EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD12371-02-9
S. 58--A 2 A. 158--A
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;
to amend chapter 629 of the laws of 1986, amending the social services
law relating to establishing a demonstration program for the delivery
of long term home health care services to certain persons, in relation
to extending the provisions thereof; 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 provid-
er protections, in relation to extending the effectiveness of certain
provisions thereof; to amend chapter 55 of the laws of 1992, amending
the tax law and other laws relating to taxes, surcharges, fees and
funding, in relation to the effectiveness thereof; to amend chapter
942 of the laws of 1983 and chapter 541 of the laws of 1984, relating
to foster family care demonstration programs, and to amend chapter 256
of the laws of 1985, amending the social services law and other laws
relating to foster family care demonstration programs, in relation to
extending the expirations thereof; to amend chapter 693 of the laws of
1996, amending the social services law relating to authorizing patient
discharge to hospices and residential health care facilities, under
the medical assistance presumptive eligibility program, in relation to
extending the provisions of such chapter; to amend chapter 631 of the
laws of 1997, amending the social services law relating to authorizing
medical assistance payments to certain clinics or diagnostic and
treatment centers, in relation to extending the effectiveness thereof;
to amend chapter 119 of the laws of 1997 relating to authorizing the
department of health to establish certain payments to general hospi-
tals, in relation to making such authorization permanent; and to
repeal section 74 of the executive law relating to the office of the
welfare inspector general (Part B); to amend the public health law, in
relation to payment by governmental agencies for general hospital
inpatient services, inpatient medical assistance rates for non-public
general hospitals, grants to public general hospitals, tobacco control
and insurance initiatives pool distributions, health care initiatives
pool distributions and payments made on behalf of persons enrolled in
Medicaid managed care or family health plus; to direct the commission-
ers of health and mental health to enhance funding of the ambulatory
patient group methodology and expand certain programs; to direct the
commissioners of health, and mental retardation and developmental
disabilities to enhance funding of the ambulatory patient group meth-
odology; to amend the social services law, in relation to establishing
the statewide health care home program; to amend the public health
law, in relation to establishing the Adirondack health care home
multipayor demonstration program; to amend the social services law, in
relation to medicaid coverage of smoking cessation, cardiac rehabili-
tation services and substance abuse intervention; to amend the social
services law, in relation to the provision and reimbursement of trans-
portation costs and the primary care case management program; to amend
the public authorities law, in relation to the authorization of the
dormitory authority to issue bonds for health care; to amend the
social services law, in relation to directing the commissioner of
health to negotiate pharmaceutical rebates, retrospective and prospec-
tive drug utilization review, and the duration of drug therapy, the
development of clinical prescribing guidelines, drug coverage for
persons who are beneficiaries under Part D; to amend the public health
S. 58--A 3 A. 158--A
law and the social services law, in relation to the clinical drug
review program; to amend the social services law, in relation to elec-
tronic transmission of prescriptions; to amend the public health law
and the education law, in relation to prohibiting certain payments to
prescribers and requiring the disclosure of other payments, prohibit-
ing the presentation of information at continuing professional educa-
tion programs that is false or misleading and requiring disclosure of
certain potential conflicts of interest in connection with such
programs, providing for transparency in the business relationships
between pharmacy benefit managers and health plans, and requiring
pharmacy benefit managers to provide certain information to health
plan participants and their prescribers; to amend the social services
law, in relation to eligibility for medical assistance and the family
health plus program; to amend the welfare reform act of 1997, in
relation to applicants for public assistance; to amend the public
health law, in relation to child insurance plans; to amend the social
services law, in relation to monthly premiums for medical assistance
and liens for public assistance care; to amend the public health law,
in relation to fees for the establishment of hospitals, approval of
the construction of hospitals, licensure of home care services agen-
cies, the establishment of certified home health agencies, changes in
the ownership of a home health agency hospice construction, distrib-
ution of the professional education pools, the general hospital indi-
gent care pool and the comprehensive diagnostic and treatment centers
indigent care program; to amend the elder law, in relation to the
program for elderly pharmaceutical insurance coverage; to amend the
public health law, in relation to patient services payments; to amend
the insurance law, in relation to examinations and appraisals of
authorized insurers and employee welfare funds, independent adjusters,
establishing a fee on insurance claims processed by independent adjus-
ters; to amend the tax law and the state finance law, in relation to
the sales of cigarettes and tobacco products and the health care
reform act (HCRA) resources fund; to repeal certain provisions of the
public health law relating to the preferred drug program and the tele-
medicine demonstration program; to repeal certain provisions of chap-
ter 62 of the laws of 2003, amending the social services law and the
public health law relating to expanding Medicaid coverage and rates of
payment for residential health care facilities, relating thereto; to
repeal certain provisions of the social services law relating to
specialized HIV pharmacies, the family health plus program, eligibil-
ity for medical assistance; to repeal certain provisions of the elder
law relating to the program for elderly pharmaceutical insurance
coverage; and providing for the repeal of certain provisions upon the
expiration thereof (Part C); to amend the public health law, in
relation to reimbursement to residential health care facilities, to
community service plans, to payments for certified home health agency
services, to establishing the long-term care nursing initiative demon-
stration project; to amend the social services law, in relation to
assisted living programs, to payment for AIDS home care programs, to
regional long-term care assessment centers, to establishing the cash
and counseling demonstration program, to Medicaid extended coverage
for the partnership for long-term care program; to amend chapter 1 of
the laws of 1999, amending the public health law and other laws,
relating to enacting the New York Health Care Reform Act of 2000, in
relation to adult day health care services; to amend the education law
and the public health law, in relation to establishing long-term care
S. 58--A 4 A. 158--A
nursing initiative demonstration projects; and providing for the
repeal of certain provisions upon expiration thereof (Part D); to
amend part E of chapter 58 of the laws of 1998, relating to the deter-
mination of state aid for the long-term sheltered employment program,
in relation to availability of funding as certified by the director of
the budget (Part E); in relation to the establishment of the authority
of the office of mental health to close wards in hospitals operated by
such office and to develop transitional placement programs for persons
discharged from such hospitals, notwithstanding certain provisions of
the mental hygiene law (Part F); to amend chapter 420 of the laws of
2002 amending the education law relating to the profession of social
work, and chapter 676 of the laws of 2002 amending the education law
relating to defining the practice of psychology, in relation to the
professions of social work and mental health practitioners (Part G);
to amend the mental hygiene law, in relation to civil commitment of
sex offenders (Part H); to amend the mental hygiene law, in relation
to the receipt of federal and state benefits received by patients
receiving care in facilities operated by an office of the department
of mental hygiene (Part I); to amend the mental hygiene law in
relation to the consolidation of certain developmental disabilities
services offices (Part J); to amend the mental hygiene law, in
relation to the closure of the Manhattan Addiction Treatment Center
(Part K); to amend chapter 57 of the laws of 2006, establishing a cost
of living adjustment for designated human services programs, in
relation to foregoing such adjustment during the 2009--2010 state
fiscal year (Part L); to amend the mental hygiene law, in relation to
the requirement for the commissioner of mental health to annually
report on child and adult non-geriatric inpatient bed closures; to
amend chapter 119 of the laws of 2007 relating to directing the
commissioner of mental health to study, evaluate and report on the
unmet mental health service needs of traditionally underserved popu-
lations, in relation to such study; to repeal subdivisions (h) and (l)
of section 41.55 of the mental hygiene law relating to reports on the
community mental health support and workforce reinvestment program; to
repeal 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, relating to reports
thereon; and to repeal subdivision (c) of section 7.15 of the mental
hygiene law relating to reports on the delivery of care and services
in family care homes and other community residences (Part M); to amend
chapter 119 of the laws of 1997 authorizing the department of health
to establish certain payments to general hospitals, in relation to
extending the authorization for the department of health to continue
certain payments to general hospitals (Part N); to amend the adminis-
trative code of the city of New York, in relation to extending the
authorization of the city of New York to lease to the state of New
York certain real property on Ward's Island (Part O); to amend the
mental hygiene law and the vehicle and traffic law, in relation to
transfer of the alcohol and drug rehabilitation program from the
department of motor vehicles to the office of alcoholism and substance
abuse services (Part P); to amend the mental hygiene law, in relation
to the operating certificate of chemical dependence service providers
(Part Q); and to amend the social services law, in relation to recer-
tification for medical assistance for a recipient of medicaid waiver
services authorized by the office of mental retardation and develop-
mental disabilities (Part R)
S. 58--A 5 A. 158--A
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 2008-2009
state fiscal year. Each component is wholly contained within a Part
identified as Parts A through R. 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. Section 2541 of the public health law, as added by chapter
428 of the laws of 1992, paragraph (a) of subdivision 8 as amended by
section 1 of part B-3 of chapter 62 of the laws of 2003 and subdivision
13-a as added by chapter 231 of the laws of 1993, is amended to read as
follows:
S 2541. Definitions. As used in this title the following terms shall
have the following meanings, unless the context clearly requires other-
wise:
1. "AGENCY" MEANS AN ENTITY WHICH EMPLOYS QUALIFIED PERSONNEL, OR
CONTRACTS WITH QUALIFIED PERSONNEL WHO ARE APPROVED BY THE DEPARTMENT,
FOR THE PROVISION OF EARLY INTERVENTION PROGRAM EVALUATIONS, SERVICE
COORDINATION OR EARLY INTERVENTION SERVICES, AND MEETS THE REQUIREMENTS
SET FORTH IN PARAGRAPH (E) OF SUBDIVISION 5 OF SECTION TWENTY-FIVE
HUNDRED FIFTY-A OF THIS TITLE.
2. "Children at risk" means children who may experience a disability
because of medical, biological or environmental factors which may
produce developmental delay, as determined by the commissioner through
regulation.
[2. "Coordinated standards and procedures" means standards and proce-
dures developed by state early intervention service agencies pursuant to
section twenty-five hundred fifty-one of this title.]
3. "Council" means the early intervention coordinating council estab-
lished under section twenty-five hundred fifty-three of this title.
4. "Developmental delay" means that a child has not attained develop-
mental milestones expected for the child's chronological age, as meas-
ured by qualified professionals using appropriate diagnostic instruments
and/or procedures and informed clinical opinion, in one or more of the
following areas of development: cognitive, physical, communication,
social or emotional, or adaptive; EXCEPT THAT FOR CHILDREN WHO HAVE BEEN
FOUND, AFTER A MULTIDISCIPLINARY EVALUATION BASED ON INFORMED CLINICAL
OPINION AND CONDUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF THIS TITLE,
TO HAVE A DELAY SOLELY IN THE AREA OF COMMUNICATION, DEVELOPMENTAL DELAY
FOR PROGRAM ELIGIBILITY SHALL BE DEFINED AS A SCORE OF TWO STANDARD
DEVIATIONS BELOW THE MEAN IN THE AREA OF COMMUNICATION AS MEASURED BY A
STANDARDIZED, NORM-REFERENCED TEST DESIGNED TO ASSESS COMMUNICATION
DEVELOPMENT, INCLUDING EXPRESSIVE AND RECEPTIVE LANGUAGE DEVELOPMENT; OR
IF NO STANDARDIZED TEST IS AVAILABLE OR APPROPRIATE FOR THE CHILD, A
DEVELOPMENTAL DELAY IN THE AREA OF COMMUNICATION SHALL BE A SEVERE DELAY
OR MARKED REGRESSION IN COMMUNICATION DEVELOPMENT AS DETERMINED BY
S. 58--A 6 A. 158--A
SPECIFIC QUALITATIVE EVIDENCE BASED CRITERIA AS SET FORTH BY THE DEPART-
MENT IN REGULATION.
5. "Disability" means:
(a) a developmental delay; or
(b) a diagnosed physical or mental condition that has a high probabil-
ity of resulting in developmental delay, such as Down syndrome or other
chromosomal abnormalities, sensory impairments, inborn errors of meta-
bolism or fetal alcohol syndrome.
6. "Early intervention official" means an appropriate municipal offi-
cial designated by the chief executive officer of a municipality and an
appropriate designee of such official.
7. "Early intervention services" means developmental services that:
(a) are provided under public supervision;
(b) are selected in collaboration with the parents;
(c) are designed to meet a child's developmental needs in any one or
more of the following areas:
(i) physical development, including vision and hearing,
(ii) cognitive development,
(iii) communication development,
(iv) social or emotional development, or
(v) adaptive development;
(d) meet [the coordinated standards and procedures] STANDARDS DEVEL-
OPED BY THE LEAD AGENCY;
(e) are provided by qualified personnel;
(f) are provided in conformity with an IFSP;
(g) are, to the maximum extent appropriate, provided in natural envi-
ronments, including the home and community settings where children with-
out disabilities would participate;
(h) include, as appropriate:
(i) family training, counseling, home visits and parent support
groups,
(ii) special instruction,
(iii) speech pathology and audiology,
(iv) occupational therapy,
(v) physical therapy,
(vi) psychological services,
(vii) case management services, hereafter referred to as service coor-
dination services,
(viii) medical services for diagnostic or evaluation purposes, subject
to reasonable prior approval requirements for exceptionally expensive
services, as prescribed by the commissioner,
(ix) early identification, screening, and assessment services,
(x) health services necessary to enable the infant or toddler to bene-
fit from the other early intervention services,
(xi) nursing services,
(xii) nutrition services,
(xiii) social work services,
(xiv) vision services,
(xv) assistive technology devices and assistive technology services,
(xvi) transportation and related costs that are necessary to enable a
child and the child's family to receive early intervention services, and
(xvii) other appropriate services approved by the commissioner[.];
(i) are cost-effective.
8. (a) "Eligible child" means an infant or toddler from birth through
age two who has a disability; provided, however, that any toddler with a
S. 58--A 7 A. 158--A
disability who has been determined to be eligible for program services
under section forty-four hundred ten of the education law and:
(i) who turns three years of age on or before the thirty-first day of
August shall, if requested by the parent, be eligible to receive early
intervention services contained in an IFSP until the first day of
September of that calendar year; or
(ii) who turns three years of age on or after the first day of Septem-
ber shall, if requested by the parent and if already receiving services
pursuant to this title, be eligible to continue receiving such services
until the second day of January of the following calendar year.
(b) Notwithstanding the provisions of paragraph (a) of this subdivi-
sion, a child who receives services pursuant to section forty-four
hundred ten of the education law shall not be an eligible child.
9. "Evaluation" means a multidisciplinary professional, objective
assessment conducted by appropriately qualified personnel and conducted
pursuant to section twenty-five hundred forty-four of this title to
determine a child's eligibility under this title.
10. "Evaluator" means a team of two or more professionals approved
pursuant to section twenty-five hundred fifty-one of this title to
conduct screenings and evaluations.
11. "IFSP" means the individualized family service plan adopted in
accordance with section twenty-five hundred forty-five of this title.
12. "INDIVIDUAL" SHALL MEAN A PERSON WHO HOLDS A STATE APPROVED OR
RECOGNIZED CERTIFICATE, LICENSE OR REGISTRATION IN ONE OF THE DISCI-
PLINES SET FORTH IN SUBDIVISION FIFTEEN OF THIS SECTION.
13 "Lead agency" means the department of health, the public agency
responsible for the administration of the early intervention system [in
collaboration with the state early intervention service agencies].
[13.] 13-A. "Municipality" means a county outside the city of New York
or the city of New York in the case of a county contained within the
city of New York.
[13-a.] 13-B. Subject to federal law and regulations, "natural envi-
ronment" or "natural setting" means a setting that is natural or normal
for the child's age peers who have no disability.
14. "Parent" means parent or person in parental relation to the child.
With respect to a child who has no parent or person in a parental
relation, "parent" shall mean the person designated to serve in parental
relation for the purposes of this title, pursuant to regulations of the
commissioner promulgated in consultation with the commissioner of social
services for children in foster care.
15. "Qualified personnel" means:
(a) persons holding a state approved or recognized certificate,
license or registration in one of the following fields:
(i) special education teachers;
(ii) speech and language pathologists and audiologists;
(iii) occupational therapists;
(iv) physical therapists;
(v) social workers;
(vi) nurses;
(vii) dieticians or nutritionists;
(viii) other persons designated by the commissioner who meet require-
ments that apply to the area in which the person is providing early
intervention services, where not in conflict with existing professional
licensing, certification and/or registration requirements.
(b) persons holding a state approved license in one of the following
fields:
S. 58--A 8 A. 158--A
(i) psychologists; or
(ii) physicians.
16. "Service coordinator" means a person who:
(a) meets the qualifications established in federal law and regulation
and demonstrates knowledge and understanding of:
(i) infants and toddlers who may be eligible for services under this
title;
(ii) principles of family-centered services;
(iii) part H of the federal individuals with disabilities education
act and its corresponding regulations;
(iv) the nature and scope of services available under this title; and
(v) the requirements for authorizing and paying for such services and
other pertinent information;
(b) is responsible for:
(i) assisting eligible children and their families in gaining access
to services listed on the IFSP;
(ii) coordinating early intervention services with other services such
as medical and health services provided to the child;
(iii) coordinating the performance of evaluations and assessments;
(iv) participating in the development, monitoring and evaluation of
the IFSP;
(v) assisting the parent in identifying available service providers;
(vi) coordinating service delivery;
(vii) informing the family of advocacy services;
(viii) where appropriate, facilitating the transition of the child to
other appropriate services; and
(ix) assisting in resolving any disputes which may arise between the
family and service providers, as necessary and appropriate; and
(c) meets such other standards as are specified pursuant to section
twenty-five hundred fifty-one of this title.
17. ["State early intervention service agencies" means the departments
of health, education and social services and the offices of mental
health, mental retardation and developmental disabilities and office of
alcoholism and substance abuse services.
18.] "Year" shall mean the twelve-month period commencing July first
unless otherwise specified.
S 2. Paragraph (b) of subdivision 3 and subdivision 6 of section 2544
of the public health law, as added by chapter 428 of the laws of 1992,
are amended, and a new subdivision 4-a is added to read as follows:
(b) If, based upon the screening, a child is believed to be eligible,
or if otherwise elected by the parent, the child shall, with the consent
of a parent, receive a multidisciplinary evaluation. All evaluations
shall be conducted in accordance with [the coordinated standards and
procedures and with regulations promulgated by] THIS SECTION AND WITH
STANDARDS AND GUIDELINES ESTABLISHED BY the commissioner IN REGULATIONS
OR OTHERWISE.
4-A. THE DEPARTMENT SHALL DEVELOP A LIST OF EVALUATION INSTRUMENTS TO
BE USED BY EVALUATORS, IN CONJUNCTION WITH INFORMED CLINICAL OPINION, IN
CONDUCTING THE MULTIDISCIPLINARY EVALUATIONS OF CHILDREN THOUGHT TO BE
ELIGIBLE FOR THE EARLY INTERVENTION PROGRAM. THE EVALUATOR SHALL PROVIDE
WRITTEN JUSTIFICATION WHY SUCH INSTRUMENT OR INSTRUMENTS ARE NOT APPRO-
PRIATE IF THE EVALUATOR DOES NOT UTILIZE AN INSTRUMENT ON THE DEPART-
MENT'S LIST AS PART OF THE MULTIDISCIPLINARY EVALUATION OF A CHILD.
EVALUATORS SHALL SET FORTH IN DETAIL HOW THE CHILD MEETS ELIGIBILITY
CRITERIA FOR THE PROGRAM.
S. 58--A 9 A. 158--A
6. Nothing in this section shall restrict an evaluator from utilizing,
in addition to findings from his or her personal examination, other
examinations, evaluations or assessments conducted for such child,
including those conducted prior to the evaluation under this section, if
such examinations, evaluations or assessments are consistent with the
[coordinated standards and procedures] REQUIREMENTS SET FORTH IN THIS
SECTION AND WITH STANDARDS AND GUIDELINES ESTABLISHED BY THE COMMISSION-
ER IN REGULATION OR OTHERWISE, PROVIDED, HOWEVER, THAT SUCH EXAMINA-
TIONS, EVALUATIONS OR ASSESSMENTS ARE USED TO AUGMENT AND NOT REPLACE
THE MULTIDISCIPLINARY EVALUATION TO DETERMINE ELIGIBILITY.
S 3. Subdivision 5 and paragraph (b) of subdivision 8 of section 2549
of the public health law, as added by chapter 428 of the laws of 1992,
are amended to read as follows:
5. The impartial hearing shall be conducted by the hearing officer in
accordance with the regulations of the commissioner. The hearing shall
be held, and a decision rendered, within thirty days after the depart-
ment receives the request for an impartial hearing except to the extent
that the parent consents, in writing, to an extension. The decision
shall be in writing and shall state the reasons for the decision and
shall be final unless appealed by a party to the proceeding. A copy of
the decision reached by the hearing officer shall be mailed to the
parent, any public or private agency that was a party to the hearing,
the service coordinator, AND the department [and any state early inter-
vention service agency with an interest in the decision]. Where ordered
by the hearing officer, the service coordinator shall modify the IFSP in
accordance with the decision within five days after such decision.
(b) Providers of service to eligible children and families shall main-
tain the confidentiality of all personally identifiable information
regarding children and families receiving their services. The provider
shall ensure that no information regarding the condition, services,
needs, or any other individual information regarding a child and family
is released to any party other than the early intervention official
without the express written consent of the parent, except as specif-
ically permitted in [the coordinated standards and procedures,] STAND-
ARDS OR GUIDELINES DEVELOPED BY THE DEPARTMENT which shall additionally
ensure that the requirements of federal or state law which pertain to
the early intervention services [of the state early intervention service
agencies] have been maintained.
S 4. Paragraph (d) of subdivision 2 of section 2550 of the public
health law, as amended by section 5 of part B3 of chapter 62 of the laws
of 2003, is amended to read as follows:
(d) monitoring of INDIVIDUALS, agencies, institutions and organiza-
tions APPROVED under this title [and agencies, institutions and organ-
izations providing early intervention services which are under the
jurisdiction of a state early intervention service agency] TO PROVIDE
EARLY INTERVENTION SERVICES AND EVALUATIONS;
S 5. The public health law is amended by adding a new section 2550-a
to read as follows:
S 2550-A. PROVIDERS OF EVALUATIONS, SERVICE COORDINATION SERVICES OR
EARLY INTERVENTION SERVICES. 1. INDIVIDUALS AND AGENCIES SHALL APPLY TO
THE DEPARTMENT FOR APPROVAL TO PROVIDE EVALUATIONS, SERVICE COORDINATION
SERVICES OR EARLY INTERVENTION SERVICES. SUCH APPROVAL SHALL BE VALID
FOR A PERIOD OF TIME AS DETERMINED BY THE DEPARTMENT, NOT TO EXCEED FIVE
YEARS. INDIVIDUALS AND AGENCIES SHALL THEREAFTER APPLY FOR REAPPROVAL TO
PROVIDE SUCH SERVICES.
S. 58--A 10 A. 158--A
2. ALL INDIVIDUALS SHALL PAY A FEE OF TWO HUNDRED SEVENTY DOLLARS TO
THE DEPARTMENT UPON SUBMISSION OF THE INDIVIDUAL'S APPLICATION FOR
APPROVAL OR REAPPROVAL. ALL AGENCY APPLICANTS SHALL PAY A FEE OF THREE
HUNDRED FORTY-FIVE DOLLARS TO THE DEPARTMENT UPON SUBMISSION OF THE
APPLICATION FOR APPROVAL OR REAPPROVAL. THE COMPTROLLER IS HEREBY
AUTHORIZED AND DIRECTED TO DEPOSIT THE FEE FOR EACH APPLICATION AND
REAPPROVAL APPLICATION INTO THE EARLY INTERVENTION PROGRAM ACCOUNT
ESTABLISHED IN SECTION NINETY-NINE-Q OF THE STATE FINANCE LAW.
3. ALL AGENCIES AND INDIVIDUALS APPROVED TO PROVIDE EVALUATIONS,
SERVICE COORDINATION SERVICES OR EARLY INTERVENTION SERVICES SHALL BE
ENROLLED AS PROVIDERS IN THE MEDICAL ASSISTANCE PROGRAM IN ACCORDANCE
WITH THE PROCEDURES FOR SUCH ENROLLMENT ESTABLISHED BY THE DEPARTMENT.
4. THE DEPARTMENT IS HEREBY AUTHORIZED TO REVIEW PROVIDER CAPACITY AND
DETERMINE PROVIDER SERVICE NEED BY MUNICIPALITY. THE DEPARTMENT MAY DENY
APPROVAL TO AN APPLICANT WHO SEEKS TO PROVIDE SERVICES IN A MUNICIPALITY
WHERE THE DEPARTMENT HAS DETERMINED THAT SUFFICIENT PROVIDER CAPACITY
EXISTS.
5. APPROVAL AND REAPPROVAL OF INDIVIDUALS AND AGENCIES SHALL BE BASED
ON THE FOLLOWING CRITERIA:
(A) THE CHARACTER AND COMPETENCE OF THE INDIVIDUAL PERSON, OR IN THE
CASE OF AGENCIES, THE OWNERS, OFFICERS, INCLUDING THE CHIEF EXECUTIVE
OFFICER AND CHIEF FINANCIAL OFFICER, MEMBERS, SHAREHOLDERS WHO OWN TEN
PERCENT OR MORE OF THE VOTING SHARES IN THE AGENCY, DIRECTORS OR SPON-
SORS, THE PROGRAM DIRECTOR AND OTHER KEY EMPLOYEES, AND THE BOARD OF
DIRECTORS OF A NOT-FOR-PROFIT ENTITY AS DETERMINED BY THE DEPARTMENT;
(B) DOCUMENTED FISCAL VIABILITY;
(C) DOCUMENTED ABILITY TO PROVIDE EVALUATIONS, SERVICE COORDINATION
SERVICES, OR EARLY INTERVENTION SERVICES IN CONFORMANCE WITH LAWS AND
REGULATIONS APPLICABLE TO THE PRACTICE OF THE PROFESSIONS. FOR INDIVID-
UALS, PROOF OF CURRENT LICENSURE, CERTIFICATION OR REGISTRATION IF
REQUIRED FOR THE SERVICE PROVIDED. FOR AGENCIES:
(I) IDENTIFICATION OF ALL EMPLOYEES WHO WILL PROVIDE EARLY INTER-
VENTION PROGRAM SERVICES, AND WHERE APPLICABLE, THE EMPLOYEES' LICENSES,
REGISTRATIONS, CERTIFICATIONS OR NATIONAL PROVIDER IDENTIFICATION
NUMBERS AND EXPIRATION DATES; AND
(II) IDENTIFICATION OF ALL STATE-APPROVED AGENCY AND INDIVIDUAL
CONTRACTORS WHO WILL BE UTILIZED TO PROVIDE SUCH SERVICES AND WHERE
APPLICABLE, THE PERSONS' LICENSES, REGISTRATIONS, CERTIFICATIONS OR
NATIONAL PROVIDER IDENTIFICATION NUMBERS AND EXPIRATION DATES;
(D) FOR AGENCY PROVIDERS, A QUALITY ASSURANCE PLAN THAT IS APPROVED BY
THE DEPARTMENT FOR EACH TYPE OF PROFESSIONAL SERVICE OFFERED BY THE
AGENCY, INCLUDING EVALUATIONS AND SERVICE COORDINATION, TO ENSURE THAT
EVALUATIONS, SERVICE COORDINATION AND EARLY INTERVENTION PROGRAM
SERVICES ARE PROVIDED IN A MANNER THAT COMPLIES WITH FEDERAL AND STATE
LAWS AND REGULATIONS. THE PLAN SHALL INCLUDE A PROVISION FOR THE EMPLOY-
MENT OF A PROFESSIONAL OR PROFESSIONALS TO MONITOR AND OVERSEE IMPLEMEN-
TATION OF THE PLAN AS REQUIRED BY SUBPARAGRAPH (II) OF PARAGRAPH (E) OF
THIS SUBDIVISION;
(E) FOR AGENCY PROVIDERS, DOCUMENTATION THAT THE AGENCY HAS IN ITS
EMPLOYMENT, OR IN ACCORDANCE WITH THIS PARAGRAPH, WILL HAVE IN ITS
EMPLOYMENT, THE FOLLOWING PERSONNEL:
(I) A FULL-TIME EQUIVALENT EARLY INTERVENTION PROGRAM DIRECTOR WITH A
MINIMUM OF TWO YEARS OF FULL-TIME EQUIVALENT EXPERIENCE IN AN EARLY
INTERVENTION, CLINICAL PEDIATRIC, OR EARLY CHILDHOOD EDUCATION PROGRAM
SERVING CHILDREN AGES BIRTH TO FIVE YEARS OF AGE, PROVIDED THAT:
S. 58--A 11 A. 158--A
(A) SUCH EXPERIENCE MUST HAVE INCLUDED DIRECT EXPERIENCE IN DELIVERING
SERVICES TO CHILDREN WITH DISABILITIES AND THEIR FAMILIES; AND
(B) AT LEAST ONE YEAR OF SUCH EXPERIENCE MUST HAVE BEEN IN THE DELIV-
ERY OF SERVICES TO CHILDREN LESS THAN THREE YEARS OF AGE AND THEIR FAMI-
LIES; AND
(II) AT LEAST ONE LICENSED PROFESSIONAL FOR EACH TYPE OF SERVICE BEING
OFFERED BY THE AGENCY, INCLUDING EVALUATIONS, WHO HOLDS A LICENSE,
CERTIFICATION OR REGISTRATION IN AN OCCUPATION AUTHORIZED TO PROVIDE
THAT TYPE OF SERVICE, AND WHOSE RESPONSIBILITIES INCLUDE MONITORING THE
QUALITY ASSURANCE PLAN DEVELOPED BY THE AGENCY FOR THE SERVICE BEING
RENDERED, TO THE EXTENT AUTHORIZED BY THE PROFESSIONAL'S LICENSURE,
CERTIFICATION OR REGISTRATION; AND
(III) A MINIMUM OF TWO QUALIFIED PERSONNEL, IN ADDITION TO THE EARLY
INTERVENTION PROGRAM DIRECTOR, EACH OF WHOM PROVIDES EVALUATIONS,
SERVICE COORDINATION OR EARLY INTERVENTION SERVICES FOR A MINIMUM OF
TWENTY HOURS PER WEEK.
(IV) FOR PURPOSES OF THIS SUBDIVISION, IF THE AGENCY APPLYING FOR
INITIAL APPROVAL HAS NOT, AT THE TIME OF APPLICATION, EMPLOYED THE
PERSONNEL REQUIRED IN SUBPARAGRAPHS (I), (II) AND (III) OF THIS PARA-
GRAPH, THE AGENCY MAY VERIFY THAT IT WILL EMPLOY SUCH PERSONNEL WITHIN
THREE MONTHS OF APPROVAL. IF APPROVED BY THE DEPARTMENT, AT THE END OF
THE THREE MONTH PERIOD, THE AGENCY SHALL SUBMIT DOCUMENTATION OF THE
EMPLOYMENT OF SUCH PERSONNEL IN ACCORDANCE WITH SAID REQUIREMENTS.
(V) AN AGENCY APPLYING FOR REAPPROVAL SHALL, AT THE TIME OF APPLICA-
TION, SUBMIT DOCUMENTATION THAT IT HAS IN ITS EMPLOYMENT THE PERSONNEL
REQUIRED IN SUBPARAGRAPHS (I), (II) AND (III) OF THIS PARAGRAPH;
(F) ADHERENCE TO, AND FOR PURPOSES OF REAPPROVAL, EVIDENCE OF DEMON-
STRATED COMPLIANCE WITH ALL APPLICABLE FEDERAL AND STATE LAWS, REGU-
LATIONS, STANDARDS AND GUIDELINES;
(G) DELIVERY OF SERVICES ON A TWELVE-MONTH BASIS AND FLEXIBILITY IN
THE HOURS OF SERVICE DELIVERY, INCLUDING WEEKEND AND EVENING HOURS IN
ACCORDANCE WITH ELIGIBLE CHILDREN'S IFSPS;
(H) AGREEMENT TO PARTICIPATE AND, FOR PURPOSES OF REAPPROVAL, EVIDENCE
OF PARTICIPATION IN CONTINUING PROFESSIONAL AND CLINICAL EDUCATION RELE-
VANT TO EARLY INTERVENTION SERVICES AND IN-SERVICE TRAINING ON STATE AND
LOCAL POLICIES AND PROCEDURES ON THE EARLY INTERVENTION PROGRAM, INCLUD-
ING DEPARTMENT-SPONSORED TRAINING;
(I) ADHERENCE TO, AND FOR PURPOSES OF REAPPROVAL, DEMONSTRATED COMPLI-
ANCE WITH THE CONFIDENTIALITY REQUIREMENTS APPLICABLE TO THE EARLY
INTERVENTION PROGRAM AS SET FORTH IN FEDERAL AND STATE LAW AND REGU-
LATIONS;
(J) PROVISION OF COPIES OF ALL ORGANIZATIONAL DOCUMENTS AS REQUESTED
BY THE DEPARTMENT AND DOCUMENTATION OF LICENSURE OR APPROVAL GRANTED TO
THE INDIVIDUAL OR AGENCY BY OTHER REGULATORY AGENCIES;
(K) FOR THE PURPOSES OF REAPPROVAL, DOCUMENTATION THAT CORRECTIVE
ACTIONS REQUIRED BY THE DEPARTMENT HAVE BEEN IMPLEMENTED AND NON-COMPLI-
ANCE CORRECTED TO THE SATISFACTION OF THE DEPARTMENT;
(L) PROVISION OF CONSOLIDATED FISCAL REPORTS TO THE DEPARTMENT OR ANY
OTHER SUCH COMPARABLE INFORMATION ON REVENUES AND EXPENSES, AS REQUESTED
AND IN A FORM DEVELOPED BY THE DEPARTMENT;
(M) FOR PURPOSES OF REAPPROVAL OF INDIVIDUAL PROVIDERS, DOCUMENTATION
THAT THE PROVIDER HAS SERVED A MINIMUM OF TEN CHILDREN ANNUALLY IN THE
PROGRAM ON AVERAGE OVER THE PRIOR APPROVAL PERIOD; PROVIDED HOWEVER THAT
THE DEPARTMENT MAY WAIVE THIS REQUIREMENT IF THE INDIVIDUAL PROVIDES
SERVICES IN A GEOGRAPHIC AREA WHERE THERE IS INSUFFICIENT CAPACITY OR
OTHERWISE MEETS A NEED FOR WHICH SUFFICIENT CAPACITY DOES NOT EXIST AS
S. 58--A 12 A. 158--A
EITHER DETERMINED BY THE DEPARTMENT, OR IDENTIFIED BY A MUNICIPALITY AND
APPROVED BY THE DEPARTMENT;
(N) DOCUMENTATION FROM A MUNICIPALITY INDICATING THE MUNICIPALITY
INTENDS TO CONTRACT WITH THE APPLICANT UPON THE APPLICANT'S RECEIPT OF
DEPARTMENT APPROVAL; AND
(O) PROVISION OF SUCH ADDITIONAL PERTINENT INFORMATION OR DOCUMENTS
NECESSARY FOR APPROVAL OR REAPPROVAL, AS REQUESTED BY THE DEPARTMENT.
6. PROVIDERS APPROVED AND REAPPROVED TO DELIVER EARLY INTERVENTION
EVALUATIONS, SERVICE COORDINATION SERVICES AND EARLY INTERVENTION
PROGRAM SERVICES SHALL MEET WITH OR OTHERWISE COMMUNICATE WITH PARENTS
AND OTHER SERVICE PROVIDERS, INCLUDING PARTICIPATION IN CASE CONFERENC-
ING AND CONSULTATION. AN AGENCY MUST FURTHER REQUIRE THAT ITS EMPLOYEES
COMPLY WITH THE PROVISIONS OF THIS SECTION.
7. AN AGENCY'S APPROVAL TO PROVIDE SERVICES IN THE EARLY INTERVENTION
PROGRAM SHALL TERMINATE UPON THE TRANSFER, ASSIGNMENT OR OTHER DISPOSI-
TION OF TEN PERCENT OR MORE OF AN INTEREST OR VOTING RIGHTS IN THE
APPROVED AGENCY. IF THERE IS A TRANSFER, ASSIGNMENT OR OTHER DISPOSI-
TION OF LESS THAN TEN PERCENT OF AN INTEREST OR VOTING RIGHTS IN THE
APPROVED AGENCY, BUT THE TRANSFER, ASSIGNMENT OR OTHER DISPOSITION
TOGETHER WITH ALL PRIOR TRANSFERS, ASSIGNMENTS OR OTHER DISPOSITIONS
WITHIN THE LAST FIVE YEARS WOULD, IN THE AGGREGATE INVOLVE TEN PERCENT
OR MORE OF AN INTEREST IN THE APPROVED AGENCY, THE AGENCY'S APPROVAL TO
PROVIDE SERVICES IN THE EARLY INTERVENTION PROGRAM SHALL TERMINATE UPON
SUCH TRANSFER, ASSIGNMENT OR DISPOSITION. IF THE AGENCY'S APPROVAL
TERMINATES AS SET FORTH IN THIS SUBDIVISION, THE AGENCY MUST APPLY FOR
APPROVAL IN ACCORDANCE WITH THIS SECTION TO PROVIDE SERVICES IN THE
EARLY INTERVENTION PROGRAM AND, IF APPROVED, SAID AGENCY SHALL BE DEEMED
IN EXISTENCE AFTER THE EFFECTIVE DATE OF THIS SECTION.
8. APPROVED PROVIDERS SHALL NOT DISSEMINATE, OR CAUSE TO BE DISSEM-
INATED ON THEIR BEHALF, MARKETING MATERIALS THAT ARE FALSE, DECEPTIVE,
OR MISLEADING. THE DEPARTMENT IS AUTHORIZED TO REQUIRE THAT PROVIDERS
PERIODICALLY SUBMIT COPIES OF MARKETING MATERIALS FOR REVIEW. MARKETING
MATERIALS THAT DO NOT COMPLY WITH THE PROVISIONS OF THIS SUBDIVISION MAY
BE A BASIS FOR ACTION AGAINST THE PROVIDER'S APPROVAL IN ACCORDANCE WITH
THE PROVISIONS OF SECTION TWENTY-FIVE HUNDRED FIFTY-B OF THIS TITLE. THE
DEPARTMENT SHALL DEVELOP STANDARDS ON APPROPRIATE MARKETING MATERIALS.
9. AN INDIVIDUAL PROVIDER SHALL NOTIFY THE DEPARTMENT WITHIN TWO BUSI-
NESS DAYS IF HIS OR HER LICENSE IS SUSPENDED, REVOKED, LIMITED OR
ANNULLED OR IF A CONTRACT THE PROVIDER HOLDS WITH A MUNICIPALITY OR
AGENCY PROVIDER IS TERMINATED. AGENCY PROVIDERS SHALL ENSURE THAT
SERVICES ARE DELIVERED BY THOSE AUTHORIZED TO DO SO AND SHALL ONLY
EMPLOY OR CONTRACT WITH QUALIFIED PERSONNEL WHO ARE LICENSED, REGISTERED
OR CERTIFIED IN COMPLIANCE WITH APPLICABLE PROVISIONS OF LAW, IF SUCH
LICENSE, REGISTRATION OR CERTIFICATION IS REQUIRED FOR THE SERVICE THAT
IS BEING PROVIDED.
10. INDIVIDUAL AND AGENCY PROVIDERS SHALL VERIFY THE ACCURACY OF ALL
BILLING RECORDS PRIOR TO SUBMISSION OF SUCH BILLING FOR PAYMENT.
11. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, THE APPROVAL OF
INDIVIDUALS AND AGENCIES THAT ARE IN EXISTENCE ON OR BEFORE THE EFFEC-
TIVE DATE OF THIS SECTION THAT WERE APPROVED TO DELIVER EARLY INTER-
VENTION SERVICES BY THE DEPARTMENT OF EDUCATION SHALL REMAIN IN EFFECT;
PROVIDED, HOWEVER THAT SUCH INDIVIDUALS OR AGENCIES SHALL BE SUBJECT TO
THE REQUIREMENTS OF THIS SECTION AND SHALL, WHEN REQUESTED BY THE
DEPARTMENT, APPLY FOR AND OBTAIN REAPPROVAL BY THE DEPARTMENT TO CONTIN-
UE PROVIDING SERVICES IN THE EARLY INTERVENTION PROGRAM.
S. 58--A 13 A. 158--A
S 6. The public health law is amended by adding a new section 2550-b
to read as follows:
S 2550-B. PROCEEDINGS INVOLVING THE APPROVAL OF AN INDIVIDUAL OR AGEN-
CY. 1. AN AGENCY'S OR INDIVIDUAL'S APPROVAL TO DELIVER EVALUATIONS,
SERVICE COORDINATION SERVICES AND EARLY INTERVENTION PROGRAM SERVICES
MAY BE REVOKED, SUSPENDED, LIMITED OR ANNULLED BY THE COMMISSIONER UPON
A FINDING THAT THE AGENCY OR INDIVIDUAL PROVIDER:
(A) HAS FAILED TO COMPLY WITH THE PROVISIONS OF THIS ARTICLE OR RULES
AND REGULATIONS PROMULGATED THEREUNDER;
(B) NO LONGER MEETS ONE OF THE CRITERIA FOR APPROVAL OR REAPPROVAL AS
SET FORTH IN SUBDIVISION FIVE OF SECTION TWENTY-FIVE HUNDRED FIFTY-A OF
THIS TITLE;
(C) DOES NOT HAVE CURRENT LICENSURE, REGISTRATION OR CERTIFICATION TO
DELIVER SERVICES IN THE EARLY INTERVENTION PROGRAM; OR
(D) FOR AGENCY PROVIDERS, USED PERSONNEL, WHETHER BY CONTRACT OR UNDER
EMPLOYMENT, TO PROVIDE AN EARLY INTERVENTION PROGRAM SERVICE WHO DID NOT
HOLD A LICENSE, REGISTRATION OR CERTIFICATION TO PROVIDE SUCH SERVICE.
2. NO APPROVAL SHALL BE REVOKED, SUSPENDED, LIMITED OR ANNULLED WITH-
OUT FIRST PROVIDING THE INDIVIDUAL OR AGENCY AN OPPORTUNITY TO BE HEARD.
THE DEPARTMENT SHALL NOTIFY THE INDIVIDUAL OR AGENCY IN WRITING OF THE
PROPOSED ACTION AND SHALL AFFORD THE INDIVIDUAL OR AGENCY AN OPPORTUNITY
TO BE HEARD IN PERSON OR BY COUNSEL. SUCH NOTICE MAY BE SERVED BY
PERSONAL DELIVERY TO THE INDIVIDUAL OR AGENCY OR BY MAILING IT BY CERTI-
FIED MAIL TO THE LAST KNOWN ADDRESS ON FILE WITH THE DEPARTMENT OR BY
ANY METHOD AUTHORIZED BY THE CIVIL PRACTICE LAW AND RULES FOR THE
SERVICE OF A SUMMONS. THE HEARING SHALL BE AT SUCH TIME AND PLACE AS
THE DEPARTMENT SHALL PRESCRIBE.
3. APPROVAL MAY BE TEMPORARILY SUSPENDED OR LIMITED WITHOUT A HEARING
FOR A PERIOD NOT EXCEEDING ONE HUNDRED TWENTY DAYS UPON WRITTEN NOTICE
TO THE PROVIDER AND AN OPPORTUNITY FOR A HEARING FOLLOWING A FINDING BY
THE DEPARTMENT THAT THE HEALTH OR SAFETY OF A CHILD, PARENTS OR STAFF OF
THE MUNICIPALITY IN WHICH THE PROVIDER IS UNDER CONTRACT IS IN IMMINENT
RISK OF DANGER OR THERE EXISTS ANY CONDITION OR PRACTICE OR A CONTINUING
PATTERN OF CONDITIONS OR PRACTICES WHICH POSES IMMINENT DANGER TO THE
HEALTH OR SAFETY OF SUCH CHILDREN, PARENTS OR STAFF OF THE MUNICIPALITY
IN WHICH THE PROVIDER IS UNDER CONTRACT. UPON SUCH A FINDING AND NOTICE,
THE DEPARTMENT MAY ALSO:
(A) PROHIBIT OR LIMIT THE ASSIGNMENT OF CHILDREN TO THE PROVIDER;
(B) REMOVE OR CAUSE TO BE REMOVED SOME OR ALL OF THE CHILDREN THE
PROVIDER CURRENTLY SERVES; AND
(C) SUSPEND OR LIMIT OR CAUSE TO BE SUSPENDED OR LIMITED PAYMENT FOR
SERVICES TO THE PROVIDER.
S 7. Section 2551 of the public health law, as added by chapter 428 of
the laws of 1992, is amended to read as follows:
S 2551. [Coordinated standards] STANDARDS and procedures. 1. The
[state early intervention service agencies shall jointly establish coor-
dinated] DEPARTMENT MAY DEVELOP standards and procedures for:
(a) early intervention services and evaluations;
(b) child find system and public awareness program; and
(c) [programs and services, operating under the approval authority of
any state early intervention service agency, which include any early
intervention services or evaluations] APPROVAL AND REAPPROVAL OF INDI-
VIDUALS AND AGENCIES PROVIDING SERVICES UNDER THIS TITLE.
2. Such [coordinated] standards and procedures shall be designed to:
(a) enhance the objectives of this title, including the provision of
services in natural environments to the maximum extent possible;
S. 58--A 14 A. 158--A
(b) minimize duplicative and inconsistent regulations and practices
among [the] state [early intervention service] agencies;
(c) [conform, to the extent appropriate, to existing standards and
procedures of state early intervention service agencies] ENSURE THAT
SERVICES ARE PROVIDED IN A MANNER CONSISTENT WITH THE REQUIREMENTS OF
THIS TITLE BY QUALIFIED INDIVIDUALS AND AGENCIES WHO MEET DEPARTMENT
CRITERIA; and
(d) ensure that persons who provide early intervention services are
trained, or can demonstrate proficiency in principles of early childhood
development.
3. [Coordinated standards] STANDARDS and procedures may include guide-
lines suggesting appropriate early intervention services for enumerated
disabilities that are most frequently found in eligible children.
4. [Coordinated standards] STANDARDS and procedures may encompass or
allow for agreements among two or more [such] STATE agencies.
5. [Any standards promulgated by regulation or otherwise by any state
early intervention service agency governing early intervention services
or evaluations shall be consistent with the coordinated standards and
procedures.
6. In the event of an inability to agree upon any coordinated standard
or procedure, any state early intervention service agency may refer the
issue to the early intervention coordinating council for its advice with
respect to the standard or procedure which the council shall provide to
the early intervention service agencies affected by the issue. The
commissioner, after obtaining such advice, shall adopt an appropriate
standard or procedure,] THE COMMISSIONER SHALL SUBMIT PROPOSED STANDARDS
AND PROCEDURES TO THE EARLY INTERVENTION COORDINATING COUNCIL FOR ITS
REVIEW AND ADVICE; provided however, that the commissioner may adopt an
interim standard or procedure while awaiting such advice.
[7. Coordinated standards and procedures shall provide that any agency
which is an approved program or service provider under section forty-
four hundred ten of the education law, and which also plans to provide
early intervention services may apply to the commissioner of education
for approval to provide such services. Such approval shall be granted
based on the agency's compliance with the coordinated standards and
procedures for early intervention services and, where applicable, educa-
tion certifications.
8. The early intervention service agencies, in consultation with the
director of the budget, shall, where appropriate, require as a condition
of approval that evaluators and providers of early intervention services
participate in the medical assistance program.
9.] 6. The [coordinated] standards and procedures shall permit such
evaluators and providers of services to rely on subcontracts or other
written agreements with qualified professionals, or agencies employing
such professionals, provided that such professionals perform their
responsibilities in conformance with regulations of the commissioner and
that providers and evaluators fully disclose any such arrangements,
including any financial or personal interests, on all applications for
approval.
[10. Coordinated standards] 7. STANDARDS and procedures may identify
circumstances and procedures under which an evaluator or service provid-
er may be disqualified under this title, including procedures whereby a
municipality may request such disqualification.
S 8. Section 2552 of the public health law is amended by adding a new
subdivision 5 to read as follows:
S. 58--A 15 A. 158--A
5. THE EARLY INTERVENTION OFFICIAL SHALL REQUIRE AN ELIGIBLE CHILD'S
PARENT TO FURNISH DOCUMENTATION NECESSARY TO DETERMINE THE PARENT'S
GROSS HOUSEHOLD INCOME. SUCH DOCUMENTATION SHALL BE PROVIDED TO THE
DEPARTMENT OR THE DEPARTMENT'S AGENT FOR THE PURPOSE OF ASSESSING AND
COLLECTING PARENTAL FEES IN ACCORDANCE WITH SECTION TWENTY-FIVE HUNDRED
FIFTY-SEVEN-A OF THIS TITLE.
S 9. Paragraph (b) of subdivision 2 of section 2553 of the public
health law, as added by chapter 428 of the laws of 1992, is amended to
read as follows:
(b) advise and assist the commissioner [and other state early inter-
vention service agencies] in the development of [coordinated] standards
and procedures pursuant to section twenty-five hundred fifty-one of this
title [in order to promote the full participation and cooperation of
such agencies];
S 10. Paragraph (k) of subdivision 4 of section 2557 of the public
health law is REPEALED.
S 10-a. Subdivisions 1, 2 and 5 of section 2557 of the public health
law, subdivision 1 as amended by section 4 of part C of chapter 1 of the
laws of 2002, subdivision 2 as added by chapter 428 of the laws of 1992
and subdivision 5 as added by section 7 of part B3 of chapter 62 of the
laws of 2003, are amended to read as follows:
1. The approved costs for an eligible child who receives an evaluation
and early intervention services pursuant to this title shall be a charge
upon the municipality wherein the eligible child resides or, where the
services are covered by the medical assistance program, upon the social
services district of fiscal responsibility with respect to those eligi-
ble children who are also eligible for medical assistance. All approved
costs, EXCEPT FOR SERVICES THAT ARE COVERED BY THE MEDICAL ASSISTANCE
PROGRAM OR UNDER AN INSURANCE POLICY OR PLAN FOR THOSE CHILDREN WHO HAVE
COVERAGE UNDER BOTH THE MEDICAL ASSISTANCE PROGRAM AND SUCH INSURANCE
POLICY OR PLAN, shall be paid in the first instance and at least quar-
terly by the appropriate governing body or officer of the municipality
upon vouchers presented and audited in the same manner as the case of
other claims against the municipality. Notwithstanding the insurance law
or regulations thereunder relating to the permissible exclusion of
payments for services under governmental programs, no such exclusion
shall apply with respect to payments made pursuant to this title.
Notwithstanding the insurance law or any other law or agreement to the
contrary, benefits under this title shall be considered secondary to
[any plan of insurance or state government benefit program under which
an eligible child may have] coverage AVAILABLE TO AN ELIGIBLE CHILD
UNDER THE MEDICAL ASSISTANCE PROGRAM OR AN INSURANCE POLICY OR PLAN AND
THE MEDICAL ASSISTANCE PROGRAM FOR THOSE CHILDREN WHO HAVE COVERAGE
UNDER BOTH THE MEDICAL ASSISTANCE PROGRAM AND SUCH INSURANCE POLICY OR
PLAN. Nothing in this section shall increase or enhance coverages
provided for within an insurance contract subject to the provisions of
this title.
2. REIMBURSEMENT FOR APPROVED COSTS PAID BY A MUNICIPALITY FOR THE
PURPOSES OF THIS TITLE, OTHER THAN FOR THOSE APPROVED COSTS REIMBURSABLE
BY THE MEDICAL ASSISTANCE PROGRAM OR UNDER AN INSURANCE POLICY OR PLAN
AND THE MEDICAL ASSISTANCE PROGRAM FOR THOSE CHILDREN WHO HAVE COVERAGE
UNDER BOTH THE MEDICAL ASSISTANCE PROGRAM AND SUCH INSURANCE POLICY OR
PLAN SHALL BE AS FOLLOWS:
I. The department shall reimburse ONE HUNDRED PERCENT OF the approved
costs paid by a municipality for the purposes of this title, [other than
those reimbursable by the medical assistance program or by third party
S. 58--A 16 A. 158--A
payors] PROVIDED HOWEVER THAT REIMBURSEMENT PURSUANT TO THIS PARAGRAPH
SHALL NOT EXCEED THE DOLLAR AMOUNT SUCH MUNICIPALITY RECEIVED FROM JULY
FIRST, TWO THOUSAND SEVEN TO JUNE THIRTIETH, TWO THOUSAND EIGHT FROM
PRIVATE INSURANCE REIMBURSEMENT FOR SERVICES COVERED UNDER AN ELIGIBLE
CHILD'S INSURANCE POLICY OR PLAN;
II. AFTER REIMBURSEMENT IS MADE IN ACCORDANCE WITH PARAGRAPH (I) OF
THIS SUBDIVISION, THE DEPARTMENT SHALL REIMBURSE ONE HUNDRED PERCENT OF
THE APPROVED COSTS PAID BY A MUNICIPALITY PROVIDED HOWEVER THAT
REIMBURSEMENT PURSUANT TO THIS PARAGRAPH SHALL NOT EXCEED AN AMOUNT
DETERMINED BY THE DEPARTMENT, AND APPROVED BY THE DIRECTOR OF THE BUDG-
ET, BASED UPON A METHOD OF ALLOCATION PROPORTIONAL TO EACH MUNICI-
PALITY'S SHARE OF THE TOTAL PAYMENTS MADE BY MUNICIPALITIES FROM JULY
FIRST, TWO THOUSAND SEVEN TO JUNE THIRTIETH, TWO THOUSAND EIGHT FOR
SERVICES PROVIDED UNDER THE EARLY INTERVENTION PROGRAM;
III. THEREAFTER, THE DEPARTMENT SHALL REIMBURSE THE APPROVED COSTS
PAID BY A MUNICIPALITY, in an amount of fifty percent of the amount
expended in accordance with the rules and regulations of the commission-
er.
IV. Such state reimbursement to the municipality MADE IN ACCORDANCE
WITH PARAGRAPHS (I), (II) AND (III) OF THIS SUBDIVISION shall not be
paid prior to April first of the year in which the approved costs are
paid by the municipality.
5. The department shall contract with an independent organization to
act as the fiscal agent for the department. [A municipality may elect to
utilize the services of such organization for early intervention program
fiscal management and claiming as determined by the commissioner or may
select an independent agent to act as the fiscal agent for such munici-
pality or may act as its own fiscal agent.] MUNICIPALITIES SHALL USE THE
FISCAL AGENT UNDER CONTRACT WITH THE DEPARTMENT FOR THE MANAGEMENT OF
MUNICIPAL PAYMENTS TO PROVIDERS UNLESS OTHERWISE APPROVED BY THE DEPART-
MENT.
S 11. The public health law is amended by adding a new section 2557-a
to read as follows:
S 2557-A. PARENTAL PARTICIPATION IN PAYMENT OF EARLY INTERVENTION
SERVICES. 1. PARENTAL PARTICIPATION IN THE PAYMENT OF EARLY INTER-
VENTION SERVICES SHALL BE ESTABLISHED ANNUALLY FOR EACH FAMILY BASED ON
A SLIDING SCHEDULE OF FEES AS SET FORTH IN SUBDIVISION THREE OF THIS
SECTION. PARENTS SHALL PROVIDE DOCUMENTATION NECESSARY TO DETERMINE THE
PARENT'S GROSS HOUSEHOLD INCOME AND PARENTAL FEE PAYMENT. THE DEPARTMENT
OR DEPARTMENT'S AGENT SHALL BEGIN COLLECTING PARENT FEES ON APRIL FIRST,
TWO THOUSAND TEN. THE FEE SHALL BE PAID ON A MONTHLY BASIS TO THE
DEPARTMENT OR THE DEPARTMENT'S AGENT AND SHALL BE DEPOSITED INTO THE
EARLY INTERVENTION PROGRAM ACCOUNT ESTABLISHED IN SECTION NINETY-NINE-Q
OF THE STATE FINANCE LAW. THE DEPARTMENT SHALL PAY EACH MUNICIPALITY
FIFTY PERCENT OF THE FEES COLLECTED IN ACCORDANCE WITH THIS SECTION FROM
PARENTS OF ELIGIBLE CHILDREN FOR WHICH THE MUNICIPALITY HAS FINANCIAL
RESPONSIBILITY. NO PARENTAL FEES, HOWEVER, MAY BE CHARGED FOR: IMPLE-
MENTING CHILD FIND, EVALUATION AND ASSESSMENT, SERVICE COORDINATION,
DEVELOPMENT, REVIEW, AND EVALUATION OF INDIVIDUALIZED FAMILY SERVICES
PLANS, OR THE IMPLEMENTATION OF PROCEDURAL SAFEGUARDS AND OTHER ADMINIS-
TRATIVE COMPONENTS OF THE EARLY INTERVENTION SYSTEM.
2. PARENTS SHALL PAY A MONTHLY FEE AS DETERMINED BY THE SCHEDULE OF
FEES SET FORTH IN SUBDIVISION THREE OF THIS SECTION FOR EACH CHILD IN
THE FAMILY RECEIVING EARLY INTERVENTION SERVICES. THE PARENTAL FEE FOR A
PARENT WHOSE GROSS HOUSEHOLD INCOME FALLS AT OR BELOW FOUR HUNDRED
PERCENT OF THE FEDERAL POVERTY LEVEL (FPL) AND WHO HAS MORE THAN THREE
S. 58--A 17 A. 158--A
CHILDREN RECEIVING SERVICES IN THE EARLY INTERVENTION PROGRAM, SHALL BE
LIMITED TO THE MONTHLY FEE CHARGED FOR PARENTS WHO HAVE THREE CHILDREN
RECEIVING SERVICES IN THE EARLY INTERVENTION PROGRAM. PARENTAL FEES
SHALL APPLY WITHOUT REGARD TO WHETHER THE ELIGIBLE CHILD HAS COVERAGE
UNDER AN INSURANCE POLICY OR PLAN.
3. PARENTAL FEES FOR THE EARLY INTERVENTION PROGRAM SHALL BE AS
FOLLOWS:
GROSS HOUSEHOLD INCOME PARENTAL FEE PER
CHILD/PER MONTH
161% FPL TO 222% FPL $15.00
223% FPL TO 250% FPL $25.00
251% FPL TO 300% FPL $35.00
301% FPL TO 350% FPL $55.00
351% FPL TO 400% FPL $75.00
401% FPL AND ABOVE $150.00
4. IF A PARENT REFUSES TO PROVIDE DOCUMENTATION NECESSARY TO DETERMINE
THE PARENT'S GROSS HOUSEHOLD INCOME, IT SHALL BE PRESUMED THAT THE
PARENT FALLS WITHIN THE HIGHEST GROSS HOUSEHOLD INCOME BRACKET FOR THE
PURPOSES OF ESTABLISHING THE PARENTAL FEE OBLIGATION.
5. AT THE WRITTEN REQUEST OF THE PARENT, THE PARENTAL FEE OBLIGATION
MAY BE ADJUSTED PROSPECTIVELY AT ANY POINT DURING THE YEAR UPON PROOF OF
A CHANGE IN HOUSEHOLD GROSS INCOME.
6. (A) THE DEPARTMENT OR THE DEPARTMENT'S AGENT SHALL MAIL A BILL TO
THE PARENT FOR THE PARENT PARTICIPATION FEE SIXTY DAYS PRIOR TO THE
FIRST DAY OF THE MONTH IN WHICH THE FEE IS DUE. THE BILL SHALL STATE THE
AMOUNT OF THE FEE AND ITS DUE DATE.
(B) IF PAYMENT HAS NOT ALREADY BEEN RECEIVED, THE DEPARTMENT OR THE
DEPARTMENT'S AGENT SHALL MAIL A NOTICE TO THE PARENT REMINDING THE
PARENT OF THE FEE DUE AT LEAST FIFTEEN DAYS PRIOR TO ITS DUE DATE. THE
NOTICE SHALL ALSO STATE THAT FAILURE TO PAY THE FEE SHALL RESULT IN THE
TERMINATION OF SERVICES AND LOSS OF ELIGIBILITY FOR THE PROGRAM.
(C) IF THE PARENT PARTICIPATION FEE IS NOT PAID ON OR BEFORE ITS DUE
DATE, THE DEPARTMENT OR DEPARTMENT'S AGENT SHALL MAIL THE PARENT A FINAL
NOTICE STATING THAT FAILURE TO PAY THE FEE WITHIN THIRTY DAYS AFTER ITS
DUE DATE SHALL RESULT IN TERMINATION OF SERVICES AND LOSS OF ELIGIBILITY
FOR THE PROGRAM. IF THE PARENT PARTICIPATION FEE IS NOT PAID WITHIN
THIRTY DAYS AFTER ITS DUE DATE, THE DEPARTMENT OR DEPARTMENT'S AGENT
SHALL NOTIFY THE MUNICIPALITY THAT THE CHILD AND FAMILY ARE NO LONGER
ELIGIBLE AND THAT SERVICES SHOULD CEASE. THE MUNICIPALITY SHALL NOTIFY
ALL PROVIDERS CURRENTLY PROVIDING SERVICES TO THE CHILD THAT THE CHILD
IS NO LONGER AUTHORIZED TO RECEIVE SERVICES. A PROVIDER SHALL BE PAID
FOR SERVICES RENDERED UNTIL SUCH TIME AS THE PROVIDER IS NOTIFIED THAT
THE CHILD IS NO LONGER AN ELIGIBLE CHILD.
7. THE INABILITY OF THE PARENTS OF AN ELIGIBLE CHILD TO PAY PARENTAL
FEES DUE TO CATASTROPHIC CIRCUMSTANCES OR EXTRAORDINARY EXPENSES SHALL
NOT RESULT IN THE DENIAL OF SERVICES TO THE CHILD OR THE CHILD'S FAMILY.
(A) PARENTS MUST DOCUMENT EXTRAORDINARY EXPENSES OR OTHER CATASTROPHIC
CIRCUMSTANCES BY PROVIDING DOCUMENTATION OF ONE OF THE FOLLOWING:
(I) OUT-OF-POCKET MEDICAL EXPENSES IN EXCESS OF FIFTEEN PERCENT OF
GROSS INCOME; OR
(II) OTHER EXTRAORDINARY EXPENSES OR CATASTROPHIC CIRCUMSTANCES CAUS-
ING DIRECT OUT-OF-POCKET PAYMENTS IN EXCESS OF FIFTEEN PERCENT OF GROSS
INCOME.
(B) PARENTS MUST PRESENT PROOF OF LOSS TO THE DEPARTMENT OR THE
DEPARTMENT'S AGENT WHO SHALL DOCUMENT IT. THE DEPARTMENT OR DEPARTMENT'S
AGENT SHALL DETERMINE WHETHER THE PARENTAL FEE OBLIGATION SHALL BE
S. 58--A 18 A. 158--A
REDUCED, FORGIVEN, OR SUSPENDED WITHIN TEN BUSINESS DAYS AFTER RECEIPT
OF THE PARENT'S REQUEST AND SUPPORTING DOCUMENTATION.
(C) A PARENT WHO DISAGREES WITH THE DETERMINATION SHALL HAVE THE ABIL-
ITY TO CONTEST THE DETERMINATION USING PROCEDURES SET FORTH IN SECTION
TWENTY-FIVE HUNDRED FORTY-NINE OF THIS TITLE. IF A PARENT SUBMITS A
WRITTEN REQUEST FOR A MEDIATION OR HEARING TO DISPUTE THE DEPARTMENT'S
DETERMINATION, EARLY INTERVENTION SERVICES SHALL NOT BE SUSPENDED FOR
NONPAYMENT OF THE PARENTAL FEE PENDING RESOLUTION OF SUCH MEDIATION OR
HEARING.
S 12. Subdivision 3 of section 2559 of the public health law, as added
by chapter 428 of the laws of 1992, paragraph (a) as amended and para-
graph (d) as added by chapter 231 of the laws of 1993, is amended to
read as follows:
3. (a) [Providers] FOR THE PERIOD MARCH FIRST, TWO THOUSAND NINE TO
MARCH THIRTY-FIRST, TWO THOUSAND TEN, PROVIDERS of early intervention
services and transportation services shall [in the first instance and]
where applicable, seek payment from [all third party payors including
governmental agencies] THE MEDICAL ASSISTANCE PROGRAM UNDER WHICH AN
ENROLLED CHILD HAS COVERAGE prior to claiming payment from a given muni-
cipality for services rendered to [eligible children,] THE ELIGIBLE
CHILD; HOWEVER FOR CHILDREN WHO HAVE COVERAGE UNDER A PRIVATE INSURANCE
POLICY OR PLAN AND ARE ALSO ENROLLED IN THE MEDICAL ASSISTANCE PROGRAM,
PROVIDERS SHALL FIRST SEEK PAYMENT UNDER THE PRIVATE INSURANCE POLICY OR
PLAN PRIOR TO CLAIMING PAYMENT FROM THE MEDICAL ASSISTANCE PROGRAM;
provided that, for the purpose of seeking payment from the medical
assistance program or from [other third party payors] PRIVATE INSURANCE
POLICIES OR PLANS IN INSTANCES WHERE A CHILD ENROLLED IN THE MEDICAL
ASSISTANCE PROGRAM ALSO HAS COVERAGE UNDER SUCH PRIVATE INSURANCE POLICY
OR PLAN, the municipality shall be deemed the provider of such early
intervention services to the extent that the provider has promptly
furnished to the municipality adequate and complete information neces-
sary to support the municipality billing, and provided further that the
obligation to seek payment shall not apply to a payment from [a third
party payor] AN INSURER OR PLAN ADMINISTRATOR who is not prohibited from
applying such payment, and will apply such payment, to an annual or
lifetime limit specified in the insured's policy.
(A-1) EFFECTIVE ON AND AFTER APRIL FIRST, TWO THOUSAND TEN, PROVIDERS
OF EARLY INTERVENTION SERVICES AND TRANSPORTATION SERVICES SHALL, WHERE
APPLICABLE, SEEK PAYMENT FROM THE MEDICAL ASSISTANCE PROGRAM UNDER WHICH
AN ENROLLED CHILD HAS COVERAGE PRIOR TO CLAIMING PAYMENT FROM A GIVEN
MUNICIPALITY FOR SERVICES RENDERED TO THE ELIGIBLE CHILD; HOWEVER FOR
CHILDREN WHO HAVE COVERAGE UNDER A PRIVATE INSURANCE POLICY OR PLAN AND
ARE ALSO ENROLLED IN THE MEDICAL ASSISTANCE PROGRAM, PROVIDERS SHALL
FIRST SEEK PAYMENT UNDER THE PRIVATE INSURANCE POLICY OR PLAN PRIOR TO
CLAIMING PAYMENT FROM THE MEDICAL ASSISTANCE PROGRAM; PROVIDED THAT A
PROVIDER SHALL NOT BE REQUIRED TO SEEK PAYMENT FROM AN INSURER OR PLAN
ADMINISTRATOR IF SUCH PAYMENT WILL BE APPLIED TO ANY ANNUAL OR LIFETIME
LIMITS SPECIFIED IN THE INSURED'S POLICY.
(b) I. The commissioner, in consultation with the director of budget
and the superintendent of insurance, shall promulgate regulations
providing public reimbursement for deductibles and copayments which are
imposed under an insurance policy or health benefit plan to the extent
that such deductibles and copayments are applicable to early inter-
vention services.
II. PARENTS SHALL PROVIDE THE MUNICIPALITY WITH INFORMATION ON ANY
INSURANCE PLAN OR POLICY UNDER WHICH AN ELIGIBLE CHILD HAS COVERAGE. THE
S. 58--A 19 A. 158--A
MUNICIPALITY SHALL PROVIDE SUCH INFORMATION TO THE DEPARTMENT OR THE
DEPARTMENT'S AGENT ON A FORM OR IN A MANNER AS THE DEPARTMENT MAY
PRESCRIBE. ON AND AFTER APRIL FIRST, TWO THOUSAND TEN, THE MUNICIPALITY
SHALL PROVIDE INFORMATION ON AN ELIGIBLE CHILD'S MEDICAL ASSISTANCE
PROGRAM AND INSURANCE PLAN OR POLICY COVERAGE TO THE PROVIDER RENDERING
SERVICES TO THE CHILD TO ENABLE THE PROVIDER TO SEEK PAYMENT FROM SUCH
PROGRAM, PLAN OR POLICY FOR COVERED SERVICES IN ACCORDANCE WITH PARA-
GRAPH (A-1) OF THIS SUBDIVISION.
