation in a
qualifying group health insurance contract [or a  qualifying  individual
health insurance contract except may impose such a limitation in a qual-

S. 2606--C                         112

ifying  individual  health  insurance  contract  that is a grandfathered
health plan].
  [(3)  For  purposes  of  paragraphs  one  and  two of this subsection,
"grandfathered health plan" means coverage provided by a corporation  in
which an individual was enrolled on March twenty-third, two thousand ten
for as long as the coverage maintains grandfathered status in accordance
with section 1251(e) of the Affordable Care Act, 42 U.S.C. S 18011(e).
  (l)]  (K)  A  qualifying  small  employer  shall elect whether to make
coverage under the qualifying group health insurance contract  available
to dependents of employees. Any employee or dependent who is enrolled in
Medicare  is  ineligible  for  coverage, unless required by federal law.
Dependents of an employee who is enrolled in Medicare will  be  eligible
for  dependent  coverage  provided the dependent is not also enrolled in
Medicare.
  [(m)] (L) A qualifying small employer must pay at least fifty  percent
of  the  premium  for  employees covered under a qualifying group health
insurance contract and must offer coverage to  all  employees  receiving
annual wages at a level of thirty thousand dollars or less, and at least
one such employee shall accept such coverage. The thirty thousand dollar
wage  level  shall  be adjusted periodically in accordance with subpara-
graph [(F)] (D) of paragraph one of subsection (c) of this section.  The
employer  premium  contribution  must  be  the  same  percentage for all
covered employees.
  [(n)] (M) Premium rate calculations for qualifying group health insur-
ance contracts [and qualifying individual  health  insurance  contracts]
shall be subject to the following:
  (1) coverage must be community rated [and include rate tiers for indi-
viduals, two adult families and at least one other family tier. The rate
differences  must  be  based upon the cost differences for the different
family units and the rate tiers must be uniformly applied. The rate tier
structure used by a  health  maintenance  organization,  corporation  or
insurer  for  the  contracts issued to qualifying small employers and to
qualifying individuals must be the same] AND ALL RATING TIERS AND STAND-
ARD RATING RELATIVITIES BETWEEN TIERS SHALL BE  FILED  WITH  THE  SUPER-
INTENDENT;
  (2)  [if  geographic  rating areas are utilized, such geographic areas
must be reasonable and in a given case may include a single county.  The
geographic  areas  utilized must be the same for the contracts issued to
qualifying small employers and to  qualifying  individuals.  The  super-
intendent  shall  not  require  the inclusion of any specific geographic
region within the proposed community rated region selected by the health
maintenance organization, corporation or insurer so long as  the  health
maintenance  organization,  corporation or insurer's proposed regions do
not contain configurations designed to  avoid  or  segregate  particular
areas  within  a  county covered by the health maintenance organization,
corporation or insurer's community rates.] BEGINNING JANUARY FIRST,  TWO
THOUSAND FOURTEEN, EVERY POLICY SUBJECT TO THIS SECTION SHALL USE STAND-
ARDIZED  REGIONS  ESTABLISHED  BY  THE SUPERINTENDENT PROVIDED, HOWEVER,
THAT THE COUNTIES OF NASSAU AND SUFFOLK SHALL TOGETHER CONSIST OF  THEIR
OWN STANDARDIZED REGION; AND
  (3)  claims  experience  under  contracts  issued  to qualifying small
employers [and to qualifying individuals] must be pooled WITH THE HEALTH
MAINTENANCE ORGANIZATION, CORPORATION OR INSURER'S SMALL GROUP  BUSINESS
for  rate  setting  purposes.  [The  premium  rates for qualifying group
health insurance contracts and qualifying  individual  health  insurance
contracts must be the same.

S. 2606--C                         113

  (o)]  (N)  A  health  maintenance organization, corporation or insurer
shall submit reports to the superintendent in such form and at times  as
may  be  reasonably  required  in  order  to evaluate the operations and
results of the standardized health insurance program established by this
section.
  [(p)  Notwithstanding  any other provision of law, all individuals and
small businesses that are  participating  in  or  covered  by  insurance
contracts  or policies issued pursuant to the New York state small busi-
ness health insurance partnership program established  by  section  nine
hundred  twenty-two  of  the  public  health  law, the voucher insurance
program established by section one thousand one  hundred  twenty-one  of
this  chapter, or uninsured pilot programs established pursuant to chap-
ter seven hundred three of the laws  of  nineteen  hundred  eighty-eight
shall be eligible for participation in the standardized health insurance
contracts  established  by this section, regardless of any of the eligi-
bility requirements established  pursuant  to  subsection  (c)  of  this
section.]
  S  57.  The insurance law is amended by adding a new section 4326-a to
read as follows:
  S 4326-A. TRANSITION OF HEALTHY NEW YORK ENROLLEES.  (A)  ON  DECEMBER
THIRTY-FIRST, TWO THOUSAND THIRTEEN, COVERAGE ISSUED TO QUALIFYING INDI-
VIDUALS  AND  QUALIFYING  SMALL  EMPLOYERS  WHO  ARE SOLE PROPRIETORS AS
DEFINED IN SECTION FOUR THOUSAND THREE  HUNDRED  TWENTY-SIX  SHALL  END,
CONTINGENT  UPON THE REQUIREMENTS OF THE PATIENT PROTECTION AND AFFORDA-
BLE CARE ACT OF 2010  BEING  FULLY  IMPLEMENTED  BY  THE  STATE  AND  AS
APPROVED  BY  THE  SECRETARY  OF  THE  DEPARTMENT  OF  HEALTH  AND HUMAN
SERVICES, AND CONTINGENT UPON FULL IMPLEMENTATION OF THE  STATE  ENROLL-
MENT CENTER.
  (B)  A  HEALTH MAINTENANCE ORGANIZATION, CORPORATION, OR INSURER SHALL
PROVIDE WRITTEN NOTICE OF THE PROGRAM DISCONTINUANCE  TO  EACH  ENROLLED
INDIVIDUAL  AND  INDIVIDUAL  PROPRIETOR AT LEAST ONE HUNDRED EIGHTY DAYS
PRIOR TO THE DATE OF PROGRAM DISCONTINUANCE.  THE WRITTEN  NOTICE  SHALL
INCLUDE AN EXPLANATION, IN PLAIN LANGUAGE, OF AVAILABLE HEALTH INSURANCE
OPTIONS.
  (C)  QUALIFYING  GROUP  HEALTH  INSURANCE  CONTRACTS  ISSUED  TO SMALL
EMPLOYERS PRIOR TO JANUARY FIRST, TWO  THOUSAND  FOURTEEN  THAT  DO  NOT
INCLUDE  ALL  ESSENTIAL  HEALTH  BENEFITS  REQUIRED  PURSUANT TO SECTION
2707(A) OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-6(A);  SHALL
BE  DISCONTINUED.    SMALL EMPLOYERS THAT ARE IMPACTED BY THE DISCONTIN-
UANCE SHALL BE TRANSITIONED TO A PLAN THAT  MEETS  THE  REQUIREMENTS  OF
SUBSECTION (E) OF SECTION FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS
CHAPTER.  A  HEALTH  MAINTENANCE  ORGANIZATION,  CORPORATION, OR INSURER
SHALL PROVIDE WRITTEN NOTICE  OF  THE  PROGRAM  DISCONTINUANCE  TO  EACH
ENROLLED  SMALL  EMPLOYER  AT LEAST ONE HUNDRED EIGHTY DAYS PRIOR TO THE
DATE OF PROGRAM DISCONTINUANCE.   THE WRITTEN NOTICE  SHALL  INCLUDE  AN
EXPLANATION,  IN  PLAIN  LANGUAGE, OF THE ABILITY TO TRANSITION TO A NEW
SMALL GROUP HEALTH INSURANCE CONTRACT OFFERED PURSUANT TO  SECTION  FOUR
THOUSAND THREE HUNDRED TWENTY-SIX OF THIS ARTICLE.
  S  58. Section 4327 of the insurance law, as added by chapter 1 of the
laws of 1999, subsection (h) as amended by chapter 419 of  the  laws  of
2000, subsection (m-1) as added by section 12 of part B of chapter 58 of
the  laws of 2010, subsection (s) as amended and subsection (t) as added
by chapter 441 of the laws of 2006, is amended to read as follows:
  S 4327. Stop loss funds for standardized  health  insurance  contracts
issued to qualifying small employers and qualifying individuals. (a) The
superintendent  shall  establish  a  fund  from which health maintenance

S. 2606--C                         114

organizations, corporations or insurers may  receive  reimbursement,  to
the  extent  of funds available therefor, for claims paid by such health
maintenance organizations, corporations or insurers for members  covered
under  qualifying  group  health  insurance contracts issued pursuant to
section four thousand three hundred twenty-six  of  this  article.  This
fund  shall be known as the "small employer stop loss fund". [The super-
intendent shall establish a separate and distinct fund from which health
maintenance  organizations,  corporations  or   insurers   may   receive
reimbursement,  to  the  extent  of funds available therefor, for claims
paid by such health maintenance organizations, corporations or  insurers
for   members  covered  under  qualifying  individual  health  insurance
contracts issued pursuant to section four thousand three  hundred  twen-
ty-six  of  this  article.  This  fund shall be known as the "qualifying
individual stop loss fund".]
  (b) [Commencing on January first, two  thousand  one,  health]  HEALTH
maintenance organizations, corporations or insurers shall be eligible to
receive reimbursement for ninety percent of claims paid between [thirty]
FIVE  thousand  and  [one  hundred]  SEVENTY-FIVE  thousand dollars in a
calendar year for any  member  covered  under  a  standardized  contract
issued  pursuant  to  section  four thousand three hundred twenty-six of
this article. Claims paid for members  covered  under  qualifying  group
health insurance contracts shall be reimbursable from the small employer
stop  loss fund. [Claims paid for members covered under qualifying indi-
vidual health insurance contracts shall be reimbursable from the  quali-
fying  individual  stop  loss  fund.]  For the purposes of this section,
claims shall include health care claims paid  by  a  health  maintenance
organization on behalf of a covered member pursuant to such standardized
contracts.
  (c)  The  superintendent  shall  promulgate regulations that set forth
procedures for the operation of the small employer stop loss  fund  [and
the  qualifying  individual  stop  loss fund] and distribution of monies
therefrom.
  (d) [The small employer stop loss fund shall operate  separately  from
the  qualifying  individual  stop  loss  fund.  Except  as  specified in
subsection (b) of this section with respect to calendar year  two  thou-
sand  one,  the  level  of  stop  loss coverage for the qualifying group
health insurance contracts and the qualifying individual  health  insur-
ance contracts need not be the same. The two stop loss funds need not be
structured  or  operated in the same manner, except as specified in this
section. The monies available for distribution from the stop loss  funds
may  be  reallocated  between  the small employer stop loss fund and the
qualifying individual stop loss fund if  the  superintendent  determines
that such reallocation is warranted due to enrollment trends] THE SUPER-
INTENDENT  MAY  ADJUST  THE  LEVEL  OF  STOP  LOSS COVERAGE SPECIFIED IN
SUBSECTION (B) OF THIS SECTION.
  (e) Claims shall be reported and funds shall be distributed  from  the
small  employer  stop loss fund [and from the qualifying individual stop
loss fund] on a calendar  year  basis.  Claims  shall  be  eligible  for
reimbursement  only  for the calendar year in which the claims are paid.
Once claims paid on behalf of a  covered  member  reach  or  exceed  one
hundred  thousand  dollars  in  a given calendar year, no further claims
paid on behalf of such member in that calendar year  shall  be  eligible
for reimbursement.
  (f) Each health maintenance organization, corporation or insurer shall
submit  a request for reimbursement from [each of] the stop loss [funds]
FUND on forms prescribed by the  superintendent.    [Each  of  the]  THE

S. 2606--C                         115

requests  for reimbursement shall be submitted no later than April first
following the end of the  calendar  year  for  which  the  reimbursement
requests  are  being made. The superintendent may require health mainte-
nance organizations, corporations or insurers to submit such claims data
in  connection  with the reimbursement requests as he deems necessary to
enable him to distribute monies and oversee the operation of  the  small
employer [and qualifying individual] stop loss [funds] FUND.  The super-
intendent  may  require  that  such  data  be submitted on a per member,
aggregate and/or categorical basis. [Data shall be  reported  separately
for  qualifying group health insurance contracts and qualifying individ-
ual health insurance contracts issued pursuant to section four  thousand
three hundred twenty-six of this article.]
  (g)  For [each] THE stop loss fund, the superintendent shall calculate
the total claims reimbursement amount for all health maintenance  organ-
izations,  corporations  or  insurers  for  the  calendar year for which
claims are being reported.
  (1) In the event that the total amount requested for reimbursement for
a calendar year exceeds funds available for distribution for claims paid
during that same calendar year, the superintendent shall provide for the
pro-rata distribution of the available funds.  Each  health  maintenance
organization,  corporation  or insurer shall be eligible to receive only
such proportionate amount of  the  available  funds  as  the  individual
health  maintenance  organization's,  corporation's  or  insurer's total
eligible claims paid bears to the total  eligible  claims  paid  by  all
health maintenance organizations, corporations or insurers.
  (2) In the event that funds available for distribution for claims paid
by all health maintenance organizations, corporations or insurers during
a  calendar year exceeds the total amount requested for reimbursement by
all health maintenance organizations, corporations  or  insurers  during
that  same  calendar year, any excess funds shall be carried forward and
made available for distribution in the next calendar year.  Such  excess
funds  shall be in addition to the monies appropriated for the stop loss
fund in the next calendar year.
  (h) Upon the request of the superintendent,  each  health  maintenance
organization  shall  be required to furnish such data as the superinten-
dent deems necessary to oversee the operation of the small employer [and
qualifying individual] stop  loss  [funds]  FUND.  Such  data  shall  be
furnished  in a form prescribed by the superintendent. Each health main-
tenance organization, corporation or insurer shall  provide  the  super-
intendent  with monthly reports of the total enrollment under the quali-
fying group health insurance contracts [and  the  qualifying  individual
health  insurance  contracts]  issued  pursuant to section four thousand
three hundred twenty-six of this article. The reports shall be in a form
prescribed by the superintendent.
  (i) The superintendent shall separately estimate the per member annual
cost of total claims reimbursement from each stop loss fund for  [quali-
fying  individual  health  insurance contracts and for] qualifying group
health insurance contracts based upon  available  data  and  appropriate
actuarial  assumptions.  Upon request, each health maintenance organiza-
tion, corporation or insurer shall furnish to the superintendent  claims
experience data for use in such estimations.
  (j) The superintendent shall determine total eligible enrollment under
qualifying  group  health insurance contracts [and qualifying individual
health insurance contracts].  [For  qualifying  group  health  insurance
contracts,  the]  THE  total  eligible enrollment shall be determined by
dividing the total funds  available  for  distribution  from  the  small

S. 2606--C                         116

employer stop loss fund by the estimated per member annual cost of total
claims reimbursement from the small employer stop loss fund. [For quali-
fying  individual health insurance contracts, the total eligible enroll-
ment  shall  be  determined  by  dividing  the total funds available for
distribution from the qualifying individual stop loss fund by the  esti-
mated  per  member  annual  cost  of total claims reimbursement from the
qualifying individual stop loss fund.]
  (k) The superintendent shall suspend the enrollment of  new  employers
under  qualifying  group  health  insurance contracts if [he] THE SUPER-
INTENDENT determines that the total enrollment reported  by  all  health
maintenance organizations, corporations or insurers under such contracts
exceeds  the total eligible enrollment, thereby resulting in anticipated
annual expenditures from the small employer stop loss fund in excess  of
the  total  funds  available  for distribution from such stop loss fund.
[The superintendent shall suspend  the  enrollment  of  new  individuals
under  qualifying individual health insurance contracts if he determines
that the total enrollment reported by all health  maintenance  organiza-
tions,  corporations  or insurers under such contracts exceeds the total
eligible enrollment, thereby resulting in  anticipated  annual  expendi-
tures  from  the  qualifying  individual stop loss fund in excess of the
total funds available for distribution from such stop loss fund.]
  (l) The superintendent shall provide the health maintenance  organiza-
tions,  corporations  or  insurers  with  notification of any enrollment
suspensions as soon as practicable after receipt of all enrollment data.
[The superintendent's determination and notification shall be made sepa-
rately for the qualifying group health insurance contracts and  for  the
qualifying individual health insurance contracts.]
  (m)  If at any point during a suspension of enrollment of new qualify-
ing small employers [and/or qualifying individuals], the  superintendent
determines  that funds are sufficient to provide for the addition of new
enrollments, the superintendent shall be authorized  to  reactivate  new
enrollments  and  to notify all health maintenance organizations, corpo-
rations or insurers that enrollment of new  employers  [and/or  individ-
uals]  may  again  commence.  [The  superintendent's  determination  and
notification shall be made separately for the  qualifying  group  health
insurance  contracts  and for the qualifying individual health insurance
contracts.]
  (m-1) In the event that the superintendent suspends the enrollment  of
new  individuals  for  qualifying  group  health insurance contracts [or
qualifying individual health insurance  contracts],  the  superintendent
shall  ensure  that  small  employers  [or  sole proprietors] seeking to
enroll in a qualified group [or individual]  health  insurance  contract
pursuant  to  section forty-three hundred twenty-six of this article are
provided information on and directed to [the family health plus employer
partnership program under section three  hundred  sixty-nine-ff  of  the
social services law] COVERAGE OPTIONS AVAILABLE THROUGH THE HEALTH BENE-
FIT EXCHANGE ESTABLISHED PURSUANT TO SECTION 1311 OF THE AFFORDABLE CARE
ACT, 42 U.S.C. S 18031.
  (n)  The  suspension  of issuance of qualifying group health insurance
contracts to new qualifying small employers shall not preclude the addi-
tion of new employees of  an  employer  already  covered  under  such  a
contract  or  new  dependents  of  employees  already covered under such
contracts.
  (o) [The suspension of issuance of qualifying individual health insur-
ance contracts to new qualifying  individuals  shall  not  preclude  the

S. 2606--C                         117

addition  of  new dependents to an existing qualifying individual health
insurance contract.
  (p)] The premiums for qualifying group health insurance contracts must
factor in the availability of reimbursement from the small employer stop
loss  fund.  [The  premiums  for  qualifying individual health insurance
contracts must factor in the  availability  of  reimbursement  from  the
qualifying individual stop loss funds.
  (q)] (P) The superintendent may obtain the services of an organization
to  administer  the stop loss funds established by this section. [If the
superintendent deems it appropriate, he or she may  utilize  a  separate
organization for administration of the small employer stop loss fund and
the  qualifying  individual  stop  loss  fund.] The superintendent shall
establish guidelines for the submission of  proposals  by  organizations
for  the  purposes  of administering the funds. The superintendent shall
make a determination whether to approve, disapprove or recommend modifi-
cation to the proposal of an  applicant  to  administer  the  funds.  An
organization  approved  to  administer the funds shall submit reports to
the superintendent in such form and at times as may be required  by  the
superintendent  in  order  to  facilitate  evaluation and ensure orderly
operation of the funds, including[,  but  not  limited  to,]  an  annual
report  of  the  affairs  and  operations of the fund, such report to be
delivered to the superintendent and to the chairs of the senate  finance
committee  and  the  assembly  ways and means committee. An organization
approved to administer the  funds  shall  maintain  records  in  a  form
prescribed  by  the  superintendent  and  which  shall  be available for
inspection by or at the request of the superintendent.  The  superinten-
dent  shall  determine  the amount of compensation to be allocated to an
approved organization as payment for fund  administration.  Compensation
shall  be  payable  from  the  stop loss coverage funds. An organization
approved to administer the funds may be removed  by  the  superintendent
and  must  cooperate  in  the  orderly transition of services to another
approved organization or to the superintendent.
  [(r)] (Q) If the superintendent deems it appropriate  for  the  proper
administration of the small employer stop loss fund [and/or the qualify-
ing individual stop loss fund], the administrator of the fund, on behalf
of  and  with the prior approval of the superintendent, shall be author-
ized to purchase stop loss insurance and/or reinsurance from  an  insur-
ance  company  licensed  to  write such type of insurance in this state.
Such stop loss insurance and/or reinsurance  may  be  purchased  to  the
extent of funds available therefor within such funds which are available
for purposes of the stop loss funds established by this section.
  [(s)] (R) The superintendent may access funding from the small employ-
er  stop loss fund [and/or the qualifying individual stop loss fund] for
the purposes of developing and implementing public  education,  outreach
and  facilitated  enrollment strategies targeted to small employers [and
working  adults]  without  health  insurance.  The  superintendent   may
contract  with  marketing organizations to perform or provide assistance
with such education, outreach, and  enrollment  strategies.  The  super-
intendent  shall  determine  the  amount  of  funding  available for the
purposes of this subsection which in no event shall exceed eight percent
of the annual funding amounts for the small employer stop loss fund [and
the qualifying individual stop loss fund].
  [(t)] (S) Brooklyn healthworks pilot program and  upstate  healthworks
pilot  program.  Commencing  on July first, two thousand six, the super-
intendent shall access funding from the small employer  stop  loss  fund
[and  the  qualifying  individual  stop  loss  fund]  for the purpose of

S. 2606--C                         118

support and expansion of the existing pilot program Brooklyn healthworks
approved by the superintendent and for the establishment  and  operation
of a pilot program to be located in upstate New York. For the purpose of
this  subsection,  in  no  event  shall  the amount of funding available
exceed two percent of the annual funding [amounts] AMOUNT for the  small
employer stop loss fund [and the qualifying individual stop loss fund].
  S  59.  Paragraph 1 of subsection (d) of section 4235 of the insurance
law is amended to read as follows:
  (1) In this section, for the purpose of insurance OTHER THAN FOR GROUP
HOSPITAL, MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPES  OF
EXPENSE  REIMBURSED INSURANCE hereunder:  "employees" includes the offi-
cers, managers, employees and retired employees of the employer  and  of
subsidiary  or  affiliated corporations of a corporate employer, and the
individual proprietors, partners, employees  and  retired  employees  of
affiliated  individuals  and  firms  controlled  by the insured employer
through stock ownership,  contract  or  otherwise;  "employees"  may  be
deemed  to include the individual proprietor or partners if the employer
is an individual proprietor or a partnership; and "employees" as used in
subparagraph (A) of paragraph one of  subsection  (c)  hereof  may  also
include  the  directors  of the employer and of subsidiary or affiliated
corporations of a corporate employer.
  S 60. Subsection (d) of section 4235 of the insurance law  is  amended
by adding a new paragraph 3 to read as follows:
  (3) IN THIS SECTION, FOR THE PURPOSE OF GROUP HOSPITAL, MEDICAL, MAJOR
MEDICAL  OR  SIMILAR COMPREHENSIVE-TYPES OF EXPENSE REIMBURSED INSURANCE
HEREUNDER, "EMPLOYEE" SHALL HAVE THE MEANING SET FORTH IN  SECTION  2791
OF  THE  PUBLIC  HEALTH  SERVICE  ACT, 42 U.S.C. S 300GG-91(D)(5) OR ANY
REGULATIONS PROMULGATED THEREUNDER.
  S 61. Subparagraph (B) of paragraph 1 of  subsection  (e)  of  section
3231  of  the  insurance  law,  as amended by chapter 107 of the laws of
2010, is amended to read as follows:
  (B) The expected minimum loss ratio for a policy form subject to  this
section, for which a rate filing or application is made pursuant to this
paragraph, other than a medicare supplemental insurance policy, or, with
the  approval of the superintendent, an aggregation of policy forms that
are combined  into  one  community  rating  experience  pool  and  rated
consistent  with  community  rating requirements, shall not be less than
eighty-two percent. In reviewing  a  rate  filing  or  application,  the
superintendent  may  modify the eighty-two percent expected minimum loss
ratio requirement if the superintendent determines the  modification  to
be in the interests of the people of this state or if the superintendent
determines  that a modification is necessary to maintain insurer solven-
cy. No later than [June thirtieth] JULY THIRTY-FIRST of each year, every
insurer subject to this subparagraph shall annually  report  the  actual
loss  ratio for the previous calendar year in a format acceptable to the
superintendent. If an expected loss ratio is not met, the superintendent
may direct the insurer to take corrective action, which may include  the
submission of a rate filing to reduce future premiums, or to issue divi-
dends, premium refunds or credits, or any combination of these.
  S  62.  Subparagraph  (A)  of paragraph 3 of subsection (c) of section
4308 of the insurance law, as added by chapter 107 of the laws of  2010,
is amended to read as follows:
  (A)  The  expected  minimum  loss ratio for a contract form subject to
this subsection for which a rate filing or application is made  pursuant
to   this  paragraph,  other  than  a  medicare  supplemental  insurance
contract, or, with the approval of the superintendent, an aggregation of

S. 2606--C                         119

contract forms that are combined into one  community  rating  experience
pool  and rated consistent with community rating requirements, shall not
be less than eighty-two percent. In reviewing a rate filing or  applica-
tion,  the  superintendent  may  modify  the eighty-two percent expected
minimum loss ratio requirement  if  the  superintendent  determines  the
modification  to  be  in the interests of the people of this state or if
the superintendent determines that a modification is necessary to  main-
tain  insurer solvency. No later than [June thirtieth] JULY THIRTY-FIRST
of each year, every corporation subject to this subparagraph shall annu-
ally report the actual loss ratio for the previous calendar  year  in  a
format  acceptable  to  the superintendent. If an expected loss ratio is
not met, the superintendent may direct the corporation to  take  correc-
tive action, which may include the submission of a rate filing to reduce
future  premiums,  or to issue dividends, premium refunds or credits, or
any combination of these.
  S 63.  Intentionally omitted.
  S 64. Subparagraph (D) of paragraph 2 of  subsection  (p)  of  section
3221  of the insurance law, as added by chapter 661 of the laws of 1997,
is amended to read as follows:
  (D) The insurer is ceasing to offer group or  blanket  policies  in  a
market in accordance with paragraph three OR SEVEN of this subsection.
  S  65.  Subsection (p) of section 3221 of the insurance law is amended
by adding a new paragraph 7 to read as follows:
  (7) NOTWITHSTANDING PARAGRAPH THREE OF THIS SUBSECTION, AN INSURER MAY
DISCONTINUE OFFERING A PARTICULAR CLASS OF GROUP OR  BLANKET  POLICY  OF
HOSPITAL,  SURGICAL OR MEDICAL EXPENSE INSURANCE OFFERED IN THE SMALL OR
LARGE GROUP MARKET, AND INSTEAD OFFER  A  GROUP  OR  BLANKET  POLICY  OF
HOSPITAL,  SURGICAL  OR MEDICAL EXPENSE INSURANCE THAT COMPLIES WITH THE
REQUIREMENTS OF SECTION 2707 OF THE PUBLIC  HEALTH  SERVICE  ACT,  S  42
U.S.C.  300GG-6  THAT  BECOME  APPLICABLE  TO  SUCH POLICY AS OF JANUARY
FIRST, TWO THOUSAND FOURTEEN, PROVIDED THAT THE INSURER:
  (A) DISCONTINUES THE EXISTING CLASS OF POLICY IN  SUCH  MARKET  AS  OF
EITHER  DECEMBER  THIRTY-FIRST,  TWO  THOUSAND  THIRTEEN  OR  THE POLICY
RENEWAL DATE OCCURRING IN TWO THOUSAND FOURTEEN IN ACCORDANCE WITH  THIS
CHAPTER;
  (B)  PROVIDES WRITTEN NOTICE TO EACH POLICYHOLDER PROVIDED COVERAGE OF
THE CLASS IN THE MARKET  (AND  TO  ALL  EMPLOYEES  AND  MEMBER  INSUREDS
COVERED  UNDER SUCH COVERAGE) OF THE DISCONTINUANCE AT LEAST NINETY DAYS
PRIOR TO THE DATE OF DISCONTINUANCE OF SUCH COVERAGE;
  (C) OFFERS TO EACH POLICYHOLDER PROVIDED COVERAGE OF THE CLASS IN  THE
MARKET,  THE  OPTION TO PURCHASE ALL (OR, IN THE CASE OF THE LARGE GROUP
MARKET, ANY) OTHER HOSPITAL, SURGICAL AND MEDICAL EXPENSE COVERAGE  THAT
COMPLIES  WITH  THE  REQUIREMENTS  OF  SECTION 2707 OF THE PUBLIC HEALTH
SERVICE ACT, 42 U.S.C. S 300GG-6 THAT BECOME APPLICABLE TO SUCH COVERAGE
AS OF JANUARY FIRST, TWO THOUSAND FOURTEEN, CURRENTLY BEING  OFFERED  BY
THE INSURER TO A GROUP IN THAT MARKET;
  (D)  IN EXERCISING THE OPTION TO DISCONTINUE COVERAGE OF THE CLASS AND
IN OFFERING THE OPTION OF COVERAGE UNDER SUBPARAGRAPH (C) OF THIS  PARA-
GRAPH,  ACTS  UNIFORMLY WITHOUT REGARD TO THE CLAIMS EXPERIENCE OF THOSE
POLICYHOLDERS OR  ANY  HEALTH  STATUS-RELATED  FACTOR  RELATING  TO  ANY
PARTICULAR  COVERED EMPLOYEE, MEMBER INSURED OR DEPENDENT, OR PARTICULAR
NEW EMPLOYEE, MEMBER INSURED, OR DEPENDENT WHO MAY BECOME  ELIGIBLE  FOR
SUCH  COVERAGE,  AND DOES NOT DISCONTINUE THE COVERAGE OF THE CLASS WITH
THE INTENT OR AS A PRETEXT TO DISCONTINUING THE  COVERAGE  OF  ANY  SUCH
EMPLOYEE, MEMBER INSURED, OR DEPENDENT; AND

S. 2606--C                         120

  (E)  AT LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE DATE OF THE DISCON-
TINUANCE OF SUCH COVERAGE, PROVIDES WRITTEN NOTICE TO THE SUPERINTENDENT
OF THE DISCONTINUANCE, INCLUDING CERTIFICATION BY AN OFFICER OR DIRECTOR
OF THE INSURER THAT THE REASON FOR THE DISCONTINUANCE IS TO REPLACE  THE
COVERAGE  WITH  NEW  COVERAGE  THAT  COMPLIES  WITH  THE REQUIREMENTS OF
SECTION 2707 OF THE PUBLIC HEALTH SERVICE ACT, S 42 U.S.C. 300GG-6  THAT
BECOME EFFECTIVE JANUARY FIRST, TWO THOUSAND FOURTEEN.
  S  66. Item (iii) of subparagraph (C) of paragraph 2 of subsection (c)
of section 4304 of the insurance law, as amended by chapter 661  of  the
laws of 1997, is amended to read as follows:
  (iii)  Discontinuance  of all individual hospital, surgical or medical
expense insurance contracts for which the premiums are paid by a  remit-
ting  agent  of  a  group, in the small group market, or the large group
market, or both markets, in this state, in conjunction with a withdrawal
from the small group market, or the large group market, or both markets,
in this state. Withdrawal from the small  group  market,  or  the  large
group  market, or both markets, shall be governed by the requirements of
subparagraphs [(B)] (E) and [(C)] (F) of paragraph three  of  subsection
(j)  of  section  four  thousand three hundred five of this article. For
purposes of this item, "withdrawal" from a market means that no coverage
is offered or maintained in such market under contracts issued  pursuant
to  this  section  or contracts issued pursuant to section four thousand
three hundred five of this article.
  S 67. Subparagraph (D) of paragraph 2 of  subsection  (j)  of  section
4305  of the insurance law, as added by chapter 661 of the laws of 1997,
is amended to read as follows:
  (D) The corporation is ceasing to offer group or blanket contracts  in
a  market  in  accordance  with paragraph three OR PARAGRAPH SIX of this
subsection.
  S 68. Subsection (j) of section 4305 of the insurance law  is  amended
by adding a new paragraph 6 to read as follows:
  (6)  NOTWITHSTANDING PARAGRAPH THREE OF THIS SUBSECTION, A CORPORATION
MAY DISCONTINUE OFFERING A PARTICULAR CLASS OF GROUP OR BLANKET CONTRACT
OF HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE OFFERED IN THE  SMALL
OR  LARGE GROUP MARKET, AND INSTEAD OFFER A GROUP OR BLANKET CONTRACT OF
HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE THAT COMPLIES  WITH  THE
REQUIREMENTS OF SECTION 2707 OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C.
S  300GG-6  THAT BECOME APPLICABLE TO SUCH CONTRACT AS OF JANUARY FIRST,
TWO THOUSAND FOURTEEN, PROVIDED THAT THE CORPORATION:
  (A) DISCONTINUES THE EXISTING CLASS OF CONTRACT IN SUCH MARKET  AS  OF
EITHER  DECEMBER  THIRTY-FIRST,  TWO  THOUSAND  THIRTEEN OR THE CONTRACT
RENEWAL DATE OCCURRING IN TWO THOUSAND FOURTEEN IN ACCORDANCE WITH  THIS
CHAPTER;
  (B)  PROVIDES WRITTEN NOTICE TO EACH CONTRACT HOLDER PROVIDED COVERAGE
OF THE CLASS IN THE MARKET (AND TO ALL  EMPLOYEES  AND  MEMBER  INSUREDS
COVERED  UNDER SUCH COVERAGE) OF THE DISCONTINUANCE AT LEAST NINETY DAYS
PRIOR TO THE DATE OF DISCONTINUANCE OF SUCH COVERAGE;
  (C) OFFERS TO EACH CONTRACT HOLDER PROVIDED COVERAGE OF THE  CLASS  IN
THE  MARKET,  THE  OPTION  TO PURCHASE ALL (OR, IN THE CASE OF THE LARGE
GROUP MARKET, ANY) OTHER HOSPITAL, SURGICAL AND MEDICAL EXPENSE COVERAGE
THAT COMPLIES WITH THE REQUIREMENTS OF SECTION 2707 OF THE PUBLIC HEALTH
SERVICE ACT, 42 U.S.C. S 300GG-6 THAT BECOME APPLICABLE TO SUCH COVERAGE
AS OF JANUARY FIRST, TWO THOUSAND FOURTEEN, CURRENTLY BEING  OFFERED  BY
THE CORPORATION TO A GROUP IN THAT MARKET;
  (D)  IN EXERCISING THE OPTION TO DISCONTINUE COVERAGE OF THE CLASS AND
IN OFFERING THE OPTION OF COVERAGE UNDER SUBPARAGRAPH (C) OF THIS  PARA-

S. 2606--C                         121

GRAPH,  ACTS UNIFORMLY WITHOUT REGARD TO THE CLAIMS  EXPERIENCE OF THOSE
CONTRACT HOLDERS OR ANY HEALTH STATUS-RELATED  FACTOR  RELATING  TO  ANY
PARTICULAR  COVERED EMPLOYEE, MEMBER INSURED OR DEPENDENT, OR PARTICULAR
NEW  EMPLOYEE,  MEMBER INSURED, OR DEPENDENT WHO MAY BECOME ELIGIBLE FOR
SUCH COVERAGE, AND DOES NOT DISCONTINUE THE COVERAGE OF THE  CLASS  WITH
THE  INTENT  OR  AS  A PRETEXT TO DISCONTINUING THE COVERAGE OF ANY SUCH
EMPLOYEE, MEMBER INSURED, OR DEPENDENT; AND
  (E) AT LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE DATE OF THE  DISCON-
TINUANCE OF SUCH COVERAGE, PROVIDES WRITTEN NOTICE TO THE SUPERINTENDENT
OF THE DISCONTINUANCE, INCLUDING CERTIFICATION BY AN OFFICER OR DIRECTOR
OF  THE CORPORATION THAT THE REASON FOR THE DISCONTINUANCE IS TO REPLACE
THE COVERAGE WITH NEW COVERAGE THAT COMPLIES WITH  THE  REQUIREMENTS  OF
SECTION 2707 OF THE PUBLIC HEALTH SERVICE ACT, 42  U.S.C. S 300GG-6 THAT
BECOME EFFECTIVE JANUARY FIRST, TWO THOUSAND FOURTEEN.
  S  69.  Subsections  (a), (b) and (c) of section 3231 of the insurance
law, subsection (a) as amended by chapter  661  of  the  laws  of  1997,
subsection (b) as amended by chapter 557 of the laws of 2002, subsection
(c)  as added by chapter 501 of the laws of 1992, are amended to read as
follows:
  (a) (1) No individual health insurance  policy  and  no  group  health
insurance  policy  covering  between  [two]  ONE  and fifty employees or
members of the group OR BETWEEN ONE AND ONE HUNDRED EMPLOYEES OR MEMBERS
OF THE GROUP FOR POLICIES ISSUED OR RENEWED ON OR AFTER  JANUARY  FIRST,
TWO  THOUSAND  SIXTEEN  exclusive of spouses and dependents, hereinafter
referred to as a small group, providing hospital  and/or  medical  bene-
fits, including medicare supplemental insurance, shall be issued in this
state  unless  such  policy  is community rated and, notwithstanding any
other provisions of law, the underwriting of  such  policy  involves  no
more  than the imposition of a pre-existing condition limitation [as] IF
OTHERWISE permitted by this article. (2) Any individual, and  dependents
of  such  individual,  and  any  small group, including all employees or
group members and dependents of employees or members, applying for indi-
vidual health insurance coverage, including medicare supplemental cover-
age, [or small  group  health  insurance  coverage,  including  medicare
supplemental  insurance,]  OR  SMALL  GROUP  HEALTH  INSURANCE COVERAGE,
INCLUDING MEDICARE SUPPLEMENTAL INSURANCE, BUT  NOT  INCLUDING  COVERAGE
ISSUED  ON  OR  AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, SPECIFIED IN
SUBSECTION (L) OF SECTION THREE THOUSAND TWO  HUNDRED  SIXTEEN  OF  THIS
ARTICLE must be accepted at all times throughout the year for any hospi-
tal  and/or  medical  coverage  offered by the insurer to individuals or
small groups in this state. (3) Once accepted for coverage, an  individ-
ual  or  small  group  cannot be terminated by the insurer due to claims
experience. Termination of an individual or small group shall  be  based
only  on  one  or  more  of  the  reasons set forth in subsection (g) of
section three thousand two hundred sixteen or subsection (p) of  section
three  thousand  two  hundred twenty-one of this article. Group hospital
and/or medical  coverage,  including  medicare  supplemental  insurance,
obtained  through  an  out-of-state  trust  covering a group of fifty or
fewer employees, OR BETWEEN ONE AND ONE HUNDRED EMPLOYEES  FOR  POLICIES
ISSUED  OR  RENEWED  ON OR AFTER JANUARY FIRST, TWO THOUSAND SIXTEEN, or
participating persons who are residents of this state must be  community
rated regardless of the situs of delivery of the policy. Notwithstanding
any other provisions of law, the underwriting of such policy may involve
no  more than the imposition of a pre-existing condition limitation [as]
IF permitted by this article, and once accepted for coverage,  an  indi-
vidual  or  small  group  cannot be terminated due to claims experience.