III. PAYMENT FOR COVERED SERVICES RENDERED TO AN ELIGIBLE CHILD SHALL
BE MADE IN THE FIRST INSTANCE BY THE MUNICIPALITY, EXCEPT THOSE COVERED
BY THE MEDICAL ASSISTANCE PROGRAM OR UNDER AN INSURANCE POLICY OR PLAN
AVAILABLE TO A CHILD WHO IS ALSO ENROLLED IN THE MEDICAL ASSISTANCE
PROGRAM. THE STATE SHALL REIMBURSE THE MUNICIPALITY FOR SUCH PAYMENT IN
ACCORDANCE WITH SUBDIVISION TWO OF SECTION TWENTY-FIVE HUNDRED
FIFTY-SEVEN OF THIS TITLE. PARENTS SHALL NOT BE REQUIRED TO PAY INSUR-
ANCE COPAYMENTS OR DEDUCTIBLES FOR PAYMENT OF EARLY INTERVENTION
SERVICES COVERED UNDER AN INSURANCE POLICY OR PLAN.
IV. EXCEPT IN THE CASE OF A CHILD WHO HAS COVERAGE UNDER AN INSURANCE
POLICY OR PLAN AND IS ALSO ENROLLED IN THE MEDICAL ASSISTANCE PROGRAM,
INSURERS AND PLAN ADMINISTRATORS SHALL NOT BE BILLED DIRECTLY FOR
COVERED SERVICES RENDERED TO AN ELIGIBLE CHILD THAT ARE AUTHORIZED BY
THE CHILD'S IFSP AND PROVIDED UNDER THE EARLY INTERVENTION PROGRAM.
(c) Payments made for early intervention services COVERED under an
insurance policy or health benefit plan which are provided as part of an
IFSP pursuant to section twenty-five hundred forty-five of this title
shall not be applied by the insurer or plan administrator against any
maximum lifetime or annual limits specified in the policy or health
benefits plan, pursuant to section eleven of [the] chapter FOUR HUNDRED
TWENTY-EIGHT of the laws of nineteen hundred ninety-two which added this
title AND SHALL NOT OTHERWISE DECREASE COVERAGE OR VISIT LIMITS AVAIL-
ABLE FOR SERVICES UNDER THE CHILD'S INSURANCE POLICY OR HEALTH BENEFIT
PLAN.
(d) [A] FOR THE PERIOD MARCH FIRST, TWO THOUSAND NINE TO MARCH THIR-
TY-FIRST, TWO THOUSAND TEN, A municipality, or its designee, shall be
subrogated, to the extent of the expenditures by such municipality for
early intervention services furnished to persons eligible for benefits
under this title, to any rights such person may have or be entitled to
from third party reimbursement. The right of subrogation does not attach
to benefits paid or provided under any health insurance policy or health
benefits plan prior to receipt of written notice of the exercise of
subrogation rights by the insurer or plan administrator providing such
benefits.
S 13. Intentionally omitted.
S 14. Section 2559-b of the public health law, as added by chapter 428
of the laws of 1992, is amended to read as follows:
S 2559-b. Regulations. The commissioner may adopt regulations neces-
sary to carry out the provisions of this title. In promulgating such
regulations, the commissioner shall [incorporate coordinated standards
and procedures, where applicable, and shall] consider the regulations,
guidelines and operating procedures of other state agencies that admin-
ister or supervise the administration of services to infants, toddlers
and preschool children to ensure that families, service providers and
municipalities are not unnecessarily required to meet differing eligi-
bility, reporting or procedural requirements.
S 15. The state finance law is amended by adding a new section 99-q to
read as follows:
S. 58--A 20 A. 158--A
S 99-Q. EARLY INTERVENTION PROGRAM ACCOUNT. 1. THERE IS HEREBY ESTAB-
LISHED IN THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSION-
ER OF THE DEPARTMENT OF TAXATION AND FINANCE AN ACCOUNT IN THE MISCELLA-
NEOUS SPECIAL REVENUE FUND TO BE KNOWN AS THE "EARLY INTERVENTION
PROGRAM ACCOUNT".
2. SUCH ACCOUNT SHALL CONSIST OF MONIES RECEIVED FROM EARLY INTER-
VENTION FEES.
3. MONIES OF THE ACCOUNT, WHEN ALLOCATED, SHALL BE AVAILABLE TO THE
DEPARTMENT OF HEALTH FOR EARLY INTERVENTION PROGRAM ADMINISTRATIVE COSTS
AND FOR THE STATE SHARE FOR REIMBURSEMENT OF EARLY INTERVENTION
SERVICES.
S 16. The opening paragraph of paragraph a of subdivision 9 of section
4410 of the education law, as amended by chapter 82 of the laws of 1995,
is amended to read as follows:
Providers of special services or programs shall apply to the commis-
sioner for program approval on a form prescribed by the commissioner;
such application shall include, but not be limited to, a listing of the
services to be provided, the population to be served, a plan for provid-
ing services in the least restrictive environment and a description of
its evaluation component, if any. [Providers of early intervention
services seeking approval pursuant to subdivision seven of section twen-
ty-five hundred fifty-one of the public health law shall apply to the
commissioner for such approval on a form prescribed by the commission-
er.] The commissioner shall approve programs in accordance with regu-
lations adopted for such purpose and shall periodically review such
programs at which time the commissioner shall provide the municipality
in which the program is located or for which the municipality bears
fiscal responsibility an opportunity for comment within thirty days of
the review. In collaboration with municipalities and representatives of
approved programs, the commissioner shall develop procedures for
conducting such reviews. Municipalities shall be allowed to participate
in such departmental review process. Such review shall be conducted by
individuals with appropriate experience as determined by the commission-
er and shall be conducted not more than once every three years.
S 17. Subdivision 18 of section 4403 of the education law is REPEALED.
S 17-a. Subsection (c) of section 3235-a of the insurance law is
REPEALED.
S 18. Subsection (b) of section 3235-a of the insurance law, as added
by section 3 of part C of chapter 1 of the laws of 2002, is amended and
subsection (d) is relettered subsection (c) to read as follows:
(b) Where a policy of accident and health insurance, including a
contract issued pursuant to article forty-three of this chapter,
provides coverage for an early intervention program service, [such
coverage] PAYMENTS MADE FOR SERVICES COVERED UNDER SUCH POLICY shall not
be applied against any maximum annual or lifetime monetary limits set
forth in such policy or contract. Visit limitations and other terms and
conditions of the policy will continue to apply to early intervention
services. However, any visits used for early intervention program
services shall not reduce the number of visits otherwise available under
the policy or contract for such services.
S 19. Paragraph (b) of subdivision 3 of section 602 of the public
health law, as added by chapter 901 of the laws of 1986, subparagraph 2
as amended by section 5 of part B of chapter 57 of the laws of 2006, is
amended to read as follows:
(b) The extent to which services in the plan will promote the public
health, which, as defined herein, shall be enhancing or sustaining the
S. 58--A 21 A. 158--A
public health, protecting the public from the threats of disease and
illness, or preventing premature death, and which assist in containing
the costs of the health care system. Services that promote the public
health are the following:
(1) 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 care and
other services appropriate to promote the birth of a healthy baby to a
healthy mother, [and] services to prevent and detect health problems in
infants, young children, and school age children, DENTAL HEALTH SERVICES
TO CHILDREN LESS THAN TWENTY-ONE YEARS OF AGE AND, WHEN PROVIDED BY
STAFF OF THE LOCAL HEALTH DEPARTMENT, EARLY INTERVENTION PROGRAM ADMIN-
ISTRATION AND SERVICE COORDINATION.
(2) disease control, which shall include activities to control and
mitigate the extent of non-infectious diseases, particularly those of a
chronic, degenerative nature, and infectious diseases. Such activities
shall include surveillance and epidemiological programs, and programs to
detect diseases in their early stages. Specific activities shall include
immunizations against infectious diseases, prevention and treatment of
sexually transmissible diseases, [and] arthropod vector-borne disease
prevention, AND INPATIENT TUBERCULOSIS TREATMENT.
(3) health education and guidance, which shall include the use of
information and education to modify or strengthen practices that will
promote the public health and prevent illness. Such activities shall
encourage people to assume personal responsibility for maintaining and
improving their own health; increase their capacity to utilize appropri-
ate health services; help them better control an illness they may have;
and[,] provide information to stimulate community action on social and
physical environmental factors that impact on health. Special emphasis
shall be given to providing health education and guidance to individuals
at the same time as they are receiving a health service.
(4) community health assessment, which shall include an analysis of
community vital statistics and mortality and morbidity indices to detect
the source of illnesses and diseases, particularly those of a carcino-
genic and mutagenic nature, in order to prevent in an efficient manner
as many persons as possible from contracting such illnesses and diseases
and to assist in addressing other problems adversely affecting the
public health. Such analysis shall also include data relating to toxic
sites and occupational illnesses.
(5) environmental health, which shall include activities that promote
health and prevent illness by ensuring sanitary conditions in water
supplies, food service establishments, and other permit sites, [and by
abating] TAKING MEASURES TO ASSURE ENFORCEMENT OF PROPERTY OWNER'S OBLI-
GATIONS TO ABATE public health nuisances, AND PERFORMING INSPECTIONS AND
PROGRAMS RELATED TO RADIOACTIVE MATERIALS LICENSING AND INSPECTION,
RADIATION-PRODUCING EQUIPMENT, HOUSING HYGIENE AND OCCUPANCY, INDIVIDUAL
WATER SUPPLIES AND INDIVIDUAL SEWAGE SYSTEMS.
(6) THE PROVISION OF HOME CARE SERVICES PURSUANT TO ARTICLE THIRTY-
SIX OF THIS CHAPTER, EXCEPT TO THE EXTENT SUCH SERVICES ARE PROVIDED BY
A LONG TERM HOME HEALTH CARE PROGRAM, AS DEFINED IN SUCH ARTICLE THIR-
TY-SIX;
(7) THE OPERATION OF A PUBLIC HEALTH LABORATORY OR UTILIZATION OF A
CONTRACT LABORATORY FOR THE TESTING, ANALYSIS, AND REPORTING OF CLINICAL
OR ENVIRONMENTAL SPECIMENS COLLECTED BY THE LOCAL HEALTH DEPARTMENT IN
THE CONDUCT OF BASIC PROGRAMS OR ACTIVITIES DESCRIBED IN THIS SECTION.
S. 58--A 22 A. 158--A
The commissioner shall promulgate rules and regulations that define
the specific activities within each of the five categories. The commis-
sioner prior to promulgation of rules and regulations defining the
nature of the specific activities, shall consult with the public health
council and county health commissioners, boards and public health direc-
tors. The list of specific activities may be altered by the commissioner
as necessary and after his consultation with the council, commissioners,
boards and public health directors named herein.
S 20. Subdivision 2 of section 605 of the public health law, as
amended by section 7 of part B of chapter 57 of the laws of 2006, is
amended to read as follows:
2. State aid reimbursement for public health services provided by a
municipality under this title, shall be made as follows:
[(a)] if the municipality is providing some or all of the basic public
health services identified in paragraph (b) of subdivision three of
section six hundred two of this title, pursuant to an approved plan, 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 reimburse-
ment shall be provided for services if they are not approved in a plan
or if no plan is submitted for such services. NO REIMBURSEMENT SHALL BE
PROVIDED TO THE EXTENT THE LIMITATIONS ON REIMBURSEMENT SET FORTH IN
SECTION SIX HUNDRED SIXTEEN OF THIS ARTICLE ARE APPLICABLE.
[(b) if the municipality is providing other public health services
within limits to be prescribed by regulation by the commissioner in
addition to some or all of the public health services required in para-
graph (b) of subdivision three of section six hundred two of this title,
pursuant to an approved plan, at a rate of not less than thirty-six per
centum of the moneys expended by the municipality for such other
services. 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.]
S 21. Subdivisions 1 and 2 of section 609 of the public health law, as
amended by chapter 474 of the laws of 1996, are amended and a new subdi-
vision 5 is added 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, equipment and
maintenance of the laboratory or laboratories. 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, with the
approval 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 labo-
ratory 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. 58--A 23 A. 158--A
5. NO REIMBURSEMENT SHALL BE PROVIDED TO THE EXTENT THE LIMITATIONS ON
REIMBURSEMENT SET FORTH IN SECTION SIX HUNDRED SIXTEEN OF THIS ARTICLE
ARE APPLICABLE.
S 22. Subdivision 1 of section 616 of the public health law, as
amended by section 9 of part B of chapter 57 of the laws of 2006, is
amended and two new subdivisions 3 and 4 are added to read as follows:
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 municipality for public health services
required by paragraph (b) of subdivision three of section six hundred
two of this article 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.]
3. NOTWITHSTANDING THE PROVISION OF SECTION SIX HUNDRED NINE OF THIS
ARTICLE, NO PAYMENTS SHALL BE MADE FROM MONEYS APPROPRIATED FOR THE
PURPOSE OF THIS ARTICLE FOR LABORATORY EXPENSES OR SERVICES, UNLESS SUCH
SERVICES ARE DIRECTLY RELATED TO THE OPERATION OF A PUBLIC HEALTH LABO-
RATORY, OR UTILIZATION OF A CONTRACT LABORATORY, FOR THE TESTING, ANALY-
SIS, AND REPORTING OF CLINICAL OR ENVIRONMENTAL SPECIMENS COLLECTED BY
THE LOCAL HEALTH DEPARTMENT IN THE CONDUCT OF BASIC PROGRAMS OR ACTIV-
ITIES DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION THREE OF SECTION SIX
HUNDRED TWO OF THIS ARTICLE.
4. PAYMENTS SHALL BE MADE FROM MONEYS APPROPRIATED FOR THE PURPOSE OF
THIS ARTICLE ONLY FOR SERVICES APPROVED BY THE DEPARTMENT AND RELATED TO
SERVICES DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION THREE OF SECTION SIX
HUNDRED TWO OF THIS ARTICLE. NO PAYMENT SHALL BE MADE FROM MONEYS
APPROPRIATED FOR THE PURPOSE OF THIS ARTICLE FOR HOSPICE SERVICES, EMER-
GENCY MEDICAL SERVICES, MEDICAL EXAMINER PROGRAM, LONG-TERM HOME HEALTH
CARE, PRE-SCHOOL ADMINISTRATIVE SERVICES, OR PRE-SCHOOL EDUCATION
SERVICES PROVIDED TO CHILDREN THREE TO FIVE YEARS OF AGE, EXCEPT AS
EXPRESSLY PROVIDED IN PARAGRAPH (B) OF SUBDIVISION THREE OF SECTION SIX
HUNDRED TWO OF THIS ARTICLE.
S 23. Paragraphs (a) and (f) of subdivision 4 of section 576 of the
public health law, as amended by chapter 436 of the laws of 1993, are
amended and a new paragraph (h) is added to read as follows:
(a) The department may adopt and amend rules and regulations to effec-
tuate the provisions and purposes of this title. [Such] FOR PERIODS
PRIOR TO JULY FIRST, TWO THOUSAND NINE, SUCH rules and regulations shall
establish inspection and reference fees for clinical laboratories and
blood banks in amounts not exceeding the cost of the inspection and
reference program for clinical laboratories and blood banks and shall be
subject to the approval of the director of the budget.
(f) The commissioner may waive all or any part of such fee charges OR
ASSESSMENT for clinical laboratories or blood banks operated by local
governments and for nonprofit clinical laboratories or blood banks
performing examinations and analyses or providing services under
contract with the state or its local governments.
S. 58--A 24 A. 158--A
(H) NOTWITHSTANDING PARAGRAPHS (B) AND (E) OF THIS SUBDIVISION OR ANY
OTHER CONTRARY PROVISION OF LAW, FOR PERIODS ON AND AFTER JULY FIRST,
TWO THOUSAND NINE, THE DEPARTMENT SHALL CHARGE CLINICAL LABORATORIES AND
BLOOD BANKS AN ANNUAL ASSESSMENT ON THE GROSS RECEIPTS RECEIVED BY SUCH
CLINICAL LABORATORIES AND BLOOD BANKS FOR ALL TESTS OR EXAMINATIONS OF
SPECIMENS PERFORMED PURSUANT TO A PERMIT ISSUED IN ACCORDANCE WITH
SECTION FIVE HUNDRED SEVENTY-FIVE OF THIS TITLE. THE ANNUAL ASSESSMENT
TO BE CHARGED FOR JULY FIRST, TWO THOUSAND NINE THROUGH JUNE THIRTIETH,
TWO THOUSAND TEN SHALL BE ONE PERCENT OF SUCH GROSS RECEIPTS FOR THE
PRECEDING CALENDAR YEAR, AND FOR JULY FIRST, TWO THOUSAND TEN THROUGH
JUNE THIRTIETH, TWO THOUSAND ELEVEN, ONE PERCENT OF SUCH GROSS RECEIPTS
FOR THE PRECEDING CALENDAR YEAR. THE ANNUAL ASSESSMENT TO BE CHARGED FOR
JULY FIRST, TWO THOUSAND ELEVEN THROUGH JUNE THIRTIETH, TWO THOUSAND
TWELVE SHALL BE NINE-TENTHS OF ONE PERCENT OF SUCH GROSS RECEIPTS FOR
THE PRECEDING CALENDAR YEAR. THE ANNUAL ASSESSMENT TO BE CHARGED FOR
JULY FIRST, TWO THOUSAND TWELVE THROUGH JUNE THIRTIETH, TWO THOUSAND
THIRTEEN AND FOR EVERY YEAR THEREAFTER SHALL BE EIGHT-TENTHS OF ONE
PERCENT OF SUCH GROSS RECEIPTS FOR THE PRECEDING CALENDAR YEAR.
S 24. Section 4364 of the public health law is amended by adding a
new subdivision 6 to read as follows:
6. (A) FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, THE
DEPARTMENT SHALL CHARGE TISSUE BANKS AND STORAGE FACILITIES AN ANNUAL
ASSESSMENT IN THE AMOUNT OF ONE PERCENT OF THE GROSS RECEIPTS RECEIVED
FOR THE PRECEDING CALENDAR YEAR BY SUCH TISSUE BANKS AND STORAGE FACILI-
TIES FOR ALL ACTIVITIES PERFORMED PURSUANT TO A LICENSE ISSUED IN
ACCORDANCE WITH THIS SECTION.
(B) EACH TISSUE BANK OR STORAGE FACILITY SHALL SUBMIT TO THE DEPART-
MENT, IN SUCH FORM AND AT SUCH TIMES AS THE DEPARTMENT MAY REQUIRE, A
REPORT CONTAINING INFORMATION REGARDING ITS GROSS ANNUAL RECEIPTS FROM
THE PERFORMANCE OF ALL ACTIVITIES PURSUANT TO A LICENSE ISSUED BY THE
DEPARTMENT PURSUANT TO THIS SECTION. THE DEPARTMENT MAY REQUIRE ADDI-
TIONAL INFORMATION AND AUDIT AND REVIEW SUCH INFORMATION TO VERIFY ITS
ACCURACY.
S 25. Subdivision 8 of section 6524 of the education law, as amended
by section 1 of part G of chapter 57 of the laws of 2008, is amended to
read as follows:
(8) Fees: pay a fee of two hundred sixty dollars to the department for
admission to a department conducted examination and for an initial
license, a fee of one hundred seventy-five dollars for each reexamina-
tion, a fee of one hundred thirty-five dollars for an initial license
for persons not requiring admission to a department conducted examina-
tion, a fee of five hundred seventy dollars for any biennial registra-
tion period commencing August first, nineteen hundred ninety-six THROUGH
FEBRUARY TWENTY-EIGHTH, TWO THOUSAND NINE AND A FEE OF NINE HUNDRED
SEVENTY DOLLARS FOR ANY BIENNIAL REGISTRATION PERIOD COMMENCING MARCH
FIRST, TWO THOUSAND NINE and thereafter. The comptroller is hereby
authorized and directed to deposit the fee for each biennial registra-
tion period into the special revenue funds-other entitled "professional
medical conduct account" for the purpose of offsetting any expenditures
made pursuant to section two hundred thirty of the public health law in
relation to the operation of the office of professional medical conduct
within the department of health, provided that for each biennial regis-
tration fee paid by the licensee using a credit card, the amount of the
administrative fee incurred by the department in processing such credit
card transaction shall be deposited by the comptroller in the office of
the professions account established by section ninety-seven-nnn of the
S. 58--A 25 A. 158--A
state finance law. The amount of the funds expended as a result of such
increase shall not be greater than such fees collected over the regis-
tration period.
S 26. Subdivisions 9 and 10 of section 225 of the public health law
are REPEALED.
S 27. Subdivision 4 of section 1352 of the public health law is
REPEALED.
S 28. Paragraph (m) of subdivision 1 of section 201 of the public
health law, as relettered by chapter 571 of the laws of 1976, is amended
to read as follows:
(m) supervise and regulate the sanitary aspects of camps, hotels,
boarding houses, public eating and drinking establishments, swimming
pools, bathing establishments and other businesses and activities
affecting public health AND RESPOND TO COMPLAINTS RELATING TO HOTELS,
BOARDING HOUSES AND TEMPORARY RESIDENCES AS DEFINED IN THE STATE SANI-
TARY CODE AND INSPECT SUCH FACILITIES WHEN OTHERWISE NECESSARY;
S 29. Paragraphs (a) and (c) of subdivision 2 and subdivision 3 of
section 1370-a of the public health law, paragraphs (a) and (c) of
subdivision 2 as added by chapter 485 of the laws of 1992 and subdivi-
sion 3 as added by section 23 of part B of chapter 58 of the laws of
2007, are amended to read as follows:
(a) promulgate and enforce regulations for screening children and
pregnant women, INCLUDING REQUIREMENTS FOR BLOOD LEAD TESTING, for lead
poisoning, and for follow up of children and pregnant women who have
elevated blood lead levels;
(c) establish a statewide registry of LEAD LEVELS OF children [with
elevated lead levels] provided such information is [monitored] MAIN-
TAINED as confidential except for (i) disclosure for medical treatment
purposes; [and] (ii) disclosure of non-identifying epidemiological data;
AND (III) DISCLOSURE OF INFORMATION FROM SUCH REGISTRY TO THE STATEWIDE
IMMUNIZATION INFORMATION SYSTEM ESTABLISHED BY SECTION TWENTY-ONE
HUNDRED SIXTY-EIGHT OF THIS CHAPTER; and
3. The department shall identify and designate [a zip code in certain
counties] AREAS IN THE STATE with significant concentrations of children
identified with elevated blood lead levels AS COMMUNITIES OF CONCERN for
purposes of implementing a [pilot] CHILDHOOD LEAD POISONING PRIMARY
PREVENTION program [to work in cooperation with local health officials
to develop a primary prevention plan for each such zip code identified
to prevent exposure to lead-based paint], AND MAY, WITHIN AMOUNTS APPRO-
PRIATED, PROVIDE GRANTS TO IMPLEMENT APPROVED PROGRAMS. THE COMMISSIONER
OF HEALTH OF A COUNTY OR PART-COUNTY HEALTH DISTRICT, A COUNTY HEALTH
DIRECTOR OR A PUBLIC HEALTH DIRECTOR AND, IN THE CITY OF NEW YORK, THE
COMMISSIONER OF THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL
HYGIENE SHALL DEVELOP AND IMPLEMENT A CHILDHOOD LEAD POISONING PRIMARY
PREVENTION PROGRAM TO PREVENT EXPOSURE TO LEAD-BASED PAINT HAZARDS FOR
THE COMMUNITIES OF CONCERN IN THEIR JURISDICTION. THE DEPARTMENT SHALL
PROVIDE FUNDING TO THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL
HYGIENE OR COUNTY HEALTH DEPARTMENTS TO IMPLEMENT THE APPROVED WORK PLAN
FOR A CHILDHOOD LEAD POISONING PRIMARY PREVENTION PROGRAM. THE WORK PLAN
AND BUDGET, WHICH SHALL BE SUBJECT TO THE APPROVAL OF THE DEPARTMENT,
SHALL INCLUDE, BUT NOT BE LIMITED TO: (A) IDENTIFICATION AND DESIGNATION
OF AN AREA OR AREAS OF HIGH RISK WITHIN COMMUNITIES OF CONCERN; (B) A
HOUSING INSPECTION PROGRAM THAT INCLUDES PRIORITIZATION AND INSPECTION
OF AREAS OF HIGH RISK FOR LEAD HAZARDS, CORRECTION OF IDENTIFIED LEAD
HAZARDS USING EFFECTIVE LEAD-SAFE WORK PRACTICES AND, APPROPRIATE OVER-
SIGHT OF REMEDIATION WORK; (C) PARTNERSHIPS WITH OTHER COUNTY OR MUNICI-
S. 58--A 26 A. 158--A
PAL AGENCIES OR COMMUNITY-BASED ORGANIZATIONS TO BUILD COMMUNITY AWARE-
NESS OF THE CHILDHOOD LEAD POISONING PRIMARY PREVENTION PROGRAM AND
ACTIVITIES, COORDINATE REFERRALS FOR SERVICES, AND SUPPORT REMEDIATION
OF HOUSING THAT CONTAINS LEAD HAZARDS AND (D) A MECHANISM TO PROVIDE
EDUCATION AND REFERRAL FOR LEAD TESTING FOR CHILDREN AND PREGNANT WOMEN
TO FAMILIES WHO ARE ENCOUNTERED IN THE COURSE OF CONDUCTING PRIMARY
PREVENTION INSPECTIONS AND OTHER OUTREACH ACTIVITIES. THE COMMISSIONER
OF HEALTH OF A COUNTY OR PART-COUNTY HEALTH DISTRICT, A COUNTY HEALTH
DIRECTOR OR A PUBLIC HEALTH DIRECTOR AND, IN THE CITY OF NEW YORK, THE
COMMISSIONER OF THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL
HYGIENE SHALL ALSO ENTER INTO AN AGREEMENT OR SUBCONTRACT WITH A MUNICI-
PAL GOVERNMENT REGARDING INSPECTION OF THE PAINT CONDITIONS IN DWELLINGS
BUILT PRIOR TO NINETEEN HUNDRED SEVENTY-EIGHT FOR THE AREA DEFINED AS
THE COMMUNITY OF CONCERN. A PORTION OF GRANT FUNDING RECEIVED TO
SUPPORT THE LOCAL PRIMARY PREVENTION PLAN MAY BE USED TO REDUCE BARRIERS
TO LEAD TESTING OF CHILDREN AND PREGNANT WOMEN WITHIN THE COMMUNITIES OF
CONCERN, INCLUDING THE PURCHASE OF LEAD TESTING DEVICES AND SUPPLIES
WHEN THE NEED FOR SUCH RESOURCES IS IDENTIFIED WITHIN THE COMMUNITY. The
commissioner, THE COMMISSIONER OF HEALTH OF A COUNTY OR PART-COUNTY
HEALTH DISTRICT, A COUNTY HEALTH DIRECTOR OR A PUBLIC HEALTH DIRECTOR
AND, IN THE CITY OF NEW YORK, THE COMMISSIONER OF THE NEW YORK CITY
DEPARTMENT OF HEALTH AND MENTAL HYGIENE is authorized to enter into
agreements, CONTRACTS, SUBCONTRACTS or memoranda of understanding with,
and provide technical and other resources to, local health officials,
local building code officials, real property owners, and community
organizations in such areas to create and implement policies, education
and other forms of community outreach to address lead exposure,
detection and risk reduction. [Such primary] PRIMARY prevention plans
shall target children less than six years of age living in the highest
risk housing in the [zip code] COMMUNITIES OF CONCERN identified. [Such
primary prevention] THE plans shall also take into consideration the
extent the weatherization assistance [or] PROGRAM AND other such
programs can be used in [collaboration] CONJUNCTION with lead-based
paint hazard risk reduction.
S 30. Subdivision 1 and paragraph (i) of subdivision 3 of section
1370-b of the public health law, as added by chapter 485 of the laws of
1992, is amended to read as follows:
1. The New York state advisory council on lead poisoning prevention is
hereby established in the department, to consist of the following, or
their designees: the commissioner; the commissioner of labor; the
commissioner of environmental conservation; the commissioner of housing
and community renewal; the commissioner of [social services] CHILDREN
AND FAMILY SERVICES; THE COMMISSIONER OF TEMPORARY AND DISABILITY
ASSISTANCE; THE SECRETARY OF STATE; THE SUPERINTENDENT OF INSURANCE; and
fifteen public members appointed by the governor. The public members
shall have a demonstrated expertise or interest in lead poisoning
prevention and at least one public member shall be representative of
each of the following: local government; community groups; labor unions;
real estate; industry; parents; educators; local housing authorities;
child health advocates; environmental groups; professional medical
organizations and hospitals. The public members of the council shall
have fixed terms of three years; except that five of the initial
appointments shall be for two years and five shall be for one year. The
council shall be chaired by the commissioner or his or her designee.
(i) To report on or before [January] DECEMBER first of each year to
the governor and the legislature concerning the PREVIOUS YEAR'S develop-
S. 58--A 27 A. 158--A
ment and implementation of the statewide plan and operation of the
program, together with recommendations it deems necessary AND THE MOST
CURRENTLY AVAILABLE LEAD SURVEILLANCE MEASURES, INCLUDING THE ACTUAL
NUMBER AND ESTIMATED PERCENTAGE OF CHILDREN TESTED FOR LEAD IN ACCORD-
ANCE WITH NEW YORK STATE REGULATIONS, INCLUDING AGE-SPECIFIC TESTING
REQUIREMENTS, AND THE ACTUAL NUMBER AND ESTIMATED PERCENTAGE OF CHILDREN
IDENTIFIED WITH ELEVATED BLOOD LEAD LEVELS. SUCH REPORT SHALL BE MADE
AVAILABLE ON THE DEPARTMENT'S WEBSITE.
S 31. Subdivision 3 of section 1370-e of the public health law, as
added by chapter 485 of the laws of 1992, is amended to read as follows:
3. Whenever an analysis of a clinical specimen for lead is performed
by a laboratory OR A PHYSICIAN OR AUTHORIZED PRACTITIONER, the director
of such laboratory OR SUCH PHYSICIAN OR AUTHORIZED PRACTITIONER shall,
within such period specified by the commissioner report the results and
any related information in connection therewith to the local and state
health officer to whom a physician or authorized practitioner is
required to report such cases pursuant to this section.
S 32. Section 2168 of the public health law, as added by chapter 544
of the laws of 2006, is amended to read as follows:
S 2168. Statewide immunization [registry] INFORMATION SYSTEM. 1. The
department is hereby directed to establish a statewide automated and
electronic immunization [registry] INFORMATION SYSTEM that will serve,
and shall be administered consistent with, the following public health
purposes:
(a) collect reports of immunizations and thus reduce the incidence of
illness, disability and death due to vaccine preventable diseases AND
COLLECT RESULTS OF BLOOD LEAD ANALYSES PERFORMED BY PHYSICIAN OFFICE
LABORATORIES TO PROVIDE TO THE STATEWIDE REGISTRY OF LEAD LEVELS OF
CHILDREN ESTABLISHED PURSUANT TO SECTION THIRTEEN HUNDRED SEVENTY-A OF
THIS CHAPTER;
(b) establish the public health infrastructure necessary to obtain,
collect, preserve, and disclose information relating to vaccine prevent-
able disease as it may promote the health and well-being of all children
in this state;
(c) make available to an individual, or parents, guardians, or other
person in a custodial relation to a child or, to local health districts,
local social services districts responsible for the care and custody of
children, health care providers and their designees, schools, WIC
PROGRAMS, and [third party payers] HEALTH INSURERS the immunization
status of children; and
(d) appropriately protecting the confidentiality of individual identi-
fying information and the privacy of persons included in the [registry]
STATEWIDE IMMUNIZATION INFORMATION SYSTEM and their families.
2. For the purposes of this section:
(a) The term "authorized user" shall mean any person or entity author-
ized to provide information to or to receive information from the STATE-
WIDE immunization [registry] INFORMATION SYSTEM and shall include health
care providers and their designees, as defined in paragraph (d) of this
subdivision, schools as defined in paragraph a of subdivision one of
section twenty-one hundred sixty-four of this title, [health maintenance
organizations certified under article forty-four of this chapter or
article forty-three of the insurance law,] HEALTH INSURERS AS DEFINED IN
PARAGRAPH (F) OF THIS SUBDIVISION, local health districts as defined by
paragraph (c) of subdivision one of section two of this chapter, [and]
local social services districts and the office of children and family
services with regard to children in their legal custody, AND WIC
S. 58--A 28 A. 158--A
PROGRAMS AS DEFINED IN PARAGRAPH (G) OF THIS SUBDIVISION. An authorized
user may be located outside New York state. An entity other than a local
health district shall be an authorized user only with respect to a
person seeking or receiving a health care service from the health care
provider, a person enrolled or seeking to be enrolled in the school, a
person insured by the health [maintenance organization] INSURER, [or] a
person in the custody of the local social services district or the
office of children and family services, OR A PERSON SEEKING OR RECEIVING
SERVICES THROUGH WIC PROGRAMS, as the case may be.
(b) The term "STATEWIDE immunization [registry] INFORMATION SYSTEM" OR
"SYSTEM" shall mean a statewide-computerized database maintained by the
department capable of collecting, storing, and disclosing the electronic
and paper records of vaccinations received by persons under nineteen
years of age.
(c) The term "citywide immunization registry" shall mean the computer-
ized database maintained by the city of New York department of health
and mental hygiene capable of collecting, storing, and disclosing the
electronic and paper records of vaccinations received by persons [under]
LESS THAN nineteen years of age. THE TERM "CITYWIDE IMMUNIZATION REGIS-
TRY" SHALL NOT INCLUDE THE CHILDHOOD BLOOD LEAD REGISTRY ESTABLISHED
PURSUANT TO THE HEALTH CODE OF THE CITY OF NEW YORK. For the purposes of
this section the term New York city department of health and mental
hygiene shall mean such agency or any successor agency responsible for
the citywide immunization registry.
(d) The term "health care provider" shall mean any person authorized
by law to order [or administer] an immunization OR ANALYSIS OF A BLOOD
SAMPLE FOR LEAD or any health care facility licensed under article twen-
ty-eight of this chapter or any certified home health agency established
under section thirty-six hundred six of this chapter; with respect to a
person seeking or receiving a health care service from the health care
provider.
(e) For purposes of this section a school is a public health authori-
ty, as defined in section 164.501 of part 45 of the federal code of
rules, responsible for screening the immunization status of each child
pursuant to section twenty-one hundred sixty-four of this article.
(F) THE TERM "HEALTH INSURER" SHALL MEAN HEALTH MAINTENANCE ORGANIZA-
TIONS CERTIFIED UNDER ARTICLE FORTY-FOUR OF THIS CHAPTER, HEALTH SERVICE
CORPORATIONS LICENSED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE
LAW, HEALTH INSURANCE COMPANIES SUBJECT TO ARTICLE THIRTY-TWO OF THE
INSURANCE LAW WHICH OFFER PREFERRED PROVIDER PRODUCTS, CORPORATIONS
SUBJECT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW WHICH OFFER
PREFERRED PROVIDER PRODUCTS, MUNICIPAL COOPERATIVE HEALTH BENEFIT PLANS
CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE LAW WHICH
OFFER PREFERRED PROVIDER PRODUCTS, AND PREFERRED PROVIDER ORGANIZATIONS
AS DEFINED IN SECTION THREE HUNDRED FIFTY-TWO OF THE WORKERS' COMPEN-
SATION LAW.
(G) FOR PURPOSES OF THIS SECTION A WIC PROGRAM IS A STATE OR LOCAL
AGENCY, AS DESCRIBED PURSUANT TO SECTION 1786 OF TITLE 42 OF THE UNITED
STATES CODE.
(H) THE TERM "PHYSICIAN OFFICE LABORATORY" SHALL MEAN A LABORATORY
OPERATED BY A HEALTH CARE PROVIDER PURSUANT TO SUBDIVISION ONE OF
SECTION FIVE HUNDRED SEVENTY-NINE OF THIS CHAPTER THAT IS CERTIFIED BY
THE CENTERS FOR MEDICARE AND MEDICAID SERVICES UNDER REGULATIONS IMPLE-
MENTING THE FEDERAL CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988
(CLIA).
S. 58--A 29 A. 158--A
3. (a) Any health care provider who administers any vaccine to a
person [under] LESS THAN nineteen years of age OR, ON OR AFTER SEPTEMBER
FIRST, TWO THOUSAND NINE, CONDUCTS A BLOOD LEAD ANALYSIS OF A SAMPLE
OBTAINED FROM A PERSON UNDER EIGHTEEN YEARS OF AGE IN ACCORDANCE WITH
PARAGRAPH (H) OF SUBDIVISION TWO OF THIS SECTION; and immunizations
received by a person [under] LESS THAN nineteen years of age in the past
if not already reported, shall report all such immunizations AND THE
RESULTS OF ANY BLOOD LEAD ANALYSIS to the department in a format
prescribed by the commissioner within fourteen days of administration OF
SUCH IMMUNIZATIONS OR OF OBTAINING THE RESULTS OF ANY SUCH BLOOD LEAD
ANALYSIS. Health care providers administering immunizations to persons
[under] LESS THAN nineteen years of age in the city of New York shall
report, in a format prescribed by the city of New York commissioner of
health and mental hygiene, all such immunizations to the citywide immun-
ization registry. The commissioner, and for the city of New York the
commissioner of health and mental hygiene, shall have the discretion to
accept for inclusion in the [registry] SYSTEM information regarding
immunizations administered to individuals nineteen years of age or older
with the express written consent of the vaccine. HEALTH CARE PROVIDERS
WHO CONDUCT A BLOOD LEAD ANALYSIS ON A PERSON UNDER EIGHTEEN YEARS OF
AGE AND WHO REPORT THE RESULTS OF SUCH ANALYSIS TO THE CITY OF NEW YORK
COMMISSIONER OF HEALTH AND MENTAL HYGIENE PURSUANT TO NEW YORK CITY
REPORTING REQUIREMENTS SHALL BE EXEMPT FROM THIS REQUIREMENT FOR REPORT-
ING BLOOD LEAD ANALYSIS RESULTS TO THE STATE COMMISSIONER OF HEALTH;
PROVIDED, HOWEVER, BLOOD LEAD ANALYSIS DATA COLLECTED FROM PHYSICIAN
OFFICE LABORATORIES BY THE COMMISSIONER OF HEALTH AND MENTAL HYGIENE OF
THE CITY OF NEW YORK PURSUANT TO THE HEALTH CODE OF THE CITY OF NEW YORK
SHALL BE PROVIDED TO THE DEPARTMENT IN A FORMAT PRESCRIBED BY THE
COMMISSIONER.
(b) The STATEWIDE immunization [registry] INFORMATION SYSTEM shall
provide a method for health care providers to determine when the regis-
trant is due or late for a recommended immunization and shall serve as a
means for authorized users to receive prompt and accurate information,
as reported to the [registry] SYSTEM, about the vaccines that the regis-
trant has received.
4. (a) All information maintained by the department, or in the case of
the citywide immunization registry, the city of New York under the
provisions of this section shall be confidential except as necessary to
carry out the provisions of this section and shall not be released for
any other purpose.
(b) The department and for the city of New York the department of
health and mental hygiene may also disclose or provide such information
to an authorized user when (i) such person or agency provides sufficient
identifying information satisfactory to the department to identify such
registrant and (ii) such disclosure or provision of information is in
the best interests of the registrant or his or her family, or will
contribute to the protection of the public health.
(c) Any data collected by the department may be included in the STATE-
WIDE immunization [registry] INFORMATION SYSTEM AND THE STATEWIDE REGIS-
TRY OF LEAD LEVELS OF CHILDREN if collection, storage and access of such
data is otherwise authorized. Such data may be disclosed to the STATE-
WIDE immunization [registry] INFORMATION SYSTEM only if provided for in
statute and regulation, and shall be subject to any provisions in such
statute or regulation limiting the use or redisclosure of the data.
Nothing contained in this paragraph shall permit inclusion of data in
the STATEWIDE immunization [registry] INFORMATION SYSTEM if that data
S. 58--A 30 A. 158--A
could not otherwise be accessed or disclosed in the absence of the
[registry] SYSTEM. For the city of New York the commissioner of health
and mental hygiene may include data collected in the citywide IMMUNIZA-
TION registry as provided in this paragraph.
(d) A person, institution or agency to whom such immunization [regis-
try] information is furnished or to whom, access to records or informa-
tion has been given, shall not divulge any part thereof so as to
disclose the identity of such person to whom such information or record
relates, except insofar as such disclosure is necessary for the best
interests of the person or other persons, consistent with the purposes
of this section.
5. (a) All health care providers and their designees, except for
providers reporting to the citywide immunization registry, shall submit
to the commissioner information about any vaccinee [under] LESS THAN
nineteen years of age and about each vaccination given after January
first, two thousand eight. The information provided to the [registry]
SYSTEM or the citywide immunization registry shall include the national
immunization program data elements and other elements required by the
commissioner. For the city of New York the commissioner of health and
mental hygiene may require additional elements with prior notice to the
commissioner of any changes.
(b) In addition to the immunization administration information
required by this section, the operation of any immunization registry
established under chapter five hundred twenty-one of the laws of nine-
teen hundred ninety-four, section 11.04 of title twenty-four of volume
eight of the compilation of the rules of the city of New York and admin-
istered by a local health district collecting information from health
care providers about vaccinations previously administered to a vaccinee
prior to the effective date of this section shall provide the commis-
sioner access to such information.
(c) All health care providers shall provide the department or, as
appropriate, the city of New York with additional or clarifying informa-
tion upon request reasonably related to the purposes of this section.
(d) Notwithstanding the above, submission of incomplete information
shall not prohibit entry of incomplete but viable data into the [regis-
try database] STATEWIDE IMMUNIZATION INFORMATION SYSTEM.
(e) The commissioner of the department of health and mental hygiene
for the city of New York shall implement the requirements of this subdi-
vision.
(f) The immunization status of children exempt from immunizations
pursuant to subdivision eight and a parent claiming exemption pursuant
to subdivision nine of section twenty-one hundred sixty-four of this
title shall be reported by the health care provider.
6. In the city of New York, the commissioner of the department of
health and mental hygiene of the city of New York may maintain its
existing registry consistent with the requirements of this section and
shall provide information to the commissioner and to authorized users.
7. Each parent or legal guardian of a newborn infant or a child newly
enrolled in the [registry] STATEWIDE IMMUNIZATION INFORMATION SYSTEM
shall receive information, developed by the department, describing the
[registry] enrollment process and how to review and correct information
and obtain a copy of the child's immunization record. The city of New
York will be responsible for providing information about the processes
for enrollment and access to the citywide immunization registry by a
parent or legal guardian of a newborn infant or newly enrolled child
residing in the city of New York.
S. 58--A 31 A. 158--A
8. Access and use of identifiable registrant information shall be
limited to authorized users consistent with this subdivision and the
purposes of this section. (a) The commissioner shall provide a method by
which authorized users apply for access to the [registry] SYSTEM. For
the city of New York, the commissioner of health and mental hygiene
shall provide a method by which authorized users apply for access to the
CITYWIDE IMMUNIZATION registry.
(b) (i) The commissioner may use the STATEWIDE immunization [registry]
INFORMATION SYSTEM AND THE BLOOD LEAD INFORMATION IN SUCH SYSTEM for
purposes of outreach, quality improvement and [vaccine] accountability,
research, epidemiological studies and disease control, AND TO OBTAIN
BLOOD LEAD TEST RESULTS FROM PHYSICIAN OFFICE LABORATORIES FOR THE
STATEWIDE REGISTRY OF LEAD LEVELS OF CHILDREN ESTABLISHED PURSUANT TO
SUBDIVISION TWO OF SECTION THIRTEEN HUNDRED SEVENTY-A OF THIS CHAPTER;
(ii) the commissioner of health and mental hygiene for the city of New
York may use the immunization registry AND THE BLOOD LEAD INFORMATION IN
SUCH SYSTEM for purposes of outreach, quality improvement and [vaccine]
accountability, research, epidemiological studies and disease control;
(iii) local health departments shall have access to the immunization
[registry] INFORMATION SYSTEM AND THE BLOOD LEAD INFORMATION IN SUCH
SYSTEM for purposes of outreach, quality improvement and [vaccine]
accountability, epidemiological studies and disease control within their
county; and
(c) health care providers and their designees shall have access to the
STATEWIDE immunization [registry] INFORMATION SYSTEM AND THE BLOOD LEAD
INFORMATION IN SUCH SYSTEM only for purposes of submission of informa-
tion about vaccinations received by a specific registrant, determination
of the immunization status of a specific registrant, DETERMINATION OF
THE BLOOD LEAD TESTING STATUS OF A SPECIFIC REGISTRANT, SUBMISSION OF
THE RESULTS FROM A BLOOD LEAD ANALYSIS OF A SAMPLE OBTAINED FROM A
SPECIFIC REGISTRANT IN ACCORDANCE WITH PARAGRAPH (H) OF SUBDIVISION TWO
OF THIS SECTION, review of practice coverage, generation of reminder
notices, quality improvement and [vaccine] accountability and printing a
copy of the immunization OR LEAD TESTING record for the registrant's
medical record, for the registrant's parent or guardian, or other person
in parental or custodial relation to a child, or for a registrant upon
reaching eighteen years of age.
(d) The following authorized users shall have access to the STATEWIDE
immunization [registry] INFORMATION SYSTEM AND THE BLOOD LEAD INFORMA-
TION IN SUCH SYSTEM and the citywide immunization registry for the
purposes stated in this paragraph: (i) schools for verifying IMMUNIZA-
TION STATUS FOR eligibility for admission; (ii) health [maintenance
organizations] INSURERS for performing quality assurance, accountability
and outreach, relating to enrollees covered by the health [maintenance
organization] INSURER; (iii) commissioners of local social services
districts with regard to a child in his/her legal custody; [and] (iv)
the commissioner of the office of children and family services with
regard to children in their legal custody, and for quality assurance and
accountability of commissioners of local social services districts, care
and treatment of children in the custody of commissioners of local
social services districts; AND (V) WIC PROGRAMS FOR THE PURPOSES OF
VERIFYING IMMUNIZATION AND LEAD TESTING STATUS FOR THOSE SEEKING OR
RECEIVING SERVICES.
9. The commissioner may judge the legitimacy of any request for immun-
ization [registry] SYSTEM information and may refuse access to the
STATEWIDE immunization [registry] INFORMATION SYSTEM based on the
S. 58--A 32 A. 158--A
authenticity of the request, credibility of the authorized user or other
reasons as provided for in regulation. For the city of New York the
commissioner of health and mental hygiene may judge the legitimacy of
requests for access to the citywide immunization registry and refuse
access to the immunization registry based on the authenticity of the
request, credibility of the authorized user or other reasons as provided
for in regulation.
10. The person to whom any immunization record relates, or his or her
parent, or guardian, or other person in parental or custodial relation
to such person may request a copy of an immunization OR LEAD TESTING
record from the registrant's healthcare provider, the STATEWIDE immuni-
zation [registry] INFORMATION SYSTEM or the citywide immunization regis-
try according to procedures established by the commissioner or, in the
case of the citywide immunization registry, by the city of New York
commissioner of the department of health and mental hygiene.
11. The commissioner, OR IN THE CITY OF NEW YORK, THE COMMISSIONER OF
THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE, may provide registrant
specific immunization records to other state registries pursuant to a
written agreement requiring that the [foreign] OUT-OF-STATE registry
conform to national standards for maintaining the integrity of the data
and will not be used for purposes inconsistent with the provisions of
this section.
12. Information that would be provided upon the enrollment in the
[registry] STATEWIDE IMMUNIZATION INFORMATION SYSTEM of a child being
vaccinated, from birth records of all infants born in New York state on
or after January first, two thousand four shall be entered into the
STATEWIDE immunization [registry] INFORMATION SYSTEM, except in the city
of New York, where birth record information shall be entered into the
citywide immunization registry.
13. The commissioner shall promulgate regulations as necessary to
effectuate the provisions of this section. Such regulations shall
include provision for orderly implementation and operation of the
[registry] STATEWIDE IMMUNIZATION INFORMATION SYSTEM, including the
method by which each category of authorized user may access the [regis-
try] SYSTEM. Access standards shall include at a minimum a method for
assigning and authenticating each user identification and password
assigned.
14. No authorized user shall be subjected to civil or criminal liabil-
ity, or be deemed to have engaged in unprofessional conduct for report-
ing to, receiving from, or disclosing information relating to the
[registry] STATEWIDE IMMUNIZATION INFORMATION SYSTEM when made reason-
ably and in good faith and in accordance with the provisions of this
section or any regulation adopted thereto.
S 33. Section 215-b of the elder law is REPEALED.
S 34. Section 223 of the elder law is REPEALED.
S 35. Subdivision 21 of section 206 of the public health law, as added
by section 24 of part B of chapter 58 of the laws of 2004, is REPEALED.
S 36. Section 210-a of the insurance law is REPEALED.
S 37. Paragraph (qq) of subdivision 1 of section 2807-v of the public
health law is REPEALED.
S 38. This act shall take effect March 1, 2009; provided that the
commissioner of health is authorized to promulgate emergency regulations
to effectuate the requirements of subdivision 4 of section 2541 of the
public health law as added by section one of this act; provided however
that sections nineteen, twenty, twenty-one and twenty-two of this act
S. 58--A 33 A. 158--A
shall take effect immediately and be deemed to have been in full force
and effect on and after January 1, 2009.
PART B
Section 1. Subdivision 2 of section 3614-a of the public health law is
amended by adding a new paragraph (c) to read as follows:
(C) NOTWITHSTANDING ANY CONTRARY PROVISIONS OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW OR REGULATION, FOR CERTIFIED HOME HEALTH
AGENCIES AND FOR PROVIDERS OF LONG TERM HOME HEALTH CARE PROGRAMS THE
ASSESSMENT SHALL BE SEVEN-TENTHS OF ONE PERCENT OF EACH AGENCY'S OR
PROVIDER'S GROSS RECEIPTS RECEIVED FROM ALL HOME HEALTH CARE SERVICES
AND OTHER OPERATING INCOME ON A CASH BASIS FOR PERIODS ON AND AFTER
MARCH FIRST, TWO THOUSAND NINE.
S 2. Subdivision 4 of section 3614-a of the public health law, as
amended by section 66 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
4. [For periods prior to January first, two thousand five, the] THE
commissioner is authorized to contract with the article forty-three
insurance law plans, or such other administrators as the commissioner
shall designate, to receive and distribute home care provider assessment
funds and personal care services provider assessment funds assessed
pursuant to section three hundred sixty-seven-i of the social services
law. In the event contracts with the article forty-three insurance law
plans or other commissioner's designees are effectuated, the commission-
er shall conduct annual audits of the receipt and distribution of the
assessment funds. The reasonable costs and expenses of an administrator
as approved by the commissioner, not to exceed for personnel services on
an annual basis two hundred thousand dollars for all assessments estab-
lished pursuant to this section and the personal care services provider
assessment established pursuant to section three hundred sixty-seven-i
of the social services law, shall be paid from the assessment funds.
S 3. Subdivision 2 of section 3614-b of the public health law, as
amended by section 9 of part CC of chapter 407 of the laws of 1999, is
amended to read as follows:
2. (A) The assessment shall be six-tenths of one percent of such
licensed home care services agency's gross receipts received from all
patient care services and other operating income on a cash basis begin-
ning April first, nineteen hundred ninety-two; provided, however, that
for all such gross receipts received on or after April first, nineteen
hundred ninety-nine, such assessment shall be two-tenths of one percent,
and further provided that such assessment shall expire and be of no
further effect for all such gross receipts received on or after January
first, two thousand.
(B) NOTWITHSTANDING ANY CONTRARY PROVISIONS OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW OR REGULATION, THE ASSESSMENT SHALL BE
SEVEN-TENTHS OF ONE PERCENT OF EACH SUCH LICENSED HOME CARE SERVICES
AGENCY'S GROSS RECEIPTS RECEIVED FROM ALL PERSONAL CARE SERVICES AND
OTHER OPERATING INCOME ON A CASH BASIS FOR PERIODS ON AND AFTER MARCH
FIRST, TWO THOUSAND NINE.
S 4. Subdivision 2 of section 367-i of the social services law, as
amended by section 10 of part CC of chapter 407 of the laws of 1999, is
amended to read as follows:
2. (A) The assessment shall be six-tenths of one percent of each such
provider's gross receipts received from all personal care services and
other operating income on a cash basis beginning January first, nineteen
S. 58--A 34 A. 158--A
hundred ninety-one; provided, however, that for all such gross receipts
received on or after April first, nineteen hundred ninety-nine, such
assessment shall be two-tenths of one percent, and further provided that
such assessment shall expire and be of no further effect for all such
gross receipts received on or after January first, two thousand.
(B) NOTWITHSTANDING ANY CONTRARY PROVISIONS OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW OR REGULATION, THE ASSESSMENT SHALL BE
SEVEN-TENTHS OF ONE PERCENT OF EACH SUCH PROVIDER'S GROSS RECEIPTS FROM
ALL PERSONAL CARE SERVICES AND OTHER OPERATING INCOME ON A CASH BASIS
FOR PERIODS ON AND AFTER MARCH FIRST, TWO THOUSAND NINE.
S 5. (a) Notwithstanding any provision of law to the contrary, in the
event that certain "proposed or final regulations of the federal Centers
for Medicare and Medicaid Services," as defined in subdivision (b) of
this section, become final and enforceable, the commissioner of health,
in consultation with the director of the budget, may impose federal
financial participation contingency requirements on expenditures that
would otherwise be required to be made pursuant to state law but which,
as a result of such final and enforceable regulations, would be required
to be made entirely with non-federal funds. In such event, the commis-
sioner of health, in consultation with the director of the budget, may
make expenditures of such non-federal funds as he or she, in his or her
discretion, deems to be available for such purposes.
(b) For purposes of this section, "proposed or final regulations of
the Centers for Medicare and Medicaid Services" are regulations subject
to a moratorium in effect until April 1, 2009 pursuant to P.L. 110-252,
specifically: (i) interim final regulation dealing with case management
and targeted case management published December 4, 2007 (CMS-2237-IFC);
(ii) final rule implementing changes to Medicaid provider tax provisions
published February 22, 2008 (CMS-2275-F); (iii) final rule dealing with
public provider cost limits published May 29, 2007 (CMS-2258-FC); (iv)
proposed rule dealing with Medicaid graduate medical education published
May 23, 2007 (CMS-2279-P); (v) proposed rule dealing with the Medicaid
rehabilitation services option published August 13, 2007 (CMS-2261-P);
and (vi) final rule concerning school-based services published December
28, 2007 (CMS-2287-F).
S 6. Section 74 of the executive law is REPEALED.
S 7. Subdivision 2 of section 30-a of the public health law, as added
by chapter 442 of the laws of 2006, is amended to read as follows:
2. "Investigation" means investigations of fraud, abuse, or illegal
acts perpetrated within the medical assistance program, by providers or
recipients of medical assistance care, services and supplies; PROVIDED
THAT FOR THE PURPOSES OF SECTION THIRTY-TWO-A OF THIS TITLE, INVESTI-
GATIONS OF FRAUD, ABUSE OR ILLEGAL ACTS RELATING TO THE PROGRAMS ADMIN-
ISTERED OR PROVIDED BY THE OFFICE OF TEMPORARY AND DISABILITY ASSIST-
ANCE, THE OFFICE OF CHILDREN AND FAMILY SERVICES OR LOCAL SOCIAL
SERVICES DISTRICTS PURSUANT TO THE SOCIAL SERVICES LAW, OR THOSE
PROGRAMS OF THE DEPARTMENT OF HEALTH THAT WERE TRANSFERRED TO SUCH
DEPARTMENT PURSUANT TO SECTION TWO HUNDRED THIRTY-THREE OF CHAPTER FOUR
HUNDRED SEVENTY-FOUR OF THE LAWS OF NINETEEN HUNDRED NINETY-SIX AND
SECTION ONE HUNDRED TWENTY-TWO OF PART B OF CHAPTER FOUR HUNDRED THIR-
TY-SIX OF THE LAWS OF NINETEEN HUNDRED NINETY-SEVEN, INCLUDING BY
CONTRACTEES OR RECIPIENTS OF SUCH PROGRAMS AS WELL AS SOCIAL SERVICES
BENEFITS AS PROVIDED BY OR REGULATED BY THE DEPARTMENT OF LABOR.
S 8. Subdivisions 1, 3 and 7 of section 32 of the public health law,
subdivisions 1 and 7 as added by chapter 442 of the laws of 2006 and
S. 58--A 35 A. 158--A
subdivision 3 as amended by chapter 109 of the laws of 2007, are amended
to read as follows:
1. to appoint such deputies, directors, assistants and other officers
and employees as may be needed for the performance of his or her duties
and may prescribe their duties and fix their compensation within the
amounts appropriated therefor; PROVIDED, HOWEVER, THAT THE INSPECTOR
SHALL APPOINT A DEPUTY INSPECTOR GENERAL FOR SOCIAL SERVICES INVESTI-
GATIONS SUBJECT TO THE LIMITATIONS OF, AND AS SET FORTH IN, SECTION
THIRTY-TWO-A OF THIS TITLE;
3. to coordinate, to the greatest extent possible, activities to
prevent, detect and investigate medical assistance program fraud and
abuse amongst the following: the department; the offices of mental
health, mental retardation and developmental disabilities, alcoholism
and substance abuse services, temporary disability assistance, and chil-
dren and family services; the commission on quality of care and advocacy
for persons with disabilities; the department of education; the fiscal
agent employed to operate the medical assistance information and payment
system; local governments and entities; and to work in a coordinated and
cooperative manner with, to the greatest extent possible, the deputy
attorney general for Medicaid fraud control; [the welfare inspector
general,] federal prosecutors, district attorneys within the state, the
special investigative unit maintained by each health insurer operating
within the state, and the state comptroller;
7. to make information and evidence relating to suspected criminal
acts which he or she may obtain in carrying out his or her duties avail-
able to appropriate law enforcement officials and to consult with the
deputy attorney general for Medicaid fraud control[, the welfare inspec-
tor general,] and other state and federal law enforcement officials for
coordination of criminal investigations and prosecutions.
The inspector shall refer suspected fraud or criminality to the deputy
attorney general for Medicaid fraud control and make any other referrals
to such deputy attorney general as required or contemplated by federal
law. At any time after such referral, with ten days written notice to
the deputy attorney general for Medicaid fraud control or such shorter
time as such deputy attorney general consents to, the inspector may
additionally provide relevant information about suspected fraud or
criminality to any other federal or state law enforcement agency that
the inspector deems appropriate under the circumstances;
S 9. The public health law is amended by adding a new section 32-a to
read as follows:
S 32-A. FUNCTIONS, DUTIES AND RESPONSIBILITIES REGARDING INVESTI-
GATIONS OF WELFARE FRAUD. 1. THE INSPECTOR SHALL APPOINT A DEPUTY
INSPECTOR GENERAL FOR SOCIAL SERVICES INVESTIGATIONS; PROVIDED, HOWEVER,
THAT A PERSON WHO IS SERVING AS THE WELFARE INSPECTOR GENERAL, AS A
RESULT OF AN APPOINTMENT BY THE GOVERNOR AND APPROVAL BY THE SENATE, ON
THE EFFECTIVE DATE OF THIS SECTION, SHALL BECOME THE DEPUTY INSPECTOR
GENERAL FOR SOCIAL SERVICES INVESTIGATIONS AND CONTINUE IN THAT ROLE
WITH THE SUPPORT OF AND IN COLLABORATION WITH THE INSPECTOR, THROUGH THE
WELFARE INSPECTOR GENERAL'S TERM, OR UNTIL HIS OR HER RESIGNATION FROM
OFFICE OR HIS OR HER REMOVAL FROM OFFICE FOR NEGLECT OR MALFEASANCE BY
THE SENATE UPON A VOTE OF TWO-THIRDS OF ITS MEMBERS.
2. THE INSPECTOR SHALL, WITHIN AMOUNTS APPROPRIATED THEREFOR, APPOINT
SUCH DIRECTORS, ASSISTANTS AND OTHER OFFICERS AND EMPLOYEES AS MAY BE
NEEDED FOR THE PERFORMANCE OF THE DUTIES SET FORTH IN THIS SECTION;
PROVIDED, HOWEVER, THAT ANY NECESSARY OFFICERS AND EMPLOYEES WHO ARE
SUBSTANTIALLY ENGAGED IN THE PERFORMANCE OF THE FUNCTIONS OF THE OFFICE
S. 58--A 36 A. 158--A
OF THE WELFARE INSPECTOR GENERAL ON THE EFFECTIVE DATE OF THIS SECTION
SHALL BE DEEMED EMPLOYEES OF THE OFFICE OF THE MEDICAID INSPECTOR GENER-
AL. IN ACCORDANCE WITH SUBDIVISION TWO OF SECTION SEVENTY OF THE CIVIL
SERVICE LAW, OFFICERS AND EMPLOYEES SO TRANSFERRED SHALL BE TRANSFERRED
WITHOUT FURTHER EXAMINATION OR QUALIFICATION AND SHALL RETAIN THEIR
RESPECTIVE CIVIL SERVICE CLASSIFICATIONS AND STATUS.
3. THE INSPECTOR, THROUGH THE DEPUTY INSPECTOR GENERAL FOR SOCIAL
SERVICES INVESTIGATIONS, AS SET FORTH IN SUBDIVISION TWO OF THIS
SECTION, SHALL HAVE THE FOLLOWING FUNCTIONS, DUTIES AND RESPONSIBIL-
ITIES:
(A) TO CONDUCT AND SUPERVISE INVESTIGATIONS OF FRAUD, ABUSE OR ILLEGAL
ACTS RELATING TO THE PROGRAMS DESCRIBED IN SUBDIVISION TWO OF SECTION
THIRTY-A OF THIS ARTICLE;
(B) TO THE GREATEST EXTENT POSSIBLE, TO COORDINATE ITS INVESTIGATIVE
ACTIVITIES WITH THE COMMISSIONER, THE DEPUTY ATTORNEY GENERAL FOR MEDI-
CAID FRAUD CONTROL OR SUCH OTHER PERSON DESIGNATED BY THE ATTORNEY
GENERAL, THE COMMISSIONER OF THE OFFICE OF TEMPORARY AND DISABILITY
ASSISTANCE, THE COMMISSIONER OF THE OFFICE OF CHILDREN AND FAMILY
SERVICES, THE COMMISSIONER OF EDUCATION, THE COMMISSIONER OF LABOR, THE
FISCAL AGENT EMPLOYED TO OPERATE THE MEDICAID MANAGEMENT INFORMATION
SYSTEM AND THE STATE COMPTROLLER;
(C) TO MAKE INFORMATION AND EVIDENCE RELATING TO CRIMINAL ACTS WHICH
HE OR SHE MAY OBTAIN AVAILABLE TO APPROPRIATE LAW ENFORCEMENT OFFICIALS
AND TO CONSULT WITH LOCAL DISTRICT ATTORNEYS AND, WHERE APPROPRIATE, THE
DEPUTY ATTORNEY GENERAL FOR MEDICAID FRAUD OR SUCH OTHER PERSON DESIG-
NATED BY THE ATTORNEY GENERAL, IN ADDITION TO FEDERAL OFFICIALS, TO
COORDINATE INVESTIGATIONS AND CRIMINAL PROSECUTIONS;
(D) TO SUBPOENA WITNESSES, ADMINISTER OATHS OR AFFIRMATIONS, TAKE
TESTIMONY AND COMPEL THE PRODUCTION OF SUCH BOOKS, PAPERS, RECORDS AND
DOCUMENTS AS HE OR SHE MAY DEEM TO BE RELEVANT TO AN INVESTIGATION
UNDERTAKEN PURSUANT TO THIS SECTION;
(E) TO KEEP THE GOVERNOR, ATTORNEY GENERAL, STATE COMPTROLLER, TEMPO-
RARY PRESIDENT OF THE SENATE AND THE MINORITY LEADER OF THE SENATE, THE
SPEAKER OF THE ASSEMBLY AND THE MINORITY AND MAJORITY LEADERS OF THE
ASSEMBLY, APPRISED OF FRAUD AND ABUSE IN SOCIAL SERVICES PROGRAMS AND
EXPENDITURES;
(F) TO RECOMMEND POLICIES RELATING TO THE PREVENTION AND DETECTION OF
FRAUD AND ABUSE OR THE IDENTIFICATION AND PROSECUTION OF PARTICIPANTS IN
SUCH FRAUD AND ABUSE;
(G) TO MONITOR THE IMPLEMENTATION BY THE RELEVANT OFFICE OF HIS OR HER
RECOMMENDATIONS AND THOSE OF OTHER INVESTIGATIVE AGENCIES; AND
(H) TO RECEIVE COMPLAINTS OF ALLEGED FAILURES OF STATE AND LOCAL OFFI-
CIALS TO PREVENT, DETECT AND PROSECUTE FRAUD AND ABUSE IN SOCIAL
SERVICES PROGRAMS AND EXPENDITURES.
4. (A) IN ADDITION TO THE AUTHORITY OTHERWISE PROVIDED BY THIS
SECTION, IN CARRYING OUT THE PROVISIONS OF THIS SECTION, THE INSPECTOR
AND THE DEPUTY INSPECTOR GENERAL FOR SOCIAL SERVICES INVESTIGATIONS, AS
SET FORTH IN SUBDIVISION TWO OF THIS SECTION, ARE AUTHORIZED:
(I) TO HAVE FULL AND UNRESTRICTED ACCESS TO ALL RECORDS, REPORTS,
AUDITS, REVIEWS, DOCUMENTS, PAPERS, RECOMMENDATIONS OR OTHER MATERIAL
AVAILABLE TO THE DEPARTMENT, THE OFFICE OF TEMPORARY AND DISABILITY
ASSISTANCE, THE OFFICE OF CHILDREN AND FAMILY SERVICES, THE DEPARTMENT
OF LABOR AND LOCAL SOCIAL SERVICES DISTRICTS RELATING TO PROGRAMS AND
OPERATIONS AS DESCRIBED IN SUBDIVISION TWO OF SECTION THIRTY-A OF THIS
ARTICLE;
S. 58--A 37 A. 158--A
(II) TO MAKE SUCH INVESTIGATIONS RELATING TO THE ADMINISTRATION OF
SOCIAL SERVICES PROGRAMS AND EXPENDITURES AS ARE, IN THE JUDGMENT OF THE
INSPECTOR, NECESSARY OR DESIRABLE; AND
(III) TO REQUEST SUCH INFORMATION, ASSISTANCE AND COOPERATION FROM ANY
FEDERAL, STATE OR LOCAL GOVERNMENTAL DEPARTMENT, BOARD, BUREAU, COMMIS-
SION, OR OTHER AGENCY OR UNIT THEREOF AS MAY BE NECESSARY FOR CARRYING
OUT THE DUTIES AND RESPONSIBILITIES ENJOINED UPON THEM BY THIS SECTION.
STATE AND LOCAL AGENCIES OR UNITS THEREOF ARE HEREBY AUTHORIZED AND
DIRECTED TO PROVIDE SUCH INFORMATION, ASSISTANCE AND COOPERATION.
(B) NOTWITHSTANDING ANY OTHER PROVISION OF LAW, RULE OR REGULATION TO
THE CONTRARY, NO PERSON SHALL PREVENT, SEEK TO PREVENT, INTERFERE WITH,
OBSTRUCT OR OTHERWISE HINDER ANY INVESTIGATION BEING CONDUCTED PURSUANT
TO THIS SECTION. SECTION ONE HUNDRED THIRTY-SIX OF THE SOCIAL SERVICES
LAW SHALL IN NO WAY BE CONSTRUED TO RESTRICT ANY PERSON OR GOVERNMENTAL
BODY FROM COOPERATING AND ASSISTING THE INSPECTOR OR HIS OR HER EMPLOY-
EES IN CARRYING OUT THEIR DUTIES UNDER THIS SECTION. ANY VIOLATION OF
THIS PARAGRAPH SHALL CONSTITUTE CAUSE FOR SUSPENSION OR REMOVAL FROM
OFFICE OR EMPLOYMENT.
5. THE INSPECTOR, IN CONSULTATION WITH THE DEPUTY INSPECTOR GENERAL
FOR SOCIAL SERVICES INVESTIGATIONS, SHALL, NO LATER THAN OCTOBER FIRST
OF EACH YEAR SUBMIT TO THE GOVERNOR, THE STATE COMPTROLLER, THE ATTORNEY
GENERAL AND THE LEGISLATURE A REPORT SUMMARIZING THE ACTIVITIES OF THE
OFFICE DURING THE PRECEDING CALENDAR YEAR WITH RESPECT TO ITS RESPONSI-
BILITIES UNDER THIS SECTION.
6. (A) THE INSPECTOR AND THE DEPUTY INSPECTOR GENERAL FOR SOCIAL
SERVICES INVESTIGATIONS SHALL NOT PUBLICLY DISCLOSE INFORMATION WHICH
IS:
(I) A PART OF ANY ONGOING INVESTIGATION; OR
(II) SPECIFICALLY PROHIBITED FROM DISCLOSURE BY ANY OTHER PROVISION OF
LAW.
(B) NOTWITHSTANDING PARAGRAPH (A) OF THIS SUBDIVISION, ANY REPORT
UNDER THIS SECTION MAY BE DISCLOSED TO THE PUBLIC IN A FORM WHICH
INCLUDES INFORMATION WITH RESPECT TO A PART OF AN ONGOING CRIMINAL
INVESTIGATION IF SUCH INFORMATION HAS BEEN INCLUDED IN A PUBLIC RECORD.
7. WITH THE EXCEPTION OF ANY DOCUMENTS OR RECORDS REQUIRED BY THE
ATTORNEY GENERAL PURSUANT TO SUBDIVISION EIGHT OF THIS SECTION, ANY
DOCUMENTS AND RECORDS RELEVANT AND NECESSARY AND RELATED TO THE TRANSFER
OF FUNCTIONS FROM THE OFFICE OF THE WELFARE INSPECTOR GENERAL SHALL BE
TRANSFERRED TO THE OFFICE OF THE MEDICAID INSPECTOR GENERAL.
8. IF, PRIOR TO THE EFFECTIVE DATE OF THIS SECTION, THE WELFARE
INSPECTOR GENERAL HAS COMMENCED A CRIMINAL PROCEEDING AGAINST ANY
PERSON, PROSECUTION OF SUCH A CASE SHALL BECOME THE RESPONSIBILITY OF
THE ATTORNEY GENERAL; PROVIDED, HOWEVER, THAT THE WELFARE INSPECTOR
GENERAL MAY CONTINUE TO ASSIST IN THE PROSECUTION OF THE CASE AS A
SPECIAL ASSISTANT ATTORNEY GENERAL, AT THE DISCRETION OF THE ATTORNEY
GENERAL. FOR PURPOSES OF THIS SUBDIVISION, A CRIMINAL PROCEEDING HAS
BEEN COMMENCED WHEN CRIMINAL CHARGES ARE PENDING IN ANY COURT OR A GRAND
JURY HAS COMMENCED AN INVESTIGATION OF THE MATTER.
9. THE DIRECTOR OF THE BUDGET IS HEREBY AUTHORIZED TO TRANSFER TO THE
OFFICE OF THE MEDICAID INSPECTOR GENERAL, FOR USE BY THE OFFICE, FUNDS
OTHERWISE APPROPRIATED OR REAPPROPRIATED TO THE OFFICE OF THE WELFARE
INSPECTOR GENERAL CONSISTENT WITH THE PURPOSES OF THIS SECTION.
10. ALL RULES, REGULATIONS, ACTS, DETERMINATIONS AND DECISIONS OF THE
WELFARE INSPECTOR GENERAL WITH RESPECT TO THE FUNCTIONS, POWERS, DUTIES,
AND OBLIGATIONS OF THE OFFICE OF THE WELFARE INSPECTOR GENERAL IN EFFECT
ON THE EFFECTIVE DATE OF THIS SECTION SHALL CONTINUE IN FULL FORCE AND
S. 58--A 38 A. 158--A
EFFECT AS RULES, REGULATIONS, ACTS, DETERMINATIONS AND DECISIONS OF THE
MEDICAID INSPECTOR GENERAL UNTIL AMENDED OR REVISED BY THE MEDICAID
INSPECTOR GENERAL.
S 10. 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, is
amended to read as follows:
2. section two of this act shall expire and be deemed repealed on
March 31, [2010] 2013;
S 11. Paragraph (e-1) of subdivision 12 of section 2808 of the public
health law, as amended by section 64 of part C of chapter 58 of the laws
of 2007, 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 for the state fiscal year beginning April first, two
thousand nine, AND EACH STATE FISCAL YEAR THEREAFTER. The amount allo-
cated 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 representative succeeding year as applicable.
S 12. 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 health care facilities, as amended by section 65
of part C of chapter 58 of the laws of 2007, 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,
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 EACH STATE
FISCAL YEAR THEREAFTER, 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 hospitals located in the county of Westchester,
S. 58--A 39 A. 158--A
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 participation 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 assist-
ance, including disproportionate 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 reconciled 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 initial-
ly 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 recon-
ciled 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 and for
state fiscal years beginning on and after April 1, 2007, based initially
on reported 2000 reconciled data as further reconciled to actual
reported data for 2007, and to actual reported data for each respective
succeeding year. The payments may be added to rates of payment or made
as aggregate payments to an eligible public general hospital.
S 13. Paragraph (b) of subdivision 1 of section 211 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 66
of part C of chapter 58 of the laws of 2007, is amended to read as
follows:
(b) Notwithstanding any inconsistent provision of law or regulation to
the contrary, effective beginning April 1, 2000, the department of
health is authorized to pay public general hospitals, other than those
operated by the state of New York or the state university of New York,
as defined in subdivision 10 of section 2801 of the public health law,
located in a city with a population of over 1 million, additional
initial payments for inpatient hospital services of $120 million during
each state fiscal year until March 31, 2003, and up to $120 million
during the state fiscal year beginning April 1, 2005 through March 31,
2006 and during the state fiscal year beginning April 1, 2006 through
March 31, 2007 and during the state fiscal year beginning April 1, 2007
through March 31, 2008 and during the state fiscal year beginning April
1, 2008 through March 31, 2009, AND EACH STATE FISCAL YEAR THEREAFTER,
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 based on the relative share
of each such non-state operated public general hospital of medical
assistance and uninsured patient losses after all other medical assist-
S. 58--A 40 A. 158--A
ance, including disproportionate share payments to such public general
hospitals for payments made during the state fiscal year ending March
31, 2001, based initially on reported 1995 reconciled data as further
reconciled to actual reported 2000 or 2001 data, for payments made
during the state fiscal year ending March 31, 2002, based initially on
reported 1995 reconciled data as further reconciled to actual reported
2001 or 2002 data, for payments made during the state fiscal year ending
March 31, 2003, based initially on reported 2000 reconciled data as
further reconciled to actual reported 2002 or 2003 data, for payments
made during the state fiscal year ending on and after March 31, 2006,
based initially on reported 2000 reconciled data as further reconciled
to actual reported 2005 or 2006 data, for payments made during the state
fiscal year ending on and after March 31, 2007, based initially on
reported 2000 reconciled data as further reconciled to actual reported
2006 or 2007 data for payments made during the state fiscal years ending
on and after March 31, 2008, based initially on reported 2000 reconciled
data as further reconciled to actual reported 2007 or 2008 data, and to
actual reported data for each respective succeeding year. The payments
may be added to rates of payment or made as aggregate payments to an
eligible public general hospital.
S 14. 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 68
of part C of chapter 58 of the laws of 2007, 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, AND
(b) [sections four through ten shall expire on June 30, 2009, 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 15. Subdivisions 2 and 4 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 69 of part C of
chapter 58 of the laws of 2007, are 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;
4. Section one 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.
S 16. Subparagraph (iii) of paragraph (f) of subdivision 4 of section
2807-c of the public health law, as amended by section 70 of part C of
chapter 58 of the laws of 2007, is amended to read as follows:
(iii) commencing April first, nineteen hundred ninety-seven through
March thirty-first, nineteen hundred ninety-nine and commencing July
S. 58--A 41 A. 158--A
first, nineteen hundred ninety-nine through March thirty-first, two
thousand and April first, two thousand through March thirty-first, two
thousand five and for periods commencing April first, two thousand five
through March thirty-first, two thousand six and for periods commencing
on and after April first, two thousand six through March thirty-first,
two thousand seven, and for periods commencing on and after April first,
two thousand seven through March thirty-first, two thousand nine, AND
FOR PERIODS COMMENCING ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, the
reimbursable inpatient operating cost component of case based rates of
payment per diagnosis-related group, excluding any operating cost compo-
nents related to direct and indirect expenses of graduate medical educa-
tion, for patients eligible for payments made by state governmental
agencies shall be reduced by three and thirty-three hundredths percent
to encourage improved productivity and efficiency. Such election shall
not alter the calculation of the group price component calculated pursu-
ant to subparagraph (i) of paragraph (a) of subdivision seven of this
section;
S 17. Subparagraph (iii) of paragraph (k) of subdivision 4 of section
2807-c of the public health law, as amended by section 71 of part C of
chapter 58 of the laws of 2007, is amended to read as follows:
(iii) commencing April first, nineteen hundred ninety-seven through
March thirty-first, nineteen hundred ninety-nine and commencing July
first, nineteen hundred ninety-nine through March thirty-first, two
thousand and April first, two thousand through March thirty-first, two
thousand five and commencing April first, two thousand five through
March thirty-first, two thousand six, and for periods commencing on and
after April first, two thousand six through March thirty-first, two
thousand seven, and for periods commencing on and after April first, two
thousand seven through March thirty-first, two thousand nine, AND FOR
PERIODS COMMENCING ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, the
operating cost component of rates of payment, excluding any operating
cost components related to direct and indirect expenses of graduate
medical education, for patients eligible for payments made by a state
governmental agency shall be reduced by three and thirty-three
hundredths percent to encourage improved productivity and efficiency.
The facility will be eligible to receive the financial incentives for
the physician specialty weighting incentive towards primary care pursu-
ant to subparagraph (ii) of paragraph (a) of subdivision twenty-five of
this section.
S 18. The opening paragraph of subparagraph (vi) of paragraph (b) of
subdivision 5 of section 2807-c of the public health law, as amended by
section 72 of part C of chapter 58 of the laws of 2007, is amended to
read as follows:
for discharges on or after April first, nineteen hundred ninety-seven
through March thirty-first, nineteen hundred ninety-nine and for
discharges on or after July first, nineteen hundred ninety-nine through
March thirty-first, two thousand and for discharges on or after April
first, two thousand through March thirty-first, two thousand five and
for discharges on or after April first, two thousand five through March
thirty-first, two thousand six, and for discharges on or after April
first, two thousand six through March thirty-first, two thousand seven,
and for discharges on or after April first, two thousand seven through
March thirty-first, two thousand nine, AND FOR DISCHARGES ON OR AFTER
APRIL FIRST, TWO THOUSAND NINE, for purposes of reimbursement of inpa-
tient hospital services for patients eligible for payments made by state
governmental agencies, the average reimbursable inpatient operating cost
S. 58--A 42 A. 158--A
per discharge of a general hospital shall, to encourage improved produc-
tivity and efficiency, be the sum of:
S 19. The opening paragraph and subparagraph (i) of paragraph (c) of
subdivision 5 of section 2807-c of the public health law, as amended by
section 73 of part C of chapter 58 of the laws of 2007, are amended to
read as follows:
Notwithstanding any inconsistent provision of this section, commencing
July first, nineteen hundred ninety-six through March thirty-first,
nineteen hundred ninety-nine and July first, nineteen hundred ninety-
nine through March thirty-first, two thousand and April first, two thou-
sand through March thirty-first, two thousand five and for periods on
and after April first, two thousand five through March thirty-first, two
thousand six, and for periods on and after April first, two thousand six
through March thirty-first, two thousand seven, and for periods on and
after April first, two thousand seven through March thirty-first, two
thousand nine, AND FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND
NINE, rates of payment for a general hospital for patients eligible for
payments made by state governmental agencies shall be further reduced by
the commissioner to encourage improved productivity and efficiency by
providers by a factor determined as follows:
(i) an aggregate reduction shall be calculated for each general hospi-
tal commencing July first, nineteen hundred ninety-six through March
thirty-first, nineteen hundred ninety-nine and July first, nineteen
hundred ninety-nine through March thirty-first, two thousand and April
first, two thousand through March thirty-first, two thousand five and
for periods on and after April first, two thousand five through March
thirty-first, two thousand six, and for periods on and after April
first, two thousand six through March thirty-first, two thousand seven,
and for periods on and after April first, two thousand seven through
March thirty-first, two thousand nine, AND FOR PERIODS ON AND AFTER
APRIL FIRST, TWO THOUSAND NINE, as the result of (A) eighty-nine million
dollars on an annualized basis for each year, multiplied by (B) the
ratio of patient days for patients eligible for payments made by state
governmental agencies provided in a base year two years prior to the
rate year by a general hospital, divided by the total of such patient
days summed for all general hospitals; and
S 20. Clause (B-1) of subparagraph (i) of paragraph (f) of subdivision
11 of section 2807-c of the public health law, as amended by section 74
of part C of chapter 58 of the laws of 2007, is amended to read as
follows:
(B-1) The increase in the statewide average case mix in the periods
January first, nineteen hundred ninety-seven through March thirty-first,
two thousand and on and after April first, two thousand through March
thirty-first, two thousand six and on and after April first, two thou-
sand 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, from the
statewide average case mix for the period January first, nineteen
hundred ninety-six through December thirty-first, nineteen hundred nine-
ty-six shall not exceed one percent for nineteen hundred ninety-seven,
two percent for nineteen hundred ninety-eight, three percent for the
period January first, nineteen hundred ninety-nine through September
thirtieth, nineteen hundred ninety-nine, four percent for the period
October first, nineteen hundred ninety-nine through December thirty-
first, nineteen hundred ninety-nine, and four percent for two thousand
plus an additional one percent per year thereafter, based on comparison
S. 58--A 43 A. 158--A
of data only for patients that are eligible for medical assistance
pursuant to title eleven of article five of the social services law,
including such patients enrolled in health maintenance organizations.
S 21. Subdivision 1 of section 46 of chapter 639 of the laws of 1996
amending the public health law and other laws relating to welfare
reform, as amended by section 75 of part C of chapter 58 of the laws of
2007, is amended to read as follows:
1. Notwithstanding any inconsistent provision of law or regulation to
the contrary, 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 general hospitals
for reimbursement of inpatient hospital services provided to patients
eligible for payments made by state governmental agencies on and after
April 1, 1996 through June 30, 1996 and on or after July 1, 1996 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, 2005 and on and after April
1, 2005 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, shall reflect no trend factor projec-
tions or adjustments for the period April 1, 1996, through March 31,
1997.
S 22. Section 4 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 76 of part C of chapter 58 of the laws of
2007, is amended to read as follows:
S 4. Notwithstanding any inconsistent provision of law, except subdi-
vision 15 of section 2807 of the public health law and section 364-j-2
of the social services law and section 32-g of part F of chapter 412 of
the laws of 1999, rates of payment for diagnostic and treatment centers
established in accordance with paragraphs (b) and (h) of subdivision 2
of section 2807 of the public health law for the period ending September
30, 1995 shall continue in effect through September 30, 2000 and for the
periods October 1, 2000 through September 30, 2003 and October 1, 2003
through September 30, 2007 and October 1, 2007 through September 30,
2009, AND ON AND AFTER OCTOBER 1, 2009, and further provided that rates
in effect on March 31, 2003 as established in accordance with paragraph
(e) of subdivision 2 of section 2807 of the public health law shall
continue in effect for the period April 1, 2003 through September 30,
2007 and October 1, 2007 through September 30, 2009, AND ON AND AFTER
OCTOBER 1, 2009, provided however that, subject to the approval of the
director of the budget, such rates may be adjusted to include expendi-
tures in those components of rates not subject to the ceilings of the
corresponding rate methodology.
S 23. Subdivision 5 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 77 of part C of
chapter 58 of the laws of 2007, is amended to read as follows:
5. Section three 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;
S 24. Section 194 of chapter 474 of the laws of 1996, amending the
education law and other laws relating to rates of residential health
S. 58--A 44 A. 158--A
care facilities, as amended by section 78 of part C of chapter 58 of the
laws of 2007, 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 shall reflect no trend factor projections or adjust-
ments 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 25. 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 major components of legislation necessary to implement the
health and mental hygiene budget for the 2007-2008 fiscal year, 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 for inpa-
tient and outpatient services provided by general hospitals and for
inpatient services and outpatient adult day health care services
provided by residential 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 January 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 26. 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 79 of
part C of chapter 58 of the laws of 2007, 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 [and], February 1, 2009 AND FEBRUARY 1 OF EACH YEAR
THEREAFTER 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
S. 58--A 45 A. 158--A
respectively, based on such data for such period. This value shall be
called the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and],
2009 AND EACH YEAR THEREAFTER statewide target percentage respectively.
S 27. 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 80 of part C of chapter 58 of the laws of 2007, is
amended to read as follows:
(ii) If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008 [and], 2009, AND EACH YEAR THEREAFTER statewide target
percentages are not for each year at least three percentage points high-
er 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 state-
wide base percentage. The percentage calculated pursuant to this para-
graph shall be called the 1997, 1998, 2000, 2001, 2002, 2003, 2004,
2005, 2006, 2007, 2008 [and], 2009, AND EACH YEAR THEREAFTER statewide
reduction percentage respectively. If the 1997, 1998, 2000, 2001, 2002,
2003, 2004, 2005, 2006, 2007, 2008 [and], 2009, AND EACH YEAR THEREAFTER
statewide target percentage for the respective year is at least three
percentage points higher than the statewide base percentage, the state-
wide reduction percentage for the respective year shall be zero.
S 28. 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 81 of part C of chapter 58 of the laws of 2007, is
amended to read as follows:
(iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008
[and], 2009, AND EACH YEAR THEREAFTER 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
[and], 2009, AND EACH YEAR THEREAFTER statewide aggregate reduction
amount. If the 1998 and the 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008 [and], 2009, AND EACH YEAR THEREAFTER statewide reduction
percentage shall be zero respectively, there shall be no 1998, 2000,
2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and], 2009, AND EACH
YEAR THEREAFTER reduction amount.
S 29. 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 82 of
part C of chapter 58 of the laws of 2007, is amended to read as follows:
(b) The 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008 [and], 2009, AND EACH YEAR THEREAFTER statewide aggre-
gate reduction amounts shall for each year be allocated by the commis-
sioner 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 [and], 2009, AND EACH YEAR THEREAFTER
target percentage and a two and one-quarter percentage point increase in
the 1999 target percentage for each year, compared to the base percent-
age, calculated on a facility specific basis for this purpose, compared
to the statewide total of the extent of each facility's failure to
S. 58--A 46 A. 158--A
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 [and], 2009,
AND EACH YEAR THEREAFTER target percentage compared to the base percent-
age. These amounts shall be called the 1996, 1997, 1998, 1999, 2000,
2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and], 2009, AND EACH
YEAR THEREAFTER facility specific reduction amounts respectively.
S 30. 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 85 of part C of chapter 58 of the
laws of 2007, 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
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 EACH YEAR THEREAFTER THE TARGET PERIOD SHALL BE JANUARY 1
THROUGH NOVEMBER 30, FOR THAT RESPECTIVE YEAR.
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.
S. 58--A 47 A. 158--A
(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, and prior to February 1, 2007, and
prior to February 1, 2008 and prior to February 1, 2009, AND PRIOR TO
FEBRUARY 1 OF EACH YEAR THEREAFTER for each regional group the commis-
sioner 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 [and], 2009, AND EACH YEAR THEREAFTER for each regional group, the
target medicaid revenue percentage for the respective year shall be
calculated by subtracting the respective year's medicaid revenue
reduction percentage from the base period medicaid revenue percentage.
The medicaid revenue reduction percentages for 1997, 1998, 2000, 2001,
2002, 2003, 2004, 2005, 2006, 2007, 2008 [and], 2009, AND EACH YEAR
THEREAFTER 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
S. 58--A 48 A. 158--A
(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 [and], 2009, AND EACH YEAR THEREAFTER 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 respec-
tive year's medicaid revenue percentage to such respective year's target
medicaid revenue percentage to determine the amount of the shortfall
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;
(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 [and], 2009, AND EACH YEAR THEREAFTER 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.
S. 58--A 49 A. 158--A
(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 [and], 2009, AND EACH YEAR THEREAFTER 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 LTHHCP's fail-
ure to achieve the target medicaid revenue percentage for the applicable
year within the applicable regional group. This proportion shall be
multiplied by the applicable year's state share reduction amount calcu-
lation 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 [and], 2009,
AND EACH YEAR THEREAFTER 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
S. 58--A 50 A. 158--A
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
of the assembly ways and means committee of the results of the calcu-
lations pursuant to this section.
S 31. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the annual percentage reductions set forth in sections twenty-
six through thirty of this act shall be prorated by the commissioner of
health for periods on and after April 1, 2009.
S 32. 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 86 of part C of
chapter 58 of the laws of 2007, 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;
S 33. 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 87 of part C of chapter 58 of the
laws of 2007, 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
S. 58--A 51 A. 158--A
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.
S 34. Paragraph (s-8) of subdivision 11 of section 2807-c of the
public health law, as amended by section 57 of part C of chapter 58 of
the laws of 2008, is amended to read as follows:
(s-8) To the extent funds are available and otherwise notwithstanding
any inconsistent provision of law to the contrary, for rate periods on
and after April first, two thousand seven through [March thirty-first]
JUNE THIRTIETH, two thousand nine, the commissioner shall increase rates
of payment for patients eligible for payments made by state governmental
agencies by an amount not to exceed sixty million dollars annually in
the aggregate. Such amount shall be allocated among those voluntary
non-profit general hospitals which continue to provide inpatient
services as of April first, two thousand seven through March thirty-
first, two thousand eight and which have medicaid inpatient discharges
percentages equal to or greater than thirty-five percent. This percent-
age shall be computed based upon data reported to the department in each
hospital's two thousand four institutional cost report, as submitted to
the department on or before January first, two thousand seven. The rate
adjustments calculated in accordance with this paragraph shall be allo-
cated proportionally based on each eligible hospital's total reported
medicaid inpatient discharges in two thousand four, to the total
reported medicaid inpatient discharges for all such eligible hospitals
in two thousand four, provided, however, that such rate adjustments
shall be subject to reconciliation to ensure that each hospital receives
in the aggregate its proportionate share of the full allocation to the
extent allowable under federal law. Such payments may be added to rates
of payment or made as aggregate payments to eligible hospitals,
provided, however, that subject to the availability of federal financial
participation and solely for the period April first, two thousand seven
through March thirty-first, two thousand eight, six million dollars in
the aggregate of this sixty million dollars shall be allocated to volun-
tary non-profit hospitals which continue to provide inpatient services
as of April first, two thousand seven through March thirty-first, two
thousand eight and which have Medicaid inpatient discharge percentages
of less than thirty-five percent and which had previously qualified for
distributions pursuant to paragraph (s-7) of this subdivision. The rate
adjustment calculated in accordance with this paragraph shall be allo-
cated proportionally based on the amount of money the hospital had
received in two thousand six.
S 35. Section 3 of chapter 629 of the laws of 1986, amending the
social services law relating to establishing a demonstration program for
the delivery of long term home health care services to certain persons,
as amended by section 71 of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
S 3. This act shall take effect July 1, 1986, and shall remain in
effect until March 31, [2012] 2013, when upon such date the provisions
of this act shall be deemed repealed.
S 36. Subdivision 1 of section 2807-p of the public health law is
amended by adding two new paragraphs (c) and (d) to read as follows:
(C) NOTWITHSTANDING PARAGRAPH (A) OF THIS SUBDIVISION, SUBDIVISION
FOUR-C OF THIS SECTION OR ANY OTHER INCONSISTENT PROVISION OF THIS
SECTION, DISTRIBUTIONS MADE PURSUANT TO THIS SECTION FOR ANNUAL PERIODS
ON AND AFTER JULY FIRST, TWO THOUSAND NINE SHALL BE SUBJECT TO A UNIFORM
REDUCTION OF TWO PERCENT.
S. 58--A 52 A. 158--A
(D) THE COMMISSIONER MAY REQUIRE FACILITIES RECEIVING DISTRIBUTIONS
PURSUANT TO THIS SECTION AS A CONDITION OF PARTICIPATING IN SUCH
DISTRIBUTIONS, TO PROVIDE REPORTS AND DATA TO THE DEPARTMENT AS THE
COMMISSIONER DEEMS NECESSARY TO ADEQUATELY IMPLEMENT THE PROVISIONS OF
THIS SECTION.
S 37. Subdivision 6-a 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 major components of legislation necessary to implement the
health and mental hygiene budget for the 2007-2008 fiscal year, is
amended to read as follows:
6-a. section fifty-seven of this act shall expire and be deemed
repealed on [March] DECEMBER 31, [2010] 2013; provided that such section
shall not apply to any person as to whom federal financial participation
is available for the costs of services provided 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 38. 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, 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, [2009]
2011;
S 39. Subdivision (r) of section 427 of chapter 55 of the laws of
1992, amending the tax law and other laws relating to taxes, surcharges,
fees and funding, as amended by section 15 of part C of chapter 56 of
the laws of 2007, is amended to read as follows:
(r) the provisions of sections two hundred eighty-six through two
hundred ninety-one of this act shall apply to all persons released on
medical parole prior to September 1, [2009] 2011, and shall expire and
be of no further effect on September 1, [2009] 2011;
S 40. Section 3 of chapter 942 of the laws of 1983, relating to foster
family care demonstration programs, as amended by chapter 219 of the
laws of 2007, is amended to read as follows:
S 3. This act shall take effect immediately and shall expire December
31, [2009] 2013.
S 41. Section 3 of chapter 541 of the laws of 1984, relating to foster
family care demonstration programs, as amended by chapter 219 of the
laws of 2007, is amended to read as follows:
S 3. This section and subdivision two of section two of this act shall
take effect immediately and the remaining provisions of this act shall
take effect on the one hundred twentieth day next thereafter. This act
shall expire December 31, [2009] 2013.
S 42. Section 6 of chapter 256 of the laws of 1985, amending the
social services law and other laws relating to foster family care demon-
stration programs, as amended by chapter 219 of the laws of 2007, is
amended to read as follows:
S 6. This act shall take effect immediately and shall expire December
31, [2009] 2013 and upon such date the provisions of this act shall be
deemed to be repealed.
S 43. Section 2 of chapter 693 of the laws of 1996, amending the
social services law relating to authorizing patient discharge to hospic-
es and residential health care facilities, under the medical assistance
presumptive eligibility program, as amended by chapter 124 of the laws
of 2006, is amended to read as follows:
S. 58--A 53 A. 158--A
S 2. This act shall take effect immediately and shall be deemed
repealed on July 31, [2009] 2012.
S 44. Section 2 of chapter 631 of the laws of 1997, amending the
social services law relating to authorizing medical assistance payments
to certain clinics or diagnostic and treatment centers, as amended by
chapter 47 of the laws of 2007, is amended to read as follows:
S 2. This act shall take effect immediately and shall be deemed to
apply to claims for reimbursement payments whether submitted before, on
or after the effective date of this act, and shall expire and be deemed
repealed July 1, [2009] 2011.
S 45. Section 4 of chapter 519 of the laws of 1999, amending the alco-
holic beverage control law and the public health law relating to the
sale of alcohol and tobacco products to minors, as amended by chapter
594 of the laws of 2007, is amended to read as follows:
S 4. This act shall take effect September 1, 1999[, and shall remain
in full force and effect until January 1, 2010 when upon such date the
provisions of this act shall expire and be deemed repealed]; provided,
however, the state liquor authority, state department of motor vehicles
and state department of health shall promulgate rules and regulations
necessary to implement the provisions of this act on or before such
date; [provided further that the provisions of this act shall apply
after such expiration date to any proceeding pursuant to the alcoholic
beverage control law or public health law to invoke or enforce the
provisions of this act which were commenced prior to such expiration
date;] and provided, further however, that the amendments to section
65-b of the alcoholic beverage control law made by section two of this
act shall not affect the repeal of such section and shall be deemed
repealed therewith.
S 46. The opening paragraph of subdivision 7-a of section 3614 of the
public health law, as amended by section 89 of part C of chapter 58 of
the laws of 2007, 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, 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 47. This act shall take effect immediately; provided, however, that
the amendments to section 2807-c of the public health law made by
sections sixteen, seventeen, eighteen, and nineteen of this act shall
not affect the expiration of such provisions and shall be deemed to
expire therewith.
PART C
Section 1. Legislative intent. (a) The legislature finds that New York
leads the nation in Medicaid spending per capita and ranks third highest
in overall health care spending per capita. Despite this extraordinary
level of spending, 2.3 million New Yorkers are uninsured and New York's
health care system is ranked average among states and below average on
hospitalizations that could have been avoided if patients had timely
S. 58--A 54 A. 158--A
access to quality outpatient care. It is the intent of this legislation
to ensure that New Yorkers have access to a high-performing health
system and that New York Medicaid buys quality, cost-effective care by:
implementing a transparent and accurate inpatient reimbursement system
that rewards quality and efficiency; investing in ambulatory care
services and supporting the development of health care homes; supporting
providers that serve uninsured patients; increasing affordable coverage
in partnership with the federal government; investing in health informa-
tion technology; and more effectively and efficiently managing pharma-
ceutical benefits.
(b) With respect to improper influences exerted on prescribing deci-
sions and the lack of transparency in the administration of pharmacy
benefits by pharmacy benefit managers, the legislature finds that:
i. The pharmaceutical, biological product and medical device indus-
tries spend billions of dollars annually to attempt to influence pres-
cribers' decisions about which drugs or other treatment to prescribe to
their patients, including more than half of all formal continuing
medical education programs. Legislation is necessary to prohibit drug
and device manufacturers from making payments to prescribers in an
attempt to influence their prescribing decisions and further to require
prescribers and manufacturers to disclose the things of value that are
legitimately transferred from drug and device manufacturers to prescri-
bers.
ii. There is compelling evidence that the vast majority of physicians
accept some type of gift or payment from pharmaceutical and medical
device manufacturers, and often such gifts and payments, even when of
little value, influence physicians to prescribe treatments that are more
expensive and no more effective or safe, and are sometimes less effec-
tive and more dangerous, than other available treatments.
iii. Legislation is necessary to prohibit presenters at continuing
professional education programs from providing false or misleading
information to prescribers and to require all potential conflicts of
interest be disclosed to attendees of such programs.
iv. Drug manufacturers, including labelers, make payments to pharmacy
benefit managers and their affiliates in an effort to influence the
drugs covered by the health plans which contract with the pharmacy bene-
fit manager and, therefore, the drugs purchased by the health plans'
participants. Health plans have been unable to obtain from pharmacy
benefit managers information about these payments and other information
material to a health plan's choice of pharmacy benefit manager and to
the health plan's evaluation of the quality and value of the pharmacy
benefit services it receives. Legislation is needed to require pharmacy
benefit managers to disclose to the health plans that contract with them
basic information about their financial dealings that affect the health
plans and their participants.
S 1-a. Short title. This act shall be known and may be cited as the
"health care improvement act".
S 1-b. Subparagraph (ii) of paragraph (a) of subdivision 33 of section
3807-c of the public health law, as added by section 12 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
(ii) for the period April first, two thousand nine through March thir-
ty-first, two thousand ten, such rates shall be revised pursuant to a
chapter of the laws of two thousand nine and as reflecting the findings
and recommendations of the commissioner as issued pursuant to the
provisions of paragraph (b) of this subdivision, provided, however, that
such revisions shall reflect an aggregate reduction in such rates of no
S. 58--A 55 A. 158--A
less than one hundred fifty-four million five hundred thousand dollars,
PROVIDED FURTHER, HOWEVER, THAT, AS DETERMINED BY THE COMMISSIONER, TO
THE EXTENT THAT A CHAPTER OF THE LAWS OF TWO THOUSAND NINE IS NOT
ENACTED RESULTING IN SUCH A AGGREGATE REDUCTION OF NO LESS THAN ONE
HUNDRED FIFTY-FOUR MILLION FIVE HUNDRED THOUSAND DOLLARS IN SUCH RATES,
THE COMMISSIONER SHALL IMPLEMENT A UNIFORM REDUCTION OF SUCH RATES IN
ACCORDANCE WITH THE METHODOLOGY DESCRIBED IN SUBPARAGRAPH (I) OF THIS
PARAGRAPH TO THE EXTENT NECESSARY, AS DETERMINED BY THE COMMISSIONER, TO
ACHIEVE SUCH AN AGGREGATE REDUCTION IN SUCH RATES FOR THE STATE FISCAL
YEAR BEGINNING APRIL FIRST, TWO THOUSAND NINE; and
S 2. Section 2807-c of the public health law is amended by adding a
new subdivision 35 to read as follows:
35. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION, OR ANY
OTHER CONTRARY PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, RATES OF PAYMENT BY GOVERNMENTAL AGEN-
CIES FOR GENERAL HOSPITAL INPATIENT SERVICES WITH REGARD TO DISCHARGES
OCCURRING ON AND AFTER JULY FIRST, TWO THOUSAND NINE SHALL BE IN ACCORD-
ANCE WITH THE FOLLOWING:
(A) FOR PERIODS ON AND AFTER JULY FIRST, TWO THOUSAND NINE THE OPERAT-
ING COST COMPONENT OF SUCH RATES OF PAYMENTS SHALL REFLECT THE USE OF
TWO THOUSAND FIVE OPERATING COSTS AS REPORTED BY EACH FACILITY TO THE
DEPARTMENT PRIOR TO DECEMBER FIRST, TWO THOUSAND EIGHT AND AS OTHERWISE
COMPUTED IN ACCORDANCE WITH THE PROVISIONS OF THIS SUBDIVISION;
(B) THE COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE
EMERGENCY REGULATIONS, ESTABLISHING METHODOLOGIES FOR THE COMPUTATION OF
GENERAL HOSPITAL INPATIENT RATES AND SUCH REGULATIONS SHALL INCLUDE, BUT
NOT BE LIMITED TO, THE FOLLOWING:
(I) THE COMPUTATION OF A CASE MIX NEUTRAL STATEWIDE BASE PRICE APPLI-
CABLE TO EACH RATE PERIOD, BUT EXCLUDING ADJUSTMENTS FOR GRADUATE
MEDICAL EDUCATION COSTS, HIGH COST OUTLIER COSTS AND COST RELATED TO
PATIENT TRANSFERS, AND AS MAY BE PERIODICALLY ADJUSTED TO REFLECT CHANG-
ES IN PROVIDER CODING PATTERNS AND CASE-MIX.
(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 AND CASE-MIX PURPOSES;
(III) SUCH RATES SHALL REFLECT THE APPLICATION OF HOSPITAL SPECIFIC
WAGE EQUALIZATION FACTORS AND POWER EQUALIZATION FACTORS REFLECTING
DIFFERENCES IN WAGE RATES AND UTILITY COSTS;
(IV) SUCH RATES SHALL REFLECT THE UTILIZATION OF THE ALL PATIENT
REFINED (APR) CASE MIX METHODOLOGY, UTILIZING DIAGNOSTIC RELATED GROUPS
WITH ASSIGNED WEIGHTS THAT INCORPORATE DIFFERING LEVELS OF SEVERITY OF
PATIENT CONDITION AND THE ASSOCIATED RISK OF MORTALITY, AND AS MAY BE
PERIODICALLY UPDATED BY THE COMMISSIONER;
(V) SUCH REGULATIONS MAY INCORPORATE QUALITY RELATED MEASURES PERTAIN-
ING TO POTENTIALLY PREVENTABLE COMPLICATIONS AND RE-ADMISSIONS;
(VI) SUCH REGULATIONS SHALL ADDRESS ADJUSTMENTS BASED ON THE COSTS OF
HIGH COST OUTLIER PATIENTS;
(VII) SUCH RATES SHALL CONTINUE TO REFLECT TREND FACTOR ADJUSTMENTS AS
OTHERWISE PROVIDED IN PARAGRAPH (C) OF SUBDIVISION TEN OF THIS SECTION;
(VIII) SUCH RATES SHALL NOT INCLUDE ANY ADJUSTMENTS PURSUANT TO SUBDI-
VISION NINE OF THIS SECTION;
(IX) RATES FOR NON-PUBLIC, NOT-FOR-PROFIT GENERAL HOSPITALS WHICH HAVE
NOT, AS OF THE EFFECTIVE DATE OF THIS SUBDIVISION, PUBLISHED AN ANCIL-
LARY CHARGES SCHEDULE AS PROVIDED IN PARAGRAPH (J) OF SUBDIVISION ONE OF
SECTION TWENTY-EIGHT HUNDRED THREE OF THIS ARTICLE SHALL HAVE THEIR
S. 58--A 56 A. 158--A
INLIER PAYMENTS INCREASED BY AN AMOUNT EQUAL TO THE STATEWIDE AVERAGE OF
COST OUTLIER PAYMENTS AS DETERMINED BY SUCH REGULATIONS;
(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 POWER EQUALIZATION FACTOR ADJUSTMENTS, AND (B)
CAPITAL COST REIMBURSEMENT;
(XI) RATES FOR TEACHING GENERAL HOSPITALS SHALL INCLUDE REIMBURSEMENT
FOR DIRECT AND INDIRECT GRADUATE MEDICAL EDUCATION AS DEFINED AND CALCU-
LATED PURSUANT TO SUCH REGULATIONS. IN ADDITION, SUCH REGULATIONS SHALL
SPECIFY THE REPORTS AND INFORMATION REQUIRED BY THE COMMISSIONER TO
ASSESS THE COST, QUALITY AND HEALTH SYSTEM NEEDS FOR MEDICAL EDUCATION
PROVIDED.
(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.
(D) CAPITAL COST REIMBURSEMENT FOR GENERAL HOSPITALS OTHERWISE SUBJECT
TO THE PROVISIONS OF THIS SUBDIVISION SHALL REMAIN SUBJECT TO THE
PROVISIONS OF SUBDIVISION EIGHT OF THIS SECTION.
(E) THE PROVISIONS OF THIS SUBDIVISION SHALL NOT APPLY TO THOSE GENER-
AL HOSPITALS OR DISTINCT UNITS OF GENERAL HOSPITALS WHOSE INPATIENT
REIMBURSEMENT DOES NOT, AS OF JUNE THIRTIETH, TWO THOUSAND NINE, REFLECT
CASE BASED PAYMENT PER DIAGNOSIS-RELATED GROUP OR WHOSE INPATIENT
REIMBURSEMENT IS, FOR PERIODS ON AND AFTER JULY FIRST, TWO THOUSAND
NINE, GOVERNED BY THE PROVISIONS OF PARAGRAPHS (E-1) OR (E-2) OF SUBDI-
VISION FOUR OF THIS SECTION.
(F) NOTWITHSTANDING SECTION ONE HUNDRED TWELVE OR ONE HUNDRED
SIXTY-THREE OF THE STATE FINANCE LAW OR ANY OTHER LAW, RULE OR REGU-
LATION TO THE CONTRARY, THE COMMISSIONER MAY CONTRACT WITH A VENDOR FOR
CONSIDERATION TO DEVELOP THE SPECIFICATIONS FOR THE DIAGNOSIS-RELATED
GROUPS METHODOLOGY AS PROVIDED FOR IN REGULATIONS PROMULGATED PURSUANT
TO PARAGRAPH (B) OF THIS SUBDIVISION IF THE COMMISSIONER CERTIFIES TO
THE COMPTROLLER THAT SUCH CONTRACT IS IN THE BEST INTEREST OF THE HEALTH
OF THE PEOPLE OF THE STATE. NOTWITHSTANDING THAT SUCH SPECIFICATIONS
SHALL BE AVAILABLE PURSUANT TO ARTICLE SIX OF THE PUBLIC OFFICERS LAW,
SUCH CONTRACT MAY PROVIDE THAT THE SPECIFICATIONS FOR SUCH ADJUSTED OR
ADDITIONAL DIAGNOSIS-RELATED GROUPS PROVIDED BY THE VENDOR SHALL BE
SUBJECT TO COPYRIGHT PROTECTION PURSUANT TO FEDERAL COPYRIGHT LAW.
(G) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION OR
ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER MAY, FOR RATE
PERIODS ON AND AFTER JULY FIRST, TWO THOUSAND NINE AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, MAKE ADDITIONAL ADJUST-
MENTS TO THE INPATIENT RATES OF PAYMENT OF ELIGIBLE GENERAL HOSPITALS,
TO FACILITATE IMPROVEMENTS IN HOSPITAL OPERATIONS AND FINANCES, IN
ACCORDANCE WITH THE FOLLOWING:
(I) GENERAL HOSPITALS ELIGIBLE FOR DISTRIBUTIONS PURSUANT TO THIS
PARAGRAPH SHALL BE THOSE NON-PUBLIC HOSPITALS WHICH, AS DETERMINED BY
THE COMMISSIONER, EXPERIENCE A REDUCTION IN THEIR MEDICAID INPATIENT
REVENUE OF A PERCENTAGE AS DETERMINED BY THE COMMISSIONER, AS A RESULT
OF THE APPLICATION OF THE PROVISIONS OF PARAGRAPHS (A) AND (B) OF THIS
SUBDIVISION.
S. 58--A 57 A. 158--A
(II) FUNDS DISTRIBUTED PURSUANT TO THIS PARAGRAPH SHALL BE ALLOCATED
BASED ON EACH ELIGIBLE FACILITY'S RELATIVE NEED AS DETERMINED BY THE
COMMISSIONER.
(III) FUNDING PURSUANT TO THIS PARAGRAPH SHALL BE AVAILABLE FOR THE
FOLLOWING PERIODS AND IN THE FOLLOWING AMOUNTS:
(A) FOR THE PERIOD JULY FIRST, TWO THOUSAND NINE THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND TEN, UP TO SEVENTY-FIVE MILLION DOLLARS;
(B) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND ELEVEN, UP TO SEVENTY-FIVE MILLION DOLLARS;
(C) FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWELVE, UP TO FIFTY MILLION DOLLARS;
(D) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, UP TO TWENTY-FIVE MILLION DOLLARS.
(IV) PAYMENTS MADE PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT TO
RETROACTIVE ADJUSTMENT OR RECONCILIATION AND MAY BE ADDED TO RATES OF
PAYMENT OR MADE AS LUMP SUM PAYMENTS.
(V) EACH HOSPITAL RECEIVING FUNDS PURSUANT TO THIS PARAGRAPH SHALL, AS
A CONDITION FOR ELIGIBILITY FOR SUCH FUNDS, ADOPT A RESOLUTION OF THE
BOARD OF DIRECTORS OF EACH SUCH HOSPITAL SETTING FORTH ITS CURRENT
FINANCIAL CONDITION AND A PLAN FOR REFORMING AND IMPROVING SUCH FINAN-
CIAL CONDITION, INCLUDING ONGOING BOARD OVERSIGHT, AND SHALL, AFTER TWO
YEARS, ISSUE A REPORT AS ADOPTED BY EACH SUCH BOARD OF DIRECTORS SETTING
FORTH WHAT PROGRESS HAS BEEN ACHIEVED REGARDING SUCH IMPROVEMENT,
PROVIDED, HOWEVER, IF SUCH REPORT IS NOT ISSUED AND ADOPTED BY EACH SUCH
BOARD OF DIRECTORS, OR IF SUCH REPORT FAILS TO SET FORTH ADEQUATE
PROGRESS, AS DETERMINED BY THE COMMISSIONER, THE COMMISSIONER MAY DEEM
SUCH FACILITY INELIGIBLE FOR FURTHER DISTRIBUTIONS PURSUANT TO THIS
PARAGRAPH AND MAY REDISTRIBUTE SUCH FURTHER DISTRIBUTIONS TO OTHER
ELIGIBLE FACILITIES IN ACCORDANCE WITH THE PROVISIONS OF THIS PARAGRAPH.
THE COMMISSIONER SHALL BE PROVIDED WITH COPIES OF ALL SUCH RESOLUTIONS
AND REPORTS.
(H) INPATIENT RATE ADJUSTMENTS MADE PURSUANT TO PARAGRAPHS (A) THROUGH
(F) OF THIS SUBDIVISION AFTER APPLICATION OF ADJUSTMENTS AUTHORIZED
PURSUANT TO SUBDIVISION THIRTY-THREE OF THIS SECTION SHALL RESULT IN A
NET STATEWIDE DECREASE IN AGGREGATE MEDICAID PAYMENTS OF NO LESS THAN
ONE HUNDRED SIXTY-EIGHT MILLION DOLLARS FOR THE PERIOD JULY FIRST, TWO
THOUSAND NINE THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TEN, AND NO LESS
THAN TWO HUNDRED SEVENTY-EIGHT MILLION DOLLARS FOR THE PERIOD APRIL
FIRST, TWO THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN.
S 3. Notwithstanding any contrary provision of law, if the commission-
er of health determines that federal financial participation will not be
available with regard to the provisions of subparagraph (ii) of para-
graph (g) of subdivision 35 of section 2807-c of the public health law,
such commissioner may deem such provision null and void and instead may
allocate funds pursuant to such paragraph (g) proportionally, based on
each eligible facility's relative share of Medicaid inpatient discharges
in the year two years prior to the distribution year.
S 4. Clause (A) of subparagraph (i) of paragraph (a) of subdivision 30
of section 2807-c of the public health law, as amended by section 22-b
of part B of chapter 58 of the laws of 2008, is amended to read as
follows:
(A) ninety-three million two hundred thousand dollars on an annualized
basis for the period April first, two thousand two through December
thirty-first, two thousand two; one hundred eighty-seven million eight
hundred thousand dollars on an annualized basis for the period January
first, two thousand three through December thirty-first, two thousand
S. 58--A 58 A. 158--A
three; two hundred sixty-two million one hundred thousand dollars on an
annualized basis for the period January first, two thousand four through
December thirty-first, two thousand six; one hundred thirty-one million
one hundred thousand dollars for the period January first, two thousand
seven through June thirtieth, two thousand seven, and two hundred
forty-three million five hundred thousand dollars for the period July
first, two thousand seven through March thirty-first, two thousand
eight, two hundred forty-three million five hundred thousand dollars for
the period April first, two thousand eight through March thirty-first,
two thousand nine; [two hundred forty-three] SIXTY million [five] EIGHT
hundred SEVENTY-FIVE thousand dollars for the period April first, two
thousand nine through [March thirty-first] JUNE THIRTIETH, two thousand
[ten] NINE[; two hundred forty-three million five hundred thousand
dollars for the period April first, two thousand ten through March thir-
ty-first, two thousand eleven].
S 5. Clause (A) of subparagraph (i) of paragraph (b) of subdivision 30
of section 2807-c of the public health law, as amended by section 22-b
of part B of chapter 58 of the laws of 2008, is amended to read as
follows:
(A) eighteen million five hundred thousand dollars on an annualized
basis for the period April first, two thousand two through December
thirty-first, two thousand two; thirty-seven million four hundred thou-
sand dollars on an annualized basis for the period January first, two
thousand three through December thirty-first, two thousand three;
fifty-two million two hundred thousand dollars on an annualized basis
for the period January first, two thousand four through December thir-
ty-first, two thousand six; twenty-six million one hundred thousand
dollars for the period January first, two thousand seven through June
thirtieth, two thousand seven[;], forty-nine million dollars for the
period July first, two thousand seven through March thirty-first, two
thousand eight[;], AND forty-nine million dollars for the period April
first, two thousand eight through March thirty-first, two thousand
nine[; forty-nine million dollars for the period April first, two thou-
sand nine through March thirty-first, two thousand ten; and forty-nine
million dollars for the period April first, two thousand ten through
March thirty-first, two thousand eleven].
S 6. Paragraphs (x) and (y) of subdivision 1 of section 2807-v of the
public health law, as amended by section 5 of part B of chapter 58 of
the laws of 2008, are amended to read as follows:
(x) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the non-public general hospital rates increases for recruitment
and retention of health care workers from the tobacco control and insur-
ance initiatives pool established for the following periods in the
following amounts:
(i) twenty-seven million one hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) fifty million eight hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
S. 58--A 59 A. 158--A
(iii) sixty-nine million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) sixty-nine million three hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) sixty-nine million three hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) sixty-five million three hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) sixty-one million one hundred fifty thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight; AND
(viii) [fifty-three] TWENTY-SIX million [one] FIVE hundred [fifty]
SEVENTY-FIVE thousand dollars for the period January first, two thousand
nine through [December thirty-first] JUNE THIRTIETH, two thousand nine[;
(ix) thirty million twenty-five thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten; and
(x) eight million eight hundred thousand dollars for the period Janu-
ary first, two thousand eleven through March thirty-first, two thousand
eleven].
(y) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to public general hospitals for recruitment and retention of
health care workers pursuant to paragraph (b) of subdivision thirty of
section twenty-eight hundred seven-c of this article from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) eighteen million five hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) thirty-seven million four hundred thousand dollars on an annual-
ized basis for the period January first, two thousand three through
December thirty-first, two thousand three;
(iii) fifty-two million two hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) fifty-two million two hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) fifty-two million two hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) forty-nine million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(vii) forty-nine million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight; AND
(viii) [forty-nine] TWELVE million TWO HUNDRED FIFTY THOUSAND dollars
for the period January first, two thousand nine through [December] MARCH
thirty-first, two thousand nine[;
(ix) forty-nine million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; and
S. 58--A 60 A. 158--A
(x) twelve million two hundred fifty thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven].
Provided, however, amounts pursuant to this paragraph may be reduced
in an amount to be approved by the director of the budget to reflect
amounts received from the federal government under the state's 1115
waiver which are directed under its terms and conditions to the health
workforce recruitment and retention program.
S 7. Paragraphs (ggg) and (hhh) of subdivision 1 of section 2807-v of
the public health law, as added by section 5 of part B of chapter 58 of
the laws of 2008, are amended to read as follows:
(ggg) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for the purpose of supporting the state
share of Medicaid expenditures for hospital translation services as
authorized pursuant to paragraph (k) of subdivision one of section twen-
ty-eight hundred seven-c of this article from the tobacco control and
initiatives pool established for the following periods in the following
amounts:
(i) sixteen million dollars for the period July first, two thousand
eight through December thirty-first, two thousand eight; AND
(ii) [sixteen] EIGHT million dollars for the period January first, two
thousand nine through [December thirty-first] JUNE THIRTIETH, two thou-
sand nine[;
(iii) sixteen million dollars for the period January first, two thou-
sand ten through December thirty-first, two thousand ten; and
(iv) four million dollars for the period January first, two thousand
eleven through March thirty-first, two thousand eleven].
(hhh) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for the purpose of supporting the state
share of Medicaid expenditures for adjustments to inpatient rates of
payment for general hospitals located in the counties of Nassau and
Suffolk as authorized pursuant to paragraph (l) of subdivision one of
section twenty-eight hundred seven-c of this article from the tobacco
control and initiatives pool established for the following periods in
the following amounts:
(i) two million five hundred thousand dollars for the period April
first, two thousand eight through December thirty-first, two thousand
eight; AND
(ii) [two] ONE million [five] TWO hundred FIFTY thousand dollars for
the period January first, two thousand nine through [December thirty-
first] JUNE THIRTIETH, two thousand nine[;
(iii) two million five hundred thousand dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
and
(iv) six hundred twenty-five thousand dollars for the period January
first, two thousand eleven through March thirty-first two thousand elev-
en].
S 8. Paragraph (s) of subdivision 1 of section 2807-v of the public
health law, as amended by section 5 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
S. 58--A 61 A. 158--A
(s) Funds shall be deposited by the commissioner within amounts appro-
priated, and the state comptroller is hereby authorized and directed to
receive for deposit to the credit of the state special revenue funds -
other, HCRA transfer fund, medical assistance account, or any successor
fund or account, for purposes of providing distributions pursuant to
paragraphs (s-5), (s-6), (s-7) and (s-8) of subdivision eleven of
section twenty-eight hundred seven-c of this article from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) eighteen million dollars for the period January first, two thou-
sand through December thirty-first, two thousand;
(ii) twenty-four million dollars annually for the periods January
first, two thousand one through December thirty-first, two thousand two;
(iii) up to twenty-four million dollars for the period January first,
two thousand three through December thirty-first, two thousand three;
(iv) up to twenty-four million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(v) up to twenty-four million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(vi) up to twenty-four million dollars for the period January first,
two thousand six through December thirty-first, two thousand six;
(vii) up to twenty-four million dollars for the period January first,
two thousand seven through December thirty-first, two thousand seven;
(viii) up to twenty-four million dollars for the period January first,
two thousand eight through December thirty-first, two thousand eight;
AND
(ix) up to [twenty-four] TWELVE million dollars for the period January
first, two thousand nine through [December thirty-first] JUNE THIRTIETH,
two thousand nine[;
(x) up to twenty-four million dollars for the period January first,
two thousand ten through December thirty-first, two thousand ten; and
(xi) up to six million dollars for the period January first, two thou-
sand eleven through March thirty-first, two thousand eleven].
S 9. Paragraph (n) of subdivision 1 of section 2807-l of the public
health law, as amended by section 4 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
(n) Funds shall be accumulated and transferred from the health care
reform act (HCRA) resources fund as follows: for the period April first,
two thousand seven through March thirty-first, two thousand eight, and
on an annual basis for the periods April first, two thousand eight
through [March thirty-first] JUNE THIRTIETH, two thousand [eleven] NINE,
funds within amounts appropriated shall be transferred and deposited and
credited to the credit of the state special revenue funds - other, HCRA
transfer fund, medical assistance account, for purposes of funding the
state share of rate adjustments made to public and voluntary hospitals
in accordance with paragraphs (i) and (j) of subdivision one of section
twenty-eight hundred seven-c of this article.
S 10. Paragraph (xx) of subdivision 1 of section 2807-v of the public
health law, as amended by section 5 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
(xx) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the general hospital rates increases for rural hospitals pursu-
S. 58--A 62 A. 158--A
ant to subdivision thirty-two of section twenty-eight hundred seven-c of
this article from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) three million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five;
(ii) three million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six;
(iii) three million five hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(iv) three million five hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight; AND
(v) [three] ONE million [five hundred] SEVEN HUNDRED FIFTY thousand
dollars for the period January first, two thousand nine through [Decem-
ber thirty-first] JUNE THIRTIETH, two thousand nine[;
(vi) three million five hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten; and
(vii) eight hundred seventy-five thousand dollars for the period Janu-
ary first, two thousand eleven through March thirty-first, two thousand
eleven; and
(viii) provided, however, in the event federal financial participation
is not available with regard to rate adjustments pursuant to subdivision
thirty-two of section twenty-eight hundred seven-c of this article,
allocations pursuant to this paragraph shall, on an annualized basis be
increased to seven million dollars for the period January first, two
thousand five through March thirty-first, two thousand eleven].
S 11. Paragraph (l) of subdivision 4 of section 2807-c of the public
health law, as added by section 15 of part C of chapter 58 of the laws
of 2008, is amended to read as follows:
(l) Notwithstanding any inconsistent provision of this section and
subject to the availability of federal financial participation, rates of
payment by governmental agencies for general hospitals which are certi-
fied by the office of alcoholism and substance abuse services to provide
inpatient detoxification and withdrawal services and, with regard to
inpatient services provided to patients discharged on and after December
first, two thousand eight and who are determined to be in diagnosis-re-
lated groups numbered seven hundred forty-three, seven hundred forty-
four, seven hundred forty-five, seven hundred forty-six, seven hundred
forty-seven, seven hundred forty-eight, seven hundred forty-nine, seven
hundred fifty, or seven hundred fifty-one, shall be made on a per diem
basis in accordance with the following:
(i) for the period December first, two thousand eight through [Decem-
ber thirty-first] FEBRUARY TWENTY-EIGHTH, two thousand nine, seventy-
five percent of the operating cost component of such rates of payments
shall reflect the operating cost component of rates of payment effective
for December thirty-first, two thousand seven, as adjusted for inflation
pursuant to paragraph (c) of subdivision ten of this section, as other-
wise modified by any applicable statutes, and twenty-five percent of
such rates shall reflect the use of two thousand six operating costs as
reported by each facility to the department prior to two thousand eight
and as computed in accordance with the provisions of subparagraph [(v)]
(III) of this paragraph;
S. 58--A 63 A. 158--A
(ii) [for the period January first, two thousand ten through December
thirty-first, two thousand ten, fifty percent of the operating cost
component of such rates of payment shall reflect the operating cost
component of rates of payment effective December thirty-first, two thou-
sand seven, as adjusted for inflation pursuant to paragraph (c) of
subdivision ten of this section, as otherwise modified by any applicable
statutes, and fifty percent of such rates of payment shall reflect the
use of two thousand six operating costs as reported by each facility to
the department prior to two thousand eight and as computed in accordance
with the provisions of subparagraph (v) of this paragraph;
(iii) for the period January first, two thousand eleven through Decem-
ber thirty-first, two thousand eleven, twenty-five percent of the oper-
ating cost component of such rates of payment shall reflect the operat-
ing cost component of rates of payment effective December thirty-first,
two thousand seven, as adjusted for inflation pursuant to paragraph (c)
of subdivision ten of this section, as otherwise modified by any appli-
cable statutes, and seventy-five percent of such rates of payment shall
reflect the use of two thousand six operating costs as reported by each
facility to the department prior to two thousand eight and as computed
in accordance with the provisions of subparagraph (v) of this paragraph;
and
(iv)] for periods on and after [January] MARCH first, two thousand
[twelve] NINE, one hundred percent of the operating cost component of
such rates of payment shall reflect the use of two thousand six operat-
ing costs as reported to the department prior to two thousand eight and
as computed in accordance with the provisions of subparagraph [(v)]
(III) of this paragraph.
[(v)] (III) rates of payment computed in accordance with this para-
graph and reflecting the use of two thousand six base year operating
costs shall be in accord with the following, provided, however that the
commissioner may establish criteria under which reimbursement may be
provided at higher percentages and for longer periods.
(A) For each of the regions within the state as described in clause
(E) of this subparagraph the commissioner shall determine the average
per diem cost incurred by general hospitals in that region subject to
the provisions of this paragraph with regard to inpatients requiring
medically managed detoxification services, as defined by applicable
regulations promulgated by the office of alcoholism and substance abuse
services. In determining such costs the commissioner shall utilize two
thousand six costs and statistics as reported by such hospitals to the
department prior to two thousand eight.
(B) Per diem payments for inpatients requiring medically managed inpa-
tient detoxification services shall reflect one hundred percent of the
per diem amounts computed pursuant to clause (A) of this subparagraph
for the applicable region in which the facility is located and as trend-
ed forward to adjust for inflation, provided however, that such payments
shall be reduced by fifty percent for any such services provided on or
after the sixth day of services through the tenth day of services, and
further provided that no payments shall be made for any services
provided on or after the eleventh day.
(C) Per diem payments for inpatients requiring medically supervised
withdrawal services, as defined by applicable regulations promulgated by
the office of alcoholism and substance abuse services, shall reflect one
hundred percent of the per diem amounts computed pursuant to clause (A)
of this subparagraph for the applicable region in which the facility is
located for the period [January first, two thousand nine] DECEMBER
S. 58--A 64 A. 158--A
FIRST, TWO THOUSAND EIGHT through December thirty-first, two thousand
nine, and as trended forward to adjust for inflation, and shall reflect
seventy-five percent of such per diem amounts for periods on and after
January first, two thousand ten, as trended forward to adjust for
inflation, provided, however, that such payments shall be reduced by
fifty percent for any services provided on or after the sixth day of
services through the tenth day of services, and further provided that no
payments shall be made for any services provided on and after the elev-
enth day.
(D) Per diem payments for inpatients placed in observation beds, as
defined by applicable regulations promulgated by the office of alcohol-
ism and substance abuse services, shall be at the same level as would be
paid pursuant to clause (A) of this [paragraph] SUBPARAGRAPH, provided,
however, that such payments shall not apply for more than two days of
care, after which payments for such inpatients shall reflect their
designation as requiring either medically managed detoxification
services or medically supervised withdrawal services, and further
provided that days of care provided in such observation beds shall, for
reimbursement purposes, be fully reflected in the computation of the
initial five days of care as set forth in clauses (A) and (B) of this
[paragraph] SUBPARAGRAPH.
(E) For the purposes of this paragraph, the regions of the state shall
be as follows:
(I) New York city, consisting of the counties of Bronx, New York,
Kings, Queens and Richmond;
(II) Long Island, consisting of the counties of Nassau and Suffolk;
(III) Northern metropolitan, consisting of the counties of Columbia,
Delaware, Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and West-
chester;
(IV) Northeast, consisting of the counties of Albany, Clinton, Essex,
Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady,
Schoharie, Warren and Washington;
(V) Utica/Watertown, consisting of the counties of Franklin, Herkimer,
Lewis, Oswego, Otsego, St. Lawrence, Jefferson, Chenango, Madison and
Oneida;
(VI) Central, consisting of the counties of Broome, Cayuga, Chemung,
Cortland, Onondaga, Schuyler, Seneca, Steuben, Tioga and Tompkins;
(VII) Rochester, consisting of Monroe, Ontario, Livingston, Wayne and
Yates; AND
(VIII) Western, consisting of the counties of Allegany, Cattaraugus,
Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.
(F) Capital cost reimbursement for general hospitals otherwise subject
to the provisions of this paragraph shall remain subject to the
provisions of subdivision eight of this section.
S 12. Subdivision 4 of section 2807-c of the public health law is
amended by adding a new paragraph (e-1) to read as follows:
(E-1) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF PARAGRAPH (E) OF
THIS SUBDIVISION OR ANY OTHER CONTRARY PROVISION OF LAW AND SUBJECT TO
THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, PER DIEM RATES OF
PAYMENT BY GOVERNMENTAL AGENCIES FOR A GENERAL HOSPITAL OR A DISTINCT
UNIT OF A GENERAL HOSPITAL FOR INPATIENT PSYCHIATRIC SERVICES THAT WOULD
OTHERWISE BE SUBJECT TO THE PROVISIONS OF PARAGRAPH (E) OF THIS SUBDIVI-
SION, AND RATES OF PAYMENT FOR OUTPATIENT PSYCHIATRIC SERVICES PROVIDED
BY SUCH FACILITIES AS SPECIFIED IN THIS PARAGRAPH, SHALL, WITH REGARD TO
DAYS OF SERVICE AND VISITS OCCURRING ON AND AFTER JULY FIRST, TWO THOU-
SAND NINE, BE IN ACCORDANCE WITH THE FOLLOWING:
S. 58--A 65 A. 158--A
(I) FOR THE PERIOD JULY FIRST, TWO THOUSAND NINE THROUGH DECEMBER
THIRTY-FIRST, TWO THOUSAND NINE, THE OPERATING COST COMPONENT OF SUCH
INPATIENT RATES SHALL REFLECT THE USE OF TWO THOUSAND FIVE OPERATING
COSTS AS REPORTED BY EACH FACILITY TO THE DEPARTMENT PRIOR TO DECEMBER
FIRST, TWO THOUSAND EIGHT AND AS ADJUSTED FOR INFLATION PURSUANT TO
PARAGRAPH (C) OF SUBDIVISION TEN OF THIS SECTION, AS OTHERWISE MODIFIED
BY ANY APPLICABLE STATUE, PROVIDED, HOWEVER, THAT SUCH TWO THOUSAND FIVE
REPORTED OPERATING COSTS, SHALL, FOR INPATIENT RATE-SETTING PURPOSES, BE
HELD TO A CEILING OF ONE HUNDRED TEN PERCENT OF THE AVERAGE OF SUCH
REPORTED INPATIENT COSTS BY SUCH FACILITIES IN THE REGION IN WHICH THE
FACILITY IS LOCATED, AS DETERMINED PURSUANT TO CLAUSE (E) OF SUBPARA-
GRAPH (III) OF PARAGRAPH (L) OF THIS SUBDIVISION.
(II) FOR RATE PERIODS ON AND AFTER JANUARY FIRST, TWO THOUSAND TEN,
THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF THE OFFICE OF
MENTAL HEALTH, SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE EMERGEN-
CY REGULATIONS, ESTABLISHING METHODOLOGIES FOR DETERMINING THE OPERATING
COST COMPONENTS OF RATES OF PAYMENTS FOR SERVICES DESCRIBED IN THIS
PARAGRAPH. SUCH REGULATIONS SHALL UTILIZE TWO THOUSAND FIVE OPERATING
COSTS AS SUBMITTED TO THE DEPARTMENT PRIOR TO DECEMBER FIRST, TWO THOU-
SAND EIGHT AND SHALL PROVIDE FOR METHODOLOGIES ESTABLISHING PER DIEM
INPATIENT RATES THAT UTILIZE CASE MIX ADJUSTMENT MECHANISMS AND PROVIDE
FOR POST-DISCHARGE REFERRAL TO OUTPATIENT SERVICES. SUCH REGULATIONS
SHALL CONTAIN CRITERIA FOR ADJUSTMENTS BASED ON LENGTH OF STAY. SUCH
REGULATIONS SHALL ALSO ESTABLISH OUTPATIENT RATES OF PAYMENT FOR THE
EVALUATION OF POTENTIAL INPATIENT PSYCHIATRIC PATIENTS AND THE PRE-AD-
MISSION REFERRAL OF SUCH PATIENTS, WHEN APPROPRIATE, TO OUTPATIENT
SERVICES.
(III) RATES OF PAYMENT ESTABLISHED PURSUANT TO SUBPARAGRAPH (II) OF
THIS PARAGRAPH SHALL REFLECT AN AGGREGATE NET STATEWIDE INCREASE IN
REIMBURSEMENT FOR SUCH SERVICES OF UP TO TWENTY-FIVE MILLION DOLLARS ON
AN ANNUAL BASIS.
(IV) CAPITAL COST REIMBURSEMENT FOR GENERAL HOSPITALS OTHERWISE
SUBJECT TO THE PROVISIONS OF THIS PARAGRAPH SHALL REMAIN SUBJECT TO THE
PROVISIONS OF SUBDIVISION EIGHT OF THIS SECTION.
S 13. Subdivision 4 of section 2807-c of the public health law is
amended by adding a new paragraph (e-2) to read as follows:
(E-2) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF PARAGRAPH (E) OF
THIS SUBDIVISION OR ANY OTHER CONTRARY PROVISION OF LAW AND SUBJECT TO
THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, PER DIEM RATES OF
PAYMENT BY GOVERNMENTAL AGENCIES FOR INPATIENT SERVICES PROVIDED BY A
GENERAL HOSPITAL OR A DISTINCT UNIT OF A GENERAL HOSPITAL FOR SERVICES,
AS DESCRIBED BELOW, THAT WOULD OTHERWISE BE SUBJECT TO THE PROVISIONS OF
PARAGRAPH (E) OF THIS SUBDIVISION, SHALL, WITH REGARD TO DAYS OF SERVICE
OCCURRING ON AND AFTER JULY FIRST, TWO THOUSAND NINE, BE IN ACCORD WITH
THE FOLLOWING:
(I) FOR PHYSICAL MEDICAL REHABILITATION SERVICES AND FOR CHEMICAL
DEPENDENCY REHABILITATION SERVICES, THE OPERATING COST COMPONENT OF SUCH
RATES SHALL REFLECT THE USE OF TWO THOUSAND FIVE OPERATING COSTS FOR
EACH RESPECTIVE CATEGORY OF SERVICES AS REPORTED BY EACH FACILITY TO THE
DEPARTMENT PRIOR TO DECEMBER FIRST, TWO THOUSAND EIGHT AND AS ADJUSTED
FOR INFLATION PURSUANT TO PARAGRAPH (C) OF SUBDIVISION TEN OF THIS
SECTION, AS OTHERWISE MODIFIED BY ANY APPLICABLE STATUTE, PROVIDED,
HOWEVER, THAT SUCH TWO THOUSAND FIVE REPORTED OPERATING COSTS SHALL, FOR
RATE-SETTING PURPOSES, BE HELD TO A CEILING OF ONE HUNDRED TEN PERCENT
OF THE AVERAGE OF SUCH REPORTED COSTS IN THE REGION IN WHICH THE FACILI-
S. 58--A 66 A. 158--A
TY IS LOCATED, AS DETERMINED PURSUANT TO CLAUSE (E) OF SUBPARAGRAPH
(III) OF PARAGRAPH (1) OF THIS SUBDIVISION.
(II) FOR SERVICES PROVIDED BY RURAL HOSPITALS DESIGNATED AS CRITICAL
ACCESS HOSPITALS IN ACCORDANCE WITH TITLE XVIII OF THE FEDERAL SOCIAL
SECURITY ACT, THE OPERATING COST COMPONENT OF SUCH RATES SHALL REFLECT
THE USE OF TWO THOUSAND FIVE OPERATING COSTS AS REPORTED BY EACH FACILI-
TY TO THE DEPARTMENT PRIOR TO DECEMBER FIRST, TWO THOUSAND EIGHT AND AS
ADJUSTED FOR INFLATION PURSUANT TO PARAGRAPH (C) OF SUBDIVISION TEN OF
THIS SECTION, AS OTHERWISE MODIFIED BY ANY APPLICABLE STATUTES,
PROVIDED, HOWEVER, THAT SUCH TWO THOUSAND FIVE REPORTED OPERATING COSTS
SHALL, FOR RATE-SETTING PURPOSES, BE HELD TO A CEILING OF ONE HUNDRED
TEN PERCENT OF THE AVERAGE OF SUCH REPORTED COSTS FOR ALL SUCH DESIG-
NATED HOSPITALS STATEWIDE.