S. 2606--C                         122

Termination of an individual or small group shall be based only  on  one
or  more  of  the  reasons  set forth in subsection (p) of section three
thousand two hundred twenty-one of this article.  (4) For  the  purposes
of  this  section, "community rated" means a rating methodology in which
the premium for all persons covered by a policy [or  contract]  form  is
the same based on the experience of the entire pool of risks [covered by
that policy or contract form] OF ALL INDIVIDUALS OR SMALL GROUPS COVERED
BY  THE INSURER without regard to age, sex, health status, TOBACCO USAGE
or occupation, EXCLUDING THOSE INDIVIDUALS OR SMALL  GROUPS  COVERED  BY
MEDICARE  SUPPLEMENTAL  INSURANCE.   FOR MEDICARE SUPPLEMENTAL INSURANCE
COVERAGE, "COMMUNITY RATED" MEANS A  RATING  METHODOLOGY  IN  WHICH  THE
PREMIUMS  FOR  ALL  PERSONS  COVERED BY A POLICY OR CONTRACT FORM IS THE
SAME BASED ON THE EXPERIENCE OF THE ENTIRE POOL OF RISKS COVERED BY THAT
POLICY OR CONTRACT FORM WITHOUT  REGARD  TO  AGE,  SEX,  HEALTH  STATUS,
TOBACCO  USAGE  OR  OCCUPATION.  CATASTROPHIC  HEALTH INSURANCE POLICIES
ISSUED PURSUANT TO SECTION 1302(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C.
S 18022(E), SHALL BE CLASSIFIED IN A DISTINCT COMMUNITY RATING POOL.
  (b) [Nothing herein shall prohibit the use of premium rate  structures
to establish different premium rates for individuals as opposed to fami-
ly  units  or] (1) THE SUPERINTENDENT MAY SET STANDARD PREMIUM TIERS AND
STANDARD RATING RELATIVITIES BETWEEN TIERS APPLICABLE  TO  ALL  POLICIES
SUBJECT TO THIS SECTION. THE SUPERINTENDENT MAY SET A STANDARD RELATIVI-
TY  APPLICABLE TO CHILD-ONLY POLICIES ISSUED PURSUANT TO SECTION 1302(F)
OF THE AFFORDABLE CARE ACT, 42 U.S.C.   S 18022(F). THE  RELATIVITY  FOR
CHILD-ONLY POLICIES SHALL BE ACTUARIALLY JUSTIFIABLE USING THE AGGREGATE
EXPERIENCE  OF INSURERS.  (2) AN INSURER SHALL ESTABLISH separate commu-
nity rates for individuals as opposed to small groups. (3) If an insurer
is required to issue  a  [contract]  POLICY  to  individual  proprietors
pursuant to subsection (i) of this section, such policy shall be subject
to subsection (a) of this section.
  (c)  (1) The superintendent shall permit the use of separate community
rates for reasonable geographic regions, which may,  in  a  given  case,
include  a  single  county.  The regions shall be approved by the super-
intendent as part of the  rate  filing.  The  superintendent  shall  not
require  the  inclusion  of  any  specific geographic regions within the
proposed community rated regions selected by the  insurer  in  its  rate
filing  so long as the insurer's proposed regions do not contain config-
urations designed to avoid or segregate particular areas within a county
covered by the insurer's community rates.    (2)  BEGINNING  ON  JANUARY
FIRST,  TWO  THOUSAND FOURTEEN, FOR EVERY POLICY SUBJECT TO THIS SECTION
THAT PROVIDES PHYSICIAN SERVICES,  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
COMPREHENSIVE-TYPE  COVERAGE,  EXCEPT  FOR  MEDICARE  SUPPLEMENT  PLANS,
INSURERS SHALL USE STANDARDIZED REGIONS ESTABLISHED BY  THE  SUPERINTEN-
DENT  PROVIDED,  HOWEVER,  THAT THE COUNTIES OF NASSAU AND SUFFOLK SHALL
TOGETHER CONSIST OF THEIR OWN STANDARDIZED REGION.
  S 70. Subsection (g) of section 3231 of the insurance law, as added by
chapter 501 of the laws of 1992, is amended to read as follows:
  (g) (1) This section shall also apply to policies issued  to  a  group
defined  in  subsection (c) of section four thousand two hundred thirty-
five, including but not limited to an association or trust of employers,
if the group includes one or  more  member  employers  or  other  member
groups  which  have  fifty  or  fewer  employees or members exclusive of
spouses and dependents. FOR POLICIES ISSUED OR RENEWED ON OR AFTER JANU-
ARY FIRST, TWO THOUSAND FOURTEEN, IF THE  GROUP  INCLUDES  ONE  OR  MORE
MEMBER  SMALL  GROUP  EMPLOYERS  ELIGIBLE  FOR  COVERAGE SUBJECT TO THIS
SECTION, THEN SUCH MEMBER EMPLOYERS SHALL BE CLASSIFIED AS SMALL  GROUPS

S. 2606--C                         123

FOR  RATING PURPOSES AND THE REMAINING MEMBERS SHALL BE RATED CONSISTENT
WITH THE RATING RULES APPLICABLE TO SUCH REMAINING MEMBERS  PURSUANT  TO
PARAGRAPH TWO OF THIS SUBSECTION.
  (2)  IF  A  POLICY  IS  ISSUED TO A GROUP DEFINED IN SUBSECTION (C) OF
SECTION FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER, INCLUDING
AN ASSOCIATION GROUP, THAT INCLUDES ONE OR MORE INDIVIDUAL OR INDIVIDUAL
PROPRIETOR MEMBERS, FOR RATING PURPOSES THE INSURER SHALL  INCLUDE  SUCH
MEMBERS  IN  ITS  INDIVIDUAL POOL OF RISKS IN ESTABLISHING PREMIUM RATES
FOR SUCH MEMBERS.
  S 71. Paragraph 2 of subsection (i) of section 3231 of  the  insurance
law,  as  amended by chapter 183 of the laws of 2011, is amended to read
as follows:
  (2) For coverage purchased pursuant to this subsection, THROUGH DECEM-
BER THIRTY-FIRST, TWO THOUSAND THIRTEEN, individual proprietors shall be
classified in their own community rating category, provided however,  up
to   and   including  December  thirty-first,  two  thousand  [fourteen]
THIRTEEN,  the  premium  rate  established  for  individual  proprietors
purchased  pursuant  to  paragraph  one  of this subsection shall not be
greater than one hundred fifteen percent of the rate established for the
same coverage issued to groups.  COVERAGE PURCHASED OR RENEWED  PURSUANT
TO  THIS  SUBSECTION  ON  OR  AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN
SHALL BE CLASSIFIED IN THE INDIVIDUAL RATING CATEGORY.
  S 72. Section 4317 of the insurance law, as added by  chapter  501  of
the  laws  of 1992, subsection (a) as amended by chapter 661 of the laws
of 1997, subsection (b) as amended and subsection (f) as added by  chap-
ter  557  of the laws of 2002, subsection (d) as amended by section 2 of
part A of chapter 494 of the laws of 2009, paragraph 2 of subsection (f)
as amended by chapter 183 of the laws of 2011, is  amended  to  read  as
follows:
  S  4317.  Rating  of  individual  and  small  group  health  insurance
contracts.  (a) (1) No individual health insurance contract and no group
health insurance contract covering between [two] ONE and fifty employees
or members of the group, OR BETWEEN ONE AND  ONE  HUNDRED  EMPLOYEES  OR
MEMBERS  OF THE GROUP FOR POLICIES ISSUED OR RENEWED ON OR AFTER JANUARY
FIRST, TWO THOUSAND SIXTEEN exclusive of spouses and dependents, includ-
ing contracts for which the premiums are paid by a remitting agent for a
group, hereinafter referred to as  a  small  group,  providing  hospital
and/or  medical  benefits,  including  Medicare  supplemental insurance,
shall be issued in this state unless such contract  is  community  rated
and,  notwithstanding  any  other provisions of law, the underwriting of
such contract involves no more than the  imposition  of  a  pre-existing
condition  limitation  [as]  IF OTHERWISE permitted by this article. (2)
Any individual, and dependents of such individual, and any small  group,
including  all employees or group members and dependents of employees or
members, applying for individual or small group health insurance  cover-
age  INCLUDING MEDICARE SUPPLEMENTAL INSURANCE, BUT NOT INCLUDING COVER-
AGE ISSUED ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN SPECIFIED IN
SUBSECTION (L) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR, AND  SECTION
FOUR  THOUSAND  THREE  HUNDRED  TWENTY-EIGHT  OF  THIS  CHAPTER, must be
accepted at all times  throughout  the  year  for  any  hospital  and/or
medical  coverage[,  including Medicare supplemental insurance,] offered
by the corporation to individuals or small groups in this  state.    (3)
Once  accepted  for  coverage,  an  individual  or small group cannot be
terminated by the insurer  due  to  claims  experience.  Termination  of
coverage  for  individuals  or  small groups may be based only on one or
more of the reasons set forth in subsection (c) of section four thousand

S. 2606--C                         124

three hundred four or subsection (j)  of  section  four  thousand  three
hundred  five  of  this  article.  (4) For the purposes of this section,
"community rated" means a rating methodology in which  the  premium  for
all  persons  covered by a policy or contract form is the same, based on
the experience of the entire pool of risks [covered by  that  policy  or
contract  form] OF ALL INDIVIDUALS OR SMALL GROUPS COVERED BY THE CORPO-
RATION without regard to age, sex, health status, TOBACCO USAGE or occu-
pation EXCLUDING THOSE INDIVIDUALS OF SMALL GROUPS COVERED  BY  MEDICARE
SUPPLEMENTAL  INSURANCE.   FOR MEDICARE SUPPLEMENTAL INSURANCE COVERAGE,
"COMMUNITY RATED" MEANS A RATING METHODOLOGY IN WHICH THE  PREMIUMS  FOR
ALL  PERSONS  COVERED  BY A POLICY OR CONTRACT FORM IS THE SAME BASED ON
THE EXPERIENCE OF THE ENTIRE POOL OF RISKS COVERED  BY  THAT  POLICY  OR
CONTRACT  FORM  WITHOUT REGARD TO AGE, SEX, HEALTH STATUS, TOBACCO USAGE
OR OCCUPATION.  CATASTROPHIC HEALTH INSURANCE CONTRACTS ISSUED  PURSUANT
TO  SECTION  1302(E)  OF  THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(E),
SHALL BE CLASSIFIED IN A DISTINCT COMMUNITY RATING POOL.
  (b) [Nothing herein shall prohibit the use of premium rate  structures
to establish different premium rates for individuals as opposed to fami-
ly  units  or] (1) THE SUPERINTENDENT MAY SET STANDARD PREMIUM TIERS AND
STANDARD RATING RELATIVITIES BETWEEN TIERS APPLICABLE TO  ALL  CONTRACTS
SUBJECT  TO  THIS  SECTION.  THE  SUPERINTENDENT MAY ALSO SET A STANDARD
RELATIVITY APPLICABLE TO CHILD-ONLY CONTRACTS ISSUED PURSUANT TO SECTION
1302(F) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(F).  THE RELATIVI-
TY FOR CHILD-ONLY CONTRACTS MUST BE ACTUARIALLY  JUSTIFIABLE  USING  THE
AGGREGATE EXPERIENCE OF CORPORATIONS TO PREVENT THE CHARGING OF UNJUSTI-
FIED  PREMIUMS.    THE  SUPERINTENDENT MAY ADJUST SUCH PREMIUM TIERS AND
RELATIVITIES PERIODICALLY BASED UPON THE AGGREGATE EXPERIENCE OF  CORPO-
RATIONS  ISSUING  CONTRACT  FORMS SUBJECT TO THIS SECTION.  (2) A CORPO-
RATION SHALL ESTABLISH  separate  community  rates  for  individuals  as
opposed  to  small  groups.  (3) If a corporation is required to issue a
contract to individual proprietors pursuant to subsection  (f)  of  this
section,   such  contract  shall  be  subject  to  the  requirements  of
subsection (a) of this section.
  (c) (1) The superintendent shall permit the use of separate  community
rates  for  reasonable  geographic  regions, which may, in a given case,
include a single county. The regions shall be  approved  by  the  super-
intendent  as  part  of  the  rate  filing. The superintendent shall not
require the inclusion of any  specific  geographic  regions  within  the
proposed community rated regions selected by the corporation in its rate
filing  so  long  as  the  corporation's proposed regions do not contain
configurations designed to avoid or segregate particular areas within  a
county  covered  by the corporation's community rates.  (2) BEGINNING ON
JANUARY FIRST, TWO THOUSAND FOURTEEN, FOR EVERY CONTRACT SUBJECT TO THIS
SECTION THAT PROVIDES PHYSICIAN  SERVICES,  MEDICAL,  MAJOR  MEDICAL  OR
SIMILAR  COMPREHENSIVE-TYPE  COVERAGE,  EXCEPT FOR MEDICARE SUPPLEMENTAL
INSURANCE, CORPORATIONS SHALL USE STANDARDIZED REGIONS.
  (d) (1) This section shall also apply to [contracts] A CONTRACT issued
to a group defined in  subsection  (c)  of  section  four  thousand  two
hundred  thirty-five  of  this  chapter, including but not limited to an
association or trust of employers, if the group  includes  one  or  more
member  employers  or  other  member  groups  which  have fifty or fewer
employees or members exclusive of spouses and dependents.  FOR CONTRACTS
ISSUED OR RENEWED ON OR AFTER JANUARY FIRST, TWO THOUSAND  FOURTEEN,  IF
THE GROUP INCLUDES ONE OR MORE MEMBER SMALL GROUP EMPLOYERS ELIGIBLE FOR
COVERAGE  SUBJECT  TO  THIS SECTION, THEN SUCH MEMBER EMPLOYERS SHALL BE
CLASSIFIED AS SMALL GROUPS FOR RATING PURPOSES AND THE REMAINING MEMBERS

S. 2606--C                         125

SHALL BE RATED CONSISTENT WITH  THE  RATING  RULES  APPLICABLE  TO  SUCH
REMAINING MEMBERS PURSUANT TO PARAGRAPH TWO OF THIS SUBSECTION.
  (2)  IF  A  CONTRACT IS ISSUED TO A GROUP DEFINED IN SUBSECTION (C) OF
SECTION FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER  INCLUDING
ASSOCIATION  GROUPS,  THAT INCLUDES ONE OR MORE INDIVIDUAL MEMBERS, THEN
FOR RATING PURPOSES THE CORPORATION SHALL INCLUDE SUCH  MEMBERS  IN  ITS
INDIVIDUAL POOL OF RISKS IN ESTABLISHING PREMIUM RATES FOR SUCH MEMBERS.
  (3) A corporation shall provide specific claims experience to a munic-
ipal  corporation, as defined in subsection (f) of section four thousand
seven hundred two of this chapter, covered by the  corporation  under  a
community  rated  contract  when  the municipal corporation requests its
claims experience for purposes of forming or joining a municipal cooper-
ative health benefit plan certified pursuant to article  forty-seven  of
this  chapter.  Notwithstanding the foregoing provisions, no corporation
shall be required to provide more than three years' claims experience to
a municipal corporation making this request.
  (e) (1) Notwithstanding any other provision of this chapter, no insur-
er, subsidiary of an insurer, or controlled person of a holding  company
system may act as an administrator or claims paying agent, as opposed to
an  insurer,  on  behalf of small groups which, if they purchased insur-
ance, would be subject to this section. No  insurer,  subsidiary  of  an
insurer,  or  controlled  person  of  a holding company may provide stop
loss, catastrophic or reinsurance coverage to  small  groups  which,  if
they purchased insurance, would be subject to this section.
  (2)  This  subsection  shall  not  apply  to  coverage insuring a plan
[which] THAT was in effect on or before December thirty-first,  nineteen
hundred  ninety-one  and  was  issued  to  a group [which] THAT includes
member small employers or other member small groups, including  but  not
limited  to  association  groups,  provided that (A) acceptance of addi-
tional small member employers (or other member groups comprised of fifty
or fewer employees or members, exclusive of spouses and dependents) into
the group on or after June first, nineteen hundred ninety-two and before
April first, nineteen hundred ninety-four  does  not  exceed  an  amount
equal  to  ten  percent  per year of the total number of persons covered
under the group as of June first, nineteen hundred ninety-two, but noth-
ing in this subparagraph shall  limit  the  addition  of  larger  member
employers;  (B) (i) after April first, nineteen hundred ninety-four, the
group thereafter accepts member small employers and member small  groups
without  underwriting  by any more than the imposition of a pre-existing
condition limitation as permitted by  this  article  and  the  cost  for
participation  in  the  group  for all persons covered shall be the same
based on the experience of the entire pool of risks  covered  under  the
entire  group,  without regard to age, sex, health status or occupation;
and; (ii) once accepted for  coverage,  an  individual  or  small  group
cannot  be terminated due to claims experience; (C) the [insurer] CORPO-
RATION has registered the names of  such  groups,  including  the  total
number of persons covered as of June first, nineteen hundred ninety-two,
with  the superintendent, in a form prescribed by the superintendent, on
or before April first, nineteen hundred ninety-three  and  shall  report
annually  thereafter  until  such  groups  comply with the provisions of
subparagraph (B) of this paragraph; and (D) the types or  categories  of
employers  or groups eligible to join the association are not altered or
expanded after June first, nineteen hundred ninety-two.
  (3) A corporation may apply to the superintendent for an extension  or
extensions  of  time beyond April first, nineteen hundred ninety-four in
which to implement the provisions of this subsection as they  relate  to

S. 2606--C                         126

groups  registered  with the superintendent pursuant to subparagraph (C)
of paragraph two of this subsection; any such  extension  or  extensions
may  not exceed two years in aggregate duration, and the ten percent per
year  limitation of subparagraph (A) of paragraph two of this subsection
shall be reduced to five percent per year during the period of any  such
extension  or  extensions. Any application for an extension shall demon-
strate that a significant financial hardship to such group would  result
from such implementation.
  (f)(1)  If the [insurer] CORPORATION issues coverage to an association
group (including chambers of commerce), as defined in  subparagraph  (K)
of  paragraph one of subsection (c) of section four thousand two hundred
thirty-five of this chapter, THEN the [insurer must]  CORPORATION  SHALL
issue  the  same coverage to individual proprietors [which] WHO purchase
coverage through the association  group  as  the  [insurer]  CORPORATION
issues  to groups [which] THAT purchase coverage through the association
group; provided, however, that [an insurer which] A CORPORATION THAT, on
the effective date of this subsection, is issuing coverage to individual
proprietors not connected with an association  group,  may  continue  to
issue  such  coverage provided that the coverage is otherwise in accord-
ance with this subsection and all other applicable provisions of law.
  (2) For coverage purchased pursuant to this subsection THROUGH  DECEM-
BER THIRTY-FIRST, TWO THOUSAND THIRTEEN, individual proprietors shall be
classified  in their own community rating category, provided however, up
to  and  including  December  thirty-first,  two   thousand   [fourteen]
THIRTEEN,  the  premium  rate  established  for  individual  proprietors
purchased pursuant to paragraph one of  this  subsection  shall  not  be
greater than one hundred fifteen percent of the rate established for the
same  coverage issued to groups.  COVERAGE PURCHASED OR RENEWED PURSUANT
TO THIS SUBSECTION ON OR AFTER  JANUARY  FIRST,  TWO  THOUSAND  FOURTEEN
SHALL BE CLASSIFIED IN THE INDIVIDUAL RATING CATEGORY.
  (3)  The  [insurer] CORPORATION may require members of the association
purchasing health insurance to verify that all employees electing health
insurance are legitimate employees of the employers,  as  documented  on
New  York  state  tax form NYS-45-ATT-MN or comparable documentation. In
order to be eligible to  purchase  health  insurance  pursuant  to  this
subsection  and  obtain the same group insurance products as are offered
to groups, a sole employee of a corporation or a sole proprietor  of  an
unincorporated  business  or  entity must (A) work at least twenty hours
per week, (B) if purchasing the coverage through an  association  group,
be  a  member  of  the  association for at least sixty days prior to the
effective date of the insurance [policy] CONTRACT,  and  (C)  present  a
copy  of  the  following  documentation  to the [insurer] CORPORATION or
health plan administrator on an annual basis:
  (i) NYS tax form 45-ATT, or comparable documentation of active employ-
ee status;
  (ii) for an unincorporated business, the prior year's  federal  income
tax Schedule C for an incorporated business subject to Subchapter S with
a  sole  employee,  federal income tax Schedule E for other incorporated
businesses with a sole employee, a W-2 annual wage statement, or federal
tax form 1099 with federal income tax Schedule F; or
  (iii) for a business in business for less than one year,  a  cancelled
business  check,  a  certificate  of  doing business, or appropriate tax
documentation; and
  (iv) such other documentation as may be  reasonably  required  by  the
insurer  as  approved  by the superintendent to verify eligibility of an
individual to purchase health insurance pursuant to this subsection.

S. 2606--C                         127

  (4) Notwithstanding the provisions  of  item  (I)  of  clause  (i)  of
subparagraph  (K)  of  paragraph  one  of subsection (c) of section four
thousand two hundred thirty-five of this chapter, for purposes  of  this
section,  an  association  group shall include chambers of commerce with
less  than  two  hundred  members and which are 501C3 or 501C6 organiza-
tions.
  S 73. Notwithstanding any inconsistent provision of law, rule or regu-
lation, for purposes of implementing the provisions of the public health
law and the social services law, references to titles XIX and XXI of the
federal social security act in the public  health  law  and  the  social
services  law  shall be deemed to include and also to mean any successor
titles thereto under the federal social security act.
  S 74. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the effectiveness of the provisions of sections 2807 and 3614 of
the public health law, section 18 of chapter 2 of the laws of 1988,  and
18  NYCRR  505.14(h), as they relate to time frames for notice, approval
or certification of rates of payment, are hereby suspended  and  without
force or effect for purposes of implementing the provisions of this act.
  S  75. Severability clause. If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair or invalidate the remainder thereof, but shall be confined in its
operation to the clause, sentence, paragraph,  subdivision,  section  or
part thereof directly involved in the controversy in which such judgment
shall have been rendered.
  S  76.  This  act shall take effect immediately and shall be deemed to
have been in full force  and  effect  on  and  after  January  1,  2013;
provided that:
  a.  sections  thirty-eight,  thirty-nine,  forty,  forty-a, forty-one,
forty-six-a, forty-seven, forty-eight, forty-nine, fifty, fifty-one  and
fifty-two of this act shall take effect January 1, 2014, and shall apply
to  all  policies  and  contracts  issued, renewed, modified, altered or
amended on or after such date.
  b. sections forty-three-a, forty-four,  forty-five  and  forty-six  of
this  act  shall  apply  to  all policies and contracts issued, renewed,
modified, altered or amended on or after October 1, 2013;
  c. section fifty-six of this act shall take effect  January  1,  2014,
contingent  upon the requirements of the Patient Protection and Afforda-
ble Care Act of 2010  being  fully  implemented  by  the  state  and  as
approved  by  the secretary of health and human services, and contingent
upon full implementation of the state enrollment center;
  d. section fifty-seven of this act shall be deemed repealed January 1,
2014;
  e. sections fifteen, fifty-eight, sixty-one and sixty-two of this  act
shall  take  effect January 1, 2015, contingent upon the requirements of
the Patient Protection and Affordable  Care  Act  of  2010  being  fully
implemented  by the state and as approved by the secretary of health and
human services, and contingent upon full  implementation  of  the  state
enrollment center provided that the amendments made to subsection (d) of
section  4327  of  the  insurance law by section fifty-eight of this act
shall expire one year after the effective date of such section;
  e-1. section fifteen-a of this act shall take effect January 1,  2014,
contingent  upon the requirements of the Patient Protection and Afforda-
ble Care Act of 2010  being  fully  implemented  by  the  state  and  as
approved  by  the secretary of health and human services, and contingent
upon full implementation of the state enrollment center;

S. 2606--C                         128

  f. sections fifty-nine and sixty of this act shall take effect January
1, 2016 and shall apply to all policies and contracts  issued,  renewed,
modified, altered, or amended on or after such date;
  g.  sections  fourteen  and  fourteen-a  of this act shall take effect
immediately and shall be deemed to have been in full force and effect on
and after April 1, 2013;
  h. the amendments to paragraphs  (e)  and  (f)  of  subdivision  2  of
section  2511  of  the  public  health law made by sections nineteen and
twenty-six of this act shall take effect January 1, 2014 or a later date
to be determined by the  commissioner  of  health  contingent  upon  the
requirements  of  the Patient Protection and Affordable Care Act of 2010
being fully implemented by the state and as approved by the secretary of
the department of health and human services; provided that  the  commis-
sioner  of  health shall notify the legislative bill drafting commission
upon the occurrence of the enactment of the legislation provided for  in
sections  nineteen  and twenty-six of this act in order that the commis-
sion may maintain an accurate and timely  effective  data  base  of  the
official  text  of  the  laws of the state of New York in furtherance of
effectuating the provisions of section 44 of  the  legislative  law  and
section 70-b of the public officers law;
  h-1.  provided  however,  the amendments to subparagraph (ii) of para-
graph (f) of subdivision 2 of section 2511 of the public health law made
by section twenty-six of this act shall take effect April 1, 2014;
  i. the amendments to subdivision 4  of  section  2511  of  the  public
health  law  made by section twenty-one of this act shall not affect the
expiration and reversion of such subdivision  and  shall  be  deemed  to
expire therewith;
  j. the amendments to subparagraph (ii) of paragraph (g) of subdivision
2  of section 2511 of the public health law made by section twenty-seven
of this act shall not affect the expiration of such paragraph and  shall
be deemed to expire therewith;
  j-1. the amendments to subparagraph (iii) of paragraph (a) of subdivi-
sion  2  of section 2511 of the public health law made by section thirty
of this act shall not affect the expiration of such paragraph and  shall
be deemed to expire therewith;
  j-2.  the  amendments  to subparagraph (iv) of paragraph (b) and para-
graph (d) of subdivision 9 of section 2511 of the public health law made
by section thirty-three of this act shall not affect the  expiration  of
such subdivision and shall be deemed to expire therewith;
  k.  any  rules or regulations necessary to implement the provisions of
this act may be promulgated and any procedures, forms,  or  instructions
necessary  for  implementation may be adopted and issued on or after the
date this act shall have become a law;
  l. this act shall not be construed to alter, change, affect, impair or
defeat any rights, obligations, duties or interests accrued, incurred or
conferred prior to the effective date of this act;
  m. the commissioner of health  and  the  superintendent  of  financial
services  and  any  appropriate  council may take any steps necessary to
implement this act prior to its effective date;
  n. notwithstanding any inconsistent provision of the state administra-
tive procedure act or any other provision of law,  rule  or  regulation,
the  commissioner of health and the superintendent of financial services
and any appropriate council is authorized to adopt or amend  or  promul-
gate  on  an  emergency  basis  any regulation he or she or such council
determines necessary to implement any  provision  of  this  act  on  its
effective date;

S. 2606--C                         129

  o.  the  provisions of this act shall become effective notwithstanding
the failure of the commissioner  of  health  or  the  superintendent  of
financial  services or any council to adopt or amend or promulgate regu-
lations implementing this act; and
  p.  the amendments made to subparagraph (7) of paragraph (b) of subdi-
vision 1 of section 366 of the social services law made by  section  one
of this act shall expire and be deemed repealed October 1, 2019.

                                 PART E

  Section 1. Intentionally omitted.
  S 2. Intentionally omitted.
  S 3. Intentionally omitted.
  S 4. Intentionally omitted.
  S 5. Intentionally omitted.
  S 6. Intentionally omitted.
  S 7. Intentionally omitted.
  S 8. Intentionally omitted.
  S 9. Intentionally omitted.
  S 10. Intentionally omitted.
  S 11. Intentionally omitted.
  S 12. Intentionally omitted.
  S 13. Intentionally omitted.
  S 14. Section 600 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  600.  State  aid; general requirements. In order to be eligible for
state aid under this title, a municipality shall be required to  do  the
following in accordance with the provisions of this article:
  1.  submit  an  application  to  the department for state aid WHICH IS
APPROVED BY THE COMMISSIONER IN ACCORDANCE WITH SECTION SIX HUNDRED  ONE
OF THIS TITLE;
  [2.  submit  a municipal public health services plan to the department
for approval;
  3. implement and adhere to the municipal public health services  plan,
as approved;
  4.  submit  a detailed report to the department of all expenditures on
services funded by this title for the immediately preceding fiscal  year
of such municipality;
  5.  employ  a  person  to  supervise  the  provision  of public health
services in accordance with the provisions of section six  hundred  four
of this chapter; and
  6.]  2.  SUBSTANTIALLY PROVIDE CORE PUBLIC HEALTH SERVICES, AS DEFINED
IN SECTION SIX HUNDRED TWO OF THIS TITLE;
  3. SUBMIT A COMMUNITY HEALTH ASSESSMENT IN ACCORDANCE WITH SECTION SIX
HUNDRED TWO-A OF THIS TITLE;
  4. ESTABLISH,  COLLECT  AND  REPORT  FEES  AND  REVENUE  FOR  SERVICES
PROVIDED BY THE MUNICIPALITY, IN ACCORDANCE WITH SECTION SIX HUNDRED SIX
OF THIS TITLE; AND
  5.  appropriate  or  otherwise  make  funds  available  to  finance  a
prescribed share of the cost of public health services.
  S 15. Section 601 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S 601. Application for state aid. 1. The governing body of each  muni-
cipality  desiring  to  make  application for state aid under this title
shall annually, on such dates as  may  be  fixed  by  the  commissioner,
submit an application for such aid.

S. 2606--C                         130

  2.  The  application  shall  be in such form as the commissioner shall
prescribe, and shall include, but not be limited to:
  (a)  an  organizational  chart  of  the municipal health agency, AND A
STATEMENT PROVIDING THE NUMBER OF EMPLOYEES, BY JOB TITLE,  PROPOSED  TO
PROVIDE PUBLIC HEALTH SERVICES FUNDED BY THIS TITLE;
  (b)  a  [detailed] budget of proposed expenditures for services funded
by this title;
  [(c) a description of proposed program activities for services  funded
by this title;
  (d)  a  copy of the municipal public health services plan prepared and
submitted pursuant to section six hundred two of this title;
  (e) a certification by the chief  executive  officer  of  the  munici-
pality,  or  in those municipalities with no chief executive officer the
chairman of the county legislature, that the proposed  expenditures  and
program  activities are consistent with the public health services plan;
and
  (f)] (C) A DESCRIPTION OF HOW THE  MUNICIPALITY  WILL  PROVIDE  PUBLIC
HEALTH SERVICES;
  (D)  AN ATTESTATION BY THE CHIEF EXECUTIVE OFFICER OF THE MUNICIPALITY
THAT SUFFICIENT FUNDS HAVE  BEEN  APPROPRIATED  TO  PROVIDE  THE  PUBLIC
HEALTH SERVICES FOR WHICH THE MUNICIPALITY IS SEEKING STATE AID;
  (E) AN ATTESTATION BY THE MUNICIPAL OFFICER IN CHARGE OF ADMINISTERING
PUBLIC  HEALTH  THAT  THE MUNICIPALITY HAS DILIGENTLY REVIEWED ITS STATE
AID APPLICATION AND THAT THE APPLICATION SEEKS STATE AID ONLY FOR ELIGI-
BLE PUBLIC HEALTH SERVICES;
  (F) A LIST OF PUBLIC HEALTH SERVICES PROVIDED BY THE MUNICIPALITY THAT
ARE NOT ELIGIBLE FOR STATE AID, AND THE COST OF EACH SERVICE;
  (G) A PROJECTION OF FEES AND REVENUE TO BE COLLECTED FOR PUBLIC HEALTH
SERVICES ELIGIBLE FOR STATE AID, IN ACCORDANCE WITH SECTION SIX  HUNDRED
SIX OF THIS TITLE; AND
  (H) such other information as the commissioner may require.
  3.  THE  COMMISSIONER  SHALL  APPROVE THE STATE AID APPLICATION TO THE
EXTENT THAT IT IS CONSISTENT WITH THIS SECTION AND ANY OTHER  CONDITIONS
OR  LIMITATIONS  ESTABLISHED IN, OR REGULATIONS PROMULGATED PURSUANT TO,
THIS ARTICLE.
  4. A MUNICIPALITY  MAY  AMEND  ITS  STATE  AID  APPLICATION  WITH  THE
APPROVAL  OF  THE COMMISSIONER, AND SUBJECT TO ANY RULES AND REGULATIONS
THAT THE COMMISSIONER MAY ADOPT.
  S 16. Section 602 of the public health  law  is  REPEALED  and  a  new
section 602 is added to read as follows:
  S  602. CORE PUBLIC HEALTH SERVICES.  1. TO BE ELIGIBLE FOR STATE AID,
A MUNICIPALITY MUST SUBSTANTIALLY  PROVIDE  THE  FOLLOWING  CORE  PUBLIC
HEALTH SERVICES:
  (A)  FAMILY  HEALTH, WHICH SHALL INCLUDE ACTIVITIES DESIGNED TO REDUCE
PERINATAL, INFANT AND MATERNAL MORTALITY AND MORBIDITY  AND  TO  PROMOTE
THE HEALTH OF INFANTS, CHILDREN, ADOLESCENTS, AND PEOPLE OF CHILDBEARING
AGE.  SUCH  ACTIVITIES  SHALL INCLUDE FAMILY CENTERED PERINATAL SERVICES
AND OTHER SERVICES APPROPRIATE TO PROMOTE THE BIRTH OF A HEALTHY BABY TO
A HEALTHY MOTHER, AND SERVICES TO ASSURE THAT INFANTS,  YOUNG  CHILDREN,
AND  SCHOOL  AGE  CHILDREN  ARE ENROLLED IN APPROPRIATE HEALTH INSURANCE
PROGRAMS AND OTHER HEALTH BENEFIT PROGRAMS FOR WHICH THEY ARE  ELIGIBLE,
AND  THAT  THE  PARENTS  OR GUARDIANS OF SUCH CHILDREN ARE PROVIDED WITH
INFORMATION CONCERNING HEALTH CARE PROVIDERS  IN  THEIR  AREA  THAT  ARE
WILLING AND ABLE TO PROVIDE HEALTH SERVICES TO SUCH CHILDREN.
  (B)  COMMUNICABLE  DISEASE  CONTROL, WHICH SHALL INCLUDE ACTIVITIES TO
CONTROL AND MITIGATE THE EXTENT OF INFECTIOUS DISEASES. SUCH  ACTIVITIES

S. 2606--C                         131

SHALL  INCLUDE,  BUT NOT BE LIMITED TO, SURVEILLANCE AND EPIDEMIOLOGICAL
PROGRAMS, PROGRAMS TO DETECT DISEASES IN THEIR EARLY  STAGES,  IMMUNIZA-
TIONS   AGAINST  INFECTIOUS  DISEASES,  INVESTIGATION  OF  DISEASES  AND
PREVENTION  OF  TRANSMISSION, PREVENTION AND TREATMENT OF SEXUALLY TRAN-
SMISSIBLE DISEASES, AND ARTHROPOD VECTOR-BORNE DISEASE PREVENTION.
  (C) CHRONIC DISEASE PREVENTION, WHICH SHALL INCLUDE PROMOTING  PUBLIC,
HEALTH  CARE  PROVIDER  AND  OTHER COMMUNITY SERVICE PROVIDER ACTIVITIES
THAT ENCOURAGE CHRONIC DISEASE PREVENTION, EARLY DETECTION  AND  QUALITY
CARE  DELIVERY.  SUCH  ACTIVITIES INCLUDE, BUT ARE NOT LIMITED TO, THOSE
THAT PROMOTE HEALTHY COMMUNITIES AND REDUCE RISK FACTORS SUCH AS TOBACCO
USE, POOR NUTRITION AND PHYSICAL  INACTIVITY.    PROVISION  OF  CLINICAL
SERVICES SHALL NOT BE ELIGIBLE FOR STATE AID, SUBJECT TO SUCH EXCEPTIONS
AS THE COMMISSIONER MAY DEEM APPROPRIATE.
  (D)  COMMUNITY  HEALTH ASSESSMENT, AS DESCRIBED IN SECTION SIX HUNDRED
TWO-A OF THIS ARTICLE.
  (E) ENVIRONMENTAL HEALTH, WHICH SHALL INCLUDE ACTIVITIES THAT  PROMOTE
HEALTH AND PREVENT ILLNESS AND INJURY BY ASSURING THAT SAFE AND SANITARY
CONDITIONS  ARE  MAINTAINED  AT  PUBLIC  DRINKING  WATER  SUPPLIES, FOOD
SERVICE ESTABLISHMENTS, AND OTHER  REGULATED  FACILITIES;  INVESTIGATING
PUBLIC  HEALTH  NUISANCES  TO  ASSURE  ABATEMENT BY RESPONSIBLE PARTIES;
PROTECTING THE PUBLIC FROM UNNECESSARY EXPOSURE TO RADIATION, CHEMICALS,
AND OTHER HARMFUL CONTAMINANTS; AND CONDUCTING INVESTIGATIONS  OF  INCI-
DENTS  THAT  RESULT IN ILLNESS, INJURY OR DEATH IN ORDER TO IDENTIFY AND
MITIGATE THE ENVIRONMENTAL CAUSES TO PREVENT  ADDITIONAL  MORBIDITY  AND
MORTALITY.
  (F) PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE, INCLUDING PLAN-
NING, TRAINING, AND MAINTAINING READINESS FOR PUBLIC HEALTH EMERGENCIES.
  2.  THE  MUNICIPALITY  MUST  INCORPORATE  INTO EACH CORE PUBLIC HEALTH
SERVICE THE FOLLOWING GENERAL ACTIVITIES:
  (A) ONGOING ASSESSMENT OF COMMUNITY HEALTH NEEDS;
  (B) EDUCATION ON PUBLIC HEALTH ISSUES;
  (C) DEVELOPMENT OF POLICIES AND PLANS TO ADDRESS HEALTH NEEDS;
  (D) ACTIONS TO ASSURE THAT SERVICES NECESSARY TO ACHIEVE  AGREED  UPON
GOALS ARE PROVIDED; AND
  (E)  THE  EXTENT  TO  WHICH  THE CORE SERVICES, ONCE IMPLEMENTED, WILL
SATISFY STANDARDS WHICH THE COMMISSIONER HAS PROMULGATED  THROUGH  RULES
AND REGULATIONS AFTER CONSULTING WITH THE PUBLIC HEALTH AND HEALTH PLAN-
NING  COUNCIL  AND COUNTY HEALTH COMMISSIONERS, BOARDS AND PUBLIC HEALTH
DIRECTORS. SUCH STANDARDS SHALL BE FOR SERVICES FUNDED UNDER THIS  TITLE
AND  SHALL INCLUDE BUT NOT BE LIMITED TO THE EFFECTS SUCH SERVICES SHALL
HAVE ON MORTALITY AND MORBIDITY AND THE REDUCTION  OF  POTENTIAL  PUBLIC
HEALTH  HAZARDS.  THE COMMISSIONER SHALL NOT HAVE THE POWER TO PRESCRIBE
THE NUMBER OF PERSONS TO BE EMPLOYED IN ANY MUNICIPALITY.
  3. A MUNICIPALITY MAY PROVIDE FEWER SERVICES THAN THOSE SET  FORTH  IN
SUBDIVISION  ONE  OF THIS SECTION, IF THE COMMISSIONER DETERMINES WITHIN
HIS DISCRETION THAT ANOTHER ENTITY IS WILLING AND ABLE TO  PROVIDE  SUCH
SERVICES.
  S  17.  The public health law is amended by adding a new section 602-a
to read as follows:
  S 602-A. COMMUNITY HEALTH ASSESSMENT.   1.  EVERY  MUNICIPALITY  SHALL
SUBMIT  TO  THE  DEPARTMENT  NO  MORE  FREQUENTLY THAN EVERY TWO YEARS A
COMMUNITY HEALTH ASSESSMENT.
  2. THE COMMUNITY HEALTH ASSESSMENT  SHALL  BE  IN  SUCH  FORM  AS  THE
COMMISSIONER SHALL PRESCRIBE, AND SHALL INCLUDE, BUT NOT BE LIMITED TO:
  (A) AN ESTIMATE AND DESCRIPTION OF THE HEALTH STATUS OF THE POPULATION
AND FACTORS THAT CONTRIBUTE TO HEALTH ISSUES;

S. 2606--C                         132

  (B)  IDENTIFICATION  OF  PRIORITY  AREAS  FOR  HEALTH  IMPROVEMENT, IN
CONJUNCTION WITH THE STATE HEALTH IMPROVEMENT PLAN;
  (C)  IDENTIFICATION  OF PUBLIC HEALTH SERVICES IN THE MUNICIPALITY AND
IN THE COMMUNITY AND OTHER RESOURCES THAT CAN BE  MOBILIZED  TO  IMPROVE
POPULATION  HEALTH,  PARTICULARLY  IN THOSE PRIORITY AREAS IDENTIFIED IN
PARAGRAPH (B) OF THIS SUBDIVISION; AND
  (D) A COMMUNITY HEALTH IMPROVEMENT PLAN CONSISTING OF  ACTIONS,  POLI-
CIES,  STRATEGIES  AND  MEASURABLE  OBJECTIVES THROUGH WHICH THE MUNICI-
PALITY AND ITS COMMUNITY PARTNERS WILL ADDRESS AREAS FOR HEALTH IMPROVE-
MENT AND TRACK PROGRESS TOWARD IMPROVEMENT OF PUBLIC HEALTH OUTCOMES.
  S 18. Section 603 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S 603. [Municipal public health  services  plan]  CORE  PUBLIC  HEALTH
SERVICES; implementation. 1. In order to be eligible for state aid under
this  title,  each  municipality shall administer its CORE public health
[programs] SERVICES in accordance with [its  approved  municipal  public
health  services  plan  and] THE standards of performance established by
the commissioner through rules and regulations [and] PURSUANT TO SECTION
SIX HUNDRED NINETEEN  OF  THIS  ARTICLE.  EACH  MUNICIPALITY  shall,  in
particular,  ensure that public health services are provided in an effi-
cient and effective manner to all persons in the municipality.
  2. The commissioner may withhold state aid  reimbursement  under  this
title  for  the appropriate services if, on ANY audit [and], review OF A
STATE AID APPLICATION OR PERIODIC CLAIM FOR STATE AID, OR OTHER INFORMA-
TION AVAILABLE TO THE  DEPARTMENT,  the  commissioner  finds  that  such
services are not furnished or rendered in conformance with the rules and
regulations  established  by the commissioner, INCLUDING BUT NOT LIMITED
TO THE STANDARDS OF PERFORMANCE  ESTABLISHED  PURSUANT  TO  SECTION  SIX
HUNDRED  NINETEEN  OF  THIS  ARTICLE,  or that the expenditures were not
[made according to the approved public health services plan required by]
FOR AN ACTIVITY SET FORTH IN section six hundred two of this  title.  In
such  cases, the commissioner, in order to ensure that the public health
is promoted as defined  in  [paragraph  (b)  of  subdivision  three  of]
section  six  hundred two of this title, may use any proportionate share
of a municipality's per  capita  or  base  grant  that  is  withheld  to
contract  with  agencies,  associations,  or  organizations.  The health
department may use any such withheld  share  to  provide  services  upon
approval  of  the director of the division of the budget. Copies of such
transactions shall be filed with the fiscal committees of  the  legisla-
ture.
  3.  CONSISTENT  WITH  PARAGRAPH  (H) OF SUBDIVISION TWO OF SECTION SIX
HUNDRED ONE OF THIS TITLE, WHEN DETERMINING WHETHER TO APPROVE  A  STATE
AID  APPLICATION OR PERIODIC CLAIM FOR STATE AID, THE COMMISSIONER SHALL
HAVE AUTHORITY TO REQUEST ANY AND  ALL  FINANCIAL  AND  OTHER  DOCUMENTS
NECESSARY OR RELEVANT TO VERIFY THAT THE CLAIMED EXPENDITURES ARE ELIGI-
BLE FOR STATE AID UNDER THIS ARTICLE.
  S 19. Section 604 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  604. Supervision of public health programs. In order to be eligible
for state aid, under this title, each municipality shall employ a  full-
time local commissioner of health or public health director to supervise
the  provision  of public health services [and to implement the approved
public health services plan]  for  that  municipality,  SUBJECT  TO  THE
FOLLOWING EXCEPTIONS:
  1.  SUCH  PERSON  MAY SERVE AS THE HEAD OF A MERGED AGENCY OR MULTIPLE
AGENCIES, IF THE APPROVAL OF THE COMMISSIONER IS OBTAINED; AND

S. 2606--C                         133

  2. SUCH PERSON MAY SERVE AS THE LOCAL COMMISSIONER OF HEALTH OR PUBLIC
HEALTH DIRECTOR OF ADDITIONAL  COUNTIES,  WHEN  AUTHORIZED  PURSUANT  TO
SECTION THREE HUNDRED FIFTY-ONE OF THIS CHAPTER.
  S 20. Section 605 of the public health law, as added by chapter 901 of
the  laws  of  1986,  subdivision 1 as amended by section 6 of part B of
chapter 57 of the laws of 2006, subdivision 2 as amended by  section  13
of  part  A  of  chapter  59  of the laws of 2011, is amended to read as
follows:
  S 605. State aid; amount of reimbursement. 1. A state aid  base  grant
shall  be reimbursed to municipalities for the [base] CORE public health
services identified in [paragraph (b) of subdivision three  of]  section
six  hundred  two  of this title, in an amount of the greater of [fifty-
five] SIXTY-FIVE cents per capita, for each person in the  municipality,
or  [five]  SIX hundred fifty thousand dollars provided that the munici-
pality expends at least [five] SIX hundred fifty  thousand  dollars  for
such [base] CORE public health services. A municipality must provide all
the  [basic] CORE public health services identified in [paragraph (b) of
subdivision three of] section six hundred two of this title  to  qualify
for  such  base  grant  unless  the municipality has the approval of the
commissioner to expend the base grant on a portion of such  [base]  CORE
public  health  services.  If  [any]  services  in  such [paragraph (b)]
SECTION are not [approved in the plan or if no  plan  is  submitted  for
such  services]  SUBSTANTIALLY  PROVIDED, the commissioner may limit the
municipality's per capita or base grant  to  [that  proportionate  share
which  will  fund those services that are submitted in a plan and subse-
quently approved] REFLECT THE SCOPE OF THE REDUCED SERVICES. The commis-
sioner may use the [proportionate share] AMOUNT that is not  granted  to
contract  with  agencies, associations, or organizations to provide such
services; or the health department may use such proportionate  share  to
provide  the  services  upon approval of the director of the division of
the budget.
  2. State aid reimbursement for public health services  provided  by  a
municipality  under  this  title,  shall  be made if the municipality is
providing some or all of the [basic] CORE public health services identi-
fied in [paragraph (b) of subdivision three of] section six hundred  two
of this title, pursuant to an approved [plan] APPLICATION FOR STATE AID,
at  a  rate  of  no  less  than  thirty-six per centum of the difference
between the amount of moneys expended by  the  municipality  for  public
health  services  required  by  [paragraph  (b) of subdivision three of]
section six hundred two of this title during the  fiscal  year  and  the
base grant provided pursuant to subdivision one of this section. No such
reimbursement  shall  be provided for services [if they are not approved
in a plan or if no plan is submitted for such  services]  THAT  ARE  NOT
ELIGIBLE FOR STATE AID PURSUANT TO THIS ARTICLE.
  3.  Municipalities  shall  make  every  reasonable  effort  to collect
payments for public health services provided. All such revenues shall be
reported to the commissioner PURSUANT TO SECTION SIX HUNDRED SIX OF THIS
TITLE and will be deducted from expenditures identified  under  subdivi-
sion two of this section to produce a net cost eligible for state aid.
  S 21. Section 606 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  606.  Assessment  of fees; THIRD-PARTY COVERAGE OR INDEMNIFICATION.
1. Assessment of fees  by  municipalities.    [Each  municipality  shall
assess  fees  for  services  provided by such municipality in accordance
with a fee and revenue plan which shall include a schedule of fees  that
the  municipality  proposes to charge for each service identified by the

S. 2606--C                         134

commissioner and each additional service identified by the  municipality
for  which  a fee is to be charged. In accordance with the provisions of
subdivision four of section six hundred two of this chapter, the commis-
sioner  shall  review each fee and revenue plan submitted to him and, on
the basis of such review, issue a notice of  intent  to  disapprove  the
plan or approve the plan, with or without conditions, within ninety days
of  his receipt of the plan. In determining whether to approve or disap-
prove a plan, the commissioner shall consider the extent  to  which  the
plan,  once  implemented,  will satisfy standards which the commissioner
has promulgated through rules and regulations after consulting with  the
public health council and county health commissioners, boards and public
health  directors. Such standards shall include a list of those environ-
mental, personal health and other  services  for  which  fees  shall  be
charged,  the calculation of cost by each municipality and the relation-
ship of cost to fees, and provisions for prohibiting the  assessment  of
fees which would impede the delivery of services deemed essential to the
protection  of the health of the public.] EACH MUNICIPALITY SHALL ESTAB-
LISH A SCHEDULE OF FEES FOR PUBLIC HEALTH SERVICES PROVIDED BY THE MUNI-
CIPALITY AND SHALL MAKE EVERY REASONABLE EFFORT TO  COLLECT  SUCH  FEES.
Fees for personal health services shall be reflective of an individual's
ability  to  pay  and  shall  not be inconsistent with the reimbursement
guidelines of articles twenty-eight and thirty-six of this  chapter  and
applicable federal laws and regulations. To the extent possible revenues
generated shall be used to enhance or expand public health services.  IN
ITS  STATE  AID APPLICATION, EACH MUNICIPALITY SHALL PROVIDE THE DEPART-
MENT WITH A PROJECTION OF FEES AND REVENUE  TO  BE  COLLECTED  FOR  THAT
YEAR. EACH MUNICIPALITY SHALL PERIODICALLY REPORT TO THE DEPARTMENT FEES
AND REVENUE ACTUALLY COLLECTED.
  2.  Assessment  of fees by the commissioner. In each municipality, the
commissioner shall  establish  a  fee  and  revenue  plan  for  services
provided by the department in a manner consistent with the standards and
regulations established pursuant to subdivision one of this section.
  3.  THIRD  PARTY  COVERAGE  OR  INDEMNIFICATION. FOR ANY PUBLIC HEALTH
SERVICE FOR WHICH COVERAGE OR INDEMNIFICATION  FROM  A  THIRD  PARTY  IS
AVAILABLE,  THE  MUNICIPALITY MUST SEEK SUCH COVERAGE OR INDEMNIFICATION
AND REPORT ANY ASSOCIATED REVENUE TO THE DEPARTMENT  IN  ITS  STATE  AID
APPLICATION.
  S 22. Subdivisions 1 and 2 of section 609 of the public health law, as
amended  by  chapter  474  of  the  laws of 1996, are amended to read as
follows:
  1. Where a laboratory shall have  been  or  is  hereafter  established
pursuant  to article five of this chapter, the state, through the legis-
lature and within the limits to be prescribed by the commissioner, shall
provide  aid  at  a  per  centum,  determined  in  accordance  with  the
provisions  of [paragraph (b) of] subdivision two of section six hundred
five of this article, of the  actual  cost  of  [installation,]  REPAIR,
RELOCATION,  equipment and maintenance of the laboratory or laboratories
FOR SERVICES ASSOCIATED WITH A CORE PUBLIC HEALTH SERVICE, AS  DESCRIBED
IN  SECTION  SIX  HUNDRED  TWO  OF  THIS TITLE.   Such cost shall be the
excess, if any, of such expenditures  over  available  revenues  of  all
types, including adequate and reasonable fees, derived from or attribut-
able to the performance of laboratory services.
  2.  Where a county or city provides or shall have provided for labora-
tory service by contracting with an established laboratory FOR  SERVICES
ASSOCIATED  WITH  A CORE PUBLIC HEALTH SERVICE, AS DESCRIBED IN SUBDIVI-
SION THREE OF SECTION SIX HUNDRED TWO OF THIS TITLE, with  the  approval