(III) FOR INPATIENT SERVICES PROVIDED BY SPECIALTY LONG TERM ACUTE
CARE HOSPITALS AND FOR INPATIENT SERVICES PROVIDED BY CANCER HOSPITALS
AS SO DESIGNATED AS OF DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHT, THE
OPERATING COST COMPONENT OF SUCH RATES SHALL REFLECT THE USE OF TWO
THOUSAND FIVE OPERATING COSTS FOR EACH RESPECTIVE CATEGORY OF FACILITY
AS REPORTED BY EACH FACILITY TO THE DEPARTMENT PRIOR TO DECEMBER FIRST,
TWO THOUSAND EIGHT AND AS ADJUSTED FOR INFLATION PURSUANT TO PARAGRAPH
(C) OF SUBDIVISION TEN OF THIS SECTION, AS OTHERWISE MODIFIED BY ANY
APPLICABLE STATUTES.
(IV) FOR FACILITIES DESIGNATED BY THE FEDERAL DEPARTMENT OF HEALTH AND
HUMAN SERVICES AS EXEMPT ACUTE CARE CHILDREN'S HOSPITALS, FOR WHICH A
DISCRETE INSTITUTIONAL COST REPORT WAS FILED FOR THE TWO THOUSAND SIX
CALENDAR YEAR, AND WHICH HAS REPORTED MEDICAID DISCHARGES GREATER THAN
FIFTY PERCENT OF TOTAL DISCHARGES IN SUCH COST REPORT, THE OPERATING
COST COMPONENT OF SUCH RATES SHALL REFLECT THE USE OF TWO THOUSAND SIX
OPERATING COSTS AS REPORTED BY EACH FACILITY TO THE DEPARTMENT PRIOR TO
DECEMBER FIRST, TWO THOUSAND EIGHT AND AS ADJUSTED FOR INFLATION PURSU-
ANT TO PARAGRAPH (C) OF SUBDIVISION TEN OF THIS SECTION, AS OTHERWISE
MODIFIED BY ANY APPLICABLE STATUTES, AND AS DETERMINED ON A PER CASE
BASIS OR PER DIEM BASIS, AS SET FORTH IN REGULATIONS PROMULGATED BY THE
COMMISSIONER.
(V) RATES ESTABLISHED PURSUANT TO THIS PARAGRAPH SHALL BE DEEMED AS
EXCLUDING REIMBURSEMENT FOR PHYSICIAN SERVICES FOR INPATIENT SERVICES
AND CLAIMS FOR MEDICAID FEE PAYMENTS FOR SUCH PHYSICIAN SERVICES FOR
SUCH INPATIENT CARE MAY BE SUBMITTED SEPARATELY FROM THE RATE IN ACCORD-
ANCE WITH OTHERWISE APPLICABLE LAW.
(VI) CAPITAL COST REIMBURSEMENT FOR GENERAL HOSPITALS OTHERWISE
SUBJECT TO THE PROVISIONS OF THIS PARAGRAPH SHALL REMAIN SUBJECT TO THE
PROVISIONS OF SUBDIVISION EIGHT OF THIS SECTION.
(VII) THE COMMISSIONER MAY PROMULGATE REGULATIONS, INCLUDING EMERGENCY
REGULATIONS, IMPLEMENTING THE PROVISIONS OF THIS PARAGRAPH.
(VIII) THE OPERATING COST COMPONENT OF RATES OF PAYMENT PURSUANT TO
THIS PARAGRAPH FOR A GENERAL HOSPITAL OR DISTINCT UNIT OF A GENERAL
HOSPITAL WITHOUT ADEQUATE COST EXPERIENCE SHALL BE BASED ON THE LOWER OF
THE FACILITY'S OR UNIT'S INPATIENT BUDGETED OPERATING COSTS PER DAY,
ADJUSTED TO ACTUAL, OR THE APPLICABLE REGIONAL CEILING, IF ANY.
S 14. Paragraphs (a) and (b) of subdivision 2-a of section 2807 of the
public health law, as added by section 18 of part C of chapter 58 of the
laws of 2008, are amended to read as follows:
(a)(i) for the period December first, two thousand eight through
[December thirty-first] JUNE THIRTIETH, two thousand nine, seventy-five
percent of such rates of payment for each general hospital's outpatient
services shall reflect the average Medicaid payment per claim, as deter-
S. 58--A 67 A. 158--A
mined by the commissioner, for services provided by that facility in the
two thousand seven calendar year, but excluding any payments for
services covered by the facility's licensure, if any, under the mental
hygiene law, and twenty-five percent of such rates of payment shall, for
the operating cost component, reflect the utilization of the ambulatory
patient groups reimbursement methodology described in paragraph (e) of
this subdivision;
(ii) for the period [January] JULY first, two thousand [ten] NINE
through [December thirty-first] JUNE THIRTIETH, two thousand ten, fifty
percent of such rates for each facility shall reflect the average Medi-
caid payment per claim, as determined by the commissioner, for services
provided by that facility in the two thousand seven calendar year, but
excluding any payments for services covered by the facility's licensure,
if any, under the mental hygiene law, and fifty percent of such rates of
payment shall, for the operating cost component, reflect the utilization
of the ambulatory patient groups reimbursement methodology described in
paragraph (e) of this subdivision;
(iii) for the period [January] JULY first, two thousand [eleven] TEN
through [December thirty-first] JUNE THIRTIETH, two thousand eleven,
twenty-five percent of such rates shall reflect the average Medicaid
payment per claim, as determined by the commissioner, for services
provided by that facility for the two thousand seven calendar year, but
excluding any payments for services covered by the facility's licensure,
if any, under the mental hygiene law, and seventy-five percent of such
rates of payment shall, for the operating cost component, reflect the
utilization of the ambulatory patient groups reimbursement methodology
described in paragraph (e) of this subdivision; and
(iv) for periods on and after [January] JULY first, two thousand
[twelve] ELEVEN, one hundred percent of such rates of payment shall
reflect the utilization of the ambulatory patient groups reimbursement
methodology described in paragraph (e) of this subdivision.
(v) This paragraph shall be effective the later of: (i) December
first, two thousand eight, or (ii) after the commissioner receives final
approval of federal financial participation in payments made for benefi-
ciaries eligible for medical assistance under title XIX of the federal
social security act for the rate methodology established pursuant to
subparagraph (i) of paragraph (a) of subdivision thirty-three of section
twenty-eight hundred seven-c of this article.
(b)(i) for the period March first, two thousand nine through [December
thirty-first] JUNE THIRTIETH, two thousand nine, seventy-five percent of
such rates of payment for services provided by each diagnostic and
treatment center and each free-standing ambulatory surgery center shall
reflect the average Medicaid payment per claim, as determined by the
commissioner, for services provided by that facility in the two thousand
seven calendar year, but excluding any payments for services covered by
the facility's licensure, if any, under the mental hygiene law, and
twenty-five percent of such rates of payment shall, for the operating
cost component, reflect the utilization of the ambulatory patient groups
reimbursement methodology described in paragraph (e) of this subdivi-
sion;
(ii) for the period [January] JULY first, two thousand [ten] NINE
through [December thirty-first] JUNE THIRTIETH, two thousand ten, fifty
percent of such rates for each facility shall reflect the average Medi-
caid payment per claim, as determined by the commissioner, for services
provided by that facility in the two thousand seven calendar year, but
excluding any payments for services covered by the facility's licensure,
S. 58--A 68 A. 158--A
if any, under the mental hygiene law, and fifty percent of such rates of
payment shall, for the operating cost component, reflect the utilization
of the ambulatory patient groups reimbursement methodology described in
paragraph (e) of this subdivision;
(iii) for the period [January] JULY first, two thousand [eleven] TEN
through [December thirty-first] JUNE THIRTIETH, two thousand eleven,
twenty-five percent of such rates for each facility shall reflect the
average Medicaid payment per claim, as determined by the commissioner,
for services provided by that facility in the two thousand seven calen-
dar year, but excluding any payments for services covered by the facili-
ty's licensure, if any, under the mental hygiene law, and seventy-five
percent of such rates of payment shall, for the operating cost compo-
nent, reflect the utilization of the ambulatory patient groups
reimbursement methodology described in paragraph (e) of this subdivi-
sion; and
(iv) for periods on and after [January] JULY first, two thousand
[twelve] ELEVEN, one hundred percent of such rates of payment shall
reflect the utilization of the ambulatory patient groups reimbursement
methodology described in paragraph (e) of this subdivision.
S 15. Paragraph (e) subdivision 2-a of section 2807 of the public
health law, as added by section 18 of part C of chapter 58 of the laws
2008, is amended to read as follows:
(e) (I) notwithstanding any inconsistent provisions of this subdivi-
sion, the commissioner shall promulgate regulations establishing,
subject to the approval of the state director of the budget, methodol-
ogies for determining rates of payment for the services described in
this subdivision. Such regulations shall reflect utilization of the
ambulatory patient group (APG) methodology, in which patients are
grouped based on their diagnosis, the intensity of the services provided
and the medical procedures performed, and with each APG assigned a
weight reflecting the projected utilization of resources. Such regu-
lations shall provide for the development of one or more base rates and
the multiplication of such base rates by the assigned weight for each
APG to establish the appropriate payment level for each such APG. Such
regulations may also utilize bundling, packaging and discounting mech-
anisms.
IF THE COMMISSIONER DETERMINES THAT THE USE OF THE APG METHODOLOGY IS
NOT, OR IS NOT YET, APPROPRIATE OR PRACTICAL FOR SPECIFIED SERVICES, THE
COMMISSIONER MAY UTILIZE EXISTING PAYMENT METHODOLOGIES FOR SUCH
SERVICES OR MAY PROMULGATE REGULATIONS, AND MAY PROMULGATE EMERGENCY
REGULATIONS, ESTABLISHING ALTERNATIVE PAYMENT METHODOLOGIES FOR SUCH
SERVICES.
(II) NOTWITHSTANDING THIS SUBDIVISION AND ANY OTHER CONTRARY PROVISION
OF LAW, THE COMMISSIONER MAY INCORPORATE WITHIN THE PAYMENT METHODOLOGY
DESCRIBED IN SUBPARAGRAPH (I) OF THIS PARAGRAPH PAYMENT FOR SERVICES
PROVIDED BY FACILITIES PURSUANT TO LICENSURE UNDER THE MENTAL HYGIENE
LAW, PROVIDED, HOWEVER, THAT SUCH APG PAYMENT METHODOLOGY MAY BE PHASED
INTO EFFECT IN ACCORDANCE WITH A SCHEDULE OR SCHEDULES AS JOINTLY DETER-
MINED BY THE COMMISSIONER, THE COMMISSIONER OF MENTAL HEALTH, THE
COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, AND THE COMMIS-
SIONER OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES.
S 16. Paragraph (i) of subdivision 2-a of section 2807 of the public
health law, as added by section 19 of part OO of chapter 57 of the laws
of 2008, 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
S. 58--A 69 A. 158--A
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, 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 MEDI-
CAID 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, HOWEVER, THAT FUNDS MADE AVAILABLE AS A RESULT OF
ANY SUCH DECREASES MAY BE UTILIZED BY THE COMMISSIONER TO INCREASE CAPI-
TATION RATES PAID TO MEDICAID MANAGED CARE PLANS AND FAMILY HEALTH PLUS
PLANS TO COVER INCREASED PAYMENTS TO HEALTH CARE PROVIDERS FOR AMBULATO-
RY 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 16-a. Subparagraph (ii) of paragraph (f) of subdivision 2-a of
section 2807 of the public health law, as added by section 18 of part C
of chapter 58 of the laws of 2008, is amended to read as follows:
(ii) notwithstanding the provisions of paragraphs (a) and (b) of this
subdivision, for periods on and after January first, two thousand nine,
the following services provided by general hospital outpatient depart-
ments and diagnostic and treatment centers shall be reimbursed with
rates of payment based entirely upon the ambulatory patient group meth-
odology as described in paragraph (e) of this subdivision, PROVIDED,
HOWEVER, THAT THE COMMISSIONER MAY UTILIZE EXISTING PAYMENT METHODOL-
OGIES OR MAY PROMULGATE REGULATIONS ESTABLISHING ALTERNATIVE PAYMENT
METHODOLOGIES FOR ONE OR MORE OF THE SERVICES SPECIFIED IN CLAUSES (C)
AND (D) OF THIS SUBPARAGRAPH, EFFECTIVE FOR PERIODS ON AND AFTER MARCH
FIRST, TWO THOUSAND NINE:
(A) services provided in accordance with the provisions of paragraphs
(q) and (r) of subdivision two of section three hundred sixty-five-a of
the social services law; and
(B) all services, but only with regard to additional payment amounts,
as determined in accordance with regulations issued in accordance with
paragraph (e) of this subdivision, for the provision of such services
during times outside the facility's normal hours of operation, as deter-
mined in accordance with criteria set forth in such regulations; and
(C) individual psychotherapy services provided by licensed social
workers, in accordance with licensing criteria set forth in applicable
regulations, to persons under the age of nineteen and to persons requir-
ing such services as a result of or related to pregnancy or giving
birth[.]; AND
(D) individual psychotherapy services provided by licensed social
workers, in accordance with licensing criteria set forth in applicable
regulations, at diagnostic and treatment centers that provided, billed
for, and received payment for these services between January first, two
thousand seven and December thirty-first, two thousand seven[.]; AND
(E) SERVICES PROVIDED TO PREGNANT WOMEN PURSUANT TO PARAGRAPH (S) OF
SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THE SOCIAL
SERVICES LAW AND, FOR PERIODS ON AND AFTER JANUARY FIRST, TWO THOUSAND
TEN, ALL OTHER SERVICES PROVIDED PURSUANT TO SUCH PARAGRAPH (S) AND
SERVICES PROVIDED PURSUANT TO PARAGRAPH (T) OF SUBDIVISION TWO OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THE SOCIAL SERVICES LAW.
S. 58--A 70 A. 158--A
S 17. Notwithstanding any contrary provision of law, except section
43.02 of the mental hygiene law, subject to availability of federal
financial participation, and within amounts appropriated therefore,
commencing on or after October 1, 2009 the commissioners of mental
health and health are jointly authorized to implement and enhance fund-
ing of the Ambulatory Patient Group (APG) reimbursement methodology, for
clinic services rendered by providers pursuant to their licensure under
article 31 of the mental hygiene law.
S 18. The commissioners of mental health and health, subject to the
approval of the state director of the budget, are jointly authorized to
implement and enhance funding of the Ambulatory Patient Group (APG)
reimbursement methodology for determining rates of payment for outpa-
tient clinic services rendered pursuant to providers' licensure under
article 31 of the mental hygiene law. The commissioner of mental health,
subject to the approval of the commissioner of health and the director
of the budget, shall promulgate regulations pursuant to article 31 of
the mental hygiene law which shall reflect utilization of the Ambulatory
Patient Group (APG) methodology, as described in subdivision 2-a of
section 2807 of the public health law, in which patients are grouped
based on their diagnosis, the intensity of the services provided and the
medical procedures performed, and with each APG assigned a weight
reflecting the projected utilization of resources. Such regulations
shall provide for the development of one or more base rates and the
multiplication of such base rates by the assigned weight for each APG to
establish the appropriate payment level for each such APG. Such regu-
lations may also utilize bundling, packaging and discounting mechanisms.
S 19. Notwithstanding any contrary provision of law, and within
amounts appropriated, commencing October 1, 2009, the commissioners of
mental health and health are jointly authorized to expand programs
including but not limited to the home-based crisis intervention program
and critical time intervention programs to reduce utilization of inpa-
tient hospital services.
S 20. Notwithstanding any contrary provision of law, and subject to
federal financial participation under Title XIX of the Social Security
Act, and within amounts appropriated therefore, commencing on or after
October 1, 2009, the commissioners of health and mental retardation and
developmental disabilities are jointly authorized to implement the Ambu-
latory Patient Group (APG) reimbursement methodology, for clinic
services rendered by providers pursuant to their licensure under article
16 of the mental hygiene law.
S 21. The commissioners of mental retardation and developmental disa-
bilities, and health, subject to the approval of the state director of
the budget, are jointly authorized to implement the Ambulatory Patient
Group (APG) reimbursement methodology for determining rates of payment
for clinic services rendered pursuant to providers' licensure under
article 16 of the mental hygiene law. The commissioner of mental retar-
dation and developmental disabilities, subject to the approval of the
commissioner of health and director of the budget, shall promulgate
regulations pursuant to article 16 of the mental hygiene law which shall
reflect utilization of the Ambulatory Patient Group (APG) methodology,
as described in subdivision 2-a of section 2807 of the public health
law, in which patients are grouped based on their diagnosis, the inten-
sity of the services provided and the procedures performed, and with
each APG assigned a weight reflecting the projected utilization of
resources. Such regulations shall provide for the development of one or
more base rates and the multiplication of such base rates by the
S. 58--A 71 A. 158--A
assigned weight for each APG to establish the appropriate payment level
for each such APG. Such regulations may also utilize bundling, packaging
and discounting mechanisms.
S 22. Notwithstanding any contrary provision of law, subject to feder-
al financial participation under Title XIX of the Social Security Act,
and within amounts appropriated therefore, commencing on or after Octo-
ber 1, 2009 the commissioners of health, and alcoholism and substance
abuse services are authorized to implement and enhance funding of the
Ambulatory Patient Group (APG) reimbursement methodology for clinic
services rendered pursuant to providers' operating certificates under
article 32 of the mental hygiene law.
S 23. The commissioners of alcoholism and substance abuse services,
and health, subject to the approval of the state director of the budget,
are jointly authorized to implement and enhance funding of the Ambulato-
ry Patient Group (APG) reimbursement methodology for determining rates
of payment for outpatient clinic services rendered pursuant to provid-
ers' operating certificates under article 32 of the mental hygiene law.
The commissioner of alcoholism and substance abuse services, subject to
the approval of the commissioner of health and the director of the
budget, shall promulgate regulations pursuant to article 32 of the
mental hygiene law which shall reflect utilization of the Ambulatory
Patient Group (APG) methodology, as described in subdivision 2-a of
section 2807 of the public health law, in which patients are grouped
based on their diagnosis, the intensity of the services provided and the
procedures performed, and with each APG assigned a weight reflecting the
projected utilization of resources. Such regulations shall provide for
the development of one or more base rates and the multiplication of such
base rates by the assigned weight for each APG to establish the appro-
priate payment level for each such APG. Such regulations may also
utilize bundling, packaging and discounting mechanisms.
S 23-a. Notwithstanding any contrary provision of law, and within
amounts appropriated, commencing April 1, 2009 the commissioners of
alcoholism and substance abuse services, and health are jointly author-
ized to increase medical assistance fees for medically supervised with-
drawal services.
S 24. Intentionally omitted.
S 25. The social services law is amended by adding a new section 364-m
to read as follows:
S 364-M. STATEWIDE HEALTH CARE HOME PROGRAM. 1. NOTWITHSTANDING ANY
INCONSISTENT PROVISION OF LAW, THE COMMISSIONER OF HEALTH IS AUTHORIZED
TO CERTIFY CERTAIN CLINICIANS AND CLINICS AS HEALTH CARE HOMES IN ORDER
TO IMPROVE HEALTH OUTCOMES AND EFFICIENCY THROUGH PATIENT CARE CONTINUI-
TY AND COORDINATION OF HEALTH SERVICES. THESE PROVIDERS WILL BE ELIGIBLE
FOR ENHANCED PAYMENTS FOR SERVICES PROVIDED TO: RECIPIENTS ELIGIBLE FOR
MEDICAL ASSISTANCE PURSUANT TO THIS TITLE ("MEDICAID FEE-FOR-SERVICE");
ENROLLEES ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO SUCH TITLE AND
ENROLLED IN APPROVED MANAGED CARE ORGANIZATIONS PURSUANT TO SECTION
THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE ("MEDICAID MANAGED CARE");
ENROLLEES ELIGIBLE FOR FAMILY HEALTH PLUS AND ENROLLED IN APPROVED
ORGANIZATIONS PURSUANT TO TITLE ELEVEN-D OF THIS ARTICLE ("FAMILY HEALTH
PLUS"); AND ENROLLEES ELIGIBLE FOR THE CHILD HEALTH INSURANCE PROGRAM
AND ENROLLED IN APPROVED ORGANIZATIONS PURSUANT TO TITLE ONE-A OF ARTI-
CLE TWENTY-FIVE OF THE PUBLIC HEALTH LAW ("CHILD HEALTH PLUS PROGRAM").
2. BY OCTOBER FIRST, TWO THOUSAND NINE, THE COMMISSIONER OF HEALTH
SHALL DEVELOP AND IMPLEMENT STANDARDS OF CERTIFICATION FOR HEALTH CARE
HOMES FOR MEDICAID FEE-FOR-SERVICE AND MEDICAID MANAGED CARE, FAMILY
S. 58--A 72 A. 158--A
HEALTH PLUS AND CHILD HEALTH PLUS PROGRAMS. IN DEVELOPING SUCH STAND-
ARDS, THE COMMISSIONER OF HEALTH SHALL: (A) CONSIDER EXISTING STANDARDS
DEVELOPED BY NATIONAL ACCREDITING AND PROFESSIONAL ORGANIZATIONS; AND
(B) CONSULT WITH NATIONAL AND LOCAL ORGANIZATIONS WORKING ON MEDICAL
HOME MODELS, PHYSICIANS, HOSPITALS, CLINICS, HEALTH PLANS AND CONSUMERS
AND THEIR REPRESENTATIVES.
3. TO MAINTAIN THEIR CERTIFICATION, HEALTH CARE HOMES MUST: (A) RENEW
THEIR CERTIFICATION AT A FREQUENCY DETERMINED BY THE COMMISSIONER OF
HEALTH; AND (B) PROVIDE DATA TO THE DEPARTMENT OF HEALTH AND TO HEALTH
PLANS TO PERMIT THE COMMISSIONER OF HEALTH, OR HIS OR HER CONTRACTOR OR
DESIGNEE, TO EVALUATE THE IMPACT OF HEALTH CARE HOMES ON QUALITY,
OUTCOMES AND COST.
4. SUBJECT TO THE AVAILABILITY OF FUNDING AND FEDERAL FINANCIAL
PARTICIPATION, THE COMMISSIONER OF HEALTH IS AUTHORIZED:
(A) TO PAY ENHANCED RATES OF PAYMENT TO CLINICS AND CLINICIANS THAT
ARE CERTIFIED AS HEALTH CARE HOMES UNDER THIS SECTION. SUCH ENHANCEMENTS
MAY BE TIERED BASED ON THE LEVEL OF STANDARD ACHIEVED BY THE CLINICIAN
OR CLINIC; AND
(B) TO PAY ADDITIONAL AMOUNTS FOR HEALTH CARE HOMES THAT MEET SPECIFIC
PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER OF HEALTH.
5. BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE, THE COMMISSIONER OF
HEALTH SHALL REPORT TO THE GOVERNOR AND THE LEGISLATURE ON THE IMPACT OF
THE STATEWIDE HEALTH CARE HOME PROGRAM ON QUALITY, COST AND OUTCOMES FOR
ENROLLEES IN MEDICAID FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY
HEALTH PLUS AND CHILD HEALTH PLUS.
S 26. Sections 2950 through 2958 of article 29-A of the public health
law are designated title 1 and a new title heading is added to read as
follows:
RURAL HEALTH CARE ACCESS
S 26-a. Article 29-A of the public health law is amended by adding a
new title 2 to read as follows:
TITLE 2
ADIRONDACK HEALTH CARE HOME MULTIPAYOR
DEMONSTRATION PROGRAM
SECTION 2959. ADIRONDACK HEALTH CARE HOME MULTIPAYOR DEMONSTRATION
PROGRAM.
S 2959. ADIRONDACK HEALTH CARE HOME MULTIPAYOR DEMONSTRATION PROGRAM.
1. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, THE COMMISSIONER
IS AUTHORIZED TO ESTABLISH AN ADIRONDACK HEALTH CARE HOME MULTIPAYOR
DEMONSTRATION PROGRAM FOR THE PURPOSE OF CERTIFYING CERTAIN CLINICIANS
AND CLINICS IN THE UPPER NORTHEASTERN REGION OF NEW YORK AS HEALTH CARE
HOMES ELIGIBLE FOR ENHANCED PAYMENTS FOR SERVICES PROVIDED TO: RECIPI-
ENTS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO TITLE ELEVEN OF ARTICLE
FIVE OF THE SOCIAL SERVICES LAW ("MEDICAID FEE-FOR-SERVICE"); ENROLLEES
ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO SUCH TITLE AND ENROLLED IN
APPROVED MANAGED CARE ORGANIZATIONS PURSUANT TO SECTION THREE HUNDRED
SIXTY-FOUR-J OF SUCH TITLE ("MEDICAID MANAGED CARE"); ENROLLEES ELIGIBLE
FOR FAMILY HEALTH PLUS AND ENROLLED IN APPROVED ORGANIZATIONS PURSUANT
TO TITLE ELEVEN-D OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW ("FAMILY
HEALTH PLUS"); ENROLLEES ELIGIBLE FOR THE CHILD HEALTH INSURANCE PROGRAM
AND ENROLLED IN APPROVED ORGANIZATIONS PURSUANT TO TITLE ONE-A OF ARTI-
CLE TWENTY-FIVE OF THIS CHAPTER ("CHILD HEALTH PLUS PROGRAM"); ENROLLEES
AND SUBSCRIBERS OF COMMERCIAL MANAGED CARE PLANS OPERATING IN ACCORDANCE
WITH THE PROVISIONS OF ARTICLE FORTY-FOUR OF THIS CHAPTER OR BY HEALTH
MAINTENANCE ORGANIZATIONS ORGANIZED AND OPERATING IN ACCORDANCE WITH
ARTICLE FORTY-THREE OF THE INSURANCE LAW; ENROLLEES AND SUBSCRIBERS OF
S. 58--A 73 A. 158--A
OTHER COMMERCIAL INSURANCE PRODUCTS; AND EMPLOYEES OF EMPLOYER-SPONSORED
SELF-INSURED PLANS. THE PURPOSE OF THIS DEMONSTRATION PROGRAM IS TO
IMPROVE HEALTH CARE OUTCOMES AND EFFICIENCY THROUGH PATIENT CARE CONTI-
NUITY AND COORDINATION OF HEALTH SERVICES.
2. (A) IN ORDER TO PROMOTE IMPROVED QUALITY OF, AND ACCESS TO, HEALTH
CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES TO THE RESIDENTS IN
THE UPPER NORTHEASTERN REGION OF NEW YORK, IT SHALL BE THE POLICY OF THE
STATE TO ENCOURAGE COOPERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGE-
MENTS BETWEEN PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE SERVICES
PROVIDERS WHO MIGHT OTHERWISE BE COMPETITORS, UNDER THE ACTIVE SUPER-
VISION OF THE COMMISSIONER. TO THE EXTENT SUCH ARRANGEMENTS MIGHT BE
ANTI-COMPETITIVE WITHIN THE MEANING AND INTENT OF THE FEDERAL ANTITRUST
LAWS, THE INTENT OF THE STATE IS TO SUPPLANT COMPETITION WITH SUCH
ARRANGEMENT TO THE EXTENT NECESSARY TO ACCOMPLISH THE PURPOSES OF THIS
ARTICLE, AND PROVIDE STATE ACTION IMMUNITY UNDER THE STATE AND FEDERAL
ANTITRUST LAWS WITH RESPECT TO THE PLANNING, IMPLEMENTATION AND OPERA-
TION OF THE ADIRONDACK HEALTH CARE HOME MULTIPAYOR DEMONSTRATION PROGRAM
AND PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE SERVICES PROVIDERS.
(B) THE COMMISSIONER OR HIS OR HER DULY AUTHORIZED REPRESENTATIVE MAY
ALSO ENGAGE IN APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS, AND MAY
INSPECT OR REQUEST ADDITIONAL DOCUMENTATION TO VERIFY THAT THE DEMON-
STRATION IS IMPLEMENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
3. THE COMMISSIONER IS AUTHORIZED TO PARTICIPATE IN, ACTIVELY SUPER-
VISE, FACILITATE AND APPROVE A PRIMARY CARE HEALTH CARE HOME COLLABORA-
TIVE WITH HEALTH CARE SERVICES PROVIDERS, WHICH MAY INCLUDE HOSPITALS,
DIAGNOSTIC AND TREATMENT CENTERS, AND PRIVATE PRACTICES, AND PAYORS OF
HEALTH CARE SERVICES, INCLUDING EMPLOYERS, HEALTH PLANS AND INSURERS, TO
ESTABLISH: (A) THE BOUNDARIES OF THE DEMONSTRATION AND THE PROVIDERS
ELIGIBLE TO PARTICIPATE; (B) PRACTICE STANDARDS FOR THE HEALTH CARE HOME
CONSISTENT WITH EXISTING STANDARDS DEVELOPED BY NATIONAL ACCREDITING AND
PROFESSIONAL ORGANIZATIONS INCLUDING THE JOINT PRINCIPLES OF THE AMERI-
CAN COLLEGE OF PHYSICIANS ("ACP"), THE AMERICAN ACADEMY OF FAMILY PHYSI-
CIANS ("AAFP"), THE AMERICAN ACADEMY OF PEDIATRICS ("AAP"), THE AMERICAN
OSTEOPATHIC ASSOCIATION ("AOA"), AND AS FURTHER DEFINED BY "PATIENT-CEN-
TERED MEDICAL HOME," AS REPRESENTED IN CERTIFICATION PROGRAMS DEVELOPED
BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE ("NCQA"); (C) METHODOL-
OGIES BY WHICH PAYORS WILL PROVIDE ENHANCED RATES OF PAYMENT TO CERTI-
FIED HEALTH CARE HOMES; AND (D) METHODOLOGIES TO PAY ADDITIONAL AMOUNTS
FOR HEALTH CARE HOMES THAT MEET SPECIFIC PROCESS OR OUTCOME STANDARDS
ESTABLISHED BY THE ADIRONDACK HEALTH CARE HOME COLLABORATIVE.
4. PATIENT AND HEALTH CARE SERVICES PROVIDER PARTICIPATION IN THE
ADIRONDACK HEALTH CARE HOME MULTIPAYOR DEMONSTRATION PROGRAM SHALL BE ON
A VOLUNTARY BASIS.
5. CLINICS AND CLINICIANS PARTICIPATING IN THIS DEMONSTRATION ARE NOT
ELIGIBLE FOR ADDITIONAL ENHANCEMENTS OR BONUSES UNDER THE STATEWIDE
HEALTH CARE HOME PROGRAM, ESTABLISHED PURSUANT TO SECTION THREE HUNDRED
SIXTY-FOUR-M OF THE SOCIAL SERVICES LAW, FOR SERVICES PROVIDED TO
PARTICIPANTS IN MEDICAID FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY
HEALTH PLUS OR CHILD HEALTH PLUS.
6. SUBJECT TO THE AVAILABILITY OF FUNDING AND FEDERAL FINANCIAL
PARTICIPATION, THE COMMISSIONER IS AUTHORIZED:
(A) TO PAY ENHANCED RATES OF PAYMENT UNDER MEDICAID FEE-FOR-SERVICE,
MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS TO CLIN-
ICS AND CLINICIANS THAT ARE CERTIFIED AS HEALTH CARE HOMES UNDER THIS
TITLE; AND
S. 58--A 74 A. 158--A
(B) TO PAY ADDITIONAL AMOUNTS FOR HEALTH CARE HOMES THAT MEET SPECIFIC
PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER, IN CONSULTA-
TION WITH THE ADIRONDACK HEALTH CARE HOME COLLABORATIVE.
S 27. Subdivision 2 of section 365-a of the social services law is
amended by adding three new paragraphs (s), (t) and (u) to read as
follows:
(S) SMOKING CESSATION COUNSELING SERVICES FOR A PREGNANT WOMAN ON ANY
DAY OF HER PREGNANCY THROUGH THE END OF THE MONTH IN WHICH THE ONE
HUNDRED EIGHTIETH DAY FOLLOWING THE END OF THE PREGNANCY OCCURS, AND
CHILDREN AND ADOLESCENTS TEN TO NINETEEN YEARS OF AGE, DURING A MEDICAL
VISIT WHEN PROVIDED BY A GENERAL HOSPITAL OUTPATIENT DEPARTMENT OR A
FREE-STANDING CLINIC, OR BY A PHYSICIAN, REGISTERED PHYSICIAN'S ASSIST-
ANT, REGISTERED NURSE PRACTITIONER OR LICENSED MIDWIFE IN OFFICE-BASED
SETTINGS; PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS PARAGRAPH
RELATING TO SMOKING CESSATION COUNSELING SERVICES SHALL NOT TAKE EFFECT
UNLESS ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE
BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF
SUCH SERVICES.
(T) CARDIAC REHABILITATION SERVICES WHEN ORDERED BY THE ATTENDING
PHYSICIAN AND PROVIDED IN A HOSPITAL-BASED OR FREE-STANDING CLINIC IN AN
AREA SET ASIDE FOR CARDIAC REHABILITATION, OR IN A PHYSICIAN'S OFFICE;
PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS PARAGRAPH RELATING TO
CARDIAC REHABILITATION SERVICES SHALL NOT TAKE EFFECT UNLESS ALL NECES-
SARY APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO
RECEIVE FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF SUCH SERVICES.
(U) SCREENING, BRIEF INTERVENTION, REFERRAL AND TREATMENT IN HOSPITAL
EMERGENCY DEPARTMENTS OF INDIVIDUALS AT RISK FOR SUBSTANCE ABUSE INCLUD-
ING REFERRAL TO THE APPROPRIATE LEVEL OF INTERVENTION AND TREATMENT IN A
COMMUNITY SETTING; PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS PARA-
GRAPH RELATING TO SCREENING, BRIEF INTERVENTION, REFERRAL AND TREATMENT
SERVICES SHALL NOT TAKE EFFECT UNLESS ALL NECESSARY APPROVALS UNDER
FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINAN-
CIAL PARTICIPATION IN SUCH COSTS.
S 28. Notwithstanding any contrary provision of law, in the event
sections two through ten of this act are not enacted into law then the
provisions of sections twenty-five through twenty-seven and section
twenty-nine of this act shall be deemed null and void and of no effect.
S 28-a. Notwithstanding any contrary provision of section 14 of part B
of chapter 1 of the laws of 2002 or any other contrary provision of law,
distributions made pursuant to section 14 of part B of chapter 1 of the
laws of 2002, shall be based on each eligible hospitals' proportionate
share of the sum of all Medicaid outpatient visits for all eligible
hospitals in the base year two years prior to the rate year.
S 29. Section 365-h of the social services law, as added by chapter 81
of the laws of 1995, subdivision 3 as amended by section 26 of part B of
chapter 1 of the laws of 2002, is amended to read as follows:
S 365-h. Provision and reimbursement of transportation costs. 1. The
local social services official AND, SUBJECT TO THE PROVISIONS OF SUBDI-
VISION FOUR OF THIS SECTION, THE COMMISSIONER OF HEALTH, shall have
responsibility for prior authorizing transportation of eligible persons
and for limiting the provision of such transportation to those recipi-
ents and circumstances where such transportation is essential, medically
necessary and appropriate to obtain medical care, services or supplies
otherwise available under this title.
2. In exercising this responsibility, the local social services offi-
cial AND, AS APPROPRIATE, THE COMMISSIONER OF HEALTH shall:
S. 58--A 75 A. 158--A
(a) make appropriate and economical use of transportation resources
available in the district in meeting the anticipated demand for trans-
portation within the district, including, but not limited to: transpor-
tation generally available free-of-charge to the general public or
specific segments of the general public, public transportation,
promotion of group rides, county vehicles, coordinated transportation,
and direct purchase of services; and
(b) maintain quality assurance mechanisms in order to ensure that (i)
only such transportation as is essential, medically necessary and appro-
priate to obtain medical care, services or supplies otherwise available
under this title is provided and (ii) no expenditures for taxi or livery
transportation are made when public transportation or lower cost trans-
portation is reasonably available to eligible persons.
3. In the event that coordination or other such cost savings measures
are implemented, the commissioner shall assure compliance with applica-
ble standards governing the safety and quality of transportation of the
population served.
4. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ASSUME RESPONSIBILITY
FROM A LOCAL SOCIAL SERVICES OFFICIAL FOR THE PROVISION AND REIMBURSE-
MENT OF TRANSPORTATION COSTS UNDER THIS SECTION. IF THE COMMISSIONER
ELECTS TO ASSUME SUCH RESPONSIBILITY, THE COMMISSIONER SHALL NOTIFY THE
LOCAL SOCIAL SERVICES OFFICIAL IN WRITING AS TO THE ELECTION, THE DATE
UPON WHICH THE ELECTION SHALL BE EFFECTIVE AND SUCH INFORMATION AS TO
TRANSITION OF RESPONSIBILITIES AS THE COMMISSIONER DEEMS PRUDENT. THE
COMMISSIONER IS AUTHORIZED TO CONTRACT WITH A TRANSPORTATION MANAGER OR
MANAGERS THAT HAVE EXPERIENCE IN COORDINATING TRANSPORTATION SERVICES IN
THE STATE TO MANAGE THE PROVISION OF SERVICES UNDER THIS SECTION. SUCH A
CONTRACT OR CONTRACTS MAY INCLUDE, WITHOUT LIMITATION, RESPONSIBILITY
FOR: REVIEW, APPROVAL AND PROCESSING OF TRANSPORTATION ORDERS; MANAGE-
MENT OF THE APPROPRIATE LEVEL OF TRANSPORTATION BASED ON DOCUMENTED
PATIENT MEDICAL NEED; AND DEVELOPMENT OF NEW TECHNOLOGIES AND APPROACHES
LEADING TO EFFICIENT TRANSPORTATION SERVICES. NOTWITHSTANDING ANY INCON-
SISTENT PROVISION OF SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-
THREE OF THE STATE FINANCE LAW, OR SECTION ONE HUNDRED FORTY-TWO OF THE
ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW, THE COMMISSIONER OF HEALTH
IS AUTHORIZED TO ENTER INTO A CONTRACT UNDER THIS SUBDIVISION WITHOUT A
COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS.
S 30. Section 364-f of the social services law, as added by chapter
904 of the laws of 1984, is amended to read as follows:
S 364-f. [Physician] PRIMARY CARE case management programs. 1. The
department is authorized to establish [physician] PRIMARY CARE case
management [demonstration] programs, under the medical assistance
program, in accordance with applicable federal law and regulations.
PRIMARY CARE CASE MANAGEMENT PROGRAMS SHALL ONLY BE AUTHORIZED IN AREAS
OF THE STATE WHERE COMPREHENSIVE HEALTH SERVICES PLANS, AS DEFINED IN
SECTION FORTY-FOUR HUNDRED ONE OF THE PUBLIC HEALTH LAW, ARE NOT YET
AVAILABLE. Subject to the approval of the director of the budget, the
commissioner is authorized to apply for the appropriate waivers under
federal law and regulation, and may waive any of the provisions of
sections three hundred sixty-five-a, three hundred sixty-six, three
hundred sixty-seven-b [and], three hundred sixty-eight-a AND THREE
HUNDRED SIXTY-FOUR-J of this chapter or any regulation of the department
when such action would be necessary to assist in promoting the objec-
tives of this section.
2. (a) A [physician] PRIMARY CARE case management program shall
provide individuals eligible for medical assistance with the opportunity
S. 58--A 76 A. 158--A
to select [voluntarily] a PRIMARY CARE case [management provider] MANAG-
ER who shall provide medical assistance services to such eligible indi-
viduals, either directly, or through referral [by a physician case
manager].
(b) [Physician] PRIMARY CARE case managers shall be limited to quali-
fied, licensed primary care [physicians] PRACTITIONERS, AS DEFINED IN
PARAGRAPH (F) OF SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-FOUR-J
OF THIS CHAPTER, who meet standards established by the commissioner [of
health] for the purposes of this program.
(c) Services [for which a physician case manager will be responsible]
THAT MAY BE COVERED BY THE PRIMARY CARE CASE MANAGEMENT PROGRAM ARE
DEFINED BY THE COMMISSIONER IN THE BENEFIT PACKAGE. COVERED SERVICES MAY
include all medical assistance services defined under section three
hundred sixty-five-a of this chapter, except:
(i) SERVICES EXCLUDED UNDER PARAGRAPH (E) OF SUBDIVISION THREE OF
SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS CHAPTER SHALL BE EXCLUDED
UNDER THIS SECTION;
(II) services provided by residential health care facilities, long
term home health care programs, child care agencies, and entities offer-
ing comprehensive health services plans;
[(ii)] (III) services provided by dentists and optometrists; and
[(iii)] (IV) eyeglasses, emergency care, mental health services and
family planning services.
(d) Case management services provided by [physician] PRIMARY CARE case
managers shall include, but need not be limited to:
(i) management of the medical and health care of each recipient to
assure that all services provided under paragraph (c) of this subdivi-
sion and which are found to be necessary, are made available in a timely
manner;
(ii) referral to, and coordination, monitoring and follow-up of,
appropriate providers for diagnosis and treatment, the need for which
has been identified by the [physician] PRIMARY CARE case manager but
which is not directly available from the [physician] PRIMARY CARE case
manager, and assisting medical assistance recipients in the prudent
selection of medical services;
(iii) arrangements for referral of recipients to appropriate provid-
ers; and
(iv) [services provided in accordance with child health assurance
program standards for individuals under twenty-one years of age] ALL
EARLY PERIODIC SCREENING, DIAGNOSIS AND TREATMENT SERVICES, AS WELL AS
INTERPERIODIC SCREENING AND REFERRAL, TO EACH PARTICIPANT UNDER THE AGE
OF TWENTY-ONE AT REGULAR INTERVALS.
3. (a) [Physician] PRIMARY CARE case management programs may be
conducted only in accordance with [plans submitted by social services
districts and approved] GUIDELINES ESTABLISHED by the commissioner[,
after consultation with the commissioner of health, and only to the
extent and period for which such plans have been approved by the commis-
sioner. The commissioner shall not authorize the implementation of such
plans in more than ten social services districts. For the purpose of
implementing and administering the physician case management programs,
social services districts may]. NOTWITHSTANDING ANY INCONSISTENT
PROVISION OF SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF
THE STATE FINANCE LAW, OR SECTION ONE HUNDRED FORTY-TWO OF THE ECONOMIC
DEVELOPMENT LAW, OR ANY OTHER LAW, THE COMMISSIONER IS AUTHORIZED TO
ENTER INTO A contract with [private not-for-profit and public agencies]
QUALIFIED ENTITIES AS DEFINED IN GUIDELINES ESTABLISHED BY THE COMMIS-
S. 58--A 77 A. 158--A
SIONER for the management AND ADMINISTRATION of [these plans provided,
however, that such contracts shall require prior approval by the commis-
sioner] THE PRIMARY CARE CASE MANAGEMENT PROGRAM WITHOUT A COMPETITIVE
BID OR REQUEST FOR PROPOSAL PROCESS.
(b) The [commissioner shall only approve plans submitted pursuant to
this section which: (i) identify and document the specific problems
which the physician case management program is designed to address with-
in the social services district;] PRIMARY CARE CASE MANAGEMENT PROGRAM
MUST:
[(ii)] (I) assure access to and delivery of high quality, appropriate
medical services;
[(iii) include a description of the quality assurance mechanisms to be
implemented] (II) PARTICIPATE IN QUALITY ASSURANCE ACTIVITIES AS
REQUIRED BY THE COMMISSIONER, as well as other mechanisms designed to
protect recipient rights under such program;
[(iv) designate the entity to be responsible for the administration of
the program within the social services district and describe the respon-
sibilities of this entity;
(v) include a fiscal impact statement which describes the anticipated
savings to federal, state and local governments, including an estimate
of those costs, including both inpatient and ambulatory costs, which
would have been incurred in the absence of the program and the projected
costs under the program;
(vi)] (III) ensure that persons eligible for medical assistance will
be provided sufficient information regarding the program to make an
informed and voluntary choice whether to participate; AND
[(vii)] (IV) provide for adequate safeguards to protect recipients
from being misled concerning the program and from being coerced into
participating in the [physician] PRIMARY CARE case management
program[;].
[(viii) assure adequate opportunity for public review and comment
prior to implementation of the program and provide adequate grievance
procedures for recipients who participate in the program; and
(ix) include any other information which the department shall deem
appropriate.]
4. (a) Individuals eligible [for medical assistance] TO PARTICIPATE IN
THE STATE'S MANAGED CARE PROGRAM, as defined in SUBPARAGRAPH THREE OF
section three hundred [sixty-six] SIXTY-FOUR-J of this chapter, may
[voluntarily] participate in a [physician] PRIMARY CARE case management
program, subject to the availability of such a program within the appli-
cable social services district, except for individuals: (i) enrolled in
an entity offering a comprehensive health services plan as defined in
paragraph (k) of subdivision two of section three hundred sixty-five-a
of this chapter; (ii) participating in another medical assistance reim-
bursed demonstration or pilot project, or (iii) receiving services as an
inpatient from a nursing home or intermediate care facility or residen-
tial services from a child care agency or services from a long term home
health care program.
(b) [All individuals eligible for medical assistance] INDIVIDUALS
choosing to participate [voluntarily] in a [physician] PRIMARY CARE case
management program will be given thirty days from the effective date of
enrollment in the program to disenroll without cause. After this thirty
day disenrollment period, all individuals participating in the program
will be enrolled for a period of [six] TWELVE months, except that all
participants will be permitted to disenroll for good cause, as defined
IN GUIDELINES ESTABLISHED by the commissioner [in regulation].
S. 58--A 78 A. 158--A
5. (a) [Physician] PRIMARY CARE case management programs may include
provisions for innovative payment mechanisms, including, but not limited
to, [sharing of any savings with providers,] payment of case management
fees [and], capitation arrangements, AND FEE-FOR-SERVICE PAYMENTS.
(b) Any new payment mechanisms and levels of payment implemented under
the [physician] PRIMARY CARE case management program shall be developed
[jointly] by the commissioner [and the commissioner of health] subject
to the approval of the director of the budget.
6. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION, PARTIC-
IPATION IN A PRIMARY CARE CASE MANAGEMENT PROGRAM WILL NOT DIMINISH THE
SCOPE OF AVAILABLE MEDICAL SERVICES TO WHICH A RECIPIENT IS ENTITLED.
7. This section shall be effective if, and as long as, federal finan-
cial participation is available therefor.
S 31. Intentionally omitted.
S 32. Intentionally omitted.
S 33. Section 2818 of the public health law is amended by adding a
new subdivision 4 to read as follows:
4. (A) NOTWITHSTANDING SUBDIVISION ONE, TWO OR THREE OF THIS SECTION,
THE COMMISSIONER, WITH THE APPROVAL OF THE DIRECTOR OF THE BUDGET, MAY
EXPEND FUNDS FOR THE PURPOSE OF PROVIDING COST EFFECTIVE INCREASED
ACCESS TO THE CAPITAL MARKETS, INCLUDING BUT NOT LIMITED TO THROUGH THE
USE OF MORTGAGE INSURANCE, CREDIT ENHANCEMENT, LETTERS OF CREDIT, BOND
INSURANCE OR OTHER ARRANGEMENTS, FOR CAPITAL PROJECTS THAT ARE DETER-
MINED TO MEET ONE OR MORE OF THE FOLLOWING OBJECTIVES FOR HOSPITALS
LICENSED UNDER THIS ARTICLE:
(I) SECURING FINANCING FOR FACILITIES IN A MANNER THAT WILL IMPROVE
THE OPERATION AND EFFICIENCY OF THE HEALTH CARE DELIVERY SYSTEM WITHIN
THE STATE;
(II) SECURING FINANCING FOR FACILITIES IN A MANNER CONSISTENT WITH THE
OBJECTIVES AND DETERMINATIONS OF THE COMMISSION ON HEALTH CARE FACILI-
TIES IN THE TWENTY-FIRST CENTURY, ESTABLISHED PURSUANT TO CHAPTER
SIXTY-THREE OF THE LAWS OF TWO THOUSAND FIVE;
(III) SECURING FINANCING FOR FACILITIES IN A MANNER THAT WILL HELP
RIGHTSIZE THE STATE'S ACUTE CARE INFRASTRUCTURE, INCLUDING REDUCING
INPATIENT CAPACITY, DOWNSIZING, RESTRUCTURING, AND CLOSING FACILITIES;
(IV) SECURING FINANCING FOR FACILITIES IN A MANNER THAT ADVANCES THE
REFORM OF THE LONG-TERM CARE SYSTEM, INCLUDING THROUGH RIGHTSIZING AND
PROVIDING COMMUNITY-BASED SERVICES;
(V) SECURING FINANCING FOR FACILITIES IN A MANNER THAT IMPROVES THE
PRIMARY AND AMBULATORY CARE SYSTEM; AND
(VI) SUCH OTHER OBJECTIVES AS THE COMMISSIONER DEEMS APPROPRIATE TO
EFFECTUATE THE INTENT OF THIS SUBDIVISION.
(B) THE COMMISSIONER MAY TRANSFER FUNDS TO OTHER STATE AGENCIES OR
PUBLIC AUTHORITIES, WITH THE APPROVAL OF THE DIRECTOR OF BUDGET, TO
EFFECTUATE THE PURPOSES OF THIS SUBDIVISION.
S 34. Subdivision 3 of section 1680-j of the public authorities law,
as amended by section 7 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
3. Notwithstanding any law to the contrary, and in accordance with
section four of the state finance law, the comptroller is hereby author-
ized and directed to transfer from the health care reform act (HCRA)
resources fund (061) to the general fund, upon the request of the direc-
tor of the budget, up to $6,500,000 on or before March 31, 2006, and the
comptroller is further hereby authorized and directed to transfer from
the healthcare reform act (HCRA); Resources fund (061) to the Capital
Projects Fund, upon the request of the director of budget, up to
S. 58--A 79 A. 158--A
$139,000,000 for the period April 1, 2006 through March 31, 2007, up to
$171,100,000 for the period April 1, 2007 through March 31, 2008, up to
$208,100,000 for the period April 1, 2008 through March 31, 2009, up to
$151,600,000 for the period April 1, 2009 through March 31, 2010, and up
to [$182,000,000] $238,000,000 for the period April 1, 2010 through
March 31, 2011.
S 35. Subdivision 7 of section 367-a of the social services law is
amended by adding a new paragraph (e) to read as follows:
(E) THE COMMISSIONER IS AUTHORIZED TO NEGOTIATE DIRECTLY WITH PHARMA-
CEUTICAL MANUFACTURERS FOR REBATES, AND TO ENTER INTO A CONTRACT OR
CONTRACTS WITH QUALIFIED ENTITIES FOR SUCH PURPOSE. NOTWITHSTANDING ANY
INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED
SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION ONE HUNDRED FORTY-TWO
OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW, THE COMMISSIONER IS
AUTHORIZED TO ENTER INTO A CONTRACT UNDER THIS SUBDIVISION WITHOUT A
COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS.
S 36. Subdivision 4 of section 272 of the public health law is
REPEALED.
S 37. Section 3-a of part Z2 of chapter 62 of the laws of 2003, amend-
ing the social services law and the public health law relating to
expanding Medicaid coverage and rates of payment for residential health
care facilities is REPEALED.
S 38. Section 369-aa of the social services law is amended by adding a
new subdivision 16 to read as follows:
16. "STEP THERAPY" SHALL MEAN THE PRACTICE OF BEGINNING DRUG THERAPY
FOR A MEDICAL CONDITION WITH THE MOST MEDICALLY APPROPRIATE AND COST
EFFECTIVE THERAPY AND PROGRESSING TO OTHER DRUGS AS MEDICALLY NECESSARY.
S 39. Section 369-cc of the social services law is amended by adding a
new subdivision 4 to read as follows:
4. THE COMMISSIONER, THROUGH THE PROSPECTIVE DUR PROGRAM, MAY REQUIRE
STEP THERAPY WHEN THERE IS MORE THAN ONE DRUG APPROPRIATE TO TREAT A
MEDICAL CONDITION. THE PURPOSE OF STEP THERAPY IS TO ENCOURAGE THE USE
OF MEDICALLY APPROPRIATE, COST EFFECTIVE DRUGS WHEN CLINICALLY INDICATED
AND TO LIMIT USE OF ALTERNATIVE DRUG THERAPIES UNLESS CERTAIN CLINICAL
REQUIREMENTS ARE MET. THE DUR BOARD SHALL RECOMMEND GUIDELINES FOR
SPECIFIC DIAGNOSES AND THERAPY REGIMENS WITHIN WHICH PRACTITIONERS MAY
PRESCRIBE DRUGS WITHOUT THE REQUIREMENT FOR PRIOR AUTHORIZATION OF THOSE
DRUGS. IN ESTABLISHING THESE GUIDELINES, THE BOARD SHALL CONSIDER CLIN-
ICAL EFFECTIVENESS, SAFETY, AND COST EFFECTIVENESS.
S 40. Paragraph (g) of subdivision 2 of section 365-a of the social
services law, as amended by section 1 of part F of chapter 497 of the
laws of 2008, 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 that 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-preferred manufactur-
ers' glucometers and test strips to prior authorization under section
two hundred seventy-three of the public health law; drugs provided on an
in-patient basis, those drugs contained on the list established by regu-
lation of the commissioner of health pursuant 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 availability of such drugs
S. 58--A 80 A. 158--A
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 quantities no greater than a
thirty day supply or one hundred doses, whichever is greater; provided
further that the commissioner of health is authorized 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 were the product used as normally indicated; PROVIDED FURTHER
THAT THE COMMISSIONER OF HEALTH MAY FROM TIME TO TIME LIMIT THE AMOUNT,
FREQUENCY AND DURATION OF DRUG THERAPY THROUGH PRIOR AUTHORIZATION AS
PART OF THE DRUG UTILIZATION REVIEW PROGRAM ESTABLISHED UNDER TITLE
ELEVEN-C OF THIS ARTICLE; medical assistance shall not include any drug
provided on other than an in-patient 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 41. Paragraph (b) of subdivision 8 of section 369-bb of the social
services law is amended by adding a new subparagraph (viii) to read as
follows:
(VIII) THE DEVELOPMENT OF CLINICAL PRESCRIBING GUIDELINES RELATING TO
QUANTITY, FREQUENCY AND DURATION OF DRUG THERAPY FOR THE COMMISSIONER'S
USE IN DETERMINING WHEN TO REQUIRE PRIOR AUTHORIZATION OF DRUGS IN THE
DUR PROGRAM PURSUANT TO THE AUTHORITY OF PARAGRAPH (G) OF SUBDIVISION
TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS ARTICLE; EXCEPTIONS TO
ANY PRIOR AUTHORIZATION IMPOSED AS A RESULT OF THESE GUIDELINES SHALL
INCLUDE, BUT NEED NOT BE LIMITED TO, PROVISION FOR EMERGENCY CIRCUM-
STANCES WHERE A MEDICAL CONDITION REQUIRES ALLEVIATION OF SEVERE PAIN OR
WHICH THREATENS TO CAUSE DISABILITY OR TO TAKE A LIFE IF NOT PROMPTLY
TREATED.
S 42. Paragraph (g) of subdivision 4 of section 365-a of the social
services law, as amended by section 61 of part C of chapter 58 of the
laws of 2007, is amended to read as follows:
(g) for eligible persons who are also beneficiaries under part D of
title XVIII of the federal social security act, drugs which are denomi-
nated as "covered part D drugs" under section 1860D-2(e) of such act[;
provided however that, for purposes of this paragraph, "covered part D
drugs" shall not mean atypical anti-psychotics, anti-depressants, anti-
retrovirals used in the treatment of HIV/AIDS, or anti-rejection drugs
used for the treatment of organ and tissue transplants].
S 43. Subparagraph (ii) of paragraph (b) of subdivision 9 of section
367-a of the social services law, as amended by section 4 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
(ii) if the drug dispensed is a multiple source prescription drug or a
brand-name prescription drug for which no specific upper limit has been
set by such federal agency, the lower of the estimated acquisition cost
of such drug to pharmacies, or the dispensing pharmacy's usual and
customary price charged to the general public. For sole and multiple
source brand name drugs, estimated acquisition cost means the average
wholesale price of a prescription drug based upon the package size
dispensed from, as reported by the prescription drug pricing service
used by the department, less sixteen and twenty-five one hundredths
S. 58--A 81 A. 158--A
percent thereof, and updated monthly by the department[; or, for a
specialized HIV pharmacy, as defined in paragraph (f) of this subdivi-
sion, acquisition cost means the average wholesale price of a
prescription drug based upon the package size dispensed from, as
reported by the prescription drug pricing service used by the depart-
ment, less twelve percent thereof, and updated monthly by the depart-
ment]. For multiple source generic drugs, estimated acquisition cost
means the lower of the average wholesale price of a prescription drug
based on the package size dispensed from, as reported by the
prescription drug pricing service used by the department, less twenty-
five percent thereof, or the maximum acquisition cost, if any, estab-
lished pursuant to paragraph (e) of this subdivision[; or, for a
specialized HIV pharmacy, as defined in paragraph (f) of this subdivi-
sion, acquisition cost means the lower of the average wholesale price of
a prescription drug based on the package size dispensed from, as
reported by the prescription drug pricing service used by the depart-
ment, less twelve percent thereof, or the maximum acquisition cost, if
any, established pursuant to paragraph (e) of this subdivision].
S 44. Paragraph (f) of subdivision 9 of section 367-a of the social
services law is REPEALED.
S 45. Subdivision 7 of section 274 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:
7. In the event that the patient does not meet the criteria for
approval established by the commissioner in subdivision six of this
section, the clinical drug review program shall provide a reasonable
opportunity for a prescriber to reasonably present his or her justifica-
tion for prior authorization. If, after [consultation with] the
program[, the prescriber, in his or her reasonable professional judg-
ment, determines that the use of the prescription drug is warranted, the
prescriber's determination shall be final and prior authorization shall
be granted under this section; provided, however, that] PROVIDES THE
PRESCRIBER SUCH REASONABLE OPPORTUNITY, THE PROGRAM DETERMINES THAT THE
USE OF THE DRUG IS NOT MEDICALLY NECESSARY, PRIOR AUTHORIZATION MAY BE
DENIED. IN ADDITION, prior authorization may be denied in cases where
the department has substantial evidence that the prescriber or patient
is engaged in fraud or abuse relating to the drug.
S 46. Paragraph (a-1) of subdivision 4 of section 365-a of the social
services law, as amended by section 11 of part C of chapter 58 of the
laws of 2005, is amended to read as follows:
(a-1) (I) a brand name drug for which a multi-source therapeutically
and generically equivalent drug, as determined by the federal food and
drug administration, is available, unless previously authorized by the
department of health. The commissioner of health is authorized to
exempt, for good cause shown, any brand name drug from the restrictions
imposed by this [paragraph] SUBPARAGRAPH. This [paragraph] SUBPARAGRAPH
shall not apply to any drug that is in a therapeutic class included on
the preferred drug list under section two hundred seventy-two of the
public health law or is in the clinical drug review program under
section two hundred seventy-four of the public health law;
(II) NOTWITHSTANDING THE PROVISIONS OF SUBPARAGRAPH (I) OF THIS PARA-
GRAPH, THE COMMISSIONER IS AUTHORIZED TO DENY REIMBURSEMENT FOR A GENER-
IC EQUIVALENT, INCLUDING A GENERIC EQUIVALENT THAT IS ON THE PREFERRED
DRUG LIST OR THE CLINICAL DRUG REVIEW PROGRAM, WHEN THE NET COST OF THE
BRAND NAME DRUG, AFTER CONSIDERATION OF ALL REBATES, IS LESS THAN THE
COST OF THE GENERIC EQUIVALENT;
S. 58--A 82 A. 158--A
S 47. Subparagraph (iii) of paragraph (c) of subdivision 6 of section
367-a of the social services law, as amended by section 9 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
(iii) Notwithstanding any other provision of this paragraph, co-
payments charged for each generic prescription drug dispensed shall be
one dollar and for each brand name prescription drug dispensed shall be
three dollars; provided, however, that the co-payments charged for each
brand name prescription drug on the preferred drug list established
pursuant to section two hundred seventy-two of the public health law AND
THE CO-PAYMENTS CHARGED FOR EACH BRAND NAME PRESCRIPTION DRUG REIMBURSED
PURSUANT TO SUBPARAGRAPH (II) OF PARAGRAPH (A-2) OF SUBDIVISION FOUR OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE shall be one dollar.
S 48. Subparagraph (ii) of paragraph (d) of subdivision 9 of section
367-a of the social services law, as amended by chapter 19 of the laws
of 1998, is amended to read as follows:
(ii) for prescription drugs categorized as brand-name prescription
[drug] DRUGS by the prescription drug pricing service used by the
department, three dollars and fifty cents per prescription, PROVIDED,
HOWEVER, THAT FOR BRAND NAME PRESCRIPTION DRUGS REIMBURSED PURSUANT TO
SUBPARAGRAPH (II) OF PARAGRAPH (A-2) OF SUBDIVISION FOUR OF SECTION
THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE, THE DISPENSING FEE SHALL BE
FOUR DOLLARS AND FIFTY CENTS PER PRESCRIPTION.
S 49. Subdivision 9 of section 367-a of the social services law is
amended by adding a new paragraph (i) to read as follows:
(I) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO PAY FINANCIAL INCEN-
TIVES TO MEDICAL PRACTITIONERS AND TO PHARMACIES FOR THE PURPOSE OF
ENCOURAGING THE ELECTRONIC TRANSMISSION OF PRESCRIPTIONS FOR DRUGS FOR
WHICH PAYMENTS ARE MADE UNDER THIS SUBDIVISION. SUCH PAYMENTS SHALL BE
IN THE FOLLOWING AMOUNTS: FOR MEDICAL PRACTITIONERS, EIGHTY CENTS PER
DISPENSED ELECTRONIC PRESCRIPTION; FOR DISPENSING PHARMACIES, TWENTY
CENTS PER DISPENSED ELECTRONIC PRESCRIPTION. ELECTRONIC PRESCRIBING
SOFTWARE SHALL NOT USE ANY MEANS OR PERMIT ANY OTHER PERSON TO USE ANY
MEANS, INCLUDING, BUT NOT LIMITED TO, ADVERTISING, INSTANT MESSAGING,
AND POP-UP ADS, TO INFLUENCE OR ATTEMPT TO INFLUENCE, THROUGH ECONOMIC
INCENTIVES OR OTHERWISE, THE PRESCRIBING DECISION OF A PRESCRIBING PRAC-
TITIONER AT THE POINT OF CARE. SUCH MEANS SHALL NOT BE TRIGGERED OR IN
SPECIFIC RESPONSE TO THE INPUT, SELECTION, OR ACT OF A PRESCRIBING PRAC-
TITIONER OR HIS OR HER AGENT IN PRESCRIBING A CERTAIN PHARMACEUTICAL OR
DIRECTING A PATIENT TO A CERTAIN PHARMACY. THE PROVISIONS OF THIS PARA-
GRAPH SHALL NOT TAKE EFFECT UNLESS ALL NECESSARY APPROVALS UNDER FEDERAL
LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL
PARTICIPATION IN THE COSTS OF SERVICES PROVIDED UNDER THIS PARAGRAPH.
S 50. The public health law is amended by adding a new section 279 to
read as follows:
S 279. PROHIBITED ACTS AND DISCLOSURE REQUIREMENTS RELATING TO DRUG
MANUFACTURERS' PROVISION OF THINGS OF VALUE TO PRESCRIBERS. 1. DEFI-
NITIONS. AS USED IN THIS SECTION:
(A) "DRUG" MEANS: (I) ARTICLES RECOGNIZED IN THE OFFICIAL UNITED
STATES PHARMACOPOEIA, OFFICIAL HOMEOPATHIC PHARMACOPOEIA OF THE UNITED
STATES, OR OFFICIAL NATIONAL FORMULARY;
(II) ARTICLES INTENDED FOR USE IN THE DIAGNOSIS, CURE, MITIGATION,
TREATMENT OR PREVENTION OF DISEASE IN HUMANS;
(III) ARTICLES (OTHER THAN FOOD) INTENDED TO AFFECT THE STRUCTURE OR
ANY FUNCTION OF THE BODY OF HUMANS;
S. 58--A 83 A. 158--A
(IV) ARTICLES INTENDED FOR USE AS A COMPONENT OF ANY ARTICLE SPECIFIED
IN SUBPARAGRAPH (I), (II) OR (III) OF THIS PARAGRAPH BUT DOES NOT
INCLUDE DEVICES OR THEIR COMPONENTS, PARTS OR ACCESSORIES;
(B) "DEVICE" MEANS ANY INSTRUMENT, APPARATUS, OR CONTRIVANCE, INCLUD-
ING COMPONENTS, PARTS OR ACCESSORIES, INTENDED:
(I) FOR USE IN THE DIAGNOSIS, CURE, MITIGATION, TREATMENT, OR
PREVENTION OF DISEASE IN HUMANS; OR
(II) TO AFFECT THE STRUCTURE OR ANY FUNCTION OF THE BODY OF HUMANS.
(C) "MANUFACTURER" MEANS (I) A PERSON OR ENTITY THAT FABRICATES,
MAKES, COMPOUNDS, MIXES, PREPARES, PRODUCES, BOTTLES OR PACKS DRUGS OR
DEVICES FOR THE PURPOSE OF DISTRIBUTING OR SELLING TO PHARMACIES, HEALTH
CARE PROVIDERS OR OTHER CHANNELS OF DISTRIBUTION, OR (II) A PERSON OR
ENTITY THAT, PURSUANT TO AN AGREEMENT WITH A PERSON OR ENTITY DESCRIBED
IN SUBPARAGRAPH (I) OF THIS PARAGRAPH, MARKETS A DRUG OR DEVICE UNDER A
DIFFERENT NAME OR LABELER CODE.
(D) "PRESCRIBER" MEANS A PHYSICIAN, DENTIST, PHYSICIAN ASSISTANT,
SPECIALIST'S ASSISTANT, NURSE PRACTITIONER, MIDWIFE, OPTOMETRIST AND
OTHER LICENSED HEALTH CARE PROVIDER AUTHORIZED UNDER TITLE EIGHT OF THE
EDUCATION LAW TO PRESCRIBE DRUGS OR DEVICES.
(E) "HEALTH CARE PROVIDER" MEANS (I) A PRESCRIBER WHO PRACTICES IN
THIS STATE IN AN INDIVIDUAL PRACTICE, GROUP PRACTICE, PARTNERSHIP,
PROFESSIONAL CORPORATION OR OTHER AUTHORIZED FORM OF ASSOCIATION, OR IN
A HOSPITAL OR OTHER HEALTH CARE INSTITUTION ISSUED AN OPERATING CERTIF-
ICATE PURSUANT TO THIS CHAPTER OR THE MENTAL HYGIENE LAW; (II) SUCH
PRESCRIBER'S INDIVIDUAL PRACTICE, GROUP PRACTICE, PARTNERSHIP, PROFES-
SIONAL CORPORATION OR OTHER AUTHORIZED FORM OF ASSOCIATION; AND (III) AN
EMPLOYEE OF A PERSON OR ENTITY DESCRIBED IN SUBPARAGRAPH (I) OR (II) OF
THIS PARAGRAPH.
(F) "DOCTOR-IN-TRAINING" MEANS A PERSON ACTIVELY ENGAGED IN THE STATE
IN POST-BACCALAUREATE EDUCATION OR PROFESSIONAL TRAINING DESIGNED TO
PREPARE PERSONS TO BE ELIGIBLE TO BE LICENSED AS A DOCTOR OF MEDICINE OR
DOCTOR OF OSTEOPATHY AND IS NOT AUTHORIZED TO PRESCRIBE DRUGS OR
DEVICES.
(G) "PAYMENT" MEANS ANYTHING WITH AN ECONOMIC VALUE, INCLUDING BUT NOT
LIMITED TO MONEY, GOODS AND SERVICES.
(H) "BENEFIT" MEANS ONE OR MORE THINGS WITH AN AGGREGATED FAIR MARKET
VALUE FOR THE YEAR EQUAL TO OR GREATER THAN FIFTY DOLLARS, THAT WOULD BE
A PAYMENT, AS DEFINED IN PARAGRAPH (G) OF THIS SUBDIVISION, EXCEPT THAT
IT COMES WITHIN THE EXCEPTION SET OUT IN PARAGRAPH (B) OR (D) OF SUBDI-
VISION THREE OF THIS SECTION.
(I) "FAIR MARKET VALUE" MEANS THE VALUE IN ARMS LENGTH TRANSACTIONS,
CONSISTENT WITH THE GENERAL MARKET VALUE.
(J) "FINANCIAL RELATIONSHIP" MEANS AN OWNERSHIP INTEREST, INVESTMENT
INTEREST OR COMPENSATION ARRANGEMENT. AN OWNERSHIP INTEREST OR INVEST-
MENT INTEREST MAY BE THROUGH EQUITY, DEBT OR OTHER MEANS; BUT SHALL NOT
INCLUDE OWNERSHIP OF INVESTMENT SECURITIES, INCLUDING SHARES OR BONDS,
DEBENTURES, NOTES OR OTHER DEBT INSTRUMENTS, WHICH WERE PURCHASED ON
TERMS GENERALLY AVAILABLE TO THE PUBLIC AND WHICH ARE IN A CORPORATION
THAT IS LISTED FOR TRADING ON THE NEW YORK STOCK EXCHANGE OR ON THE
AMERICAN STOCK EXCHANGE, OR IS A NATIONAL MARKET SYSTEM SECURITY TRADED
UNDER AN AUTOMATED INTERDEALER QUOTATION SYSTEM OPERATED BY THE NATIONAL
ASSOCIATION OF SECURITIES DEALERS, AND HAD, AT THE END OF THE CORPO-
RATION'S MOST RECENT FISCAL YEAR, TOTAL ASSETS EXCEEDING ONE HUNDRED
MILLION DOLLARS.
(K) "DISCOUNT" MEANS A REDUCTION IN THE AMOUNT A HEALTH CARE PROVIDER,
ACTING AS A BUYER OR PAYER, IS CHARGED FOR AN ITEM OR SERVICE, WHERE THE
S. 58--A 84 A. 158--A
REDUCTION IS OFFERED BY OR ON BEHALF OF A MANUFACTURER, AND INCLUDES ALL
SUCH REDUCTIONS WHENEVER THEY ARE GIVEN, INCLUDING BEFORE OR AFTER THE
TIME OF SALE, PROVIDED THAT SUCH REDUCTIONS GIVEN TO A HEALTH CARE
PROVIDER HAVE A FAIR MARKET VALUE AGGREGATED FOR THE CALENDAR YEAR EQUAL
TO OR GREATER THAN FIFTY DOLLARS. FOR THE PURPOSE OF THIS PARAGRAPH,
"REDUCTION" MEANS A DECREASE FROM THE AMOUNT THAT WOULD BE CHARGED BASED
ON AN ARMS-LENGTH TRANSACTION OR THAT IS REPRESENTED TO THE PRESCRIBER
AS CONSTITUTING SUCH A DECREASE.
2. PROHIBITED ACTS. (A) A MANUFACTURER SHALL NOT, DIRECTLY OR INDI-
RECTLY, GIVE OR OFFER TO GIVE ONE OR MORE PAYMENTS WITH AN AGGREGATED
FAIR MARKET VALUE IN EXCESS OF FIFTY DOLLARS DURING A CALENDAR YEAR, TO
ANY HEALTH CARE PROVIDER OR DOCTOR-IN-TRAINING.
(B) A HEALTH CARE PROVIDER OR A DOCTOR-IN-TRAINING SHALL NOT, DIRECTLY
OR INDIRECTLY, REQUEST OR RECEIVE FROM ANY MANUFACTURER ONE OR MORE
PAYMENTS WITH AN AGGREGATED FAIR MARKET VALUE IN EXCESS OF FIFTY DOLLARS
DURING A CALENDAR YEAR.
3. EXCEPTIONS. THE FOLLOWING PAYMENTS SHALL NOT BE PROHIBITED UNDER
SUBDIVISION TWO OF THIS SECTION AND SHALL BE DISCLOSED, AS APPLICABLE,
PURSUANT TO SUBDIVISION FOUR OF THIS SECTION:
(A) SAMPLES OF PRESCRIPTION DRUGS THAT THE MANUFACTURER'S EMPLOYEE
PROVIDES DIRECTLY TO A PRESCRIBER WHO PROVIDES OR ADMINISTERS SUCH
SAMPLE TO A PATIENT WITHOUT CHARGE;
(B) ANY PAYMENT TO SUPPORT A SPECIFIED AND BONA FIDE RESEARCH, CLIN-
ICAL OR EDUCATIONAL ACTIVITY IN CONNECTION WITH WHICH THE RECIPIENT (I)
PRIOR TO RECEIPT OF ANY SUCH PAYMENT, HAS SUBMITTED TO THE MANUFACTURER
A PROPOSAL THAT DESCRIBES THE PURPOSE AND METHODS TO BE USED IN CARRYING
OUT THE ACTIVITY, THE OUTCOMES OF THE ACTIVITY THAT WILL BE MEASURED AND
THE METHODS TO BE USED TO MEASURE SUCH OUTCOMES, A PROCEDURE FOR
ACCOUNTING FOR SUCH PAYMENT AND A DEADLINE FOR SUBMITTING TO THE
MANUFACTURER A FINAL REPORT CONCERNING THE ACTIVITY; (II) HAS SUBMITTED
TO THE MANUFACTURER THE FINAL REPORT, WITH ALL REQUIRED INFORMATION AS
DESCRIBED IN ITS PROPOSAL AS SET FORTH IN SUBPARAGRAPH (I) OF THIS PARA-
GRAPH, WITHIN THE DEADLINE SET OUT IN SUCH PROPOSAL OR AS EXTENDED IN
WRITING BY THE MANUFACTURER; AND (III) MAKES SUCH FINAL REPORT AVAIL-
ABLE TO THE DEPARTMENT AND HEALTH CARE PROVIDERS UPON REQUEST;
(C) A REDUCTION IN THE COST TO THE HEALTH CARE PROVIDER OF ONE OR MORE
OF THE MANUFACTURER'S DRUGS OR DEVICES;
(D) REIMBURSEMENT FOR TRAVEL, LODGING AND PERSONAL EXPENSES OR REMUN-
ERATION PROVIDED TO A PRESCRIBER OR SUCH REIMBURSEMENT PROVIDED TO A
DOCTOR-IN-TRAINING, THE AMOUNT OF WHICH REMUNERATION OR REIMBURSEMENT IS
NOT DEPENDENT, DIRECTLY OR INDIRECTLY, ON THE AMOUNT OR VOLUME OF THE
MANUFACTURER'S DRUGS OR DEVICES ANY PERSON OR ENTITY PRESCRIBES, IF:
(I) WITH RESPECT TO PRESCRIBERS, THE REMUNERATION OR REIMBURSEMENT IS
PROVIDED IN CONNECTION WITH BONA FIDE TEACHING, SCIENTIFIC RESEARCH,
WRITING OR CONSULTING SERVICES THE PRESCRIBER ACTUALLY PROVIDES, THE
NATURE AND PROVISION OF WHICH CAN BE VERIFIED BY DOCUMENTS THE MANUFAC-
TURER MAINTAINS FOR NOT LESS THAN THREE YEARS, PROVIDED THAT (A) THE
AMOUNT OF BOTH THE REMUNERATION AND REIMBURSEMENT IS CONSISTENT WITH THE
FAIR MARKET VALUE OF THE SERVICES THE PRESCRIBER PROVIDES TO OR ON
BEHALF OF THE MANUFACTURER, (B) WITH RESPECT TO TEACHING ACTIVITIES, THE
PRESCRIBER IS PART OF THE FACULTY FOR AN EDUCATIONAL PROGRAM AND
PROVIDES ATTENDEES WITH SIGNIFICANT SCIENTIFIC OR CLINICAL INFORMATION,
AND (C) WITH RESPECT TO WRITING, THE PRESCRIBER IS IDENTIFIED AS AN
AUTHOR ONLY WHEN HE OR SHE HAS HAD UNRESTRICTED ACCESS TO ALL DATA
PERTAINING TO THE SUBJECT OF THE MANUSCRIPT, HAS GIVEN FINAL APPROVAL OF
THE MANUSCRIPT, HAS PARTICIPATED SUFFICIENTLY IN THE WORK TO TAKE PUBLIC
S. 58--A 85 A. 158--A
RESPONSIBILITY FOR AT LEAST PART OF THE CONTENT, AND HAS MADE SUBSTAN-
TIAL CONTRIBUTIONS TO THE INTELLECTUAL CONTENT OF THE WRITTEN WORK IN
EITHER CONCEPTION AND DESIGN OR ACQUISITION OF DATA AND IN EITHER DRAFT-
ING OR CRITICAL REVISION OF THE MANUSCRIPT FOR IMPORTANT INTELLECTUAL
CONTENT; AND
(II) WITH RESPECT TO DOCTORS-IN-TRAINING, THE REIMBURSEMENT IS
PROVIDED IN CONNECTION WITH ATTENDANCE AT A BONA FIDE MEDICAL CONFER-
ENCE, THE PRINCIPAL PURPOSE OF WHICH IS TO IMPART SCIENTIFIC OR CLINICAL
INFORMATION, PROVIDED THAT (A) THE AMOUNT OF ANY REIMBURSEMENT IS
CONSISTENT WITH THE FAIR MARKET VALUE OF THE TRAVEL, LODGING AND
PERSONAL EXPENSES BEING REIMBURSED, AND (B) THE MANUFACTURER TRANSFERS
ALL SUCH FUNDS TO THE DOCTOR'S-IN-TRAINING MEDICAL SCHOOL OR PROFES-
SIONAL EMPLOYER, THE MEDICAL SCHOOL OR PROFESSIONAL EMPLOYER SELECTS THE
DOCTORS-IN-TRAINING WHOSE ATTENDANCE THE MANUFACTURER WILL FUND AND THE
MEDICAL CONFERENCES THEY WILL ATTEND, AND THE SCHOOL, EMPLOYER AND
MANUFACTURER DO NOT, DIRECTLY OR INDIRECTLY, INFORM THE DOCTOR-IN-TRAIN-
ING OF THE SOURCE OF SUCH FUNDS; AND
(E) ANYTHING OF ECONOMIC VALUE GIVEN BY A PERSON WITH A FINANCIAL
RELATIONSHIP WITH A MANUFACTURER WHO IS RELATED BY BLOOD, MARRIAGE OR
ADOPTION WITHIN THREE DEGREES OF CONSANGUINITY TO THE RECIPIENT PRESCRI-
BER.
4. DISCLOSURE. (A) ANNUAL DISCLOSURE. ANNUALLY, AT A TIME AND IN A
MANNER TO BE DETERMINED BY THE DEPARTMENT, EACH HEALTH CARE PROVIDER OR
DOCTOR-IN-TRAINING AND EACH MANUFACTURER DOING BUSINESS WITH ANY SUCH
HEALTH CARE PROVIDER OR DOCTOR-IN-TRAINING SHALL PROVIDE TO THE DEPART-
MENT A REPORT THAT CONTAINS THE INFORMATION REQUIRED BY PARAGRAPHS (B),
(C), AND (D) OF THIS SUBDIVISION WHERE (I) SUCH HEALTH CARE PROVIDER OR
DOCTOR-IN-TRAINING OFFERED, GAVE OR RECEIVED A BENEFIT; (II) SUCH
MANUFACTURER GAVE A DISCOUNT TO A HEALTH CARE PROVIDER; OR (III) A
FINANCIAL RELATIONSHIP EXISTED BETWEEN SUCH A MANUFACTURER AND SUCH A
PROVIDER OR DOCTOR-IN-TRAINING. ACCESS TO SUCH REPORTS SHALL NOT BE
DENIED, THE REPORTS SHALL NOT BE WITHHELD, AND IDENTIFYING INFORMATION
SHALL NOT BE DELETED FROM SUCH REPORTS PURSUANT TO SECTION EIGHTY-SEVEN
OR EIGHTY-NINE OF THE PUBLIC OFFICERS LAW.
(B) DISCLOSURE OF BENEFITS. EACH REPORT REQUIRED BY PARAGRAPH (A) OF
THIS SUBDIVISION PERTAINING TO A BENEFIT TRANSFERRED DURING THE REPORT-
ING PERIOD SHALL DESCRIBE THE NATURE AND FAIR MARKET VALUE OF THE BENE-
FIT THAT WAS OFFERED OR TRANSFERRED; THE NATURE OF ANY GOOD OR SERVICE
THAT WAS PROVIDED TO THE MANUFACTURER OR ANY OTHER PERSON OR ENTITY IN
CONNECTION WITH THE PROVISION OF THE BENEFIT; AND SUCH OTHER INFORMATION
AS SHALL BE REQUIRED BY THE DEPARTMENT BY REGULATION.
(C) DISCLOSURE OF DISCOUNTS. THE REPORTS REQUIRED BY PARAGRAPH (A) OF
THIS SUBDIVISION SHALL NOT REQUIRE A MANUFACTURER TO DISCLOSE DISCOUNT
INFORMATION SEPARATELY FOR EACH TRANSACTION. THE DEPARTMENT SHALL BY
REGULATION SPECIFY THE MANNER IN WHICH THE VALUE OF THE DISCOUNT SHALL
BE REPORTED, INCLUDING A THRESHOLD FOR THE VALUE OF DISCOUNTS THAT MUST
BE REPORTED. THE MANUFACTURER SHALL REPORT ALL DISCOUNTS THAT OCCURRED
DURING THE REPORTING PERIOD, INCLUDING THOSE DISCOUNTS THE VALUE OF
WHICH WAS REALIZED BY THE PURCHASER DURING THE REPORTING PERIOD BUT
PERTAIN TO SALES THAT OCCURRED AT A DIFFERENT TIME.
(D) DISCLOSURE OF FINANCIAL RELATIONSHIPS. EACH REPORT A MANUFACTURER,
HEALTH CARE PROVIDER OR DOCTOR-IN-TRAINING IS REQUIRED TO MAKE BY PARA-
GRAPH (A) OF THIS SUBDIVISION PERTAINING TO FINANCIAL RELATIONSHIPS
SHALL CONTAIN SUCH INFORMATION AS IS REQUIRED BY THE DEPARTMENT BY REGU-
LATION, WHICH SHALL SPECIFY THE MANNER IN WHICH THE VALUE OF FINANCIAL
S. 58--A 86 A. 158--A
RELATIONSHIPS SHALL BE REPORTED, INCLUDING THE THRESHOLD VALUE OF FINAN-
CIAL RELATIONSHIPS THAT MUST BE REPORTED.
5. VIOLATIONS. THE COMMISSIONER MAY ASSESS A CIVIL PENALTY FOR
VIOLATIONS OF THIS SECTION IN AN AMOUNT THAT IS, FOR A MANUFACTURER'S
VIOLATION OF PARAGRAPH (A) OF SUBDIVISION TWO OF THIS SECTION OR SUBDI-
VISION FOUR OF THIS SECTION, NOT LESS THAN FIVE THOUSAND DOLLARS AND NOT
MORE THAN FIFTY THOUSAND DOLLARS PER VIOLATION, AND FOR A HEALTH CARE
PROVIDER'S VIOLATION OF PARAGRAPH (B) OF SUBDIVISION TWO OF THIS SECTION
OR SUBDIVISION FOUR OF THIS SECTION, NOT LESS THAN FIVE THOUSAND DOLLARS
AND NOT MORE THAN TEN THOUSAND DOLLARS PER VIOLATION.
S 51. Section 6509 of the education law is amended by adding a new
subdivision 15 to read as follows:
(15) A VIOLATION OF SECTION TWO HUNDRED SEVENTY-NINE OF THE PUBLIC
HEALTH LAW.
S 52. Section 6530 of the education law is amended by adding a new
subdivision 50 to read as follows:
50. A VIOLATION OF SECTION TWO HUNDRED SEVENTY-NINE OF THE PUBLIC
HEALTH LAW.
S 53. Article 29-D of the public health law is amended by adding a new
title 4 to read as follows:
TITLE 4
CONTINUING PROFESSIONAL EDUCATION
SECTION 2999-G. DEFINITIONS.
2999-H. REQUIREMENTS FOR CONDUCTING A CONTINUING PROFESSIONAL
EDUCATION PROGRAM.
2999-I. VIOLATIONS.
S 2999-G. DEFINITIONS. FOR THE PURPOSE OF THIS TITLE:
1. "CONTINUING PROFESSIONAL EDUCATION PROGRAM" MEANS COURSE WORK OR
TRAINING PROVIDED TO PHYSICIANS, DENTISTS, PHYSICIAN ASSISTANTS,
SPECIALIST ASSISTANTS, NURSE PRACTITIONERS, MIDWIVES, OPTOMETRISTS OR
OTHER LICENSED HEALTH CARE PROVIDERS AUTHORIZED BY LAW TO PRESCRIBE
DRUGS OR DEVICES, WHICH PERTAINS TO THE PRACTICE OF THEIR PROFESSION AND
FOR WHICH CONTINUING MEDICAL EDUCATION OR CONTINUING PROFESSIONAL EDUCA-
TION CREDITS MAY BE AWARDED.
2. "PROVIDER" MEANS THE PERSON OR ENTITY THAT REPRESENTS TO MEMBERS OF
THE RELEVANT PROFESSION THAT IT IS THE ORGANIZER OF A CONTINUING PROFES-
SIONAL EDUCATION PROGRAM. A CONTINUING PROFESSIONAL EDUCATION PROGRAM
CAN HAVE MORE THAN ONE PROVIDER, BUT EVERY SUCH PROGRAM MUST HAVE AT
LEAST ONE PROVIDER. MANUFACTURERS AND DISTRIBUTORS ARE NOT PROVIDERS.
3. "MANUFACTURER" MEANS (I) A PERSON OR ENTITY THAT FABRICATES, MAKES,
COMPOUNDS, MIXES, PREPARES, PRODUCES, BOTTLES OR PACKS DRUGS OR DEVICES
FOR THE PURPOSE OF DISTRIBUTING OR SELLING TO PHARMACIES, HEALTH CARE
PROVIDERS OR OTHER CHANNELS OF DISTRIBUTION, OR (II) A PERSON OR ENTITY
THAT, PURSUANT TO AN AGREEMENT WITH A PERSON OR ENTITY DESCRIBED IN
SUBPARAGRAPH (I) OF THIS PARAGRAPH, MARKETS A DRUG OR DEVICE UNDER A
DIFFERENT NAME OR LABELER CODE.
4. "DISTRIBUTOR" MEANS A PERSON OR ENTITY THAT DELIVERS, OTHER THAN BY
DISPENSING, A DRUG PRODUCT TO ANY PERSON.
5. "DRUG" MEANS: (I) ARTICLES RECOGNIZED IN THE OFFICIAL UNITED
STATES PHARMACOPOEIA, OFFICIAL HOMEOPATHIC PHARMACOPOEIA OF THE UNITED
STATES, OR OFFICIAL NATIONAL FORMULARY;
(II) ARTICLES INTENDED FOR USE IN THE DIAGNOSIS, CURE, MITIGATION,
TREATMENT OR PREVENTION OF DISEASE IN HUMANS;
(III) ARTICLES (OTHER THAN FOOD) INTENDED TO AFFECT THE STRUCTURE OR
ANY FUNCTION OF THE BODY OF HUMANS;
S. 58--A 87 A. 158--A
(IV) ARTICLES INTENDED FOR USE AS A COMPONENT OF ANY ARTICLE SPECIFIED
IN SUBPARAGRAPH (I), (II) OR (III) OF THIS PARAGRAPH BUT DOES NOT
INCLUDE DEVICES OR THEIR COMPONENTS, PARTS OR ACCESSORIES;
6. "DEVICE" MEANS ANY INSTRUMENT, APPARATUS, OR CONTRIVANCE, INCLUDING
COMPONENTS, PARTS OR ACCESSORIES, INTENDED:
(I) FOR USE IN THE DIAGNOSIS, CURE, MITIGATION, TREATMENT, OR
PREVENTION OF DISEASE IN HUMANS; OR
(II) TO AFFECT THE STRUCTURE OR ANY FUNCTION OF THE BODY OF HUMANS.
7. "PRESENTER" IS A NATURAL PERSON WHO CONDUCTS, TEACHES AND PARTIC-
IPATES, OTHER THAN SOLELY AS AN ATTENDEE, IN ANY ASPECT OF A CONTINUING
PROFESSIONAL EDUCATION PROGRAM, REGARDLESS OF WHETHER SUCH PROGRAM IS
PROVIDED IN PERSON OR BY ELECTRONIC OR OTHER MEANS.
8. "FINANCIAL RELATIONSHIP" MEANS AN OWNERSHIP INTEREST, INVESTMENT
INTEREST OR COMPENSATION ARRANGEMENT. AN OWNERSHIP INTEREST OR INVEST-
MENT INTEREST MAY BE THROUGH EQUITY, DEBT OR OTHER MEANS; BUT SHALL NOT
INCLUDE OWNERSHIP OF INVESTMENT SECURITIES, INCLUDING SHARES OR BONDS,
DEBENTURES, NOTES OR OTHER DEBT INSTRUMENTS, WHICH WERE PURCHASED ON
TERMS GENERALLY AVAILABLE TO THE PUBLIC AND WHICH ARE IN A CORPORATION
THAT IS LISTED FOR TRADING ON THE NEW YORK STOCK EXCHANGE OR ON THE
AMERICAN STOCK EXCHANGE, OR IS A NATIONAL MARKET SYSTEM SECURITY TRADED
UNDER AN AUTOMATED INTERDEALER QUOTATION SYSTEM OPERATED BY THE NATIONAL
ASSOCIATION OF SECURITIES DEALERS, AND HAD, AT THE END OF THE CORPO-
RATION'S MOST RECENT FISCAL YEAR, TOTAL ASSETS EXCEEDING ONE HUNDRED
MILLION DOLLARS.
9. "CONTINUING PROFESSIONAL EDUCATION MATERIAL" MEANS ANY INFORMATION
CONCERNING ANY ASPECT OF THE PRACTICE OF A PROFESSION REFERENCED IN
SUBDIVISION ONE OF THIS SECTION WHICH IS COMMUNICATED BY ORAL, WRITTEN,
GRAPHIC, AUDIO, VISUAL, ELECTRONIC OR OTHER MEANS DURING A CONTINUING
PROFESSIONAL EDUCATION PROGRAM AND IS NOT BEING DISSEMINATED BY OR ON
BEHALF OF A MANUFACTURER OR DISTRIBUTOR CONCERNING ONE OR MORE OF ITS
PRODUCTS.
S 2999-H. REQUIREMENTS FOR CONDUCTING A CONTINUING PROFESSIONAL EDUCA-
TION PROGRAM. 1. IN CONNECTION WITH ANY CONTINUING PROFESSIONAL EDUCA-
TION PROGRAM CONDUCTED IN THE STATE, A PRESENTER:
(A) SHALL NOT KNOWINGLY PRESENT ANY CONTINUING PROFESSIONAL EDUCATION
MATERIALS THAT ARE FALSE OR MISLEADING;
(B) SHALL NOT REPRESENT, EXPLICITLY OR BY NOT DISCLOSING ANOTHER
AUTHOR, THAT HE OR SHE WAS THE AUTHOR OF ANY CONTINUING PROFESSIONAL
EDUCATION MATERIALS UNLESS THE PRESENTER HAS GIVEN FINAL APPROVAL OF
SUCH MATERIALS, HAS PARTICIPATED SUFFICIENTLY IN THE DEVELOPMENT OF SUCH
MATERIALS TO TAKE PUBLIC RESPONSIBILITY FOR THE CONTENT, AND HAS MADE
SUBSTANTIAL CONTRIBUTIONS TO THE INTELLECTUAL CONTENT OF SUCH MATERIALS
EITHER IN DRAFTING OR IN CRITICAL REVISION OF SUCH MATERIALS FOR IMPOR-
TANT INTELLECTUAL CONTENT;
(C) SHALL DISCLOSE TO THE PROVIDER ALL FINANCIAL RELATIONSHIPS HE OR
SHE HAS WITH ANY MANUFACTURER OR DISTRIBUTOR, INCLUDING THE NAME OF SUCH
ENTITIES WITH WHICH HE OR SHE HAS A FINANCIAL RELATIONSHIP, THE NATURE
OF THE RELATIONSHIP, AND THE FAIR MARKET VALUE OF ANYTHING OF ECONOMIC
VALUE THE PRESENTER RECEIVED DURING THE PRECEDING TWELVE MONTHS IN
CONNECTION WITH OR AS A RESULT OF SUCH RELATIONSHIP; AND
(D) SHALL DISCLOSE TO THE PROVIDER ANY INFORMATION OR WRITTEN, GRAPH-
IC, AUDIO, VISUAL OR ELECTRONIC MATERIALS OF ANY KIND THAT THE PRESENTER
INTENDS TO COMMUNICATE AT THE CONTINUING PROFESSIONAL EDUCATION PROGRAM
WHICH ARE EXEMPTED FROM THE DEFINITION OF CONTINUING PROFESSIONAL EDUCA-
TION MATERIALS BECAUSE THEY ARE BEING DISSEMINATED BY OR ON BEHALF OF A
S. 58--A 88 A. 158--A
MANUFACTURER OR DISTRIBUTOR, WHICH INFORMATION OR MATERIALS THE PRESEN-
TER SHALL DESCRIBE WITH SPECIFICITY.
2. IN CONNECTION WITH ANY CONTINUING PROFESSIONAL EDUCATION PROGRAM
CONDUCTED IN THE STATE, A PROVIDER:
(A) SHALL INFORM EVERY PRESENTER OF HIS OR HER OBLIGATIONS UNDER
SUBDIVISION ONE OF THIS SECTION;
(B) SHALL ACT PRUDENTLY TO OBTAIN FROM EACH PRESENTER THE INFORMATION
HE OR SHE IS REQUIRED TO DISCLOSE BY PARAGRAPHS (C) AND (D) OF SUBDIVI-
SION ONE OF THIS SECTION; AND
(C) SHALL DISCLOSE TO ALL PERSONS ATTENDING A CONTINUING PROFESSIONAL
EDUCATION PROGRAM:
(I) THE INFORMATION REQUIRED BY PARAGRAPHS (C) AND (D) OF SUBDIVISION
ONE OF THIS SECTION THAT EACH PRESENTER AT SUCH PROGRAM HAS DISCLOSED TO
THE PROVIDER; AND
(II) THE NATURE OF ANY SUPPORT FOR THE CONTINUING PROFESSIONAL EDUCA-
TION PROGRAM, WHETHER MONETARY OR IN KIND, PROVIDED BY A MANUFACTURER OR
DISTRIBUTOR, AND THE FAIR MARKET VALUE OF ALL SUCH SUPPORT.
S 2999-I. VIOLATIONS. THE COMMISSIONER MAY ASSESS A CIVIL PENALTY FOR
VIOLATIONS OF THIS SECTION IN AN AMOUNT THAT IS, FOR A VIOLATION OF
SUBDIVISION ONE OF SECTION TWENTY-NINE HUNDRED NINETY-NINE-H OF THIS
TITLE, NOT MORE THAN TWENTY-FIVE HUNDRED DOLLARS PER VIOLATION AND, FOR
A VIOLATION OF SUBDIVISION TWO OF SECTION TWENTY-NINE HUNDRED
NINETY-NINE-H OF THIS TITLE, NOT MORE THAN TEN THOUSAND DOLLARS PER
VIOLATION.
S 54. Section 6509 of the education law is amended by adding a new
subdivision 16 to read as follows:
(16) A VIOLATION OF SUBDIVISION ONE OF SECTION TWENTY-NINE HUNDRED
NINETY-NINE-H OF THE PUBLIC HEALTH LAW.
S 55. Section 6530 of the education law is amended by adding a new
subdivision 51 to read as follows:
51. A VIOLATION OF SUBDIVISION ONE OF SECTION TWENTY-NINE HUNDRED
NINETY-NINE-H OF THE PUBLIC HEALTH LAW.
S 56. The public health law is amended by adding a new article 44-A to
read as follows:
ARTICLE 44-A
PHARMACY BENEFIT MANAGERS
SECTION 4450. DEFINITIONS.
4451. MATTERS UNAFFECTED BY THIS ARTICLE.
4452. THE PHARMACY BENEFIT MANAGER'S GENERAL OBLIGATIONS.
4453. THE PHARMACY BENEFIT MANAGER'S DISCLOSURE OF INFORMATION
TO THE HEALTH PLAN.
4454. THE PHARMACY BENEFIT MANAGER'S COMMUNICATION WITH PARTIC-
IPANTS AND PRESCRIBERS IN CERTAIN SITUATIONS.
4455. DISTRIBUTION OF PRESCRIPTION DATA.
4456. ENFORCEMENT.
S 4450. DEFINITIONS. FOR THE PURPOSE OF THIS ARTICLE:
1. "HEALTH PLAN" MEANS A NONPROFIT HOSPITAL OR MEDICAL SERVICE ORGAN-
IZATION, INSURER, HEALTH COVERAGE PLAN OR HEALTH MAINTENANCE ORGANIZA-
TION LICENSED PURSUANT TO THE INSURANCE LAW; A HEALTH PROGRAM ADMINIS-
TERED BY THE DEPARTMENT OF HEALTH, THE STATE OR A POLITICAL SUBDIVISION
IN THE CAPACITY OF PROVIDER OF HEALTH COVERAGE; OR AN EMPLOYER, LABOR
UNION OR OTHER GROUP OF PERSONS ORGANIZED IN THE STATE THAT PROVIDES
HEALTH COVERAGE TO PARTICIPANTS WHO ARE EMPLOYED OR RESIDE IN THE STATE.
"HEALTH PLAN" DOES NOT INCLUDE A HEALTH PLAN THAT PROVIDES COVERAGE ONLY
FOR ACCIDENTAL INJURY, SPECIFIED DISEASE, HOSPITAL INDEMNITY, MEDICARE
S. 58--A 89 A. 158--A
SUPPLEMENT, DISABILITY INCOME, LONG-TERM CARE OR OTHER LIMITED BENEFIT
HEALTH INSURANCE POLICIES AND CONTRACTS.
2. "PARTICIPANT" MEANS A MEMBER, PARTICIPANT, ENROLLEE, CONTRACT HOLD-
ER, POLICY HOLDER OR BENEFICIARY OF A HEALTH PLAN WHO RESIDES OR IS
EMPLOYED IN THE STATE TO WHOM THE HEALTH PLAN PROVIDES HEALTH COVERAGE.
"PARTICIPANT" INCLUDES A DEPENDENT OR OTHER PERSON PROVIDED HEALTH
COVERAGE THROUGH A POLICY, CONTRACT OR PLAN FOR A PARTICIPANT.
3. "PRESCRIPTION DRUG" OR "DRUG" MEANS: (A) ARTICLES RECOGNIZED IN THE
OFFICIAL UNITED STATES PHARMACOPOEIA, OFFICIAL HOMEOPATHIC PHARMACOPOEIA
OF THE UNITED STATES, OR OFFICIAL NATIONAL FORMULARY;
(B) ARTICLES INTENDED FOR USE IN THE DIAGNOSIS, CURE, MITIGATION,
TREATMENT OR PREVENTION OF DISEASE IN HUMANS;
(C) ARTICLES (OTHER THAN FOOD) INTENDED TO AFFECT THE STRUCTURE OR ANY
FUNCTION OF THE BODY OF HUMANS;
(D) ARTICLES INTENDED FOR USE AS A COMPONENT OF ANY ARTICLE SPECIFIED
IN PARAGRAPH (A), (B) OR (C) OF THIS SUBDIVISION BUT DOES NOT INCLUDE
DEVICES OR THEIR COMPONENTS, PARTS OR ACCESSORIES;
FOR WHICH A PRESCRIPTION IS REQUIRED UNDER THE FEDERAL FOOD, DRUG AND
COSMETIC ACT.
4. "PRESCRIBER" MEANS A PHYSICIAN, DENTIST, PHYSICIAN ASSISTANT,
SPECIALIST'S ASSISTANT, NURSE PRACTITIONER, MIDWIFE, OPTOMETRIST AND
OTHER LICENSED HEALTH CARE PROVIDER AUTHORIZED UNDER TITLE EIGHT OF THE
EDUCATION LAW TO PRESCRIBE DRUGS OR DEVICES, WHO IS PRACTICING IN THE
STATE.
5. "PATIENT" IS A NATURAL PERSON FOR WHOM A PRESCRIBER WRITES A
PRESCRIPTION FOR A PRESCRIPTION DRUG OR TO WHOM A PHARMACY DISPENSES
SUCH A PRODUCT.
6. "PHARMACY BENEFIT MANAGEMENT SERVICES" MEANS THE NEGOTIATION OF THE
AMOUNT TO BE PAID FOR PRESCRIPTION DRUGS BY THE HEALTH PLAN OR PARTIC-
IPANTS IN THE STATE, THE ADMINISTRATION OR MANAGEMENT OF PRESCRIPTION
DRUG BENEFITS PROVIDED BY A HEALTH PLAN FOR THE BENEFIT OF PARTICIPANTS,
OR ANY OF THE SERVICES LISTED IN PARAGRAPHS (A) THROUGH (G) OF THIS
SUBDIVISION THAT ARE PROVIDED WITH REGARD TO THE ADMINISTRATION OF
PARTICIPANTS' PHARMACY BENEFITS:
(A) MAIL SERVICE PHARMACY;
(B) SPECIALTY PHARMACY;
(C) CLAIMS PROCESSING, RETAIL NETWORK MANAGEMENT AND PAYMENT OF CLAIMS
TO PHARMACIES FOR PRESCRIPTION DRUGS DISPENSED TO PARTICIPANTS;
(D) CLINICAL FORMULARY DEVELOPMENT AND MANAGEMENT SERVICES;
(E) REBATE CONTRACTING AND ADMINISTRATION;
(F) PATIENT COMPLIANCE, THERAPEUTIC INTERVENTION AND GENERIC SUBSTI-
TUTION PROGRAMS; AND
(G) DISEASE MANAGEMENT PROGRAMS.
7. "PHARMACY BENEFIT MANAGER" IS A PERSON OR ENTITY THAT PROVIDES
PHARMACY BENEFIT MANAGEMENT SERVICES TO A HEALTH PLAN.
8. "AFFILIATE" MEANS A CORPORATION OR OTHER BUSINESS ENTITY A MAJORITY
OF WHOSE SHARES IS OWNED OR CONTROLLED BY SHAREHOLDERS, DIRECTORS OR
OFFICERS OF ANOTHER CORPORATION OR OTHER BUSINESS ENTITY, WHO OWN OR
CONTROL A MAJORITY OF THE SHARES OF THE OTHER CORPORATION OR OTHER BUSI-
NESS ENTITY.
9. "COVERED" WHEN USED IN CONNECTION WITH A DRUG, DISPENSED
PRESCRIPTION, GOOD OR SERVICE, REFERS TO A DRUG, DISPENSED PRESCRIPTION,
GOOD OR SERVICE IN CONNECTION WITH WHICH THE PHARMACY BENEFIT MANAGER
PROVIDES OR OFFERS TO PROVIDE PHARMACY BENEFIT MANAGEMENT SERVICES TO A
HEALTH PLAN.
S. 58--A 90 A. 158--A
10. "PAYMENT" MEANS ANYTHING OF VALUE A PHARMACY BENEFIT MANAGER
RECEIVES FROM ANY ENTITY, INCLUDING AN AFFILIATE BUT EXCLUDING THE
HEALTH PLAN THAT CONTRACTS WITH IT FOR PHARMACY BENEFIT MANAGEMENT
SERVICES, IN CONNECTION WITH A COVERED DRUG, COVERED DISPENSED
PRESCRIPTION, COVERED GOOD OR COVERED SERVICE, OR ANY OTHER ASPECT OF
THE PHARMACY BENEFIT MANAGER'S BUSINESS FAIRLY ATTRIBUTABLE TO THE PHAR-
MACY BENEFIT MANAGEMENT SERVICES IT PROVIDES TO THE HEALTH PLAN.
11. "NET PRICE" OR "NET COST" MEANS THE PRICE PAID AFTER DEDUCTING ALL
DISCOUNTS, REBATES, CHARGEBACKS AND ANY OTHER PRICE CONCESSION OR
PAYMENT CONTINGENT ON A PURCHASE, BUT EXCLUDES ANY AMOUNT PAID TO A
PHARMACY AS A DISPENSING FEE.
12. "SWITCH", AS IN "DRUG SWITCH" OR "SWITCH A PRESCRIPTION", MEANS AN
ATTEMPT BY A PHARMACY BENEFIT MANAGER OR BY A PHARMACY OR OTHER ENTITY
AT THE REQUEST OR ON BEHALF OF THE PHARMACY BENEFIT MANAGER TO CHANGE
THE DRUG PRESCRIBED FOR A PARTICIPANT WHEN (A) SUCH ATTEMPT IS PART OF A
CONCERTED EFFORT BY THE PHARMACY BENEFIT MANAGER TO EFFECT SUCH A CHANGE
FOR MULTIPLE PARTICIPANTS BASED EITHER ON CLINICAL CONSIDERATIONS THAT
ARE NOT SPECIFIC TO SUCH INDIVIDUAL PARTICIPANTS OR ON THE ECONOMIC
VALUE OF THE SWITCH TO THE PHARMACY BENEFIT MANAGER AND (B) THE ATTEMPT
WOULD NOT SUBSTITUTE A LOWER OR EQUALLY PRICED THERAPEUTICALLY EQUIV-
ALENT DRUG. "LOWER OR EQUALLY PRICED" MEANS THE PARTICIPANT'S CO-PAYMENT
OR CO-INSURANCE AMOUNT.
13. "THERAPEUTICALLY EQUIVALENT DRUGS" MEAN DRUGS IDENTIFIED AS BEING
THERAPEUTICALLY EQUIVALENT TO EACH OTHER ON THE LIST REQUIRED BY PARA-
GRAPH (O) OF SUBDIVISION ONE OF SECTION TWO HUNDRED SIX OF THIS CHAPTER.
14. A "BRAND NAME DRUG" MEANS A DRUG MARKETED UNDER A PROPRIETARY,
TRADEMARK-PROTECTED NAME.
15. A "GENERIC DRUG" MEANS THE SAME AS A BRAND NAME DRUG IN ACTIVE
INGREDIENTS, DOSAGE, SAFETY, STRENGTH, ROUTE OF ADMINISTRATION, QUALITY,
PERFORMANCE, AND INTENDED USE, BUT WHICH IS NOT MARKETED UNDER A PROPRI-
ETARY, TRADEMARK-PROTECTED NAME.
16. "PHARMACY CATEGORIES" MEAN CHAIN RETAIL PHARMACIES (FOUR OR MORE
STORES), INDEPENDENT RETAIL PHARMACIES (THREE OR FEWER STORES), PHARMA-
CIES IN FOOD STORES, PHARMACIES IN MASS MERCHANDISE STORES, MAIL-SERVICE
PHARMACIES, SPECIALTY PHARMACIES (RETAIL AND MAIL-SERVICE COMBINED), AND
OTHER PHARMACIES.
17. "DRUG CATEGORIES" MEANS SINGLE-SOURCE BRAND NAME DRUG,
MULTI-SOURCE BRAND NAME DRUG AND GENERIC DRUG.
S 4451. MATTERS UNAFFECTED BY THIS ARTICLE. 1. NOTHING IN THIS ARTICLE
SHALL ALTER THE RELATIONSHIP BETWEEN A HEALTH PLAN AND ITS PARTICIPANTS
OR BETWEEN A HEALTH PLAN AND ANY ENTITY THAT, WITH RESPECT TO A SPECIFIC
ACTIVITY, QUALIFIES AS A FIDUCIARY OF THE HEALTH PLAN UNDER THE FEDERAL
EMPLOYEE RETIREMENT INCOME SECURITY ACT.
2. THIS ARTICLE DOES NOT CREATE ANY OBLIGATION FOR A HEALTH PLAN TO
DISCLOSE ANY INFORMATION TO ANY OF ITS PARTICIPANTS.
3. NOTHING IN THIS ARTICLE AFFECTS ANY CIVIL OR CRIMINAL PROCEEDINGS
THAT MAY BE BROUGHT IN CONNECTION WITH MATTERS WITHIN THE SCOPE OF THIS
ARTICLE.
S 4452. THE PHARMACY BENEFIT MANAGER'S GENERAL OBLIGATIONS. A PHARMACY
BENEFIT MANAGER:
1. SHALL PERFORM ITS DUTIES IN CONNECTION WITH PHARMACY BENEFIT
MANAGEMENT SERVICES IT PROVIDES TO A HEALTH PLAN OR PARTICIPANTS IN THE
STATE WITH CARE, SKILL, PRUDENCE AND DILIGENCE;
2. SHALL NOT INITIATE A DRUG SWITCH FOR THE PARTICIPANTS OF A HEALTH
PLAN FOR WHICH IT PROVIDES PHARMACY BENEFIT MANAGEMENT SERVICES EXCEPT
PURSUANT TO THE HEALTH PLAN'S WRITTEN APPROVAL OR AGREEMENT TO SWITCH-
S. 58--A 91 A. 158--A
ING THE SPECIFIC DRUGS. THE HEALTH PLAN'S AGREEMENT OR APPROVAL OF A
DRUG SWITCH SHALL NOT RELIEVE THE PHARMACY BENEFIT MANAGER OF ANY
RESPONSIBILITIES PERTAINING TO SUCH DRUG SWITCH UNDER THIS ARTICLE; AND
3. SHALL NOT PAY AN AFFILIATED ENTITY MORE FOR ANY COVERED DRUG,
COVERED DISPENSED PRESCRIPTION, COVERED GOOD OR COVERED SERVICE THAN IT
PAYS SIMILARLY SITUATED ENTITIES FOR THE SAME DRUG, DISPENSED
PRESCRIPTION, GOOD OR SERVICE ON BEHALF OF THE SAME HEALTH PLAN. A SIMI-
LARLY SITUATED PHARMACY IS A PHARMACY IN THE SAME PHARMACY CATEGORY.
S 4453. THE PHARMACY BENEFIT MANAGER'S DISCLOSURE OF INFORMATION TO
THE HEALTH PLAN. 1. CONFIDENTIALITY. THE PHARMACY BENEFIT MANAGER MAY
DESIGNATE INFORMATION IT DISCLOSES TO A HEALTH PLAN AS CONFIDENTIAL, AND
THE HEALTH PLAN SHALL NOT RE-DISCLOSE SUCH INFORMATION TO OTHER ENTITIES
EXCEPT TO AGENTS OR INDEPENDENT CONTRACTORS WITH WHOM THE HEALTH PLAN
CONTRACTS TO ADMINISTER THE PHARMACY BENEFIT OR AUDIT SUCH ADMINIS-
TRATION, PROVIDED SUCH AGENT OR INDEPENDENT CONTRACTOR PREVIOUSLY CERTI-
FIES THAT IT WILL NOT DISCLOSE SUCH CONFIDENTIAL INFORMATION TO ANY
OTHER PERSON OR ENTITY. WITH RESPECT TO DOCUMENTS DISCLOSED TO A HEALTH
PLAN THAT ARE SUBJECT TO ARTICLE SIX OF THE PUBLIC OFFICERS LAW, THE
PHARMACY BENEFIT MANAGER SHALL NOT DESIGNATE AS "CONFIDENTIAL" ANY DOCU-
MENT TO WHICH THE PUBLIC WOULD HAVE ACCESS UNDER SAID LAW, AND THE
PROVISIONS OF ARTICLE SIX OF THE PUBLIC OFFICERS LAW SHALL APPLY TO THE
DOCUMENTS DISCLOSED TO SUCH A HEALTH PLAN. THE APPLICABILITY OF ARTICLE
SIX OF THE PUBLIC OFFICERS LAW TO A HEALTH PLAN'S RECORDS DOES NOT
AFFECT THE PHARMACY BENEFIT MANAGER'S OBLIGATION UNDER THIS ARTICLE TO
DISCLOSE DOCUMENTS TO THE HEALTH PLAN.
2. DISCLOSURE IN CONNECTION WITH CONTRACT NEGOTIATIONS. PRIOR TO
ENTERING INTO ITS INITIAL CONTRACT AND EACH SUBSEQUENT CONTRACT OR
CONTRACT AMENDMENT WITH A HEALTH PLAN, THE PHARMACY BENEFIT MANAGER
SHALL PROVIDE TO THE HEALTH PLAN IN WRITING EACH CATEGORY OF INFORMATION
DESCRIBED IN PARAGRAPHS (A) THROUGH (C) OF THIS SUBDIVISION:
(A) A DESCRIPTION OF ALL PHARMACY BENEFIT MANAGEMENT SERVICES AND
COVERED GOODS IT OFFERS TO PROVIDE THE HEALTH PLAN AND THE NET COST FOR
EACH SUCH SERVICE OR GOOD;
(B) THE METHODOLOGY, WITH CLEARLY DEFINED TERMINOLOGY, THE PHARMACY
BENEFIT MANAGER PROPOSES TO USE TO DISTINGUISH AMONG DRUGS, SUCH AS A
METHODOLOGY BASED ON DRUG CATEGORY, FOR THE PURPOSE OF DETERMINING THE
COST OF A DISPENSED PRESCRIPTION TO THE HEALTH PLAN OR THE PARTICIPANT'S
CO-PAYMENT OR CO-INSURANCE AMOUNT FOR A DISPENSED PRESCRIPTION; AND
(C) A COMPLETE DESCRIPTION OF THE DESIGN AND OPERATION OF ANY FORMU-
LARY THE PHARMACY BENEFIT MANAGER RECOMMENDS THAT THE HEALTH PLAN ADOPT.
3. INITIAL AND PERIODIC DISCLOSURE. (A) PRIOR TO ENTERING INTO ITS
INITIAL CONTRACT WITH A HEALTH PLAN AND ANNUALLY THEREAFTER UNTIL THE
PHARMACY BENEFIT MANAGER DISCONTINUES PROVIDING PHARMACY BENEFIT
MANAGEMENT SERVICES TO THE HEALTH PLAN, THE PHARMACY BENEFIT MANAGER
SHALL FULLY DISCLOSE TO THE HEALTH PLAN (I) THE CONTENT OF ALL CONTRACTS
AND OTHER AGREEMENTS IT DIRECTLY OR INDIRECTLY HAS WITH, AND ALL
PAYMENTS IT RECEIVES FROM, A DRUG MANUFACTURER, LABELER OR OTHER THIRD-
PARTY IN CONNECTION WITH ANY PHARMACY BENEFIT MANAGEMENT SERVICE IT
PROVIDES TO THE HEALTH PLAN, INCLUDING BUT NOT LIMITED TO COVERED DRUGS,
COVERED DISPENSED PRESCRIPTIONS, COVERED GOODS, COVERED SERVICES,
PROMOTING OR MARKETING ANY DRUG OR DRUG SWITCHES AND (II) THE PERCENTAGE
OF ALL SUCH PAYMENTS RETAINED BY THE PHARMACY BENEFIT MANAGER OR
DISTRIBUTED TO THE HEALTH PLAN.
(B) IN DISCLOSING PRIOR TO THE INITIAL CONTRACT THE VALUE OF A CATEGO-
RY OF PAYMENT DESCRIBED IN SUBPARAGRAPH (I) OF PARAGRAPH (A) OF THIS
SUBDIVISION OR THE PERCENTAGE OF SUCH PAYMENT RETAINED BY THE PHARMACY
S. 58--A 92 A. 158--A
BENEFIT MANAGER OR DISTRIBUTED TO THE HEALTH PLAN AS DESCRIBED IN
SUBPARAGRAPH (II) OF PARAGRAPH (A) OF THIS SUBDIVISION, THE PHARMACY
BENEFIT MANAGER SHALL ESTIMATE THE VALUE BASED ON CONTRACTS THE
EXECUTION OF WHICH IS CONTINGENT ON THE PHARMACY BENEFIT MANAGER
CONTRACTING WITH THE HEALTH PLAN TO WHICH THE INFORMATION IS BEING
DISCLOSED AND ON THE PHARMACY BENEFIT MANAGER'S EXISTING CONTRACTS WITH
OTHER HEALTH PLANS, AND, WHERE RELEVANT, ON THE NEGOTIATING HEALTH
PLAN'S PAST OR EXPECTED DRUG UTILIZATION. FOR SUBSEQUENT REPORTING PERI-
ODS, THE PHARMACY BENEFIT MANAGER SHALL DISCLOSE THE ACTUAL VALUE OF
EACH PAYMENT CATEGORY AND THE PERCENTAGE OF EACH SUCH CATEGORY THAT THE
PHARMACY BENEFIT MANAGER RETAINED AND THE PERCENTAGE IT PAID TO OR
PASSED THROUGH TO THE NEGOTIATING HEALTH PLAN.
4. DISCLOSURE DURING A CONTRACT PERIOD. (A) THE PHARMACY BENEFIT
MANAGER SHALL PROVIDE TO THE HEALTH PLAN IN WRITING THE INFORMATION
REQUIRED BY SUBPARAGRAPHS (I) THROUGH (VII) OF THIS PARAGRAPH ON A QUAR-
TERLY BASIS DURING THE OPERATION OF THE CONTRACT BETWEEN THE PHARMACY
BENEFIT MANAGER AND THE HEALTH PLAN: (I) THE HEALTH PLAN'S PARTICIPANTS'
ACTUAL UTILIZATION OF DRUGS BY NATIONAL DRUG CODE (NDC) DIRECTORY
NUMBER; (II) EVERY ACTIVITY, POLICY OR PRACTICE OF THE PHARMACY BENEFIT
MANAGER THAT DIRECTLY OR INDIRECTLY PRESENTS ANY ACTUAL OR POTENTIAL
CONFLICT OF INTEREST WITH THE HEALTH PLAN; (III) ANY INCREASE IN THE NET
PRICE TO THE HEALTH PLAN FOR ANY COVERED DRUG AND THE REASON FOR SUCH
INCREASE; (IV) ANY INCREASE IN THE DISPENSING FEE PAID TO ANY PHARMACY
AND THE REASON FOR SUCH INCREASE; (V) ALL CONTRACTS AND OTHER AGREEMENTS
ENTERED INTO DURING THE REPORTED QUARTER BETWEEN THE PHARMACY BENEFIT
MANAGER AND ANY PHARMACY THAT IS WITHIN THE PHARMACY NETWORK IDENTIFIED
BY THE PHARMACY BENEFIT MANAGER AT WHICH THE HEALTH PLAN'S PARTICIPANTS
MAY FILL COVERED PRESCRIPTIONS, INCLUDING PHARMACIES AFFILIATED WITH THE
PHARMACY BENEFIT MANAGER; (VI) ALL CONTRACTS AND OTHER AGREEMENTS THAT
PERTAIN TO ANY COVERED DRUG OR COVERED DISPENSED PRESCRIPTION ENTERED
INTO DURING THE REPORTED QUARTER BETWEEN THE PHARMACY BENEFIT MANAGER
AND ANY MANUFACTURER, LABELER, REPACKAGER OR DISTRIBUTOR OF A DRUG OR
ANY OTHER THIRD-PARTY, INCLUDING ANY ENTITY ACTING ON BEHALF OF SUCH
MANUFACTURER, LABELER, REPACKAGER, DISTRIBUTOR OR THIRD-PARTY; (VII)
DOCUMENTS SUFFICIENT FOR THE HEALTH PLAN TO DETERMINE WHETHER ANY
COVERED DISPENSED PRESCRIPTION FILLED WITH A REPACKAGED DRUG, INCLUDING
A DRUG REPACKAGED BY AN AFFILIATE OF THE PHARMACY BENEFIT MANAGER, HAD
EITHER A HIGHER NET COST TO THE HEALTH PLAN OR A HIGHER CO-PAYMENT OR
CO-INSURANCE AMOUNT TO THE PARTICIPANT THAN ANY THERAPEUTICALLY EQUIV-
ALENT DRUG AVAILABLE ON THE DATE THE PRESCRIPTION WAS FILLED. UPON THE
HEALTH PLAN'S REQUEST, THE PHARMACY BENEFIT MANAGER SHALL PROVIDE
DOCUMENTATION SUPPORTING THE REASON FOR ANY INCREASE IN NET PRICE OR THE
REASON FOR ANY INCREASE IN DISPENSING FEE.
(B) DURING THE TIME A PHARMACY BENEFIT MANAGER PROVIDES PHARMACY BENE-
FIT MANAGEMENT SERVICES TO A HEALTH PLAN, UPON THE HEALTH PLAN'S DEMAND,
THE PHARMACY BENEFIT MANAGER SHALL PROMPTLY:
(I) PROVIDE THE HEALTH PLAN WITH ACCESS TO ALL FINANCIAL, UTILIZATION,
PRICING AND CLAIMS INFORMATION AND DOCUMENTS PERTAINING TO ANY ASPECT OF
THE PHARMACY BENEFIT MANAGER'S BUSINESS THAT IS FAIRLY ATTRIBUTABLE TO
THE PHARMACY BENEFIT MANAGEMENT SERVICES IT PROVIDES TO THE HEALTH PLAN,
INCLUDING ELECTRONIC CLAIMS DATA FOR EACH SEPARATE CLAIM; AND
(II) ALLOW THE HEALTH PLAN TO CONDUCT ANNUAL AUDITS OF THOSE ASPECTS
OF THE PHARMACY BENEFIT MANAGER'S BUSINESS THAT ARE FAIRLY ATTRIBUTABLE
TO THE PHARMACY BENEFIT MANAGEMENT SERVICES IT PROVIDES TO THE HEALTH
PLAN. THE PHARMACY BENEFIT MANAGER SHALL ALLOW THE HEALTH PLAN TO
CONDUCT SUCH AUDITS ITSELF OR BY A CERTIFIED PUBLIC ACCOUNTING FIRM OF
S. 58--A 93 A. 158--A
THE HEALTH PLAN'S CHOOSING THAT WILL CONDUCT THE AUDIT IN CONFORMANCE
WITH ACCEPTED AUDITING PROCEDURES AND STANDARDS.
5. THE DEPARTMENT MAY PROMULGATE REGULATIONS THAT SET OUT THE NATURE,
CONTENT AND FORMAT OF THE DISCLOSURES REQUIRED BY THIS SECTION.
S 4454. THE PHARMACY BENEFIT MANAGER'S COMMUNICATION WITH PARTICIPANTS
AND PRESCRIBERS IN CERTAIN SITUATIONS. 1. NOTIFYING THE PATIENT OF A
PROPOSED DRUG SWITCH. BEFORE A PHARMACY BENEFIT MANAGER, OR A PHARMACY
OR OTHER ENTITY AT THE REQUEST OR ON BEHALF OF A PHARMACY BENEFIT MANAG-
ER, REQUESTS A PRESCRIBER TO SWITCH A PRESCRIPTION FOR A PARTICIPANT OF
A HEALTH PLAN, THE PHARMACY BENEFIT MANAGER, PHARMACY OR OTHER ENTITY
SHALL NOTIFY IN WRITING THE PATIENT AND, IF RELEVANT, THE PATIENT'S
GUARDIAN OF THIS INTENTION. SUCH NOTICE SHALL BE SENT TO THE PATIENT
AND, IF RELEVANT, THE PATIENT'S GUARDIAN IN A MANNER REASONABLY CALCU-
LATED TO REACH THE PATIENT AND, IF RELEVANT, THE PATIENT'S GUARDIAN NOT
LESS THAN TWO BUSINESS DAYS BEFORE THE PRESCRIBER IS CONTACTED CONCERN-
ING THE PROPOSED DRUG SWITCH. SUCH NOTICE SHALL NOT CONTAIN ANY FALSE OR
MISLEADING INFORMATION ABOUT THE ORIGINALLY PRESCRIBED OR THE PROPOSED
SUBSTITUTION DRUGS, INCLUDING THEIR RELATIVE COST TO THE PARTICIPANT.
2. INFORMATION TO BE PROVIDED TO A PRESCRIBER WHEN A DRUG SWITCH IS
REQUESTED. WHEN A PHARMACY BENEFIT MANAGER, OR A PHARMACY OR OTHER ENTI-
TY AT THE REQUEST OR ON BEHALF OF A PHARMACY BENEFIT MANAGER, REQUESTS A
PRESCRIBER TO SWITCH A PRESCRIPTION THE PRESCRIBER HAS WRITTEN FOR A
PARTICIPANT, IT SHALL PROVIDE THE PRESCRIBER WITH ALL OF THE FINANCIAL
AND CLINICAL INFORMATION THE PRESCRIBER NEEDS TO DETERMINE WHETHER THE
DRUG SWITCH IS IN THE PATIENT'S BEST INTERESTS.
3. CONTINUING OBLIGATIONS. (A) NOTHING CONTAINED IN THIS ARTICLE
RELIEVES A PRESCRIBER OF ANY OBLIGATION THE PRESCRIBER MAY OTHERWISE
HAVE TO DISCUSS WITH THE PATIENT THE RISKS AND BENEFITS OF A PRESCRIBED
DRUG OR TO OBTAIN THE PATIENT'S CONSENT TO TREATMENT WITH A SPECIFIC
DRUG, OR RELIEVES A PHARMACIST OF ANY OBLIGATION THE PHARMACIST MAY
OTHERWISE HAVE TO ALERT THE PATIENT OR PRESCRIBER TO ANY SAFETY OR EFFI-
CACY CONCERNS RAISED BY DISPENSING A PARTICULAR DRUG TO THE INDIVIDUAL
PATIENT.
(B) A PHARMACY BENEFIT MANAGER SHALL NOT TAKE ANY ACTION THAT WOULD
RENDER IT LESS LIKELY THAT A PHARMACY WILL SUBSTITUTE A GENERIC DRUG
WHEN REQUIRED TO DO SO BY SECTION SIXTY-EIGHT HUNDRED SIXTEEN-A OF THE
EDUCATION LAW.
4. RECORD RETENTION. A PHARMACY BENEFIT MANAGER, OR A PHARMACY OR
OTHER ENTITY ACTING AT THE PHARMACY BENEFIT MANAGER'S REQUEST OR ON ITS
BEHALF, WHICH NOTIFIES A PATIENT AND, IF RELEVANT, THE PATIENT'S GUARDI-
AN OF ITS INTENTION TO CONTACT A PRESCRIBER TO SWITCH A DRUG OR REQUESTS
THE PRESCRIBER TO SWITCH A PRESCRIPTION, SHALL MAINTAIN FOR THREE YEARS
WRITTEN OR ELECTRONIC DOCUMENTATION OF SUCH CONTACT. UPON REQUEST, THE
PHARMACY BENEFIT MANAGER SHALL MAKE SUCH DOCUMENTATION PROMPTLY AVAIL-
ABLE TO THE HEALTH PLAN OR THE DEPARTMENT.
5. DISEASE OR TREATMENT INFORMATION. PHARMACY BENEFIT MANAGERS SHALL
ENSURE THAT EVERY WRITTEN OR ELECTRONIC DOCUMENT CONTAINING INFORMATION
ABOUT A DISEASE, CONDITION OR TREATMENT FOR A DISEASE OR CONDITION THAT
IT PROVIDES DIRECTLY OR INDIRECTLY TO ANY PARTICIPANT IS NOT FALSE OR
MISLEADING AND DISCLOSES ANY SUPPORT OR INVOLVEMENT OF A DRUG OR DEVICE
MANUFACTURER OR LABELER IN THE DEVELOPMENT, WRITING, OR DISTRIBUTION OF
SUCH MATERIALS.
S 4455. DISTRIBUTION OF PRESCRIPTION DATA. 1. A PHARMACY BENEFIT
MANAGER SHALL OBTAIN A HEALTH PLAN'S WRITTEN AGREEMENT BEFORE IT
DISCLOSES ANY INFORMATION CONCERNING DISPENSED PRESCRIPTIONS COVERED BY
THE HEALTH PLAN OR THE HEALTH PLAN'S DRUG-UTILIZATION OR CLAIMS DATA FOR
S. 58--A 94 A. 158--A
COVERED DRUGS OR COVERED DISPENSED PRESCRIPTIONS TO AN ENTITY OTHER THAN
THE HEALTH PLAN, AN ENTITY THAT QUALIFIES IN CONNECTION WITH THE DISCLO-
SURE OF SUCH INFORMATION AS THE HEALTH PLAN'S FIDUCIARY UNDER THE FEDER-
AL EMPLOYEE RETIREMENT INCOME SECURITY ACT, THE HEALTH PLAN'S SPONSOR, A
PARTICIPANT WITH RESPECT TO HIS OR HER INFORMATION, A PRESCRIBER WITH
THE PATIENT'S CONSENT, OR A GOVERNMENT AGENCY AUTHORIZED TO RECEIVE SUCH
INFORMATION. SUCH WRITTEN AGREEMENT IS REQUIRED REGARDLESS OF WHETHER
THE INFORMATION IS AGGREGATED OR IS IDENTIFIABLE BY INDIVIDUAL OR CATE-
GORY OF PARTICIPANT OR PRESCRIBER. WHEN THE HEALTH PLAN'S AGREEMENT TO
THE DISCLOSURE OF SUCH INFORMATION IS REQUIRED BY THIS SECTION, THE
PHARMACY BENEFIT MANAGER'S REQUEST FOR SUCH APPROVAL SHALL INCLUDE ALL
THE INFORMATION REQUIRED BY PARAGRAPHS (A) THROUGH (D) OF THIS SUBDIVI-
SION:
(A) THE IDENTITY OF THE ENTITY TO WHICH THE INFORMATION WILL BE
PROVIDED;
(B) THE SPECIFIC, ITEMIZED CATEGORIES OF INFORMATION THAT WILL BE
PROVIDED;
(C) THE SPECIFIC PRACTICES ACTUALLY IN OPERATION TO PROTECT THE PRIVA-
CY OF THE HEALTH PLAN'S PARTICIPANTS; AND
(D) THE AMOUNT OF ANY PAYMENTS PAID OR PROVIDED TO THE PHARMACY BENE-
FIT MANAGER BY OR ON BEHALF OF THE ENTITY THAT SEEKS SUCH INFORMATION
AND THE PURPOSE OF SUCH PAYMENTS THAT HAVE BEEN OR WILL BE PAID OR
PROVIDED TO THE PHARMACY BENEFIT MANAGER.
2. A PHARMACY BENEFIT MANAGER VIOLATES THIS ARTICLE WHEN IT DISCLOSES
INFORMATION FOR WHICH THIS SECTION REQUIRES THE HEALTH PLAN'S PRIOR
WRITTEN AGREEMENT WITHOUT FIRST OBTAINING SUCH WRITTEN PERMISSION.
3. THE PHARMACY BENEFIT MANAGER AND THE HEALTH PLAN SHALL RETAIN FOR
FIVE YEARS THE DOCUMENTATION OF THE PHARMACY BENEFIT MANAGER'S REQUEST
AND THE HEALTH PLAN'S AGREEMENT THAT THE INFORMATION DESCRIBED IN SUBDI-
VISION ONE OF THIS SECTION MAY BE PROVIDED.
S 4456. ENFORCEMENT. 1. ANY HEALTH PLAN THAT HAS BEEN INJURED BY
REASON OF A PHARMACY BENEFIT MANAGER'S VIOLATION OF ANY PROVISION OF
THIS ARTICLE MAY BRING AN ACTION IN THE NAME OF THE HEALTH PLAN FOR
EQUITABLE RELIEF AND TO RECOVER THE HEALTH PLAN'S ACTUAL DAMAGES AND A
CIVIL PENALTY TO BE PAID TO THE HEALTH PLAN NOT TO EXCEED THREE TIMES
SUCH ACTUAL DAMAGES.
2. ANY PHARMACY BENEFIT MANAGER THAT IS INJURED BY THE DISCLOSURE BY A
HEALTH PLAN, A HEALTH PLAN'S AGENT OR INDEPENDENT CONTRACTOR OR A HEALTH
PLAN'S CERTIFIED PUBLIC ACCOUNTING FIRM, OF INFORMATION THE PHARMACY
BENEFIT MANAGER DESIGNATED AS CONFIDENTIAL PURSUANT TO SUBDIVISION ONE
OF SECTION FORTY-FOUR HUNDRED FIFTY-THREE OF THIS ARTICLE AND THAT IS
NOT SUBJECT TO DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW,
SHALL HAVE A CAUSE OF ACTION IN THE NAME OF THE PHARMACY BENEFIT MANAGER
FOR EQUITABLE RELIEF AND TO RECOVER THE PHARMACY BENEFIT MANAGER'S ACTU-
AL DAMAGES AND A CIVIL PENALTY NOT TO EXCEED THREE TIMES SUCH ACTUAL
DAMAGES.
3. UPON DEMAND, A PHARMACY BENEFIT MANAGER SHALL PROVIDE THE DEPART-
MENT WITH ACCESS, AT TIMES AND LOCATIONS THAT ARE CONVENIENT TO THE
DEPARTMENT, TO THE RECORDS, BOOKS AND OTHER DOCUMENTS OF THE PHARMACY
BENEFIT MANAGER AND ITS AFFILIATES WHICH PERTAIN TO THE PHARMACY BENEFIT
MANAGER'S COMPLIANCE WITH THIS ARTICLE. THE OFFICERS, AGENTS AND EMPLOY-
EES OF THE PHARMACY BENEFIT MANAGER AND ITS AFFILIATES SHALL FACILITATE
AND AID IN THE DEPARTMENT'S EXAMINATION OF SUCH RECORDS, BOOKS AND OTHER
DOCUMENTS.
S. 58--A 95 A. 158--A
4. THE COMMISSIONER MAY ASSESS A CIVIL PENALTY FOR VIOLATIONS OF THIS
ARTICLE IN AN AMOUNT OF NOT MORE THAN FIFTY THOUSAND DOLLARS PER
VIOLATION.
S 57. Intentionally omitted.