S. 2606--C                         135

of  the commissioner, it shall be entitled to state aid at a per centum,
determined in accordance with  the  provisions  of  [paragraph  (b)  of]
subdivision two of section six hundred five of this article, of the cost
of the contracts. [State aid shall be available for a district laborato-
ry  supply  station  maintained  and operated in accordance with article
five of this chapter in the same manner and to the same  extent  as  for
laboratory services.]
  S 23. Intentionally omitted.
  S  24.  Paragraphs  (a)  and (c) of subdivision 1 and subdivision 4 of
section 613 of the public health law, paragraphs (a) and (c) of subdivi-
sion 1 as amended by chapter 36 of the laws of 2010,  subdivision  4  as
amended  by  chapter  207  of  the  laws of 2004, are amended to read as
follows:
  (a) The commissioner shall develop and supervise the  execution  of  a
program of immunization, surveillance and testing, to raise to the high-
est  reasonable  level the immunity of the children of the state against
communicable diseases including, but not limited to, influenza,  poliom-
yelitis,  measles,  mumps, rubella, haemophilus influenzae type b (Hib),
diphtheria, pertussis, tetanus,  varicella,  hepatitis  B,  pneumococcal
disease,  and the immunity of adults of the state against diseases iden-
tified by the commissioner, including  but  not  limited  to  influenza,
smallpox,  [and]  hepatitis  AND SUCH OTHER DISEASES AS THE COMMISSIONER
MAY DESIGNATE THROUGH REGULATION.  The commissioner shall encourage  the
municipalities  in  the  state  to  develop and shall assist them in the
development and the execution of local programs of [inoculation] IMMUNI-
ZATION to raise the immunity of the children and adults of each  munici-
pality  to  the  highest  reasonable  level. Such programs shall include
ASSURANCE OF provision of vaccine, [surveillance of  vaccine  effective-
ness  by  means of laboratory tests,] serological testing of individuals
and educational efforts to inform health care providers and target popu-
lations or their parents, if they are minors, of the facts  relative  to
these  diseases  and [inoculation] IMMUNIZATIONS to prevent their occur-
rence.
  (c) The commissioner shall invite and encourage the active  assistance
and  cooperation in such education activities of: the medical societies,
organizations of other  licensed  health  personnel,  hospitals,  corpo-
rations  subject  to  article  forty-three  of  the insurance law, trade
unions, trade associations, parents and teachers and their associations,
organizations of child care resource and referral agencies, the media of
mass communication, and such other voluntary groups and organizations of
citizens as he or she shall deem  appropriate.  The  public  health  AND
HEALTH  PLANNING council, the department of education, the department of
family assistance, and the department of mental  hygiene  shall  provide
the  commissioner with such assistance in carrying out the program as he
or she shall request.  All other state agencies shall also  render  such
assistance  as the commissioner may reasonably require for this program.
Nothing in this subdivision shall authorize  mandatory  immunization  of
adults  or  children,  except as provided in sections twenty-one hundred
sixty-four and twenty-one hundred sixty-five of this chapter.
  4. The commissioner shall expend such funds as the  legislature  shall
make available for the purchase of the vaccines described in subdivision
one of this section. All immunization vaccines purchased with such funds
shall  be  purchased by sealed competitive state bids through the office
of general services.  [Immunization  vaccine]  VACCINES  purchased  with
funds  made available under this section shall be made available without
charge to licensed  private  physicians,  hospitals,  clinics  and  such

S. 2606--C                         136

others  as  the  commissioner  shall determine [in accordance with regu-
lations to be promulgated by the commissioner], and no charge  shall  be
made to any patient for such vaccines.
  S 25. Intentionally Omitted.
  S  26. Subdivision 2 of section 614 of the public health law, as added
by chapter 901 of the laws of 1986, is amended to read as follows:
  2. "City", each city of the state having a population of [fifty  thou-
sand]  ONE  MILLION  or  more,  according  to the last preceding federal
census[, but does not include any such city which is included as a  part
of a county health district pursuant to this chapter].
  S 27. Section 616 of the public health law, as added by chapter 901 of
the  laws of 1986 and subdivision 1 as amended by section 9 of part B of
chapter 57 of the laws of 2006, is amended to read as follows:
  S 616. Limitations on state aid. 1. The  total  amount  of  state  aid
provided  pursuant to this article shall be limited to the amount of the
annual appropriation made by the  legislature.  In  no  event,  however,
shall  such  state  aid  be less than an amount to provide the full base
grant and, as otherwise provided by paragraph (a) of subdivision two  of
section six hundred five of this article, at least thirty-six per centum
of  the  difference between the amount of moneys expended by the munici-
pality for ELIGIBLE public health services [required by paragraph (b) of
subdivision three of section six hundred two of this  article]  PURSUANT
TO  AN APPROVED APPLICATION FOR STATE AID during the fiscal year and the
base grant provided pursuant to subdivision one of section  six  hundred
five  of  this article. [A municipality shall also receive not less than
thirty-six per centum of the moneys expended  for  other  public  health
services  pursuant  to  paragraph  (b) of subdivision two of section six
hundred five of this article,  and,  at  least  the  minimum  amount  so
required for the services identified in title two of this article.]
  2.  No payments shall be made from moneys appropriated for the purpose
of this article to a municipality for contributions by the  municipality
for  indirect  costs  and fringe benefits, including but not limited to,
employee retirement funds, health insurance  and  federal  old  age  and
survivors insurance.
  S 28. Section 617 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  617.  Maintenance of effort. Such amount of state aid provided will
be used to support and to the extent practicable, to increase the  level
of  funds  that  would otherwise be made available for such purposes and
not to supplant the amount to be provided by the  municipalities.  If  a
municipality  that  is  provided state aid pursuant to title one of this
article reduces its expenditures beneath the amount expended in its base
year, which is [the greater of  its  expenditures  in  its  fiscal  year
ending in either nineteen hundred eighty-five or] the most recent fiscal
year  for  which  the municipality has filed [an annual] ALL expenditure
[report] REPORTS to the department,  state  aid  reimbursement  provided
pursuant  to subdivision one of section six hundred five of this article
will be reduced by  the  [difference  between  the  reduction  in  local
expenditures  between  its base year and its current fiscal year and the
reduction in state aid between the base year and the current fiscal year
pursuant to paragraphs (a) and (b) of subdivision  two  of  section  six
hundred  five  of  this  article.  A  municipality  may include revenue,
excluding third party  reimbursement,  raised  by  the  municipality  in
calculating  its maintenance of effort] PERCENTAGE REDUCTION IN EXPENDI-
TURES BETWEEN ITS BASE YEAR AND ITS CURRENT FISCAL YEAR. FOR PURPOSES OF
THIS SECTION, REDUCTIONS IN  EXPENDITURES  SHALL  BE  ADJUSTED  FOR:  AN

S. 2606--C                         137

ABSENCE  OF  EXTRAORDINARY  EXPENDITURES  OF A TEMPORARY NATURE, SUCH AS
DISASTER RELIEF; UNAVOIDABLE OR JUSTIFIABLE PROGRAM REDUCTIONS, SUCH  AS
A  PROGRAM  BEING  SUBSUMED BY ANOTHER AGENCY; OR IN CIRCUMSTANCES WHERE
THE MUNICIPALITY CAN DEMONSTRATE, TO THE DEPARTMENT'S SATISFACTION, THAT
THE NEED FOR THE EXPENDITURE NO LONGER EXISTS.
  S 29. Intentionally omitted.
  S 30. Section 619 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  619.  Commissioner; regulatory powers. The commissioner shall adopt
regulations to effectuate the provisions and purposes of  this  article,
including, but not limited to:
  1.  setting  standards  of  performance [and reasonable costs] for the
provision of [basic] CORE public health  services  which  shall  include
performance  criteria  to  ensure  that reimbursable health services are
delivered in an efficient and effective manner by a municipality; and
  2. monitoring, COLLECTING DATA and evaluating the provision of [basic]
CORE public health  services  by  the  municipalities  and  the  amounts
expended by the municipalities for such services.
  S  31.  The public health law is amended by adding a new section 619-a
to read as follows:
  S 619-A. INCENTIVE STANDARDS OF PERFORMANCE. 1. THE COMMISSIONER SHALL
ESTABLISH STATEWIDE INCENTIVE PERFORMANCE STANDARDS, SUBJECT TO LEGISLA-
TIVE APPROVAL, FOR THE DELIVERY OF CORE PUBLIC  HEALTH  SERVICES  ON  OR
BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND THIRTEEN.
  2.  WITHIN  AMOUNTS  APPROPRIATED,  AND SUBJECT TO THE APPROVAL OF THE
DIRECTOR OF THE BUDGET, THE COMMISSIONER MAY INCREASE STATE AID  TO  ANY
MUNICIPALITY THAT MEETS OR EXCEEDS STATEWIDE INCENTIVE PERFORMANCE STAN-
DARDS  ESTABLISHED  UNDER  THIS SECTION, PROVIDED THAT THE TOTAL OF SUCH
PAYMENTS TO ALL MUNICIPALITIES MAY NOT EXCEED ONE MILLION DOLLARS  ANNU-
ALLY.
  S  32.  The article heading of article 23 of the public health law, as
amended by chapter 878 of the laws  of  1980,  is  amended  to  read  as
follows:
        CONTROL OF SEXUALLY [TRANSMISSIBLE] TRANSMITTED DISEASES
  S  33. Sections 2300, 2301, 2302 and 2303 of the public health law are
REPEALED.
  S 34. The section heading and subdivisions 1 and 2 of section 2304  of
the  public  health  law, as amended by chapter 878 of the laws of 1980,
are amended and two new subdivisions 4  and  5  are  added  to  read  as
follows:
  Sexually  [transmissible]  TRANSMITTED diseases; treatment facilities;
administration. 1. It shall be  the  responsibility  of  each  board  of
health  of  a  health  district  to  provide adequate facilities for the
[free] diagnosis and treatment of persons living within its jurisdiction
who are suspected of being infected or  are  infected  with  a  sexually
[transmissible] TRANSMITTED disease.
  2.  The  health officer of said health district shall administer these
facilities DIRECTLY OR THROUGH CONTRACT, and shall promptly  examine  or
arrange  for the examination of persons suspected of being infected with
a sexually  [transmissible]  TRANSMITTED  disease,  and  shall  promptly
institute  treatment  or  arrange  for  the  treatment of those found or
otherwise known to be infected with a sexually [transmissible] TRANSMIT-
TED disease[,]; provided that any person may, at his OR HER  option,  be
treated  at his OR HER own expense by a licensed physician of his OR HER
choice.

S. 2606--C                         138

  4. EACH BOARD OF HEALTH AND LOCAL HEALTH  OFFICER  SHALL  ENSURE  THAT
DIAGNOSIS  AND  TREATMENT  SERVICES  ARE  AVAILABLE AND, TO THE GREATEST
EXTENT PRACTICABLE, SEEK THIRD PARTY  COVERAGE  OR  INDEMNIFICATION  FOR
SUCH  SERVICES; PROVIDED, HOWEVER, THAT NO BOARD OF HEALTH, LOCAL HEALTH
OFFICER,  OR  OTHER MUNICIPAL OFFICER OR ENTITY SHALL REQUEST OR REQUIRE
THAT SUCH COVERAGE OR INDEMNIFICATION BE  UTILIZED  AS  A  CONDITION  OF
PROVIDING DIAGNOSIS OR TREATMENT SERVICES.
  5.  THE  TERM  "HEALTH  OFFICER"  AS USED IN THIS ARTICLE SHALL MEAN A
COUNTY HEALTH OFFICER, A CITY HEALTH OFFICER, A TOWN HEALTH  OFFICER,  A
VILLAGE  HEALTH  OFFICER,  THE  HEALTH  OFFICER OF A CONSOLIDATED HEALTH
DISTRICT OR A STATE DISTRICT HEALTH OFFICER.
  S 35.  Intentionally omitted.
  S 36. Section 2306 of the public health law, as amended by chapter  41
of the laws of 2010, is amended to read as follows:
  S  2306.  Sexually  [transmissible]  TRANSMITTED diseases; reports and
information, confidential. All reports or information secured by a board
of health or health officer under the provisions of this  article  shall
be  confidential  except  in  so  far  as  is necessary to carry out the
purposes of this article. Such report or information may be disclosed by
court order in a criminal proceeding in which it is otherwise admissible
or in a proceeding pursuant to article ten of the family  court  act  in
which it is otherwise admissible, to the prosecution and to the defense,
or  in  a  proceeding pursuant to article ten of the family court act in
which it is otherwise admissible,  to  the  petitioner,  respondent  and
attorney  for  the  child,  provided  that  the subject of the report or
information has waived the confidentiality provided for by this  section
EXCEPT  INSOFAR  AS IS NECESSARY TO CARRY OUT THE PURPOSES OF THIS ARTI-
CLE. INFORMATION MAY BE DISCLOSED TO THIRD PARTY  REIMBURSERS  OR  THEIR
AGENTS  TO  THE  EXTENT NECESSARY TO REIMBURSE HEALTH CARE PROVIDERS FOR
HEALTH SERVICES; PROVIDED THAT, WHEN NECESSARY, AN OTHERWISE APPROPRIATE
AUTHORIZATION FOR SUCH DISCLOSURE HAS BEEN SECURED BY  THE  PROVIDER.  A
person  waives  the confidentiality provided for by this section if such
person voluntarily discloses or consents to disclosure of such report or
information or a portion thereof. If such person lacks the  capacity  to
consent to such a waiver, his or her parent, guardian or attorney may so
consent.  An  order  directing disclosure pursuant to this section shall
specify that no report or information shall  be  disclosed  pursuant  to
such  order  which  identifies  or  relates to any person other than the
subject of the report or information. REPORTS  AND  INFORMATION  MAY  BE
USED  IN  THE AGGREGATE IN PROGRAMS APPROVED BY THE COMMISSIONER FOR THE
IMPROVEMENT OF THE QUALITY OF MEDICAL  CARE  PROVIDED  TO  PERSONS  WITH
SEXUALLY  TRANSMITTED  DISEASES;  OR  WITH PATIENT IDENTIFIERS WHEN USED
WITHIN THE STATE OR LOCAL HEALTH DEPARTMENT  BY  PUBLIC  HEALTH  DISEASE
PROGRAMS  TO  ASSESS  CO-MORBIDITY  OR  COMPLETENESS OF REPORTING AND TO
DIRECT PROGRAM NEEDS, IN WHICH CASE PATIENT  IDENTIFIERS  SHALL  NOT  BE
DISCLOSED OUTSIDE THE STATE OR LOCAL HEALTH DEPARTMENT.
  S  37. The section heading of section 2308 of the public health law is
amended to read as follows:
  [Venereal] SEXUALLY TRANSMITTED disease; pregnant  women;  blood  test
for syphilis.
  S  38.  Section 2308-a of the public health law, as amended by chapter
878 of the laws of 1980, is amended to read as follows:
  S 2308-a. Sexually [transmissible]  TRANSMITTED  diseases;  tests  for
sexually  [transmissible]  TRANSMITTED diseases.   1. The administrative
officer or other person in charge of a clinic or other facility  provid-
ing gynecological, obstetrical, genito-urological, contraceptive, steri-

S. 2606--C                         139

lization or termination of pregnancy services or treatment shall require
the  staff  of  such  clinic or facility to offer to administer to every
resident of the state of New York coming to such clinic or facility  for
such  services  or  treatment, appropriate examinations or tests for the
detection of sexually [transmissible] TRANSMITTED diseases.
  2. Each physician providing gynecological, obstetrical, genito-urolog-
ical, contraceptive, sterilization, or termination of pregnancy services
or treatment shall offer to administer to every resident of the state of
New York coming to such physician for such services or treatment, appro-
priate examinations or tests for the detection of sexually  [transmissi-
ble] TRANSMITTED diseases.
  S 39. Sections 2309 and 2310 of the public health law are REPEALED.
  S  40.  Section 2311 of the public health law, as added by chapter 878
of the laws of 1980, is amended to read as follows:
  S 2311. Sexually [transmissible] TRANSMITTED disease list. The commis-
sioner shall promulgate a list of sexually  [transmissible]  TRANSMITTED
diseases, such as gonorrhea and syphilis, for the purposes of this arti-
cle.  The  commissioner,  in  determining the diseases to be included in
such list, shall consider those conditions  principally  transmitted  by
sexual  contact,  OTHER SECTIONS OF THIS CHAPTER ADDRESSING COMMUNICABLE
DISEASES and the impact of particular diseases on  individual  morbidity
and the health of newborns.
  S  41.  Section  2  of  chapter  577 of the laws of 2008, amending the
public health law relating to  expedited  partner  therapy  for  persons
infected with chlamydia trachomatis, is amended to read as follows:
  S 2. This act shall take effect on the one hundred twentieth day after
it  shall  have  become  a  law [and shall expire and be deemed repealed
January 1, 2014].
  S 42. Intentionally omitted.
  S 43. Subdivisions 1, 2, 2-a, 2-b and 3 of section 2802 of the  public
health law, subdivisions 1, 2 and 2-b as amended by section 58 of part A
of  chapter  58  of the laws of 2010, subdivision 2-a as added and para-
graph (e) of subdivision 3 as amended by chapter  731  of  the  laws  of
1993,  subdivision  3 as amended by chapter 609 of the laws of 1982, are
amended to read as follows:
  1. An application for  such  construction  shall  be  filed  with  the
department,  together  with such other forms and information as shall be
prescribed by, or acceptable to, the department. Thereafter the  depart-
ment  shall forward a copy of the application and accompanying documents
to the public health and health planning council, and the health systems
agency, if any, having geographical jurisdiction of the area  where  the
hospital is located.
  2. The commissioner shall not act upon an application for construction
of  a  hospital  until the public health and health planning council and
the health systems agency have had a reasonable  time  to  submit  their
recommendations, and unless (a) the applicant has obtained all approvals
and  consents  required  by  law  for its incorporation or establishment
(including the approval of the public health and health planning council
pursuant to the provisions of this article) provided, however, that  the
commissioner  may  act upon an application for construction by an appli-
cant possessing a valid operating certificate when the application qual-
ifies for review without the recommendation of the council  pursuant  to
regulations adopted by the council and approved by the commissioner; and
(b)  the  commissioner  is  satisfied  as  to  the  public  need for the
construction,  at  the  time  and  place  and  under  the  circumstances
proposed, provided however that[,] in the case of an application by: (I)

S. 2606--C                         140

a  hospital established or operated by an organization defined in subdi-
vision one of section four hundred eighty-two-b of the  social  services
law,  the  needs of the members of the religious denomination concerned,
for  care  or  treatment  in  accordance with their religious or ethical
convictions, shall be deemed to be public need[.]; (II) A GENERAL HOSPI-
TAL OR DIAGNOSTIC AND TREATMENT CENTER, ESTABLISHED UNDER THIS  ARTICLE,
TO  CONSTRUCT A FACILITY TO PROVIDE PRIMARY CARE SERVICES, AS DEFINED IN
REGULATION, THE CONSTRUCTION MAY BE APPROVED WITHOUT REGARD  FOR  PUBLIC
NEED;  OR (III) A GENERAL HOSPITAL OR A DIAGNOSTIC AND TREATMENT CENTER,
ESTABLISHED UNDER THIS ARTICLE, TO UNDERTAKE CONSTRUCTION THAT DOES  NOT
INVOLVE:    (A)  A  CHANGE  IN CAPACITY, THE TYPES OF SERVICES PROVIDED,
MAJOR MEDICAL EQUIPMENT; (B) FACILITY REPLACEMENT; OR (C) THE GEOGRAPHIC
LOCATION OF SERVICES, THE CONSTRUCTION MAY BE  APPROVED  WITHOUT  REGARD
FOR PUBLIC NEED.
  2-a.  The council shall afford the applicant an opportunity to present
information in person concerning an application to  a  committee  desig-
nated by the council.
  2-b.  Beginning  on  January  first, nineteen hundred ninety-four, and
each year thereafter, a complete application  received  between  January
first and June thirtieth of each year shall be reviewed by the appropri-
ate health systems agency and the department and presented to the public
health  and  health planning council for its consideration prior to June
thirtieth of the following year  and  a  complete  application  received
between  July  first  and  December  thirty-first  of each year shall be
reviewed by the appropriate health systems agency and the department and
presented to the public health and health planning council for consider-
ation prior to December thirty-first of the following year.
  3. Subject to the provisions of paragraph (b) of subdivision two,  the
commissioner in approving the construction of a hospital shall take into
consideration  and  be empowered to request information and advice as to
(a) the availability of facilities or  services  such  as  preadmission,
ambulatory  or  home  care  services  which may serve as alternatives or
substitutes  for  the  whole  or  any  part  of  the  proposed  hospital
construction;
  (b)  the need for special equipment in view of existing utilization of
comparable equipment at the time and place and under  the  circumstances
proposed;
  (c)  the  possible  economies and improvements in service to be antic-
ipated from the operation of joint central services including,  but  not
limited  to  laboratory,  research,  radiology,  pharmacy,  laundry  and
purchasing;
  (d) the adequacy of financial resources and sources of future revenue,
PROVIDED THAT THE COMMISSIONER MAY, BUT IS NOT REQUIRED TO, CONSIDER THE
ADEQUACY OF  FINANCIAL  RESOURCES  AND  SOURCES  OF  FUTURE  REVENUE  IN
RELATION TO APPLICATIONS UNDER SUBPARAGRAPHS (II) AND (III) OF PARAGRAPH
(B) OF SUBDIVISION TWO OF THIS SECTION; and
  (e)  whether  the facility is currently in substantial compliance with
all applicable codes, rules and regulations, provided, however, that the
commissioner shall not disapprove an application  solely  on  the  basis
that  the  facility  is  not currently in substantial compliance, if the
application is specifically:
  (i) to correct life safety code or patient care deficiencies;
  (ii) to correct deficiencies which are necessary to protect the  life,
health, safety and welfare of facility patients, residents or staff;

S. 2606--C                         141

  (iii)  for replacement of equipment that no longer meets the generally
accepted operational standards existing for such equipment at  the  time
it was acquired; and
  (iv) for decertification of beds and services.
  S  44.  Subdivisions 1, 2 and 3 of section 2807-z of the public health
law, as amended by chapter 400 of the laws of 2012, are amended to  read
as follows:
  1. Notwithstanding any provision of this chapter or regulations or any
other  state  law  or  regulation,  for  any eligible capital project as
defined in subdivision six of this section, the  department  shall  have
thirty days of receipt of the certificate of need OR CONSTRUCTION appli-
cation,  PURSUANT  TO  SECTION TWENTY-EIGHT HUNDRED TWO OF THIS ARTICLE,
for  a  limited  or  administrative  review  to  deem  such  application
complete.  If the department determines the application is incomplete or
that more information is  required,  the  department  shall  notify  the
applicant in writing within thirty days of the date of the application's
submission, and the applicant shall have twenty business days to provide
additional information or otherwise correct the deficiency in the appli-
cation.
  2.  For an eligible capital project requiring a limited or administra-
tive review, within ninety days of the department deeming  the  applica-
tion complete, the department shall make a decision to approve or disap-
prove  the  certificate  of  need  OR  CONSTRUCTION application for such
project. If the department determines to  disapprove  the  project,  the
basis for such disapproval shall be provided in writing; however, disap-
proval  shall  not be based on the incompleteness of the application. If
the department fails to take action to approve or disapprove the  appli-
cation  within  ninety days of the certificate of need application being
deemed complete, the application will be deemed approved.
  3. For an eligible capital project requiring full review by the  coun-
cil, the certificate of need OR CONSTRUCTION application shall be placed
on the next council agenda following the department deeming the applica-
tion complete.
  S 45. Intentionally omitted.
  S  46.  Section 2801-a of the public health law is amended by adding a
new subdivision 3-b to read as follows:
  3-B. NOTWITHSTANDING ANY OTHER  PROVISIONS  OF  THIS  CHAPTER  TO  THE
CONTRARY,  THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL MAY APPROVE THE
ESTABLISHMENT OF DIAGNOSTIC OR TREATMENT CENTERS TO BE ISSUED  OPERATING
CERTIFICATES  FOR  THE  PURPOSE OF PROVIDING PRIMARY CARE, AS DEFINED BY
THE COMMISSIONER IN REGULATIONS, WITHOUT REGARD TO THE  REQUIREMENTS  OF
PUBLIC NEED AND FINANCIAL RESOURCES AS SET FORTH IN SUBDIVISION THREE OF
THIS SECTION.
  S 47.  Intentionally omitted.
  S 48.  Intentionally omitted.
  S 49.  Intentionally omitted.
  S 50. Intentionally omitted.
  S  51. The mental hygiene law is amended by adding a new section 32.20
to read as follows:
S 32.20 TEMPORARY OPERATOR.  1. FOR THE PURPOSES OF THIS SECTION:
  (A) "CHEMICAL DEPENDENCE  TREATMENT  PROGRAM"  SHALL  MEAN  A  PROGRAM
CERTIFIED PURSUANT TO SECTION 32.05 OF THIS ARTICLE;
  (B)  "ESTABLISHED  OPERATOR"  SHALL  MEAN  THE  OPERATOR OF A CHEMICAL
DEPENDENCE TREATMENT PROGRAM THAT HAS BEEN  ESTABLISHED  AND  ISSUED  AN
OPERATING CERTIFICATE PURSUANT TO SECTION 32.05 OF THIS ARTICLE;

S. 2606--C                         142

  (C)  "TEMPORARY OPERATOR" SHALL MEAN ANY OASAS STAFF MEMBER, PERSON OR
ENTITY THAT:
  (I)  AGREES  TO  OPERATE  A  PROGRAM  ON A TEMPORARY BASIS IN THE BEST
INTERESTS OF ITS PATIENTS AND THE COMMUNITY SERVED BY THE PROGRAM;
  (II) HAS DEMONSTRATED THAT HE OR SHE HAS THE CHARACTER, COMPETENCE AND
ABILITY TO OPERATE AN OASAS-CERTIFIED PROGRAM IN COMPLIANCE WITH  APPLI-
CABLE STANDARDS; AND
  (III)  PRIOR TO HIS OR HER APPOINTMENT AS TEMPORARY OPERATOR, DEVELOPS
WITH GUIDANCE FROM THE COMMISSIONER A SATISFACTORY PLAN TO  ADDRESS  THE
PROGRAM'S DEFICIENCIES;
  (D)  "SERIOUS  FINANCIAL INSTABILITY" SHALL INCLUDE BUT NOT BE LIMITED
TO DEFAULTING OR VIOLATING KEY COVENANTS OF BOND ISSUES, MISSED MORTGAGE
PAYMENTS, GENERAL UNTIMELY PAYMENT OF DEBTS, FAILURE TO PAY ITS  EMPLOY-
EES  OR  VENDORS,  INSUFFICIENT  FUNDS  TO  MEET  THE  GENERAL OPERATING
EXPENSES OF THE PROGRAM AND/OR FACILITY, FAILURE  TO  MAINTAIN  REQUIRED
DEBT  SERVICE  COVERAGE  RATIOS AND/OR, AS APPLICABLE, FACTORS THAT HAVE
TRIGGERED A WRITTEN EVENT OF DEFAULT NOTICE TO THE OFFICE BY THE  DORMI-
TORY AUTHORITY OF THE STATE OF NEW YORK; AND
  (E)  "EXTRAORDINARY  FINANCIAL  ASSISTANCE"  SHALL  MEAN  STATE  FUNDS
PROVIDED TO, OR REQUESTED BY, A  PROGRAM  FOR  THE  EXPRESS  PURPOSE  OF
PREVENTING  THE  CLOSURE  OF  THE  PROGRAM  THAT  THE COMMISSIONER FINDS
PROVIDES ESSENTIAL AND NECESSARY SERVICES WITHIN THE COMMUNITY.
  2. (A) IN THE EVENT THAT: (I)  THE  OFFICE  IMPOSED  A  PENALTY  ON  A
PROGRAM  WITHIN  THE  PRIOR  TWELVE  MONTHS; (II) THE PROGRAM IS SEEKING
EXTRAORDINARY FINANCIAL ASSISTANCE; (III) OFFICE  COLLECTED  DATA  INDI-
CATES  THAT  THE  PROGRAM  IS EXPERIENCING SERIOUS FINANCIAL INSTABILITY
ISSUES; (IV) OFFICE COLLECTED DATA INDICATES THAT THE PROGRAM'S BOARD OF
DIRECTORS OR ADMINISTRATION ARE UNABLE OR UNWILLING TO ENSURE THE PROPER
OPERATION OF THE PROGRAM; (V) THE PROGRAM HAS VIOLATED THE TERMS OF  ITS
CONTRACT  WITH  THE STATE; OR (VI) OFFICE COLLECTED DATA INDICATES THERE
ARE CONDITIONS THAT SERIOUSLY ENDANGER OR JEOPARDIZE CONTINUED ACCESS TO
NECESSARY CHEMICAL DEPENDENCE TREATMENT SERVICES WITHIN  THE  COMMUNITY,
THE  COMMISSIONER  SHALL  NOTIFY  THE ESTABLISHED OPERATOR OF HIS OR HER
INTENTION TO APPOINT A TEMPORARY OPERATOR TO ASSUME SOLE  RESPONSIBILITY
FOR  THE  PROGRAM'S  TREATMENT OPERATIONS OF THAT FACILITY FOR A LIMITED
PERIOD OF TIME. THE APPOINTMENT OF A TEMPORARY OPERATOR SHALL BE  EFFEC-
TUATED  PURSUANT  TO THIS SECTION, AND SHALL BE IN ADDITION TO ANY OTHER
REMEDIES PROVIDED BY LAW.
  (B) THE ESTABLISHED OPERATOR OF A PROGRAM MAY AT ANY TIME REQUEST  THE
COMMISSIONER  TO  APPOINT  A  TEMPORARY  OPERATOR. UPON RECEIVING SUCH A
REQUEST, THE COMMISSIONER MAY, IF HE OR  SHE  DETERMINES  THAT  SUCH  AN
ACTION IS NECESSARY, ENTER INTO AN AGREEMENT WITH THE ESTABLISHED OPERA-
TOR  FOR  THE APPOINTMENT OF A TEMPORARY OPERATOR TO RESTORE OR MAINTAIN
THE PROVISION OF QUALITY CARE TO  THE  PATIENTS  UNTIL  THE  ESTABLISHED
OPERATOR  CAN  RESUME  OPERATIONS WITHIN THE DESIGNATED TIME PERIOD; THE
PATIENTS MAY BE TRANSFERRED TO OTHER OASAS-CERTIFIED PROVIDERS;  OR  THE
PROGRAM OPERATIONS OF THAT FACILITY SHOULD BE COMPLETELY DISCONTINUED.
  3.  (A)  A TEMPORARY OPERATOR APPOINTED PURSUANT TO THIS SECTION SHALL
USE HIS OR HER BEST EFFORTS TO IMPLEMENT THE  PLAN  DEVELOPED  WITH  THE
GUIDANCE OF THE COMMISSIONER TO CORRECT OR ELIMINATE ANY DEFICIENCIES IN
THE  PROGRAM  AND  TO  PROMOTE THE QUALITY AND ACCESSIBILITY OF CHEMICAL
DEPENDENCE TREATMENT SERVICES IN THE COMMUNITY SERVED BY THE PROGRAM.
  (B) IF THE IDENTIFIED PROGRAM DEFICIENCIES CANNOT BE ADDRESSED IN  THE
TIME PERIOD DESIGNATED IN THE PLAN, THE PATIENTS SHALL BE TRANSFERRED TO
OTHER OASAS-CERTIFIED PROVIDERS.

S. 2606--C                         143

  (C)  DURING THE TERM OF HIS OR HER APPOINTMENT, THE TEMPORARY OPERATOR
SHALL HAVE THE AUTHORITY TO DIRECT THE PROGRAM STAFF OF THE FACILITY  IN
ALL  ASPECTS  NECESSARY  TO  APPROPRIATELY  TREAT  AND/OR  TRANSFER  THE
PATIENTS. THE TEMPORARY OPERATOR SHALL, DURING THIS PERIOD, OPERATE  THE
PROGRAM IN SUCH A MANNER AS TO PROMOTE SAFETY AND THE QUALITY AND ACCES-
SIBILITY  OF  CHEMICAL  DEPENDENCE  TREATMENT  SERVICES IN THE COMMUNITY
SERVED BY THE FACILITY UNTIL EITHER THE ESTABLISHED OPERATOR CAN  RESUME
PROGRAM  OPERATIONS  OR UNTIL THE PATIENTS ARE APPROPRIATELY TRANSFERRED
TO OTHER OASAS-CERTIFIED PROVIDERS.
  (D) THE TEMPORARY OPERATOR SHALL NOT BE REQUIRED TO FILE ANY BOND.  NO
SECURITY INTEREST IN ANY REAL OR PERSONAL PROPERTY COMPRISING THE FACIL-
ITY  OR CONTAINED WITHIN THE FACILITY OR IN ANY FIXTURE OF THE FACILITY,
SHALL BE IMPAIRED OR DIMINISHED IN PRIORITY BY THE  TEMPORARY  OPERATOR.
NEITHER THE TEMPORARY OPERATOR NOR THE OFFICE SHALL ENGAGE IN ANY ACTIV-
ITY THAT CONSTITUTES A CONFISCATION OF PROPERTY.
  4.  THE  TEMPORARY  OPERATOR SHALL BE ENTITLED TO A REASONABLE FEE, AS
DETERMINED BY THE COMMISSIONER, AND NECESSARY EXPENSES  INCURRED  DURING
HIS  OR  HER  PERFORMANCE  AS TEMPORARY OPERATOR. THE TEMPORARY OPERATOR
SHALL BE LIABLE ONLY IN HIS OR HER CAPACITY AS TEMPORARY OPERATOR OF THE
PROGRAM FOR INJURY TO PERSON AND PROPERTY BY REASON OF HIS OR HER OPERA-
TION OF SUCH PROGRAM; HE OR SHE SHALL NOT HAVE ANY LIABILITY IN  HIS  OR
HER PERSONAL CAPACITY, EXCEPT FOR GROSS NEGLIGENCE AND INTENTIONAL ACTS.
  5.  (A)  THE INITIAL TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR
SHALL NOT EXCEED NINETY DAYS. AFTER NINETY  DAYS,  IF  THE  COMMISSIONER
DETERMINES  THAT  TERMINATION  OF  THE  TEMPORARY  OPERATOR  WOULD CAUSE
SIGNIFICANT DETERIORATION OF THE QUALITY OF, OR ACCESS TO,  HEALTH  CARE
IN THE COMMUNITY OR THAT REAPPOINTMENT IS NECESSARY TO CORRECT THE DEFI-
CIENCIES  THAT  REQUIRED  THE APPOINTMENT OF THE TEMPORARY OPERATOR, THE
COMMISSIONER MAY AUTHORIZE AN ADDITIONAL NINETY-DAY TERM. HOWEVER,  SUCH
AUTHORIZATION  SHALL INCLUDE THE COMMISSIONER'S REQUIREMENTS FOR CONCLU-
SION OF THE TEMPORARY OPERATORSHIP TO BE SATISFIED WITHIN THE ADDITIONAL
TERM.
  (B) WITHIN FOURTEEN DAYS PRIOR TO THE TERMINATION OF EACH TERM OF  THE
APPOINTMENT  OF  THE  TEMPORARY  OPERATOR,  THE TEMPORARY OPERATOR SHALL
SUBMIT TO THE COMMISSIONER AND TO  THE  ESTABLISHED  OPERATOR  A  REPORT
DESCRIBING:
  (I)  THE  ACTIONS TAKEN DURING THE APPOINTMENT TO ADDRESS: THE IDENTI-
FIED PROGRAM DEFICIENCIES; THE RESUMPTION OF PROGRAM OPERATIONS  BY  THE
ESTABLISHED   OPERATOR;  OR  THE  TRANSFER  OF  THE  PATIENTS  TO  OTHER
OASAS-CERTIFIED PROVIDERS;
  (II) OBJECTIVES FOR THE CONTINUATION OF THE TEMPORARY OPERATORSHIP  IF
NECESSARY AND A SCHEDULE FOR SATISFACTION OF SUCH OBJECTIVES; AND
  (III) IF APPLICABLE, THE RECOMMENDED ACTIONS FOR THE ONGOING OPERATION
OF THE PROGRAM SUBSEQUENT TO THE TEMPORARY OPERATORSHIP.
  (C)  THE  TERM  OF THE INITIAL APPOINTMENT AND OF ANY SUBSEQUENT REAP-
POINTMENT MAY BE TERMINATED PRIOR TO THE EXPIRATION  OF  THE  DESIGNATED
TERM,  IF  THE ESTABLISHED OPERATOR AND THE COMMISSIONER AGREE ON A PLAN
OF CORRECTION AND THE IMPLEMENTATION OF SUCH PLAN.
  6. (A) THE COMMISSIONER SHALL,  UPON  MAKING  A  DETERMINATION  OF  AN
INTENTION  TO  APPOINT A TEMPORARY OPERATOR PURSUANT TO PARAGRAPH (A) OF
SUBDIVISION TWO OF THIS SECTION CAUSE THE ESTABLISHED  OPERATOR  OF  THE
FACILITY TO BE NOTIFIED OF THE INTENTION BY REGISTERED OR CERTIFIED MAIL
ADDRESSED  TO  THE  PRINCIPAL  OFFICE  OF THE ESTABLISHED OPERATOR. SUCH
NOTIFICATION SHALL INCLUDE A DETAILED DESCRIPTION OF THE FINDINGS UNDER-
LYING THE INTENTION TO APPOINT A TEMPORARY OPERATOR, AND  THE  DATE  AND
TIME  OF  A  REQUIRED  MEETING  WITH  THE COMMISSIONER AND/OR HIS OR HER

S. 2606--C                         144

DESIGNEE WITHIN TEN BUSINESS DAYS OF THE RECEIPT OF SUCH NOTICE. AT SUCH
MEETING, THE ESTABLISHED OPERATOR SHALL HAVE THE OPPORTUNITY  TO  REVIEW
AND DISCUSS ALL RELEVANT FINDINGS. AT SUCH MEETING, THE COMMISSIONER AND
THE  ESTABLISHED  OPERATOR SHALL ATTEMPT TO DEVELOP A MUTUALLY SATISFAC-
TORY PLAN OF CORRECTION AND SCHEDULE FOR IMPLEMENTATION. IN SUCH  EVENT,
THE  COMMISSIONER SHALL NOTIFY THE ESTABLISHED OPERATOR THAT THE COMMIS-
SIONER WILL ABSTAIN FROM APPOINTING A TEMPORARY OPERATOR CONTINGENT UPON
THE ESTABLISHED OPERATOR REMEDIATING THE IDENTIFIED DEFICIENCIES  WITHIN
THE AGREED UPON TIMEFRAME.
  (B)  SHOULD THE COMMISSIONER AND THE ESTABLISHED OPERATOR BE UNABLE TO
ESTABLISH A PLAN OF CORRECTION PURSUANT TO PARAGRAPH (A) OF THIS  SUBDI-
VISION,  OR  SHOULD  THE  ESTABLISHED  OPERATOR  FAIL  TO RESPOND TO THE
COMMISSIONER'S INITIAL NOTIFICATION, THERE SHALL  BE  AN  ADMINISTRATIVE
HEARING ON THE COMMISSIONER'S DETERMINATION TO APPOINT A TEMPORARY OPER-
ATOR  TO  BEGIN NO LATER THAN THIRTY DAYS FROM THE DATE OF THE NOTICE TO
THE ESTABLISHED OPERATOR. ANY SUCH HEARING SHALL BE STRICTLY LIMITED  TO
THE  ISSUE OF WHETHER THE DETERMINATION OF THE COMMISSIONER TO APPOINT A
TEMPORARY OPERATOR IS SUPPORTED BY SUBSTANTIAL EVIDENCE. A COPY  OF  THE
DECISION SHALL BE SENT TO THE ESTABLISHED OPERATOR.
  (C)  IF  THE  DECISION  TO APPOINT A TEMPORARY OPERATOR IS UPHELD SUCH
TEMPORARY OPERATOR SHALL BE APPOINTED AS  SOON  AS  IS  PRACTICABLE  AND
SHALL OPERATE THE PROGRAM PURSUANT TO THE PROVISIONS OF THIS SECTION.
  7. NOTWITHSTANDING THE APPOINTMENT OF A TEMPORARY OPERATOR, THE ESTAB-
LISHED  OPERATOR  REMAINS  OBLIGATED  FOR THE CONTINUED OPERATION OF THE
FACILITY SO THAT THE  PROGRAM  CAN  FUNCTION  IN  A  NORMAL  MANNER.  NO
PROVISION  CONTAINED  IN  THIS  SECTION  SHALL  BE DEEMED TO RELIEVE THE
ESTABLISHED OPERATOR OR ANY  OTHER  PERSON  OF  ANY  CIVIL  OR  CRIMINAL
LIABILITY  INCURRED,  OR  ANY  DUTY IMPOSED BY LAW, BY REASON OF ACTS OR
OMISSIONS OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON PRIOR  TO  THE
APPOINTMENT  OF  ANY  TEMPORARY  OPERATOR  OF THE PROGRAM HEREUNDER; NOR
SHALL ANYTHING CONTAINED IN THIS SECTION BE CONSTRUED TO SUSPEND  DURING
THE TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR OF THE PROGRAM ANY
OBLIGATION OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON FOR THE MAIN-
TENANCE  AND  REPAIR  OF  THE  FACILITY,  PROVISION OF UTILITY SERVICES,
PAYMENT OF TAXES OR OTHER OPERATING  AND  MAINTENANCE  EXPENSES  OF  THE
FACILITY,  NOR  OF  THE ESTABLISHED OPERATOR OR ANY OTHER PERSON FOR THE
PAYMENT OF MORTGAGES OR LIENS.
  S 52. Intentionally omitted.
  S 53. Intentionally omitted.
  S 54. Intentionally omitted.
  S 55. Intentionally omitted.
  S 56. Intentionally omitted.
  S 57. Intentionally omitted.
  S 58. Intentionally omitted.
  S 59. Intentionally omitted.
  S 60. Intentionally omitted.
  S 61. Intentionally omitted.
  S 62. Intentionally omitted.
  S 63. Intentionally omitted.
  S 64. Intentionally omitted.
  S 65. Intentionally omitted.
  S 66. Intentionally omitted.
  S 67. Intentionally omitted.
  S 68. Intentionally omitted.
  S 69. Intentionally omitted.
  S 70. Intentionally omitted.