S 58. Clauses (ii) and (iii) of subparagraph 1 and subparagraphs 3 and
4 of paragraph (a) of subdivision 1 of section 366 of the social
services law, subparagraph 1 as amended by section 60 of part C of chap-
ter 58 of the laws of 2008, subparagraph 3 as amended by chapter 309 of
the laws of 1996, subparagraph 4 as amended by chapter 1080 of the laws
of 1974, are amended to read as follows:
(ii) such person [may have resources up to the amount specified in
subparagraph four of paragraph (a) of subdivision two of this section]
SHALL NOT BE SUBJECT TO A RESOURCE TEST;
(iii) a person whose income [and resources are] IS within the [limits]
LIMIT set forth in [clauses] CLAUSE (i) [and (ii)] of this subparagraph
shall be deemed to have unmet needs for purposes of the eligibility
requirements of the safety net program as it existed on the first day of
November, nineteen hundred ninety-seven;
(3) is a child under the age of twenty-one years receiving care (A)
away from his own home in accordance with title two of article six of
this chapter; (B) during the initial thirty days of placement with the
division for youth pursuant to section 353.3 of the family court act;
(C) in an authorized agency when placed pursuant to section seven
hundred fifty-six or 353.3 of the family court act; or (D) in residence
at a division foster family home or a division contract home, and has
not, according to the criteria promulgated by the department, sufficient
income [and resources], including available support from his parents, to
meet all costs of required medical care and services available under
this title; or
(4) is receiving care, in the case of and in connection with the birth
of an out of wedlock child, in accordance with title two of article six
of this chapter, and has not, according to the criteria promulgated by
the department, sufficient income [and resources], including available
support from responsible relatives, to meet all costs of required
medical care and services available under this title; or
S 59. Subparagraphs 5, 6 and 8 of paragraph (a) of subdivision 1 of
section 366 of the social services law, subparagraph 5 as amended by
section 55 of part B of chapter 436 of the laws of 1997, subparagraph 6
as amended by chapter 710 of the laws of 1988 and subparagraph 8 as
amended by section 60 of part C of chapter 58 of the laws of 2008, are
amended and a new subparagraph 5-a is added to read as follows:
(5) although not receiving public assistance or care for his or her
maintenance under other provisions of this chapter, has [not, according
to the criteria and standards established by this article or by action
of the department, sufficient] income and resources, including available
support from responsible relatives, [to meet all the costs of medical
care and services available under this title,] THAT DOES NOT EXCEED THE
AMOUNTS SET FORTH IN PARAGRAPH (A) OF SUBDIVISION TWO OF THIS SECTION,
and is (i) [under the age of twenty-one years, or] sixty-five years of
age or older, or certified blind or certified disabled or (ii) [a spouse
of a cash public assistance recipient living with him or her and essen-
tial or necessary to his or her welfare and whose needs are taken into
account in determining the amount of his or her cash payment or (iii)]
for reasons other than income or resources[: (A)], is eligible for
federal supplemental security income benefits and/or additional state
payments[, or (B) would meet the eligibility requirements of the aid to
S. 58--A 96 A. 158--A
dependent children program as it existed on the sixteenth day of July,
nineteen hundred ninety-six]; or
(5-A) ALTHOUGH NOT RECEIVING PUBLIC ASSISTANCE OR CARE FOR HIS OR HER
MAINTENANCE UNDER OTHER PROVISIONS OF THIS CHAPTER, HAS INCOME, INCLUD-
ING 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) UNDER THE AGE OF TWENTY-ONE YEARS, OR (II) A SPOUSE
OF A CASH PUBLIC ASSISTANCE RECIPIENT LIVING WITH HIM OR HER AND ESSEN-
TIAL OR NECESSARY TO HIS OR HER WELFARE AND WHOSE NEEDS ARE TAKEN INTO
ACCOUNT IN DETERMINING THE AMOUNT OF HIS OR HER CASH PAYMENT, OR (III)
FOR REASONS OTHER THAN INCOME OR RESOURCES, WOULD MEET THE ELIGIBILITY
REQUIREMENTS OF THE AID TO DEPENDENT CHILDREN PROGRAM AS IT EXISTED ON
THE SIXTEENTH DAY OF JULY, NINETEEN HUNDRED NINETY-SIX; OR
(6) is 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; or
(8) is a member of a family which contains a dependent child living
with a caretaker relative, which has net available income not in excess
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 Novem-
ber, nineteen hundred ninety-seven, to be increased annually by the same
percentage as the percentage increase in the federal consumer price
index[, and which has net available resources not in excess of the
amount specified in subparagraph four of paragraph (a) of subdivision
two of this section]; for purposes of this subparagraph, the net avail-
able income [and resources] of a family shall be determined using the
methodology of the family assistance program as it exists on the first
day of November, nineteen hundred ninety-seven, except that no part of
the methodology of the family assistance program will be used which is
more restrictive than the methodology of the aid to dependent children
program as it existed on the sixteenth day of July, nineteen hundred
ninety-six; for purposes of this subparagraph, the term dependent child
means a person under twenty-one years of age 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; or
S 59-a. Subparagraph 10 of paragraph (a) of subdivision 1 of section
366 of the social services law, as amended by section 1 of part E of
chapter 57 of the laws of 2000, is amended to read as follows:
(10) is a child who is under twenty-one years of age, who is not
living with a caretaker relative, who has net available income not in
excess of the income standards of the family assistance program as it
existed on the first day of November, nineteen hundred ninety-seven[,
and who has net available resources not in excess of one thousand
dollars]; for purposes of this subparagraph, the child's net available
income [and resources] shall be determined using the methodology of the
family assistance program as it existed on the first day of November,
nineteen hundred ninety-seven, except that [(i) there shall be disre-
garded an additional amount of resources equal to the difference between
S. 58--A 97 A. 158--A
the applicable resource standard of the family assistance program as it
exists on the first day of November, nineteen hundred ninety-seven and
one thousand dollars and (ii)] no part of the methodology of the family
assistance program will be used which is more restrictive than the meth-
odology of the aid to dependent children program as it existed on the
sixteenth day of July, nineteen hundred ninety-six; or
S 59-b. Paragraph (i) of subdivision 1 of section 369-ee of the social
services law is REPEALED.
S 59-c. The opening paragraph of paragraph (b) of subdivision 2 of
section 369-ee of the social services law, as amended by section 45-d of
part C of chapter 58 of the laws of 2008, is amended to read as follows:
Subject to the provisions of paragraph (d) of this subdivision, in
order to establish [income] eligibility under this subdivision, WHICH
SHALL BE DETERMINED WITHOUT REGARD TO RESOURCES, an individual shall
provide such documentation as is necessary and sufficient to initially,
and annually thereafter, determine an applicant's eligibility for cover-
age under this title. Such documentation shall include, but not be
limited to the following, if needed to verify eligibility:
S 59-d. Paragraph (c) of subdivision 2 of section 369-ee of the social
services law is REPEALED.
S 60. Subdivision 1 and paragraph (a) of subdivision 2 of section
366-a of the social services law, subdivision 1 as amended by chapter
532 of the laws of 1972 and paragraph (a) of subdivision 2 as added by
section 51 of part A of chapter 1 of the laws of 2002, are 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 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.
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 disabled, 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, [in accordance
with department regulations, when an application is made by mail,] a
personal interview [shall be conducted] with the applicant or with the
person who made application [in] ON his OR HER behalf [when the appli-
cant cannot be interviewed due to his physical or mental condition]
SHALL NOT BE REQUIRED AS PART OF A DETERMINATION OF INITIAL OR CONTINU-
ING ELIGIBILITY PURSUANT TO THIS TITLE.
(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 verify
the eligibility of such applicant. In accordance with the regulations of
the department of health, it shall be the responsibility of the appli-
cant to provide information and documentation necessary for the determi-
nation of initial and ongoing eligibility for medical assistance. If an
applicant or recipient is unable to provide necessary documentation, the
public welfare official 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 appli-
cant 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 there-
S. 58--A 98 A. 158--A
for. [To the extent practicable, any interview conducted as a result of
an application for medical assistance shall be conducted in the home of
the person interviewed or in the institution in which such person is
receiving medical assistance.]
S 61. Paragraph (a) of subdivision 5 of section 369-ee of the social
services law, as added by chapter 1 of the laws of 1999, is amended to
read as follows:
(a) [Personal interviews, pursuant to section three hundred
sixty-six-a of this chapter, may be required upon initial application
only and may be conducted in community settings.] A PERSONAL 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. Recertification of eligi-
bility shall take place on no more than an annual basis [and shall not
require a personal interview]. Nothing herein shall abridge the partic-
ipant's obligation to report changes in residency, financial circum-
stances or household composition.
S 62. Section 23-a of part B of chapter 436 of the laws of 1997,
constituting the welfare reform act of 1997, is amended to read as
follows:
S 23-a. Notwithstanding any contrary provision thereof, section 266 of
chapter 83 of the laws of 1995 shall apply to applicants for or recipi-
ents of public assistance and care[, including medical assistance];
provided, however, that [with respect to medical assistance, such
section shall apply only to persons who are subject to the photograph
identification requirements established by the commissioner of health
for] SUCH SECTION SHALL NOT APPLY TO the medical assistance program.
S 63. Subparagraph 8 of paragraph (a) of subdivision 1 of section 366
of the social services law, as amended by section 60 of part C of chap-
ter 58 of the laws of 2008, is amended to read as follows:
(8) is a member of a family which contains a dependent child living
with a caretaker relative, which has: (I) SUBJECT TO THE APPROVAL OF THE
FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES, GROSS INCOME NOT IN
EXCESS OF ONE HUNDRED PERCENT OF THE FEDERAL INCOME OFFICIAL POVERTY
LINE (AS DEFINED AND ANNUALLY REVISED BY THE FEDERAL OFFICE OF MANAGE-
MENT AND BUDGET) FOR A FAMILY OF THE SAME SIZE AS THE FAMILIES THAT
INCLUDE THE CHILDREN OR (II) IN THE ABSENCE OF SUCH APPROVAL, net avail-
able income not in excess 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, to be
increased annually by the same percentage as the percentage increase in
the federal consumer price index, and which has net available resources
not in excess of the amount specified in subparagraph four of paragraph
(a) of subdivision two of this section; for purposes of this subpara-
graph, the net available income and resources of a family shall be
determined using the methodology of the family assistance program as it
exists on the first day of November, nineteen hundred ninety-seven,
except that no part of the methodology of the family assistance program
will be used which is more restrictive than the methodology of the aid
to dependent children program as it existed on the sixteenth day of
July, nineteen hundred ninety-six; for purposes of this subparagraph,
the term dependent child means a person under twenty-one years of age
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
S. 58--A 99 A. 158--A
reason of the unemployment of the parent, as defined by the department
of health; or
S 64. Paragraph (a) of subdivision 1 of section 366 of the social
services law is amended by adding a new subparagraph 8-a to read as
follows:
(8-A) IS AN INDIVIDUAL WHO IS AT LEAST NINETEEN BUT UNDER TWENTY-ONE
YEARS OF AGE AND IS A MEMBER OF A HOUSEHOLD WHICH HAS GROSS INCOME NOT
IN EXCESS OF ONE HUNDRED PERCENT OF THE FEDERAL INCOME OFFICIAL POVERTY
LINE (AS DEFINED AND ANNUALLY REVISED BY THE FEDERAL OFFICE OF MANAGE-
MENT AND BUDGET) FOR A HOUSEHOLD OF THE SAME SIZE; OR
S 65. Paragraph (p) of subdivision 4 of section 366 of the social
services law, as added by chapter 651 of the laws of 1990, subparagraph
2 as amended by section 97 of part B of chapter 436 of the laws of 1997,
is amended to read as follows:
(p) (1) Children who are at least one year of age but younger than
[six] NINETEEN years of age who are not otherwise eligible for medical
assistance and whose families have: (I) SUBJECT TO THE APPROVAL OF THE
FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES, GROSS INCOMES NOT IN
EXCESS OF ONE HUNDRED SIXTY PERCENT OF THE FEDERAL INCOME OFFICIAL
POVERTY LINE (AS DEFINED AND ANNUALLY REVISED BY THE FEDERAL OFFICE OF
MANAGEMENT AND BUDGET) FOR A FAMILY OF THE SAME SIZE AS THE FAMILIES
THAT INCLUDE THE CHILDREN OR (II) IN THE ABSENCE OF SUCH APPROVAL, NET
incomes equal to or less than one hundred thirty-three percent of the
federal income official poverty line (as defined and annually revised by
the federal office of management and budget) for a family of the same
size as the families that include the children shall be eligible for
medical assistance and shall remain eligible therefor as provided in
subparagraph three of this paragraph.
(2) For purposes of determining eligibility for medical assistance
under this paragraph, family income shall be determined by use of the
same methodology used to determine eligibility for the aid to dependent
children program as it existed on the sixteenth day of July, nineteen
hundred ninety-six provided, however, that costs incurred for medical or
remedial care shall not be considered and resources available to such
families 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.
(3) An eligible child who is receiving medically necessary in-patient
services for which medical assistance is provided on the date the child
attains [six] 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.
S 65-a. Subparagraph 1 of paragraph (m) of subdivision 4 of section
366 of the social services law, as added by Chapter 584 of the laws of
1989, is amended to read as follows:
(1) Pregnant women and infants younger than one year of age who are
not otherwise eligible for medical assistance and whose families have
NET incomes equal to or less than one hundred percent of the [compara-
ble] federal [income official] poverty line (as defined and annually
revised by the [federal office of management and budget] UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES) for families of the same size
SHALL BE ELIGIBLE FOR MEDICAL ASSISTANCE AS PROVIDED IN SUBPARAGRAPH
THREE OF THIS PARAGRAPH. SUBJECT TO THE APPROVAL OF THE FEDERAL CENTERS
FOR MEDICARE AND MEDICAID SERVICES, FINANCIAL ELIGIBILITY PURSUANT TO
S. 58--A 100 A. 158--A
THIS PARAGRAPH MAY BE DETERMINED USING AN EQUIVALENT METHODOLOGY BASED
ON THE FAMILY'S GROSS INCOME.
S 65-b. Subparagraph 1 of paragraph (n) of subdivision 4 of section
366 of the social services law, as amended by section 2 of part D of
chapter 57 of the laws of 2000, is amended to read as follows:
(1) Infants younger than one year who are not otherwise eligible for
medical assistance and whose families have: (I) SUBJECT TO THE APPROVAL
OF THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES, GROSS INCOMES
NOT IN EXCESS OF 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 AS THE FAMILIES
THAT INCLUDE THE CHILDREN OR (II) IN THE ABSENCE OF SUCH APPROVAL, NET
incomes equal to or less than two hundred percent of the federal [income
official] poverty line (as defined and annually revised by the United
States department of health and human services) for a family of the same
size as the families that include the infants, shall be eligible for
medical assistance as provided in subparagraph three of this paragraph.
For purposes of this paragraph, family income shall be determined by use
of the same methodology used to determine eligibility for the aid to
dependent children program as it existed on the sixteenth day of July,
nineteen hundred ninety-six.
S 65-c. Subparagraph 1 of paragraph (o) of subdivision 4 of section
366 of the social services law, as amended by section 3 of part D of
chapter 57 of the laws of 2000, is amended to read as follows:
(1) Pregnant women who are not otherwise eligible for medical assist-
ance [are eligible for services provided under the prenatal care assist-
ance program established pursuant to title two of article twenty-five of
the public health law if the income of the family that includes the
pregnant woman does not exceed] AND WHOSE FAMILIES HAVE: (I) SUBJECT TO
THE APPROVAL OF THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES,
GROSS INCOMES NOT IN EXCESS OF 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
AS THE FAMILIES THAT INCLUDE THE CHILDREN OR (II) IN THE ABSENCE OF SUCH
APPROVAL, NET INCOMES EQUAL TO OR LESS THAN two hundred percent of the
[comparable] federal [income official] poverty line (as defined and
annually revised by the United States department of health and human
services) for families of the same size, SHALL BE ELIGIBLE FOR COVERAGE
OF PRENATAL CARE SERVICES AS PROVIDED IN SUBPARAGRAPH THREE OF THIS
PARAGRAPH.
S 65-d. Paragraph (a) of subdivision 2 of section 2529 of the public
health law is amended to read as follows:
2. (a) Any inconsistent provision of law notwithstanding, a pregnant
woman shall be presumed to be an eligible service recipient beginning on
the date that a qualified provider determines, on the basis of prelimi-
nary information, that the pregnant woman's NET household income does
not exceed the applicable income level of eligibility. SUBJECT TO THE
APPROVAL OF THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES,
FINANCIAL ELIGIBILITY PURSUANT TO THIS SUBDIVISION MAY BE DETERMINED
USING AN EQUIVALENT METHODOLOGY BASED ON THE FAMILY'S GROSS INCOME.
S 66. Paragraph (q) of subdivision 4 of section 366 of the social
services law is REPEALED.
S 67. Subparagraph (v) of paragraph (a) of subdivision 2 of section
369-ee of the social services law, as amended by chapter 419 of the laws
of 2000, is amended to read as follows:
S. 58--A 101 A. 158--A
(v) (A) in the case of a parent or stepparent of a child under the age
of twenty-one who lives with such child, has gross family income equal
to or less than the applicable percent of the federal income official
poverty line (as defined and updated by the United States Department of
Health and Human Services) for a family of the same size; for purposes
of this clause, the applicable percent effective as of:
(I) January first, two thousand one, is one hundred twenty percent;
and
(II) October first, two thousand one, is one hundred thirty-three
percent; and
(III) October first, two thousand two, is one hundred fifty percent;
[or] AND
(IV) APRIL FIRST, TWO THOUSAND TEN, IS ONE HUNDRED SIXTY PERCENT; OR
(B) in the case of an individual WHO IS AT LEAST TWENTY-ONE YEARS OF
AGE AND who is not a parent or stepparent living with his or her child
under the age of twenty-one, has gross family income equal to or less
than one hundred percent of the federal income official poverty line (as
defined and updated by the United States Department of Health and Human
Services) for a family of the same size[.]; OR
(C) IN THE CASE OF AN INDIVIDUAL WHO IS AT LEAST NINETEEN BUT UNDER
TWENTY-ONE YEARS OF AGE AND WHO IS NOT A PARENT OR STEPPARENT LIVING
WITH HIS OR HER CHILD UNDER THE AGE OF TWENTY-ONE, HAS GROSS FAMILY
INCOME EQUAL TO OR LESS THAN ONE HUNDRED SIXTY PERCENT OF THE FEDERAL
INCOME OFFICIAL POVERTY LINE (AS DEFINED AND UPDATED BY THE UNITED
STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES) FOR A FAMILY OF THE SAME
SIZE; OR
(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
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 CHAPTER 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-FED-
ERAL SHARE OF EXPENDITURES PURSUANT TO THIS SUBPARAGRAPH, PROVIDED
HOWEVER THAT THE COMMISSIONER MAY DEMONSTRATE 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. ELIGI-
BILITY UNDER THIS CLAUSE MAY BE PROVIDED TO RESIDENTS 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.
S 67-a. Notwithstanding any contrary provision of law, the commis-
sioner of health is authorized to enter into an agreement with the
United States department of health and human services establishing a
waiver agreement pursuant to section 1115 of the federal social security
act which may include the redirection of such Medicaid payments
described below, or a portion thereof, and the utilization of such funds
to expand coverage under the family health plus program to families with
gross income equal to or less than 200 percent of the federal poverty
level, as provided in clause (D) of subparagraph (v) of paragraph (a) of
S. 58--A 102 A. 158--A
subdivision two of section 369-ee of the social services law. Such waiv-
er may include the following:
1. Notwithstanding any inconsistent provisions of sections 211, 212,
213 and 214 of chapter 474 of the laws of 1996, as amended, sections 13,
14, 18 and 21 of part B of chapter 1 of the laws of 2002, as amended,
and sections 12, 14, 15 and 22 of part A of chapter 1 of the laws of
2002, as amended, or any other contrary provision of law, and subject to
the availability of federal financial participation and the receipt of
all necessary federal approvals, Medicaid payments authorized pursuant
to section 211 and paragraph (a) of subdivision 1 of section 212 of
chapter 474 of the laws of 1996, but not including any payments to
general hospitals operated by the state of New York or the university of
the state of New York, sections 13 and 14 of part B of chapter 1 of the
laws of 2002, and sections 12 and 14 of part A of chapter 1 of the laws
of 2002, shall be in accord with the provisions of this section.
2. Social services districts which elect to participate in the program
for such expanded family health plus coverage may have the non-federal
share of the payment amounts described in subdivision one of this
section, or a portion thereof, redirected by the commissioner of health
to support the non-federal share of payments associated with such
expanded family health plus coverage. Such elections shall be irrev-
ocable and applicable to all future periods. Such elections by each
social services district shall be subject to the approval of the commis-
sioner of health and with the consent of the public hospitals which are
located within each such social services district and which are other-
wise eligible to receive such redirected payments.
3. The non-federal share payment obligations of social services
districts that elect to participate in such expanded family health plus
coverage shall be established at 50 percent of the amount of final
reconciled Medicaid payments authorized pursuant to section 211 and
paragraph (a) of subdivision 1 of section 212 of chapter 474 of the laws
of 1996, as amended, for the social services district for the year two
years prior to the social services district's election to participate
and shall not be subject to further adjustment. Further non-federal
share payment obligations of social services districts that elect to
participate in such expanded family health plus coverage shall be estab-
lished as follows: (a) 50 percent of the amount actually expended in
state fiscal year 2008-2009 for Medicaid payments authorized pursuant to
section 12 of part A of chapter 1 of the laws of 2002 and pursuant to
section 13 of part B of chapter 1 of the laws of 2002, and, (b) 50
percent of the amount actually expended in state fiscal year 2004-2005
for Medicaid payments authorized pursuant to section 14 of part A of
chapter 1 of the laws of 2002, and pursuant to section 14 of part B of
chapter 1 of the laws of 2002.
4. For electing social services districts, the portion of each such
payment obligation to be utilized for such expanded family health plus
coverage shall be determined by the commissioner of health.
5. Payments to public general hospitals, other than those operated by
the state of New York or the state university of New York, pursuant to
section 211 and paragraph (a) of subdivision 1 of section 212 of chapter
474 of the laws of 1996, sections 13 and 14 of part B of chapter 1 of
the laws of 2002 and sections 12 and 14 of part A of chapter 1 of the
laws of 2002, located in electing social services districts, shall be
reduced to an amount that can be supported by the non-federal share
payment obligations of such social services districts as reduced by the
S. 58--A 103 A. 158--A
portion of such payment obligations to be utilized for expanded family
health plus coverage as described above.
S 67-b. Notwithstanding any contrary provision of law, the commis-
sioner of health is authorized to enter into a waiver agreement with the
United States department of health and human services pursuant to
section 1115 of the federal social security act to utilize federal funds
available to the state under its federal disproportionate share hospital
allotment pursuant to section 1923(f) of the federal social security
act, that are projected to be in excess of the amounts necessary to
fully fund existing state authorized disproportionate share hospital
programs, to provide funding for expanded coverage under the family
health plus program as provided in clause (D) of subparagraph (v) of
paragraph (a) of subdivision 2 of section 369-ee of the social services
law.
S 68. Subparagraph (iii) of paragraph (a) of subdivision 2 of section
369-ee of the social services law, as amended by section 28 of part E of
chapter 63 of the laws of 2005, is amended to read as follows:
(iii) does not have equivalent health care coverage under insurance or
equivalent mechanisms, as defined by the commissioner in consultation
with the superintendent of insurance[, and is not a federal, state,
county, municipal or school district employee that is eligible for
health care coverage through his or her employer];
S 69. Intentionally omitted.
S 70. Intentionally omitted.
S 71. Intentionally omitted.
S 72. Intentionally omitted.
S 73. Subdivision 9 of section 2510 of the public health law is
amended by adding a new paragraph (d) 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 AMERICAN 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) FIFTEEN 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 FORTY-FIVE DOLLARS PER MONTH PER FAMILY; AND
(III) TWENTY-FIVE 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 SEVENTY-FIVE DOLLARS PER MONTH PER FAMILY; AND
(IV) THIRTY-FIVE DOLLARS PER MONTH FOR EACH ELIGIBLE CHILD WHOSE FAMI-
LY 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 ONE HUNDRED FIVE DOLLARS PER MONTH PER FAMILY;
(V) FIFTY-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 SIXTY-FIVE DOLLARS PER MONTH PER FAMILY; AND
(VI) SEVENTY-FIVE 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 TWO HUNDRED TWENTY-FIVE DOLLARS PER MONTH PER FAMILY.
S. 58--A 104 A. 158--A
S 74. Clause (iii) of subparagraph 2 of paragraph (b) of subdivision 2
of section 366 of the social services law, as added by chapter 170 of
the laws of 1994, subclause (B) as amended by chapter 656 of the laws of
1997, is amended to read as follows:
(iii) Notwithstanding the provisions of clauses (i) and (ii) of this
subparagraph, in the case of an applicant or recipient who is disabled,
as such term is defined in section 1614(a)(3) of the federal social
security act, the department must not consider as available income or
resources the corpus or income of the following trusts which comply with
the provisions of the regulations authorized by clause (iv) of this
subparagraph: (A) a trust containing the assets of such a disabled indi-
vidual which was established for the benefit of the disabled individual
while such individual was under sixty-five years of age by a parent,
grandparent, legal guardian, or court of competent jurisdiction, if upon
the death of such individual the state will receive all amounts remain-
ing in the trust up to the total value of all medical assistance paid on
behalf of such individual; (B) and a trust containing the assets of such
a disabled individual established and managed by a non-profit associ-
ation which maintains separate accounts for the benefit of disabled
individuals, but, for purposes of investment and management of trust
funds, pools the accounts, provided that accounts in the trust fund are
established solely for the benefit of individuals who are disabled as
such term is defined in section 1614(a)(3) of the federal social securi-
ty act by such disabled individual, a parent, grandparent, legal guardi-
an, or court of competent jurisdiction, and [to the extent that amounts
remaining in the individual's account are not retained by the trust]
PROVIDED THAT upon the death of the individual, the state will receive
all [such remaining amounts up to] AMOUNTS REMAINING IN THE INDIVIDUAL'S
ACCOUNT THAT ARE NOT RETAINED BY THE TRUST OR NINETY PERCENT OF THE
TOTAL AMOUNT REMAINING IN THE INDIVIDUAL'S TRUST ACCOUNT, WHICHEVER IS
GREATER, BUT NOT TO EXCEED the total value of all medical assistance
paid on behalf of such individual. Notwithstanding any law to the
contrary, a not-for-profit corporation may, in furtherance of and as an
adjunct to its corporate purposes, act as trustee of a trust for persons
with disabilities established pursuant to this subclause, provided that
a trust company, as defined in subdivision seven of section one
hundred-c of the banking law, acts as co-trustee.
S 75. Subdivision 12 of section 367-a of the social services law, as
amended by section 63-a of part C of chapter 58 of the laws of 2007, is
amended to read as follows:
12. Prior to receiving medical assistance under subparagraphs twelve
and thirteen of paragraph (a) of subdivision one of section three
hundred sixty-six of this title, a person whose net available income is
at least one 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, must pay a monthly premium, in
accordance with a procedure to be established by the commissioner. The
amount of such premium shall be [twenty-five dollars for an individual
who is otherwise eligible for medical assistance under such subpara-
graphs, and fifty dollars for a couple, both of whom are otherwise
eligible for medical assistance under such subparagraphs] AS FOLLOWS:
(A) FOR AN INDIVIDUAL OR MARRIED COUPLE WHO ARE OTHERWISE ELIGIBLE FOR
MEDICAL ASSISTANCE UNDER SUCH SUBPARAGRAPHS AND WHOSE NET AVAILABLE
INCOME IS AT LEAST ONE HUNDRED FIFTY PERCENT BUT DOES NOT EXCEED ONE
HUNDRED EIGHTY-FIVE PERCENT OF THE APPLICABLE FEDERAL INCOME OFFICIAL
POVERTY LINE FOR A HOUSEHOLD OF THE SAME SIZE, TWENTY-FIVE DOLLARS PER
S. 58--A 105 A. 158--A
MONTH FOR AN INDIVIDUAL AND FIFTY DOLLARS PER MONTH FOR A COUPLE; (B)
FOR AN INDIVIDUAL OR MARRIED COUPLE WHO ARE OTHERWISE ELIGIBLE FOR
MEDICAL ASSISTANCE UNDER SUCH SUBPARAGRAPHS AND WHOSE NET AVAILABLE
INCOME IS GREATER THAN ONE HUNDRED EIGHTY-FIVE PERCENT BUT DOES NOT
EXCEED TWO HUNDRED TWENTY PERCENT OF THE APPLICABLE FEDERAL INCOME OFFI-
CIAL POVERTY LINE FOR A HOUSEHOLD OF THE SAME SIZE, FIFTY DOLLARS PER
MONTH FOR AN INDIVIDUAL AND ONE HUNDRED DOLLARS PER MONTH FOR A COUPLE;
AND (C) FOR AN INDIVIDUAL OR MARRIED COUPLE WHO ARE OTHERWISE ELIGIBLE
FOR MEDICAL ASSISTANCE UNDER SUCH SUBPARAGRAPHS AND WHOSE NET AVAILABLE
INCOME IS GREATER THAN TWO HUNDRED TWENTY PERCENT BUT DOES NOT EXCEED
TWO HUNDRED FIFTY PERCENT OF THE APPLICABLE FEDERAL INCOME OFFICIAL
POVERTY LINE FOR A HOUSEHOLD OF THE SAME SIZE, SEVENTY-FIVE DOLLARS PER
MONTH FOR AN INDIVIDUAL AND ONE HUNDRED FIFTY DOLLARS PER MONTH FOR A
COUPLE. FOR PURPOSES OF THIS SUBDIVISION, HOUSEHOLD SIZE SHALL BE DETER-
MINED BY THE SAME METHODOLOGY USED FOR DETERMINING ELIGIBILITY FOR
FEDERAL SUPPLEMENTAL SECURITY BENEFITS UNDER TITLE XVI OF THE FEDERAL
SOCIAL SECURITY ACT. No premium shall be required from a person whose
net available income is less than one 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.
S 76. Subdivision 1 of section 104-b of the social services law, as
amended by chapter 271 of the laws of 1965 and such section as renum-
bered by chapter 550 of the laws of 1971, is amended to read as follows:
1. If a recipient of public assistance and care shall have a right of
action, suit, claim, counterclaim or demand against another on account
of any personal injuries suffered by such recipient, then THE PLEADINGS
IN SUCH ACTION, SUIT, CLAIM, COUNTERCLAIM OR DEMAND SHALL CONTAIN A
DEMAND FOR MEDICAL EXPENSES INCURRED BY THE RECIPIENT AS A DIRECT OR
INDIRECT RESULT OF THOSE PERSONAL INJURIES, AND the [public welfare
official for the public welfare] SOCIAL SERVICES OFFICIAL AND SOCIAL
SERVICES district providing such assistance and care shall have a lien
for such amount as may be fixed by the [public welfare] SOCIAL SERVICES
official not exceeding, however, the total amount of such assistance and
care furnished by such [public welfare] SOCIAL SERVICES official on and
after the date when such injuries were incurred. IN ALL SUCH CASES,
NOTICE OF THE PLEADINGS SHALL BE SERVED UPON THE SOCIAL SERVICES
DISTRICT THAT HAS PROVIDED OR IS PROVIDING SUCH ASSISTANCE AND CARE, OR
UPON THE DEPARTMENT OF HEALTH.
The [welfare] commissioner OF HEALTH shall endeavor to ascertain
whether such person, firm or corporation alleged to be responsible for
such injuries is insured with a liability insurance company, as the case
may be, and the name thereof.
S 77. Section 104-b of the social services law is amended by adding a
new subdivision 1-a to read as follows:
1-A. NO RIGHT OF ACTION, SUIT, CLAIM, COUNTERCLAIM OR DEMAND AGAINST
ANOTHER ON ACCOUNT OF PERSONAL INJURIES SUFFERED BY A RECIPIENT OF
PUBLIC ASSISTANCE AND CARE SHALL BE SETTLED WITHOUT THE APPROVAL OF THE
SOCIAL SERVICES DISTRICT THAT HAS PROVIDED OR IS PROVIDING SUCH ASSIST-
ANCE AND CARE, OR THE DEPARTMENT OF HEALTH. UNLESS WAIVED IN WHOLE OR IN
PART BY THE DISTRICT OR DEPARTMENT, ANY SUCH SETTLEMENT MUST ALLOCATE
FOR MEDICAL EXPENSES A SUFFICIENT AMOUNT:
(A) TO REPAY THE MEDICAL ASSISTANCE PROGRAM IN FULL, IF THE TOTAL
AMOUNT OF MEDICAL ASSISTANCE PROVIDED TO THE RECIPIENT DOES NOT EXCEED
ONE-THIRD OF THE GROSS PROCEEDS OF THE SETTLEMENT; OR
S. 58--A 106 A. 158--A
(B) TO REPAY THE MEDICAL ASSISTANCE PROGRAM AN AMOUNT EQUAL TO
ONE-THIRD OF THE GROSS PROCEEDS OF THE SETTLEMENT, IF THE TOTAL AMOUNT
OF MEDICAL ASSISTANCE PROVIDED TO THE RECIPIENT EXCEEDS SUCH AMOUNT.
S 78. Subdivision 8 of section 2511 of the public health law is
amended by adding a new paragraph (d) to read as follows:
(D)(I) EFFECTIVE APRIL FIRST, TWO THOUSAND NINE, PAYMENT FOR MARKETING
AND FACILITATED ENROLLMENT ACTIVITIES SET FORTH IN SUBDIVISION NINE OF
THIS SECTION AND INCLUDED IN SUBSIDY PAYMENTS MADE TO APPROVED ORGANIZA-
TIONS PROVIDING SUCH SERVICES PURSUANT TO A CONTRACT WITH THE STATE
SHALL BE LIMITED TO AN AMOUNT DETERMINED ANNUALLY BY THE COMMISSIONER.
(II) SUCH SUBSIDY PAYMENTS SHALL BE ADJUSTED BY THE COMMISSIONER TO
REMOVE ANY COSTS OF APPROVED ORGANIZATIONS IN EXCESS OF THE AMOUNT
DETERMINED IN ACCORDANCE WITH SUBPARAGRAPH (I) OF THIS PARAGRAPH BASED
ON COST REPORTS SUBMITTED TO THE DEPARTMENT BY APPROVED ORGANIZATIONS.
S 79. Subdivision 8 of section 2510 of the public health law, as
amended by chapter 2 of the laws of 1998, is amended to read as follows:
8. "Subsidy payment" means a payment made to an approved organization
for the cost of covered health care services coverage to an eligible
child or children, THE AMOUNT OF WHICH SHALL BE DETERMINED SOLELY BY THE
COMMISSIONER.
S 80. Subdivision 5 of section 2511 of the public health law, as
amended by section 34 of part A of chapter 58 of the laws of 2007, is
amended to read as follows:
5. Notwithstanding any inconsistent provisions of subdivision two of
this section, an individual who meets the criteria of paragraphs (b) and
(c) of subdivision two of this section but not the criteria of paragraph
(a) of such subdivision may be enrolled for covered health care
services, provided however, that an approved organization shall not be
eligible to receive a subsidy payment for providing coverage to such
individuals. The cost of coverage shall be determined by the commission-
er[, in consultation with the superintendent] and shall be no more than
the cost of providing such coverage.
S 81. Paragraph (b) of subdivision 7 of section 2511 of the public
health law, as amended by chapter 923 of the laws of 1990, is amended to
read as follows:
(b) The commissioner, in consultation with the superintendent, shall
make a determination whether to approve, disapprove or recommend modifi-
cation of the proposal. In order for a proposal to be approved by the
commissioner, the proposal must also be approved by the superintendent
with respect to the provisions of subparagraphs (viii) through (X) AND
(xii) of paragraph (a) of this subdivision.
S 82. Intentionally omitted.
S 83. Intentionally omitted.
S 84. Intentionally omitted.
S 85. Intentionally omitted.
S 86. Section 2801-a of the public health law is amended by adding a
new subdivision 16 to read as follows:
16. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR THE ESTABLISH-
MENT OF HOSPITALS THE FOLLOWING APPLICATION FEE:
(I) FOR GENERAL HOSPITALS: $3,000
(II) FOR NURSING HOMES: $3,000
(III) FOR SAFETY NET DIAGNOSTIC
AND TREATMENT CENTERS AS
DEFINED IN PARAGRAPH (C) OF
THIS SUBDIVISION: $1,000
(IV) FOR ALL OTHER DIAGNOSTIC
S. 58--A 107 A. 158--A
AND TREATMENT CENTERS: $2,000
(B) AN APPLICANT FOR BOTH ESTABLISHMENT AND CONSTRUCTION OF A HOSPITAL
SHALL NOT BE SUBJECT TO THIS SUBDIVISION AND SHALL BE SUBJECT TO FEES
AND CHARGES AS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED TWO OF THIS
ARTICLE.
(C) THE COMMISSIONER MAY DESIGNATE A DIAGNOSTIC AND TREATMENT CENTER
OR PROPOSED DIAGNOSTIC AND TREATMENT CENTER AS A "SAFETY NET DIAGNOSTIC
AND TREATMENT CENTER" IF IT IS OPERATED OR PROPOSES TO BE OPERATED BY A
NOT-FOR-PROFIT CORPORATION OR LOCAL HEALTH DEPARTMENT; PARTICIPATES OR
INTENDS TO PARTICIPATE IN THE MEDICAL ASSISTANCE PROGRAM; DEMONSTRATES
OR PROJECTS THAT A SIGNIFICANT PERCENTAGE OF ITS VISITS, AS DETERMINED
BY THE COMMISSIONER, WERE BY UNINSURED INDIVIDUALS; AND PRINCIPALLY
PROVIDES PRIMARY CARE SERVICES AS DEFINED BY THE COMMISSIONER.
(D) THE FEES AND CHARGES PAID BY AN APPLICANT PURSUANT TO THIS SUBDI-
VISION FOR ANY APPLICATION FOR ESTABLISHMENT OF A HOSPITAL APPROVED IN
ACCORDANCE WITH THIS SECTION SHALL BE DEEMED ALLOWABLE CAPITAL COSTS IN
THE DETERMINATION OF REIMBURSEMENT RATES ESTABLISHED PURSUANT TO THIS
ARTICLE. THE COST OF SUCH FEES AND CHARGES SHALL NOT BE SUBJECT TO
REIMBURSEMENT CEILING OR OTHER PENALTIES USED BY THE COMMISSIONER FOR
THE PURPOSE OF ESTABLISHING REIMBURSEMENT RATES PURSUANT TO THIS ARTI-
CLE. ALL FEES PURSUANT TO THIS SECTION SHALL BE PAYABLE TO THE DEPART-
MENT OF HEALTH FOR DEPOSIT INTO THE SPECIAL REVENUE FUNDS - OTHER,
MISCELLANEOUS SPECIAL REVENUE FUND - 339, CERTIFICATE OF NEED ACCOUNT.
S 87. Subdivision 7 of section 2802 of the public health law, as
amended by section 1 of part C of chapter 1 of the laws of 2002, is
amended to read as follows:
7. (A) The commissioner shall charge to applicants for construction of
hospitals the following fees and charges for administrative services so
as to recover departmental costs in performing these functions. Each
applicant for construction of a hospital shall pay to the department an
application fee of [one thousand two hundred fifty dollars] TWO THOUSAND
DOLLARS, PROVIDED, HOWEVER, THAT DIAGNOSTIC AND TREATMENT CENTERS DESIG-
NATED BY THE COMMISSIONER AS SAFETY NET DIAGNOSTIC AND TREATMENT
CENTERS, AS DEFINED IN PARAGRAPH (C) OF SUBDIVISION SIXTEEN OF SECTION
TWENTY-EIGHT HUNDRED ONE-A OF THIS ARTICLE, SHALL PAY A FEE OF ONE THOU-
SAND TWO HUNDRED FIFTY DOLLARS.
(B) At such time as the commissioner's written approval OF THE
CONSTRUCTION is granted, each applicant shall pay [an] THE FOLLOWING
additional fee [of forty-five hundredths of one percent of the total
capital value of the application, provided that only those applications
requiring review by the State Hospital Review and Planning Council shall
be subject to such fee.]:
(I) FOR HOSPITAL, NURSING HOME AND DIAGNOSTIC AND TREATMENT CENTER
APPLICATIONS THAT REQUIRE APPROVAL BY THE COUNCIL, THE ADDITIONAL FEE
SHALL BE FIFTY-FIVE HUNDREDTHS OF ONE PERCENT OF THE TOTAL CAPITAL VALUE
OF THE APPLICATION, PROVIDED HOWEVER THAT APPLICATIONS FOR CONSTRUCTION
OF A SAFETY NET DIAGNOSTIC AND TREATMENT CENTER, AS DEFINED IN PARAGRAPH
(C) OF SUBDIVISION SIXTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A OF THIS
ARTICLE, SHALL BE SUBJECT TO A FEE OF FORTY-FIVE HUNDREDTHS OF ONE
PERCENT OF THE TOTAL CAPITAL VALUE OF THE APPLICATION; AND
(II) FOR HOSPITAL, NURSING HOME AND DIAGNOSTIC AND TREATMENT CENTER
APPLICATIONS THAT DO NOT REQUIRE APPROVAL BY THE COUNCIL, THE ADDITIONAL
FEE SHALL BE THIRTY HUNDREDTHS OF ONE PERCENT OF THE TOTAL CAPITAL VALUE
OF THE APPLICATION, PROVIDED HOWEVER THAT SAFETY NET DIAGNOSTIC AND
TREATMENT CENTER APPLICATIONS, AS DEFINED IN PARAGRAPH (C) OF SUBDIVI-
SION SIXTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A OF THIS ARTICLE,
S. 58--A 108 A. 158--A
SHALL BE SUBJECT TO A FEE OF TWENTY-FIVE HUNDREDTHS OF ONE PERCENT OF
THE TOTAL CAPITAL VALUE OF THE APPLICATION.
(C) THE COMMISSIONER IS AUTHORIZED TO ESTABLISH REDUCED FEES FOR
APPLICATIONS SUBJECT TO LIMITED REVIEW, AS DESCRIBED IN REGULATION, THAT
DO NOT REQUIRE REVIEW BY THE COUNCIL.
(D) The fees and charges paid by an applicant pursuant to this subdi-
vision for any application for construction of a hospital approved in
accordance with this section shall be deemed allowable capital costs in
the determination of reimbursement rates established pursuant to this
article. The cost of such fees and charges shall not be subject to
reimbursement ceiling or other penalties used by the commissioner for
the purpose of establishing reimbursement rates pursuant to this arti-
cle. All fees pursuant to this section shall be payable to the depart-
ment of health for deposit into the special revenue funds - other,
miscellaneous special revenue fund - 339, certificate of need account.
S 88. Section 3605 of the public health law is amended by adding a new
subdivision 13 to read as follows:
13. THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR THE LICENSURE OF
HOME CARE SERVICES AGENCIES AN APPLICATION FEE OF TWO THOUSAND DOLLARS.
ALL FEES PURSUANT TO THIS SECTION SHALL BE PAYABLE TO THE DEPARTMENT OF
HEALTH FOR DEPOSIT INTO THE SPECIAL REVENUE FUNDS - OTHER, MISCELLANEOUS
SPECIAL REVENUE FUND - 339, CERTIFICATE OF NEED ACCOUNT.
S 89. Section 3606 of the public health law is amended by adding a new
subdivision 4 to read as follows:
4. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR THE ESTABLISH-
MENT OF CERTIFIED HOME HEALTH AGENCIES AN APPLICATION FEE OF TWO THOU-
SAND DOLLARS.
(B) AN APPLICANT FOR BOTH ESTABLISHMENT AND CONSTRUCTION OF A CERTI-
FIED HOME HEALTH AGENCY SHALL NOT BE SUBJECT TO THIS SUBDIVISION AND
SHALL BE SUBJECT TO FEES AND CHARGES AS SET FORTH IN SECTION THIRTY-SIX
HUNDRED SIX-A OF THIS ARTICLE.
(C) THE FEES AND CHARGES PAID BY AN APPLICANT PURSUANT TO THIS SUBDI-
VISION FOR ANY APPLICATION APPROVED IN ACCORDANCE WITH THIS SECTION
SHALL BE DEEMED ALLOWABLE COSTS IN THE DETERMINATION OF REIMBURSEMENT
RATES ESTABLISHED PURSUANT TO THIS ARTICLE. ALL FEES PURSUANT TO THIS
SECTION SHALL BE PAYABLE TO THE DEPARTMENT OF HEALTH FOR DEPOSIT INTO
THE SPECIAL REVENUE FUNDS - OTHER, MISCELLANEOUS SPECIAL REVENUE FUND -
339, CERTIFICATE OF NEED ACCOUNT.
S 90. Section 3606-a of the public health law is amended by adding a
new subdivision 9 to read as follows:
9. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR CONSTRUCTION OF
CERTIFIED HOME HEALTH AGENCIES AN APPLICATION FEE OF TWO THOUSAND
DOLLARS. EACH SUCH APPLICANT SHALL, AT SUCH TIME AS THE COMMISSIONER'S
WRITTEN APPROVAL OF THE CONSTRUCTION IS GRANTED, PAY AN ADDITIONAL FEE
OF THIRTY HUNDREDTHS OF ONE PERCENT OF THE TOTAL CAPITAL VALUE OF THE
APPLICATION.
(B) THE FEES AND CHARGES PAID BY AN APPLICANT PURSUANT TO THIS SUBDI-
VISION FOR ANY APPLICATION APPROVED IN ACCORDANCE WITH THIS SECTION
SHALL BE DEEMED ALLOWABLE COSTS IN THE DETERMINATION OF REIMBURSEMENT
RATES ESTABLISHED PURSUANT TO THIS ARTICLE. ALL FEES PURSUANT TO THIS
SECTION SHALL BE PAYABLE TO THE DEPARTMENT OF HEALTH FOR DEPOSIT INTO
THE SPECIAL REVENUE FUNDS - OTHER, MISCELLANEOUS SPECIAL REVENUE FUND -
339, CERTIFICATE OF NEED ACCOUNT.
S 91. Section 3610 of the public health law is amended by adding a
new subdivision 6 to read as follows:
S. 58--A 109 A. 158--A
6. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR THE AUTHORI-
ZATION OR CONSTRUCTION OF LONG TERM HOME HEALTH CARE PROGRAMS AN APPLI-
CATION FEE OF TWO THOUSAND DOLLARS. EACH SUCH APPLICANT SHALL, AT SUCH
TIME AS THE COMMISSIONER'S WRITTEN APPROVAL OF A CONSTRUCTION APPLICA-
TION IS GRANTED, PAY AN ADDITIONAL FEE OF THIRTY HUNDREDTHS OF ONE
PERCENT OF THE TOTAL CAPITAL VALUE OF THE APPLICATION.
(B) THE FEES PAID BY AN APPLICANT PURSUANT TO THIS SUBDIVISION FOR ANY
APPLICATION APPROVED IN ACCORDANCE WITH THIS SECTION SHALL BE DEEMED
ALLOWABLE COSTS IN THE DETERMINATION OF REIMBURSEMENT RATES ESTABLISHED
PURSUANT TO THIS ARTICLE. ALL FEES PURSUANT TO THIS SECTION SHALL BE
PAYABLE TO THE DEPARTMENT OF HEALTH FOR DEPOSIT INTO THE SPECIAL REVENUE
FUNDS - OTHER, MISCELLANEOUS SPECIAL REVENUE FUND - 339, CERTIFICATE OF
NEED ACCOUNT.
S 92. Section 3611-a of the public health law, as added by chapter 959
of the laws of 1984, is amended to read as follows:
S 3611-a. Change in the operator or owner. 1. Any change in the person
who, or ANY TRANSFER, ASSIGNMENT, OR OTHER DISPOSITION OF AN INTEREST OR
VOTING RIGHTS OF TEN PERCENT OR MORE, OR ANY TRANSFER, ASSIGNMENT OR
OTHER DISPOSITION WHICH RESULTS IN THE OWNERSHIP OR CONTROL OF AN INTER-
EST OR VOTING RIGHTS OF TEN PERCENT OR MORE, IN A LIMITED LIABILITY
COMPANY OR A partnership which is the operator of a licensed home care
services agency or a certified home health agency shall be approved by
the public health council in accordance with the provisions of subdivi-
sion four of section three thousand six hundred five of this [chapter]
ARTICLE relative to licensure or subdivision two of section three thou-
sand six hundred six of this [chapter] ARTICLE relative to certificate
of approval, EXCEPT THAT:
(A) PUBLIC HEALTH COUNCIL APPROVAL SHALL BE REQUIRED ONLY WITH RESPECT
TO THE PERSON, OR THE MEMBER OR PARTNER THAT IS ACQUIRING THE INTEREST
OR VOTING RIGHTS; AND
(B) WITH RESPECT TO CERTIFIED HOME HEALTH AGENCIES, SUCH CHANGE SHALL
NOT BE SUBJECT TO THE PUBLIC NEED ASSESSMENT DESCRIBED IN PARAGRAPH (A)
OF SUBDIVISION TWO OF SECTION THREE THOUSAND SIX HUNDRED SIX OF THIS
ARTICLE.
(C) NO PRIOR APPROVAL OF THE PUBLIC HEALTH COUNCIL SHALL BE REQUIRED
WITH RESPECT TO A TRANSFER, ASSIGNMENT OR DISPOSITION OF:
(I) AN INTEREST OR VOTING RIGHTS TO ANY PERSON PREVIOUSLY APPROVED BY
THE PUBLIC HEALTH COUNCIL FOR THAT OPERATOR; OR
(II) AN INTEREST OR VOTING RIGHTS OF LESS THAN TEN PERCENT IN THE
OPERATOR. HOWEVER, NO SUCH TRANSACTION SHALL BE EFFECTIVE UNLESS AT
LEAST NINETY DAYS PRIOR TO THE INTENDED EFFECTIVE DATE THEREOF, THE
PARTNER OR MEMBER COMPLETES AND FILES WITH THE PUBLIC HEALTH COUNCIL
NOTICE ON FORMS TO BE DEVELOPED BY THE PUBLIC HEALTH COUNCIL, WHICH
SHALL DISCLOSE SUCH INFORMATION AS MAY REASONABLY BE NECESSARY FOR THE
PUBLIC HEALTH COUNCIL TO DETERMINE WHETHER IT SHOULD BAR THE TRANS-
ACTION. SUCH TRANSACTION WILL BE FINAL AS OF THE INTENDED EFFECTIVE DATE
UNLESS, PRIOR THERETO, THE PUBLIC HEALTH COUNCIL SHALL STATE SPECIFIC
REASONS FOR BARRING SUCH TRANSACTIONS UNDER THIS PARAGRAPH AND SHALL
NOTIFY EACH PARTY TO THE PROPOSED TRANSACTION.
2. Any transfer, assignment or other disposition of ten percent or
more of the stock or voting rights thereunder of a corporation which is
the operator of a licensed home care services agency or a certified home
health agency, or any transfer, assignment or other disposition of the
stock or voting rights thereunder of such a corporation which results in
the ownership or control of more than ten percent of the stock or voting
rights thereunder of such corporation by any person shall be subject to
S. 58--A 110 A. 158--A
approval by the public health council in accordance with the provisions
of subdivision four of section three thousand six hundred five of this
[chapter] ARTICLE relative to licensure or subdivision two of section
three thousand six hundred six of this [chapter] ARTICLE relative to
certificate of approval , EXCEPT THAT:
(A) PUBLIC HEALTH COUNCIL APPROVAL SHALL BE REQUIRED ONLY WITH RESPECT
TO THE PERSON OR ENTITY ACQUIRING SUCH STOCK OR VOTING RIGHTS; AND
(B) WITH RESPECT TO CERTIFIED HOME HEALTH AGENCIES, SUCH CHANGE SHALL
NOT BE SUBJECT TO THE PUBLIC NEED ASSESSMENT DESCRIBED IN PARAGRAPH (A)
OF SUBDIVISION TWO OF SECTION THREE THOUSAND SIX HUNDRED SIX OF THIS
ARTICLE. In the absence of such approval, the license or certificate of
approval shall be subject to revocation or suspension.
(C) NO PRIOR APPROVAL OF THE PUBLIC HEALTH COUNCIL SHALL BE REQUIRED
WITH RESPECT TO A TRANSFER, ASSIGNMENT OR DISPOSITION OF AN INTEREST OR
VOTING RIGHTS TO ANY PERSON PREVIOUSLY APPROVED BY THE PUBLIC HEALTH
COUNCIL FOR THAT OPERATOR. HOWEVER, NO SUCH TRANSACTION SHALL BE EFFEC-
TIVE UNLESS AT LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE INTENDED
EFFECTIVE DATE THEREOF, THE PARTNER OR MEMBER COMPLETES AND FILES WITH
THE PUBLIC HEALTH COUNCIL NOTICE ON FORMS TO BE DEVELOPED BY THE PUBLIC
HEALTH COUNCIL, WHICH SHALL DISCLOSE SUCH INFORMATION AS MAY REASONABLY
BE NECESSARY FOR THE PUBLIC HEALTH COUNCIL TO DETERMINE WHETHER IT
SHOULD BAR THE TRANSACTION. SUCH TRANSACTION WILL BE FINAL AS OF THE
INTENDED EFFECTIVE DATE UNLESS, PRIOR THERETO, THE PUBLIC HEALTH COUNCIL
SHALL STATE SPECIFIC REASONS FOR BARRING SUCH TRANSACTIONS UNDER THIS
PARAGRAPH AND SHALL NOTIFY EACH PARTY TO THE PROPOSED TRANSACTION.
3. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR A CHANGE IN
OPERATOR OR OWNER OF A LICENSED HOME CARE SERVICES AGENCY OR A CERTIFIED
HOME HEALTH AGENCY AN APPLICATION FEE IN THE AMOUNT OF TWO THOUSAND
DOLLARS.
(B) THE FEES PAID BY CERTIFIED HOME HEALTH AGENCIES PURSUANT TO THIS
SUBDIVISION FOR ANY APPLICATION APPROVED IN ACCORDANCE WITH THIS SECTION
SHALL BE DEEMED ALLOWABLE COSTS IN THE DETERMINATION OF REIMBURSEMENT
RATES ESTABLISHED PURSUANT TO THIS ARTICLE. ALL FEES PURSUANT TO THIS
SECTION SHALL BE PAYABLE TO THE DEPARTMENT OF HEALTH FOR DEPOSIT INTO
THE SPECIAL REVENUE FUNDS - OTHER, MISCELLANEOUS SPECIAL REVENUE FUND -
339, CERTIFICATE OF NEED ACCOUNT.
S 93. Section 4004 of the public health law is amended by adding a new
subdivision 5 to read as follows:
5. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR THE ESTABLISH-
MENT OF A HOSPICE AN APPLICATION FEE IN THE AMOUNT OF TWO THOUSAND
DOLLARS.
(B) AN APPLICANT FOR BOTH ESTABLISHMENT AND CONSTRUCTION OF A HOSPICE
SHALL NOT BE SUBJECT TO THIS SUBDIVISION AND SHALL BE SUBJECT TO FEES
AND CHARGES AS SET FORTH IN SECTION FOUR THOUSAND SIX OF THIS ARTICLE.
(C) ALL FEES PURSUANT TO THIS SECTION SHALL BE PAYABLE TO THE DEPART-
MENT OF HEALTH FOR DEPOSIT INTO THE SPECIAL REVENUE FUNDS - OTHER,
MISCELLANEOUS SPECIAL REVENUE FUND - 339, CERTIFICATE OF NEED ACCOUNT.
S 94. Section 4006 of the public health law is amended by adding a new
subdivision 9 to read as follows:
9. (A) THE COMMISSIONER SHALL CHARGE TO APPLICANTS FOR CONSTRUCTION OF
A HOSPICE AN APPLICATION FEE OF TWO THOUSAND DOLLARS.
(B) AT SUCH TIME AS THE COMMISSIONER'S WRITTEN APPROVAL OF THE
CONSTRUCTION IS GRANTED, EACH SUCH APPLICANT SHALL PAY AN ADDITIONAL FEE
OF THIRTY HUNDREDTHS OF ONE PERCENT OF THE TOTAL CAPITAL VALUE OF THE
APPLICATION.
S. 58--A 111 A. 158--A
(C) ALL FEES PURSUANT TO THIS SECTION SHALL BE PAYABLE TO THE DEPART-
MENT OF HEALTH FOR DEPOSIT INTO THE SPECIAL REVENUE FUND - OTHER,
MISCELLANEOUS SPECIAL REVENUE FUND - 339, CERTIFICATE OF NEED ACCOUNT.
S 95. The opening paragraph of paragraph (s) of subdivision 1 of
section 2807-m of the public health law, as amended by section 16 of
part B of chapter 58 of the laws of 2008, is amended to read as follows:
"Adjustment amount" means an amount determined for each teaching
hospital FOR PERIODS PRIOR TO JANUARY FIRST, TWO THOUSAND NINE by:
S 96. Paragraph (b) of subdivision 2 of section 2807-m of the public
health law, as amended by chapter 1 of the laws of 1999, is amended to
read as follows:
(b) [Each] FOR PERIODS PRIOR TO JANUARY FIRST, TWO THOUSAND NINE, EACH
regional pool shall be distributed on a monthly basis to teaching gener-
al hospitals for costs associated with graduate medical education
provided by such teaching general hospitals in accordance with the
distribution methodology set forth in subdivision three of this section;
provided however, teaching general hospitals with a resident count of
zero as of July first of the year preceding the distribution period
shall not be eligible for distributions pursuant to this section.
General hospitals may elect to have their distribution paid through the
consortium.
S 97. Paragraphs (a), (c), (e) and (f) and the opening paragraphs of
paragraphs (b) and (d) of subdivision 3 of section 2807-m of the public
health law, paragraph (a) and the opening paragraph of paragraph (b) as
added by chapter 639 of the laws of 1996, paragraph (c) as amended by
chapter 419 of the laws of 2000, the opening paragraph of paragraph (d)
as amended by section 17 of part B of chapter 58 of the laws of 2008,
paragraph (e) as amended by section 11 of part OO of chapter 57 of the
laws of 2008 and paragraph (f) as amended by section 13 of part E of
chapter 63 of the laws of 2005, are amended to read as follows:
(a) Distributions to teaching general hospitals shall be made from the
regional pools described in subdivision two of this section for each
period PRIOR TO JANUARY FIRST, TWO THOUSAND NINE, less amounts set aside
pursuant to subdivision five of this section. To be eligible to partic-
ipate in distributions pursuant to this section, a teaching general
hospital and consortium must be in compliance with graduate medical
education reporting requirements set forth in subdivision four of this
section.
[Each] FOR PERIODS PRIOR TO JANUARY FIRST, TWO THOUSAND NINE, EACH
teaching general hospital in a region shall have a proxy calculated for
its graduate medical education costs as follows:
(c) [A] FOR PERIODS PRIOR TO JANUARY FIRST, TWO THOUSAND NINE, A
distribution amount for each teaching general hospital shall be calcu-
lated from the applicable regional pool described in subdivision two of
this section as adjusted pursuant to paragraph (d) of this subdivision
based upon its percentage of the regional total of the graduate medical
education proxies, except that for purposes of this paragraph the state-
wide amount used to compute such distribution amounts shall be four
hundred ninety million dollars on an annual basis for the periods Janu-
ary first, two thousand through December thirty-first, two thousand two
and two hundred forty-five million dollars for the period January first,
two thousand three through June thirtieth, two thousand three, less
amounts set aside each period pursuant to subdivision seven of this
section.
[Each] FOR PERIODS PRIOR TO JANUARY FIRST, TWO THOUSAND NINE, EACH
teaching general hospital shall receive a distribution from the applica-
S. 58--A 112 A. 158--A
ble regional pool based on its distribution amount determined under
paragraph (c) of this subdivision adjusted by a reduction amount that is
determined as follows:
(e) Effective April first, two thousand four THROUGH DECEMBER THIRTY-
FIRST, TWO THOUSAND EIGHT, the distribution amount calculated pursuant
to paragraphs (c) and (d) of this subdivision for each non-public teach-
ing general hospital shall be reduced by the amount calculated and
included in rates pursuant to paragraph (d) of subdivision twenty-five
of section twenty-eight hundred seven-c of this article.
(f) Effective January first, two thousand five THROUGH DECEMBER THIR-
TY-FIRST, TWO THOUSAND EIGHT, each teaching general hospital shall
receive a distribution from the applicable regional pool based on its
distribution amount determined under paragraphs (c), (d) and (e) of this
subdivision and reduced by its adjustment amount calculated pursuant to
paragraph [(1)] (S) of subdivision one of this section and, for distrib-
utions for the period January first, two thousand five through December
thirty-first, two thousand five, further reduced by its extra reduction
amount calculated pursuant to paragraph [(m)] (T) of subdivision one of
this section.
S 98. The opening paragraph of paragraph (b), paragraph (c), the open-
ing paragraphs of paragraphs (d) and (e) and paragraphs (f) and (g) of
subdivision 5-a of section 2807-m of the public health law, the opening
paragraph of paragraph (b), paragraph (c), the opening paragraph of
paragraph (e), and paragraphs (f) and (g) as added by section 75-c of
part C of chapter 58 of the laws of 2008 and the opening paragraph of
paragraph (d) as amended by section 15 of part OO of chapter 57 of the
laws of 2008, are amended to read as follows:
Empire clinical research investigator program (ECRIP) and other gradu-
ate medical education reforms. [Thirty-one] THIRTY million FOUR HUNDRED
THOUSAND dollars annually for the period January first, two thousand
nine through December thirty-first, two thousand ten, and seven million
[seven hundred fifty] SIX HUNDRED thousand dollars for the period Janu-
ary first, two thousand eleven through March thirty-first, two thousand
eleven, shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
to be allocated regionally with two-thirds of the available funding
going to New York city and one-third of the available funding going to
the rest of the state and shall be available for distribution as
follows:
(c) Ambulatory care training. [Five] FOUR million NINE HUNDRED THOU-
SAND dollars for the period January first, two thousand eight through
December thirty-first, two thousand eight, [five] FOUR million NINE
HUNDRED THOUSAND dollars for the period January first, two thousand nine
through December thirty-first, two thousand nine, [five] FOUR million
NINE HUNDRED THOUSAND dollars for the period January first, two thousand
ten through December thirty-first, two thousand ten, and one million two
hundred [fifty] TWENTY-FIVE thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven, shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
and shall be available for distributions to sponsoring institutions to
be directed to support clinical training of medical students and resi-
dents in free-standing ambulatory care settings, including community
health centers and private practices. Such funding shall be allocated
regionally with two-thirds of the available funding going to New York
city and one-third of the available funding going to the rest of the
S. 58--A 113 A. 158--A
state and shall be distributed to sponsoring institutions in each region
pursuant to a request for application or request for proposal process
with preference being given to sponsoring institutions which provide
training in sites located in underserved rural or inner-city areas and
those that include medical students in such training.
[Two] ONE million NINE HUNDRED SIXTY THOUSAND dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight, [two] ONE million NINE HUNDRED SIXTY THOUSAND dollars
for the period January first, two thousand nine through December thir-
ty-first, two thousand nine, [two] ONE million NINE HUNDRED SIXTY THOU-
SAND dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten, and [five] FOUR hundred NINETY
thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, shall be set aside and
reserved by the commissioner from the regional pools established pursu-
ant to subdivision two of this section and shall be available for
purposes of physician loan repayment in accordance with subdivision ten
of this section. Such funding shall be allocated regionally with one-
third of available funds going to New York city and two-thirds of avail-
able funds going to the rest of the state and shall be distributed in a
manner to be determined by the commissioner as follows:
[Five] FOUR million NINE HUNDRED THOUSAND dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight, [five] FOUR million NINE HUNDRED THOUSAND dollars annually
for the period January first, two thousand nine through December thir-
ty-first, two thousand ten, and one million two hundred [fifty] TWENTY-
FIVE thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, shall be set aside and
reserved by the commissioner from the regional pools established pursu-
ant to subdivision two of this section and shall be available for
purposes of physician practice support. Such funding shall be allocated
regionally with one-third of available funds going to New York city and
two-thirds of available funds going to the rest of the state and shall
be distributed in a manner to be determined by the commissioner as
follows:
(f) Study on physician workforce. [Six] FIVE hundred NINETY thousand
dollars annually for the period January first, two thousand eight
through December thirty-first, two thousand ten, and one hundred [fifty]
FORTY-EIGHT thousand dollars for the period January first, two thousand
eleven through March thirty-first, two thousand eleven, shall be set
aside and reserved by the commissioner from the regional pools estab-
lished pursuant to subdivision two of this section and shall be avail-
able to fund a study of physician workforce needs and solutions includ-
ing, but not limited to, an analysis of residency programs and projected
physician workforce and community needs. The commissioner shall enter
into agreements with one or more organizations to conduct such study
based on a request for proposal process.
(g) Diversity in medicine/post-baccalaureate program. Notwithstanding
any inconsistent provision of section one hundred twelve or one hundred
sixty-three of the state finance law or any other law, [two] ONE million
NINE HUNDRED SIXTY THOUSAND dollars annually for the period January
first, two thousand eight through December thirty-first, two thousand
ten, and [five] FOUR hundred NINETY thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
S. 58--A 114 A. 158--A
and shall be available for distributions to the Associated Medical
Schools of New York to fund its diversity program including existing and
new post-baccalaureate programs for minority and economically disadvan-
taged students and encourage participation from all medical schools in
New York. The associated medical schools of New York shall report to the
commissioner on an annual basis regarding the use of funds for such
purpose in such form and manner as specified by the commissioner.
S 99. Subdivision 7 of section 2807-m of the public health law, as
amended by section 75-d of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
7. Notwithstanding any inconsistent provision of section one hundred
twelve or one hundred sixty-three of the state finance law or any other
law, up to one million dollars for the period January first, two thou-
sand through December thirty-first, two thousand, one million six
hundred thousand dollars annually for the periods January first, two
thousand one through December thirty-first, two thousand [ten,] EIGHT,
ONE MILLION FIVE HUNDRED THOUSAND DOLLARS ANNUALLY FOR THE PERIODS JANU-
ARY FIRST, TWO THOUSAND NINE THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND
TEN, and [four] THREE hundred SEVENTY-FIVE thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven, shall be set aside and reserved by the commissioner
from the regional pools established pursuant to subdivision two of this
section and shall be available for distributions to the New York state
area health education center program for the purpose of expanding commu-
nity-based training of medical students. In addition, one million
dollars annually for the period January first, two thousand eight
through December thirty-first, two thousand ten, and two hundred fifty
thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, shall be set aside and
reserved by the commissioner from the regional pools established pursu-
ant to subdivision two of this section and shall be available for
distributions to the New York state area health education center program
for the purpose of post-secondary training of health care professionals
who will achieve specific program outcomes within the New York state
area health education center program. The New York state area health
education center program shall report to the commissioner on an annual
basis regarding the use of funds for each purpose in such form and
manner as specified by the commissioner.
S 100. Paragraph (a) of subdivision 7 of section 2807-s of the public
health law, as amended by section 22 of part A of chapter 58 of the laws
of 2007, subparagraphs (viii), (ix) and (xii) as amended by section 14
of part B of chapter 58 of the laws of 2008, is amended to read as
follows:
(a) funds shall be accumulated in regional professional education
pools established by the commissioner or the healthcare reform act
(HCRA) resources fund established pursuant to section ninety-two-dd of
the state finance law, whichever is applicable, for distribution in
accordance with section twenty-eight hundred seven-m of this article, in
the following amounts:
(i) ninety-two and forty-five-hundredths percent of the funds accumu-
lated less seventy-six million dollars for the period January first,
nineteen hundred ninety-seven through December thirty-first, nineteen
hundred ninety-seven,
(ii) ninety-two and forty-five-hundredths percent of the funds accumu-
lated less seventy-six million dollars for the period January first,
S. 58--A 115 A. 158--A
nineteen hundred ninety-eight through December thirty-first, nineteen
hundred ninety-eight,
(iii) ninety-two and forty-five-hundredths percent of the funds accu-
mulated less one hundred one million dollars for the period January
first, nineteen hundred ninety-nine through December thirty-first, nine-
teen hundred ninety-nine,
(iv) four hundred ninety-four million dollars on an annual basis for
the periods January first, two thousand through December thirty-first,
two thousand three,
(v) four hundred sixty-three million dollars for the period January
first, two thousand four through December thirty-first, two thousand
four,
(vi) four hundred eighty-eight million dollars for the period January
first, two thousand five through December thirty-first, two thousand
five,
(vii) four hundred ninety-four million dollars for the period January
first, two thousand six through December thirty-first, two thousand six,
(viii) four hundred seventy million dollars [annually] for the period
January first, two thousand seven through December thirty-first, two
thousand [ten] SEVEN, [and]
(ix) [one hundred seventeen] FOUR HUNDRED FORTY-SIX MILLION SIX
HUNDRED THOUSAND DOLLARS FOR THE PERIOD JANUARY FIRST, TWO THOUSAND
EIGHT THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHT,
(X) FORTY-SEVEN MILLION TWO HUNDRED TEN THOUSAND DOLLARS ON AN ANNUAL
BASIS FOR THE PERIODS JANUARY FIRST, TWO THOUSAND NINE THROUGH DECEMBER
THIRTY-FIRST, TWO THOUSAND TEN; AND
(XI) ELEVEN million [five] EIGHT hundred thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven;
[(x)] (XII) provided, however, FOR PERIODS PRIOR TO JANUARY FIRST, TWO
THOUSAND NINE, amounts set forth in this paragraph may be reduced by the
commissioner in an amount to be approved by the director of the budget
to reflect the amount received from the federal government under the
state's 1115 waiver which is directed under its terms and conditions to
the graduate medical education program established pursuant to section
twenty-eight hundred seven-m of this article;
[(xi)] (XIII) provided further, however, FOR PERIODS PRIOR TO JULY
FIRST, TWO THOUSAND NINE, amounts set forth in this paragraph shall be
reduced by an amount equal to the total actual distribution reductions
for all facilities pursuant to paragraph (e) of subdivision three of
section twenty-eight hundred seven-m of this article; and
[(xii)] (XIV) provided further, however, FOR PERIODS PRIOR TO JULY
FIRST, TWO THOUSAND NINE, amounts set forth in this paragraph shall be
reduced by an amount equal to the actual distribution reductions for all
facilities pursuant to paragraph (s) of subdivision one of section twen-
ty-eight hundred seven-m of this article.
S 101. Section 2807-k of the public health law is amended by adding a
new subdivision 5-b to read as follows:
5-B. 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 NINE, FUNDS AVAILABLE PURSUANT TO PARAGRAPH (A-1) OF SUBDIVI-
SION FOUR OF THIS SECTION AND AN ADDITIONAL TWO HUNDRED EIGHTY-THREE
MILLION DOLLARS AS IS OTHERWISE AVAILABLE FOR DISTRIBUTION PURSUANT TO
S. 58--A 116 A. 158--A
THIS SECTION, SHALL BE RESERVED AND SET ASIDE AND DISTRIBUTED ON AN
ANNUAL BASIS IN ACCORDANCE WITH THE FOLLOWING:
(A) DISTRIBUTIONS PURSUANT TO THIS SUBDIVISION SHALL BE LIMITED TO
GENERAL HOSPITALS WHICH ARE TEACHING HOSPITALS AS DEFINED IN APPLICABLE
REGULATIONS.