S. 2606--C                         145

  S 71. Intentionally omitted.
  S 72. Intentionally omitted.
  S 73. Intentionally omitted.
  S 74. Intentionally omitted.
  S 75. Intentionally omitted.
  S 76. Intentionally omitted.
  S 77. Intentionally omitted.
  S 78. Intentionally omitted.
  S 79. Intentionally omitted.
  S 80. Intentionally omitted.
  S 81. Intentionally omitted.
  S 82. Intentionally omitted.
  S 83. Intentionally omitted.
  S 84. Intentionally omitted.
  S 85. Intentionally omitted.
  S 86. Intentionally omitted.
  S 87.  Intentionally omitted.
  S 88.  Intentionally omitted.
  S 89. Intentionally omitted.
  S  90.  Subdivision 1 of section 6605-b of the education law, as added
by chapter 437 of the laws of 2001, is amended to read as follows:
  1. [A] NOTWITHSTANDING ANY PROVISION HEREIN TO THE CONTRARY, A  dental
hygienist  shall  not  administer  or monitor nitrous oxide analgesia or
local infiltration anesthesia in the practice of dental hygiene  without
a  dental hygiene restricted local infiltration anesthesia/nitrous oxide
analgesia certificate and except under the  personal  supervision  of  a
dentist and in conjunction with the performance of dental hygiene proce-
dures  authorized  by law and in accordance with regulations promulgated
by the commissioner. Personal supervision, for purposes of this section,
means that the supervising dentist remains in the  dental  office  where
the  local  infiltration  anesthesia or nitrous oxide analgesia services
are being performed, personally authorizes and  prescribes  the  use  of
local infiltration anesthesia or nitrous oxide analgesia for the patient
and,  before dismissal of the patient, personally examines the condition
of the patient after the use of local infiltration anesthesia or nitrous
oxide analgesia is  completed.  It  is  professional  misconduct  for  a
dentist to fail to provide the supervision required by this section, and
any  dentist  found  guilty  of  such  misconduct  under  the procedures
prescribed in section sixty-five hundred ten  of  this  title  shall  be
subject to the penalties prescribed in section sixty-five hundred eleven
of this title.
  S  91.  Subdivision 1 of section 6606 of the education law, as amended
by chapter 437 of the laws of 2001, is amended to read as follows:
  1. The practice of the profession of dental hygiene is defined as  the
performance  of  dental services which shall include removing calcareous
deposits, accretions and stains from the exposed surfaces of  the  teeth
which  begin  at  the  epithelial attachment and applying topical agents
indicated for a complete dental prophylaxis, removing cement, placing or
removing rubber dam, removing sutures, placing  matrix  band,  providing
patient  education,  applying  topical  medication, placing and exposing
DIAGNOSTIC DENTAL X-ray films, performing topical fluoride  applications
and  topical  anesthetic  applications,  polishing teeth, taking medical
history, charting caries, taking impressions for  study  casts,  placing
and   removing  temporary  restorations,  administering  and  monitoring
nitrous oxide analgesia and administering and  monitoring  local  infil-
tration  anesthesia, subject to certification in accordance with section

S. 2606--C                         146

sixty-six hundred five-b of this article, and any other function in  the
definition  of  the  practice  of  dentistry  as  may  be delegated by a
licensed dentist in  accordance  with  regulations  promulgated  by  the
commissioner.  The  practice  of  dental hygiene may be conducted in the
office of any licensed dentist or in any appropriately  equipped  school
or public institution but must be done EITHER under the supervision of a
licensed  dentist OR, IN THE CASE OF A REGISTERED DENTAL HYGIENIST WORK-
ING FOR A HOSPITAL AS DEFINED IN  ARTICLE  TWENTY-EIGHT  OF  THE  PUBLIC
HEALTH  LAW,  PURSUANT  TO  A  COLLABORATIVE ARRANGEMENT WITH A LICENSED
DENTIST PURSUANT TO REGULATIONS PROMULGATED PURSUANT TO ARTICLE  TWENTY-
EIGHT OF THE PUBLIC HEALTH LAW.
  S  92. Section 6608 of the education law, as amended by chapter 300 of
the laws of 2006, is amended to read as follows:
  S 6608. Definition of practice  of  certified  dental  assisting.  The
practice  of certified dental assisting is defined as providing support-
ive services to a dentist in  his/her  performance  of  dental  services
authorized  under  this  article.  Such  support shall include providing
patient education, taking preliminary medical histories and vital  signs
to be reviewed by the dentist, placing and removing rubber dams, select-
ing  and  prefitting provisional crowns, selecting and prefitting ortho-
dontic bands, removing orthodontic arch wires and ligature ties, placing
and removing matrix bands, taking impressions for study casts  or  diag-
nostic  casts,  removing  periodontal  dressings,  and such other dental
supportive services authorized by  the  dentist  consistent  with  regu-
lations  promulgated  by  the commissioner, provided that such functions
are performed under  the  direct  personal  supervision  of  a  licensed
dentist  in  the  course  of  the  performance  of dental services. Such
services shall not include diagnosing and/or performing surgical  proce-
dures,  irreversible  procedures or procedures that would alter the hard
or soft tissue of the oral and maxillofacial area or  any  other  proce-
dures  determined  by  the  department. The practice of certified dental
assisting may be conducted in the office of any licensed dentist  or  in
any appropriately equipped school or public institution but must be done
under  the  direct  personal  supervision of a licensed dentist.  Direct
personal supervision, for purposes of this section, means supervision of
dental procedures based on instructions given by a licensed  dentist  in
the  course  of  a  procedure who remains in the dental office where the
supportive services are being performed, personally diagnoses the condi-
tion to be treated, personally authorizes  the  procedures,  and  before
dismissal of the patient, who remains the responsibility of the licensed
dentist, evaluates the services performed by the dental assistant. Noth-
ing  herein authorizes a dental assistant to perform any of the services
or functions defined as part  of  the  practice  of  dental  hygiene  in
accordance  with  the provisions of subdivision one of section sixty-six
hundred six of this article, except those functions authorized  pursuant
to this section. All dental supportive services provided in this section
may  be  performed  by  currently  registered  dental hygienists under a
dentist's supervision OR BY A REGISTERED DENTAL HYGIENIST WORKING FOR  A
HOSPITAL AS DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW WHO
PRACTICES  IN  COLLABORATION  WITH A LICENSED DENTIST IN ACCORDANCE WITH
SUBDIVISION ONE OF SECTION SIXTY-SIX HUNDRED SIX  OF  THIS  ARTICLE,  as
defined in regulations of the commissioner.
  S  93. Subdivision 10 of section 6611 of the education law, as amended
by chapter 65 of the laws of 2011, is amended to read as follows:
  10. [Beginning January first, two thousand nine,  each]  EACH  dentist
AND  REGISTERED  DENTAL  HYGIENIST  WORKING FOR A HOSPITAL AS DEFINED IN

S. 2606--C                         147

ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW WHO PRACTICES  IN  COLLAB-
ORATION  WITH  A LICENSED DENTIST shall become certified in cardiopulmo-
nary resuscitation (CPR) from an approved provider and thereafter  main-
tain  current  certification,  which  shall be included in the mandatory
hours of continuing education acceptable  for  dentists  to  the  extent
provided  in the commissioner's regulations. In the event the dentist OR
REGISTERED DENTAL HYGIENIST cannot physically perform CPR,  the  commis-
sioner's  regulations  shall  allow  the  dentist  OR  REGISTERED DENTAL
HYGIENIST to make arrangements for another individual in the  office  to
administer  CPR.  All dental facilities shall have an automatic external
defibrillator or other defibrillator at the facility.
  S 94. Subdivision 2 of section 903 of the education law, as  added  by
chapter 281 of the laws of 2007, is amended to read as follows:
  2.  a.  A  dental  health  certificate  shall  be  requested from each
student.  Each student is requested to furnish a dental  health  certif-
icate  at the same time that health certificates are required. An [exam-
ination] ASSESSMENT and dental  health  history  of  any  child  may  be
requested  by  the  local  school  authorities  at  any  time  in  their
discretion to promote the educational  interests  of  such  child.  Each
certificate  shall be signed by a duly licensed dentist, OR A REGISTERED
DENTAL HYGIENIST who is authorized by law to practice in this state, and
consistent with any applicable written practice agreement, or by a  duly
licensed  dentist  OR  REGISTERED  DENTAL HYGIENIST who is authorized to
practice in the jurisdiction in which the [examination]  ASSESSMENT  was
given, provided that the commissioner has determined that such jurisdic-
tion  has standards of licensure and practice comparable to those of New
York. Each such certificate shall describe the dental  health  condition
of  the  student when the [examination] ASSESSMENT was made, which shall
not be more than twelve months prior to the commencement of  the  school
year in which the [examination] ASSESSMENT is requested, and shall state
whether  such student is in fit condition of dental health to permit his
or her attendance at the public schools.
  b. A notice  of  request  for  dental  health  certificates  shall  be
distributed  at  the  same  time  that  parents  or  person  in parental
relationship to students are notified of health examination requirements
and shall state that a list of DENTAL PRACTICES, dentists AND REGISTERED
DENTAL HYGIENISTS to which children [who need comprehensive dental exam-
inations] may be referred for [treatment] DENTAL SERVICES on a  free  or
reduced  cost basis is available upon request at the child's school. The
department shall,  in  collaboration  with  the  department  of  health,
compile and maintain a list of DENTAL PRACTICES, dentists AND REGISTERED
DENTAL HYGIENISTS to which children [who need comprehensive dental exam-
inations]  may  be referred for [treatment] DENTAL SERVICES on a free or
reduced cost basis. Such list shall be  made  available  to  all  public
schools and be made available to parents or person in parental relation-
ship upon request. The department shall promulgate regulations to ensure
the  gathering and dissemination of the proper information to interested
parties.
  S 95. Intentionally omitted.
  S 96. Subdivisions 3 and 5 of section 6542 of the  education  law,  as
amended  by  chapter  48  of  the  laws  of 2012, are amended to read as
follows:
  3. No physician shall employ or supervise more than [two] FOUR  physi-
cian assistants in his or her private practice.
  5.  Notwithstanding any other provision of this article, nothing shall
prohibit a physician employed by or rendering services to the department

S. 2606--C                         148

of corrections and community supervision under contract from supervising
no more than [four] SIX physician assistants in his or her practice  for
the department of corrections and community supervision.
  S 97. The opening paragraph, and paragraphs (k) and (l) of subdivision
1  of  section 3510 of the public health law, as added by chapter 175 of
the laws of 2006, are amended and four new paragraphs (m), (n), (o)  and
(p) are added to read as follows:
  The  license,  registration  or  intravenous  contrast  administration
certificate of a [radiological] RADIOLOGIC technologist may be suspended
for a fixed period, revoked or  annulled,  or  such  licensee  censured,
reprimanded,  subject  to  a  civil  penalty  not to exceed two thousand
dollars for every such violation, or otherwise disciplined,  in  accord-
ance  with  the  provisions and procedures defined in this article, upon
decision after due hearing that the individual is guilty of the  follow-
ing misconduct:
  (k)  using  the prefix "Dr.", the word "doctor" or any suffix or affix
to indicate or imply that the licensee is a duly  licensed  practitioner
as defined in this article when not so licensed; [or]
  (l) incompetence or negligence[.];
  (M)  BEING  CONVICTED  OF COMMITTING AN ACT CONSTITUTING A CRIME UNDER
(I) NEW YORK STATE LAW; (II) FEDERAL LAW; OR (III) THE  LAW  OF  ANOTHER
JURISDICTION  AND  WHICH,  IF  COMMITTED  WITHIN  THIS STATE, WOULD HAVE
CONSTITUTED A CRIME UNDER NEW YORK STATE LAW;
  (N) HAVING BEEN FOUND GUILTY  OF  IMPROPER  PROFESSIONAL  PRACTICE  OR
PROFESSIONAL  MISCONDUCT  BY A DULY AUTHORIZED PROFESSIONAL DISCIPLINARY
AGENCY OF ANOTHER STATE WHERE THE CONDUCT UPON  WHICH  THE  FINDING  WAS
BASED,  IF  COMMITTED  IN  NEW YORK STATE, WOULD CONSTITUTE PROFESSIONAL
MISCONDUCT UNDER THE LAWS OF NEW YORK STATE;
  (O) HAVING BEEN FOUND GUILTY IN AN ADJUDICATORY PROCEEDING OF  VIOLAT-
ING  A STATE OR FEDERAL STATUTE OR REGULATION, PURSUANT TO A FINAL DECI-
SION OR DETERMINATION, AND WHEN NO APPEAL IS PENDING,  OR  AFTER  RESOL-
UTION  OF  THE  PROCEEDING  BY  STIPULATION  OR  AGREEMENT, AND WHEN THE
VIOLATION WOULD CONSTITUTE PROFESSIONAL MISCONDUCT UNDER THE LAWS OF NEW
YORK STATE; OR
  (P) HAVING HIS OR HER LICENSE TO PRACTICE AS A RADIOLOGIC TECHNOLOGIST
REVOKED, SUSPENDED OR HAVING OTHER DISCIPLINARY ACTION TAKEN, OR  HAVING
HIS  OR  HER  APPLICATION FOR A LICENSE REFUSED, REVOKED OR SUSPENDED OR
HAVING VOLUNTARILY OR OTHERWISE SURRENDERED HIS OR HER LICENSE  AFTER  A
DISCIPLINARY  ACTION  WAS  INSTITUTED  BY A DULY AUTHORIZED PROFESSIONAL
DISCIPLINARY AGENCY OF ANOTHER STATE, WHERE THE CONDUCT RESULTING IN THE
REVOCATION,  SUSPENSION  OR  OTHER  DISCIPLINARY  ACTION  INVOLVING  THE
LICENSE  OR  REFUSAL,  REVOCATION  OR SUSPENSION OF AN APPLICATION FOR A
LICENSE OR THE SURRENDER OF THE LICENSE WOULD, IF COMMITTED IN NEW  YORK
STATE,  CONSTITUTE  PROFESSIONAL  MISCONDUCT  UNDER THE LAWS OF NEW YORK
STATE. A RADIOLOGIC TECHNOLOGIST LICENSED IN NEW YORK STATE WHO IS  ALSO
LICENSED  OR  SEEKING LICENSURE IN ANOTHER STATE MUST IMMEDIATELY REPORT
TO THE DEPARTMENT  ANY  REVOCATION,  SUSPENSION  OR  OTHER  DISCIPLINARY
ACTION  INVOLVING  THE  OUT-OF-STATE  LICENSE  OR REFUSAL, REVOCATION OR
SUSPENSION OF AN APPLICATION FOR AN OUT-OF-STATE LICENSE OR THE  SURREN-
DER OF THE OUT-OF-STATE LICENSE.
  S 98. Intentionally omitted.
  S 99. Intentionally omitted.
  S 100. Intentionally omitted.
  S  101. Section 2801-a of the public health law is amended by adding a
new subdivision 17 to read as follows:

S. 2606--C                         149

  17. (A) DIAGNOSTIC OR TREATMENT CENTERS ESTABLISHED TO PROVIDE  HEALTH
CARE SERVICES WITHIN THE SPACE OF A RETAIL BUSINESS OPERATION, SUCH AS A
PHARMACY,  A STORE OPEN TO THE GENERAL PUBLIC OR A SHOPPING MALL, MAY BE
OPERATED BY LEGAL ENTITIES FORMED UNDER  THE  LAWS  OF  NEW  YORK  WHOSE
STOCKHOLDERS  OR  MEMBERS,  AS  APPLICABLE,  ARE NOT NATURAL PERSONS AND
WHOSE PRINCIPAL STOCKHOLDERS AND MEMBERS, AS APPLICABLE, AND CONTROLLING
PERSONS COMPLY WITH ALL APPLICABLE  REQUIREMENTS  OF  THIS  SECTION  AND
DEMONSTRATE,  TO  THE SATISFACTION OF THE PUBLIC HEALTH AND HEALTH PLAN-
NING COUNCIL, SUFFICIENT EXPERIENCE AND  EXPERTISE  IN  DELIVERING  HIGH
QUALITY  HEALTH  CARE  SERVICES.  SUCH  DIAGNOSTIC AND TREATMENT CENTERS
SHALL BE REFERRED TO IN THIS SECTION AS "LIMITED SERVICES CLINICS".  FOR
PURPOSES  OF  THIS  SUBDIVISION,  THE  PUBLIC HEALTH AND HEALTH PLANNING
COUNCIL SHALL ADOPT AND AMEND RULES AND REGULATIONS, NOTWITHSTANDING ANY
INCONSISTENT PROVISION OF THIS SECTION, TO ADDRESS ANY MATTER  IT  DEEMS
PERTINENT  TO  THE  ESTABLISHMENT  OF LIMITED SERVICES CLINICS; PROVIDED
THAT SUCH RULES AND REGULATIONS SHALL INCLUDE, BUT NOT  BE  LIMITED  TO,
PROVISIONS  GOVERNING OR RELATING TO: (I) ANY DIRECT OR INDIRECT CHANGES
OR TRANSFERS OF OWNERSHIP INTERESTS OR VOTING RIGHTS IN SUCH ENTITIES OR
THEIR STOCKHOLDERS OR MEMBERS, AS APPLICABLE,  AND  PROVIDE  FOR  PUBLIC
HEALTH AND HEALTH PLANNING COUNCIL APPROVAL OF ANY CHANGE IN CONTROLLING
INTERESTS,  PRINCIPAL  STOCKHOLDERS, CONTROLLING PERSONS, PARENT COMPANY
OR SPONSORS; (II) OVERSIGHT OF THE  OPERATOR  AND  ITS  SHAREHOLDERS  OR
MEMBERS,  AS  APPLICABLE,  INCLUDING  LOCAL  GOVERNANCE  OF  THE LIMITED
SERVICES CLINICS; AND (III) RELATING TO THE CHARACTER AND COMPETENCE AND
QUALIFICATIONS OF, AND CHANGES RELATING TO, THE DIRECTORS AND  OFFICERS,
THE OPERATOR AND ITS PRINCIPAL STOCKHOLDERS, CONTROLLING PERSONS, COMPA-
NY OR SPONSORS.
  (B) THE FOLLOWING PROVISIONS OF THIS SECTION SHALL NOT APPLY TO LIMIT-
ED SERVICES CLINICS OPERATED PURSUANT TO THIS SUBDIVISION: (I) PARAGRAPH
(B)  OF  SUBDIVISION THREE OF THIS SECTION, RELATING TO STOCKHOLDERS AND
MEMBERS; (II) PARAGRAPH (C) OF SUBDIVISION FOUR OF THIS SECTION,  RELAT-
ING  TO  THE  DISPOSITION OF STOCK OR VOTING RIGHTS; AND (III) PARAGRAPH
(E) OF SUBDIVISION FOUR OF THIS SECTION, RELATING TO  THE  OWNERSHIP  OF
STOCK OR MEMBERSHIP.
  (C)  A  LIMITED  SERVICES  CLINIC SHALL BE DEEMED TO BE A "HEALTH CARE
PROVIDER" FOR THE PURPOSES OF TITLE TWO-D OF ARTICLE TWO OF  THIS  CHAP-
TER.  A  PRESCRIBER PRACTICING IN A LIMITED SERVICES CLINIC SHALL NOT BE
DEEMED TO BE IN THE EMPLOY OF A PHARMACY OR PRACTICING IN A HOSPITAL FOR
PURPOSES OF SUBDIVISION TWO OF SECTION SIXTY-EIGHT HUNDRED SEVEN OF  THE
EDUCATION LAW.
  (D) THE COMMISSIONER SHALL PROMULGATE REGULATIONS SETTING FORTH OPERA-
TIONAL  AND PHYSICAL PLANT STANDARDS FOR LIMITED SERVICES CLINICS, WHICH
MAY BE DIFFERENT FROM THE REGULATIONS OTHERWISE APPLICABLE TO DIAGNOSTIC
OR TREATMENT CENTERS, INCLUDING, BUT  NOT  LIMITED  TO:  DESIGNATING  OR
LIMITING  THE  DIAGNOSES  AND SERVICES THAT MAY BE PROVIDED; PROHIBITING
THE PROVISION OF SERVICES TO PATIENTS TWENTY-FOUR MONTHS OF AGE OR YOUN-
GER; AND REQUIREMENTS OR GUIDELINES FOR ADVERTISING AND SIGNAGE, DISCLO-
SURE OF OWNERSHIP INTERESTS, INFORMED CONSENT, RECORD KEEPING,  REFERRAL
FOR  TREATMENT  AND  CONTINUITY OF CARE, CASE REPORTING TO THE PATIENT'S
PRIMARY CARE OR  OTHER  HEALTH  CARE  PROVIDERS,  DESIGN,  CONSTRUCTION,
FIXTURES,  AND  EQUIPMENT. IN MAKING REGULATIONS UNDER THIS SECTION, THE
COMMISSIONER MAY CONSULT WITH A WORKGROUP INCLUDING BUT NOT  LIMITED  TO
REPRESENTATIVES  OF  PROFESSIONAL  SOCIETIES  OF APPROPRIATE HEALTH CARE
PROFESSIONALS, INCLUDING THOSE IN PRIMARY CARE AND OTHER SPECIALTIES AND
SHALL PROMOTE AND STRENGTHEN PRIMARY CARE; THE INTEGRATION  OF  SERVICES
PROVIDED  BY  LIMITED SERVICES CLINICS WITH THE SERVICES PROVIDED BY THE

S. 2606--C                         150

PATIENT'S OTHER HEALTH CARE PROVIDERS; AND THE REFERRAL OF  PATIENTS  TO
APPROPRIATE HEALTH CARE PROVIDERS, INCLUDING APPROPRIATE TRANSMISSION OF
PATIENT HEALTH RECORDS.
  (E)  NOTWITHSTANDING  THIS SUBDIVISION AND ANY OTHER LAW OR REGULATION
TO THE CONTRARY AND SUBJECT TO THE PROVISIONS  OF  SECTION  TWENTY-EIGHT
HUNDRED  TWO  OF  THIS ARTICLE, A GENERAL HOSPITAL MAY OPERATE A LIMITED
SERVICES CLINIC WHICH MEETS THE REGULATION PROMULGATED PURSUANT TO PARA-
GRAPH (D) OF THIS SUBDIVISION REGARDING OPERATIONAL AND  PHYSICAL  PLANT
STANDARDS FOR LIMITED SERVICES CLINICS.
  S 102. Intentionally omitted.
  S 103. Intentionally omitted.
  S  104.  Section  2801-a of the public health law is amended by adding
two new subdivisions 18 and 19 to read as follows:
  18. (A) THE COMMISSIONER IS AUTHORIZED TO ESTABLISH A PILOT PROGRAM TO
ASSIST IN ESTABLISHING OR RESTRUCTURING  HEALTH  CARE  DELIVERY  SYSTEMS
THROUGH  INCREASED CAPITAL INVESTMENT IN HEALTH CARE FACILITIES.  PURSU-
ANT TO THE PILOT PROGRAM, THE PUBLIC HEALTH AND HEALTH PLANNING  COUNCIL
SHALL  APPROVE  THE  ESTABLISHMENT, IN ACCORDANCE WITH THE PROVISIONS OF
SUBDIVISION THREE OF THIS SECTION, OF NO MORE THAN TEN  ENTITIES  FORMED
UNDER  EITHER  THIS SUBDIVISION OR SUBDIVISION NINETEEN OF THIS SECTION,
AT LEAST ONE OF WHICH SHALL BE THE OPERATOR OF A HOSPITAL  OR  HOSPITALS
IN KINGS COUNTY. SUCH ENTITIES SHALL AFFILIATE, THE EXTENT OF THE AFFIL-
IATION  TO BE DETERMINED BY THE COMMISSIONER, WITH AT LEAST ONE ACADEMIC
MEDICAL INSTITUTION OR TEACHING HOSPITAL APPROVED BY THE COMMISSIONER.
  (B) IN ORDER TO ACHIEVE SUCCESS IN THE PILOT PROGRAM WHILE MAINTAINING
THE HEALTH AND COMMUNITY MISSION OF A HOSPITAL OR HOSPITALS,  THE  PILOT
PROGRAM MAY ADOPT EITHER A PILOT PROGRAM USING THE PROVISIONS OF ARTICLE
SEVENTEEN  OF  THE BUSINESS CORPORATION LAW PERTAINING TO BENEFIT CORPO-
RATIONS OR, IN THE ALTERNATIVE, THE PROCESS SET FORTH HEREIN IN SUBDIVI-
SION NINETEEN OF THIS SECTION. NOTWITHSTANDING ANY OTHER  PROVISIONS  TO
THE  CONTRARY,  A  PILOT  PROGRAM MAY BE A HOSPITAL CORPORATION OWNED OR
OPERATED THROUGH A BENEFIT CORPORATION BUT NOT A PUBLICLY TRADED  CORPO-
RATION.
  (C)  NOTWITHSTANDING  ANY  PROVISION  OF LAW TO THE CONTRARY, ENTITIES
ESTABLISHED PURSUANT TO THIS SUBDIVISION OR SUBDIVISION NINETEEN OF THIS
SECTION SHALL BE  DEEMED  ELIGIBLE  TO  PARTICIPATE  IN  DEBT  FINANCING
PROVIDED  BY  THE  DORMITORY  AUTHORITY  OF THE STATE OF NEW YORK, LOCAL
DEVELOPMENT CORPORATIONS AND ECONOMIC DEVELOPMENT CORPORATIONS.
  (D) THE FOLLOWING PROVISIONS OF THIS CHAPTER SHALL NOT APPLY TO  ENTI-
TIES ESTABLISHED PURSUANT TO THIS SUBDIVISION OR SUBDIVISION NINETEEN OF
THIS  SECTION:  (I) PARAGRAPH (B) OF SUBDIVISIONS THREE OF THIS SECTION,
RELATING TO STOCKHOLDERS; (II) PARAGRAPH (C) OF SUBDIVISION FOUR OF THIS
SECTION, RELATING TO THE DISPOSITION OF STOCK OR  VOTING  RIGHTS;  (III)
PARAGRAPH  (E)  OF  SUBDIVISION  FOUR  OF  THIS SECTION, RELATING TO THE
OWNERSHIP OF STOCK; AND (IV)  PARAGRAPH  (A)  OF  SUBDIVISION  THREE  OF
SECTION FOUR THOUSAND FOUR OF THIS CHAPTER, RELATING TO THE OWNERSHIP OF
STOCK.    NOTWITHSTANDING  THE  FOREGOING,  THE PUBLIC HEALTH AND HEALTH
PLANNING COUNCIL MAY REQUIRE THE DISCLOSURE OF THE  IDENTITY  OF  STOCK-
HOLDERS OR OTHER INDIVIDUALS SUCH AS LIMITED PARTNERS, PROVIDED THAT THE
NUMBER OF STOCKHOLDERS DOES NOT EXCEED THIRTY-FIVE.
  (E)  THE  CORPORATION  POWERS  AND PURPOSES OF A CORPORATION WHO IS AN
OPERATOR PURSUANT TO THIS SUBDIVISION SHALL BE LIMITED TO THE  OWNERSHIP
AND  OPERATION,  OR  OPERATION,  OF A HOSPITAL OR HOSPITALS SPECIFICALLY
NAMED AND THE LOCATION OR LOCATIONS OF WHICH ARE SPECIFICALLY DESIGNATED
BY STREET ADDRESS, CITY, TOWN, VILLAGE OF LOCALITY AND COUNTY; PROVIDED,
HOWEVER, THAT THE CORPORATE POWERS AND PURPOSES  MAY  ALSO  INCLUDE  THE

S. 2606--C                         151

OWNERSHIP AND OPERATION, OR OPERATION, OF A CERTIFIED HOME HEALTH AGENCY
OR  LICENSED HOME CARE SERVICES AGENCY OR AGENCIES AS DEFINED IN ARTICLE
THIRTY-SIX OF THIS CHAPTER OR A HOSPICE OR HOSPICES AS DEFINED IN  ARTI-
CLE FORTY OF THIS CHAPTER, IF THE CORPORATION HAS RECEIVED ALL APPROVALS
REQUIRED  UNDER  SUCH LAW TO OWN AND OPERATE, OR OPERATE, SUCH HOME CARE
SERVICE AGENCY OR AGENCIES OR  HOSPICE  OR  HOSPICES.  SUCH    CORPORATE
POWERS  AND  PURPOSES  SHALL NOT BE MODIFIED, AMENDED OR DELETED WITHOUT
THE PRIOR APPROVAL OF THE COMMISSIONER.
  (F) (1) ENTITIES FORMED UNDER THIS SUBDIVISION OR SUBDIVISION NINETEEN
OF THIS SECTION SHALL PROVIDE, THAT, IN DISCHARGING THE DUTIES OF  THEIR
RESPECTIVE  POSITIONS,  THE  BOARD OF DIRECTORS, COMMITTEES OF THE BOARD
AND INDIVIDUAL DIRECTORS AND OFFICERS OF AN ENTITY OPERATING PURSUANT TO
THIS SUBDIVISION SHALL CONSIDER THE EFFECTS OF ANY ACTION UPON:
  (A) THE ABILITY OF THE ENTITY TO ACCOMPLISH ITS PURPOSE;
  (B) THE SHAREHOLDERS OF THE BUSINESS  CORPORATION  OR  PARTNERS  IN  A
PARTNERSHIP;
  (C) THE EMPLOYEES AND WORKFORCE OF THE BUSINESS;
  (D) THE INTERESTS OF PATIENTS OF THE HOSPITAL OR HOSPITALS;
  (E)  COMMUNITY  AND  SOCIETAL  CONSIDERATIONS,  INCLUDING THOSE OF ANY
COMMUNITY IN WHICH FACILITIES OF THE CORPORATION ARE LOCATED;
  (F) THE LOCAL AND GLOBAL ENVIRONMENT; AND
  (G) THE SHORT-TERM AND LONG-TERM INTERESTS OF  THE  ENTITY,  INCLUDING
BENEFITS THAT MAY ACCRUE FROM ITS LONG TERM PLANS.
  (2)  THE CONSIDERATION OF INTERESTS AND FACTORS IN THE MANNER REQUIRED
BY PARAGRAPH ONE OF THIS SUBDIVISION:
  (A) SHALL NOT CONSTITUTE A VIOLATION  OF  THE  PROVISIONS  OF  SECTION
SEVEN  HUNDRED FIFTEEN OR SEVEN HUNDRED SEVENTEEN OF THE BUSINESS CORPO-
RATION LAW; AND
  (B) IS IN ADDITION TO THE ABILITY OF DIRECTORS TO  CONSIDER  INTERESTS
AND  FACTORS AS PROVIDED IN SECTION SEVEN HUNDRED SEVENTEEN OF THE BUSI-
NESS CORPORATION LAW.
  (G) A SALE, LEASE, CONVEYANCE, EXCHANGE, TRANSFER, OR  OTHER  DISPOSI-
TION  OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION SHALL
NOT BE EFFECTIVE UNLESS THE TRANSACTION IS APPROVED BY THE COMMISSIONER.
  (H) NO LATER THAN TWO YEARS AFTER  THE  ESTABLISHMENT  OF  A  BUSINESS
CORPORATION  UNDER  THIS SUBDIVISION, THE COMMISSIONER SHALL PROVIDE THE
GOVERNOR, THE MAJORITY LEADER OF THE  SENATE  AND  THE  SPEAKER  OF  THE
ASSEMBLY WITH A WRITTEN EVALUATION OF THE PROGRAM. SUCH EVALUATION SHALL
ADDRESS  THE OVERALL EFFECTIVENESS OF THE PROGRAM IN ALLOWING FOR ACCESS
TO CAPITAL INVESTMENT IN HEALTH CARE  FACILITIES  AND  THE  IMPACT  SUCH
ACCESS MAY HAVE ON THE QUALITY OF CARE PROVIDED BY HOSPITALS OPERATED BY
BUSINESS CORPORATIONS ESTABLISHED UNDER THIS SUBDIVISION.
  19.  (A)  THE COMMISSIONER MAY ESTABLISH A PROGRAM WHEREBY THE DEPART-
MENT ACCEPTS APPLICATIONS FOR DEMONSTRATION PROJECTS  IN  THE  STATE  TO
DEVELOP,  EVALUATE AND IMPLEMENT A FLEXIBLE APPROACH TO ALLOWING PRIVATE
CAPITAL INVESTMENTS AND PRIVATE EQUITY INTERESTS IN HOSPITALS. IN  LIGHT
OF  THE SEVERE CONSTRAINTS ON THE AVAILABILITY OF INVESTMENT CAPITAL FOR
THE HEALTH CARE SYSTEM IN NEW  YORK,  DEMONSTRATION  PROJECTS  SHALL  BE
DESIGNED  TO  PROMOTE  THE DEVELOPMENT OF NEW SOURCES OF CAPITAL FOR THE
OPERATION OF HOSPITALS AND TO EVALUATE THE IMPACT PRIVATE EQUITY INVEST-
MENT HAS ON THE QUALITY OF CARE, ACCESS  TO  CARE  AND  BENEFIT  TO  THE
HOSPITAL,  ITS  PATIENTS AND THE SURROUNDING COMMUNITY. THE COMMISSIONER
MAY, IN APPROVING A DEMONSTRATION PROJECT, WAIVE THE PROVISIONS OF  THIS
ARTICLE  WHICH  RELATE  TO  THE OWNERSHIP STRUCTURE, PROVIDED THE PUBLIC
HEALTH AND HEALTH PLANNING COUNCIL SHALL APPROVE SUCH PROJECT.
  (B) APPLICANTS SHALL AT A MINIMUM DEMONSTRATE THAT:

S. 2606--C                         152

  (I) THE FACILITY OR FACILITIES HAVE HISTORIES OF PROVIDING CARE;
  (II)  THE  PROJECT  IS COMMITTED TO PRESERVING QUALITY, ACCESS TO CARE
AND ACCEPTANCE OF A BROAD MIX OF PAYOR TYPES;
  (III) THE PROJECT WILL PROVIDE A POSITIVE BENEFIT TO THE HOSPITAL, ITS
PATIENTS AND THE COMMUNITY AT LARGE; AND
  (IV) ALL APPLICABLE DUTIES, PROCEDURES, OBLIGATIONS  AND  REQUIREMENTS
APPLICABLE TO PUBLIC HOSPITALS IN NEW YORK INCLUDING, BUT NOT LIMITED TO
CHARITABLE  CARE AND SUPPORT, COMMUNITY PLANS AND OBLIGATIONS, PROVISION
OF CARE TO THOSE IN NEED AND ALL ATTAINMENT OF  QUALITY  CARE  STANDARDS
SET FORTH IN THIS CHAPTER WILL BE ADHERED TO.
  (C)  HOSPITALS  PARTICIPATING  IN  THIS DEMONSTRATION PROGRAM SHALL BE
SUBJECT TO ALL OPERATING STANDARDS AS SET FORTH IN THIS CHAPTER AND  THE
REGULATIONS  PROMULGATED  PURSUANT  THERETO, AND SHALL BE SUBJECT TO ANY
PROVISIONS OF THIS CHAPTER FOR FAILURE TO COMPLY WITH SUCH STANDARDS.
  (D) DEMONSTRATION PROJECTS APPROVED BY THE COMMISSIONER SHALL  PROVIDE
DETAILED REPORTING NO LESS THAN ANNUALLY TO THE DEPARTMENT IN A FORM AND
MANNER  TO  BE  DETERMINED  BY  THE COMMISSIONER TO INSURE THE GOALS ARE
BEING MET. THE COMMISSIONER SHALL PROVIDE THE  GOVERNOR,  THE  TEMPORARY
PRESIDENT  OF THE SENATE AND THE SPEAKER OF THE  ASSEMBLY WITH A WRITTEN
REPORT ON THE PROGRAM, INCLUDING DETAILS OF ALL  APPLICATIONS  RECEIVED,
THE  BASIS FOR APPROVAL OR DENIAL OF THE APPLICATIONS, AND A FULL EVALU-
ATION OF DEMONSTRATION PROJECTS WHICH WERE APPROVED BASED ON  THE  GOALS
OF  THE  PROGRAM  NO LATER THAN TWO YEARS AFTER THE FIRST HOSPITAL MAKES
APPLICATION UNDER THE DEMONSTRATION PROGRAM.
  S 105. Intentionally omitted.
  S 105-a. Intentionally omitted.
  S 106.  Part S of chapter 56 of the laws  of  2012,  relating  to  the
excess medical malpractice liability coverage pool, is amended by adding
a new section 2-a to read as follows:
  S  2-A.  NOTWITHSTANDING  ANY LAW, RULE OR REGULATION TO THE CONTRARY,
ONLY PHYSICIANS OR DENTISTS WHO WERE ELIGIBLE, AND FOR WHOM  THE  SUPER-
INTENDENT OF FINANCIAL SERVICES AND THE COMMISSIONER OF HEALTH, OR THEIR
DESIGNEE, PURCHASED, WITH FUNDS AVAILABLE IN THE HOSPITAL EXCESS LIABIL-
ITY  POOL,  A  FULL  OR PARTIAL POLICY FOR EXCESS COVERAGE OR EQUIVALENT
EXCESS COVERAGE FOR THE COVERAGE PERIODS ENDING THE THIRTIETH  OF  JUNE,
TWO  THOUSAND THIRTEEN, SHALL BE ELIGIBLE TO APPLY FOR SUCH COVERAGE FOR
THE COVERAGE PERIOD BEGINNING THE FIRST OF JULY, TWO THOUSAND  THIRTEEN.
A  GENERAL  HOSPITAL  MAY  CERTIFY  ADDITIONAL  ELIGIBLE  PHYSICIANS  OR
DENTISTS UP TO THE TOTAL NUMBER  OF  ELIGIBLE  PHYSICIANS  AND  DENTISTS
CERTIFIED  BY  THE  GENERAL  HOSPITAL FOR THE COVERAGE PERIOD ENDING THE
THIRTIETH DAY OF JUNE, TWO THOUSAND THIRTEEN.
  S 107. Intentionally omitted.
  S 108. Intentionally omitted.
  S 109. Intentionally omitted.
  S 110. Intentionally omitted.
  S 111. Intentionally omitted.
  S 112. Intentionally omitted.
  S 113. Intentionally omitted.
  S 114. Intentionally omitted.
  S 115. Intentionally omitted.
  S 116. Intentionally omitted.
  S 117. Intentionally omitted.
  S 118. Intentionally omitted.
  S 119. Notwithstanding any inconsistent  provision  of  law,  rule  or
regulation,  for  purposes  of implementing the provisions of the public
health law and the social services law, references to titles XIX and XXI

S. 2606--C                         153

of the federal social security act in the  public  health  law  and  the
social  services  law  shall  be  deemed to include and also to mean any
successor titles thereto under the federal social security act.
  S  120.  Notwithstanding  any  inconsistent  provision of law, rule or
regulation, the effectiveness of the provisions  of  sections  2807  and
3614  of  the  public health law, section 18 of chapter 2 of the laws of
1988, and 18 NYCRR 505.14(h), as they relate to time frames for  notice,
approval  or certification of rates of payment, are hereby suspended and
without force or effect for purposes of implementing the  provisions  of
this act.
  S 121. Intentionally omitted.
  S  122.   Section 2807 of the public health law is amended by adding a
new subdivision 20 to read as follows:
  20. MEDICAL ASSISTANCE RECOUPMENTS AND REDUCTIONS. NOTWITHSTANDING ANY
OTHER PROVISION OF LAW TO THE CONTRARY, ON AND AFTER  APRIL  FIRST,  TWO
THOUSAND  NINE,  ANY  RECOUPMENTS  OR  REDUCTIONS  IN MEDICAL ASSISTANCE
PAYMENTS, INCLUDING BUT NOT LIMITED TO ARTICLE  TWENTY-EIGHT  FACILITIES
LICENSED  PURSUANT  TO  THIS  ARTICLE OR FISCAL INTERMEDIARIES OPERATING
PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF  THE  SOCIAL  SERVICES
LAW SHALL NOT BE SUBJECT TO INTEREST OR INTEREST PENALTIES.
  S  123.  Section  2808 of the public health law is amended by adding a
new subdivision 27 to read as follows:
  27. MEDICAL ASSISTANCE RECOUPMENTS AND  REDUCTIONS.    NOTWITHSTANDING
ANY  OTHER  PROVISION  OF LAW TO THE CONTRARY, ON AND AFTER APRIL FIRST,
TWO THOUSAND NINE, ANY RECOUPMENTS OR REDUCTIONS IN  MEDICAL  ASSISTANCE
PAYMENTS,  INCLUDING  BUT NOT LIMITED TO ARTICLE TWENTY-EIGHT FACILITIES
LICENSED PURSUANT TO THIS ARTICLE  OR  FISCAL  INTERMEDIARIES  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW SHALL NOT BE SUBJECT TO INTEREST OR INTEREST PENALTIES.
  S 124. Short title.  Sections  one  hundred  twenty-four  through  one
hundred  twenty-six  of  this act shall be known and may be cited as the
"home care stabilization act".
  S 125. The public health law is amended by  adding  two  new  sections
3614-d and 3621 to read as follows:
  S  3614-D.  STANDARDS  FOR  PROMPT,  FAIR  AND EQUITABLE SETTLEMENT OF
CLAIMS FOR PAYMENTS FOR PERSONAL CARE,  HOME  HEALTH  CARE  SERVICES  OR
OTHER  LONG TERM CARE SERVICES. 1. IN THE PROCESSING OF CLAIMS SUBMITTED
UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO OR  BETWEEN  CERTI-
FIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, LICENSED
HOME CARE SERVICES PROGRAMS, FISCAL INTERMEDIARIES OPERATING PURSUANT TO
SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW, INSURERS,
MANAGED  LONG  TERM  CARE  PLANS,  MANAGED  CARE  PLANS OR ORGANIZATIONS
LICENSED OR OPERATED PURSUANT TO THE PROVISIONS  OF  THIS  CHAPTER,  THE
SOCIAL  SERVICES LAW OR THE INSURANCE LAW AND FOR ALL BILLS FOR PERSONAL
CARE, HOME HEALTH CARE SERVICES, CONSUMER DIRECTED  PERSONAL  ASSISTANCE
SERVICES OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE
SOCIAL  SERVICES  LAW  OR  OTHER  LONG  TERM  CARE  SERVICES RENDERED BY
LICENSED HOME CARE SERVICES PROGRAMS, CERTIFIED  HOME  HEALTH  AGENCIES,
LONG  TERM  HOME HEALTH CARE PROGRAMS OR A FISCAL INTERMEDIARY OPERATING
PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF  THE  SOCIAL  SERVICES
LAW  PURSUANT TO SUCH CONTRACTS OR AGREEMENTS, ANY CERTIFIED HOME HEALTH
CARE AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, INSURER,  MANAGED  LONG
TERM  CARE  PLAN, MANAGED CARE PLAN OR ORGANIZATION LICENSED OR OPERATED
PURSUANT TO THE PROVISIONS OF THIS CHAPTER, THE SOCIAL SERVICES LAW, THE
EXECUTIVE LAW OR THE INSURANCE LAW, SHALL ADHERE TO THE FOLLOWING STAND-
ARDS:

S. 2606--C                         154

  (A) SHALL PAY A CLEAN CLAIM SUBMITTED BY A LICENSED HOME CARE SERVICES
PROGRAM, CERTIFIED HOME  HEALTH  AGENCY,  LONG  TERM  HOME  HEALTH  CARE
PROGRAM  OR  A  FISCAL  INTERMEDIARY OPERATING PURSUANT TO SECTION THREE
HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW WITHIN  THIRTY  DAYS  OF
RECEIPT OF THE CLEAN CLAIM FOR SERVICES RENDERED THAT IS TRANSMITTED VIA
THE  INTERNET  OR  ELECTRONIC MAIL, OR FORTY-FIVE DAYS OF RECEIPT OF THE
CLEAN CLAIM FOR SERVICES RENDERED THAT IS SUBMITTED BY OTHER MEANS, SUCH
AS PAPER OR FACSIMILE;
  (B) SHALL PAY ANY UNDISPUTED PORTION OF A CLAIM AS A  CLEAN  CLAIM  AS
SET  FORTH  IN PARAGRAPH (A) OF THIS SUBDIVISION SUBMITTED BY A LICENSED
HOME CARE SERVICES PROGRAM, CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME
HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY OPERATING PURSUANT TO SECTION
THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW;
  (C) NOTIFY ANY SUCH AGENCY, PROGRAM OR FISCAL INTERMEDIARY IN  WRITING
WITHIN  FIFTEEN  CALENDAR DAYS OF THE RECEIPT OF AN INITIAL CLAIM OF ALL
SPECIFIC DEFECTS OR DISPUTES OF SUCH CLAIM AND SPECIFICALLY  REQUEST  IN
WRITING  THE  ADDITIONAL  INFORMATION  OR  REMEDY  NEEDED TO PROCESS ANY
DISPUTED PORTIONS OF THE CLAIM; AND
  (D) ANY DISPUTED CLAIM REMEDIED SHALL BE PAID AS A CLEAN CLAIM AS  SET
FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION.
  2. FOR THE PURPOSES OF THIS SECTION, A "CLEAN CLAIM" SHALL:
  (A)  IDENTIFY  THE LICENSED HOME CARE SERVICES PROGRAM, CERTIFIED HOME
HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY
OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F OF  THE  SOCIAL
SERVICES LAW;
  (B) SUFFICIENTLY IDENTIFY THE ELIGIBLE COVERED PERSON;
  (C) LIST THE DATE AND PLACE OF SERVICE;
  (D) SUBSTANTIATE THE APPROPRIATENESS OF THE SERVICE PROVIDED;
  (E) STATE IF PRIOR AUTHORIZATION IS REQUIRED FOR SUCH ELIGIBLE COVERED
PERSON AND SERVICE; AND
  (F)  STATE  ANY  DOCUMENTATION  AS  REASONABLY  REQUIRED BY ANY ENTITY
REFERENCED IN THIS SECTION.
  3. EACH CLEAN CLAIM OR PAYMENT FOR SERVICES PROCESSED IN VIOLATION  OF
THIS  SECTION  SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION TO THE
PENALTIES PROVIDED IN THIS CHAPTER, ANY ORGANIZATION OR CORPORATION THAT
FAILS TO ADHERE TO THE STANDARDS CONTAINED  IN  THIS  SECTION  SHALL  BE
OBLIGATED  TO  PAY  TO  CERTIFIED  HOME  HEALTH AGENCIES, LONG TERM HOME
HEALTH CARE PROGRAMS, LICENSED  HOME  HEALTH  CARE  PROGRAMS  OR  FISCAL
INTERMEDIARIES  OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F
OF THE SOCIAL SERVICES LAW IN FULL SETTLEMENT  OF  THE  BILL,  CLAIM  OR
PAYMENT  PLUS  INTEREST  ON THE AMOUNT OF SUCH BILL, CLAIM OR PAYMENT OF
THE GREATER OF THE RATE EQUAL TO THE RATE SET  BY  THE  COMMISSIONER  OF
TAXATION  AND  FINANCE  FOR CORPORATE TAXES PURSUANT TO PARAGRAPH ONE OF
SUBSECTION (E) OF SECTION ONE THOUSAND NINETY-SIX  OF  THE  TAX  LAW  OR
TWELVE  PERCENT  PER ANNUM, TO BE COMPUTED FROM THE DATE THE BILL, CLAIM
OR PAYMENT WAS REQUIRED TO BE MADE.
  S 3621. MEDICAL ASSISTANCE RECOUPMENTS AND REDUCTIONS.   NOTWITHSTAND-
ING  ANY  OTHER  PROVISION  OF  LAW  TO THE CONTRARY, ON AND AFTER APRIL
FIRST, TWO THOUSAND NINE,  ANY  RECOUPMENTS  OR  REDUCTIONS  IN  MEDICAL
ASSISTANCE  PAYMENTS FOR LICENSED HOME CARE SERVICES AGENCIES, CERTIFIED
HOME HEALTH AGENCIES LICENSED PURSUANT TO THIS ARTICLE OR FISCAL  INTER-
MEDIARIES  OPERATING  PURSUANT  TO SECTION THREE HUNDRED SIXTY-FIVE-F OF
THE SOCIAL SERVICES LAW SHALL NOT BE SUBJECT  TO  INTEREST  OR  INTEREST
PENALTIES.
  S  126. Section 4406-c of the public health law is amended by adding a
new subdivision 9 to read as follows:

S. 2606--C                         155

  9. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW,  CONTRACTS  WITH
CERTIFIED  HOME  HEALTH  AGENCIES,  LONG TERM HOME HEALTH CARE PROGRAMS,
LICENSED HOME CARE SERVICES PROGRAMS OR FISCAL INTERMEDIARIES  OPERATING
PURSUANT  TO  SECTION  THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES
LAW  TO PROVIDE HOME CARE AIDE SERVICES AS DEFINED IN SECTION THIRTY-SIX
HUNDRED FOURTEEN-C OF THIS CHAPTER OR CONSUMER DIRECTED PERSONAL ASSIST-
ANCE  SERVICES  AS  AUTHORIZED  PURSUANT  TO   SECTION   THREE   HUNDRED
SIXTY-FIVE-F  OF  THE SOCIAL SERVICES LAW SHALL AT A MINIMUM ENSURE THAT
THE RESOURCES MADE AVAILABLE BY SUCH  CONTRACTS  SHALL  SUPPORT  COMPEN-
SATION  FOR  PERSONS PROVIDING SUCH HOME CARE AIDE SERVICES AND CONSUMER
DIRECTED PERSONAL ASSISTANCE SERVICES TO ENSURE THE RETENTION OF A QUAL-
IFIED WORKFORCE CAPABLE OF PROVIDING HIGH QUALITY CARE TO RECIPIENTS  OF
SUCH SERVICES CONSISTENT WITH THE PROVISIONS OF SUCH SECTION.
  S  126-a.  Paragraphs  11,  12, 13, 14, 16 and 17 of subsection (a) of
section 3217-a of the insurance law, as added by chapter 705 of the laws
of 1996, are amended and three new paragraphs 16-a, 18 and 19 are  added
to read as follows:
  (11)  where  applicable,  notice that an insured enrolled in a managed
care product OR A  COMPREHENSIVE  POLICY  THAT  UTILIZES  A  NETWORK  OF
PROVIDERS  offered by the insurer may obtain a referral to a health care
provider outside of the insurer's network or panel when the insurer does
not have a health care provider with appropriate training and experience
in the network or panel to meet the particular health care needs of  the
insured and the procedure by which the insured can obtain such referral;
  (12)  where  applicable,  notice that an insured enrolled in a managed
care product OR A  COMPREHENSIVE  POLICY  THAT  UTILIZES  A  NETWORK  OF
PROVIDERS offered by the insurer with a condition which requires ongoing
care  from  a  specialist  may  request  a  standing  referral to such a
specialist and the procedure for requesting and obtaining such a  stand-
ing referral;
  (13)    where applicable, notice that an insured enrolled in a managed
care product OR A  COMPREHENSIVE  POLICY  THAT  UTILIZES  A  NETWORK  OF
PROVIDERS  offered  by the insurer with (i) a life-threatening condition
or disease, or (ii) a degenerative and disabling condition  or  disease,
either of which requires specialized medical care over a prolonged peri-
od of time may request a specialist responsible for providing or coordi-
nating  the  insured's medical care and the procedure for requesting and
obtaining such a specialist;
  (14) where applicable, notice that an insured enrolled  in  a  managed
care  product  OR  A  COMPREHENSIVE  POLICY  THAT  UTILIZES A NETWORK OF
PROVIDERS offered by the insurer with (i) a  life-threatening  condition
or  disease,  or (ii) a degenerative and disabling condition or disease,
either of which requires specialized medical care over a prolonged peri-
od of time, may request access to a specialty care center and the proce-
dure by which such access may be obtained;
  (16) notice of all appropriate mailing addresses and telephone numbers
to be utilized by insureds seeking information or authorization; [and]
  (16-A) WHERE APPLICABLE, NOTICE THAT  AN  INSURED  SHALL  HAVE  DIRECT
ACCESS  TO  PRIMARY  AND  PREVENTIVE  OBSTETRIC AND GYNECOLOGIC SERVICES
INCLUDING ANNUAL EXAMINATIONS, CARE RESULTING FROM SUCH ANNUAL  EXAMINA-
TIONS,  AND  TREATMENT OF ACUTE GYNECOLOGIC CONDITIONS, FROM A QUALIFIED
PROVIDER OF SUCH SERVICES OF HER CHOICE FROM WITHIN THE PLAN OR FOR  ANY
CARE RELATED TO A PREGNANCY;
  (17) where applicable, a listing by specialty, which may be in a sepa-
rate  document that is updated annually, of the name, address, and tele-
phone number of all participating providers, including  facilities,  and

S. 2606--C                         156

in   addition,  in  the  case  of  physicians,  board  certification[.],
LANGUAGES SPOKEN AND AFFILIATION WITH PARTICIPATING HOSPITALS. THE LIST-
ING SHALL ALSO BE POSTED ON THE INSURER'S WEBSITE AND THE INSURER  SHALL
UPDATE THE WEBSITE WITHIN FIFTEEN DAYS OF THE ADDITION OR TERMINATION OF
A  PROVIDER  FROM  THE  INSURER'S  NETWORK  OR A CHANGE IN A PHYSICIAN'S
HOSPITAL AFFILIATION;
  (18) A DESCRIPTION OF THE METHOD BY WHICH  AN  INSURED  MAY  SUBMIT  A
CLAIM  FOR  HEALTH  CARE SERVICES, INCLUDING THROUGH THE INTERNET, ELEC-
TRONIC MAIL OR BY FACSIMILE; AND
  (19) WHERE APPLICABLE, WHEN A POLICY  OFFERS  OUT-OF-NETWORK  COVERAGE
PURSUANT  TO  SUBSECTIONS  (B)  AND  (C)  OF  SECTION THREE THOUSAND TWO
HUNDRED FORTY OF THIS ARTICLE:
  (A) A CLEAR DESCRIPTION OF THE METHODOLOGY  USED  BY  THE  INSURER  TO
DETERMINE REIMBURSEMENT FOR OUT-OF-NETWORK HEALTH CARE SERVICES;
  (B)  A DESCRIPTION OF THE AMOUNT THAT THE INSURER WILL REIMBURSE UNDER
THE METHODOLOGY FOR OUT-OF-NETWORK HEALTH CARE SERVICES SET FORTH  AS  A
PERCENTAGE  OF  THE  USUAL  AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH
CARE SERVICES; AND
  (C) EXAMPLES OF ANTICIPATED OUT-OF-POCKET COSTS FOR FREQUENTLY  BILLED
OUT-OF-NETWORK HEALTH CARE SERVICES.
  S 127. Paragraphs 11 and 12 of subsection (b) of section 3217-a of the
insurance  law, as added by chapter 705 of the laws of 1996, are amended
and three new paragraphs 13, 14 and 15 are added to read as follows:
  (11) where applicable, provide the written application procedures  and
minimum  qualification  requirements  for  health  care  providers to be
considered by the insurer for participation in the insurer's network for
a managed care product; [and]
  (12) disclose such other information as required  by  the  superinten-
dent,  provided  that  such requirements are promulgated pursuant to the
state administrative procedure act[.];
  (13) DISCLOSE WHETHER A HEALTH CARE PROVIDER SCHEDULED  TO  PROVIDE  A
HEALTH CARE SERVICE IS AN IN-NETWORK PROVIDER;
  (14)  WHERE  APPLICABLE,  WITH  RESPECT  TO  OUT-OF-NETWORK  COVERAGE,
DISCLOSE THE DOLLAR AMOUNT THAT THE INSURER  WILL  PAY  FOR  A  SPECIFIC
OUT-OF-NETWORK HEALTH CARE SERVICE; AND
  (15)  PROVIDE  INFORMATION  IN WRITING AND THROUGH AN INTERNET WEBSITE
THAT REASONABLY PERMITS AN INSURED OR PROSPECTIVE INSURED  TO  DETERMINE
THE  ANTICIPATED  OUT-OF-POCKET  COST  FOR  OUT-OF-NETWORK  HEALTH  CARE
SERVICES IN A GEOGRAPHICAL AREA OR ZIP CODE BASED  UPON  THE  DIFFERENCE
BETWEEN  WHAT  THE INSURER WILL REIMBURSE FOR OUT-OF-NETWORK HEALTH CARE
SERVICES AND THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH CARE
SERVICES.
  S 128. Section 3217-a of the insurance law is amended by adding a  new
subsection (f) to read as follows:
  (F)  FOR  PURPOSES  OF  THIS SECTION, "USUAL AND CUSTOMARY COST" SHALL
MEAN THE EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE  PARTICULAR  HEALTH
CARE  SERVICE  PERFORMED  BY A PROVIDER IN THE SAME OR SIMILAR SPECIALTY
AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE  SUPER-
INTENDENT.  THE  NONPROFIT  ORGANIZATION SHALL NOT BE AFFILIATED WITH AN
INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF THIS CHAPTER, A
MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO  ARTICLE
FORTY-SEVEN OF THIS CHAPTER, OR A HEALTH MAINTENANCE ORGANIZATION CERTI-
FIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
  S  129. Section 3217-d of the insurance law is amended by adding a new
subsection (d) to read as follows:

S. 2606--C                         157

  (D) AN INSURER THAT ISSUES A  COMPREHENSIVE  POLICY  THAT  UTILIZES  A
NETWORK OF PROVIDERS AND IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT
AS  DEFINED IN SUBSECTION (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE
OF  THIS  CHAPTER,  SHALL  PROVIDE  ACCESS  TO  OUT-OF-NETWORK  SERVICES
CONSISTENT WITH THE REQUIREMENTS OF SUBSECTION (A) OF SECTION FOUR THOU-
SAND  EIGHT HUNDRED FOUR OF THIS CHAPTER, SUBSECTIONS (G-6) AND (G-7) OF
SECTION FOUR THOUSAND NINE HUNDRED OF THIS  CHAPTER,  SUBSECTIONS  (A-1)
AND  (A-2)  OF  SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER,
PARAGRAPHS THREE AND FOUR OF SUBSECTION (B)  OF  SECTION  FOUR  THOUSAND
NINE HUNDRED TEN OF THIS CHAPTER, AND SUBPARAGRAPHS (C) AND (D) OF PARA-
GRAPH FOUR OF SUBSECTION (B) OF SECTION FOUR THOUSAND NINE HUNDRED FOUR-
TEEN OF THIS CHAPTER.
  S  130. Section 3224-a of the insurance law is amended by adding a new
subsection (j) to read as follows:
  (J) AN INSURER OR AN ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED
PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL ACCEPT CLAIMS SUBMITTED BY
A  POLICYHOLDER  OR COVERED PERSON THROUGH THE INTERNET, ELECTRONIC MAIL
OR BY FACSIMILE.
  S 131. The insurance law is amended by adding a new  section  3240  to
read as follows:
  S  3240.  NETWORK  COVERAGE.   (A) AN INSURER, A CORPORATION ORGANIZED
PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER, OR A MUNICIPAL  COOPER-
ATIVE  HEALTH  BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF
THIS CHAPTER THAT ISSUES A HEALTH INSURANCE POLICY OR  CONTRACT  WITH  A
NETWORK  OF  HEALTH  CARE  PROVIDERS  SHALL  ENSURE  THAT THE NETWORK IS
ADEQUATE TO MEET THE HEALTH NEEDS OF INSUREDS AND PROVIDE AN APPROPRIATE
CHOICE OF PROVIDERS SUFFICIENT TO RENDER THE SERVICES COVERED UNDER  THE
POLICY  OR  CONTRACT.  THE  SUPERINTENDENT  SHALL  REVIEW THE NETWORK OF
HEALTH CARE PROVIDERS FOR ADEQUACY AT THE TIME OF  THE  SUPERINTENDENT'S
INITIAL  APPROVAL  OF  A  HEALTH  INSURANCE POLICY OR CONTRACT; AT LEAST
EVERY THREE YEARS THEREAFTER; AND UPON APPLICATION FOR EXPANSION OF  ANY
SERVICE  AREA ASSOCIATED WITH THE POLICY OR CONTRACT. TO THE EXTENT THAT
THE NETWORK HAS BEEN DETERMINED BY THE COMMISSIONER OF  HEALTH  TO  MEET
THE  STANDARDS  SET  FORTH  IN SUBDIVISION FIVE OF SECTION FOUR THOUSAND
FOUR HUNDRED THREE OF THE PUBLIC  HEALTH  LAW,  SUCH  NETWORK  SHALL  BE
DEEMED ADEQUATE BY THE SUPERINTENDENT.
  (B)   AN   INSURER,   A  CORPORATION  ORGANIZED  PURSUANT  TO  ARTICLE
FORTY-THREE OF THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN
CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, OR  A  HEALTH
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
PUBLIC  HEALTH  LAW,  THAT PROVIDES COVERAGE FOR OUT-OF-NETWORK SERVICES
SHALL PROVIDE SIGNIFICANT COVERAGE OF THE USUAL AND CUSTOMARY  COSTS  OF
OUT-OF-NETWORK HEALTH CARE SERVICES.
  (C)   AN   INSURER,   A  CORPORATION  ORGANIZED  PURSUANT  TO  ARTICLE
FORTY-THREE OF THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN
CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, OR  A  HEALTH
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
PUBLIC  HEALTH  LAW,  THAT PROVIDES COVERAGE FOR OUT-OF-NETWORK SERVICES
SHALL OFFER AT LEAST ONE POLICY OR CONTRACT OPTION IN EACH  GEOGRAPHICAL
REGION COVERED THAT PROVIDES COVERAGE FOR AT LEAST EIGHTY PERCENT OF THE
USUAL  AND  CUSTOMARY  COST OF OUT-OF-NETWORK HEALTH CARE SERVICES AFTER
IMPOSITION OF A DEDUCTIBLE.
  (D) FOR THE PURPOSES OF THIS SECTION "USUAL AND CUSTOMARY COST"  SHALL
MEAN  THE  EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR HEALTH
CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME  OR  SIMILAR  SPECIALTY

S. 2606--C                         158

AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE  MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE SUPER-
INTENDENT. THE NONPROFIT ORGANIZATION SHALL NOT BE  AFFILIATED  WITH  AN
INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF THIS ARTICLE, A
MUNICIPAL  COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE
FORTY-SEVEN OF THIS CHAPTER, OR A HEALTH MAINTENANCE ORGANIZATION CERTI-
FIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
  S 132. Section 4306-c of the insurance law is amended by adding a  new
subsection (d) to read as follows:
  (D)  A  CORPORATION,  INCLUDING A MUNICIPAL COOPERATIVE HEALTH BENEFIT
PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN  OF  THIS  CHAPTER,  THAT
ISSUES  A  COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF PROVIDERS AND
IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT AS DEFINED IN SUBSECTION
(C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE OF  THIS  CHAPTER,  SHALL
PROVIDE  ACCESS  TO OUT-OF-NETWORK SERVICES CONSISTENT WITH THE REQUIRE-
MENTS OF SUBSECTION (A) OF SECTION FOUR THOUSAND EIGHT HUNDRED  FOUR  OF
THIS  CHAPTER, SUBSECTIONS (G-6) AND (G-7) OF SECTION FOUR THOUSAND NINE
HUNDRED OF THIS CHAPTER, SUBSECTIONS (A-1) AND  (A-2)  OF  SECTION  FOUR
THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER, PARAGRAPHS THREE AND FOUR OF
SUBSECTION  (B)  OF SECTION FOUR THOUSAND NINE HUNDRED TEN OF THIS CHAP-
TER, AND SUBPARAGRAPHS (C) AND (D) OF PARAGRAPH FOUR OF  SUBSECTION  (B)
OF SECTION FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER.
  S  133.  Paragraphs 11, 12, 13, 14, 16-a, 17, and 18 of subsection (a)
of section 4324 of the insurance law, as added by  chapter  705  of  the
laws  of  1996,  paragraph  16-a  as added by chapter 554 of the laws of
2002, are amended and two new paragraphs 19 and 20 are added to read  as
follows:
  (11)  where applicable, notice that a subscriber enrolled in a managed
care  product  OR  A  COMPREHENSIVE  CONTRACT THAT UTILIZES A NETWORK OF
PROVIDERS offered by the corporation may obtain a referral to  a  health
care  provider  outside  of  the corporation's network or panel when the
corporation does not have a health care provider with appropriate train-
ing and experience in the network or panel to meet the particular health
care needs of the subscriber and the procedure by which  the  subscriber
can obtain such referral;
  (12)  where applicable, notice that a subscriber enrolled in a managed
care product OR A COMPREHENSIVE CONTRACT  THAT  UTILIZES  A  NETWORK  OF
PROVIDERS  offered  by  the  corporation with a condition which requires
ongoing care from a specialist may request a standing referral to such a
specialist and the procedure for requesting and obtaining such a  stand-
ing referral;
  (13)  where applicable, notice that a subscriber enrolled in a managed
care product OR A COMPREHENSIVE CONTRACT  THAT  UTILIZES  A  NETWORK  OF
PROVIDERS  offered by the corporation with (i) a life-threatening condi-
tion or disease, or (ii)  a  degenerative  and  disabling  condition  or
disease,  either  of  which  requires  specialized  medical  care over a
prolonged period of  time  may  request  a  specialist  responsible  for
providing  or  coordinating the subscriber's medical care and the proce-
dure for requesting and obtaining such a specialist;
  (14) where applicable, notice that a subscriber enrolled in a  managed
care  product  OR  A  COMPREHENSIVE  CONTRACT THAT UTILIZES A NETWORK OF
PROVIDERS offered by the corporation with (i) a life-threatening  condi-
tion  or  disease,  or  (ii)  a  degenerative and disabling condition or
disease, either of  which  requires  specialized  medical  care  over  a
prolonged  period  of time may request access to a specialty care center
and the procedure by which such access may be obtained;

S. 2606--C                         159

  (16-a) where applicable, notice that an  enrollee  shall  have  direct
access  to  primary  and  preventive  obstetric and gynecologic services
INCLUDING ANNUAL EXAMINATIONS, CARE RESULTING FROM SUCH ANNUAL  EXAMINA-
TIONS,  AND  TREATMENT OF ACUTE GYNECOLOGIC CONDITIONS, from a qualified
provider  of  such  services  of her choice from within the plan [for no
fewer than two examinations annually for such services] or [to] FOR  any
care  related  to A pregnancy [and that additionally, the enrollee shall
have direct access to primary and preventive obstetric  and  gynecologic
services required as a result of such annual examinations or as a result
of an acute gynecologic condition];
  (17) where applicable, a listing by specialty, which may be in a sepa-
rate  document that is updated annually, of the name, address, and tele-
phone number of all participating providers, including  facilities,  and
in  addition,  in  the  case  of physicians, board certification[; and],
LANGUAGES SPOKEN AND AFFILIATION  WITH  PARTICIPATING  HOSPITALS.    THE
LISTING SHALL ALSO BE POSTED ON THE CORPORATION'S WEBSITE AND THE CORPO-
RATION  SHALL  UPDATE THE WEBSITE WITHIN FIFTEEN DAYS OF THE ADDITION OR
TERMINATION OF A PROVIDER FROM THE CORPORATION'S NETWORK OR A CHANGE  IN
A PHYSICIAN'S HOSPITAL AFFILIATION;
  (18)  a description of the mechanisms by which subscribers may partic-
ipate in the development of the policies of the corporation[.];
  (19) A DESCRIPTION OF THE METHOD BY WHICH A SUBSCRIBER  MAY  SUBMIT  A
CLAIM  FOR  HEALTH  CARE SERVICES, INCLUDING THROUGH THE INTERNET, ELEC-
TRONIC MAIL OR BY FACSIMILE; AND
  (20) WHERE APPLICABLE, WHEN A CONTRACT OFFERS OUT-OF-NETWORK  COVERAGE
PURSUANT  TO  SUBSECTIONS  (B)  AND  (C)  OF  SECTION THREE THOUSAND TWO
HUNDRED FORTY OF THIS CHAPTER:
  (A) A CLEAR DESCRIPTION OF THE METHODOLOGY USED BY THE CORPORATION  TO
DETERMINE REIMBURSEMENT FOR OUT-OF-NETWORK HEALTH CARE SERVICES;
  (B)  A  DESCRIPTION  OF THE AMOUNT THAT THE CORPORATION WILL REIMBURSE
UNDER THE METHODOLOGY FOR OUT-OF-NETWORK HEALTH CARE SERVICES SET  FORTH
AS  A  PERCENTAGE  OF  THE  USUAL  AND CUSTOMARY COST FOR OUT-OF-NETWORK
HEALTH CARE SERVICES; AND
  (C) EXAMPLES OF ANTICIPATED OUT-OF-POCKET COSTS FOR FREQUENTLY  BILLED
OUT-OF-NETWORK HEALTH CARE SERVICES.
  S  134.  Paragraphs 11 and 12 of subsection (b) of section 4324 of the
insurance law, as added by chapter 705 of the laws of 1996, are  amended
and three new paragraphs 13, 14 and 15 are added to read as follows:
  (11)  where applicable, provide the written application procedures and
minimum qualification requirements  for  health  care  providers  to  be
considered  by  the  corporation  for participation in the corporation's
network for a managed care product; [and]
  (12) disclose such other information as required  by  the  superinten-
dent,  provided  that  such requirements are promulgated pursuant to the
state administrative procedure act[.];
  (13) DISCLOSE WHETHER A HEALTH CARE PROVIDER SCHEDULED  TO  PROVIDE  A
HEALTH CARE SERVICE IS AN IN-NETWORK PROVIDER;
  (14)  WHERE  APPLICABLE,  WITH  RESPECT  TO  OUT-OF-NETWORK  COVERAGE,
DISCLOSE THE DOLLAR AMOUNT THAT THE CORPORATION WILL PAY FOR A  SPECIFIC
OUT-OF-NETWORK HEALTH CARE SERVICE; AND
  (15)  PROVIDE  INFORMATION  IN WRITING AND THROUGH AN INTERNET WEBSITE
THAT REASONABLY PERMITS A SUBSCRIBER OR PROSPECTIVE SUBSCRIBER TO DETER-
MINE THE ANTICIPATED OUT-OF-POCKET COST FOR OUT-OF-NETWORK  HEALTH  CARE
SERVICES  IN  A  GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE
BETWEEN WHAT THE CORPORATION WILL REIMBURSE  FOR  OUT-OF-NETWORK  HEALTH

S. 2606--C                         160

CARE SERVICES AND THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH
CARE SERVICES.
  S  135.  Section  4324 of the insurance law is amended by adding a new
subsection (f) to read as follows:
  (F) FOR PURPOSES OF THIS SECTION, "USUAL  AND  CUSTOMARY  COST"  SHALL
MEAN  THE  EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR HEALTH
CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME  OR  SIMILAR  SPECIALTY
AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE  MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE SUPER-
INTENDENT. THE NONPROFIT ORGANIZATION SHALL NOT BE  AFFILIATED  WITH  AN
INSURER,  A CORPORATION SUBJECT TO THIS ARTICLE, A MUNICIPAL COOPERATIVE
HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE  FORTY-SEVEN  OF  THIS
CHAPTER,  OR  A  HEALTH  MAINTENANCE  ORGANIZATION CERTIFIED PURSUANT TO
ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
  S 136. Subsection (g-7) of section 4900 of the insurance law is redes-
ignated subsection (g-8) and a new subsection (g-7) is added to read  as
follows:
  (G-7)  "OUT-OF-NETWORK REFERRAL DENIAL" MEANS A DENIAL UNDER A MANAGED
CARE PRODUCT AS DEFINED IN SUBSECTION (C) OF SECTION FOUR THOUSAND EIGHT
HUNDRED ONE OF THIS CHAPTER OF A REQUEST FOR AN AUTHORIZATION OR  REFER-
RAL TO AN OUT-OF-NETWORK PROVIDER ON THE BASIS THAT THE HEALTH CARE PLAN
HAS  A  HEALTH  CARE  PROVIDER IN THE IN-NETWORK BENEFITS PORTION OF ITS
NETWORK WITH APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE  PARTICULAR
HEALTH  CARE  NEEDS  OF  AN  INSURED,  AND  WHO  IS  ABLE TO PROVIDE THE
REQUESTED HEALTH SERVICE. THE NOTICE OF A DENIAL  OF  AN  OUT-OF-NETWORK
REFERRAL  PROVIDED  TO  AN  INSURED SHALL INCLUDE INFORMATION EXPLAINING
WHAT INFORMATION THE INSURED MUST SUBMIT IN ORDER TO APPEAL  THE  DENIAL
OF  AN  OUT-OF-NETWORK  REFERRAL PURSUANT TO SUBSECTION (A-2) OF SECTION
FOUR THOUSAND NINE HUNDRED FOUR OF THIS ARTICLE. A DENIAL OF AN  OUT-OF-
NETWORK  REFERRAL  UNDER  THIS SUBSECTION DOES NOT CONSTITUTE AN ADVERSE
DETERMINATION AS DEFINED IN THIS ARTICLE. A DENIAL OF AN  OUT-OF-NETWORK
REFERRAL  SHALL  NOT BE CONSTRUED TO INCLUDE AN OUT-OF-NETWORK DENIAL AS
DEFINED IN SUBSECTION (G-6) OF THIS SECTION.
  S 137. Subsection (b) of section 4903 of the insurance law,  as  added
by chapter 705 of the laws of 1996, is amended to read as follows:
  (b)  A utilization review agent shall make a utilization review deter-
mination involving health care services which require  pre-authorization
and provide notice of a determination to the insured or insured's desig-
nee  and  the insured's health care provider by telephone and in writing
within three business days of receipt of the necessary information.  THE
NOTIFICATION  SHALL IDENTIFY WHETHER THE SERVICES ARE CONSIDERED IN-NET-
WORK OR OUT-OF-NETWORK.
  S 138. Section 4904 of the insurance law is amended by  adding  a  new
subsection (a-2) to read as follows:
  (A-2)  AN  INSURED OR THE INSURED'S DESIGNEE MAY APPEAL A DENIAL OF AN
OUT-OF-NETWORK REFERRAL BY A HEALTH CARE PLAN BY  SUBMITTING  A  WRITTEN
STATEMENT  FROM  THE  INSURED'S  ATTENDING  PHYSICIAN,  WHO  MUST  BE  A
LICENSED, BOARD CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRAC-
TICE IN THE SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT THE  INSURED
FOR  THE  HEALTH  SERVICE  SOUGHT  THAT:  (1) THE IN-NETWORK HEALTH CARE
PROVIDER OR PROVIDERS RECOMMENDED BY THE HEALTH CARE PLAN  DO  NOT  HAVE
THE  APPROPRIATE  TRAINING  AND EXPERIENCE TO MEET THE PARTICULAR HEALTH
CARE NEEDS OF THE INSURED FOR THE HEALTH SERVICE; AND (2) RECOMMENDS  AN
OUT-OF-NETWORK  PROVIDER WITH THE APPROPRIATE TRAINING AND EXPERIENCE TO
MEET THE PARTICULAR HEALTH CARE NEEDS OF THE INSURED, AND WHO IS ABLE TO
PROVIDE THE REQUESTED HEALTH SERVICE.

S. 2606--C                         161

  S 139. Subsection (b) of section 4910 of the insurance law is  amended
by adding a new paragraph 4 to read as follows:
  (4)  (A)  THE INSURED HAS HAD AN OUT-OF-NETWORK REFERRAL DENIED ON THE
GROUNDS THAT THE HEALTH CARE PLAN HAS A  HEALTH  CARE  PROVIDER  IN  THE
IN-NETWORK BENEFITS PORTION OF ITS NETWORK WITH APPROPRIATE TRAINING AND
EXPERIENCE  TO  MEET THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED, AND
WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE.
  (B) THE INSURED'S ATTENDING PHYSICIAN, WHO SHALL BE A LICENSED,  BOARD
CERTIFIED  OR  BOARD  ELIGIBLE  PHYSICIAN  QUALIFIED  TO PRACTICE IN THE
SPECIALTY AREA OF PRACTICE APPROPRIATE TO  TREAT  THE  INSURED  FOR  THE
HEALTH SERVICE SOUGHT, CERTIFIES THAT THE IN-NETWORK HEALTH CARE PROVID-
ER  OR  PROVIDERS  RECOMMENDED  BY  THE HEALTH CARE PLAN DO NOT HAVE THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR  HEALTH  CARE
NEEDS  OF AN INSURED, AND RECOMMENDS AN OUT-OF-NETWORK PROVIDER WITH THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR  HEALTH  CARE
NEEDS  OF  AN  INSURED,  AND WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH
SERVICE.
  S 140. Paragraph 4 of subsection (b) of section 4914 of the  insurance
law is amended by adding a new subparagraph (D) to read as follows:
  (D)  FOR  EXTERNAL  APPEALS  REQUESTED  PURSUANT  TO PARAGRAPH FOUR OF
SUBSECTION (B) OF SECTION FOUR THOUSAND NINE HUNDRED TEN OF  THIS  TITLE
RELATING  TO AN OUT-OF-NETWORK REFERRAL, THE EXTERNAL APPEAL AGENT SHALL
REVIEW THE UTILIZATION REVIEW AGENT'S FINAL ADVERSE  DETERMINATION  AND,
IN  ACCORDANCE  WITH THE PROVISIONS OF THIS TITLE, SHALL MAKE A DETERMI-
NATION AS TO WHETHER THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED BY THE
HEALTH PLAN; PROVIDED THAT SUCH DETERMINATION SHALL:
  (I) BE CONDUCTED ONLY BY ONE OR A GREATER ODD NUMBER OF CLINICAL  PEER
REVIEWERS;
  (II) BE ACCOMPANIED BY A WRITTEN STATEMENT:
  (I)  THAT  THE  OUT-OF-NETWORK REFERRAL SHALL BE COVERED BY THE HEALTH
CARE PLAN EITHER WHEN THE REVIEWER OR A MAJORITY OF THE PANEL OF REVIEW-
ERS DETERMINES, UPON REVIEW  OF  THE  TRAINING  AND  EXPERIENCE  OF  THE
IN-NETWORK  HEALTH  CARE PROVIDER OR PROVIDERS PROPOSED BY THE PLAN, THE
TRAINING AND EXPERIENCE OF THE REQUESTED  OUT-OF-NETWORK  PROVIDER,  THE
CLINICAL  STANDARDS OF THE PLAN, THE INFORMATION PROVIDED CONCERNING THE
INSURED, THE ATTENDING PHYSICIAN'S RECOMMENDATION, THE INSURED'S MEDICAL
RECORD, AND ANY OTHER PERTINENT INFORMATION, THAT THE HEALTH  PLAN  DOES
NOT HAVE A PROVIDER WITH THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET
THE  PARTICULAR  HEALTH  CARE NEEDS OF AN INSURED WHO IS ABLE TO PROVIDE
THE REQUESTED HEALTH SERVICE, AND THAT THE OUT-OF-NETWORK  PROVIDER  HAS
THE  APPROPRIATE  TRAINING  AND EXPERIENCE TO MEET THE PARTICULAR HEALTH
CARE NEEDS OF AN INSURED,  IS  ABLE  TO  PROVIDE  THE  REQUESTED  HEALTH
SERVICE,  AND IS LIKELY TO PRODUCE A MORE CLINICALLY BENEFICIAL OUTCOME;
OR
  (II) UPHOLDING THE HEALTH PLAN'S DENIAL OF COVERAGE;
  (III) BE SUBJECT TO THE TERMS AND CONDITIONS GENERALLY  APPLICABLE  TO
BENEFITS UNDER THE EVIDENCE OF COVERAGE UNDER THE HEALTH CARE PLAN;
  (IV) BE BINDING ON THE PLAN AND THE INSURED; AND
  (V) BE ADMISSIBLE IN ANY COURT PROCEEDING.
  S  141. The public health law is amended by adding a new section 23 to
read as follows:
  S 23. DISCLOSURE.  1. A HEALTH CARE  PROFESSIONAL  SHALL  DISCLOSE  TO
PATIENTS  OR  PROSPECTIVE  PATIENTS THROUGH AN INTERNET WEBSITE OR, UPON
REQUEST, IN WRITING THE HEALTH CARE  PLANS  IN  WHICH  THE  HEALTH  CARE
PROFESSIONAL  IS  A  PARTICIPATING PROVIDER AND THE HOSPITALS WITH WHICH
THE HEALTH CARE PROFESSIONAL IS AFFILIATED.

S. 2606--C                         162

  2. IF A HEALTH CARE PROFESSIONAL DOES NOT PARTICIPATE IN  THE  NETWORK
OF  A  PATIENT'S  OR  PROSPECTIVE PATIENT'S HEALTH CARE PLAN, THE HEALTH
CARE PROFESSIONAL SHALL, UPON RECEIPT OF A REQUEST  FROM  A  PATIENT  OR
PROSPECTIVE  PATIENT,  DISCLOSE TO THE PATIENT OR PROSPECTIVE PATIENT IN
WRITING  A GOOD FAITH ESTIMATED AMOUNT THE HEALTH CARE PROFESSIONAL WILL
BILL THE  PATIENT  OR  PROSPECTIVE  PATIENT  FOR  HEALTH  CARE  SERVICES
PROVIDED  OR  ANTICIPATED  TO  BE PROVIDED TO THE PATIENT OR PROSPECTIVE
PATIENT.
  3. A HEALTH CARE PROFESSIONAL WHO  IS  A  PHYSICIAN  SHALL  PROVIDE  A
PATIENT  OR  PROSPECTIVE  PATIENT  WITH THE NAME, PRACTICE NAME, MAILING
ADDRESS, AND TELEPHONE NUMBER OF ANY HEALTH CARE  PROVIDER  OF  ANESTHE-
SIOLOGY,  LABORATORY, PATHOLOGY, RADIOLOGY OR ASSISTANT SURGEON SERVICES
PERFORMED IN THE PHYSICIAN'S OFFICE OR COORDINATED OR  REFERRED  BY  THE
PHYSICIAN.
  4.    A  HEALTH  CARE  PROFESSIONAL  WHO  IS  A PHYSICIAN SHALL, FOR A
PATIENT'S SCHEDULED HOSPITAL ADMISSION OR SCHEDULED OUTPATIENT  HOSPITAL
SERVICES,  PROVIDE  A  PATIENT  AND THE HOSPITAL WITH THE NAME, PRACTICE
NAME, MAILING ADDRESS AND TELEPHONE NUMBER OF ANY OTHER PHYSICIAN  WHOSE
SERVICES WILL BE ARRANGED BY THE PHYSICIAN AND ARE SCHEDULED AT THE TIME
OF THE PRE-ADMISSION TESTING, REGISTRATION  OR ADMISSION.
  5.  A  HOSPITAL  SHALL  ESTABLISH, UPDATE, MAKE PUBLIC AND POST ON THE
HOSPITAL'S WEBSITE, A LIST OF THE HOSPITAL'S STANDARD CHARGES FOR  ITEMS
AND  SERVICES  PROVIDED BY THE HOSPITAL, INCLUDING FOR DIAGNOSIS-RELATED
GROUPS ESTABLISHED UNDER SECTION 1886(D)(4) OF THE FEDERAL SOCIAL  SECU-
RITY ACT.
  6.  A  HOSPITAL  SHALL POST ON THE HOSPITAL'S WEBSITE:  (A) THE HEALTH
CARE PLANS IN WHICH THE HOSPITAL IS A PARTICIPATING  PROVIDER;  AND  (B)
THE  NAME,  PRACTICE  NAME, MAILING ADDRESS, AND TELEPHONE NUMBER OF ANY
HEALTH CARE PROFESSIONAL WHO IS A PHYSICIAN AND WHOSE SERVICES  WILL  BE
PROVIDED AT THE HOSPITAL, BUT WILL NOT BE BILLED AS PART OF THE HOSPITAL
CHARGES.
  7.  A  HOSPITAL SHALL, AT THE EARLIER OF EITHER PRE-ADMISSION TESTING,
OUTPATIENT REGISTRATION, OR  A  NON-EMERGENCY  HOSPITAL  ADMISSION:  (A)
PROVIDE  A  PATIENT OR PROSPECTIVE PATIENT WITH THE NAME, PRACTICE NAME,
MAILING ADDRESS AND TELEPHONE NUMBER OF ANY HEALTH CARE PROFESSIONAL WHO
IS A PHYSICIAN AND WHOSE SERVICES ARE REASONABLY ANTICIPATED AT THE TIME
OF THE PRE-ADMISSION TESTING, REGISTRATION  OR  ADMISSION  AND  WILL  BE
PROVIDED AT THE HOSPITAL, BUT WILL NOT BE BILLED AS PART OF THE HOSPITAL
CHARGES, AS REPORTED BY THE PATIENT'S PHYSICIAN; AND (B) DISCLOSE WHETH-
ER  THE  SERVICES  OF  HEALTH  CARE PROFESSIONALS WHO ARE PHYSICIANS AND
TYPICALLY PROVIDE HOSPITAL SERVICES SUCH AS, BUT NOT LIMITED TO, ANESTH-
ESIOLOGY, PATHOLOGY OR RADIOLOGY ARE BILLED  AS  PART  OF  THE  HOSPITAL
CHARGES.
  8. FOR PURPOSES OF THIS SECTION:
  (A)  "HEALTH  CARE  PLAN"  MEANS A HEALTH INSURER INCLUDING AN INSURER
LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE SUBJECT TO ARTICLE THIR-
TY-TWO OF THE INSURANCE LAW; A CORPORATION ORGANIZED PURSUANT TO ARTICLE
FORTY-THREE OF THE INSURANCE LAW; A MUNICIPAL COOPERATIVE HEALTH BENEFIT
PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE  LAW;  A
HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR
OF THIS CHAPTER; OR A SELF-FUNDED EMPLOYEE WELFARE BENEFIT PLAN.
  (B) "HEALTH CARE PROFESSIONAL" MEANS AN APPROPRIATELY LICENSED, REGIS-
TERED  OR  CERTIFIED HEALTH CARE PROFESSIONAL PURSUANT TO TITLE EIGHT OF
THE EDUCATION LAW.
  S 142. Paragraphs (p-1), (q) and (r) of subdivision 1 of section  4408
of the public health law, paragraph (p-1) as added by chapter 554 of the

S. 2606--C                         163

laws  of  2002 and paragraphs (q) and (r) as added by chapter 705 of the
laws of 1996, are amended and two new paragraphs (s) and (t)  are  added
to read as follows:
  (p-1)  notice that an enrollee shall have direct access to primary and
preventive obstetric and gynecologic services INCLUDING ANNUAL  EXAMINA-
TIONS,  CARE  RESULTING  FROM SUCH ANNUAL EXAMINATIONS, AND TREATMENT OF
ACUTE GYNECOLOGIC CONDITIONS, from a qualified provider of such services
of her choice from within the plan [for no fewer than  two  examinations
annually  for such services] or [to] FOR any care related to A pregnancy
[and that additionally, the enrollee shall have direct access to primary
and preventive obstetric and gynecologic services required as  a  result
of  such  annual  examinations  or  as  a result of an acute gynecologic
condition];
  (q) notice of all appropriate mailing addresses and telephone  numbers
to be utilized by enrollees seeking information or authorization; [and]
  (r)  a  listing by specialty, which may be in a separate document that
is updated annually, of the name, address and telephone  number  of  all
participating  providers, including facilities, and, in addition, in the
case of physicians, board certification[.], LANGUAGES SPOKEN AND  AFFIL-
IATION WITH PARTICIPATING HOSPITALS. THE LISTING SHALL ALSO BE POSTED ON
THE HEALTH MAINTENANCE ORGANIZATION'S WEBSITE AND THE HEALTH MAINTENANCE
ORGANIZATION  SHALL  UPDATE THE WEBSITE WITHIN FIFTEEN DAYS OF THE ADDI-
TION OR TERMINATION OF A PROVIDER FROM THE HEALTH MAINTENANCE  ORGANIZA-
TION'S NETWORK OR A CHANGE IN A PHYSICIAN'S HOSPITAL AFFILIATION;
  (S) WHERE APPLICABLE, A DESCRIPTION OF THE METHOD BY WHICH AN ENROLLEE
MAY  SUBMIT  A  CLAIM  FOR  HEALTH  CARE SERVICES, INCLUDING THROUGH THE
INTERNET, ELECTRONIC MAIL OR BY FACSIMILE; AND
  (T) WHERE APPLICABLE, WHEN A CONTRACT OFFERS  OUT-OF-NETWORK  COVERAGE
PURSUANT  TO  SUBSECTIONS  (B)  AND  (C)  OF  SECTION THREE THOUSAND TWO
HUNDRED FORTY OF THE INSURANCE LAW:
  (I) A CLEAR DESCRIPTION OF THE METHODOLOGY USED BY THE HEALTH  MAINTE-
NANCE  ORGANIZATION TO DETERMINE REIMBURSEMENT FOR OUT-OF-NETWORK HEALTH
CARE SERVICES;
  (II) A DESCRIPTION OF THE AMOUNT THAT THE HEALTH MAINTENANCE ORGANIZA-
TION WILL REIMBURSE UNDER THE METHODOLOGY FOR OUT-OF-NETWORK HEALTH CARE
SERVICES SET FORTH AS A PERCENTAGE OF THE USUAL AND CUSTOMARY  COST  FOR
OUT-OF-NETWORK HEALTH CARE SERVICES; AND
  (III)  EXAMPLES  OF  ANTICIPATED  OUT-OF-POCKET  COSTS  FOR FREQUENTLY
BILLED OUT-OF-NETWORK HEALTH CARE SERVICES.
  S 143. Paragraphs (k) and (l) of subdivision 2 of section 4408 of  the
public  health  law,  as  added  by chapter 705 of the laws of 1996, are
amended and three new paragraphs (m), (n) and (o) are added to  read  as
follows:
  (k)  provide the written application procedures and minimum qualifica-
tion requirements for health care providers  to  be  considered  by  the
health maintenance organization; [and]
  (1)  disclose  other  information  as  required  by  the commissioner,
provided that such requirements are promulgated pursuant  to  the  state
administrative procedure act[.];
  (M)  DISCLOSE  WHETHER  A  HEALTH CARE PROVIDER SCHEDULED TO PROVIDE A
HEALTH CARE SERVICE IS AN IN-NETWORK PROVIDER;
  (N)  WHERE  APPLICABLE,  WITH  RESPECT  TO  OUT-OF-NETWORK   COVERAGE,
DISCLOSE THE DOLLAR AMOUNT THAT THE HEALTH MAINTENANCE ORGANIZATION WILL
PAY FOR A SPECIFIC OUT-OF-NETWORK HEALTH CARE SERVICE; AND
  (O)  PROVIDE  INFORMATION  IN  WRITING AND THROUGH AN INTERNET WEBSITE
THAT REASONABLY PERMITS AN ENROLLEE OR PROSPECTIVE ENROLLEE TO DETERMINE

S. 2606--C                         164

THE  ANTICIPATED  OUT-OF-POCKET  COST  FOR  OUT-OF-NETWORK  HEALTH  CARE
SERVICES  IN  A  GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE
BETWEEN WHAT THE HEALTH  MAINTENANCE  ORGANIZATION  WILL  REIMBURSE  FOR
OUT-OF-NETWORK HEALTH CARE SERVICES AND THE USUAL AND CUSTOMARY COST FOR
OUT-OF-NETWORK HEALTH CARE SERVICES.
  S  144.  Section  4408 of the public health law is amended by adding a
new subdivision 7 to read as follows:
  7.  FOR PURPOSES OF THIS SECTION, "USUAL  AND  CUSTOMARY  COST"  SHALL
MEAN  THE  EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR HEALTH
CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME  OR  SIMILAR  SPECIALTY
AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE  MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE SUPER-
INTENDENT OF FINANCIAL SERVICES. THE NONPROFIT ORGANIZATION SHALL NOT BE
AFFILIATED WITH AN INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE
OF THE INSURANCE LAW, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTI-
FIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE LAW, OR  A  HEALTH
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO THIS ARTICLE.
  S  145.  Subdivision  7-g  of section 4900 of the public health law is
renumbered subdivision 7-h and a new subdivision 7-g is added to read as
follows:
  7-G. "OUT-OF-NETWORK REFERRAL DENIAL" MEANS A DENIAL OF A REQUEST  FOR
AN  AUTHORIZATION OR REFERRAL TO AN OUT-OF-NETWORK PROVIDER ON THE BASIS
THAT THE HEALTH CARE PLAN HAS A HEALTH CARE PROVIDER IN  THE  IN-NETWORK
BENEFITS PORTION OF ITS NETWORK WITH APPROPRIATE TRAINING AND EXPERIENCE
TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN ENROLLEE, AND WHO IS ABLE
TO  PROVIDE  THE  REQUESTED HEALTH SERVICE. THE NOTICE OF A DENIAL OF AN
OUT-OF-NETWORK REFERRAL PROVIDED TO AN ENROLLEE SHALL  INCLUDE  INFORMA-
TION  EXPLAINING  WHAT  INFORMATION THE ENROLLEE MUST SUBMIT IN ORDER TO
APPEAL THE DENIAL OF AN OUT-OF-NETWORK REFERRAL PURSUANT TO  SUBDIVISION
ONE-B  OF  SECTION  FOUR  THOUSAND  NINE HUNDRED FOUR OF THIS ARTICLE. A
DENIAL OF AN OUT-OF-NETWORK REFERRAL UNDER  THIS  SUBDIVISION  DOES  NOT
CONSTITUTE AN ADVERSE DETERMINATION AS DEFINED IN THIS ARTICLE. A DENIAL
OF  AN OUT-OF-NETWORK REFERRAL SHALL NOT BE CONSTRUED TO INCLUDE AN OUT-
OF-NETWORK DENIAL AS DEFINED IN SUBDIVISION SEVEN-F OF THIS SECTION.
  S 146. Subdivision 2 of section 4903 of  the  public  health  law,  as
added by chapter 705 of the laws of 1996, is amended to read as follows:
  2. A utilization review agent shall make a utilization review determi-
nation  involving  health  care services which require pre-authorization
and provide notice of a determination  to  the  enrollee  or  enrollee's
designee  and  the  enrollee's  health care provider by telephone and in
writing within three business days of receipt of the necessary  informa-
tion.  THE  NOTIFICATION SHALL IDENTIFY WHETHER THE SERVICES ARE CONSID-
ERED IN-NETWORK OR OUT-OF-NETWORK.
  S 147. Section 4904 of the public health law is amended  by  adding  a
new subdivision 1-b to read as follows:
  1-B.  AN ENROLLEE OR THE ENROLLEE'S DESIGNEE MAY APPEAL A DENIAL OF AN
OUT-OF-NETWORK REFERRAL BY A HEALTH CARE PLAN BY  SUBMITTING  A  WRITTEN
STATEMENT  FROM  THE  ENROLLEE'S  ATTENDING  PHYSICIAN,  WHO  MUST  BE A
LICENSED, BOARD CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRAC-
TICE IN THE SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT THE ENROLLEE
FOR THE HEALTH SERVICE SOUGHT  THAT:  (A)  THE  IN-NETWORK  HEALTH  CARE
PROVIDER  OR  PROVIDERS  RECOMMENDED BY THE HEALTH CARE PLAN DO NOT HAVE
THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET  THE  PARTICULAR  HEALTH
CARE NEEDS OF THE ENROLLEE FOR THE HEALTH SERVICE; AND (B) RECOMMENDS AN
OUT-OF-NETWORK  PROVIDER WITH THE APPROPRIATE TRAINING AND EXPERIENCE TO

S. 2606--C                         165

MEET THE PARTICULAR HEALTH CARE NEEDS OF THE ENROLLEE, AND WHO  IS  ABLE
TO PROVIDE THE REQUESTED HEALTH SERVICE.
  S  148.  Subdivision  2  of  section  4910 of the public health law is
amended by adding a new paragraph (d) to read as follows:
  (D) (I) THE ENROLLEE HAS HAD AN OUT-OF-NETWORK REFERRAL DENIED ON  THE
GROUNDS  THAT  THE  HEALTH  CARE  PLAN HAS A HEALTH CARE PROVIDER IN THE
IN-NETWORK BENEFITS PORTION OF ITS NETWORK WITH APPROPRIATE TRAINING AND
EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN ENROLLEE,  AND
WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE.
  (II)  THE  ENROLLEE'S  ATTENDING  PHYSICIAN,  WHO SHALL BE A LICENSED,
BOARD CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRACTICE IN THE
SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT  THE  ENROLLEE  FOR  THE
HEALTH SERVICE SOUGHT, CERTIFIES THAT THE IN-NETWORK HEALTH CARE PROVID-
ER  OR  PROVIDERS  RECOMMENDED  BY  THE HEALTH CARE PLAN DO NOT HAVE THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR  HEALTH  CARE
NEEDS OF AN ENROLLEE, AND RECOMMENDS AN OUT-OF-NETWORK PROVIDER WITH THE
APPROPRIATE  TRAINING  AND EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE
NEEDS OF AN ENROLLEE, AND WHO IS ABLE TO PROVIDE  THE  REQUESTED  HEALTH
SERVICE.
  S  149.  Paragraph  (d) of subdivision 2 of section 4914 of the public
health law is amended by adding  a  new  subparagraph  (D)  to  read  as
follows:
  (D) FOR EXTERNAL APPEALS REQUESTED PURSUANT TO PARAGRAPH (D) OF SUBDI-
VISION  TWO  OF  SECTION  FOUR  THOUSAND  NINE HUNDRED TEN OF THIS TITLE
RELATING TO AN OUT-OF-NETWORK REFERRAL, THE EXTERNAL APPEAL AGENT  SHALL
REVIEW  THE  UTILIZATION REVIEW AGENT'S FINAL ADVERSE DETERMINATION AND,
IN ACCORDANCE WITH THE PROVISIONS OF THIS TITLE, SHALL MAKE  A  DETERMI-
NATION AS TO WHETHER THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED BY THE
HEALTH PLAN; PROVIDED THAT SUCH DETERMINATION SHALL:
  (I)  BE CONDUCTED ONLY BY ONE OR A GREATER ODD NUMBER OF CLINICAL PEER
REVIEWERS;
  (II) BE ACCOMPANIED BY A WRITTEN STATEMENT:
  (1) THAT THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED  BY  THE  HEALTH
CARE PLAN EITHER WHEN THE REVIEWER OR A MAJORITY OF THE PANEL OF REVIEW-
ERS  DETERMINES,  UPON  REVIEW  OF  THE  TRAINING  AND EXPERIENCE OF THE
IN-NETWORK HEALTH CARE PROVIDER OR PROVIDERS PROPOSED BY THE  PLAN,  THE
TRAINING  AND  EXPERIENCE  OF THE REQUESTED OUT-OF-NETWORK PROVIDER, THE
CLINICAL STANDARDS OF THE PLAN, THE INFORMATION PROVIDED CONCERNING  THE
ENROLLEE,  THE  ATTENDING  PHYSICIAN'S  RECOMMENDATION,  THE  ENROLLEE'S
MEDICAL RECORD, AND ANY OTHER PERTINENT  INFORMATION,  THAT  THE  HEALTH
PLAN  DOES NOT HAVE A PROVIDER WITH THE APPROPRIATE TRAINING AND EXPERI-
ENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN ENROLLEE WHO IS ABLE
TO PROVIDE THE REQUESTED HEALTH SERVICE,  AND  THAT  THE  OUT-OF-NETWORK
PROVIDER HAS THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTIC-
ULAR  HEALTH CARE NEEDS OF AN ENROLLEE, IS ABLE TO PROVIDE THE REQUESTED
HEALTH SERVICE, AND IS LIKELY TO PRODUCE A  MORE  CLINICALLY  BENEFICIAL
OUTCOME; OR
  (2) UPHOLDING THE HEALTH PLAN'S DENIAL OF COVERAGE;
  (III)  BE  SUBJECT TO THE TERMS AND CONDITIONS GENERALLY APPLICABLE TO
BENEFITS UNDER THE EVIDENCE OF COVERAGE UNDER THE HEALTH CARE PLAN;
  (IV) BE BINDING ON THE PLAN AND THE ENROLLEE; AND
  (V) BE ADMISSIBLE IN ANY COURT PROCEEDING.
  S 150. The financial services law is amended by adding a new article 7
to read as follows:
                                 ARTICLE 7
                       EMERGENCY MEDICAL SERVICES

S. 2606--C                         166

SECTION 701. DEFINITIONS.
        702. PROHIBITION OF EXCESSIVE CHARGES FOR EMERGENCY SERVICES.
        703. DISPUTE RESOLUTION.
        704. CRITERIA FOR DETERMINING EXCESSIVE CHARGES.
  S 701. DEFINITIONS. FOR THE PURPOSES OF THIS ARTICLE:
  (A) "EMERGENCY CONDITION" MEANS A MEDICAL OR BEHAVIORAL CONDITION THAT
MANIFESTS  ITSELF  BY  ACUTE  SYMPTOMS OF SUFFICIENT SEVERITY, INCLUDING
SEVERE PAIN, SUCH THAT A PRUDENT LAYPERSON, POSSESSING AN AVERAGE  KNOW-
LEDGE  OF  MEDICINE  AND  HEALTH, COULD REASONABLY EXPECT THE ABSENCE OF
IMMEDIATE MEDICAL ATTENTION TO RESULT IN (1) PLACING THE HEALTH  OF  THE
PERSON AFFLICTED WITH SUCH CONDITION IN SERIOUS JEOPARDY, OR IN THE CASE
OF A BEHAVIORAL CONDITION PLACING THE HEALTH OF SUCH PERSON OR OTHERS IN
SERIOUS  JEOPARDY;  (2) SERIOUS IMPAIRMENT TO SUCH PERSON'S BODILY FUNC-
TIONS; (3) SERIOUS DYSFUNCTION OF ANY  BODILY  ORGAN  OR  PART  OF  SUCH
PERSON;  (4)  SERIOUS  DISFIGUREMENT  OF SUCH PERSON; OR (5) A CONDITION
DESCRIBED IN CLAUSE (I), (II) OR (III) OF SECTION 1867(E)(1)(A)  OF  THE
SOCIAL SECURITY ACT.
  (B)  "EMERGENCY  SERVICES"  MEANS, WITH RESPECT TO AN EMERGENCY CONDI-
TION: (1) A MEDICAL SCREENING EXAMINATION AS REQUIRED UNDER SECTION 1867
OF THE SOCIAL SECURITY ACT, 42 U.S.C. S  1395DD,  WHICH  IS  WITHIN  THE
CAPABILITY  OF  THE EMERGENCY DEPARTMENT OF A HOSPITAL, INCLUDING ANCIL-
LARY SERVICES ROUTINELY AVAILABLE TO THE EMERGENCY DEPARTMENT TO  EVALU-
ATE SUCH EMERGENCY MEDICAL CONDITION; AND (2) WITHIN THE CAPABILITIES OF
THE STAFF AND FACILITIES AVAILABLE AT THE HOSPITAL, SUCH FURTHER MEDICAL
EXAMINATION  AND  TREATMENT  AS  ARE  REQUIRED UNDER SECTION 1867 OF THE
SOCIAL SECURITY ACT, 42 U.S.C.  S 1395DD, TO STABILIZE THE PATIENT.
  (C) "EXCESSIVE FEE" MEANS A FEE THAT IS IN EXCESS OF AN AMOUNT  DETER-
MINED IN ACCORDANCE WITH SECTION SEVEN HUNDRED FOUR OF THIS ARTICLE.
  (D)  "HEALTH  CARE  PLAN"  MEANS A HEALTH INSURER INCLUDING AN INSURER
LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE SUBJECT TO ARTICLE THIR-
TY-TWO OF THE INSURANCE LAW; A CORPORATION ORGANIZED PURSUANT TO ARTICLE
FORTY-THREE OF THE INSURANCE LAW; A MUNICIPAL COOPERATIVE HEALTH BENEFIT
PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE  LAW;  A
HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR
OF  THE  PUBLIC  HEALTH  LAW;  OR A SELF-FUNDED EMPLOYEE WELFARE BENEFIT
PLAN.
  (E) "INSURED" MEANS A PATIENT COVERED UNDER A POLICY OR CONTRACT  WITH
A HEALTH CARE PLAN.
  (F)  "PATIENT"  MEANS A PERSON WHO RECEIVES EMERGENCY SERVICES IN THIS
STATE.
  (G) "USUAL AND CUSTOMARY COST" MEANS THE EIGHTIETH PERCENTILE  OF  ALL
CHARGES  FOR  THE PARTICULAR HEALTH CARE SERVICE PERFORMED BY A PROVIDER
IN THE SAME OR SIMILAR SPECIALTY AND PROVIDED IN THE  SAME  GEOGRAPHICAL
AREA  AS  REPORTED  IN A BENCHMARKING DATABASE MAINTAINED BY A NONPROFIT
ORGANIZATION SPECIFIED BY THE SUPERINTENDENT. THE NONPROFIT ORGANIZATION
SHALL NOT BE AFFILIATED WITH AN INSURER, A CORPORATION SUBJECT TO  ARTI-
CLE  FORTY-THREE  OF  THE  INSURANCE LAW, A MUNICIPAL COOPERATIVE HEALTH
BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE  INSURANCE
LAW,  OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW.
  S 702. PROHIBITION OF EXCESSIVE CHARGES FOR EMERGENCY SERVICES.  (A) A
PHYSICIAN WHO PROVIDES HEALTH CARE SERVICES  IN  THIS  STATE  SHALL  NOT
CHARGE  AN  EXCESSIVE  FEE BASED ON THE CRITERIA FOR PROVIDING EMERGENCY
SERVICES IN SECTION SEVEN HUNDRED THREE OF THIS ARTICLE.
  (B) THIS ARTICLE SHALL NOT APPLY TO EMERGENCY SERVICES WHERE  PROVIDER
FEES  ARE  SUBJECT  TO SCHEDULES OR OTHER MONETARY LIMITATIONS UNDER ANY

S. 2606--C                         167

OTHER LAW, INCLUDING THE WORKERS' COMPENSATION LAW AND ARTICLE FIFTY-ONE
OF THE INSURANCE LAW, AND SHALL NOT PREEMPT ANY SUCH LAW.
  S 703. DISPUTE RESOLUTION.  (A) A HEALTH CARE PLAN OR A PATIENT ALLEG-
ING THAT A PHYSICIAN HAS CHARGED AN EXCESSIVE FEE FOR PROVIDING EMERGEN-
CY  SERVICES MAY SUBMIT THE DISPUTE FOR REVIEW TO AN INDEPENDENT DISPUTE
RESOLUTION ENTITY, IN ACCORDANCE WITH  REGULATIONS  PROMULGATED  BY  THE
SUPERINTENDENT,  IF THE PHYSICIAN'S CHARGE EXCEEDS THE USUAL AND CUSTOM-
ARY COST OF THE HEALTH CARE SERVICES.
  (B) A PATIENT SHALL NOT BE REQUIRED TO  PAY  THE  PHYSICIAN'S  FEE  IN
ORDER TO BE ELIGIBLE TO SUBMIT THE DISPUTE FOR REVIEW TO THE INDEPENDENT
DISPUTE RESOLUTION ENTITY.
  (C)  A HEALTH CARE PLAN SHALL NOT SUBMIT THE DISPUTE FOR REVIEW TO THE
INDEPENDENT DISPUTE RESOLUTION ENTITY UNLESS SUCH PLAN HAS MADE PAYMENT,
IN FULL, OF THE PHYSICIAN'S FEE, EXCEPT FOR  THE  INSURED'S  CO-PAYMENT,
COINSURANCE  OR  DEDUCTIBLE,  FOR THE SERVICES RENDERED. THE HEALTH CARE
PLAN MAY ADVISE THE PHYSICIAN THAT  THE  PAYMENT  IS  BEING  MADE  UNDER
PROTEST.
  S  704. CRITERIA FOR DETERMINING EXCESSIVE CHARGES.  (A) (1) THE INDE-
PENDENT DISPUTE RESOLUTION ENTITY SHALL DECIDE WHETHER THE  FEE  CHARGED
BY  THE PHYSICIAN FOR THE SERVICES RENDERED IS EXCESSIVE. IN MAKING SUCH
A DETERMINATION THE INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL CONSIDER
ALL RELEVANT FACTORS INCLUDING:
  (I) WHETHER THERE IS A GROSS DISPARITY BETWEEN THE FEE CHARGED BY  THE
PHYSICIAN  FOR  SERVICES  RENDERED  AS COMPARED TO: (A) FEES PAID BY THE
HEALTH CARE PLAN TO REIMBURSE SIMILARLY  QUALIFIED  PHYSICIANS  FOR  THE
SAME  SERVICES IN THE SAME REGION WHO DO NOT PARTICIPATE WITH THE HEALTH
CARE PLAN; AND (B) FEES PAID TO THE  INVOLVED  PHYSICIAN  FOR  THE  SAME
SERVICES  RENDERED  BY THE PHYSICIAN TO PATIENTS IN HEALTH CARE PLANS IN
WHICH THE PHYSICIAN DOES NOT PARTICIPATE;
  (II) THE LEVEL OF TRAINING, EDUCATION AND EXPERIENCE OF THE PHYSICIAN;
  (III) THE PHYSICIAN'S USUAL CHARGE FOR COMPARABLE SERVICES WITH REGARD
TO PATIENTS IN HEALTH CARE PLANS IN WHICH THE PHYSICIAN DOES NOT PARTIC-
IPATE;
  (IV) THE CIRCUMSTANCES AND COMPLEXITY OF THE PARTICULAR CASE,  INCLUD-
ING TIME AND PLACE OF THE SERVICE;
  (V) INDIVIDUAL PATIENT CHARACTERISTICS; AND
  (VI) THE USUAL AND CUSTOMARY COST OF THE SERVICE.
  (2)  IF  THE INDEPENDENT DISPUTE RESOLUTION ENTITY DETERMINES THAT THE
FEE CHARGED IS EXCESSIVE, THEN THE INDEPENDENT DISPUTE RESOLUTION ENTITY
SHALL DETERMINE A REASONABLE FEE FOR THE SERVICES BASED  UPON  THE  SAME
CONDITIONS  AND  FACTORS  SET FORTH IN THIS SUBDIVISION, WHICH FEE SHALL
NOT BE LESS THAN THE USUAL AND CUSTOMARY COST FOR SUCH  SERVICES.    THE
PHYSICIAN  SHALL  RETURN  TO THE HEALTH CARE PLAN ANY PORTION OF THE FEE
PAID BY THE HEALTH CARE PLAN IN EXCESS OF THE AMOUNT  DETERMINED  TO  BE
REASONABLE BY THE INDEPENDENT DISPUTE RESOLUTION ENTITY.
  (B)  THE  DETERMINATION  OF  AN  INDEPENDENT DISPUTE RESOLUTION ENTITY
SHALL BE BINDING ON THE HEALTH CARE PLAN,  PHYSICIAN  AND  PATIENT,  AND
SHALL  BE  ADMISSIBLE  IN  ANY  COURT PROCEEDING BETWEEN THE HEALTH CARE
PLAN, PHYSICIAN OR PATIENT, OR IN ANY ADMINISTRATIVE PROCEEDING  BETWEEN
THIS STATE AND THE PHYSICIAN.
  (C) THE SUPERINTENDENT SHALL PROMULGATE REGULATIONS TO ESTABLISH STAN-
DARDS  FOR THE DISPUTE RESOLUTION PROCESS INCLUDING STANDARDS FOR ESTAB-
LISHING WHICH PARTY SHALL BE RESPONSIBLE  FOR  PAYMENT  OF  THE  DISPUTE
RESOLUTION PROCESS.

S. 2606--C                         168

  S 150-a. Paragraph (u) of subdivision 4 of section 364-j of the social
services  law,  as  amended by section 40 of part D of chapter 56 of the
laws of 2012, is amended to read as follows:
  (u)  A  managed  care provider that provides coverage for prescription
drugs shall permit each participant  to  fill  any  mail  order  covered
prescription,  at  his or her option, at any mail order pharmacy or non-
mail-order retail pharmacy in the managed care provider network, if  the
non-mail-order retail pharmacy offers to accept a price that is compara-
ble  to  that  of  the  mail  order  pharmacy.  FOR THE PURPOSES OF THIS
SECTION, "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE  PRIMARY  BUSINESS
IS  TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX OR THROUGH ELECTRONIC
SUBMISSIONS, AND TO DISPENSE MEDICATION TO PATIENTS THROUGH THE  USE  OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES, AND
PROVIDES  ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE
TO FACE. Every  non-mail-order  retail  pharmacy  in  the  managed  care
provider's network with respect to any prescription drug shall be deemed
to  be  in  the  managed  care  provider's  network  for  every  covered
prescription drug[; provided, however, that the  managed  care  provider
may limit its network of pharmacies for specified drugs, approved by the
commissioner,  based  on  clinical,  professional or cost criteria. Such
limitation shall not be based solely on cost].
  S 151. The public health law is amended by adding a new section 4403-g
to read as follows:
  S 4403-G. HOME AND COMMUNITY-BASED CARE WORK GROUP. 1. THE COMMISSION-
ER SHALL CONVENE A HOME AND COMMUNITY-BASED CARE WORK GROUP  TO  EXAMINE
ISSUES  SURROUNDING  CONTINUITY  OF  CARE,  REGULATORY GUIDANCE, QUALITY
ASSURANCE, AND CARE DELIVERY AMONG HOME AND COMMUNITY-BASED HEALTH  CARE
PROVIDERS  IN  THEIR  TRANSITION TO MANAGED CARE. THE COMMISSIONER SHALL
CONVENE THE WORKGROUP AS SOON AS PRACTICABLE, HOWEVER NO LATER THAN  MAY
FIRST,  TWO  THOUSAND THIRTEEN. IT SHALL INCLUDE, BUT NOT BE LIMITED TO,
REPRESENTATIVES OF MANAGED LONG TERM CARE PLANS, CERTIFIED  HOME  HEALTH
AGENCIES,  LONG  TERM  HOME  HEALTH  CARE  PROGRAMS,  LICENSED HOME CARE
SERVICES AGENCIES, CONSUMER DIRECTED CARE AGENCIES,  CONSUMER  ORGANIZA-
TIONS  AND  STATE ASSOCIATIONS REPRESENTATIVES THEREOF ALONG WITH OTHERS
WITH DEMONSTRATED EXPERTISE  IN  QUALITY  MEASUREMENTS,  REPORTING,  AND
OTHER  AREAS OF CONSIDERATION. THE WORKGROUP SHALL ISSUE RECOMMENDATIONS
ON TOPICS INCLUDING, BUT NOT LIMITED TO:
  (A) THE WORKGROUP SHALL IDENTIFY AND  MAKE  RECOMMENDATIONS  REGARDING
CONSOLIDATION,  SIMPLIFICATION,  AND  WHERE POSSIBLE, MAKE UNIFORM RULES
AND REGULATIONS RELATED TO THE INTEGRATION OF EXISTING HOME AND COMMUNI-
TY-BASED CARE WITHIN MANAGED CARE. RECOMMENDATIONS  SHALL  INCLUDE,  BUT
NOT BE LIMITED TO, CONSIDERATIONS OF:
  (I)  STREAMLINING OF DUPLICATIVE FUNCTIONS SHARED BETWEEN MANAGED CARE
AND HOME AND COMMUNITY-BASED PROVIDERS;
  (II) BEST PRACTICES FOR EFFICIENT DELIVERY AND MANAGEMENT OF SERVICES;
  (III) ASSESSMENT AND REASSESSMENT REQUIREMENTS OF THE PATIENT, INCLUD-
ING BUT NOT LIMITED TO THE USE OF A  SINGLE  FORM  FOR  ASSESSMENTS  AND
REASSESSMENTS AND FREQUENCY;
  (IV) THE DETERMINATION OF ELIGIBILITY;
  (V)  THE  DEVELOPMENT  OF THE WRITTEN PLAN OF CARE AND PROCUREMENT AND
DOCUMENTATION OF VERBAL AND WRITTEN PHYSICIAN ORDERS;
  (VI) CARE COORDINATION INCLUDING COMMUNICATIONS  BETWEEN  HEALTH  CARE
PROVIDERS AND PHYSICIANS;
  (VII) DOCUMENTATION AND MAINTENANCE OF PATIENT RECORDS; AND
  (VIII) REQUIREMENTS FOR DIRECT CARE STAFF SUPERVISION.

S. 2606--C                         169

  (B)  THE  WORKGROUP  SHALL IDENTIFY AND MAKE RECOMMENDATIONS REGARDING
QUALITY IMPROVEMENT MEASURES, HEALTH  OUTCOMES  DATA,  INTERNAL  QUALITY
ASSESSMENT  PROCESSES,  AND  REPORTING  MECHANISMS TO ENSURE AND PROMOTE
HIGH QUALITY, INTEGRATED AND COST EFFECTIVE CARE AS INDIVIDUALS  TRANSI-
TION TO MANAGED CARE.
  (C)  THE WORKGROUP SHALL MAKE RECOMMENDATIONS REGARDING THE CONTINUITY
AND TRANSITION OF TELEHEALTH INTO MANAGED CARE SYSTEMS.  RECOMMENDATIONS
SHALL INCLUDE, BUT NOT BE LIMITED TO, CONSIDERATIONS OF:
  (I) THE DETERMINATION OF ELIGIBILITY;
  (II)  STREAMLINING  DUPLICATIVE  FUNCTIONS SHARED BETWEEN MANAGED CARE
AND HOME AND COMMUNITY-BASED PROVIDERS;
  (III) CURRENT ADMINISTRATIVE, REGULATORY, AND INDUSTRY GUIDELINES;
  (IV) BEST PRACTICES FOR EFFICIENT DELIVERY AND MANAGEMENT OF SERVICES;
  (V) SPECIFIC DELINEATIONS OF  RESPECTIVE  RESPONSIBILITIES  AMONG  THE
PROVIDERS WHERE APPROPRIATE;
  (VI) INFRASTRUCTURE READINESS;
  (VII) CONTINUITY OF CARE;
  (VIII) CARE COORDINATION;
  (IX) CONSISTENT RATING AND REIMBURSEMENT METHODOLOGIES; AND
  (X) PROJECTED IMPACTS TO COUNTY POPULATIONS DISPROPORTIONATELY RELIANT
ON TELEHEALTH, SPECIFICALLY POPULATIONS OF TWO HUNDRED THOUSAND OR LESS.
  2. THE WORKGROUP SHALL REPORT ITS RECOMMENDATIONS AS SOON AS PRACTICA-
BLE  BUT  NO  LATER  THAN  OCTOBER  FIRST, TWO THOUSAND THIRTEEN, TO THE
COMMISSIONER, TEMPORARY PRESIDENT OF THE SENATE, SPEAKER OF  THE  ASSEM-
BLY,  AND  CHAIRS  OF  THE  SENATE AND ASSEMBLY HEALTH COMMITTEES. EVERY
EFFORT SHALL BE MADE BY THE COMMISSIONER TO  INCORPORATE  AND  IMPLEMENT
THE RECOMMENDATIONS OF THE WORKGROUP.
  S  152.  Notwithstanding  any contrary provision of law or regulation,
retroactive to January first, two thousand ten, rates of payment made by
state governmental agencies for general  hospital  inpatient  total  hip
joint  replacement  and total knee joint replacement cases shall utilize
the diagnosis-related groups and service intensity weights in effect  on
December  thirty-first, two thousand seven pursuant to subdivision three
of section 2807-c of the public health  law.  Such  rates  may  only  be
adjusted  for  a  general  hospital if the majority of inpatient surgery
cases for the general hospital are orthopedic cases, the general  hospi-
tal  has  developed  a  center  of  excellence in orthopedic surgery and
sports medicine, the general hospital incurred a  significant  reduction
in  reimbursement  for  such  cases beginning in two thousand eight as a
result of revisions to the service intensity weights  for  these  cases,
and  such adjustment would not increase reimbursement from state govern-
mental agencies to the general hospital by more than an average  of  two
hundred  thousand  dollars  a year. Such adjustment shall not affect the
diagnosis related groups and service intensity  weights  for  any  other
cases or for any other general hospital.
  S  153.  Subdivision  1  of  section  206  of the public health law is
amended by adding a new paragraph (s) to read as follows:
  (S) ISSUE A READINESS REPORT TO THE LEGISLATURE, DETAILING THE  STATUS
OF  THE  STATEWIDE  HEALTH  BENEFIT EXCHANGE ESTABLISHED UNDER EXECUTIVE
ORDER 42 OF 2012, ON OR BEFORE AUGUST THIRTIETH, TWO THOUSAND  THIRTEEN.
THE  READINESS  REPORT MAY BE PROVIDED IN ELECTRONIC FORMAT AND SHALL BE
DISTRIBUTED TO THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE
ASSEMBLY, THE CHAIR OF THE SENATE STANDING COMMITTEE ON HEALTH, AND  THE
CHAIR  OF  THE  ASSEMBLY  HEALTH  COMMITTEE.  THE READINESS REPORT SHALL
OUTLINE THE PROGRESS AND PREPAREDNESS OF THE  HEALTH  BENEFIT  EXCHANGE,

S. 2606--C                         170

AND  DETAIL HOW THE EXCHANGE WILL CARRY OUT ITS FUNCTIONS INCLUDING, BUT
NOT BE LIMITED TO:
  (1)  THE  PROCESS  BY  WHICH  THE  HEALTH  BENEFIT EXCHANGE WILL BEGIN
ACCEPTING APPLICATIONS ON OCTOBER FIRST, TWO THOUSAND THIRTEEN;
  (2) THE PROCESS BY WHICH THE  HEALTH  BENEFIT  EXCHANGE  WILL  CERTIFY
QUALIFIED HEALTH PLANS;
  (3)  THE  ANTICIPATED  COST  OF INDIVIDUAL AND SMALL GROUP PLANS BEING
OFFERED IN THE HEALTH BENEFIT EXCHANGE;
  (4) THE NUMBER OF NAVIGATORS APPROVED;
  (5) THE PLAN FOR FULL OPERATION BY JANUARY FIRST, TWO  THOUSAND  FOUR-
TEEN; AND
  (6)  THE PLAN TO BECOME FISCALLY SELF-SUSTAINING BY JANUARY FIRST, TWO
THOUSAND FIFTEEN.
  S 154. Subdivision 1 of section  206  of  the  public  health  law  is
amended by adding a new paragraph (t) to read as follows:
  (T)  MAKE  AN  ANNUAL REPORT TO THE LEGISLATURE ON OR BEFORE THE FIRST
DAY OF DECEMBER.  THIS REPORT MAY BE PROVIDED IN ELECTRONIC  FORMAT  AND
SHALL  BE  DISTRIBUTED  TO  THE  TEMPORARY  PRESIDENT OF THE SENATE, THE
SPEAKER OF THE ASSEMBLY, THE CHAIR OF THE SENATE STANDING  COMMITTEE  ON
HEALTH, AND THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE. THE REPORT SHALL
ALSO  BE POSTED ON THE DEPARTMENT'S WEBSITE.  THIS REPORT SHALL INCLUDE,
BUT NOT LIMITED TO:
  (1) A DETAILED DESCRIPTION OF THE DEPARTMENT'S MISSION, PRIORITIES AND
GOALS FOR THE UPCOMING YEAR;
  (2) ANY AND ALL RELEVANT DATA AND STATISTICS;
  (3) A SUMMARY OF THE ACHIEVEMENTS AND INITIATIVES OF THE DEPARTMENT IN
THE PAST YEAR;
  (4) INFORMATION CONCERNING EACH DIVISION, BUREAU, OFFICE  OR  INSTITU-
TION  WITHIN THE DEPARTMENT, AND THEIR ACTIVITIES, AFFAIRS AND RECOMMEN-
DATIONS;
  (5) ANY MATTERS EXPRESSLY REQUIRED  BY  LAW  TO  BE  INCLUDED  IN  THE
REPORT; AND
  (6) ANY OTHER MATTERS DEEMED NECESSARY BY THE COMMISSIONER.
  S  155. Section 23 of part A of chapter 56 of the laws of 2012, amend-
ing the public health law relating to evaluations or services under  the
early  intervention  program  for infants and toddlers with disabilities
and their families, is amended to read as follows:
  S 23. This act shall take effect January 1, 2013;  provided,  however,
that sections two-a, four, five, seven, eight, nine-a, ten, eighteen and
nineteen of this act shall take effect April 1, 2013, AND THE PROVISIONS
OF  SUBPARAGRAPH (III) OF PARAGRAPH (A) OF SUBDIVISION 3 OF SECTION 2559
OF THE PUBLIC HEALTH LAW, AS ADDED BY SECTION ELEVEN OF THIS ACT,  SHALL
TAKE  EFFECT  AUGUST 1, 2013; AND PROVIDED, FURTHER, THAT THE DEPARTMENT
OF HEALTH SHALL NOT PROMULGATE REGULATIONS OR  TAKE  ANY  ADMINISTRATIVE
ACTION  PURSUANT  TO THIS ACT AFFECTING PROVIDER RELATIONSHIPS OR AGREE-
MENTS PRIOR TO APRIL 1, 2014.
  S 156. Article 29-A of the public health law is amended  by  adding  a
new title 3 to read as follows:
                                 TITLE 3
                     BROADSCALE SYSTEMS INTEGRATION
                          DEMONSTRATION PROGRAM
SECTION 2959-1. BROADSCALE SYSTEMS INTEGRATION DEMONSTRATION PROGRAM.
  S  2959-1.  BROADSCALE  SYSTEMS INTEGRATION DEMONSTRATION PROGRAM.  1.
FEDERAL HEALTH CARE REFORM AND THE CURRENT PROPOSALS TO  TRANSITION  NEW
YORK  STATE  MEDICAID  PROVIDERS TO A MANAGED CARE MODEL, HAVE INITIATED
SIGNIFICANT CHANGES TO HEALTH CARE  DELIVERY  WITHIN  THE  STATE.    THE

S. 2606--C                         171

LEGISLATURE  RECOGNIZES  THESE CHANGES, AS WELL AS THE NEED FOR GUIDANCE
ON HOW PROVIDERS CAN COMPLY IN AN EFFECTIVE AND  COST-EFFICIENT  MANNER.
GIVEN  THE UNIQUE CHARACTERISTICS AND NEEDS OF RURAL COUNTIES WITHIN THE
STATE,  INCLUDING  DISPARITIES  IN  SUPPLY AND ACCESS TO HEALTH CARE, AS
WELL AS PROVIDER SHORTAGES AND HIGHER RATES OF  UNDERINSURED  AND  UNIN-
SURED,  IT  IS IMPERATIVE THAT THE STATE ADDRESS THE UNIQUE NEEDS OF ITS
RURAL POPULATION AND PROVIDE  INFORMATION  ON  THE  KEY  VARIABLES  THAT
PROVIDERS MUST UTILIZE FOR A RESPONSIBLE TRANSITION TO MANAGED CARE.
  2.(A)  THE  COMMISSIONER  SHALL,  WITHIN MONIES APPROPRIATED THEREFOR,
ESTABLISH A BROADSCALE  SYSTEMS  INTEGRATION  DEMONSTRATION  PROGRAM  IN
COUNTIES  HAVING  A POPULATION OF NOT LESS THAN ONE HUNDRED THIRTY THOU-
SAND AND NOT MORE THAN ONE HUNDRED FORTY THOUSAND, ACCORDING TO THE  TWO
THOUSAND  TEN DECENNIAL FEDERAL CENSUS. THE COMMISSIONER AND THE COMMIS-
SIONER OF MENTAL HEALTH SHALL, IN COORDINATION WITH A NON-PROFIT  ORGAN-
IZATION  ACTING AS A SAFETY NET PROVIDER SERVING IN SUCH COUNTY TO STUDY
COST SAVINGS ACHIEVED THROUGH THE PROVISION OF SERVICES,  INCLUDING  BUT
NOT  LIMITED  TO,  DENTAL,  HEALTH,  BEHAVIORAL  HEALTH, EMPLOYMENT, AND
SOCIAL SERVICES INTERVENTION WITHIN A MANAGED  CARE  MODEL  IN  A  RURAL
SETTING. SUCH A STUDY SHALL DETERMINE:
  (I)  THE  QUALITY  OF CARE PROVIDED THROUGH AN INTEGRATED MODEL VERSUS
CURRENT DELIVERY SYSTEMS;
  (II) COST SAVINGS ACHIEVED BY IMPLEMENTING AN INTEGRATED MANAGED  CARE
DELIVERY SYSTEM;
  (III)  COROLLARIES  BETWEEN  AN INTEGRATED SYSTEM AND IMPROVED PATIENT
OUTCOMES;
  (IV) CARE COORDINATION/CASE MANAGEMENT AMONG DELIVERY SYSTEMS;
  (V) IMPLEMENTATION AND TRANSITION COSTS;
  (VI) DATA ON ACCESS TO CARE AND THE UNINSURED IN RURAL AREAS;
  (VII) SOCIOECONOMIC BENCHMARKS  AND  IMPROVEMENTS  INCLUDING  BUT  NOT
LIMITED  TO  DATA  OF  UNEMPLOYMENT, POVERTY, AND UNDERINSURED AND UNIN-
SURED;
  (VIII) STAFFING SHORTAGES AND/OR STAFFING MODIFICATIONS IN THE TRANSI-
TION TO A MANAGED CARE MODEL;
  (IX) RECOMMENDATIONS FOR REPLICATION/IMPROVEMENT IN OTHER RURAL AREAS;
AND
  (X) SUCH OTHER ACTIVITIES AS THE COMMISSIONER MAY DEEM  NECESSARY  AND
APPROPRIATE TO THIS SECTION.
  (B)  THE  ORGANIZATION,  IN  CONSULTATION  WITH THE DEPARTMENT AND THE
OFFICE OF MENTAL HEALTH, SHALL EVALUATE THE FINDINGS OF  THE  STUDY  AND
REPORT  TO  THE  GOVERNOR,  THE  TEMPORARY  PRESIDENT OF THE SENATE, THE
SPEAKER OF THE ASSEMBLY, THE COMMISSIONER AND THE CHAIR OF THE  LEGISLA-
TIVE COMMISSION ON RURAL RESOURCES ON ITS FINDINGS, SO AS TO PROVIDE THE
COST  BENCHMARKS WITH AND WITHOUT THE BROADSCALE SYSTEMS INTEGRATION, AS
WELL AS PROVIDING COST BENEFIT MEASUREMENTS  IN  TERMS  OF  THE  QUALITY
BENEFIT OUTCOMES FOR EACH OF THE BENCHMARKS.
  (C)  ADDITIONALLY,  TO  THE  EXTENT  OF  FUNDS  APPROPRIATED THEREFOR,
MEDICAL ASSISTANCE FUNDS, INCLUDING ANY FUNDING OR SHARED SAVINGS AS MAY
BECOME AVAILABLE THROUGH FEDERAL WAIVERS OR OTHERWISE  UNDER  TITLES  18
AND  19 OF THE FEDERAL SOCIAL SECURITY ACT, MAY BE USED FOR EXPENDITURES
IN SUPPORT OF THE DEMONSTRATION PROGRAM.
  S 157. Sections one hundred fifty-seven and  one  hundred  fifty-eight
this act shall be known and may be cited as "Aidan's Law".
  S  158. Subdivision (a) of section 2500-a of the public health law, as
amended by chapter 863 of the laws  of  1986,  is  amended  to  read  as
follows:

S. 2606--C                         172

  (a) It shall be the duty of the administrative officer or other person
in  charge  of  each institution caring for infants twenty-eight days or
less of age and the person required in pursuance of  the  provisions  of
section  forty-one  hundred thirty of this chapter to register the birth
of  a child, to cause to have administered to every such infant or child
in its or his care a test for phenylketonuria,  homozygous  sickle  cell
disease,  hypothyroidism,  branched-chain ketonuria, galactosemia, homo-
cystinuria, ADRENOLEUKODYSTROPHY and such other diseases and  conditions
as may from time to time be designated by the commissioner in accordance
with  rules  or regulations prescribed by the commissioner. Testing, the
recording of the results of such tests, tracking, follow-up reviews  and
educational  activities  shall  be  performed  at such times and in such
manner as may be prescribed by the commissioner. The commissioner  shall
promulgate  regulations  setting  forth  the manner in which information
describing the purposes of the requirements of  this  section  shall  be
disseminated to parents or a guardian of the infant tested.
  S  159.  Subdivision  2-a  of section 2807 of the public health law is
amended by adding a new paragraph (j) to read as follows:
  (J) NOTWITHSTANDING ANY OTHER PROVISION OF  THIS  SUBDIVISION  OR  ANY
OTHER  PROVISION OF LAW TO THE CONTRARY AND, SUBJECT TO AN APPROPRIATION
THEREFOR, ON AND AFTER APRIL FIRST,  TWO  THOUSAND  THIRTEEN,  RATES  OF
PAYMENT   FOR   DIAGNOSTIC  AND  TREATMENT  CENTER  SERVICES,  EMERGENCY
SERVICES, GENERAL  HOSPITAL  OUTPATIENT  SERVICES,  AMBULATORY  SURGICAL
SERVICES  AND REFERRED AMBULATORY SERVICES, PROVIDED BY A RURAL HOSPITAL
DESIGNATED AS A CRITICAL ACCESS HOSPITAL IN ACCORDANCE WITH TITLE  XVIII
OF  THE  FEDERAL  SOCIAL  SECURITY ACT SHALL BE EQUAL TO ONE HUNDRED ONE
PERCENT OF THE REASONABLE COSTS OF A FACILITY IN PROVIDING SUCH SERVICES
TO PATIENTS ELIGIBLE FOR PAYMENTS MADE IN ACCORDANCE WITH THIS  SUBDIVI-
SION.  REASONABLE  COSTS SHALL BE DETERMINED IN A MANNER CONSISTENT WITH
THAT USED TO DETERMINE PAYMENT FOR OUTPATIENT CRITICAL  ACCESS  HOSPITAL
SERVICES  PROVIDED TO BENEFICIARIES OF TITLE XVIII OF THE FEDERAL SOCIAL
SECURITY ACT. FOR FACILITIES  WITHOUT  ADEQUATE  COST  EXPERIENCE,  SUCH
RATES  SHALL  BE  BASED  ON  BUDGETED COSTS SUBSEQUENTLY ADJUSTED TO ONE
HUNDRED ONE PERCENT OF REASONABLE ACTUAL COSTS.
  S 160. Subdivision 2 of section 99-f of  the  state  finance  law,  as
amended  by  chapter  612  of  the  laws  of 1999, is amended to read as
follows:
  2. The fund shall consist of all monies appropriated for its  purpose,
all  monies required by this section or any other provision of law to be
paid into or credited to such fund, and FIVE AND SIX-TENTHS  PER  CENTUM
OF  monies  COLLECTED  BY  THE  MANDATORY SURCHARGES IMPOSED PURSUANT TO
SUBDIVISION ONE OF SECTION EIGHTEEN HUNDRED  NINE  OF  THE  VEHICLE  AND
TRAFFIC  LAW in an amount not to exceed eight million five hundred thou-
sand dollars [collected by the mandatory surcharges imposed pursuant  to
subdivision  one  of  section  eighteen  hundred nine of the vehicle and
traffic law]. Nothing contained herein shall prevent the  department  of
health  from receiving grants, gifts or bequests for the purposes of the
fund as defined in this  section  and  depositing  them  into  the  fund
according to law.
  S  161. Section 365-d of the social services law is REPEALED and a new
section 365-d is added to read as follows:
  S 365-D. HEALTH TECHNOLOGY ASSESSMENT  COMMITTEE.  1.  THE  DEPARTMENT
SHALL  CONVENE  A  HEALTH TECHNOLOGY ASSESSMENT COMMITTEE. THE COMMITTEE
SHALL, AT THE REQUEST OF  THE  COMMISSIONER,  PROVIDE  ADVICE  AND  MAKE
RECOMMENDATIONS  REGARDING COVERAGE OF HEALTH TECHNOLOGY FOR PURPOSES OF
THE MEDICAL ASSISTANCE PROGRAM.  THE  COMMISSIONER  SHALL  CONSULT  SUCH