(B) FOR THE PURPOSES OF DISTRIBUTIONS IN ACCORDANCE WITH THIS SUBDIVI-
SION, EACH ELIGIBLE FACILITY'S RELATIVE UNCOMPENSATED CARE NEED AMOUNT
SHALL BE DETERMINED UTILIZING THE METHODOLOGY SET FORTH IN PARAGRAPH (C)
OF SUBDIVISION FIVE-A OF THIS SECTION.
(C) DISTRIBUTIONS MADE PURSUANT TO THIS SUBDIVISION REMAIN SUBJECT TO
THE PROVISIONS OF PARAGRAPH (D) OF SUBDIVISION FIVE-A OF THIS SECTION.
S 102. Paragraph (c) of subdivision 5-a of section 2807-k of the
public health law, as added by section 28-b of part B of chapter 58 of
the laws of 2008, is amended to read as follows:
(c) For the purposes of distributions in accordance with paragraphs
(a) and (b) of this subdivision, each facility's relative uncompensated
care need amount shall be determined [by multiplying reported inpatient
and outpatient units of service from the calendar year two years prior
to the distribution year, but excluding referred ambulatory services
units of service, for all uninsured patients by the applicable Medicaid
rates, but not including prospective rate adjustments and rate add-ons,
in effect for the calendar year two years prior to the distribution year
for such services, provided, however, that for distributions on and
after January first, two thousand ten, each facility's uncompensated
need amount shall be reduced by the sum of all payment amounts collected
from such patients. The total uncompensated care need for each facility
subject to paragraph (a) or (b) of this subdivision shall then be
adjusted by application of the nominal need scale set forth in subdivi-
sion five of this section.] IN ACCORDANCE WITH THE FOLLOWING:
(I) INPATIENT UNITS OF SERVICES FOR ALL UNINSURED PATIENTS FROM THE
CALENDAR YEAR TWO YEARS PRIOR TO THE DISTRIBUTION YEAR, BUT EXCLUDING
REFERRED AMBULATORY UNITS OF SERVICES, SHALL BE MULTIPLIED BY THE APPLI-
CABLE MEDICAID INPATIENT RATES IN EFFECT FOR SUCH PRIOR YEAR, BUT NOT
INCLUDING PROSPECTIVE RATE ADJUSTMENTS AND RATE ADD-ONS, PROVIDED,
HOWEVER, THAT FOR DISTRIBUTIONS ON AND AFTER JANUARY FIRST, TWO THOUSAND
TEN, THE UNCOMPENSATED AMOUNT FOR INPATIENT SERVICES SHALL UTILIZE THE
INPATIENT RATES IN EFFECT AS OF JULY FIRST OF THE PRIOR YEAR;
(II) OUTPATIENT UNITS OF SERVICE FOR ALL UNINSURED PATIENTS FROM THE
CALENDAR YEAR TWO YEARS PRIOR TO THE DISTRIBUTION YEAR, INCLUDING EMER-
GENCY DEPARTMENT SERVICES AND AMBULATORY SURGERY SERVICES, BUT EXCLUDING
REFERRED AMBULATORY SERVICES UNITS OF SERVICE, SHALL BE MULTIPLIED BY
MEDICAID OUTPATIENT RATES THAT REFLECT THE EXCLUSIVE UTILIZATION OF THE
AMBULATORY PATIENT GROUPS (APG) RATE-SETTING METHODOLOGY AS SET FORTH IN
REGULATIONS PROMULGATED PURSUANT TO SUBDIVISION TWO-A OF SECTION TWEN-
TY-EIGHT HUNDRED SEVEN OF THIS ARTICLE, AS IN EFFECT FOR THE DISTRIB-
UTION YEAR, PROVIDED FURTHER, HOWEVER, THAT FOR THOSE SERVICES FOR WHICH
APG RATES ARE NOT AVAILABLE THE APPLICABLE MEDICAID OUTPATIENT RATE
SHALL BE THE RATE IN EFFECT FOR THE CALENDAR YEAR TWO YEARS PRIOR TO THE
DISTRIBUTION YEAR;
(III) THE UNCOMPENSATED CARE NEED FOR EACH FACILITY FOR PERIODS ON AND
AFTER JANUARY FIRST, TWO THOUSAND TEN SHALL BE REDUCED BY THE SUM OF ALL
PAYMENT AMOUNTS COLLECTED FROM SUCH PATIENTS; AND
(IV) THE TOTAL UNCOMPENSATED CARE NEED FOR EACH FACILITY SUBJECT TO
THIS SUBDIVISION SHALL THEN BE ADJUSTED BY APPLICATION OF THE NOMINAL
NEED SCALE SET FORTH IN SUBDIVISION FIVE OF THIS SECTION.
S. 58--A 117 A. 158--A
S 103. Section 2807-p of the public health law is amended by adding a
new subdivision 10 to read as follows:
10. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR
ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER IS AUTHORIZED TO
SEEK A WAIVER FROM THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES
PURSUANT TO SECTION ELEVEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURI-
TY ACT, OR SUCH OTHER FEDERAL LAW PROVISION AS MAY BE DEEMED APPROPRI-
ATE, SEEKING FEDERAL FINANCIAL PARTICIPATION IN PAYMENTS MADE PURSUANT
TO THIS SECTION, IN WHICH CASE THE STATE FUNDING MADE AVAILABLE PURSUANT
TO THIS SECTION SHALL BE UTILIZED AS THE NON-FEDERAL SHARE OF SUCH
PAYMENTS. TO THE EXTENT AS MAY BE REQUIRED, PAYMENTS MADE PURSUANT TO
THIS SECTION AND IN ACCORDANCE WITH THIS SUBDIVISION, MAY BE DEEMED TO
BE DISPROPORTIONATE SHARE HOSPITAL PAYMENTS IN ACCORDANCE WITH THE
PROVISIONS OF THE FEDERAL SOCIAL SECURITY ACT.
(B) IF FEDERAL FINANCIAL PARTICIPATION IN PAYMENTS MADE PURSUANT TO
THIS SECTION ARE MADE AVAILABLE IN ACCORDANCE WITH THE PROVISIONS OF
THIS SUBDIVISION, FREE-STANDING CLINICS LICENSED SOLELY PURSUANT TO
ARTICLE THIRTY-ONE OF THE MENTAL HYGIENE LAW SHALL ALSO BE DEEMED ELIGI-
BLE FOR PARTICIPATION IN SUCH PAYMENTS TO THE SAME DEGREE AND IN ACCORD-
ANCE WITH THE SAME DISTRIBUTION METHODOLOGY OTHERWISE PROVIDED IN THIS
SECTION, PROVIDED, HOWEVER, THAT ONLY THOSE UNITS OF SERVICE PROVIDED BY
SUCH FREE-STANDING CLINICS THAT CONSTITUTE MEDICAL SERVICES THAT ARE
OTHERWISE ELIGIBLE FOR CONSIDERATION FOR MEDICAID PAYMENTS SHALL BE
REFLECTED IN DISTRIBUTIONS MADE PURSUANT TO THIS SECTION, AND FURTHER
PROVIDED, HOWEVER, THAT THE COMMISSIONER MAY, IN CONSULTATION WITH THE
COMMISSIONER OF THE OFFICE OF MENTAL HEALTH, REQUIRE SUCH CLINICS, AS A
CONDITION OF RECEIVING SUCH DISTRIBUTIONS, TO PROVIDE REPORTS AND DATA
TO THE DEPARTMENT AS THE COMMISSIONER DEEMS NECESSARY TO ADEQUATELY
IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION WITH REGARD TO SUCH CLIN-
ICS.
S 104. Subdivision 3 of section 241 of the elder law is amended to
read as follows:
3. "Income" shall mean "household gross income" as defined in the real
property tax circuit breaker credit program, pursuant to subparagraph
(C) of paragraph one of subsection (e) of section six hundred six of the
tax law, but only shall include the income of program applicants and
spouses and shall exclude the income of other members of the household;
PROVIDED, HOWEVER, THAT THE PANEL MAY ADOPT POLICIES TO EXCLUDE FROM
INCOME CERTAIN NON-RECURRING ITEMS THAT WOULD ACT TO ARTIFICIALLY
INFLATE THE AVAILABILITY OF FUNDS TO MEET CURRENT NEEDS INCLUDING, BUT
NOT LIMITED TO, A RETIREE'S PREVIOUS YEAR'S WAGES, AND NON-RECURRING
DISTRIBUTIONS FROM AN INDIVIDUAL RETIREMENT ACCOUNT.
S 105. Subdivision 1 of section 241 of the elder law, as amended by
section 29 of part A of chapter 58 of the laws of 2008, is amended to
read as follows:
1. "Covered drug" shall mean a drug dispensed subject to a legally
authorized prescription pursuant to section sixty-eight hundred ten of
the education law, and insulin, an insulin syringe, or an insulin
needle. Such term shall not include: (a) any drug determined by the
commissioner of the federal food and drug administration to be ineffec-
tive or unsafe; (b) any drug dispensed in a package, or form of dosage
or administration, as to which the commissioner of health finally deter-
mines in accordance with the provisions of section two hundred fifty-two
of this title that a less expensive package, or form of dosage or admin-
istration, is available that is pharmaceutically equivalent and equiv-
alent in its therapeutic effect for the general health characteristics
S. 58--A 118 A. 158--A
of the eligible program participant population; (c) any device for the
aid or correction of vision; (d) any drug, including vitamins, which is
generally available without a physician's prescription; [and] (e) drugs
for the treatment of sexual or erectile dysfunction, unless such drugs
are used to treat a condition, other than sexual or erectile dysfunc-
tion, for which the drugs have been approved by the federal food and
drug administration; [and] (f) a brand name drug for which a multi-
source therapeutically and generically equivalent drug, as determined by
the federal food and drug administration, is available, unless previous-
ly authorized by the elderly pharmaceutical insurance coverage program,
provided, however, that the elderly pharmaceutical insurance coverage
panel is authorized to exempt, for good cause shown, any brand name drug
from such restriction, and provided further that such restriction shall
not apply to any drug that is included on the preferred drug list under
section two hundred seventy-two of the public health law or is in the
clinical drug review program under section two hundred seventy-four of
the public health law to the extent that the preferred drug program and
the clinical drug review program are applied to the elderly pharmaceu-
tical insurance coverage program pursuant to section two hundred seven-
ty-five of the public health law, or to any drug covered under a program
participant's Medicare part D or other primary insurance plan; AND (G)
ANY DRUG EXCLUDED FROM COVERAGE BY THE MEDICAL ASSISTANCE PROGRAM ESTAB-
LISHED UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
Any of the drugs enumerated in the preceding sentence shall be consid-
ered a covered drug or a prescription drug for purposes of this article
if it is added to the preferred drug list under article two-A of the
public health law. For the purpose of this title, except as otherwise
provided in this section, a covered drug shall be dispensed in quanti-
ties no greater than a thirty day supply or one hundred units, whichever
is greater. In the case of a drug dispensed in a form of administration
other than a tablet or capsule, the maximum allowed quantity shall be a
thirty day supply; the panel is authorized to approve exceptions to
these limits for specific products following consideration of recommen-
dations from pharmaceutical or medical experts regarding commonly pack-
aged quantities, unusual forms of administration, length of treatment or
cost effectiveness. In the case of a drug prescribed pursuant to section
thirty-three hundred thirty-two of the public health law to treat one of
the conditions that have been enumerated by the commissioner of health
pursuant to regulation as warranting the prescribing of greater than a
thirty day supply, such drug shall be dispensed in quantities not to
exceed a three month supply.
S 106. The opening paragraph of paragraph (f) and paragraph (h) of
subdivision 3 of section 242 of the elder law, as added by section 3 of
part B of chapter 58 of the laws of 2007, are amended to read as
follows:
As a condition of continued eligibility for benefits under this title,
if a program participant is eligible for Medicare part D drug coverage
under section 1860D of the federal social security act, the participant
is required to enroll in Medicare part D at the first available enroll-
ment period and to maintain such enrollment. This requirement shall be
waived if such enrollment would result [in significant additional finan-
cial liability by the participant, including, but not limited to, indi-
viduals in a Medicare advantage plan whose cost sharing would be
increased, or if such enrollment would result] in the loss of any health
coverage through a union or employer plan for the participant, the
participant's spouse or other dependent. The elderly pharmaceutical
S. 58--A 119 A. 158--A
insurance coverage program shall provide premium assistance for all
participants enrolled in Medicare part D as follows:
(h) In order to maximize prescription drug coverage under Medicare
part D, the elderly pharmaceutical insurance coverage program is author-
ized to represent program participants under this title in the pursuit
of such coverage. Such representation [shall not result in any addi-
tional financial liability on behalf of such program participants and]
shall include, but not be limited to, the following actions:
(i) application for the premium and cost-sharing subsidies, AND THE
MEDICARE SAVINGS PROGRAMS, on behalf of eligible program participants;
(ii) enrollment in a prescription drug plan or MA-PD plan; the elderly
pharmaceutical insurance coverage program shall provide program partic-
ipants with prior written notice of, and the opportunity to decline such
facilitated enrollment subject, however, to the provisions of paragraph
(f) of this subdivision;
(iii) pursuit of appeals, grievances, or coverage determinations.
S 107. Paragraph (c) of subdivision 3 of section 242 of the elder law,
as amended by section 4 of part A of chapter 58 of the laws of 2005, is
amended to read as follows:
(c) The fact that some of an individual's prescription drug expenses
are paid or reimbursable under the provisions of the medicare program
shall not disqualify an individual, if he or she is otherwise eligible,
from receiving assistance under this title. [In such cases, the state
shall pay the portion of the cost of those prescriptions for qualified
drugs for which no payment or reimbursement is made by the medicare
program or any federally funded prescription drug benefit, less the
participant's co-payment required on the amount not paid by the medicare
program.] HOWEVER, EXCEPT FOR DRUGS EXCLUDED FROM MEDICARE COVERAGE IN
ACCORDANCE WITH SECTION EIGHTEEN HUNDRED SIXTY-D-2 OF THE FEDERAL SOCIAL
SECURITY ACT, SUCH ASSISTANCE SHALL BE LIMITED TO PRESCRIPTION DRUGS
COVERED BY THE INDIVIDUAL'S MEDICARE PLAN. IN SUCH CASES, THE STATE
SHALL COVER THE AMOUNT THAT IS THE RESPONSIBILITY OF THE INDIVIDUAL
UNDER THE MEDICARE PLAN BENEFIT, SUBJECT TO THE INDIVIDUAL'S COST-SHAR-
ING RESPONSIBILITY UNDER SECTIONS TWO HUNDRED FORTY-SEVEN OR TWO HUNDRED
FORTY-EIGHT OF THIS TITLE ON SUCH AMOUNT. In addition, the participant
registration fee charged to eligible program participants for comprehen-
sive coverage pursuant to section two hundred forty-seven of this title
shall be waived for the portion of the annual coverage period that the
participant is also enrolled as a transitional assistance beneficiary in
the medicare prescription drug discount card program, authorized pursu-
ant to title XVIII of the federal social security act, provided that:
(i) any sponsor of such drug discount card program has signed an agree-
ment to complete coordination of benefit functions with EPIC, and has
been endorsed by the EPIC panel; or (ii) any exclusive sponsor of such
drug discount card program authorized pursuant to title XVIII of the
federal social security act that limits the participants to the medicare
prescription drug discount card program sponsored by such exclusive
sponsor, shall coordinate benefits available under such discount card
program with EPIC. [The participant registration fee charged to eligible
program participants for comprehensive coverage pursuant to section two
hundred forty-seven of this title shall be waived for the portion of the
annual coverage period that the participant is also enrolled as a full
subsidy individual in a prescription drug or MA-PD plan under Part D of
title XVIII of the federal social security act.]
S. 58--A 120 A. 158--A
S 107-a. Paragraph (g) of subdivision 3 of section 242 of the elder
law, as added by section 3 of part B of chapter 58 of the laws of 2007,
is amended to read as follows:
(g) The elderly pharmaceutical insurance coverage program is author-
ized and directed to conduct an enrollment program to facilitate, in as
prompt and streamlined a fashion as possible, the enrollment into Medi-
care part D of program participants who are required by the provisions
of this section to enroll in part D. [Provided, however, that a partic-
ipant shall not be prevented from receiving his or her drugs immediately
at the pharmacy under the elderly pharmaceutical insurance coverage
program as a result of such participant's enrollment in Medicare part
D.]
S 108. Subdivision 6 of section 250 of the elder law is REPEALED.
S 109. The opening paragraph of subdivision 2 and paragraph (b) of
subdivision 3 of section 247 of the elder law are amended to read as
follows:
Eligible individuals electing to meet the requirements of this subdi-
vision shall pay a quarterly registration fee in a manner and form
determined by the executive director; at the option of the participant,
the registration fee may be paid annually in a lump sum upon the begin-
ning of the annual coverage period. No eligible individual electing to
meet the requirements of this subdivision shall have his OR HER partic-
ipation in the program lapse by virtue of non-payment of the applicable
registration fee unless the contractor has provided notification of the
amount and due date thereof, and more than thirty days have elapsed
since the due date of the individual's registration fee. The registra-
tion fee to be charged to eligible program participants for comprehen-
sive coverage under this option shall be in accordance with the follow-
ing schedule, EXCEPT THAT SUCH FEE SHALL BE WAIVED FOR PARTICIPANTS WITH
INCOME AT OR BELOW ONE HUNDRED FIFTY PERCENT OF THE OFFICIAL POVERTY
LINE MAINTAINED BY THE FEDERAL SECRETARY OF HEALTH AND HUMAN SERVICES:
(b) The point of sale co-payment amounts which are to be charged
eligible program participants shall be in accordance with the following
schedule:
For each prescription of covered drugs costing $15.00 or less.....$3.00
For each prescription of covered drugs costing $15.01 to $35.00...$7.00
For each prescription of covered drugs costing $35.01 [to $55.00..$15.00
For each prescription of covered drugs costing $55.01] or
more....[$20.00] $15.00
S 110. Subdivision 2 of section 241 of the elder law, as amended by
section 13 of part B of chapter 57 of the laws of 2006, is amended to
read as follows:
2. "Provider pharmacy" shall mean a pharmacy registered in the state
of New York pursuant to section sixty-eight hundred eight of the educa-
tion law, A NON-RESIDENT ESTABLISHMENT REGISTERED PURSUANT TO SECTION
SIXTY-EIGHT HUNDRED EIGHT-B OF THE EDUCATION LAW, or a pharmacy regis-
tered in a state bordering the state of New York when certified as
necessary by the executive director pursuant to section two hundred
fifty-three of this title, for which an agreement to provide pharmacy
services for purposes of this program pursuant to section two hundred
forty-nine of this title is in effect.
S 111. Subdivision 1 of section 249 of the elder law is amended to
read as follows:
1. The state shall offer an opportunity to participate in this program
to all provider pharmacies as defined in section two hundred forty-one
of this title, PROVIDED, HOWEVER, THAT THE PARTICIPATION OF PHARMACIES
S. 58--A 121 A. 158--A
REGISTERED IN THE STATE PURSUANT TO SECTION SIXTY-EIGHT HUNDRED EIGHT-B
OF THE EDUCATION LAW SHALL BE LIMITED TO STATE ASSISTANCE PROVIDED UNDER
THIS TITLE FOR PRESCRIPTION DRUGS COVERED BY A PROGRAM PARTICIPANT'S
MEDICARE OR OTHER DRUG PLAN.
S 112. Paragraph (e) of subdivision 3 of section 242 of the elder law,
as amended by section 3 of part B of chapter 58 of the laws of 2007, is
amended to read as follows:
(e) As a condition of continued eligibility for benefits under this
title, if a program participant's income indicates that the participant
could be eligible for an income-related subsidy under section 1860D-14
of the federal social security act BY EITHER APPLYING FOR SUCH SUBSIDY
OR BY ENROLLING IN A MEDICARE SAVINGS PROGRAM AS A QUALIFIED MEDICARE
BENEFICIARY (QMB), A SPECIFIED LOW-INCOME MEDICARE BENEFICIARY (SLMB),
OR A QUALIFYING INDIVIDUAL (QI), a program participant is required to
provide[, and to authorize the elderly pharmaceutical insurance coverage
program to obtain,] any information or documentation required to estab-
lish the participant's eligibility for such subsidy, AND TO AUTHORIZE
THE ELDERLY PHARMACEUTICAL INSURANCE COVERAGE PROGRAM TO APPLY ON BEHALF
OF THE PARTICIPANT FOR THE SUBSIDY OR THE MEDICARE SAVINGS PROGRAM. The
elderly pharmaceutical insurance coverage program shall make a reason-
able effort to notify the program participant of his or her need to
provide any of the above required information. After a reasonable effort
has been made to contact the participant, a participant shall be noti-
fied in writing that he or she has sixty days to provide such required
information. If such information is not provided within the sixty day
period, the participant's coverage may be terminated.
S 113. Section 2807-j of the public health law is amended by adding a
new subdivision 13 to read as follows:
13. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS SECTION OR
ANY OTHER CONTRARY PROVISION OF LAW, FOR PERIODS ON AND AFTER JULY
FIRST, TWO THOUSAND NINE, EACH THIRD PARTY PAYOR WHICH HAS ENTERED INTO
AN ELECTION AGREEMENT WITH THE COMMISSIONER PURSUANT TO SUBDIVISION FIVE
OF THIS SECTION SHALL, AS A CONDITION OF SUCH ELECTION, PAY TO THE
COMMISSIONER OR THE COMMISSIONER'S DESIGNEE, A PERCENTAGE SURCHARGE
EQUAL TO THE SURCHARGE PERCENT SET FORTH IN PARAGRAPH (C) OF SUBDIVISION
TWO OF THIS SECTION FOR THE SAME PERIOD AND APPLIED TO ALL PAYMENTS MADE
BY SUCH THIRD PARTY PAYORS FOR PATIENT CARE SERVICES PROVIDED WITHIN THE
STATE BY PHYSICIANS IN PHYSICIAN OFFICES OR IN URGENT CARE FACILITIES
THAT ARE NOT OTHERWISE LICENSED PURSUANT TO THIS ARTICLE AND WHICH ARE
BILLED AS SURGERY OR RADIOLOGY SERVICES IN ACCORDANCE WITH THE CURRENT
PROCEDURE TERMINOLOGY, FOURTH EDITION, AS PUBLISHED BY THE AMERICAN
MEDICAL ASSOCIATION.
(B) SUCH PAYMENTS SHALL BE MADE AND REPORTED AT THE SAME TIME AND IN
THE SAME MANNER AS THE PAYMENTS AND REPORTS WHICH ARE OTHERWISE SUBMIT-
TED BY EACH THIRD PARTY PAYOR TO THE COMMISSIONER OR THE COMMISSIONER'S
DESIGNEE IN ACCORDANCE WITH THIS SECTION. SUCH PAYMENTS SHALL BE SUBJECT
TO AUDIT BY THE COMMISSIONER IN THE SAME MANNER AS THE OTHER PAYMENTS
OTHERWISE SUBMITTED AND REPORTED PURSUANT TO THIS SECTION. THE COMMIS-
SIONER MAY TAKE ALL MEASURES TO COLLECT DELINQUENT PAYMENTS DUE PURSUANT
TO THIS SUBDIVISION AS ARE OTHERWISE PERMITTED WITH REGARD TO DELINQUENT
PAYMENTS DUE PURSUANT TO OTHER SUBDIVISIONS OF THIS SECTION.
(C) SURCHARGES PURSUANT TO THIS SUBDIVISION SHALL NOT APPLY TO
PAYMENTS MADE BY THIRD PARTY PAYORS FOR SERVICES PROVIDED TO PATIENTS
INSURED BY MEDICAID OR BY THE CHILD HEALTH PLUS PROGRAM OR TO ANY
PATIENT IN A CATEGORY THAT IS EXEMPT FROM SURCHARGE OBLIGATIONS ASSESSED
PURSUANT TO SUBDIVISIONS ONE THROUGH TWELVE OF THIS SECTION.
S. 58--A 122 A. 158--A
S 114. Paragraph (b) of subdivision 1-a of section 2807-s of the
public health law, as added by chapter 639 of the laws of 1996, is
amended to read as follows:
(b) "Specified third-party payors", for purposes of this section and
sections twenty-eight hundred seven-j and twenty-eight hundred seven-t
of this article, shall include corporations organized and operating in
accordance with article forty-three of the insurance law, organizations
operating in accordance with the provisions of article forty-four of
this chapter, self-insured funds and administrators acting on behalf of
self-insured funds, and commercial insurers [licensed to do business in
this state and] authorized to write accident and health insurance and
whose policy provides coverage on an expense incurred basis. Specified
third-party payors, for purposes of this section, shall not include
governmental agencies or providers of coverage pursuant to the compre-
hensive motor vehicle insurance reparations act, the workers' compen-
sation law, the volunteer firefighters' benefit law, or the volunteer
ambulance workers' benefit law.
S 115. Paragraph (j) of subdivision 1 of section 2807-v of the public
health law, as amended by section 5 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
(j) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the tobacco use prevention and
control program established pursuant to sections thirteen hundred nine-
ty-nine-ii and thirteen hundred ninety-nine-jj of this chapter, from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) up to thirty million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to forty million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to forty million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
(iv) up to thirty-six million nine hundred fifty thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(v) up to thirty-six million nine hundred fifty thousand dollars for
the period January first, two thousand four through December thirty-
first, two thousand four;
(vi) up to forty million six hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(vii) up to eighty-one million nine hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six, provided, however, that within amounts appropriated, a
portion of such funds may be transferred to the Roswell Park Cancer
Institute Corporation to support costs associated with cancer research;
(viii) up to ninety-four million one hundred fifty thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven, provided, however, that within amounts
appropriated, a portion of such funds may be transferred to the Roswell
Park Cancer Institute Corporation to support costs associated with
cancer research; AND
(ix) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand eight through December thirty-
first, two thousand eight[;
S. 58--A 123 A. 158--A
(x) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand nine through December thirty-
first, two thousand nine;
(xi) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand ten through December thirty-
first, two thousand ten; and
(xii) up to twenty-three million five hundred thirty-seven thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven].
S 116. Paragraph (b) of subdivision 2 of section 367-a of the social
services law, as amended by section 58 of part C of chapter 58 of the
laws of 2007, is amended to read as follows:
(b) Any inconsistent provision of this chapter or other law notwith-
standing, upon furnishing assistance under this title to any applicant
or recipient of medical assistance, the local social services district
or the department shall be subrogated, to the extent of the expenditures
by such district or department for medical care furnished, to any rights
such person may have to medical support or [third party reimbursement]
REIMBURSEMENT FROM LIABLE THIRD PARTIES, INCLUDING BUT NOT LIMITED TO
HEALTH INSURERS, SELF-INSURED PLANS, GROUP HEALTH PLANS, SERVICE BENEFIT
PLANS, MANAGED CARE ORGANIZATIONS, PHARMACY BENEFIT MANAGERS, OR OTHER
PARTIES THAT ARE, BY STATUTE, CONTRACT, OR AGREEMENT, LEGALLY RESPONSI-
BLE FOR PAYMENT OF A CLAIM FOR A HEALTH CARE ITEM OR SERVICE. For
purposes of this section, the term medical support shall mean the right
to support specified as support for the purpose of medical care by a
court or administrative order. The right of subrogation does not attach
to insurance benefits paid or provided under any health insurance policy
prior to the receipt of written notice of the exercise of subrogation
rights by the carrier issuing such insurance, nor shall such right of
subrogation attach to any benefits which may be claimed by a social
services official or the department, by agreement or other established
procedure, directly from an insurance carrier. No right of subrogation
to insurance benefits available under any health insurance policy shall
be enforceable unless written notice of the exercise of such subrogation
right is received by the carrier within three years from the date
services for which benefits are provided under the policy or contract
are rendered. The local social services district or the department shall
also notify the carrier when the exercise of subrogation rights has
terminated because a person is no longer receiving assistance under this
title. Such carrier shall establish mechanisms to maintain the confiden-
tiality of all individually identifiable information or records. Such
carrier shall limit the use of such information or record to the specif-
ic purpose for which such disclosure is made, and shall not further
disclose such information or records.
S 117. Paragraph (a) of subdivision 11 of section 367-a of the social
services law, as amended by chapter 170 of the laws of 1994, is amended
to read as follows:
(a) Any inconsistent provisions of this title or other law notwith-
standing, no health insurer, [health maintenance organization] SELF-IN-
SURED PLAN, MANAGED CARE ORGANIZATION, PHARMACY BENEFIT MANAGER, or
other [entity providing medical benefits] PARTY THAT IS, BY STATUTE,
CONTRACT, OR AGREEMENT, LEGALLY RESPONSIBLE FOR PAYMENT OF A CLAIM FOR A
HEALTH CARE ITEM OR SERVICE, employer or organization who has a plan,
including an employee retirement income security act or service benefit
plan, providing care and other medical benefits for persons, whether by
insurance or otherwise, shall exclude a person from eligibility, cover-
S. 58--A 124 A. 158--A
age or entitlement to medical benefits by reason of the eligibility of
such person for medical assistance under this title, or by reason of the
fact that such person would, except for such plan, be eligible for bene-
fits under this title.
S 118. Paragraph 2 of subsection (b) of section 313 of the insurance
law is amended to read as follows:
(2) Notwithstanding any provisions of this section to the contrary, in
case of an examination or appraisal of [a domestic] AN AUTHORIZED insur-
er made within this state, the traveling and living expense of the
person or persons making the examination shall be considered a cost of
operation, as referred to in section three hundred thirty-two of this
article and not an expense of examination.
S 119. Section 332 of the insurance law, subsection (a) as amended by
chapter 61 of the laws of 1989, is amended to read as follows:
S 332. Assessments to defray [operating] expenses of department. (a)
[The] FOR PURPOSES OF THIS SECTION, THE expenses of the department,
excluding the expenses of the supervision of employee welfare funds,
SHALL INCLUDE ALL APPROPRIATIONS WHETHER ADMINISTERED BY THE DEPARTMENT
OR SUBALLOCATED TO ANOTHER STATE DEPARTMENT, BOARD, OR AGENCY, for any
fiscal year, including all direct and indirect costs, as approved by the
director of the budget and audited by the comptroller, except as other-
wise provided by sections one hundred fifty-one and two hundred twenty-
eight of the workers' compensation law and by section sixty of the
volunteer firefighters' benefit law, shall be assessed by the super-
intendent pro rata upon all [domestic] AUTHORIZED insurers [and all
licensed United States branches of alien insurers domiciled in this
state within the meaning of paragraph four of subsection (b) of section
seven thousand four hundred eight of this chapter], in proportion to the
gross direct premiums and other considerations, written or received by
them in this state during the calendar year ending December thirty-first
immediately preceding the end of the fiscal year for which the assess-
ment is made (less return premiums and considerations thereon) for poli-
cies or contracts of insurance covering property or risks resident or
located in this state the issuance of which policies or contracts
requires a license from the superintendent; and the superintendent shall
levy and collect such assessments and pay the same into the state treas-
ury, subject to the provisions of section one hundred twenty-one of the
state finance law and subsection (b) [hereof] OF THIS SECTION.
(b) For each fiscal year commencing on or after April first, nineteen
hundred eighty-three, a partial payment shall be made by each insurer
subject to this section in a sum equal to twenty-five per centum of the
annual expenses assessed upon it for the fiscal year as estimated by the
superintendent. Such payment shall be made on March tenth of the preced-
ing fiscal year and on June tenth, September tenth and December tenth of
each year, or at such other dates as the director of the budget may
prescribe. [Provided, however, that the payment due March tenth, nine-
teen hundred eighty-three for the fiscal year beginning April first,
nineteen hundred eighty-three shall not be required to be paid until
June tenth, nineteen hundred eighty-three.] The balance of assessments
for the fiscal year shall be paid upon determination of the actual
amount due in accordance with the provisions of this section. Any over-
payment of annual assessment resulting from complying with the require-
ments of this subsection shall be refunded or at the option of the
assessed applied as a credit against the assessment for the succeeding
fiscal year. The partial payment schedule provided for herein shall not
be applicable to any insurer whose annual assessment pursuant to this
S. 58--A 125 A. 158--A
section for the fiscal year is estimated to be less than one hundred
dollars and such insurers shall make a single annual payment on or
before September thirtieth of the fiscal year.
S 120. Subparagraphs (vi), (vii) and (viii) of paragraph (uu) of
subdivision 1 of section 2807-v of the public health law, as amended by
section 5 of part B of chapter 58 of the laws of 2008, are amended to
read as follows:
(vi) [nine] SEVEN million [five] EIGHT hundred THIRTY-THREE thousand
THREE HUNDRED THIRTY-THREE dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine, of which
seven million five hundred thousand dollars shall be available for
disease management demonstration programs and [two million] THREE
HUNDRED THIRTY-THREE THOUSAND THREE HUNDRED THIRTY-THREE dollars shall
be available for telemedicine demonstration programs FOR THE PERIOD
JANUARY FIRST, TWO THOUSAND NINE THROUGH MARCH FIRST, TWO THOUSAND NINE;
(vii) [nine] SEVEN million five hundred thousand dollars for the peri-
od January first, two thousand ten through December thirty-first, two
thousand ten[, of which seven million five hundred thousand dollars]
shall be available for disease management demonstration programs [and
two million dollars shall be available for telemedicine demonstration
programs]; and
(viii) [two] ONE million [three] EIGHT hundred seventy-five thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven[, of which one million eight hundred
seventy-five thousand dollars] shall be available for disease management
demonstration programs [and five hundred thousand dollars shall be
available for telemedicine demonstration programs].
S 121. Section 3621 of the public health law is REPEALED.
S 122. Paragraph 1 of subsection (g) of section 2101 of the insurance
law, as amended by chapter 301 of the laws of 2008, is amended to read
as follows:
(1) The term "independent adjuster" means any person, firm, associ-
ation or corporation who[,] or [which,] THAT for money, commission or
any other thing of value, acts [in this state] on behalf of an insurer
in the work of investigating and adjusting claims arising under insur-
ance contracts issued by such insurer and who performs such duties
required by such insurer as are incidental to such claims; ANY PERSON,
FIRM, ASSOCIATION OR CORPORATION WHO OR THAT FOR MONEY, COMMISSION OR
ANY OTHER THING OF VALUE, PAYS CLAIMS OR ADMINISTERS THE PAYMENT OF
CLAIMS ON BEHALF OF AN INSURER; and [also includes] any person who for
compensation or anything of value investigates and adjusts claims on
behalf of any independent adjuster, except that such term shall not
include:
(A) any officer, director or regular salaried employee of an author-
ized insurer or entity licensed pursuant to article forty-four of the
public health law providing comprehensive health service plans (as used
in this paragraph, a "health maintenance organization"), or any manager
thereof, individual or corporate, or the manager, agent or general agent
of any department thereof, individual or corporate, or attorney in fact
of any reciprocal insurer or Lloyds underwriter, or marine underwriting
office, unless acting as an auto body repair estimator as defined in
subsection (j) of this section;
(B) any officer, director or regular salaried employee of an insurer
authorized to write accident and health insurance, a corporation
licensed under article forty-three of this chapter (collectively, as
used in this paragraph, a "health insurer") or a health maintenance
S. 58--A 126 A. 158--A
organization, or any manager thereof, individual or corporate, when the
claim to be adjusted is issued [or administered] by another health
insurer or health maintenance organization within the same holding
company system as the health insurer or health maintenance organization
adjusting the claim;
(C) [any officer, director or regular salaried employee of an article
fifteen holding company or a controlled person within such holding
company system providing administrative services within that holding
company, or any manager thereof, individual or corporate, when the claim
to be adjusted is submitted for payment under a health benefit plan that
is issued or administered by a health insurer or health maintenance
organization within that same holding company system;
(D)] any officer, director or regular salaried employee of an author-
ized insurer that is licensed to write the kind of insurance to be
adjusted, or any manager thereof, individual or corporate, when the
claim to be adjusted is pursuant to a policy that is issued [or adminis-
tered] by another insurer within the same holding company system as the
authorized insurer adjusting the claim, unless acting as an auto body
repair estimator as defined in subsection (j) of this section;
[(E)] (D) any officer, director or regular salaried employee of an
authorized life insurance company, or any manager thereof, individual or
corporate, or the manager, agent or general agent of any department
thereof, individual or corporate, when the claim to be adjusted is
submitted under an insurance contract issued by another insurer and the
claim: (i) is within the scope of a contract of reinsurance between the
two insurers for all of the underlying risks and none of the underlying
risks are later reinsured back to the ceding insurer OR AN AFFILIATE,
PARENT OR SUBSIDIARY OF THE CEDING INSURER; and (ii) relates to a kind
of insurance that the authorized life insurance company adjusting the
claim is licensed to write;
(E) ANY OFFICER, DIRECTOR OR REGULAR SALARIED EMPLOYEE OF A LICENSED
INDEPENDENT ADJUSTER WHO DOES NOT INVESTIGATE OR ADJUST CLAIMS;
(F) any adjustment bureau or association owned and maintained by
insurers to adjust or investigate losses, or any regular salaried
employee or manager thereof who devotes substantially all of his time to
the business of such bureau or association, unless acting as an auto
body repair estimator as defined in subsection (j) of this section;
(G) any licensed agent of an authorized insurer who adjusts losses for
such insurer solely under policies issued through his or its agency,
provided the agent receives no compensation for such services in excess
of fifty dollars per loss adjusted;
(H) any licensed attorney at law of this state;
(I) any average adjuster or adjuster of maritime losses; or
(J) any agent or other representative of an insurer authorized to
issue life and annuity contracts, provided he receives no compensation
for such services.
S 123. The insurance law is amended by adding a new section 9112 to
read as follows:
S 9112. FEE ON INSURANCE CLAIMS PROCESSED BY AN INDEPENDENT ADJUSTER.
(A) AN INDEPENDENT ADJUSTER SHALL PAY A FEE OF ONE DOLLAR PER CLAIM FOR
EACH INSURANCE CLAIM OVER TWENTY DOLLARS IN VALUE THAT IT INVESTIGATES,
ADJUSTS, PAYS OR ADMINISTERS THE PAYMENT IN NEW YORK STATE. THE FEE
SHALL BE PAID ON A MONTHLY BASIS TO THE COMMISSIONER OF HEALTH OR THE
COMMISSIONER OF HEALTH'S DESIGNEE FOR DEPOSIT INTO THE HEALTH CARE
REFORM ACT RESOURCES FUND AUTHORIZED BY SECTION NINETY-TWO-DD OF THE
STATE FINANCE LAW. THE COMMISSIONER OF HEALTH MAY PERMIT AN INDEPENDENT
S. 58--A 127 A. 158--A
ADJUSTER THAT HAS AT LEAST TWELVE FULL MONTHS OF PAYMENT EXPERIENCE TO
MAKE ANNUAL, RATHER THAN MONTHLY PAYMENTS, BASED ON AN ANNUAL DEMON-
STRATION BY THE INDEPENDENT ADJUSTER THROUGH THE ADJUSTERS PRIOR YEARS'
PAYMENTS UNDER THIS SECTION THAT ITS PAYMENTS ARE NOT EXPECTED TO EXCEED
TWENTY-FIVE THOUSAND DOLLARS ANNUALLY.
(B) FEES PAID PURSUANT TO THIS SECTION SHALL BE SUBJECT TO AUDIT AND
COLLECTION BY THE COMMISSIONER OF HEALTH IN ACCORDANCE WITH THE
PROVISIONS OF SUBDIVISION EIGHT-A OF SECTION TWENTY-EIGHT HUNDRED
SEVEN-J OF THE PUBLIC HEALTH LAW.
(C) IF MORE THAN ONE INDEPENDENT ADJUSTER IS INVOLVED IN INVESTIGAT-
ING, ADJUSTING OR PAYING A CLAIM ON BEHALF OF AN INSURER, THE ADJUSTERS
MAY ENTER INTO AN APPORTIONMENT AGREEMENT TO SATISFY THE PAYMENT OBLI-
GATIONS OF THIS SECTION. AGGREGATE PAYMENTS MUST TOTAL ONE HUNDRED
PERCENT OF THE AMOUNT DUE. APPORTIONMENT AGREEMENTS AND ANY MODIFICA-
TIONS, AMENDMENTS OR TERMINATIONS THEREOF MUST BE IN WRITING, SIGNED BY
ALL PARTIES AND RETAINED FOR A PERIOD OF NOT LESS THAN SIX YEARS AFTER
TERMINATION OF THE AGREEMENT. THE INDEPENDENT ADJUSTER SHALL MAKE THE
AGREEMENT AVAILABLE TO THE COMMISSIONER OF HEALTH UPON REQUEST FOR AUDIT
VERIFICATION PURPOSES.
(D) THE FEE REQUIRED BY SUBSECTION (A) OF THIS SECTION SHALL NOT BE
ASSESSED UPON INSURANCE CLAIMS INVESTIGATED, ADJUSTED OR PAID IN
CONJUNCTION WITH:
(1) PART A OR B OF TITLE XVIII OF THE SOCIAL SECURITY ACT;
(2) TITLE XIX OF THE SOCIAL SECURITY ACT;
(3) THE FEDERAL EMPLOYEE HEALTH BENEFITS ACT, CHAPTER 5 U.S. CODE,
SECTION 8901-8913;
(4) THE CHILD HEALTH INSURANCE PROGRAM AUTHORIZED BY SECTION
TWENTY-FIVE HUNDRED ELEVEN OF THE PUBLIC HEALTH LAW;
(5) THE FAMILY HEALTH PLUS PROGRAM AUTHORIZED BY SECTION THREE HUNDRED
SIXTY-NINE-EE OF THE SOCIAL SERVICES LAW;
(6) CLAIMS ARISING UNDER AN INSURANCE CONTRACT ISSUED BY AN INSURER
SUBJECT TO THE FRANCHISE TAX ON GROSS DIRECT PREMIUMS PURSUANT TO ARTI-
CLE THIRTY-THREE OF THE TAX LAW;
(7) CLAIMS ARISING UNDER AN INSURANCE CONTRACT ISSUED BY AN INSURER
LICENSED UNDER ARTICLE FORTY-THREE, FORTY-FIVE, FORTY-SEVEN OR
SIXTY-SEVEN OF THIS CHAPTER OR THE STATE INSURANCE FUND;
(8) CLAIMS ARISING UNDER A CONTRACT ISSUED BY A LICENSED HEALTH MAIN-
TENANCE ORGANIZATION PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW;
(9) CLAIMS ARISING UNDER A CONTRACT ISSUED BY A CHARITABLE ANNUITY
SOCIETY THAT COMPLIES WITH THE REQUIREMENTS OF SECTION ONE THOUSAND ONE
HUNDRED TEN OF THIS CHAPTER; OR
(10) CLAIMS ARISING UNDER AN INSURANCE POLICY, WHERE THE GROSS PREMIUM
IS TAXABLE PURSUANT TO SUBSECTION (D) OF SECTION TWO THOUSAND ONE
HUNDRED EIGHTEEN OF THIS CHAPTER.
S 123-a. Subdivision 1 of section 2807-y of the public health law, as
added by section 67 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
1. For periods on and after January first, two thousand five, the
commissioner is authorized to contract with the article forty-three
insurance law plans, or such other contractors as the commissioner shall
designate, to receive and distribute funds from the allowances [and],
assessments AND FEES established pursuant to:
(a) subdivision eighteen of section twenty-eight hundred seven-c of
this article;
(b) section twenty-eight hundred seven-j of this article;
S. 58--A 128 A. 158--A
(c) section twenty-eight hundred seven-s of this article;
(d) section twenty-eight hundred seven-t of this article;
(e) section twenty-eight hundred seven-v of this article;
(f) section twenty-eight hundred seven-d of this article;
(g) section thirty-six hundred fourteen-a of this chapter; [and]
(h) section three hundred sixty-seven-i of the social services law[.];
AND
(I) SECTION NINE THOUSAND ONE HUNDRED TWELVE OF THE INSURANCE LAW.
S 123-b. Subdivision 8-a of section 2807-j of the public health law is
amended by adding a new paragraph (g) to read as follows:
(G) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTION ONE HUNDRED
TWELVE OR ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW OR ANY OTHER
LAW, AT THE DISCRETION OF THE COMMISSIONER WITHOUT A COMPETITIVE BID OR
REQUEST FOR PROPOSAL PROCESS, CONTRACTS IN EFFECT AS OF APRIL FIRST, TWO
THOUSAND NINE FOR THE PURPOSE OF CONDUCTING AUDITS OF PAYOR AND PROVIDER
COMPLIANCE WITH THE REQUIREMENTS OF THIS SECTION AND SECTIONS
TWENTY-EIGHT HUNDRED SEVEN-S AND TWENTY-EIGHT HUNDRED SEVEN-T OF THIS
ARTICLE MAY BE AMENDED AS NECESSARY FOR THE PURPOSE OF CONDUCTING PAYOR
COMPLIANCE AUDITS WITH REGARD TO THE REQUIREMENTS OF SUBDIVISION THIR-
TEEN OF THIS SECTION AND SECTION NINE THOUSAND ONE HUNDRED TWELVE OF THE
INSURANCE LAW.
S 124. Paragraph (kk) of subdivision 1 of section 2807-v of the public
health law, as amended by section 5 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
(kk) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds -- other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of [Medicaid] MEDICAL ASSISTANCE PROGRAM expenditures [for pharma-
cy services] from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) thirty-eight million eight hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(ii) up to two hundred ninety-five million dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) up to four hundred seventy-two million dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) up to nine hundred million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to eight hundred sixty-six million three hundred thousand
dollars for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) up to six hundred sixteen million seven hundred thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven;
(vii) up to five hundred seventy-eight million nine hundred twenty-
five thousand dollars for the period January first, two thousand eight
through December thirty-first, two thousand eight; AND
(viii) [up to five hundred fifty-one million dollars for the period]
WITHIN AMOUNTS APPROPRIATED ON AND AFTER January first, two thousand
nine [through December thirty-first, two thousand nine;
S. 58--A 129 A. 158--A
(ix) up to three hundred twenty million six hundred twenty-five thou-
sand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten; and
(x) up to sixty-one million one hundred twenty-five thousand dollars
for the period January first, two thousand eleven through March thirty-
first, two thousand eleven].
S 125. Paragraphs (a) and (b) of subdivision 2 of section 480-a of the
tax law, as added by chapter 190 of the laws of 1990, are amended to
read as follows:
(a) (I) Every retail dealer and every person owning or, if the owner
is not the operator, then any person operating one or more vending
machines through which cigarettes or tobacco products are sold in this
state, who is required under section eleven hundred thirty-six of this
chapter to file a return for the quarterly period ending on the last day
of August, nineteen hundred ninety or for the quarterly period ending on
the last day of August in any year thereafter, [shall] MUST file an
application for registration under this section with [such] THAT quar-
terly return, in such form as shall be prescribed by the commissioner
[of taxation and finance].
(II) Each retail dealer [shall] MUST pay an application fee with
[such] THE quarterly return [of one hundred dollars] DESCRIBED BY
SUBPARAGRAPH (I) OF THIS PARAGRAPH for each retail place of business in
this state through which it sells cigarettes or tobacco products, WHICH
IS BASED ON GROSS SALES OF THAT PLACE OF BUSINESS DURING THE PREVIOUS
CALENDAR YEAR. THE APPLICATION FEE IS: ONE THOUSAND DOLLARS FOR EACH
RETAIL LOCATION WITH GROSS SALES TOTALING LESS THAN ONE MILLION DOLLARS;
TWO THOUSAND FIVE HUNDRED DOLLARS FOR EACH RETAIL LOCATION WITH GROSS
SALES TOTALING AT LEAST ONE MILLION DOLLARS BUT LESS THAN TEN MILLION
DOLLARS; AND FIVE THOUSAND DOLLARS FOR EACH RETAIL LOCATION WITH GROSS
SALES TOTALING AT LEAST TEN MILLION DOLLARS.
(III) Every person who owns or, if the owner is not the operator, then
any person who operates one or more vending machines through which ciga-
rettes or tobacco products are sold in this state, regardless of whether
located on the premises of the vending machine owner or, if the owner is
not the operator, then the premises of the operator or the premises of
any other person, [shall] MUST pay an application fee with [such] THE
quarterly return [of twenty-five dollars] DESCRIBED BY SUBPARAGRAPH (I)
OF THIS PARAGRAPH for each [such] vending machine, WHICH IS BASED ON
GROSS SALES OF THAT VENDING MACHINE DURING THE PREVIOUS CALENDAR YEAR.
THE APPLICATION FEE IS: TWO HUNDRED FIFTY DOLLARS FOR EACH VENDING
MACHINE WITH GROSS SALES TOTALING LESS THAN ONE HUNDRED THOUSAND
DOLLARS; SIX HUNDRED TWENTY-FIVE DOLLARS FOR EACH VENDING MACHINE WITH
GROSS SALES TOTALING AT LEAST ONE HUNDRED THOUSAND DOLLARS BUT LESS THAN
ONE MILLION DOLLARS; AND ONE THOUSAND TWO HUNDRED FIFTY DOLLARS FOR EACH
VENDING MACHINE WITH GROSS SALES TOTALING AT LEAST ONE MILLION DOLLARS.
The department [shall] WILL issue a registration certificate, as
prescribed by the commissioner [of taxation and finance], after receipt
of a registration application and the appropriate registration fee,
prior to the next succeeding January first.
(b) Every retail dealer and every person who owns or, if the owner is
not the operator, then any person who operates one or more vending
machines through which cigarettes or tobacco products are sold in this
state who commences business after the last day of August, nineteen
hundred ninety, or who commences selling cigarettes or tobacco products
at retail through a new or different place of business in this state
after such date, or who commences selling cigarettes or tobacco products
S. 58--A 130 A. 158--A
through new or different vending machines after such date, [shall] MUST
file with the commissioner [of taxation and finance] an application for
registration, in a form prescribed by him OR HER, at least thirty days
prior to commencing [such] business or commencing [such] sales. Each
[such] application [shall] MUST be accompanied by an application fee [of
one hundred dollars] for each retail place of business [to be regis-
tered] and [twenty-five dollars for] each vending machine to be regis-
tered. THE AMOUNT OF THE APPLICATION FEE IS DETERMINED BY SUBPARAGRAPHS
(II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION, EXCEPT THAT ANY
RETAIL LOCATION OR VENDING MACHINE WITH ZERO DOLLARS IN GROSS SALES
DURING THE PREVIOUS CALENDAR YEAR IS SUBJECT TO THE LOWEST APPLICATION
FEE REQUIRED BY SUCH SUBPARAGRAPHS. The department, within ten days
after receipt of an application for registration under this paragraph
and payment of the proper fee for application for registration, [shall]
WILL issue a registration certificate, as prescribed by the commission-
er, for each retail place of business or cigarette or tobacco products
vending machine registered.
S 125-a. Subdivision 3 of section 480-a of the tax law, as amended by
chapter 262 of the laws of 2000, is amended to read as follows:
3. In addition to any other penalty imposed by this chapter: (a) Any
retail dealer who violates the provisions of this section [shall], after
due notice and an opportunity for a hearing, for a first violation [be]
IS liable for a civil fine not less than five [hundred] THOUSAND dollars
but not to exceed [two] TWENTY-FIVE thousand dollars and for a second or
subsequent violation within three years following a prior finding of
violation [be] IS liable for a civil fine not less than [one] TEN thou-
sand dollars but not to exceed [three thousand five hundred] THIRTY-FIVE
THOUSAND dollars; or
(b) Any person who owns or, if the owner is not the operator, then any
person who operates one or more vending machines through which ciga-
rettes or tobacco products are sold in this state and who violates the
provisions of this section [shall], after due notice and an opportunity
for a hearing, for a first violation [be] IS liable for a civil fine not
less than [seventy-five] SEVEN HUNDRED FIFTY dollars but not to exceed
two [hundred] THOUSAND dollars and for a second or subsequent violation
within three years following a prior finding of violation be liable for
a civil fine not less than two [hundred] THOUSAND dollars but not to
exceed six [hundred] THOUSAND dollars.
S 125-b. Section 482 of the tax law, as amended by section 3 of part
RR-1 of chapter 57 of the laws of 2008, is amended to read as follows:
S 482. Deposit and disposition of revenue. (A) All taxes, fees, inter-
est and penalties collected or received by the commissioner under this
article and article twenty-A of this chapter shall be deposited and
disposed of pursuant to the provisions of section one hundred seventy-
one-a of this chapter. (B) From the taxes, interest and penalties
collected or received by the commissioner under sections four hundred
seventy-one and four hundred seventy-one-a of this article, effective on
and after March first, two thousand, forty-nine and fifty-five
hundredths, and effective on and after February first, two thousand two,
forty-three and seventy hundredths; and effective on and after May
first, two thousand two, sixty-four and fifty-five hundredths; and
effective on and after April first, two thousand three, sixty-one and
twenty-two hundredths percent; and effective on and after June third,
two thousand eight, seventy and sixty-three hundredths percent collected
or received under [such] THOSE sections [shall] MUST be deposited to the
credit of the tobacco control and insurance initiatives pool to be
S. 58--A 131 A. 158--A
established and distributed by the commissioner of health in accordance
with section twenty-eight hundred seven-v of the public health law. (C)
FROM THE FEES COLLECTED OR RECEIVED BY THE COMMISSIONER UNDER SUBDIVI-
SION TWO OF SECTION FOUR HUNDRED EIGHTY-A OF THIS ARTICLE, EFFECTIVE ON
OR AFTER SEPTEMBER FIRST, TWO THOUSAND NINE, ANY MONIES COLLECTED OR
RECEIVED UNDER THAT SECTION IN EXCESS OF THREE MILLION DOLLARS MUST BE
DEPOSITED TO THE CREDIT OF THE TOBACCO CONTROL AND INSURANCE INITIATIVES
POOL TO BE DISTRIBUTED BY THE COMMISSIONER OF HEALTH IN ACCORDANCE WITH
SECTION TWENTY-EIGHT HUNDRED SEVEN-V OF THE PUBLIC HEALTH LAW.
S 125-c. Subdivisions (a) and (b) of section 92-dd of the state
finance law, as added by section 89 of part B of chapter 58 of the laws
of 2005, are amended to read as follows:
(a) On and after April first, two thousand five, such fund shall
consist of the revenues heretofore and hereafter collected or required
to be deposited pursuant to paragraph (a) of subdivision eighteen of
section twenty-eight hundred seven-c, and sections twenty-eight hundred
seven-j, twenty-eight hundred seven-s and twenty-eight hundred seven-t
of the public health law, SUBDIVISIONS (B) AND (C) OF section four
hundred eighty-two of the tax law and required to be credited to the
tobacco control and insurance initiatives pool, subparagraph (O) of
paragraph four of subsection (j) of section four thousand three hundred
one of the insurance law, section twenty-seven of part A of chapter one
of the laws of two thousand two and all other moneys credited or trans-
ferred thereto from any other fund or source pursuant to law.
(b) The pool administrator under contract with the commissioner of
health pursuant to section twenty-eight hundred seven-y of the public
health law shall continue to collect moneys required to be collected or
deposited pursuant to paragraph (a) of subdivision eighteen of section
twenty-eight hundred seven-c, and sections twenty-eight hundred seven-j,
twenty-eight hundred seven-s and twenty-eight hundred seven-t of the
public health law, and shall deposit such moneys in the HCRA resources
fund. The comptroller shall deposit moneys collected or required to be
deposited pursuant to SUBDIVISIONS (B) AND (C) OF section four hundred
eighty-two of the tax law and required to be credited to the tobacco
control and insurance initiatives pool, subparagraph (O) of paragraph
four of subsection (j) of section four thousand three hundred one of the
insurance law, section twenty-seven of part A of chapter one of the laws
of two thousand two and all other moneys credited or transferred thereto
from any other fund or source pursuant to law in the HCRA resources
fund.
S 125-d. Clause (i) of subparagraph 7 of paragraph (a) subdivision 2
of section 366 of the social services law, as added by section 47 of
part C of chapter 58 of the laws of 2008, is amended to read as follows:
(i) The amounts for one and two person households and families shall
be equal to twelve times the standard of monthly need IN EFFECT ON MAY
THIRTY-FIRST, TWO THOUSAND NINE OR SUCH HIGHER STANDARD AS MAY BE ESTAB-
LISHED for determining eligibility for and the amount of additional
state payments for aged, blind and disabled persons pursuant to section
two hundred nine of this article rounded up to the next highest one
hundred dollars for eligible individuals and couples living alone,
respectively.
S 126. 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
of the federal social security act in the public health law and the
S. 58--A 132 A. 158--A
social services law shall be deemed to include and also to mean any
successor titles thereto under the federal social security act.
S 127. Notwithstanding any inconsistent provision of law, rule or
regulation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of
section 2807 of the public health law and section 18 of chapter 2 of the
laws of 1988, as they relate to time frames for notice, approval or
certification of rates of payment, are hereby suspended and shall, for
purposes of implementing the provisions of this act, be deemed to have
been without any force or effect from and after October 1, 2008 for such
rates effective for the period January 1, 2008 through December 31,
2008.
S 128. 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 129. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009; provided
that:
(a) sections forty-three, forty-four, seventy-four and seventy-eight
through eighty-one of this act shall take effect April 1, 2009;
(b) sections forty-five and seventy-three of this act shall take
effect June 1, 2009;
(c) sections two through ten, twelve through twenty-three, twenty-five
through twenty-seven, sixty-two and one hundred four through one hundred
twelve of this act shall take effect July 1, 2009;
(d) sections twenty-nine, thirty-eight through forty-two, forty-six,
forty-seven, forty-eight and seventy-five of this act shall take effect
September 1, 2009;
(e) sections fifty through fifty-nine, one hundred twenty-two and one
hundred twenty-three of this act shall take effect October 1, 2009;
(f) sections sixty, sixty-one, sixty-three through sixty-seven,
sixty-seven-a, seventy-seven-b, one hundred eighteen and one hundred
nineteen of this act shall take effect April 1, 2010;
(g) section twenty-five of this act shall expire and be deemed
repealed April 1, 2013;
(h) section twenty-six of this act shall expire and be deemed repealed
April 1, 2014;
(h-1) section one hundred twenty-five of this act applies only to fees
related to applications for registration for the 2010 calendar year and
thereafter;
(h-2) sections one hundred twenty-five-a, one hundred twenty-five-b,
and one hundred twenty-five-c of this act shall take effect September 1,
2009.
(i) 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;
(j) 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;
S. 58--A 133 A. 158--A
(k) the commissioner of health and the superintendent of insurance and
any appropriate council may take any steps necessary to implement this
act prior to its effect date;
(l) 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 insurance and any
appropriate council is authorized to adopt or amend or promulgate 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;
(m) the provisions of this act shall become effective notwithstanding
the failure of the commissioner of health or the superintendent of
insurance or any council to adopt or amend or promulgate regulations
implementing this act;
(n) the amendments to section 364-f of the social services law made by
section thirty of this act shall not affect the expiration of such
section and shall be deemed to expire therewith;
(o) the amendments to subdivision 7 of section 274 of the public
health law made by section forty-five of this act shall not affect the
repeal of such section and shall be deemed repealed therewith;
(p) the amendments to paragraph (a-1) of subdivision 4 of section
365-a of the social services law made by section forty-six of this act
shall not affect the expiration of such paragraph and shall be deemed to
expire therewith;
(q) the amendments to subparagraph (iii) of paragraph (c) of subdivi-
sion 6 of section 367-a of the social services law made by section
forty-seven of this act shall not affect the expiration of such para-
graph and shall be deemed to expire therewith;
(r) the amendments to subdivision 9 of section 367-a of the social
services law made by sections forty-eight and forty-nine of this act
shall not affect the expiration of such subdivision and shall be deemed
to expire therewith;
(s) section 279 of the public health law as added by section fifty of
this act shall not affect the repeal of article 2-A of such law and
shall be deemed repealed therewith;
(t) section sixty-eight of this act shall take effect on the same date
and in the same manner as the amendments made to subparagraph (iii) of
paragraph (a) of subdivision 2 of section 369-ee of the social services
law by section 28 of part E of chapter 63 of the laws of 2005, takes
effect;
(u) the amendments to subdivision 8 of section 2510 of the public
health law made by section seventy-nine of this act shall not affect the
expiration of such subdivision and shall be deemed to expire therewith;
(v) the amendments to subdivision 5 of section 2511 of the public
health law made by section eighty of this act shall not affect the expi-
ration of such subdivision and shall be deemed to expire therewith;
(w) the amendments to section 2807-s of the public health law made by
sections one hundred and one hundred fourteen of this act shall not
affect the expiration of such section and shall be deemed to expire
therewith;
(x) the amendments to paragraph (c) of subdivision 5-a of section
2807-k of the public health law made by section one hundred two of this
act shall not affect the expiration of such subdivision and shall be
deemed to expire therewith;
(y) the amendments to subdivision one of section 241 of the elder law
made by section one hundred five of this act shall not affect the expi-
ration of such subdivision and shall be deemed to expire therewith; and
S. 58--A 134 A. 158--A
(z) the amendments to section 2807-j of the public health law made by
sections one hundred thirteen and one hundred twenty-three-b of this act
shall not affect the expiration of such section and shall be deemed to
expire therewith.
PART D
Section 1. The legislature finds that New York leads the nation in
Medicaid spending on long-term care services and that Medicaid spending
on home and personal care services are among the fastest growing areas
of Medicaid expenditure despite the fact that the number of benefici-
aries receiving these services has not increased. Current processes for
assessing the service needs of elderly and disabled beneficiaries do not
consistently result in appropriate placement and services and show wide
variation across the state. Current reimbursement levels and methodol-
ogies do not ensure quality or efficiency, with providers in the same
community serving comparable populations receiving markedly different
Medicaid payments. It is the intent of this legislation to ensure that
elderly and disabled beneficiaries have access to the right level of
care in the most appropriate setting; to implement transparent and accu-
rate reimbursement systems for nursing and home care services; and to
reward quality and efficiency as well as to make targeted investments to
improve long-term care services.
S 1-a. Short title. This act shall be known and may be cited as "The
Long-Term Care Reform Act".
S 2. Subdivision 2-b of section 2808 of the public health law is
amended by adding a new paragraph (h) to read as follows:
(H) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION OR ANY OTHER
CONTRARY PROVISION OF LAW OR REGULATION, THIS SUBDIVISION SHALL BE NULL
AND VOID AS OF MARCH FIRST, TWO THOUSAND NINE.
S 3. Section 2808 of the public health law is amended by adding a new
subdivision 2-c to read as follows:
2-C. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION
OR ANY OTHER CONTRARY PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY
OF FEDERAL FINANCIAL PARTICIPATION, THE OPERATING COSTS OF RATES OF
PAYMENT BY GOVERNMENTAL AGENCIES FOR INPATIENT SERVICES PROVIDED ON AND
AFTER MARCH FIRST, TWO THOUSAND NINE SHALL BE DETERMINED IN ACCORDANCE
WITH THE FOLLOWING:
(I) THE OPERATING COST COMPONENT OF FACILITIES' RATES WILL BE COMPUTED
ON A REGIONAL BASIS, USING ALLOWABLE OPERATING COSTS, AS DETERMINED BY
THE COMMISSIONER, FROM THE TWO THOUSAND FIVE CERTIFIED COST REPORTS FROM
FACILITIES ON FILE WITH THE DEPARTMENT AS OF DECEMBER FIRST, TWO THOU-
SAND EIGHT, AS ADJUSTED FOR INFLATION IN ACCORDANCE WITH PARAGRAPH (C)
OF SUBDIVISION TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THIS ARTI-
CLE. FOR THE PURPOSE OF THIS PARAGRAPH, THE REGIONS OF THE STATE SHALL
BE AS FOLLOWS:
(A) NEW YORK CITY, CONSISTING OF THE COUNTIES OF BRONX, NEW YORK,
KINGS, QUEENS AND RICHMOND;
(B) LONG ISLAND, CONSISTING OF THE COUNTIES OF NASSAU AND SUFFOLK;
(C) NORTHERN METROPOLITAN, CONSISTING OF THE COUNTIES OF COLUMBIA,
DELAWARE, DUTCHESS, ORANGE, PUTNAM, ROCKLAND, SULLIVAN, ULSTER AND WEST-
CHESTER;
(D) NORTHEAST CONSISTING OF THE COUNTIES OF ALBANY, CLINTON, ESSEX,
FULTON, GREENE, MONTGOMERY, RENSSELAER, SARATOGA, SCHENECTADY, SCHOHAR-
IE, WARREN AND WASHINGTON;
S. 58--A 135 A. 158--A
(E) UTICA/WATERTOWN, CONSISTING OF THE COUNTIES OF FRANKLIN, HAMILTON,
HERKIMER, LEWIS, OSWEGO, OTSEGO, ST. LAWRENCE, JEFFERSON, CHENANGO,
MADISON AND ONEIDA;
(F) CENTRAL, CONSISTING OF THE COUNTIES OF BROOME, CAYUGA, CHEMUNG,
CORTLAND, ONONDAGA, SCHUYLER, STEUBEN, TIOGA AND TOMPKINS;
(G) ROCHESTER, CONSISTING OF MONROE, ONTARIO, LIVINGSTON, SENECA,
WAYNE AND YATES; AND
(H) WESTERN, CONSISTING OF THE COUNTIES OF ALLEGANY, CATTARAUGUS,
CHAUTAUQUA, ERIE, GENESEE, NIAGARA, ORLEANS AND WYOMING.
(II) THE CAPITAL COMPONENT OF RATES ON AND AFTER JANUARY FIRST, TWO
THOUSAND NINE SHALL FULLY REFLECT THE COST OF LOCAL PROPERTY TAXES AND
PAYMENTS MADE IN LIEU OF LOCAL PROPERTY TAXES, AS REPORTED IN EACH
FACILITY'S COST REPORT SUBMITTED FOR THE YEAR TWO YEARS PRIOR TO THE
RATE YEAR.
(III) THE DIRECT COMPONENT OF THE OPERATING COMPONENT OF RATES SHALL
BE SUBJECT TO CASE MIX ADJUSTMENT THROUGH APPLICATION OF THE MINIMUM
DATA SET (MDS) CLASSIFICATION EMPLOYED BY THE FEDERAL GOVERNMENT WITH
REGARD TO PAYMENTS TO SKILLED NURSING FACILITIES PURSUANT TO TITLE XVIII
OF THE FEDERAL SOCIAL SECURITY ACT (MEDICARE) TO REFLECT PATIENT SERVICE
INTENSITY, AS MAY BE ADJUSTED BY THE COMMISSIONER. SUCH ADJUSTMENTS
SHALL BE MADE SEMI-ANNUALLY IN EACH CALENDAR YEAR, AND BOTH THE ADJUST-
MENTS AND THE RELATED PATIENT CLASSIFICATIONS IN EACH FACILITY SHALL BE
SUBJECT TO AUDIT REVIEW IN ACCORDANCE WITH REGULATIONS PROMULGATED BY
THE COMMISSIONER.
(IV) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW, RULE OR REGULATION, RATES OF PAYMENT
FOR INPATIENT SERVICES PROVIDED ON AND AFTER MARCH FIRST, TWO THOUSAND
NINE BY RESIDENTIAL HEALTH CARE FACILITIES SHALL, EXCEPT FOR THE ESTAB-
LISHMENT OF ANY REGIONAL PRICES, BE CALCULATED UTILIZING ONLY THE NUMBER
OF PATIENTS PROPERLY ASSESSED AND REPORTED IN EACH PATIENT CLASSIFICA-
TION GROUP AND ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO TITLE ELEVEN
OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
(V) NOTWITHSTANDING SUBPARAGRAPH (I) OF PARAGRAPH (A) OF THIS SUBDIVI-
SION, THE OPERATING COST COMPONENT OF THE RATES, EFFECTIVE MARCH FIRST,
TWO THOUSAND NINE FOR THE FOLLOWING CATEGORIES OF FACILITIES, AS ESTAB-
LISHED PURSUANT TO APPLICABLE REGULATIONS, SHALL REFLECT THE RATES IN
EFFECT FOR SUCH FACILITIES ON DECEMBER THIRTY-FIRST, TWO THOUSAND SIX,
AS ADJUSTED FOR INFLATION IN ACCORDANCE WITH PARAGRAPH (C) OF SUBDIVI-
SION TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THIS ARTICLE: (A)
AIDS FACILITIES OR DISCRETE AIDS UNITS WITHIN FACILITIES, (B) DISCRETE
UNITS FOR RESIDENTS RECEIVING CARE IN A LONG-TERM INPATIENT REHABILI-
TATION PROGRAM FOR TRAUMATIC BRAIN INJURED PERSONS, (C) DISCRETE UNITS
PROVIDING SPECIALIZED PROGRAMS FOR RESIDENTS REQUIRING BEHAVIORAL INTER-
VENTIONS, (D) DISCRETE UNITS FOR LONG-TERM VENTILATOR DEPENDENT RESI-
DENTS, AND (E) FACILITIES OR DISCRETE UNITS WITHIN FACILITIES THAT
PROVIDE EXTENSIVE NURSING, MEDICAL, PSYCHOLOGICAL AND COUNSELING SUPPORT
SERVICES SOLELY TO CHILDREN. SUCH RATE SHALL REMAIN IN EFFECT UNTIL THE
DEPARTMENT, IN CONSULTATION WITH REPRESENTATIVES OF THE NURSING HOME
INDUSTRY, AS SELECTED BY THE COMMISSIONER, DEVELOPS A REGIONAL PRICING
OR ALTERNATIVE METHODOLOGY FOR DETERMINING SUCH RATES.