S. 2606--C                         173

COMMITTEE PRIOR TO ANY DETERMINATION TO EXCLUDE FROM COVERAGE ANY HEALTH
TECHNOLOGY  FROM  THE  MEDICAL  ASSISTANCE PROGRAM. FOR PURPOSES OF THIS
SECTION, "HEALTH TECHNOLOGY" MEANS MEDICAL DEVICES AND  SURGICAL  PROCE-
DURES  USED  IN  THE  PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE AND
OTHER MEDICAL CONDITIONS.
  2. (A) THE HEALTH TECHNOLOGY ASSESSMENT  COMMITTEE  SHALL  CONSIST  OF
THIRTEEN  MEMBERS,  WHO  SHALL  BE APPOINTED BY THE COMMISSIONER AND WHO
SHALL SERVE THREE YEAR TERMS; EXCEPT THAT FOR THE  INITIAL  APPOINTMENTS
TO  THE COMMITTEE, FIVE MEMBERS SHALL SERVE ONE YEAR TERMS, FIVE MEMBERS
SHALL SERVE TWO YEAR TERMS, AND THREE MEMBERS  SHALL  SERVE  THREE  YEAR
TERMS. COMMITTEE MEMBERS MAY BE REAPPOINTED UPON THE COMPLETION OF THEIR
TERMS. WITH THE EXCEPTION OF THE CHAIRPERSON, NO MEMBER OF THE COMMITTEE
SHALL  BE  AN  EMPLOYEE OF THE STATE OR ANY POLITICAL SUBDIVISION OF THE
STATE, OTHER THAN FOR HIS OR HER MEMBERSHIP ON THE COMMITTEE, EXCEPT FOR
EMPLOYEES OF HEALTH CARE FACILITIES  OR  UNIVERSITIES  OPERATED  BY  THE
STATE, A PUBLIC BENEFIT CORPORATION, THE STATE UNIVERSITY OF NEW YORK OR
MUNICIPALITIES.
  (B) THE MEMBERSHIP OF SUCH COMMITTEE SHALL BE AS FOLLOWS:
  (I) SIX PERSONS LICENSED AND ACTIVELY ENGAGED IN THE PRACTICE OF MEDI-
CINE IN THIS STATE;
  (II) ONE PERSON LICENSED AND ACTIVELY ENGAGED IN THE PRACTICE OF NURS-
ING  AS  A  NURSE  PRACTITIONER, OR IN THE PRACTICE OF MIDWIFERY IN THIS
STATE;
  (III) ONE PERSON WHO IS A REPRESENTATIVE OF  A  HEALTH  TECHNOLOGY  OR
MEDICAL  DEVICE  ORGANIZATION  WITH  A  REGIONAL,  STATEWIDE OR NATIONAL
CONSTITUENCY AND WHO IS A HEALTH CARE PROFESSIONAL LICENSED UNDER  TITLE
EIGHT OF THE EDUCATION LAW;
  (IV)  ONE PERSON WITH EXPERTISE IN HEALTH TECHNOLOGY ASSESSMENT WHO IS
A HEALTH CARE PROFESSIONAL LICENSED UNDER TITLE EIGHT OF  THE  EDUCATION
LAW;
  (V)  THREE PERSONS WHO SHALL BE CONSUMERS OR REPRESENTATIVES OF ORGAN-
IZATIONS WITH A REGIONAL OR STATEWIDE CONSTITUENCY  AND  WHO  HAVE  BEEN
INVOLVED IN ACTIVITIES RELATED TO HEALTH CARE CONSUMER ADVOCACY; AND
  (VI) A MEMBER OF THE DEPARTMENT WHO SHALL ACT AS CHAIRPERSON AS DESIG-
NATED BY THE COMMISSIONER.
  3.  THE  HEALTH TECHNOLOGY ASSESSMENT COMMITTEE SHALL BE A PUBLIC BODY
UNDER ARTICLE SEVEN OF THE PUBLIC OFFICERS LAW AND  SUBJECT  TO  ARTICLE
SIX  OF  THE  PUBLIC OFFICERS LAW. THE DEPARTMENT SHALL PROVIDE INTERNET
ACCESS TO ALL  MEETINGS  OF  SUCH  COMMITTEE  THROUGH  THE  DEPARTMENT'S
WEBSITE.
  4.  THE  MEMBERS  OF  THE HEALTH TECHNOLOGY ASSESSMENT COMMITTEE SHALL
RECEIVE NO COMPENSATION FOR THEIR SERVICES BUT SHALL BE  REIMBURSED  FOR
EXPENSES  ACTUALLY  AND NECESSARILY INCURRED IN THE PERFORMANCE OF THEIR
DUTIES. COMMITTEE MEMBERS SHALL BE DEEMED TO BE EMPLOYEES OF THE DEPART-
MENT FOR PURPOSES OF SECTION SEVENTEEN OF THE PUBLIC OFFICERS  LAW,  AND
SHALL  NOT  PARTICIPATE  IN  ANY MATTER FOR WHICH A CONFLICT OF INTEREST
EXISTS.
  5. THE HEALTH TECHNOLOGY ASSESSMENT COMMITTEE SHALL, AT THE REQUEST OF
THE COMMISSIONER, CONSIDER ANY  MATTER  RELATING  TO  HEALTH  TECHNOLOGY
ASSESSMENT.  THE COMMISSIONER SHALL PROVIDE THIRTY DAYS PUBLIC NOTICE ON
THE DEPARTMENT'S WEBSITE PRIOR TO ANY MEETING OF THE COMMITTEE TO DEVEL-
OP RECOMMENDATIONS CONCERNING HEALTH TECHNOLOGY COVERAGE DETERMINATIONS.
SUCH NOTICE SHALL INCLUDE A DESCRIPTION OF THE PROPOSED HEALTH TECHNOLO-
GY TO BE REVIEWED, THE CONDITIONS OR DISEASES  IMPACTED  BY  THE  HEALTH
TECHNOLOGY,  AND  THE  PROPOSALS TO BE CONSIDERED BY THE COMMITTEE.  THE
COMMITTEE SHALL ALLOW INTERESTED PARTIES  A  REASONABLE  OPPORTUNITY  TO

S. 2606--C                         174

MAKE  AN  ORAL PRESENTATION TO THE COMMITTEE RELATED TO THE HEALTH TECH-
NOLOGY TO BE REVIEWED AND TO SUBMIT WRITTEN INFORMATION.  THE  COMMITTEE
SHALL CONSIDER ANY INFORMATION PROVIDED BY ANY INTERESTED PARTY, INCLUD-
ING,  BUT NOT LIMITED TO, HEALTH CARE PROVIDERS, HEALTH CARE FACILITIES,
PATIENTS, CONSUMERS AND MANUFACTURERS.
  6. THE COMMISSIONER SHALL PROVIDE NOTICE OF ANY  COVERAGE  RECOMMENDA-
TIONS DEVELOPED BY THE COMMITTEE BY MAKING SUCH INFORMATION AVAILABLE ON
THE DEPARTMENT'S WEBSITE. SUCH PUBLIC NOTICE SHALL INCLUDE: A SUMMARY OF
THE  DELIBERATIONS OF THE COMMITTEE; A SUMMARY OF THE POSITIONS OF THOSE
MAKING PUBLIC COMMENTS AT MEETINGS OF THE COMMITTEE; THE RESPONSE OF THE
COMMITTEE TO THOSE COMMENTS, IF ANY; THE CLINICAL  EVIDENCE  UPON  WHICH
THE COMMITTEE BASES ITS RECOMMENDATION; AND THE FINDINGS AND RECOMMENDA-
TIONS OF THE COMMITTEE.
  7.  THE  COMMISSIONER  SHALL PROVIDE PUBLIC NOTICE ON THE DEPARTMENT'S
WEBSITE OF HIS OR HER FINAL DETERMINATION, INCLUDING: THE NATURE OF  THE
DETERMINATION;  AN ANALYSIS OF THE IMPACT OF THE COMMISSIONER'S DETERMI-
NATION ON STATE PUBLIC HEALTH PLAN POPULATIONS AND  PROVIDERS;  AND  THE
PROJECTED  FISCAL IMPACT TO THE STATE PUBLIC HEALTH PLAN PROGRAMS OF THE
COMMISSIONER'S DETERMINATION.  THE  COMMISSIONER'S  FINAL  DETERMINATION
SHALL  NOT  OCCUR  PRIOR  TO  THE  THIRTIETH DAY FROM THE POSTING OF THE
COMMITTEE'S RECOMMENDATIONS AND FINDINGS ON THE DEPARTMENT'S WEBSITE.
  8. THE RECOMMENDATIONS OF THE HEALTH TECHNOLOGY ASSESSMENT  COMMITTEE,
MADE  PURSUANT TO THIS SECTION, SHALL BE BASED ON CLINICAL EFFECTIVENESS
AND SAFETY. THE COMMITTEE SHALL TRIENNIALLY REVIEW PREVIOUS  RECOMMENDA-
TIONS  OF THE COMMITTEE AND PERMIT ORAL PRESENTATIONS AND THE SUBMISSION
OF NEW EVIDENCE AT SUCH TRIENNIAL REVIEW. SUCH REVIEW SHALL OCCUR PURSU-
ANT TO THE PROCEDURE ESTABLISHED IN SUBDIVISIONS FIVE AND  SIX  OF  THIS
SECTION.  THE COMMISSIONER MAY ALTER OR REVOKE HIS OR HER FINAL DETERMI-
NATION AFTER SUCH TRIENNIAL REVIEW PURSUANT TO THE PROCEDURE ESTABLISHED
IN SUBDIVISION SEVEN OF THIS SECTION.
  9. THE DEPARTMENT SHALL PROVIDE ADMINISTRATIVE SUPPORT TO THE  COMMIT-
TEE.
  S 162. Section 33 of the public health law, as added by chapter 442 of
the  laws  of  2006, subdivision 1 as amended by section 45 of part C of
chapter 58 of the laws of 2007, is amended to read as follows:
  S 33. Cooperation of agency officials and employees. 1. In addition to
the authority otherwise provided by this title, the inspector, in carry-
ing out the provisions of this title,  is  authorized  to  request  such
information, assistance and cooperation from any federal, state or local
governmental  department,  board, bureau, commission, or other agency or
unit thereof as may be necessary for carrying out the duties and respon-
sibilities enjoined upon the inspector by this section. State and  local
agencies  or units thereof are hereby authorized and directed to provide
to the inspector, or, at the request of the inspector, to state agencies
or their contractors,  such  information,  assistance  and  cooperation.
Notwithstanding any other provision of law to the contrary, requests for
information,  assistance and cooperation may include, but not be limited
to, all state and local government birth,  death  and  vital  statistics
which  may  be  contained in files, databases or registries, and for all
information shall, upon request, include, where possible,  making  elec-
tronic  copies  or  record exchanges available. Executive agencies shall
coordinate and facilitate the  transfer  of  appropriate  functions  and
positions  to  the office as necessary and in accordance with applicable
law.
  2. NOTWITHSTANDING ANY PROVISIONS  OF  THIS  ARTICLE  A  LOCAL  SOCIAL
SERVICES  DISTRICT  IS  DEEMED TO HAVE THE AUTHORITY TO CONDUCT MEDICAID

S. 2606--C                         175

PROVIDER INVESTIGATIONS, AND UPON A FINDING OF FRAUD AND ABUSE, TO REFER
THE SUSPECTED FRAUD OR CRIMINALITY TO ITS DISTRICT ATTORNEY'S OFFICE.
  3. Upon request of a local social services district or a prosecutor of
competent jurisdiction, the office, department, any other state or local
government entity and the Medicaid fraud control unit shall provide such
information  and  assistance  [as  such entity or unit shall deem neces-
sary,] appropriate and available to aid and facilitate the investigation
of fraud and abuse within the medical assistance program and the recoup-
ment of improperly expended funds.
  S 163. The public health law is amended by adding a new section 37  to
read as follows:
  S  37.  OVERSIGHT  AUDIT,  REVIEW AND EVALUATION. THE DEPARTMENT SHALL
CONTRACT WITH AN INDEPENDENT AGENCY FOR THE  PURPOSE  OF  CONDUCTING  AN
ANNUAL  AUDIT,  REVIEW  AND EVALUATION OF THE STATE MEDICAID PROGRAM AND
THE OFFICE OF THE MEDICAID INSPECTOR  GENERAL.  THE  AUDIT,  REVIEW  AND
EVALUATION  SHALL  ENSURE MEDICAID FUNDS ARE BEING EFFECTIVELY AND EFFI-
CIENTLY SPENT, AND THAT CASES OF FRAUD AND ABUSE ARE BEING APPROPRIATELY
INVESTIGATED AND PURSUED. THE REVIEW SHALL INCLUDE  RECOMMENDATIONS  FOR
INCREASING COST EFFECTIVENESS AND FRAUD AND ABUSE RECOVERIES. THE REVIEW
SHALL  ALSO  PROVIDE  AN EVALUATION OF PATIENT CARE, HEALTH OUTCOMES AND
THE COMPARATIVE COSTS IN EACH SECTOR OF HEALTH CARE FUNDED BY  MEDICAID,
ALONG WITH RECOMMENDATIONS FOR SYSTEMIC IMPROVEMENTS TO EACH SECTOR. THE
AUDIT, REVIEW AND EVALUATION SHALL BE DISTRIBUTED TO THE TEMPORARY PRES-
IDENT  OF  THE  SENATE,  THE  SPEAKER  OF THE ASSEMBLY, THE CHAIR OF THE
SENATE STANDING COMMITTEE ON HEALTH,  AND  THE  CHAIR  OF  THE  ASSEMBLY
HEALTH COMMITTEE BY THE FIRST OF JANUARY EACH YEAR.
  S  164. The social services law is amended by adding a new article 5-A
to read as follows:
                                ARTICLE 5-A
                      MEDICAID FRAUD REIMBURSEMENT
SECTION 370-BB. DISPOSITION OF MONEYS RECEIVED  AS  THE  RESULT  OF  THE
                  PROSECUTION OF MEDICAID FRAUD.
  S  370-BB.  DISPOSITION OF MONEYS RECEIVED AS THE RESULT OF THE PROSE-
CUTION OF MEDICAID FRAUD. 1. FOR THE PURPOSES OF THIS SECTION, "MEDICAID
FRAUD" SHALL MEAN THE KNOWING COMMISSION OF ANY  CRIME  WITH  INTENT  TO
ILLEGALLY RECEIVE BENEFITS, OR REIMBURSEMENT FROM THE MEDICAL ASSISTANCE
FOR  NEEDY PERSONS PROGRAM ESTABLISHED AND ADMINISTERED PURSUANT TO THIS
CHAPTER, THE PUBLIC HEALTH LAW AND FEDERAL LAW.
  2. SHOULD ANY COUNTY OR THE CITY OF NEW  YORK  SUCCESSFULLY  PROSECUTE
ANY  CASE  FOR  MEDICAID  FRAUD  AND A COURT AWARDS RESTITUTION OR CIVIL
FORFEITURE, THE FOLLOWING  PORTION  OF  THE  NON-FEDERAL  SHARE  OF  THE
PROCEEDS  OF  SUCH RESTITUTION OR CIVIL FORFEITURE SHALL BE ALLOCATED AS
FOLLOWS:
  (I) THE COUNTY OR THE CITY OF  NEW  YORK  SHALL  RECEIVE  ONE  HUNDRED
PERCENT OF THE LOCAL SHARE OF SUCH FUNDS, IN EFFECT IMMEDIATELY PRIOR TO
SUCH  DATE  AS CERTIFIED BY THE DIVISION OF BUDGET OR TEN PERCENT OF THE
TOTAL RECOVERY WHICHEVER NUMBER IS GREATER;
  (II) THE REMAINDER THEREOF SHALL BE DEPOSITED INTO THE GENERAL FUND OF
THE STATE.
  3. NOTHING IN THIS ARTICLE SHALL IMPAIR ANY COUNTY OR THE CITY OF  NEW
YORK'S ABILITY TO SEEK DAMAGES UNDER SECTION ONE HUNDRED FORTY-FIVE-B OF
THIS CHAPTER.
  S  165.  Paragraph (a) of subdivision 2 of section 145-b of the social
services law, as amended by chapter 109 of the laws of 2007, is  amended
to read as follows:

S. 2606--C                         176

  (a)  For  civil damages collected by a local social services district,
relating to the medical assistance program, pursuant to a judgment OR  A
SETTLEMENT  under  this  subdivision,  such amounts shall be apportioned
between the local social  services  district  and  the  state.  [If  the
violation  occurred:  (i) prior to January first, two thousand six, the]
THE amount apportioned to the local social services  district  shall  be
ONE  HUNDRED  PERCENT  OF the local share [percentage] OF SUCH FUNDS, in
effect immediately prior to such date as certified by  the  division  of
budget[,  or  (ii)  after  January  first,  two thousand six, the amount
apportioned to the local social services district shall be  based  on  a
reimbursement  schedule,  created  by  the  office of Medicaid inspector
general, in effect at the time the violation occurred; provided that, if
there is no schedule in effect at the time the violation  occurred,  the
schedule to be used shall be the first schedule adopted pursuant to this
subdivision.  Such  schedule  shall provide for reimbursement to a local
social services district in an amount between ten and fifteen percent of
the gross amount collected. Such schedule shall be set on  a  county  by
county  basis  and  shall be periodically reviewed and updated as neces-
sary; provided, however, that any such updated  schedule  shall  not  be
less  than  ten  percent  nor  greater than fifteen percent of the gross
amount collected] OR TEN PERCENT OF THE TOTAL RECOVERY WHICHEVER  NUMBER
IS GREATER; and
  S 166. The public health law is amended by adding a new article 2-B to
read as follows:
                                ARTICLE 2-B
            MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC
                        TECHNOLOGY PILOT PROGRAM
SECTION 290. MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY
               PILOT PROGRAM.
        291. DEFINITIONS.
        292. BIOMETRIC TECHNOLOGY USE.
        293. RULES AND REGULATIONS.
  S  290.  MEDICAID  IDENTIFICATION  AND ANTI-FRAUD BIOMETRIC TECHNOLOGY
PILOT PROGRAM. THERE IS HEREBY ESTABLISHED IN THE DEPARTMENT  THE  MEDI-
CAID  IDENTIFICATION  AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PILOT PROGRAM.
THE DEPARTMENT, IN CONSULTATION WITH THE OFFICE OF THE MEDICAID  INSPEC-
TOR GENERAL AND THE OFFICE OF THE ATTORNEY GENERAL, SHALL IMPLEMENT SUCH
PILOT PROGRAM AT TWO GENERAL HOSPITALS, AS DEFINED BY SUBDIVISION TEN OF
SECTION  TWENTY-EIGHT  HUNDRED  ONE  OF  THIS  CHAPTER, AS AN ANTI-FRAUD
APPLICATION IN THE MEDICAID PROGRAM.
  S 291. DEFINITIONS. AS USED IN THIS ARTICLE:
  1. "BIOMETRIC TECHNOLOGY" MEANS TECHNOLOGY THAT MEASURES AND  ANALYZES
BIOLOGICAL  DATA,  INCLUDING  BUT  NOT  LIMITED  TO DNA, FINGER IMAGING,
VASCULAR PATTERNS,  EYE  RETINAS  AND  IRISES,  VOICE  PATTERNS,  FACIAL
PATTERNS AND HAND MEASUREMENTS, FOR AUTHENTICATION PURPOSES.
  2.    "BIOMETRIC  VERIFICATION DEVICE" MEANS A DEVICE CAPABLE OF USING
BIOMETRIC VERIFICATION TECHNOLOGY TO VERIFY THE IDENTITY OF  A  MEDICAID
RECIPIENT OR PROVIDER.
  S  292.  BIOMETRIC  TECHNOLOGY USE. 1. THE DEPARTMENT, IN CONSULTATION
WITH THE OFFICE OF THE MEDICAID INSPECTOR GENERAL AND THE OFFICE OF  THE
ATTORNEY  GENERAL,  SHALL DEVELOP A REQUEST FOR PROPOSALS TO IMPLEMENT A
PROGRAM UTILIZING BIOMETRIC TECHNOLOGY BY HOSPITALS FOR THE PURPOSES  OF
PATIENT  AND PROVIDER IDENTIFICATION AND FOR USE AS AN ANTI-FRAUD APPLI-
CATION IN THE MEDICAID PROGRAM.
  2. SUCH REQUEST FOR PROPOSALS SHALL INCLUDE  AT  A  MINIMUM  THAT  (A)
MEDICAID RECIPIENTS AND PROVIDERS SHALL PROVIDE BIOMETRIC PROOF OF THEIR

S. 2606--C                         177

IDENTITY  ALONG  WITH  OTHER INFORMATION DEEMED NECESSARY BY THE COMMIS-
SIONER.
  (B)  SUCH  PROGRAM  WILL BE CAPABLE OF STORING BIOMETRIC MARKERS AND A
LOG OF GENERAL HOSPITAL AND PHARMACY VISITS FOR EACH SERVICE  BILLED  TO
THE MEDICAID PROGRAM.
  (C)  MEDICAID  IDENTIFICATION  SHALL  BE ISSUED TO AND ACCEPTED BY THE
ADMITTING STAFF OF  HEALTH  CARE  FACILITIES,  MEDICAL  STAFF  PROVIDING
SERVICE TO MEDICAID RECIPIENTS AND PHARMACY STAFF.
  (D)  MEDICAID  RECIPIENTS SHALL BE REQUIRED TO PROVIDE BIOMETRIC PROOF
OF IDENTIFY AT THE TIME OF EACH VISIT TO A GENERAL HOSPITAL AT THE POINT
OF ACTUALLY BEING SEEN BY THE DOCTOR OR CLINICAL STAFF, AND SHALL  AGAIN
PROVIDE PROOF OF IDENTITY UPON COMPLETION OF CARE OR SERVICES.
  (E) PROVISIONS MAY BE INCLUDED FOR EMERGENCY SERVICES OR PRESCRIPTIONS
AND  ALTERNATE IDENTIFICATION METHODS FOR MEDICAID RECIPIENTS PHYSICALLY
OR MENTALLY UNABLE TO PROVIDE BIOMETRIC IDENTIFICATION.
  (F) FRAUD PREVENTION MARKERS INCORPORATED INTO SOFTWARE WHICH  MAY  BE
USED TO OPERATE THE HARDWARE COMPONENT OF THE BIOMETRIC TECHNOLOGY SHALL
PREVENT  AND/OR REJECT THE PAYMENT BY THE MEDICAID PROGRAM AND ALERT THE
SERVICE PROVIDER AT POINT OF SERVICE IF  FRAUD  OR  POTENTIAL  FRAUD  IS
IDENTIFIED BY THE BIOMETRIC TECHNOLOGY SYSTEM.
  (G)  PROVISIONS  SHALL  BE INCLUDED TO ENSURE THAT MEDICAID RECIPIENTS
HAVE ACCESS TO EMERGENCY HEALTH SERVICES IN  THE  CASE  OF  A  BIOMETRIC
TECHNOLOGY SYSTEM MALFUNCTION OR FRAUD DETECTION ALARM.
  (H)  EVALUATION  AND  SELECTION OF PROPOSALS THAT ADDRESS THE REQUIRE-
MENTS OF MEDICAID BENEFICIARIES AND PROVIDERS  SHALL  BE  BASED  ON  THE
FOLLOWING  CRITERIA: SECURITY, PRIVACY, USABILITY, PERFORMANCE, HYGIENE,
BIOMETRIC CAPTURE AND STORAGE REQUIREMENTS, AND INTEROPERABILITY.
  3. SUCH REQUEST FOR PROPOSALS SHALL SET FORTH REQUIREMENTS AS  TO  THE
RESULTS AND GOALS TO BE ACHIEVED, RATHER THAN SPECIFIC TECHNICAL METHODS
OR  SYSTEMS,  TO  ALLOW  CONSIDERATION  OF THE WIDEST POSSIBLE CHOICE OF
AVAILABLE TECHNOLOGY.
  4. SUCH REQUEST FOR PROPOSALS SHALL  REQUIRE:  (A)  THAT  THE  PROGRAM
SHALL  BE  REVENUE NEUTRAL ON AN ANNUAL BASIS, WHEREBY ANY PROGRAM COSTS
ARE AT LEAST OFFSET BY STATE MEDICAID  SAVINGS,  AND  SHALL  HAVE  AS  A
PRIMARY  GOAL  REDUCTION OF MEDICAID EXPENDITURES THROUGH ELIMINATION OF
FRAUD AND ABUSE; AND (B) THAT THE  PROGRAM  SHALL  BE  COST  NEUTRAL  TO
PROVIDERS FROM INCEPTION, WHEREBY ANY PROVIDER COSTS ARE AT LEAST OFFSET
BY  PROVIDER  SAVINGS, AND SHALL HAVE AS A PRIMARY GOAL PROVIDER SAVINGS
THROUGH INCREASED EFFICIENCIES.
  5. THE COMMISSIONER SHALL  ACCEPT  TWO  PROPOSALS  FOR  PILOT  PROGRAM
PARTICIPATION,  PROVIDED,  HOWEVER,  THAT AT LEAST ONE PROPOSAL SHALL BE
FROM THE UPSTATE REGION. FOR THE  PURPOSES  OF  THIS  ARTICLE,  "UPSTATE
REGION"  SHALL INCLUDE THE FOLLOWING COUNTIES: ALBANY, ALLEGANY, BROOME,
CATTARAUGUS, CAYUGA, CHAUTAUQUA, CHEMUNG, CHENANGO,  CLINTON,  COLUMBIA,
CORTLAND,  DELAWARE,  ERIE,  ESSEX,  FRANKLIN,  FULTON, GENESEE, GREENE,
HAMILTON, HERKIMER, JEFFERSON, LEWIS, LIVINGSTON, MADISON, MONROE, MONT-
GOMERY, NIAGARA, ONEIDA, ONONDAGA,  ONTARIO,  ORLEANS,  OSWEGO,  OTSEGO,
RENSSELAER,  SARATOGA,  SCHENECTADY,  SCHOHARIE,  SCHUYLER,  SENECA, ST.
LAWRENCE, STEUBEN, SULLIVAN, TIOGA, TOMKINS, WARREN, WASHINGTON,  WAYNE,
WYOMING AND YATES.
  6.  (A) SUCH REQUEST FOR PROPOSALS FOR THE IMPLEMENTATION OF A PROGRAM
FOR BIOMETRIC TECHNOLOGY USE SHALL BE PUBLISHED  ON  OR  BEFORE  JANUARY
FIFTEENTH, TWO THOUSAND FOURTEEN, AND SHALL PROVIDE THAT PROPOSALS SHALL
BE OPENED ON OR BEFORE MARCH FIRST, TWO THOUSAND FOURTEEN.
  (B) THE COMMISSIONER SHALL REPORT TO THE GOVERNOR, THE TEMPORARY PRES-
IDENT  OF  THE SENATE AND THE SPEAKER OF THE ASSEMBLY ONE YEAR AFTER THE

S. 2606--C                         178

EFFECTIVE DATE OF THIS ARTICLE WITH REGARD TO THE PROGRESS MADE  IN  THE
DEVELOPMENT  OF CRITERIA FOR A PILOT PROGRAM OF BIOMETRIC IDENTIFICATION
AND OF THE IMPLEMENTATION OF SUCH PILOT PROGRAM.
  S  293.  RULES  AND  REGULATIONS.  THE  COMMISSIONER IS AUTHORIZED AND
DIRECTED TO PROMULGATE SUCH RULES AND REGULATIONS AS HE OR SHE MAY  DEEM
NECESSARY OR APPROPRIATE TO EFFECTUATE THE PURPOSES OF THIS ARTICLE.
  S  167.  Subdivision 1 of section 367-b of the social services law, as
added by chapter 639 of the laws of 1976, is amended to read as follows:
  1. The department, IN CONSULTATION WITH THE  COMMISSIONER  OF  HEALTH,
shall  design  and  implement a statewide medical assistance information
and payments system for the purpose of providing individual  and  aggre-
gate  data  to  social services districts to assist them in making basic
management decisions, to the department  and  other  state  agencies  to
assist  in  the administration of the medical assistance program, and to
the governor and the legislature as may be necessary to assist in making
major administrative and policy decisions affecting such program.   Such
system shall be designed so as to be capable of the following:
  a. receiving and processing information relating to the eligibility of
each  person  applying  for  medical assistance and of issuing a medical
assistance identification card, AND WHEN AVAILABLE UTILIZING THE  BIOME-
TRIC  IDENTIFICATION  ISSUED  BY THE DEPARTMENT OF HEALTH, CONFORMING TO
THE REQUIREMENTS SET FORTH IN THE MEDICAID IDENTIFICATION AND ANTI-FRAUD
BIOMETRIC TECHNOLOGY PROGRAM ESTABLISHED PURSUANT TO  ARTICLE  TWO-B  OF
THE  PUBLIC  HEALTH LAW to persons determined by a social services offi-
cial to be eligible for such assistance;
  b.   ACTIVATING MEDICAL  ASSISTANCE  IDENTIFICATION  BY  REQUIRING  AN
APPLICANT  RECEIVING  SUCH IDENTIFICATION FROM THE DEPARTMENT TO HAVE IT
VERIFIED AT A SOCIAL SERVICES DISTRICT OFFICE  IN  THE  SOCIAL  SERVICES
DISTRICT IN WHICH THE APPLICANT RESIDES;
  C.  receiving  and  processing  information relating to each qualified
provider of medical assistance furnishing care, services or supplies for
which claims for payment are made pursuant to this title;
  [c.] D. receiving and processing, in a form and manner  prescribed  by
the  department, all claims for medical care, services and supplies, and
making payments for valid claims to providers of medical care,  services
and supplies on behalf of social services districts; AND
  [d.]  E.  maintaining  information  necessary to allow the department,
consistent with the powers and duties of the department  of  health,  to
review the appropriateness, scope and duration of medical care, services
and  supplies provided to any eligible person pursuant to this chapter[;
and
  e. initiating  implementation  of  such  a  system  for  the  district
comprising  the  city of New York, in a manner compatible with expansion
of such system to districts other than the district comprising the  city
of New York].
  S 168. Section 2818 of the public health law is REPEALED.
  S  169.  The state finance law is amended by adding a new section 99-u
to read as follows:
  S 99-U. HEALTH CARE EFFICIENCY AND AFFORDABILITY LAW  OF  NEW  YORKERS
(HEAL  NY) ACCOUNT.  1. THERE IS HEREBY ESTABLISHED IN THE JOINT CUSTODY
OF THE STATE COMPTROLLER AND THE COMMISSIONER OF  TAXATION  AND  FINANCE
THE  "HEALTH  CARE EFFICIENCY AND AFFORDABILITY LAW OF NEW YORKERS (HEAL
NY) ACCOUNT".
  2. THE ACCOUNT SHALL CONSIST OF ALL MONIES RECEIVED  AND/OR  APPROPRI-
ATED FOR THE HEALTH CARE EFFICIENCY AND AFFORDABILITY LAW OF NEW YORKERS
(HEAL NY) CAPITAL GRANT PROGRAM.

S. 2606--C                         179

  3.  NOTWITHSTANDING  ANY  PROVISION OF LAW TO THE CONTRARY, ALL MONIES
SHALL REMAIN IN SUCH ACCOUNT  UNLESS  OTHERWISE  DISBURSED  PURSUANT  TO
APPROPRIATION BY THE LEGISLATURE.
  S 170.  Severability. If any clause, sentence, paragraph, subdivision,
section  or part of this act shall be adjudged by any court of competent
jurisdiction to be invalid, such judgment shall not  affect,  impair  or
invalidate the remainder thereof, but shall be confined in its operation
to the clause, sentence, paragraph, subdivision, section or part thereof
directly  involved  in  the controversy in which the judgment shall have
been rendered. It is hereby declared to be the intent of the legislature
that this act would have been enacted even if  such  invalid  provisions
had not been included herein.
  S  171. This act shall take effect immediately; provided that sections
one through one hundred twenty of this act shall be deemed to have  been
in  full force and effect on and after April 1, 2013; provided, however,
that the provisions of sections one through one hundred twenty  of  this
act  shall  apply  only to actions and proceedings commenced on or after
such effective date; provided, further, that:
  (a) sections fourteen, fifteen, sixteen,  seventeen,  eighteen,  nine-
teen,  twenty,  twenty-one, twenty-two, twenty-four, twenty-six, twenty-
seven, twenty-eight, and thirty of this act shall take effect January 1,
2014;
  (b) sections forty-three, forty-four, forty-six and one hundred one of
this act shall take effect on the one hundred  eightieth  day  after  it
shall have become a law;
  (c)  sections ninety, ninety-one, ninety-three and ninety-four of this
act shall take effect April 1, 2014, provided that effective  immediate-
ly,  the  addition,  amendment  and/or  repeal of any rule or regulation
necessary for the implementation of such sections on the effective  date
of  this  act are authorized and directed to be made and completed on or
before such effective date;
  (d) section ninety-six of this act shall take effect on the  ninetieth
day after it shall have become a law;
  (e)  any rules or regulations necessary to implement the provisions of
this act may be promulgated and any procedures, forms,  or  instructions
necessary  for such implementation may be adopted and issued on or after
the date this act shall have become a law;
  (f) this act shall not be construed to alter, change,  affect,  impair
or defeat any rights, obligations, duties or interests accrued, incurred
or conferred prior to the effective date of this act;
  (g)  the  commissioner  of  health and the superintendent of financial
services and any appropriate council may take  any  steps  necessary  to
implement this act prior to its effective date;
  (h)  notwithstanding  any inconsistent provision of the state adminis-
trative procedure act or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of financial  services
and  any  appropriate council is authorized to adopt or amend or promul-
gate on an emergency basis any regulation he  or  she  or  such  council
determines  necessary  to  implement  any  provision  of this act on its
effective date;
  (i) the provisions of this act shall become effective  notwithstanding
the  failure  of  the  commissioner  of  health or the superintendent of
financial services or any council to adopt or amend or promulgate  regu-
lations implementing this act;

S. 2606--C                         180

  (j)  section  3621  of  the public health law, as added by section one
hundred twenty-five of this act shall  expire  and  be  deemed  repealed
March 31, 2015;
  (k)  sections  one  hundred  twenty-six-a through one hundred fifty of
this act shall take effect September 1, 2013,  provided,  however,  that
for  policies  renewed  on and after such date, such sections shall take
effect on the renewal date;
  (l) sections one hundred  thirty-seven,  one  hundred  forty-one,  one
hundred  forty-six  and  one  hundred  fifty  of this act shall apply to
health care services provided on and after such  date  and  section  one
hundred fifty of this act shall expire and be deemed repealed January 1,
2016;
  (m)  sections  one  hundred  thirty-six, one hundred thirty-eight, one
hundred thirty-nine, one hundred  forty,  one  hundred  forty-five,  one
hundred  forty-seven, one hundred forty-eight and one hundred forty-nine
of this act shall apply to denials issued on and after such date;
  (n) the amendments to section 364-j of the social services  law,  made
by  section one hundred fifty-a of this act shall not affect the expira-
tion and repeal of such section and shall expire and be deemed  repealed
therewith;
  (o)  sections  one  hundred fifty-seven and one hundred fifty-eight of
this act shall take effect on the one hundred  eightieth  day  after  it
shall  have become a law; provided, however, that effective immediately,
the addition, amendment and/or repeal of any rule or  regulation  neces-
sary  for  the  implementation  of  this  act  on its effective date are
authorized and directed to be made  and  completed  on  or  before  such
effective date;
  (p)  the  implementation  of  the  provisions  of  section one hundred
fifty-nine of this act shall be subject to the appropriation  of  moneys
specifically for the purposes thereof;
  (q)  the  amendments  to  section 33 of the public health law, made by
section one hundred sixty-two of this act shall  expire  and  be  deemed
repealed one year after the effective date of this act; and
  (r) sections one hundred sixty-four and one hundred sixty-five of this
act  shall expire and be deemed repealed three years after the effective
date of this act.

                                 PART F

  Section 1. Section 19.16 of the mental hygiene law, as added by  chap-
ter 223 of the laws of 1992, is amended to read as follows:
S 19.16 Methadone Registry.
  The  office  shall  establish and maintain, either directly or through
contract, a central registry for purposes of preventing multiple enroll-
ment,  ENSURING  ACCURATE  DOSAGE  DELIVERY  AND  FACILITATING  DISASTER
MANAGEMENT in methadone programs. The office shall require all methadone
programs  to  utilize  such  registry and shall have the power to assess
methadone programs such fees as are necessary and appropriate; PROVIDED,
HOWEVER, THAT PROVISIONS RELATING TO ENSURING ACCURATE  DOSAGE  DELIVERY
AND  FACILITATING  DISASTER  MANAGEMENT SHALL NOT RESULT IN UNREIMBURSED
COSTS TO, OR EXPENDITURES BY, METHADONE PROGRAMS.
  S 2. This act shall take effect April 1, 2013.

                                 PART G

  Section 1. Article 26 of the mental hygiene law is REPEALED.

S. 2606--C                         181

  S 2. The article heading of article 25 of the mental hygiene  law,  as
added by chapter 471 of the laws of 1980, is amended to read as follows:
                 [FUNDING FOR SUBSTANCE ABUSE SERVICES]
          FUNDING FOR SERVICES OF THE OFFICE OF ALCOHOLISM AND
                        SUBSTANCE ABUSE SERVICES
  S  3.  Paragraphs 1, 2, 3 and 4 of subdivision (a) of section 25.01 of
the mental hygiene law, paragraph 1 as added by chapter 471 of the  laws
of 1980, and paragraphs 2, 3 and 4 as amended by chapter 223 of the laws
of 1992, are amended, and four new paragraphs 5, 6, 7 and 8 are added to
read as follows:
  1. ["Local  agency" shall mean a county governmental unit for a county
not wholly within a city, and a city governmental unit for a city having
a population of one million or more, designated by such county  or  city
as  responsible  for  substance  abuse services in such county or city.]
"LOCAL GOVERNMENTAL UNIT" SHALL HAVE THE SAME MEANING AS THAT  CONTAINED
IN ARTICLE FORTY-ONE OF THIS CHAPTER.
  2. "Operating  [costs]  EXPENSES"  shall mean expenditures[, excluding
capital costs and debt service, subject to the approval of the  office,]
APPROVED BY THE OFFICE AND incurred for the maintenance and operation of
substance  [abuse]  USE  DISORDER programs, including but not limited to
expenditures for treatment, administration, personnel,  AND  contractual
services[,  rental,  depreciation  and  interest  expenses  incurred, in
connection with the design, construction,  acquisition,  reconstruction,
rehabilitation or improvement of a substance abuse program facility, and
payments  made  to  the facilities development corporation for substance
abuse program facilities; provided that where the].  OPERATING  EXPENSES
DO  NOT  INCLUDE CAPITAL COSTS AND DEBT SERVICE UNLESS SUCH EXPENSES ARE
RELATED  TO  THE  rent,  financing  or  refinancing   of   the   design,
construction, acquisition, reconstruction, rehabilitation or improvement
of  a  substance  [abuse]  USE DISORDER program facility [is through the
facilities development corporation, operating costs  shall  include  the
debt service to be paid to amortize obligations, including principal and
interest,  issued  by the New York State medical care facilities finance
agency to finance or refinance the capital  costs  of  such  facilities]
PURSUANT  TO  THE  MENTAL HYGIENE FACILITIES FINANCE PROGRAM THROUGH THE
DORMITORY AUTHORITY OF THE STATE OF NEW YORK (DASNY;  SUCCESSOR  TO  THE
FACILITIES  DEVELOPMENT  CORPORATION),  OR  OTHERWISE  APPROVED  BY  THE
OFFICE.
  3. "Debt service" shall mean amounts, subject to the approval  of  the
office,  [as  shall  be]  required  to  be  paid to amortize obligations
including principal and interest [issued by the New York  state  housing
finance agency, the New York State medical care facilities finance agen-
cy or], ASSUMED by or on behalf of a [substance abuse program] VOLUNTARY
AGENCY or a PROGRAM OPERATED BY A local [agency to finance capital costs
for substance abuse program facilities] GOVERNMENTAL UNIT.
  4. "Capital  costs"  shall mean [expenditures, subject to the approval
of the office, as shall be obligated to acquire, construct, reconstruct,
rehabilitate or improve a substance abuse program facility.]  THE  COSTS
OF A PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT OR A VOLUNTARY AGENCY
WITH RESPECT TO THE ACQUISITION OF REAL PROPERTY ESTATES, INTERESTS, AND
COOPERATIVE  INTERESTS  IN  REALTY,  THEIR  DESIGN, CONSTRUCTION, RECON-
STRUCTION, REHABILITATION  AND  IMPROVEMENT,  ORIGINAL  FURNISHINGS  AND
EQUIPMENT, SITE DEVELOPMENT, AND APPURTENANCES OF A FACILITY.
  5. "STATE AID" SHALL MEAN FINANCIAL SUPPORT PROVIDED THROUGH APPROPRI-
ATIONS  OF THE OFFICE TO SUPPORT THE PROVISION OF SUBSTANCE USE DISORDER
TREATMENT, COMPULSIVE GAMBLING, PREVENTION OR OTHER AUTHORIZED SERVICES,

S. 2606--C                         182

WITH THE EXCLUSION OF APPROPRIATIONS FOR THE PURPOSE OF MEDICAL  ASSIST-
ANCE.
  6.  "VOLUNTARY  AGENCY  CONTRIBUTIONS"  SHALL  MEAN REVENUE SOURCES OF
VOLUNTARY AGENCIES EXCLUSIVE OF STATE AID AND LOCAL TAX LEVY.
  7. "APPROVED NET OPERATING COST" SHALL MEAN  THE  REMAINDER  OF  TOTAL
OPERATING  EXPENSES APPROVED BY THE OFFICE, LESS ALL SOURCES OF REVENUE,
INCLUDING VOLUNTARY AGENCY CONTRIBUTIONS AND LOCAL TAX LEVY.
  8. "VOLUNTARY AGENCY" SHALL MEAN A CORPORATION ORGANIZED  OR  EXISTING
PURSUANT  TO  THE  NOT-FOR-PROFIT  CORPORATION  LAW  FOR  THE PURPOSE OF
PROVIDING  SUBSTANCE  USE  DISORDER,  TREATMENT,  COMPULSIVE   GAMBLING,
PREVENTION OR OTHER AUTHORIZED SERVICES.
  S  4.  Subdivisions (a) and (b) of section 25.03 of the mental hygiene
law, subdivision (a) as amended by chapter 558 of the laws of  1999  and
subdivision  (b)  as  amended  by  chapter  223 of the laws of 1992, are
amended and a new subdivision (d) is added to read as follows:
  (a) In accordance with the provisions  of  this  article,  AND  WITHIN
APPROPRIATIONS   MADE  AVAILABLE,  the  office  may  provide  [financial
support] STATE AID to a [substance abuse program or a] PROGRAM  OPERATED
BY  A  local  [agency]  GOVERNMENTAL  UNIT OR VOLUNTARY AGENCY up to one
hundred per centum of the APPROVED NET operating costs of such [program]
PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT or VOLUNTARY  agency,  and
[either  fifty per centum of the capital cost or fifty per centum of the
debt service,] STATE AID MAY ALSO BE GRANTED TO A PROGRAM OPERATED BY  A
LOCAL  GOVERNMENTAL UNIT OR A VOLUNTARY AGENCY FOR CAPITAL COSTS ASSOCI-
ATED WITH THE PROVISION OF SERVICES AT A  RATE  OF  UP  TO  ONE  HUNDRED
PERCENT  OF  APPROVED CAPITAL COSTS. SUCH STATE AID SHALL NOT BE GRANTED
UNLESS AND UNTIL SUCH PROGRAM OPERATED BY A LOCAL GOVERNMENTAL  UNIT  OR
VOLUNTARY  AGENCY  IS  IN COMPLIANCE WITH ALL REGULATIONS PROMULGATED BY
THE COMMISSIONER REGARDING THE FINANCING OF CAPITAL PROJECTS. SUCH STATE
AID for approved [services] NET OPERATING COSTS SHALL BE MADE  AVAILABLE
by  way  of  advance  or reimbursement, through EITHER contracts entered
into between the office and such [program or]  VOLUNTARY  agency[,  upon
such  terms  and conditions as the office shall deem appropriate, except
as provided in section 25.07 of this article, provided,  however,  that,
upon  issuance  of  an  operating certificate in accordance with article
thirty-two of this chapter, if required, the office shall provide finan-
cial support for approved chemical  dependence  services  in  accordance
with article twenty-six of this title.] OR BY DISTRIBUTION OF SUCH STATE
AID  TO  LOCAL  GOVERNMENTS  THROUGH A GRANT PROCESS PURSUANT TO SECTION
25.11 OF THIS ARTICLE.
  (b) Financial support by the office shall be subject to  the  approval
of the director of the budget AND WITHIN AVAILABLE APPROPRIATIONS.
  (D) NOTHING IN THIS SECTION SHALL BE CONSTRUED TO REQUIRE THE STATE TO
INCREASE  SUCH  STATE  AID  SHOULD  A  LOCAL GOVERNMENTAL UNIT CHOOSE TO
REMOVE ANY PORTION OF ITS LOCAL TAX LEVY SUPPORT OF VOLUNTARY  AGENCIES,
ALTHOUGH THE STATE MAY CHOOSE TO DO SO TO ADDRESS AN URGENT PUBLIC NEED,
OR CONVERSELY, MAY CHOOSE TO REDUCE ITS STATE AID.
  S  5.  Section  25.05 of the mental hygiene law, as amended by chapter
223 of the laws of 1992, is amended to read as follows:
S 25.05 Reimbursement from other sources.
  The office shall not provide a  [substance  abuse  program]  VOLUNTARY
AGENCY  or a PROGRAM OPERATED BY A local [agency] GOVERNMENTAL UNIT with
financial support for obligations incurred  by  or  on  behalf  of  such
program  or agency for substance [abuse] USE DISORDER services for which
reimbursement is or may be claimed under any provision of law other than
this article.

S. 2606--C                         183

  S 6. The section heading and subdivisions (a) and (c) of section 25.06
of the mental hygiene law, as amended by chapter  223  of  the  laws  of
1992, are amended to read as follows:
Disclosures  by  closely allied entities of [substance abuse programs] A
          VOLUNTARY AGENCY.
  (a) A closely allied entity of a [substance abuse  program]  VOLUNTARY
AGENCY  that  is funded or has applied for funding from the office shall
provide the office with the following information:
  1. A schedule of the dates, nature and amounts of  all  fiscal  trans-
actions  between  the  closely  allied  entity  and the [substance abuse
program] VOLUNTARY AGENCY that is funded or has applied for funding from
the office.
  2. A copy of the closely allied entity's  certified  annual  financial
statements.
  3.  With  respect  to  any  lease agreement between the closely allied
entity, as lessor, and the [substance abuse  program]  VOLUNTARY  AGENCY
that is funded or has applied for funding from the office, as lessee, of
real or personal property:
  (i) A certified statement by an independent outside entity providing a
fair  market  appraisal of the real property space to be rented, as well
as of any rental of personal property.
  (ii) A statement of projected operating costs  of  the  allied  entity
relative  to any such leased property for the budget period. The closely
allied entity must furnish the office with a certified statement of  its
actual operating costs relative to the leased property.
  4.  A  statement of the funds received by the closely allied entity in
connection with its fund raising activities conducted on behalf  of  the
substance [abuse] USE DISORDER program that is funded or has applied for
funding from the office which clearly identifies how such funds were and
will be distributed or applied to such program.
  5.  Any  other data or information which the office may deem necessary
for purposes of making a funding decision.
  (c) For purposes of this section,  a  "closely  allied  entity"  shall
mean, but not be limited to, a corporation, partnership or unincorporat-
ed  association  or  other  body that has been formed or is organized to
provide financial assistance and aid for the  benefit  of  a  [substance
abuse  program] VOLUNTARY AGENCY that is funded or has applied for fund-
ing from the  office  AND  which  FINANCIAL  ASSISTANCE  AND  AID  shall
include,  but  not  be  limited to, engaging in fund raising activities,
administering funds, holding title to real property, having an  interest
in personal property of any nature whatsoever, and engaging in any other
activities  for  the  benefit  of any such program.  Moreover, an entity
shall be deemed closely allied to a [substance abuse program]  VOLUNTARY
AGENCY  that is funded or has applied for funding from the office to the
extent that such entity and applicable fiscal transactions are  required
to be disclosed within the annual financial statements of the [substance
abuse  program] VOLUNTARY AGENCY that is funded or has applied for fund-
ing from the office, under the category of related  party  transactions,
as defined by and in accordance with generally accepted accounting prin-
ciples  (GAAP)  and  generally  accepted  auditing  standards (GAAS), as
promulgated by the American institute of  certified  public  accountants
(AICPA).
  S  7. Section 25.07 of the mental hygiene law, as added by chapter 471
of the laws of 1980, is amended to read as follows:
S 25.07 Non-substitution.

S. 2606--C                         184

  A [substance abuse program] VOLUNTARY AGENCY or a PROGRAM OPERATED  BY
A local [agency] GOVERNMENTAL UNIT shall not substitute state monies for
cash  contributions,  federal aid otherwise committed to or intended for
use in such program or by such agency, revenues derived from the  opera-
tion of such program or agency, or the other resources available for use
in the operation of the program or agency.
  S  8.  Section  25.09 of the mental hygiene law, as amended by chapter
223 of the laws of 1992, is amended to read as follows:
S 25.09 Administrative costs.
  Subject to the approval of the director  of  the  budget,  the  office
shall  establish a limit on the amount of financial support which may be
advanced or reimbursed to a [substance abuse program]  VOLUNTARY  AGENCY
or  a  PROGRAM  OPERATED  BY  A local [agency] GOVERNMENTAL UNIT for the
administration of a [substance abuse] program.
  S 9. Section 25.11 of the mental hygiene law, as added by chapter  471
of  the  laws  of 1980, subdivision (a) as amended by chapter 223 of the
laws of 1992, is amended to read as follows:
S 25.11 [Comprehensive plan]  DISTRIBUTION  OF  STATE  AID  TO  A  LOCAL
          GOVERNMENTAL UNIT.
  [(a)  A  local  agency  intending  to  seek financial support from the
office shall no later than July first of each year submit to the  office
a  comprehensive substance abuse services plan, which shall describe the
programs and activities planned for its ensuing fiscal year.  Such  plan
shall  indicate to the extent possible, the nature of the services to be
provided, whether such services are to  be  provided  directly,  through
subcontract,  or  through  the utilization of existing public resources,
the area or areas to be served, and an estimate  of  the  cost  of  such
services,  including  amounts to be provided other than by office finan-
cial support, specifically identifying the amount of local  governmental
funds  committed  to  substance abuse programs during its current fiscal
year, and a commitment that no less than such an  amount  will  be  used
from  such  funds  for  the  operation  of such programs during the next
fiscal year. Such plan shall make provisions for  all  needed  substance
abuse  services  and  for  the  evaluation  of the effectiveness of such
services.
  (b) When a comprehensive plan includes a local school  district  based
substance  abuse  program  such  plan  shall  include  the details of an
adequate distribution of in-school and community-wide preventive  educa-
tion services, including, but not limited to, services to be provided by
local  drug  abuse  prevention  councils, and shall emphasize the use of
other volunteer agency services as may be available. The description  of
the  program  and  activities thereunder shall be separately stated, and
the data and information required to be provided shall  conform  to  the
provisions  of subdivision (a) of this section except that the period to
be covered may, notwithstanding the fiscal year  of  the  local  agency,
conform  to the school year.] NOTWITHSTANDING SECTION ONE HUNDRED TWELVE
OF THE STATE FINANCE LAW, THE OFFICE IS AUTHORIZED TO  GRANT  STATE  AID
ANNUALLY TO LOCAL GOVERNMENTAL UNITS IN THE FOLLOWING MANNER:
  (A) LOCAL GOVERNMENTAL UNITS SHALL BE GRANTED STATE AID BY A STATE AID
FUNDING AUTHORIZATION LETTER ISSUED BY THE OFFICE FOR APPROVED NET OPER-
ATING  COSTS  FOR VOLUNTARY AGENCIES TO SUPPORT THE BASE AMOUNT OF STATE
AID PROVIDED TO SUCH VOLUNTARY AGENCIES FOR THE PRIOR YEAR PROVIDED THAT
THE LOCAL GOVERNMENTAL UNIT HAS APPROVED AND SUBMITTED BUDGETS  FOR  THE
VOLUNTARY  AGENCIES  TO  THE  OFFICE. THE VOLUNTARY AGENCY BUDGETS SHALL
IDENTIFY THE NATURE OF  THE  SERVICES  TO  BE  PROVIDED  WHICH  MUST  BE
CONSISTENT  WITH  THE LOCAL SERVICES PLAN SUBMITTED BY THE LOCAL GOVERN-

S. 2606--C                         185

MENTAL UNIT PURSUANT TO ARTICLE FORTY-ONE OF THIS CHAPTER, THE AREAS  TO
BE  SERVED  AND  INCLUDE  A DESCRIPTION OF THE VOLUNTARY AGENCY CONTRIB-
UTIONS AND LOCAL GOVERNMENTAL UNIT FUNDING PROVIDED. THE  LOCAL  GOVERN-
MENTAL  UNIT  SHALL  ENTER  INTO  CONTRACTS  WITH THE VOLUNTARY AGENCIES
RECEIVING SUCH STATE AID. SUCH CONTRACTS SHALL INCLUDE FUNDING  REQUIRE-
MENTS SET BY THE OFFICE INCLUDING BUT NOT LIMITED TO RESPONSIBILITIES OF
VOLUNTARY  AGENCIES  RELATING  TO  WORK  SCOPES, PROGRAM PERFORMANCE AND
OPERATIONS, APPLICATION OF PROGRAM  INCOME,  PROHIBITED  USE  OF  FUNDS,
RECORDKEEPING  AND  AUDIT  OBLIGATIONS.  UPON DESIGNATION BY THE OFFICE,
LOCAL GOVERNMENTAL UNITS SHALL  NOTIFY  VOLUNTARY  AGENCIES  AS  TO  THE
SOURCE OF FUNDING RECEIVED BY SUCH VOLUNTARY AGENCIES.
  (B) STATE AID MADE AVAILABLE TO A LOCAL GOVERNMENTAL UNIT FOR APPROVED
NET OPERATING COSTS FOR A VOLUNTARY AGENCY MAY BE REDUCED WHERE A REVIEW
OF  SUCH VOLUNTARY AGENCY'S PRIOR YEAR'S BUDGET AND/OR PERFORMANCE INDI-
CATES:
  (1) THAT THE PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT  OR  VOLUN-
TARY  AGENCY  HAS  FAILED  TO  MEET  MINIMUM  PERFORMANCE  STANDARDS AND
REQUIREMENTS OF THE OFFICE INCLUDING, BUT NOT  LIMITED  TO,  MAINTAINING
SERVICE  UTILIZATION  RATES  AND  PRODUCTIVITY  STANDARDS  AS SET BY THE
OFFICE;
  (2) THAT THE VOLUNTARY AGENCY HAS HAD AN INCREASE IN VOLUNTARY  AGENCY
CONTRIBUTIONS THAT REDUCES THE APPROVED NET OPERATING COSTS NECESSARY;
  (3)  THAT  THE  OFFICE,  UPON CONSULTATION WITH THE LOCAL GOVERNMENTAL
UNIT, OTHERWISE DETERMINES THERE IS A NEED TO REDUCE THE AMOUNT OF STATE
AID AVAILABLE.
  S 10. Section 25.13 of the mental hygiene law, as amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.13 Office is authorized state agency.
  (a)  The  office  when designated by the governor is the agency of the
state to administer and/or supervise the state plan or plans  concerning
substance  [abuse]  USE  DISORDER services specified in the federal drug
abuse office and treatment act of nineteen hundred  seventy-two  and  to
cooperate  with the duly designated federal authorities charged with the
administration thereof.
  (b) The office and all entities to which it provides financial support
shall do all that is required and shall render necessary cooperation  to
ensure  optimum  use  of  federal aid for substance [abuse] USE DISORDER
services.
  (c) The commissioner is authorized and empowered to take  such  steps,
not  inconsistent  with  law,  as  may  be  necessary for the purpose of
procuring for the people of this state all of the benefits  and  assist-
ance,  financial  and  otherwise, provided, or to be provided for, by or
pursuant to any act of congress relating to substance [abuse] USE DISOR-
DER services.
  S 11. Section 25.15 of the mental hygiene law, as amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.15 Optimizing federal aid.
  (a)  A  PROGRAM  OPERATED  BY  A  local  [agency] GOVERNMENTAL UNIT or
[substance abuse program] VOLUNTARY  AGENCY  shall,  unless  a  specific
written waiver of this requirement is made by the office, cause applica-
tions  to  be  completed on such forms and in such manner as directed by
the office and submit the same to the office for the purpose of  causing
a  determination  to  be  made whether the cost of the services provided
individuals and groups qualify for federal aid which  may  be  available
for  services  provided  pursuant  to  titles IV, XVI, XIX and XX of the
federal social security act, or any other federal law. A  PROGRAM  OPER-

S. 2606--C                         186

ATED  BY  A  local  [agency]  GOVERNMENTAL  UNIT  or  a [substance abuse
program] VOLUNTARY AGENCY shall furnish to the office such other data as
may be required and shall render such cooperation as may be necessary to
maximize  such  potential  federal  aid.  All information concerning the
identity of individuals obtained and provided pursuant to this  subdivi-
sion shall be kept confidential.
  (b)  To the extent that federal aid may be available for any substance
[abuse] USE DISORDER services, the  office,  notwithstanding  any  other
inconsistent  provision of law, and with the approval of the director of
the budget, is hereby authorized to seek such federal aid on  behalf  of
[substance  abuse programs] VOLUNTARY AGENCIES and A PROGRAM OPERATED BY
A local [agencies] GOVERNMENTAL UNIT  either  directly  or  through  the
submission  of  claims  to another state agency authorized to submit the
same to an appropriate federal agency. The office is further  authorized
to  certify for payment to [substance abuse programs] VOLUNTARY AGENCIES
and A PROGRAM OPERATED BY  A  local  [agencies]  GOVERNMENTAL  UNIT  any
federal  aid  received  by the state which is attributable to the activ-
ities financed by such programs and agencies.
  S 12. Section 25.17 of the mental hygiene law, as amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.17 Fees for services.
  [Local  agencies  GOVERNMENTS  and substance abuse treatment programs]
VOLUNTARY AGENCIES AND PROGRAMS OPERATED  BY  LOCAL  GOVERNMENTAL  UNITS
funded in whole or in part by the office shall establish, subject to the
approval of the office, fee schedules for substance [abuse] USE DISORDER
services,  not specifically covered by the rates established pursuant to
article twenty-eight of the public health law or title  two  of  article
five  of  the  social  services  law.  Such  fees  shall  be charged for
substance [abuse] USE DISORDER services furnished  to  persons  who  are
financially able to pay the same, provided, that such services shall not
be refused to any person because of his inability to pay therefor.
  S  13.  Subdivision (d) of section 41.18 of the mental hygiene law, as
amended by chapter 558 of the laws  of  1999,  is  amended  to  read  as
follows:
  (d)  The liability of the state in any state fiscal year for state aid
pursuant to this section shall  exclude  chemical  dependence  services,
which  are  subject to article [twenty-six] TWENTY-FIVE of this chapter,
and shall be limited to the amounts appropriated for such state  aid  by
the legislature for such state fiscal year.
  S  14.  This  act  shall take effect April 1, 2013; provided, however,
that effective immediately, any rule or  regulation  necessary  for  the
implementation  of  this  act  on  its  effective date is authorized and
directed to be made and completed on or before such effective date.

                                 PART H

  Section 1. Section 7.17 of the mental hygiene law is amended by adding
a new subdivision (a-1) to read as follows:
  (A-1) NOTWITHSTANDING ANY LAW TO THE CONTRARY, INPATIENT FACILITIES IN
THE OFFICE SHALL ONLY BE  ESTABLISHED  PURSUANT  TO  EXPLICIT  STATUTORY
AUTHORITY.
  S  2. The commissioner of mental health shall provide a report regard-
ing the proposed restructuring of state-operated facilities that provide
inpatient care to individuals with mental illness to the legislature  no
later than September 1, 2013, and shall provide an update of such report

S. 2606--C                         187

every six months thereafter. Such report shall address topics including,
but not limited to:
  (a)  the size and location of, and type of services to be provided by,
facilities;
  (b) the relative quality of the care and  treatment  provided  by  any
hospital  subject  to a proposed closure, as may be informed by internal
or external quality or accreditation reviews;
  (c) the current and  anticipated  long-term  need  for  the  types  of
services provided by existing and proposed facilities;
  (d) the availability of staff sufficient to address current and antic-
ipated long term service needs;
  (e)  the  long  term  capital  investment  required to ensure that the
facilities meets relevant  state  and  federal  regulatory  and  capital
construction requirements, and national accreditation standards;
  (f)  anticipated  savings  based  upon  economics  of  scale  or other
factors;
  (g) community mental health services available in the  catchment  area
of  proposed  facilities  and hospitals subject to proposed closure, and
the ability of such community mental health services to meet the  behav-
ioral health needs of the impacted consumers;
  (h)  how  restructuring  would address the obligations of the state to
place persons with mental disabilities in community settings rather than
in institutions, when appropriate;
  (i) the anticipated impact of a proposed closure on access  to  mental
health services;
  (j) the impact on the state workforce, and strategies for the develop-
ment of necessary retraining and redeployment programs;
  (k) the impact on the local and regional economies; and
  (l)  proposed alternative uses for land and buildings to be vacated by
the office of mental health.
  S 3. Section 7 of part R2 of chapter 62 of the laws of 2003,  amending
the  mental hygiene law and the state finance law relating to the commu-
nity mental health  support  and  workforce  reinvestment  program,  the
membership  of  subcommittees  for  mental  health of community services
boards and the duties of such subcommittees and creating  the  community
mental  health and workforce reinvestment account, as amended by section
2 of part C of chapter 111 of the laws of 2010, is amended  to  read  as
follows:
  S 7. This act shall take effect immediately and shall expire March 31,
[2013]  2014  when  upon  such  date the provisions of this act shall be
deemed repealed.
  S 4. Severability clause. If any clause, sentence, paragraph, subdivi-
sion, section or part of this act shall be  adjudged  by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall  be  confined  in
its  operation  to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  5. This act shall take effect April 1, 2013; provided, however that
if this act shall become a law after April 1, 2013, this act shall  take
effect  immediately  and  shall be deemed to have been in full force and
effect on and after April 1, 2013.

                                 PART I

S. 2606--C                         188

  Section 1. Subdivisions (d), (e), (f) and (g) of section 41.44 of  the
mental  hygiene  law  are relettered subdivisions (e), (f), (g), and (h)
and a new subdivision (d) is added to read as follows:
  (D)  THE  COMMISSIONER IS AUTHORIZED TO RECOVER FUNDING FROM PROVIDERS
OF COMMUNITY  RESIDENCES  LICENSED  BY  THE  OFFICE  OF  MENTAL  HEALTH,
CONSISTENT  WITH CONTRACTUAL OBLIGATIONS OF SUCH PROVIDERS, AND NOTWITH-
STANDING ANY OTHER INCONSISTENT PROVISION OF LAW TO THE  CONTRARY,  SUCH
RECOVERY  AMOUNT  SHALL  EQUAL  FIFTY  PERCENT  OF  THE MEDICAID REVENUE
RECEIVED BY SUCH PROVIDERS WHICH EXCEEDS  THE  FIXED  AMOUNT  OF  ANNUAL
MEDICAID REVENUE LIMITATIONS, AS ESTABLISHED BY THE COMMISSIONER.
  S  2.  This act shall take effect immediately, shall be deemed to have
been in full force and effect on and after  April  1,  2013,  and  shall
expire and be deemed repealed March 31, 2014.

                                 PART J
                          Intentionally Omitted

                                 PART K

  Section  1.  Subdivisions  (a),  (b)  and  (c) of section 10.09 of the
mental hygiene law, subdivisions (a) and (c) as added by  chapter  7  of
the  laws  of 2007 and subdivision (b) as amended by section 3 of part P
of chapter 56 of the laws of 2012, are amended to read as follows:
  (a) The commissioner shall provide  the  respondent  and  counsel  for
respondent  with  [an  annual] A written notice of the right to petition
the court for discharge, WHICH SHALL BE PROVIDED NO  LATER  THAN  ELEVEN
MONTHS  AFTER  THE  DATE ON WHICH THE SUPREME OR COUNTY COURT JUDGE LAST
ORDERED OR CONFIRMED THE NEED FOR CONTINUED CONFINEMENT PURSUANT TO THIS
ARTICLE. The notice shall contain a form for the waiver of the right  to
petition for discharge.
  (b)  The commissioner shall also assure that each respondent committed
under this article shall have an examination for evaluation  of  his  or
her  mental  condition made [at least once every] NO LATER THAN ONE year
[(calculated from] AFTER the date on which the supreme or  county  court
judge  last  ordered  or  confirmed  the  need for continued confinement
pursuant to this article [or the date on which the respondent waived the
right to petition for discharge pursuant to this section,  whichever  is
later, as applicable)]. SUCH EXAMINATION SHALL BE conducted by a psychi-
atric  examiner  who shall report to the commissioner his or her written
findings as to whether the  respondent  is  currently  a  dangerous  sex
offender  requiring confinement. At such time, the respondent also shall
have the right to be evaluated by an independent  psychiatric  examiner.
If the respondent is financially unable to obtain an examiner, the court
shall  appoint  an examiner of the respondent's choice to be paid within
the limits prescribed by law. Following such evaluation, each  psychiat-
ric  examiner shall report his or her findings in writing to the commis-
sioner and to counsel for  respondent.  The  commissioner  shall  review
relevant records and reports, along with the findings of the psychiatric
examiners,  and  shall make a determination in writing as to whether the
respondent is currently a dangerous sex offender requiring confinement.
  (c) The commissioner shall [annually] forward the  notice  and  waiver
form,  along with a report including the commissioner's written determi-
nation and the findings of the psychiatric examination, to  the  supreme
or county court where the respondent is located, WHICH SHALL BE PROVIDED
NO  LATER  THAN  ONE  YEAR AFTER THE DATE ON WHICH THE SUPREME OR COUNTY

S. 2606--C                         189

COURT JUDGE LAST ORDERED OR CONFIRMED THE NEED FOR CONTINUED CONFINEMENT
PURSUANT TO THIS ARTICLE.
  S  2.  This  act  shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2013.

                                 PART L

  Section 1. The mental hygiene law is amended by adding a  new  section
31.37 to read as follows:
S 31.37 MENTAL HEALTH INCIDENT REVIEW PANELS.
  (A)  THE  COMMISSIONER  IS  AUTHORIZED TO, ON HIS OR HER OWN ACCORD OR
PURSUANT TO A REQUEST BY A LOCAL GOVERNMENT  UNIT,  ESTABLISH  A  MENTAL
HEALTH  INCIDENT  REVIEW PANEL FOR THE PURPOSES OF REVIEWING IN CONJUNC-
TION WITH LOCAL REPRESENTATION, THE CIRCUMSTANCES AND EVENTS RELATED  TO
A SERIOUS INCIDENT INVOLVING A PERSON WITH MENTAL ILLNESS.  FOR PURPOSES
OF  THIS  SECTION,  A  "SERIOUS  INCIDENT INVOLVING A PERSON WITH MENTAL
ILLNESS" MEANS AN INCIDENT OCCURRING IN THE COMMUNITY IN WHICH A  PERSON
WITH  A  SERIOUS MENTAL ILLNESS IS PHYSICALLY INJURED OR CAUSES PHYSICAL
INJURY TO ANOTHER PERSON, OR SUFFERS A SERIOUS AND  PREVENTABLE  MEDICAL
COMPLICATION  OR  BECOMES  INVOLVED  IN  A  CRIMINAL  INCIDENT INVOLVING
VIOLENCE. A PANEL SHALL CONDUCT A REVIEW OF SUCH SERIOUS INCIDENT IN  AN
ATTEMPT  TO  IDENTIFY PROBLEMS OR GAPS IN MENTAL HEALTH DELIVERY SYSTEMS
AND TO MAKE  RECOMMENDATIONS  FOR  CORRECTIVE  ACTIONS  TO  IMPROVE  THE
PROVISION  OF  MENTAL HEALTH OR RELATED SERVICES, TO IMPROVE THE COORDI-
NATION, INTEGRATION AND ACCOUNTABILITY OF  CARE  IN  THE  MENTAL  HEALTH
SERVICE SYSTEM, AND TO ENHANCE INDIVIDUAL AND PUBLIC SAFETY.
  (B)  A MENTAL HEALTH INCIDENT REVIEW PANEL SHALL INCLUDE, BUT NEED NOT
BE LIMITED TO, REPRESENTATIVES FROM THE OFFICE OF MENTAL HEALTH AND  THE
LOCAL  GOVERNMENTAL  UNIT  WHERE THE SERIOUS INCIDENT INVOLVING A PERSON
WITH A MENTAL ILLNESS OCCURRED. A MENTAL HEALTH  INCIDENT  REVIEW  PANEL
MAY ALSO INCLUDE, IF DEEMED APPROPRIATE BY THE COMMISSIONER BASED ON THE
NATURE  OF  THE  SERIOUS  INCIDENT BEING REVIEWED, ONE OR MORE REPRESEN-
TATIVES FROM  MENTAL  HEALTH  PROVIDERS,  LOCAL  DEPARTMENTS  OF  SOCIAL
SERVICES,  HUMAN  SERVICES PROGRAMS, HOSPITALS, LOCAL SCHOOLS, EMERGENCY
MEDICAL OR MENTAL HEALTH SERVICES, THE OFFICE OF THE COUNTY ATTORNEY,  A
COUNTY PROSECUTOR'S OFFICE, STATE OR LOCAL LAW ENFORCEMENT AGENCIES, THE
OFFICE OF THE MEDICAL EXAMINER OR THE OFFICE OF THE CORONER, THE JUDICI-
ARY, OR OTHER APPROPRIATE STATE OR LOCAL OFFICIALS.
  (C)  NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY AND TO
THE EXTENT CONSISTENT WITH FEDERAL LAW, A MENTAL HEALTH INCIDENT  REVIEW
PANEL  SHALL  HAVE  ACCESS  TO  THOSE  CLIENT-IDENTIFIABLE MENTAL HEALTH
RECORDS, AS WELL AS ALL RECORDS, DOCUMENTATION AND REPORTS  RELATING  TO
THE  INVESTIGATION OF AN INCIDENT BY A FACILITY IN ACCORDANCE WITH REGU-
LATIONS OF THE COMMISSIONER, WHICH ARE NECESSARY FOR  THE  INVESTIGATION
OF  THE  INCIDENT  AND  THE  PREPARATION OF A REPORT OF THE INCIDENT, AS
PROVIDED  IN SUBDIVISION (E) OF THIS SECTION. A MENTAL  HEALTH  INCIDENT
REVIEW PANEL ESTABLISHED PURSUANT TO THIS SECTION SHALL BE PROVIDED WITH
ACCESS  TO  ALL  OTHER RECORDS IN THE POSSESSION OF STATE OR LOCAL OFFI-
CIALS OR AGENCIES, WITHIN TWENTY-ONE  DAYS  OF  RECEIPT  OF  A  REQUEST,
EXCEPT:  (1)  THOSE  RECORDS PROTECTED BY SECTION 190.25 OF THE CRIMINAL
PROCEDURE LAW; AND (2) WHERE PROVISION OF LAW ENFORCEMENT RECORDS  WOULD
INTERFERE  WITH  AN  ONGOING  LAW  ENFORCEMENT INVESTIGATION OR JUDICIAL
PROCEEDING, IDENTIFY A  CONFIDENTIAL  SOURCE  OR  DISCLOSE  CONFIDENTIAL
INFORMATION RELATING TO AN ONGOING CRIMINAL INVESTIGATION, HIGHLY SENSI-
TIVE  CRIMINAL  INVESTIGATIVE  TECHNIQUES OR PROCEDURES, OR ENDANGER THE
SAFETY OR WELFARE OF AN INDIVIDUAL.

S. 2606--C                         190

  (D) MENTAL HEALTH INCIDENT REVIEW PANELS, MEMBERS OF THE REVIEW PANELS
AND PERSONS WHO PRESENT INFORMATION TO A REVIEW PANEL SHALL HAVE IMMUNI-
TY FROM CIVIL AND CRIMINAL LIABILITY FOR ALL REASONABLE AND  GOOD  FAITH
ACTIONS  TAKEN  PURSUANT TO THIS SECTION, AND SHALL NOT BE QUESTIONED IN
ANY  CIVIL  OR  CRIMINAL  PROCEEDING  REGARDING ANY OPINIONS FORMED AS A
RESULT OF A MEETING OF SUCH REVIEW PANEL. NOTHING IN THIS SECTION  SHALL
BE  CONSTRUED  TO  PREVENT  A  PERSON  FROM TESTIFYING AS TO INFORMATION
OBTAINED INDEPENDENTLY OF A MENTAL  HEALTH  INCIDENT  REVIEW  PANEL,  OR
INFORMATION WHICH IS PUBLIC.
  (E)  NOTWITHSTANDING  ANY  OTHER PROVISION OF LAW TO THE CONTRARY, ALL
MEETINGS CONDUCTED, ALL REPORTS AND RECORDS MADE AND MAINTAINED AND  ALL
BOOKS AND PAPERS OBTAINED BY A MENTAL HEALTH INCIDENT REVIEW PANEL SHALL
BE  CONFIDENTIAL,  AND  SHALL  NOT  BE OPEN OR MADE AVAILABLE, EXCEPT BY
COURT ORDER OR AS SET FORTH IN SUBDIVISION (G)  OF  THIS  SECTION.  EACH
MENTAL  HEALTH INCIDENT REVIEW PANEL SHALL DEVELOP A REPORT OF THE INCI-
DENT INVESTIGATED. SUCH REPORT SHALL NOT CONTAIN ANY INDIVIDUALLY  IDEN-
TIFIABLE  INFORMATION  AND  SHALL  BE  PROVIDED  TO THE OFFICE OF MENTAL
HEALTH UPON COMPLETION. SUCH REPORTS MUST BE APPROVED BY THE  OFFICE  OF
MENTAL HEALTH PRIOR TO BECOMING FINAL.
  (F) IF QUALITY PROBLEMS OF PARTICULAR MENTAL HEALTH PROGRAMS ARE IDEN-
TIFIED  BASED  ON SUCH REVIEWS, THE COMMISSIONER IS AUTHORIZED, PURSUANT
TO THE RELEVANT PROVISIONS OF THIS CHAPTER, TO TAKE APPROPRIATE  ACTIONS
REGARDING  THE  LICENSURE OF PARTICULAR PROVIDERS, TO REFER THE ISSUE TO
OTHER RESPONSIBLE PARTIES FOR INVESTIGATION, OR TO TAKE OTHER  APPROPRI-
ATE ACTION WITHIN THE SCOPE OF HIS OR HER AUTHORITY.
  (G)  IN HIS OR HER DISCRETION, THE COMMISSIONER SHALL BE AUTHORIZED TO
PROVIDE THE FINAL REPORT OF A REVIEW PANEL OR PORTIONS  THEREOF  TO  ANY
INDIVIDUAL  OR  ENTITY  FOR  WHOM  THE  REPORT MAKES RECOMMENDATIONS FOR
CORRECTIVE OR OTHER APPROPRIATE ACTIONS THAT SHOULD BE TAKEN. ANY  FINAL
REPORT OR PORTION THEREOF SHALL NOT BE FURTHER DISSEMINATED BY THE INDI-
VIDUAL OR ENTITY RECEIVING SUCH REPORT.  FURTHER, THE COMMISSIONER SHALL
SUBMIT  THE  FINAL  REPORT OF A REVIEW PANEL, WITHIN FIFTEEN DAYS OF THE
CONCLUSION OF A PANEL, TO THE TEMPORARY PRESIDENT OF THE SENATE AND  THE
SPEAKER OF THE ASSEMBLY.
  (H)  THE  COMMISSIONER SHALL SUBMIT AN ANNUAL CUMULATIVE REPORT TO THE
GOVERNOR AND THE LEGISLATURE INCORPORATING THE DATA IN THE MENTAL HEALTH
INCIDENT REVIEW PANEL REPORTS AND INCLUDING A SUMMARY  OF  THE  FINDINGS
AND RECOMMENDATIONS MADE BY SUCH REVIEW PANELS, WHICH MEASURES THAT HAVE
BEEN  IMPLEMENTED,  AND  A DESCRIPTION OF THE IMPACT OF SUCH IMPLEMENTA-
TIONS.  THE ANNUAL CUMULATIVE REPORTS MAY THEREAFTER BE  MADE  AVAILABLE
TO THE PUBLIC.
  S  2.  Subdivision  (c)  of section 33.13 of the mental hygiene law is
amended by adding a new paragraph 16 to read as follows:
  16. TO A MENTAL HEALTH INCIDENT  REVIEW  PANEL,  OR  MEMBERS  THEREOF,
ESTABLISHED BY THE COMMISSIONER PURSUANT TO SECTION 31.37 OF THIS TITLE,
IN CONNECTION WITH INCIDENT REVIEWS CONDUCTED BY SUCH PANEL.
  S 3. Subdivision 3 of section 6527 of the education law, as amended by
chapter 257 of the laws of 1987, is amended to read as follows:
  3. No individual who serves as a member of (a) a committee established
to  administer  a  utilization  review  plan  of a hospital, including a
hospital as defined in article twenty-eight of the public health law  or
a  hospital  as defined in subdivision ten of section 1.03 of the mental
hygiene law, or (b) a committee having the responsibility of the  inves-
tigation of an incident reported pursuant to section 29.29 of the mental
hygiene  law  or  the  evaluation and improvement of the quality of care
rendered in a hospital as defined in article twenty-eight of the  public

S. 2606--C                         191

health  law  or a hospital as defined in subdivision ten of section 1.03
of the mental hygiene law,  or  (c)  any  medical  review  committee  or
subcommittee thereof of a local, county or state medical, dental, podia-
try  or  optometrical  society,  any such society itself, a professional
standards review organization or  an  individual  when  such  committee,
subcommittee,  society,  organization  or  individual  is performing any
medical or quality assurance review function including the investigation
of an incident reported pursuant to section 29.29 of the mental  hygiene
law,  either  described  in  clauses  (a)  and  (b) of this subdivision,
required by law, or involving any controversy or dispute between  (i)  a
physician,  dentist, podiatrist or optometrist or hospital administrator
and a patient concerning  the  diagnosis,  treatment  or  care  of  such
patient  or  the  fees or charges therefor or (ii) a physician, dentist,
podiatrist or optometrist or hospital administrator and  a  provider  of
medical,  dental,  podiatric  or  optometrical  services  concerning any
medical or health charges or fees of such physician, dentist, podiatrist
or optometrist, or (d) a committee appointed pursuant to  section  twen-
ty-eight  hundred  five-j of the public health law to participate in the
medical and dental malpractice prevention program, or (e) any individual
who participated in the preparation of incident reports required by  the
department  of health pursuant to section twenty-eight hundred five-l of
the public health law, or (f) a committee established  to  administer  a
utilization  review  plan,  or  a committee having the responsibility of
evaluation and improvement of the quality of care rendered, in a  health
maintenance  organization  organized  under  article  forty-four  of the
public health law or article forty-three of the insurance law, including
a committee of an  individual  practice  association  or  medical  group
acting  pursuant  to a contract with such a health maintenance organiza-
tion, OR (G) A MENTAL HEALTH INCIDENT REVIEW PANEL CONVENED PURSUANT  TO
SECTION  31.37  OF THE MENTAL HYGIENE LAW, shall be liable in damages to
any person for any action taken or recommendations made, by him  OR  HER
within  the  scope of his OR HER function in such capacity provided that
(a) such individual has taken action or made recommendations within  the
scope  of his OR HER function and without malice, and (b) in the reason-
able belief after reasonable investigation that the act  or  recommenda-
tion was warranted, based upon the facts disclosed.
  Neither  the  proceedings nor the records relating to performance of a
medical or a quality assurance review function  or  participation  in  a
medical  and  dental  malpractice  prevention  program  nor  any  report
required by the department of health pursuant  to  section  twenty-eight
hundred  five-l of the public health law described herein, including the
investigation of an incident reported pursuant to section 29.29  of  the
mental  hygiene  law OR REVIEWED PURSUANT TO SECTION 31.37 OF THE MENTAL
HYGIENE LAW, shall be subject to disclosure under article thirty-one  of
the  civil  practice  law and rules except as hereinafter provided or as
provided by any other provision of law. No person  in  attendance  at  a
meeting  when  a  medical or a quality assurance review or a medical and
dental malpractice prevention program or an incident reporting  function
described  herein was performed, including the investigation of an inci-
dent reported pursuant to section 29.29 of the mental hygiene law OR  AN
INCIDENT  REVIEWED  PURSUANT TO SECTION 31.37 OF THE MENTAL HYGIENE LAW,
shall be required to testify as to what transpired thereat. The prohibi-
tion relating to discovery of testimony shall not apply  to  the  state-
ments  made by any person in attendance at such a meeting who is a party
to an action or proceeding the subject matter of which was  reviewed  at
such meeting.

S. 2606--C                         192

  S  4.  This  act  shall take effect on the sixtieth day after it shall
have become a law.

                                 PART M

  Section 1. Section 20 of chapter 723 of the laws of 1989, amending the
mental  hygiene  law  and  other  laws  relating to the establishment of
comprehensive psychiatric emergency programs, is REPEALED.
  S 2. Subdivision (c) of section 7.15 of  the  mental  hygiene  law  is
REPEALED.
  S  3.    Subdivision (c) of section 13.15 of the mental hygiene law is
REPEALED.
  S 4. Paragraph 3 of subdivision (d) of section  16.19  of  the  mental
hygiene law is REPEALED.
  S  5. Subparagraph e of paragraph 2 of subdivision (b) of section 5.07
of the mental hygiene law, as added by chapter 322 of the laws of  1992,
is amended as follows:
  e.  a  description  of  the available community-based acute inpatient,
out-patient, [emergency, and community support]  COMMUNITY  SUPPORT  AND
EMERGENCY  services, WHICH SHALL INCLUDE COMPREHENSIVE PSYCHIATRIC EMER-
GENCY PROGRAMS LICENSED PURSUANT TO SECTION 31.27 OF THIS CHAPTER.  Such
description should include  the  extent  to  which  these  services  are
currently  utilized  by  persons  with mental illness and, as available,
compare estimates of utilization with estimates  of  the  prevalence  of
mental  illness  among persons residing in the service area to determine
unmet need;
  S 6. This act shall take effect April 1, 2013.

                                 PART N

  Section 1.  Subdivisions 3-b and 3-c of section 1  and  section  4  of
part  C  of  chapter  57 of the laws of 2006, relating to establishing a
cost of living adjustment for designated  human  services  programs,  as
amended  by  section  1  of part H of chapter 56 of the laws of 2012, is
amended to read as follows:
  3-b. Notwithstanding any  inconsistent  provision  of  law,  beginning
April  1, 2009 and ending March 31, [2013] 2014, the commissioners shall
not include a COLA for the purpose of establishing  rates  of  payments,
contracts or any other form of reimbursement.
  3-c.  Notwithstanding  any  inconsistent  provision  of law, beginning
April 1, [2013] 2014 and ending March 31, [2016] 2017, the commissioners
shall develop the COLA under this section using the actual U.S. consumer
price index for all urban consumers  (CPI-U)  published  by  the  United
States  department  of  labor, bureau of labor statistics for the twelve
month period ending in July of the  budget  year  prior  to  such  state
fiscal  year,  for  the  purpose  of  establishing  rates  of  payments,
contracts or any other form of reimbursement.
  S 4. This act shall take effect immediately and  shall  be  deemed  to
have  been in full force and effect on and after April 1, 2006; provided
section one of this act shall expire and be  deemed  repealed  April  1,
[2016]  2017; provided, further, that sections two and three of this act
shall expire and be deemed repealed December 31, 2009.
  S 2. This act shall take effect immediately and  shall  be  deemed  to
have been in full force and effect on and after April 1, 2013; provided,
however, that the amendments to section 1 of part C of chapter 57 of the

S. 2606--C                         193

laws of 2006 made by section one of this act shall not affect the repeal
of such section and shall be deemed repealed therewith.

                                 PART O

  Section  1.  Legislative  findings  and purpose. Recent actions by the
United States Center for  Medicare  and  Medicaid  Services  impact  the
stability  of  New  York  state's mental hygiene system. While the state
must embark on a deliberate path to replace the existing,  long-standing
financing  system  for developmental disability services, replacement of
the sudden loss of $1.1 billion in federal revenue is too significant to
be solved solely by actions within the mental hygiene system. A partner-
ship with the entire health care community is needed to manage this loss
over time. Accordingly, this part authorizes the actions  necessary  and
creates  the Mental Hygiene Stabilization Fund that will be supported by
department of health medicaid resources under the Global Cap  in  annual
amounts  not  to  exceed  $730,000,000  in  state  fiscal  year 2013-14,
$445,000,000 in 2014-15, $267,000,000 in 2015-16,  and  $267,000,000  in
2016-17.
  S  2.  Notwithstanding any contrary provision of law, the commissioner
of health shall annul implementation  of  the  reimbursement  reductions
authorized  by section one of part A of this act commencing February 15,
2014.
  S 3. Notwithstanding any contrary provision of law, implementation  of
the  provisions of sections twenty-two, twenty-three, and/or twenty-four
of part A of this act shall be delayed to the state fiscal  year  begin-
ning April 1, 2014.
  S  4. Notwithstanding any inconsistent provision of law, rule or regu-
lation, for purposes of implementing the provisions of the public health
law and the social services law, references to titles XIX and XXI of the
federal social security act in the public  health  law  and  the  social
services  law  shall be deemed to include and also to mean any successor
titles thereto under the federal social security act.
  S 5. Notwithstanding any inconsistent provision of law, rule or  regu-
lation, the effectiveness of the provisions of sections 2807 and 3614 of
the  public  health law, section 18 of chapter 2 of the laws of 1988, as
amended, and 18 NYCRR 505.14(h), as  they  relate  to  time  frames  for
notice,  approval  or  certification  of  rates  of  payment, are hereby
suspended and without force or effect for purposes of  implementing  the
provisions of this act.
  S 6. Severability clause. If any clause, sentence, paragraph, subdivi-
sion,  section  or  part  of  this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment  shall  not  affect,
impair or invalidate the remainder thereof, but shall be confined in its
operation  to  the  clause, sentence, paragraph, subdivision, section or
part thereof directly involved in the controversy in which such judgment
shall have been rendered. It is hereby declared to be the intent of  the
legislature  that  this act would have been enacted even if such invalid
provisions had not been included herein.
  S 7. This act shall take effect immediately and  shall  be  deemed  to
have been in full force and effect on and after April 1, 2013.

                                 PART P

  Section  1.  Legislative intent. The legislature hereby finds that the
goals of the state include providing individuals with  mental  illnesses

S. 2606--C                         194

the tools necessary to: (a) make informed choices and decisions; and (b)
achieve equality of opportunity, full inclusion and integration in soci-
ety, employment, independent living, and economic and social self-suffi-
ciency.  The legislature further finds that such goals are best achieved
by providing individuals with mental illnesses a variety of  residential
options  that  are  both integrated and appropriate to the needs of each
person.  Therefore, the legislature finds it appropriate and prudent  to
continue  overseeing the regulation of adult homes as the state develops
community based settings sufficient to meet the  desires  and  needs  of
individuals with mental illnesses.
  S  2.  Definitions.  For the purposes of this act, the following terms
shall have the following meanings:
  (a) "Administrative action" means any decision or action by an  execu-
tive agency, including but not limited to, the promulgation, implementa-
tion or enforcement of regulations.
  (b) "Adult home" means an adult care facility established and operated
for  the  purpose  of providing long-term residential care, room, board,
housekeeping, personal care and supervision to five or more  adults  who
are unrelated to the operator.
  (c) "Mental health census" means the number or percentage of residents
in a facility who are persons with serious mental illness, as defined in
subdivision (d) of this section.
  (d)  "Persons  with  serious  mental illness" means persons who are in
psychiatric crisis; or persons who have a designated diagnosis of mental
illness under the most recent edition of the Diagnostic and  Statistical
Manual  of  Mental  Disorders, and whose severity and duration of mental
illness results in substantial functional disability.
  S 3. Notwithstanding any law, rule  or  regulation  to  the  contrary,
absent explicit statutory authority, no executive agency shall undertake
any  administrative action designed to limit or reduce the mental health
census of an adult home.
  (a) Prior to provision of such statutory authority:
  (1) The commissioner of health and the commissioner of  mental  health
shall,  in consultation with stakeholders, including representation from
the legislature, mental health advocacy  organizations,  and  the  adult
home  industry,  jointly  develop a report and recommendations regarding
the provision of integrated housing that is appropriate to the needs  of
individuals  with  serious mental illnesses. Such report and recommenda-
tions shall  include  a  plan  and  timeline  for  developing  community
settings and community services in all regions of the state; guidance as
to  how  adult  homes impacted by such plan can support, and continue to
serve, residents; details as to which adult homes and residents would be
impacted by such plan, as well as any foreseeable effects on local econ-
omies; proposals for evaluating persons with  serious  mental  illnesses
residing in adult homes, and providing the support necessary to aid them
in  making  informed  decisions  regarding future treatment; and details
with regard to the progress of the department of health and  the  office
of mental health in facilitating such informed decisions.
  (2)  The  commissioner of health and the commissioner of mental health
shall certify that  sufficient  alternative  housing  options  exist  to
accommodate  those  persons  with  serious  mental illnesses residing in
adult homes who chose to transition to an appropriate community setting,
within a reasonable distance from individuals' current housing.
  (b) Such report and recommendations shall be provided to the temporary
president of the senate and the speaker of the assembly  no  later  than

S. 2606--C                         195

December 31, 2013, and shall be updated no less frequently than once per
year.
  S 4. This act shall take effect immediately.
  S 2. Severability clause. If any clause, sentence, paragraph, subdivi-
sion,  section  or  part  of  this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment  shall  not  affect,
impair,  or  invalidate  the remainder thereof, but shall be confined in
its operation to the clause, sentence, paragraph,  subdivision,  section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the  legislature  that  this  act  would  have been enacted even if such
invalid provisions had not been included herein.
  S 3. This act shall take effect immediately  provided,  however,  that
the  applicable effective date of Parts A through P of this act shall be
as specifically set forth in the last section of such Parts.

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