(B) THE OPERATING COMPONENT OF RATES OF PAYMENT, AS ADJUSTED FOR
INFLATION IN ACCORDANCE WITH SUBPARAGRAPH (I) OF PARAGRAPH (A) OF THIS
SUBDIVISION, SHALL, BY NO LATER THAN THE TWO THOUSAND TWELVE RATE PERI-
OD, BE BASED ON ALLOWABLE COSTS, AS REPORTED ON ANNUAL FACILITY COST
REPORTS SUBMITTED AS REQUIRED BY THE COMMISSIONER, FROM A BASE YEAR
PERIOD NO EARLIER THAN THREE YEARS PRIOR TO THE INITIAL RATE YEAR.
S. 58--A 136 A. 158--A
THEREAFTER, THE BASE YEAR UTILIZED FOR RATE-SETTING PURPOSES SHALL BE
UPDATED TO BE CURRENT NO LESS FREQUENTLY THAN EVERY SIX YEARS; PROVIDED,
HOWEVER, THAT FOR THE PURPOSES OF THIS PARAGRAPH, CURRENT SHALL MEAN
THAT THE OPERATING COMPONENTS OF THE INITIAL RATE YEAR, UTILIZING SUCH
UPDATED BASE YEAR, SHALL REFLECT ALLOWABLE COSTS AS REPORTED IN ANNUAL
FACILITY COST REPORTS FOR PERIODS NO EARLIER THAN THREE YEARS PRIOR TO
SUCH INITIAL RATE YEAR, AS ADJUSTED FOR INFLATION IN ACCORDANCE WITH
SUBPARAGRAPH (I) OF PARAGRAPH (A) OF THIS SUBDIVISION.
(C) THE OPERATING COMPONENT OF RATES MAY BE ADJUSTED TO REFLECT A PER
DIEM ADD-ON, AS DETERMINED BY THE COMMISSIONER, FOR THE FOLLOWING
PATIENTS: (I) EACH PATIENT WHOSE BODY MASS INDEX IS GREATER THAN THIR-
TY-FIVE; (II) EACH PATIENT WHO QUALIFIES UNDER THE RUG-III IMPAIRED
COGNITION AND BEHAVIORAL PROBLEMS CATEGORIES, OR HAS BEEN DIAGNOSED WITH
ALZHEIMER'S DISEASE OR DEMENTIA, AND IS CLASSIFIED IN THE REDUCED PHYS-
ICAL FUNCTIONS A, B, OR C, OR IN BEHAVIORAL PROBLEMS A OR B CATEGORIES,
AND HAS AN ACTIVITIES OF DAILY LIVING INDEX SCORE OF LESS THAN TEN;
(III) EACH PATIENT WHO QUALIFIES FOR EXTENDED CARE AS A RESULT OF TRAU-
MATIC BRAIN INJURY AS DEFINED BY APPLICABLE REGULATIONS.
(D) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION OR
ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER MAY, SUBJECT TO
THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, MAKE ADDITIONAL
TRANSITION ADJUSTMENTS TO RATES OF PAYMENT FOR RESIDENTIAL HEALTH CARE
FACILITIES FOR THE PERIODS BEGINNING MARCH FIRST, TWO THOUSAND NINE
THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND THIRTEEN TO FACILITATE
IMPROVEMENTS IN RESIDENTIAL HEALTH CARE FACILITIES OPERATIONS AND
FINANCES IN ACCORDANCE WITH THE FOLLOWING:
(I) RESIDENTIAL HEALTH CARE FACILITIES ELIGIBLE FOR DISTRIBUTIONS
PURSUANT TO THIS PARAGRAPH SHALL BE THOSE NON-PUBLIC FACILITIES AND
STATE OPERATED PUBLIC RESIDENTIAL HEALTH CARE FACILITIES, WHICH HAVE AN
AVERAGE ANNUAL MEDICAID UTILIZATION PERCENTAGE OF FIFTY PERCENT OR
GREATER, FOR THE PERIOD TWO YEARS PRIOR TO THE RATE YEAR AND WHICH, AS
DETERMINED BY THE COMMISSIONER, EXPERIENCE A REDUCTION IN THEIR MEDICAID
REVENUE OF A PERCENTAGE AS DETERMINED BY THE COMMISSIONER AS A RESULT OF
THE APPLICATION OF REGIONAL PRICING AS DESCRIBED IN THIS SUBDIVISION.
(II) TRANSITION FUNDS DISTRIBUTED PURSUANT TO THIS PARAGRAPH SHALL BE
ALLOCATED BASED ON EACH ELIGIBLE FACILITY'S RELATIVE NEED AS DETERMINED
BY THE COMMISSIONER.
(III) TRANSITION FUNDING PURSUANT TO THIS PARAGRAPH SHALL BE AVAILABLE
FOR THE FOLLOWING PERIODS AND IN THE FOLLOWING AMOUNTS:
(A) FOR THE PERIOD MARCH FIRST, TWO THOUSAND NINE THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND TEN, UP TO SEVENTY-FIVE MILLION DOLLARS;
(B) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND ELEVEN, UP TO SEVENTY-FIVE MILLION DOLLARS;
(C) FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWELVE, UP TO FIFTY MILLION DOLLARS;
(D) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, UP TO TWENTY-FIVE MILLION DOLLARS.
(IV) PAYMENTS MADE PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT TO
RETROACTIVE ADJUSTMENT OR RECONCILIATION AND MAY BE ADDED TO RATES OF
PAYMENT OR MADE AS LUMP SUM PAYMENTS.
(V) EACH RESIDENTIAL HEALTH CARE FACILITY RECEIVING FUNDS PURSUANT TO
THIS PARAGRAPH SHALL, AS A CONDITION FOR ELIGIBILITY FOR SUCH FUNDS,
ADOPT A RESOLUTION OF THE BOARD OF DIRECTORS OR SUBMIT A REPORT BY THE
OWNER ACCEPTABLE TO THE COMMISSIONER SETTING FORTH ITS CURRENT FINANCIAL
CONDITION AND A PLAN FOR REFORMING AND IMPROVING SUCH FINANCIAL CONDI-
TION, INCLUDING ONGOING BOARD OR OWNER OVERSIGHT, AND SHALL, AFTER TWO
S. 58--A 137 A. 158--A
YEARS, ISSUE A REPORT AS ADOPTED BY EACH SUCH BOARD OR ISSUE A FURTHER
REPORT BY THE OWNER ACCEPTABLE TO THE COMMISSIONER SETTING FORTH WHAT
PROGRESS HAS BEEN ACHIEVED REGARDING SUCH IMPROVEMENT, PROVIDED, HOWEV-
ER, IF SUCH FURTHER REPORT IS NOT SUBMITTED TO THE COMMISSIONER, OR IF
SUCH FURTHER REPORT FAILS TO SET FORTH ADEQUATE PROGRESS, AS DETERMINED
BY THE COMMISSIONER, THE COMMISSIONER MAY DEEM SUCH FACILITY INELIGIBLE
FOR FURTHER DISTRIBUTIONS PURSUANT TO THIS PARAGRAPH AND MAY REDISTRIB-
UTE SUCH FURTHER DISTRIBUTIONS TO OTHER ELIGIBLE FACILITIES IN ACCORD-
ANCE WITH THE PROVISIONS OF THIS PARAGRAPH. THE COMMISSIONER SHALL BE
PROVIDED WITH COPIES OF ALL SUCH RESOLUTIONS AND REPORTS.
(E) THE COMMISSIONER MAY PROMULGATE REGULATIONS, INCLUDING EMERGENCY
REGULATIONS, TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
S 4. Subdivision 11 of section 2808 of the public health law, as
amended by chapter 474 of the laws of 1996, is amended to read as
follows:
11. Residential health care facility reimbursement rate promulgation.
With regard to a residential health care facility, the provisions of
[paragraph (a) of] subdivision seven of section twenty-eight hundred
seven of this article relating to advance notification of rates shall
not apply to prospective or retroactive adjustments to rates that are
based on rate appeals filed by such facility, audits, changes in patient
conditions or acuity levels, the correction of errors or omissions of
data or errors in the computations of such rates, the submission of cost
report data from facilities without an established cost basis, the judi-
cial annulment or invalidation of existing rates or changes in the meth-
odology used to compute rates which changes are promulgated following
the judicial annulment or invalidation of existing rates or as otherwise
authorized by law. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR
REGULATION, AS OF MARCH FIRST, TWO THOUSAND NINE, WITH REGARD TO ADMIN-
ISTRATIVE RATE APPEALS, THE DEPARTMENT WILL ONLY REVIEW SUCH APPEALS FOR
(A) THE CORRECTION OF COMPUTATIONAL ERRORS OR OMISSIONS OF DATA BY THE
DEPARTMENT IN DETERMINING THE OPERATING RATE BASED UPON THE INFORMATION
PROVIDED TO THE DEPARTMENT PRIOR TO THE COMPUTATION OF THE RATE, (B)
CAPITAL COST REIMBURSEMENT, OR (C) SUCH REASONS AS THE COMMISSIONER
DETERMINES ARE APPROPRIATE. THE DEPARTMENT WILL NOT CONSIDER ANY
REVISIONS MADE TO A FACILITY'S ANNUAL COST REPORT FOR OPERATING RATE
ADJUSTMENT PURPOSES LATER THAN THE DUE DATE ESTABLISHED BY THE COMMIS-
SIONER.
S 5. Paragraph d of subdivision 20 of section 2808 of the public
health law is relettered paragraph e and a new paragraph d is added to
read as follows:
D. (I) CAPITAL COST REIMBURSEMENT FOR PROPRIETARY RESIDENTIAL HEALTH
CARE FACILITIES. ANY PROPRIETARY FACILITY WHICH OTHERWISE WOULD BE ENTI-
TLED TO RESIDUAL REIMBURSEMENT AS PROVIDED UNDER APPLICABLE REGULATION,
MAY HAVE THE CAPITAL COST COMPONENT OF ITS RATE RECALCULATED BY THE
DEPARTMENT TO TAKE INTO ACCOUNT ANY CAPITAL IMPROVEMENTS AND/OR RENO-
VATIONS MADE TO THE FACILITY'S EXISTING INFRASTRUCTURE FOR THE PURPOSE
OF CONVERTING BEDS TO ALTERNATIVE LONG-TERM CARE USES OR PROTECTING THE
HEALTH AND SAFETY OF PATIENTS, SUBJECT TO THE APPROVAL OF THE COMMIS-
SIONER AND ALL APPLICABLE CERTIFICATE OF NEED REQUIREMENTS.
(II) THE DEPARTMENT SHALL EVALUATE THE ADEQUACY OF CURRENT CAPITAL
COST REIMBURSEMENT FOR VOLUNTARY RESIDENTIAL HEALTH CARE FACILITIES.
S 6. Notwithstanding any contrary provision of law, if the commission-
er of health determines that federal financial participation will not be
available with regard to the provisions of subparagraph (ii) of para-
graph (d) of subdivision 2-c of section 2808 of the public health law,
S. 58--A 138 A. 158--A
the commissioner of health may deem such provision null and void and
instead may allocate funds pursuant to such subparagraph (ii) propor-
tionally, based on each eligible facility's relative share of Medicaid
days in the year two years prior to the distribution year.
S 7. Subdivision 21 of section 2808 of the public health law, as added
by section 27 of part C of chapter 58 of the laws of 2004 and paragraphs
(a), (b), (f), (g) and (h) as amended by chapter 746 of the laws of
2004, is amended to read as follows:
21. (a) Notwithstanding any inconsistent provision of law or regu-
lation to the contrary, for the purposes specified in subdivision nine-
teen of this section, the commissioner shall adjust medical assistance
rates of payment established pursuant to this article for services
provided on and after October first, two thousand four through December
thirty-first, two thousand four and annually thereafter for services
provided on and after January first, two thousand five, to include a
rate adjustment to assist qualifying facilities pursuant to this subdi-
vision, PROVIDED, HOWEVER, THAT PUBLIC RESIDENTIAL HEALTH CARE FACILI-
TIES SHALL NOT BE ELIGIBLE FOR RATE ADJUSTMENTS PURSUANT TO THIS SUBDI-
VISION FOR RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND NINE.
(b) Eligibility for such rate adjustments shall be determined on the
basis of each residential health care facility's operating margin over
the most recent three-year period for which financial data are available
from the RHCF-4 cost report or the institutional cost report. For
purposes of the adjustments made for the period October first, two thou-
sand four through December thirty-first, two thousand four, financial
information for the calendar years two thousand through two thousand two
shall be utilized. For each subsequent rate year, the financial data for
the three-year period ending two years prior to the applicable rate year
shall be utilized for this purpose.
(c) Each facility's operating margin for the three-year period shall
be calculated by subtracting total operating expenses for the three-year
period from total operating revenues for the three-year period, and
dividing the result by the total operating revenues for the three-year
period, with the result expressed as a percentage. For hospital-based
residential health care facilities for which an operating margin cannot
be calculated on the basis of the submitted cost reports, the sponsoring
hospital's overall three-year operating margin, as reported in the
institutional cost report, shall be utilized for this purpose. All
facilities with negative operating margins calculated in this way over
the three-year period shall be arrayed into quartiles based on the
magnitude of the operating margin. Any facility with a positive operat-
ing margin for the most recent three-year period, a negative operating
margin that places the facility in the quartile of facilities with the
smallest negative operating margins, a positive total margin in the most
recent year of the three year period, or an average Medicaid utilization
percentage of fifty percent or less during the most recent year of the
three-year period shall be disqualified from receiving an adjustment
pursuant to this subdivision, PROVIDED, HOWEVER, THAT FOR RATE PERIODS
ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, SUCH DISQUALIFICATION:
(I) SHALL NOT BE APPLIED SOLELY ON THE BASIS OF A FACILITY'S HAVING A
POSITIVE TOTAL MARGIN IN THE MOST RECENT YEAR OF SUCH THREE-YEAR PERIOD;
(II) SHALL BE EXTENDED TO THOSE FACILITIES IN THE QUARTILE OF FACILI-
TIES WITH THE SECOND SMALLEST NEGATIVE OPERATING MARGINS; AND
(III) SHALL ALSO BE EXTENDED TO THOSE FACILITIES WITH AN AVERAGE MEDI-
CAID UTILIZATION PERCENTAGE OF LESS THAN SEVENTY PERCENT DURING THE MOST
RECENT YEAR OF THE THREE-YEAR PERIOD.
S. 58--A 139 A. 158--A
(d) For each facility remaining after the exclusions made pursuant to
paragraph (c) of this subdivision, the commissioner shall calculate the
average annual operating loss for the three-year period by subtracting
total operating expenses for the three-year period from total operating
revenues for the three-year period, and dividing the result by three,
PROVIDED, HOWEVER, THAT FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOU-
SAND NINE, THE AMOUNT OF SUCH AVERAGE ANNUAL OPERATING LOSS SHALL BE
REDUCED BY AN AMOUNT EQUAL TO THE AMOUNT RECEIVED BY SUCH FACILITY
PURSUANT TO SUBPARAGRAPH (II) OF PARAGRAPH (A) OF SUBDIVISION TWO-B OF
THIS SECTION. For this purpose, for hospital-based residential health
care facilities for which the average annual operating loss cannot be
calculated on the basis of the submitted cost reports, the sponsoring
hospital's overall average annual operating loss for the three-year
period shall be apportioned to the residential health care facility
based on the proportion the residential health care facility's total
revenues for the period bears to the total revenues reported by the
sponsoring hospital, AND SUCH APPORTIONED AVERAGE ANNUAL OPERATING LOSS
SHALL THEN BE REDUCED BY AN AMOUNT EQUAL TO THE AMOUNT RECEIVED BY SUCH
FACILITY PURSUANT TO SUBPARAGRAPH (II) OF PARAGRAPH (A) OF SUBDIVISION
TWO-B OF THIS SECTION.
(e) [Each] FOR PERIODS PRIOR TO APRIL FIRST, TWO THOUSAND NINE, EACH
such facility's qualifying operating loss shall be determined by multi-
plying the facility's average annual operating loss for the three-year
period as calculated pursuant to paragraph (d) of this subdivision by
the applicable percentage shown in the tables below for the quartile
within which the facility's negative operating margin for the three-year
period is assigned.
i. For a facility located in a county with a total population of two
hundred thousand or more as determined by the two thousand U.S. Census:
First Quartile (lowest operating margins): 30 percent
Second Quartile: 15 percent
Third Quartile: 7.5 percent
ii. For a facility located in a county with a total population of fewer
than two hundred thousand as determined by the two thousand U.S. Census:
First Quartile (lowest operating margins): 35 percent
Second Quartile: 20 percent
Third Quartile: 12.5 percent
(f) The amount of any facility's financially disadvantaged residential
health care facility distribution calculated in accordance with this
subdivision shall be reduced by the facility's estimated rate year bene-
fit of the two thousand one update to the regional input price adjust-
ment factors authorized pursuant to FORMER subdivision seventeen of this
section as amended by section 24 of part C of chapter 58 of the laws of
2004, OR AS AUTHORIZED BY SUBDIVISION SEVENTEEN-A OF THIS SECTION, AS
ADDED BY SECTION 56 OF PART C OF CHAPTER 58 OF THE LAWS OF 2007, if any,
PROVIDED, HOWEVER, THAT SUCH REDUCTION SHALL NOT BE APPLIED WITH REGARD
TO RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND NINE. After all
other adjustments to a facility's financially disadvantaged residential
health care facility distribution have been made in accordance with this
subdivision, the amount of each facility's distribution shall be limited
to no more than four hundred thousand dollars during the period October
first, two thousand four through December thirty-first, two thousand
S. 58--A 140 A. 158--A
four and [during any subsequent annual rate period], ON AN ANNUALIZED
BASIS, FOR RATE PERIODS THROUGH MARCH THIRTY-FIRST, TWO THOUSAND NINE,
AND NO MORE THAN ONE MILLION DOLLARS FOR THE PERIOD APRIL FIRST, TWO
THOUSAND NINE THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND NINE AND FOR
EACH ANNUAL RATE PERIOD THEREAFTER.
(g) The adjustment made to each qualifying facility's medical assist-
ance rate of payment determined pursuant to this article shall be calcu-
lated by dividing the facility's financially disadvantaged residential
health care facility distribution calculated in accordance with this
subdivision by the facility's total medical assistance patient days
reported in the cost report submitted two years prior to the rate year,
provided however, that such rate adjustments for the period October
first, two thousand four through December thirty-first, two thousand
four shall be calculated based on twenty-five percent of each facility's
reported total medical assistance patient days as reported in the appli-
cable two thousand two cost report. Such amounts shall not be reconciled
to reflect changes in medical assistance utilization between the year
two years prior to the rate year and the rate year.
(h) The total amount of funds to be allocated and distributed as
medical assistance for financially disadvantaged residential health care
facility rate adjustments to eligible facilities for a rate period in
accordance with this subdivision shall be thirty million dollars for the
period October first, two thousand four through December thirty-first,
two thousand four and thirty million dollars [for annual] ON AN ANNUAL-
IZED BASIS FOR rate periods on and after January first, two thousand
five THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHT AND FORTY MILLION
DOLLARS ON AN ANNUALIZED BASIS ON AND AFTER JANUARY FIRST, TWO THOUSAND
NINE. The nonfederal share of such [total shall be fifteen million
dollars which] RATE ADJUSTMENTS shall be paid by the state, with no
local share, from allocations made pursuant to paragraph (hh) of subdi-
vision one of section twenty-eight hundred seven-v of this chapter. In
the event the statewide total of the ANNUAL rate adjustments determined
pursuant to paragraph (g) of this subdivision varies from [thirty
million dollars] THE AMOUNTS SET FORTH IN THIS PARAGRAPH, each qualify-
ing facility's rate adjustment shall be proportionately increased or
decreased such that the total OF THE ANNUAL rate adjustments made pursu-
ant to this subdivision is equal to [thirty million dollars] THE AMOUNTS
SET FORTH IN THIS PARAGRAPH on a statewide basis.
(i) This subdivision shall be effective if, and as long as, federal
financial participation is available for expenditures made for benefici-
aries eligible for medical assistance under title XIX of the federal
social security act for the rate adjustments determined in accordance
with this subdivision.
(J) FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, RESIDEN-
TIAL HEALTH CARE FACILITIES WHICH ARE OTHERWISE ELIGIBLE FOR RATE
ADJUSTMENTS PURSUANT TO THIS SUBDIVISION SHALL ALSO, AS A CONDITION FOR
RECEIPT OF SUCH RATE ADJUSTMENTS, SUBMIT TO THE COMMISSIONER A WRITTEN
RESTRUCTURING PLAN THAT IS ACCEPTABLE TO THE COMMISSIONER AND WHICH IS
IN ACCORD WITH THE FOLLOWING:
(I) SUCH AN ACCEPTABLE PLAN SHALL BE SUBMITTED TO THE COMMISSIONER
WITHIN SIXTY DAYS OF THE FACILITY'S RECEIPT OF RATE ADJUSTMENTS PURSUANT
TO THIS SUBDIVISION FOR A RATE PERIOD SUBSEQUENT TO MARCH THIRTY-FIRST,
TWO THOUSAND EIGHT, PROVIDED, HOWEVER, THAT FACILITIES WHICH ARE ALLO-
CATED FOUR HUNDRED THOUSAND DOLLARS OR LESS ON AN ANNUALIZED BASIS SHALL
BE REQUIRED TO SUBMIT SUCH PLANS WITHIN ONE HUNDRED TWENTY DAYS, AND
S. 58--A 141 A. 158--A
FURTHER PROVIDED THAT THESE PERIODS MAY BE EXTENDED BY THE COMMISSIONER
BY NO MORE THAN THIRTY DAYS, FOR GOOD CAUSE SHOWN; AND
(II) SUCH PLAN SHALL PROVIDE A DETAILED DESCRIPTION OF THE STEPS THE
FACILITY WILL TAKE TO IMPROVE OPERATIONAL EFFICIENCY AND ALIGN ITS
EXPENDITURES WITH ITS REVENUES, AND SHALL INCLUDE A PROJECTED SCHEDULE
OF QUANTIFIABLE BENCHMARKS TO BE ACHIEVED IN THE IMPLEMENTATION OF THE
PLAN; AND
(III) SUCH PLAN SHALL REQUIRE PERIODIC REPORTS TO THE COMMISSIONER, IN
ACCORDANCE WITH A SCHEDULE ACCEPTABLE TO THE COMMISSIONER, SETTING FORTH
THE PROGRESS THE FACILITY HAS MADE IN IMPLEMENTING ITS PLAN; AND
(IV) SUCH PLAN MAY INCLUDE THE FACILITY'S RETENTION OF A QUALIFIED
CHIEF RESTRUCTURING OFFICER TO ASSIST IN THE IMPLEMENTATION OF THE PLAN,
PROVIDED, HOWEVER, THAT THIS REQUIREMENT MAY BE WAIVED BY THE COMMIS-
SIONER, FOR GOOD CAUSE SHOWN, UPON WRITTEN APPLICATION BY THE FACILITY.
(K) IF A RESIDENTIAL HEALTH CARE FACILITY FAILS TO SUBMIT AN ACCEPTA-
BLE RESTRUCTURING PLAN IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPH
(J) OF THIS SUBDIVISION, THE FACILITY SHALL, FROM THAT TIME FORWARD, BE
PRECLUDED FROM RECEIPT OF ALL FURTHER RATE ADJUSTMENTS MADE PURSUANT TO
THIS SUBDIVISION AND SHALL BE DEEMED INELIGIBLE FROM ANY FUTURE RE-AP-
PLICATION FOR SUCH ADJUSTMENTS. FURTHER, IF THE COMMISSIONER DETERMINES
THAT A FACILITY HAS FAILED TO MAKE SUBSTANTIAL PROGRESS IN IMPLEMENTING
ITS PLAN OR IN ACHIEVING THE BENCHMARKS SET FORTH IN SUCH PLAN, THEN THE
COMMISSIONER MAY, UPON THIRTY DAYS NOTICE TO THAT FACILITY, DISQUALIFY
THE FACILITY FROM FURTHER PARTICIPATION IN THE RATE ADJUSTMENTS AUTHOR-
IZED BY THIS SUBDIVISION AND THE COMMISSIONER MAY REQUIRE THE FACILITY
TO REPAY SOME OR ALL OF THE PREVIOUS RATE ADJUSTMENTS.
S 8. Clause (A) of subparagraph (i) of paragraph (a) of subdivision 18
of section 2808 of the public health law, as amended by section 73-b of
part C of chapter 58 of the laws of 2008, is amended to read as follows:
(A) fifty-three million five hundred thousand dollars on an annualized
basis for the period April first, two thousand two through December
thirty-first, two thousand two; eighty-three million three hundred thou-
sand dollars on an annualized basis for the period January first, two
thousand three through December thirty-first, two thousand three; one
hundred fifteen million eight hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand six; fifty-seven million nine hundred thou-
sand dollars for the period January first, two thousand seven through
June thirtieth, two thousand seven, fifty-seven million nine hundred
thousand dollars for the period July first, two thousand seven through
March thirty-first, two thousand eight, and [sixty-four] FIFTY-NINE
million [eight] FOUR hundred thousand dollars for the period April
first, two thousand eight through March [thirty-first] FIRST, two thou-
sand nine [and twenty-six million two hundred thousand dollars for the
period April first, two thousand nine through March thirty-first, two
thousand ten and each state fiscal year thereafter].
S 9. Clause (A) of subparagraph (i) of paragraph (b) of subdivision 18
of section 2808 of the public health law, as amended by section 73-a of
part C of chapter 58 of the laws of 2008, is amended to read as follows:
(A) seven million five hundred thousand dollars on an annualized basis
for the period April first, two thousand two through December thirty-
first, two thousand two; eleven million seven hundred thousand dollars
on an annualized basis for the period January first, two thousand three
through December thirty-first, two thousand three; sixteen million two
hundred thousand dollars on an annualized basis for the period January
first, two thousand four through December thirty-first, two thousand
S. 58--A 142 A. 158--A
six; and eight million one hundred thousand dollars for the period Janu-
ary first, two thousand seven through June thirtieth, two thousand
seven, eight million one hundred thousand dollars for the period July
first, two thousand seven through March thirty-first, two thousand
eight, [seven] SIX million [three] SIX hundred NINETY thousand dollars
for the period April first, two thousand eight through March [thirty-
first] FIRST, two thousand nine [and one million nine hundred thousand
dollars for the period April first, two thousand nine through March
thirty-first, two thousand ten and each state fiscal year thereafter].
S 9-a. Subdivision 5 of section 2808 of the public health law is
amended by adding a new paragraph (c) to read as follows:
(C) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION, ON
AND AFTER MARCH FIRST, TWO THOUSAND NINE, NO NON-PUBLIC RESIDENTIAL
HEALTH CARE FACILITY, WHETHER OPERATED AS A FOR-PROFIT FACILITY OR AS A
NOT-FOR-PROFIT FACILITY, MAY WITHDRAW EQUITY OR TRANSFER ASSETS WHICH IN
THE AGGREGATE EXCEED THREE PERCENT OF SUCH FACILITY'S TOTAL MEDICAID
REVENUE IN THE PRIOR CALENDAR YEAR, WITHOUT THE PRIOR WRITTEN APPROVAL
OF THE COMMISSIONER. THE COMMISSIONER SHALL MAKE A DETERMINATION TO
APPROVE OR DISAPPROVE A REQUEST FOR WITHDRAWAL OF EQUITY OR ASSETS UNDER
THIS SUBDIVISION WITHIN SIXTY DAYS OF THE DATE OF THE RECEIPT OF A WRIT-
TEN REQUEST FROM THE FACILITY. REQUESTS SHALL BE MADE IN A FORM ACCEPT-
ABLE TO THE DEPARTMENT BY CERTIFIED OR REGISTERED MAIL. IN ADDITION TO
ANY OTHER REMEDY OR PENALTY AVAILABLE UNDER THIS CHAPTER, AND AFTER
OPPORTUNITY FOR A HEARING, THE COMMISSIONER MAY REQUIRE REPLACEMENT OF
THE WITHDRAWN EQUITY OR ASSETS AND MAY IMPOSE A PENALTY FOR VIOLATION OF
THE PROVISIONS OF THIS SUBDIVISION IN AN AMOUNT NOT TO EXCEED TEN
PERCENT OF ANY AMOUNT WITHDRAWN WITHOUT PRIOR APPROVAL.
S 10. Notwithstanding any inconsistent provision of law or regulation,
effective March 1, 2009, for rates of payment by government agencies for
impatient services provided by residential health care facilities, in
determining the operating component of a facility's rate for care
provided for an AIDS patient in a residential health care facility
designated as an AIDS facility or having a discrete AIDS unit, the oper-
ating component shall not reflect an occupancy factor increase.
S 11. Paragraph (a) of subdivision 1 of section 461-l of the social
services law, as amended by chapter 597 of the laws of 2005, is amended
to read as follows:
(a) "Assisted living program" means an entity or entities with identi-
cal ownership, which are approved to operate pursuant to subdivision
three of this section and possesses a valid operating certificate as A
RESIDENTIAL HEALTH CARE FACILITY ISSUED PURSUANT TO ARTICLE TWENTY-EIGHT
OF THE PUBLIC HEALTH LAW OR an adult care facility, other than a shelter
for adults, a residence for adults or a family type home for adults,
issued pursuant to this article and which possesses either: (i) a valid
license as a home care services agency issued pursuant to section thir-
ty-six hundred five of the public health law; or (ii) a valid certif-
icate of approval as a certified home health agency issued pursuant to
section thirty-six hundred six of the public health law; or (iii) valid
authorization as a long term home health care program issued pursuant to
section thirty-six hundred ten of the public health law.
S 12. Paragraph (c) of subdivision 1 of section 461-l of the social
services law, as amended by chapter 597 of the laws of 2005, is amended
to read as follows:
(c) "Eligible applicant" means:
(i) A single entity [that is]:
S. 58--A 143 A. 158--A
(A) THAT IS only: (1) a natural person [or]; (2) A partnership
composed only of natural persons[,]; (3) a not-for-profit
corporation[,]; (4) a public corporation[,]; (5) a business corporation
other than a corporation whose shares are traded on a national securi-
ties exchange or are regularly quoted on a national over-the-counter
market or a subsidiary of such a corporation or a corporation any of the
stock of which is owned by another corporation[,]; (6) a limited liabil-
ity company provided that if a limited liability company has a member
that is a corporation, a limited liability company or a partnership, the
shareholders of the member corporation, the members of the member limit-
ed liability company, or the partners of the member partnership must be
natural persons[,]; (7) a social services district; or (8) other govern-
mental agency [which possesses or is eligible pursuant to this article
to apply for an adult care facility operating certificate]; [and]
(B) THAT (1) POSSESSES OR IS ELIGIBLE PURSUANT TO THIS ARTICLE TO
APPLY FOR AN ADULT CARE FACILITY OPERATING CERTIFICATE; OR (2) POSSESSES
A NURSING HOME OPERATING CERTIFICATE ISSUED PURSUANT TO ARTICLE TWENTY-
EIGHT OF THE PUBLIC HEALTH LAW; AND
(C) THAT IS either: (1) an entity which possesses or is eligible
pursuant to article thirty-six of the public health law to apply for
licensure as a home care services agency; (2) an entity which possesses
valid authorization as a long term home health care program; or (3) an
entity which possesses a valid certificate of approval as a certified
home health agency pursuant to article thirty-six of the public health
law; or
(ii) One or more entities listed in subparagraph (i) of this paragraph
with identical owners that, in combination, meet each of the criteria
set forth by subparagraph (i) of this paragraph.
S 13. Subdivision 4 of section 461-l of the social services law, as
added by chapter 165 of the laws of 1991, is amended to read as follows:
4. Revocation, suspension, limitation or annulment. Authorization to
operate an assisted living program may be revoked, suspended, limited or
annulled by the commissioner:
(A) in accordance with the provisions of this article if the adult
care facility fails to comply with applicable provisions of this chapter
or rules or regulations promulgated hereunder OR IF THE NURSING HOME
FAILS TO COMPLY WITH SUCH PROVISIONS OR THE PROVISIONS OF ARTICLE TWEN-
TY-EIGHT OF THE PUBLIC HEALTH LAW OR RULES OR REGULATIONS PROMULGATED
THEREUNDER; or [by the commissioner of health]
(B) in accordance with the provisions of article thirty-six of the
public health law if the licensed home care service agency, certified
home health agency or long term home health care program fails to comply
with the provisions of article thirty-six of the public health law or
rules or regulations promulgated thereunder.
S 14. Subdivision 3 of section 461-l of the social services law is
amended by adding a new paragraph (i) to read as follows:
(I) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ADD UP TO SIX THOUSAND
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 NINE, PROVIDED THAT, FOR EACH ASSISTED LIVING PROGRAM BED
SO ADDED, A NURSING HOME BED HAS BEEN DECERTIFIED UPON THE APPLICATION
OF THE NURSING HOME OPERATOR OR THAT THE COMMISSIONER OF HEALTH HAS
FOUND PURSUANT TO SUBDIVISION SIX OF SECTION TWENTY-EIGHT HUNDRED SIX OF
THE PUBLIC HEALTH LAW THAT ANY ASSISTED LIVING PROGRAM BED SO ADDED
WOULD SERVE AS A MORE APPROPRIATE ALTERNATIVE TO A CERTIFIED NURSING
HOME BED AND HAS ACCORDINGLY LIMITED OR REVOKED THE OPERATING CERTIF-
S. 58--A 144 A. 158--A
ICATE OF THE NURSING HOME PROVIDING THAT CERTIFIED NURSING HOME BED. THE
COMMISSIONER OF HEALTH SHALL NOT BE REQUIRED TO REVIEW ON A COMPARATIVE
BASIS APPLICATIONS SUBMITTED FOR ASSISTED LIVING PROGRAM BEDS MADE
AVAILABLE UNDER THIS PARAGRAPH. THE COMMISSIONER OF HEALTH SHALL ONLY
AUTHORIZE THE ADDITION OF SIX THOUSAND BEDS PURSUANT TO A FIVE YEAR
PLAN.
S 14-a. Paragraph (a) of subdivision 6 of section 3614 of the public
health law, as added by chapter 165 of the Laws of 1991 and amended by
chapter 645 of the Laws of 2003, is amended to read as follows:
(a) The commissioner shall, subject to the approval of the state
director of the budget, establish capitated rates of payment for
services provided by assisted living programs as defined by paragraph
(a) of subdivision one of section four hundred sixty-one-l of the social
services law. Such rates of payment shall be related to costs incurred
by residential health care facilities. The rates shall reflect the wage
equalization factor established by the commissioner for residential
health care facilities in the region in which the assisted living
program is provided and real property capital construction costs associ-
ated with the construction of a free-standing assisted living program
such rate shall include a payment equal to the cost of interest owed and
depreciation costs of such construction. The rates shall also reflect
the efficient provision of a quality and quantity of services to
patients in such residential health care facilities, with needs compara-
ble to the needs of residents served in such assisted living programs.
Such rates of payment shall be equal to fifty percent of the amounts
which otherwise would have been expended, BASED UPON THE MEAN PRICES FOR
THE FIRST OF JULY, NINETEEN HUNDRED NINETY-TWO (UTILIZING NINETEEN
HUNDRED EIGHTY-THREE COSTS) FOR FREESTANDING, LOW INTENSITY RESIDENTIAL
HEALTH CARE FACILITIES WITH LESS THAN THREE HUNDRED BEDS, AND FOR YEARS
SUBSEQUENT TO NINETEEN HUNDRED NINETY-TWO, ADJUSTED FOR INFLATION IN
ACCORDANCE WITH THE PROVISIONS OF SUBDIVISION TEN OF SECTION
TWENTY-EIGHT HUNDRED SEVEN-C OF THIS CHAPTER, to provide the appropriate
level of care for such residents in residential health care facilities
in the applicable wage equalization factor regions plus an amount equal
to capital construction costs associated with the construction of an
assisted living program facility as provided for in this subdivision.
S 15. Section 21 of chapter 1 of the laws of 1999 amending the public
health law and other laws relating to enacting the New York Health Care
Reform Act of 2000, as amended by section 8 of part A of chapter 57 of
the laws of 2000, is amended to read as follows:
S 21. Notwithstanding any inconsistent provision of law, effective
April 1, 2000, in determining rates of payment for residential health
care facilities pursuant to section 2808 of the public health law,
hospital outpatient services and diagnostic and treatment centers pursu-
ant to section 2807 of the public health law, unless otherwise subject
to the limits set forth in section 4 of chapter 81 of the laws of 1995,
as amended by this act, certified home health agencies and long term
home health care programs pursuant to section 3614-a of the public
health law and personal care services pursuant to section 367-i of the
social services law, AND FOR PERIODS ON AND AFTER MARCH 1, 2009, ADULT
DAY HEALTH CARE SERVICES PROVIDED TO PATIENTS DIAGNOSED WITH AIDS AS
DEFINED BY APPLICABLE REGULATIONS, the commissioner of health shall
apply trend factors using the methodology described in paragraph (c) of
subdivision 10 of section 2807-c of the public health law, except that
such trend factors shall not be applied to services for which rates of
payment are established by the commissioners of the department of mental
S. 58--A 145 A. 158--A
hygiene. Nothing in this section is intended to reduce a change in any
existing provision of law establishing maximum reimbursement rates.
S 16. Intentionally omitted.
S 16-a. Subparagraph (iii) of paragraph (a) of subdivision 23 of
section 2808 of the public health law, as added by section 29 of part C
of chapter 109 of the laws of 2006, is amended to read as follows:
(iii) For such programs which have not achieved an occupancy percent-
age of ninety percent or greater for a calendar year prior to April
first, two thousand seven, the operating component of the rate of
payment established pursuant to this article shall be calculated utiliz-
ing allowable costs reported in the first calendar year after two thou-
sand six in which such a program achieves an occupancy percentage of
ninety percent or greater effective January first of such calendar year
except for calendar year two thousand seven, effective no earlier than
April first of such year, provided, however, that effective January
first, two thousand nine, for programs that have not achieved an occu-
pancy percentage of ninety percent or greater for a calendar year prior
to January first, two thousand nine, the operating component of the rate
of payment established pursuant to this article shall be calculated
utilizing allowable costs reported in the two thousand nine cost report
filed by the sponsoring residential health care facility divided by
visits imputed at actual or ninety percent occupancy, whichever is
greater. THIS SUBPARAGRAPH SHALL ALSO APPLY TO PROGRAMS WHICH ACHIEVED
AN OCCUPANCY PERCENTAGE OF NINETY PERCENT OR GREATER PRIOR TO CALENDAR
YEAR TWO THOUSAND FOUR BUT IN SUCH YEAR HAD AN APPROVED CAPACITY THAT
WAS NOT THE SAME AS IN CALENDAR YEAR TWO THOUSAND FOUR.
S 16-b. Paragraph (e-1) of subdivision 12 of section 2808 of the
public health law, as amended by section 64 of part C of chapter 58 of
the laws of 2007, 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. 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 representative succeeding year as applicable.
S 17. Section 3614 of the public health law is amended by adding a new
subdivision 12 to read as follows:
12. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGU-
LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
IPATION, EFFECTIVE JANUARY FIRST, TWO THOUSAND TEN, PAYMENTS BY GOVERN-
MENT AGENCIES FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES
S. 58--A 146 A. 158--A
SHALL BE BASED ON EPISODIC PAYMENTS. IN ESTABLISHING SUCH PAYMENTS, A
STATEWIDE BASE PRICE SHALL BE ESTABLISHED FOR EACH SIXTY DAY EPISODE OF
CARE AND ADJUSTED BY A PROVIDER REGIONAL WAGE INDEX FACTOR AND AN INDI-
VIDUAL PATIENT CASE MIX INDEX. SUCH EPISODIC PAYMENTS MAY BE FURTHER
ADJUSTED FOR LOW UTILIZATION CASES AND TO REFLECT A PERCENTAGE OF THE
COST FOR HIGH-UTILIZATION CASES THAT EXCEED OUTLIER THRESHOLDS OF SUCH
PAYMENTS. BASE YEAR EPISODIC PAYMENTS SHALL BE FURTHER ADJUSTED TO THE
APPLICABLE RATE YEAR IN ACCORDANCE WITH PARAGRAPH C OF SUBDIVISION TEN
OF SECTION TWO THOUSAND EIGHT HUNDRED SEVEN-C OF THIS CHAPTER.
(B) INITIAL BASE YEAR EPISODIC PAYMENTS SHALL BE BASED ON MEDICAID
PAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, FOR SERVICE PROVIDED BY
ALL CERTIFIED HOME HEALTH AGENCIES IN THE BASE YEAR TWO THOUSAND SEVEN.
SUBSEQUENT BASE YEAR EPISODIC PAYMENTS MAY BE BASED ON MEDICAID PAID
CLAIMS FOR SERVICES PROVIDED BY ALL CERTIFIED HOME HEALTH AGENCIES IN A
BASE YEAR SUBSEQUENT TO TWO THOUSAND SEVEN AND AS DETERMINED BY THE
COMMISSIONER. IN DETERMINING CASE MIX, EACH PATIENT SHALL BE CLASSIFIED
USING A SYSTEM BASED ON MEASURES INCLUDING, BUT NOT LIMITED TO, CLINICAL
AND FUNCTIONAL MEASURES, AS REPORTED ON THE FEDERAL OUTCOME AND ASSESS-
MENT INFORMATION SET (OASIS).
(C) AS DETERMINED BY THE COMMISSIONER, AGENCIES WILL BE REQUIRED TO
COLLECT AND SUBMIT ANY DATA REQUIRED TO IMPLEMENT THIS SECTION. THE
COMMISSIONER MAY ADOPT REGULATIONS, INCLUDING EMERGENCY REGULATIONS, TO
IMPLEMENT THE PROVISIONS OF THIS SECTION.
S 18. Paragraph (a) of subdivision 5 of section 3614 of the public
health law, as added by chapter 884 of the laws of 1990, is amended to
read as follows:
(a) During the period July first, nineteen hundred ninety through
December thirty-first, nineteen hundred ninety, the period January
first, nineteen hundred ninety-one through December thirty-first, nine-
teen hundred ninety-one and for each calendar year period commencing on
January first thereafter, rates of payment by governmental agencies
established in accordance with subdivision three of this section appli-
cable for services provided by certified home health agencies to indi-
viduals eligible for medical assistance pursuant to title eleven of
article five of the social services law for certified home health agen-
cies which can demonstrate, on forms provided by the commissioner, loss-
es from a disproportionate share of bad debt and charity care during the
base year period as used in determining such rates may include an allow-
ance determined in accordance with this subdivision to reflect the needs
of the certified home health agency for the financing of losses result-
ing from bad debt and the cost of charity care. Losses resulting from
bad debt and the delivery of charity care shall be determined by the
commissioner considering, but not limited to, such factors as the losses
resulting from bad debt and the costs of charity care provided by the
certified home health agency and the availability of other financial
support, including state local assistance public health aid, to meet the
losses resulting from bad debt and the costs of charity care of the
certified home health agency. The bad debt and charity care allowance
for a certified home health agency for a rate period shall be determined
by the commissioner in accordance with rules and regulations adopted by
the state hospital review and planning council and approved by the
commissioner, and shall be consistent with the purposes for which such
allowances are authorized for general hospitals pursuant to the
provisions of article twenty-eight of this chapter and rules and regu-
lations promulgated by the commissioner. For purposes of distribution of
bad debt and charity care allowances to eligible certified home health
S. 58--A 147 A. 158--A
agencies, the commissioner, in accordance with rules and regulations
adopted by the state hospital review and planning council and approved
by the commissioner, may limit application of a bad debt and charity
care allowance to a particular home care services unit or units of
service, such as nursing service. A certified home health agency apply-
ing for a bad debt and charity care allowance pursuant to this subdivi-
sion shall provide assurances satisfactory to the commissioner that it
shall undertake reasonable efforts to maintain financial support from
community and public funding sources and reasonable efforts to collect
payments for services from third party insurance payors, governmental
payors and self-paying patients. To be eligible for an allowance pursu-
ant to this subdivision, a certified home health agency shall: have
professional assistance available on a seven day per week, twenty-four
hour per day basis to all registered clients [and must]; demonstrate
compliance with minimum charity care certification obligation levels
established pursuant to rules and regulations adopted by the state
hospital review and planning council and approved by the commissioner;
AND PROVIDE TO THE COMMISSIONER AND MAINTAIN A COMMUNITY SERVICE PLAN
WHICH OUTLINES THE AGENCY'S ORGANIZATIONAL MISSION AND COMMITMENT TO
MEET THE HOME CARE NEEDS OF THE COMMUNITY, IN ACCORDANCE WITH PARAGRAPH
(H) OF THIS SUBDIVISION.
S 19. Paragraph (h) of subdivision 5 of section 3614 of the public
health law is relettered paragraph (i) and a new paragraph (h) is added
to read as follows:
(H) COMMUNITY SERVICE PLANS. (I) THE GOVERNING BODY OF A CERTIFIED
HOME HEALTH AGENCY SHALL ISSUE AN ORGANIZATIONAL MISSION STATEMENT IDEN-
TIFYING AT A MINIMUM THE POPULATIONS AND COMMUNITIES SERVED BY THE AGEN-
CY AND THE AGENCY'S COMMITMENT TO MEETING THE HOME CARE NEEDS OF THE
COMMUNITY. THE COMMISSIONER SHALL TAKE INTO CONSIDERATION THE LIMITA-
TIONS OF AGENCY SIZE AND RESOURCES, AND ALLOW FLEXIBILITY IN COMPLYING
WITH THE PROVISIONS OF THIS SECTION.
(II) THE GOVERNING BODY OF THE CERTIFIED HOME HEALTH AGENCY SHALL AT
LEAST ONCE EVERY THREE YEARS:
(A) REVIEW AND AMEND AS NECESSARY THE AGENCY'S MISSION STATEMENT;
(B) SOLICIT THE VIEWS OF THE COMMUNITIES SERVED BY THE AGENCY ON SUCH
ISSUES AS THE AGENCY'S PERFORMANCE AND SERVICE PRIORITIES;
(C) DEMONSTRATE THE AGENCY'S OPERATIONAL AND FINANCIAL COMMITMENT TO
MEETING COMMUNITY HOME CARE NEEDS, TO PROVIDE CHARITY CARE SERVICE AND
TO IMPROVE ACCESS TO HOME CARE SERVICES BY THE UNDERSERVED; AND
(D) PREPARE AND MAKE AVAILABLE TO THE PUBLIC A STATEMENT SHOWING THE
PROVISION OF FREE, REDUCED CHARGE AND/OR OTHER SERVICES OF A CHARITABLE
OR COMMUNITY NATURE.
(III) THE GOVERNING BODY OF THE CERTIFIED HOME HEALTH AGENCY SHALL
ANNUALLY MAKE AVAILABLE TO THE PUBLIC A REVIEW OF THE AGENCY'S PERFORM-
ANCE IN MEETING THE HOME CARE NEEDS OF THE COMMUNITY, PROVIDING CHARITY
CARE SERVICES, AND IMPROVING ACCESS TO HOME CARE SERVICES BY THE UNDER-
SERVED.
(IV) THE GOVERNING BODY OF THE CERTIFIED HOME HEALTH AGENCY SHALL FILE
WITH THE COMMISSIONER ITS MISSION STATEMENT, ITS ANNUAL PERFORMANCE
REVIEW, AND AT LEAST EVERY THREE YEARS A REPORT DETAILING AMENDMENTS TO
THE STATEMENT REFLECTING CHANGES IN THE AGENCY'S OPERATIONAL AND FINAN-
CIAL COMMITMENT TO MEETING THE HOME CARE NEEDS OF THE COMMUNITY, PROVID-
ING CHARITY CARE SERVICES, AND IMPROVING ACCESS TO HOME CARE SERVICES BY
THE UNDERSERVED.
(V) THE COMMISSIONER SHALL PROMULGATE REGULATIONS ESTABLISHING A
REVISED PERCENTAGE FOR THE CHARITY CARE REQUIREMENT.
S. 58--A 148 A. 158--A
S 19-a. Paragraphs (e) and (f) of subdivision 9 of section 3614 of the
public health law, as amended by section 22-e of part B of chapter 58 of
the laws of 2008, are amended to read as follows:
(e) for the period April first, two thousand nine through March thir-
ty-first, two thousand ten, up to [one hundred] NINETY million SEVEN
HUNDRED FIFTY THOUSAND dollars, PROVIDED, HOWEVER, THAT UP TO
TWENTY-SEVEN MILLION SEVEN HUNDRED FIFTY THOUSAND DOLLARS OF SUCH AMOUNT
SHALL BE RESERVED AND DISTRIBUTED TO CERTIFIED HOME HEALTH AGENCIES FOR
THE PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH DECEMBER THIRTY-FIRST,
TWO THOUSAND NINE IN ACCORDANCE WITH THE PROVISIONS OF SUBDIVISION TEN
OF THIS SECTION, AND FURTHER PROVIDED THAT THE REMAINING FUNDS SHALL BE
DISTRIBUTED TO ELIGIBLE PROVIDERS THAT ARE NOT CERTIFIED HOME HEALTH
AGENCIES AND FURTHER PROVIDED THAT ON AND AFTER JANUARY FIRST, TWO THOU-
SAND TEN CERTIFIED HOME HEALTH AGENCIES SHALL NOT BE ELIGIBLE FOR
DISTRIBUTIONS PURSUANT TO THIS SUBDIVISION AND SUBDIVISION TEN;
(f) for the period April first, two thousand ten through March thir-
ty-first, two thousand eleven, up to [one hundred] SIXTY-THREE million
dollars.
S 20. Subdivision 3 of section 367-e of the social services law, as
added by chapter 622 of the laws of 1988, is amended to read as follows:
3. The commissioner shall apply for any waivers, including home and
community based services waivers pursuant to section nineteen hundred
fifteen-c of the social security act, necessary to implement AIDS home
care programs. Notwithstanding any inconsistent provision of law but
subject to expenditure limitations of this section, the commissioner,
subject to the approval of the state director of the budget, may author-
ize the utilization of medical assistance funds to pay for services
provided by AIDS home care programs in addition to those services
included in the medical assistance program under section three hundred
sixty-five-a of this [chapter] TITLE, so long as federal financial
participation is available for such services. TOTAL MONTHLY EXPENDI-
TURES MADE UNDER THIS TITLE FOR A PERSON RECEIVING AIDS HOME CARE
PROGRAM SERVICES SHALL NOT EXCEED ONE HUNDRED PERCENT OF THE AVERAGE OF
THE CURRENT MONTHLY RATES PAYABLE UNDER THIS TITLE FOR NURSING HOME
SERVICES WITHIN THE APPLICABLE SOCIAL SERVICES DISTRICT. HOWEVER, IF A
CONTINUING ASSESSMENT OF SUCH PERSON'S NEEDS DEMONSTRATES THAT HE OR SHE
REQUIRES INCREASED SERVICES, THE SOCIAL SERVICES OFFICIAL MAY AUTHORIZE
THE EXPENDITURE OF ANY AMOUNT ACCRUED UNDER THIS SECTION DURING THE PAST
TWELVE MONTHS AS THE RESULT OF THE EXPENDITURES FOR THAT PERSON NOT
HAVING EXCEEDED SUCH MAXIMUM AMOUNT. IF THE ASSESSMENT OF SUCH PERSON'S
NEEDS DEMONSTRATES THAT HE OR SHE REQUIRES INCREASED SERVICES THE
PAYMENT FOR WHICH WOULD EXCEED SUCH MONTHLY MAXIMUM, BUT IT CAN BE
REASONABLY ANTICIPATED THAT TOTAL EXPENDITURES FOR REQUIRED SERVICES FOR
SUCH PERSON WILL NOT EXCEED SUCH MAXIMUM CALCULATED OVER A ONE YEAR
PERIOD, THE SOCIAL SERVICES OFFICIAL MAY AUTHORIZE PAYMENT FOR SUCH
SERVICES. Expenditures made under this subdivision shall be deemed
payments for medical assistance for needy persons and shall be subject
to reimbursement by the state in accordance with the provisions of
section three hundred sixty-eight-a of this [chapter] TITLE.
S 21. Paragraph (k) of subdivision 2 of section 365-a of the social
services law, as amended by chapter 659 of the laws of 1997, is amended
to read as follows:
(k) care and services furnished by an entity offering a comprehensive
health services plan, including an entity that has received a certif-
icate of authority pursuant to sections forty-four hundred three,
forty-four hundred three-a or forty-four hundred eight-a of the public
S. 58--A 149 A. 158--A
health law (as added by chapter six hundred thirty-nine of the laws of
nineteen hundred ninety-six) or a health maintenance organization
authorized under article forty-three of the insurance law, to eligible
individuals residing in the geographic area served by such entity, when
such services are furnished in accordance with an agreement approved by
the department which meets the requirements of federal law and regu-
lations provided, that no such agreement shall allow for medical assist-
ance payments on a capitated basis for nursing facility[, home care or
other long term care] services of a duration and scope defined in regu-
lations of the department of health promulgated pursuant to section
forty-four hundred three-f of the public health law, unless such entity
has received a certificate of authority as a managed long term care plan
or is an operating demonstration or is an approved managed long term
care demonstration, pursuant to such section.
S 22. Subdivision 4 of section 4403-f of the public health law is
REPEALED and two new subdivisions 4 and 4-a are added to read as
follows:
4. SOLVENCY. (A) THE COMMISSIONER, WITH REGARD TO FISCAL SOLVENCY,
SHALL BE RESPONSIBLE FOR EVALUATING, APPROVING AND REGULATING ALL
MATTERS RELATING TO FISCAL SOLVENCY, INCLUDING RESERVES, SURPLUS AND
PROVIDER CONTRACTS. THE COMMISSIONER MAY PROMULGATE REGULATIONS TO
IMPLEMENT THIS SECTION. THE COMMISSIONER, IN THE ADMINISTRATION OF THIS
SUBDIVISION:
(I) SHALL BE GUIDED BY THE STANDARDS WHICH 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 MANAGED LONG TERM CARE
PLANS. THE COMMISSIONER SHALL BE SATISFIED THAT THE ELIGIBLE APPLICANT
IS FINANCIALLY SOUND, AND HAS MADE ADEQUATE PROVISIONS TO PAY FOR
SERVICES.
4-A. ROLE OF THE SUPERINTENDENT OF INSURANCE. (A) THE SUPERINTENDENT
OF INSURANCE 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 INSURANCE SHALL
RELATE TO PREMIUMS CHARGED TO THOSE ENROLLEES NOT ELIGIBLE UNDER TITLE
XIX OF THE FEDERAL SOCIAL SECURITY ACT.
(B) THE SUPERINTENDENT OF INSURANCE SHALL EVALUATE AND APPROVE ANY
ENROLLEE CONTRACTS WHENEVER THOSE ENROLLEE CONTRACTS ARE TO COVER ANY
POPULATION OF ENROLLEES NOT ELIGIBLE UNDER TITLE XIX OF THE FEDERAL
SOCIAL SECURITY ACT.
S 22-a. Subdivision 6 of section 4403-f of the public health law, as
added by chapter 659 of the laws of 1997, paragraph (a) as added by
section 16 and paragraph (d) as amended by section 17 of part C of chap-
ter 58 of the laws of 2007, is amended to read as follows:
6. Approval authority. (a) An applicant shall be issued a certificate
of authority as a managed long term care plan upon a determination by
the commissioner[, subject to any applicable evaluations, approvals, and
regulations of the superintendent of insurance as stated in this
S. 58--A 150 A. 158--A
section,] that the applicant complies with the operating requirements
for a managed long term care plan under this section. The commissioner
shall issue no more than fifty certificates of authority to managed long
term care plans pursuant to this section. For purposes of issuance of no
more than fifty certificates of authority, such certificates shall
include those certificates issued pursuant to paragraphs (b) and (c) of
this subdivision.
(b) An operating demonstration shall be issued a certificate of
authority as a managed long term care plan upon a determination by the
commissioner[, subject to the necessary evaluations, approvals and regu-
lations of the superintendent of insurance as stated in this section,]
that such demonstration complies with the operating requirements for a
managed long term care plan under this section. Except as otherwise
expressly provided in paragraphs (d) and (e) of subdivision seven of
this section, nothing in this section shall be construed to affect the
continued legal authority of an operating demonstration to operate its
previously approved program.
(c) An approved managed long term care demonstration shall be issued a
certificate of authority as a managed long term care plan upon a deter-
mination by the commissioner[, subject to the necessary evaluations,
approvals and regulations of the superintendent of insurance set forth
in this section,] that such demonstration complies with the operating
requirements for a managed long term care plan under this section.
Notwithstanding any inconsistent provision of law to the contrary, all
authority for the operation of approved managed long term care demon-
strations which have not been issued a certificate of authority as a
managed long term care plan, shall expire one year after the adoption of
regulations implementing managed long term care plans.
(d) The majority leader of the senate and the speaker of the assembly
may each designate in writing up to fifteen eligible applicants to apply
to be approved managed long term care demonstrations or plans. The
commissioner may designate in writing up to eleven eligible applicants
to apply to be approved managed long term care demonstrations or plans.
S 22-b. Paragraph (f) of subdivision 7 of section 4403-f of the public
health law, as added by chapter 659 of the laws of 1997 and as relet-
tered by section 20 of part C of chapter 58 of the laws of 2007, is
amended to read as follows:
(f) Continuation of a certificate of authority issued under this
section[, subject to the necessary evaluations, approvals and regu-
lations of the superintendent of insurance,] shall be contingent upon
satisfactory performance by the managed long term care plan in the
delivery, continuity, accessibility, cost effectiveness and quality of
the services to enrolled members; compliance with applicable provisions
of this section and rules and regulations promulgated thereunder; the
continuing fiscal solvency of the organization; and, federal financial
participation in payments on behalf [on] OF enrollees who are eligible
to receive services under title XIX of the federal social security act.
S 22-c. Subdivision 9 of section 4403-f of the public health law, as
added by chapter 659 of the laws of 1997, is amended to read as follows:
9. Reports. The department shall provide an interim report to the
governor, temporary president of the senate and the speaker of the
assembly on or before April first, two thousand three and a final report
on or before April first, two thousand six on the results of the managed
long term care plans under this section. Such results shall be based on
data provided by the managed long term care plans and shall include but
not be limited to the quality, accessibility and appropriateness of
S. 58--A 151 A. 158--A
services; consumer satisfaction; the mean and distribution of impairment
measures of the enrollees by payor for each plan; the current method of
calculating premiums and the cost of comparable health and long term
care services provided on a fee-for-service basis for enrollees eligible
for services under title XIX of the federal social security act; and the
results of periodic reviews of enrollment levels and practices. [Such
reports shall contain a section prepared by the superintendent of insur-
ance as to the results of the plans approved in accordance with this
section concerning the matters regulated by the superintendent of insur-
ance.] Such reports shall [also] provide data on the demographic and
clinical characteristics of enrollees, voluntary and involuntary disen-
rollments from plans, utilization of services and shall examine the
feasibility of increasing the number of plans that may be approved. Data
collected pursuant to this section shall be available to the public in
an aggregated format to protect individual confidentiality, however
under no circumstance will data be released on items with cells with
smaller than statistically acceptable standards.
S 23. The social services law is amended by adding a new section 367-w
to read as follows:
S 367-W. REGIONAL LONG-TERM CARE ASSESSMENT CENTERS. 1. NOTWITHSTAND-
ING ANY PROVISION OF LAW TO THE CONTRARY, THE DEPARTMENT OF HEALTH IS
AUTHORIZED TO ESTABLISH LONG-TERM CARE ASSESSMENT CENTERS TO SERVE
REGIONS OF THE STATE AS MAY BE ESTABLISHED BY THE DEPARTMENT OF HEALTH,
INCLUDING THE CITY OF NEW YORK, FOR THE PURPOSE OF TRANSFERRING FROM THE
SOCIAL SERVICES DISTRICT TO THE REGIONAL LONG-TERM CARE ASSESSMENT
CENTERS RESPONSIBILITY FOR ACTIVITIES RELATED TO THE ASSESSMENT OF A
PERSON'S NEED FOR, AND THE AUTHORIZATION OF, LONG-TERM CARE SERVICES AND
PROGRAMS IDENTIFIED IN SUBDIVISIONS TWO, THREE AND FOUR OF THIS SECTION.
THE DEPARTMENT IS AUTHORIZED TO CONTRACT WITH ONE OR MORE ENTITIES TO
OPERATE REGIONAL LONG-TERM CARE ASSESSMENT CENTERS.
2. THE REGIONAL LONG-TERM CARE ASSESSMENT CENTER SHALL HAVE RESPONSI-
BILITY FOR ASSESSMENT OF LONG-TERM CARE NEEDS OF AN APPLICANT FOR, OR
RECIPIENT OF, MEDICAL ASSISTANCE AND FOR AUTHORIZATION OF SERVICES AND
PARTICIPATION IN PROGRAMS INCLUDING: PERSONAL CARE SERVICES, INCLUDING
PERSONAL EMERGENCY RESPONSE SERVICES, UNDER PARAGRAPH (E) OF SUBDIVISION
TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE; CONSUMER-DI-
RECTED PERSONAL ASSISTANCE SERVICES UNDER SECTION THREE HUNDRED
SIXTY-FIVE-F OF THIS TITLE; THE CASH AND COUNSELING DEMONSTRATION
PROGRAM UNDER SECTION THREE HUNDRED SIXTY-SEVEN-V OF THIS TITLE; THE
ASSISTED LIVING PROGRAM UNDER SECTION FOUR HUNDRED SIXTY-ONE-L OF THIS
CHAPTER; AND PARTICIPATION IN THE LONG-TERM HOME HEALTH CARE PROGRAM
UNDER SECTION THREE HUNDRED SIXTY-SEVEN-C OF THIS TITLE AND SECTION
THIRTY-SIX HUNDRED SIXTEEN OF THE PUBLIC HEALTH LAW, INCLUDING THE AIDS
HOME CARE PROGRAM UNDER THE PROVISIONS OF SECTION THREE HUNDRED
SIXTY-SEVEN-E OF THIS TITLE AND SECTION THIRTY-SIX HUNDRED TWENTY OF THE
PUBLIC HEALTH LAW.
3. NOTWITHSTANDING ANY PROVISION OF SECTION FORTY-FOUR HUNDRED THREE-F
OF THE PUBLIC HEALTH LAW TO THE CONTRARY, THE REGIONAL LONG-TERM CARE
ASSESSMENT CENTER SHALL HAVE RESPONSIBILITY FOR REVIEWING ASSESSMENTS TO
VERIFY THAT AN INDIVIDUAL REQUIRES A NURSING HOME LEVEL OF CARE AND,
AFTER CONFIRMING THAT AN ENROLLMENT IS VOLUNTARY, FOR AUTHORIZING
PARTICIPATION IN A MANAGED LONG-TERM CARE PLAN OR AN APPROVED MANAGED
LONG-TERM CARE DEMONSTRATION UNDER PARAGRAPH (O) OF SUBDIVISION TWO OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE.
4. THE REGIONAL LONG-TERM CARE ASSESSMENT CENTER SHALL HAVE RESPONSI-
BILITY FOR REVIEWING DOCUMENTATION FROM A PERSON'S PHYSICIAN AND A
S. 58--A 152 A. 158--A
CERTIFIED HOME HEALTH AGENCY AND FOR MAKING THE DETERMINATION AS TO THE
CONTINUING NEED FOR HOME HEALTH SERVICES BEYOND SIXTY DAYS PROVIDED BY A
CERTIFIED HOME HEALTH AGENCY UNDER PARAGRAPH (D) OF SUBDIVISION TWO OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE.
5. THIS SECTION SHALL APPLY TO THOSE CONSUMERS WHO APPLY FOR THE
SERVICES SPECIFIED IN THIS SECTION ON AND AFTER THE LATER OF JANUARY
FIRST, TWO THOUSAND TEN OR THE DATE SPECIFIED IN THE CONTRACT BETWEEN
THE DEPARTMENT AND THE ENTITY SELECTED TO BE A REGIONAL LONG-TERM CARE
ASSESSMENT CENTER, AND SHALL APPLY TO THOSE CONSUMERS WHO ARE IN RECEIPT
OF SUCH SERVICES ON SUCH LATER DATE, AND WHOSE AUTHORIZATION FOR
SERVICES IS UNINTERRUPTED AFTER SUCH LATER DATE, ON AND AFTER JANUARY
FIRST, TWO THOUSAND TWELVE.
6. THE COMMISSIONER OF HEALTH SHALL SUBMIT A REPORT TO THE GOVERNOR,
TEMPORARY PRESIDENT OF THE SENATE AND SPEAKER OF THE ASSEMBLY NO LATER
THAN JANUARY FIRST, TWO THOUSAND TWELVE, ON THE IMPLEMENTATION OF THIS
SECTION. SUCH REPORT SHALL INCLUDE AN ASSESSMENT OF THE PROJECT, AN
ANALYSIS OF THE LEVEL AND COSTS OF SERVICES MANAGED UNDER THE CONTRACTS,
ANY RECOMMENDATIONS FOR CHANGES TO PERSONAL CARE SERVICES ASSESSMENT AND
DELIVERY PROTOCOLS, ANY RECOMMENDATIONS FOR LEGISLATIVE ACTION, AND SUCH
OTHER MATTERS AS MAY BE PERTINENT.
S 23-a. Section 3614 of the public health law is amended by adding a
new subdivision 14 to read as follows:
14. (A) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW, AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, FOR RATE PERIODS ON AND AFTER MARCH
FIRST, TWO THOUSAND NINE, THE RATES OF PAYMENT PAID BY GOVERNMENTAL
AGENCIES FOR HOME HEALTH CARE SERVICES TO EACH CERTIFIED HOME HEALTH
AGENCY SHALL, AFTER APPLICATION OF ANY APPLICABLE ADJUSTMENTS TO THE
TREND FACTORS AFFECTING SUCH RATES, BE SUBJECT TO A UNIFORM REDUCTION OF
THREE AND ONE-HALF PERCENT.
(B) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW, AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, FOR RATE PERIODS ON AND AFTER MARCH
FIRST, TWO THOUSAND NINE, THE RATES OF PAYMENT PAID BY GOVERNMENTAL
AGENCIES FOR HOME HEALTH CARE SERVICES TO EACH LONG TERM HOME HEALTH
CARE PROGRAM AND EACH AIDS HOME CARE PROGRAM SHALL, AFTER APPLICATION OF
ANY APPLICABLE ADJUSTMENTS TO THE TREND FACTORS AFFECTING SUCH RATES, BE
SUBJECT TO A UNIFORM REDUCTION OF ONE AND ONE-HALF PERCENT.
(C) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW, AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, FOR RATE PERIODS ON AND AFTER MARCH
FIRST, TWO THOUSAND NINE, THE RATES OF PAYMENT PAID BY GOVERNMENTAL
AGENCIES FOR PERSONAL CARE SERVICES, INCLUDING PERSONAL CARE SERVICES
PROVIDED IN THOSE SOCIAL SERVICE DISTRICTS WHOSE RATES OF PAYMENT FOR
SUCH SERVICES ARE ESTABLISHED BY SUCH SOCIAL SERVICE DISTRICTS PURSUANT
TO A RATE-SETTING EXEMPTION ISSUED BY THE COMMISSIONER TO SUCH SOCIAL
SERVICE DISTRICTS IN ACCORDANCE WITH APPLICABLE REGULATIONS, SHALL,
AFTER APPLICATION OF ANY APPLICABLE ADJUSTMENTS TO THE TREND FACTORS
AFFECTING SUCH RATES, BE SUBJECT TO A UNIFORM REDUCTION OF ONE AND ONE-
HALF PERCENT.
(D) UPON THE IMPLEMENTATION OF THE PROVISIONS OF SUBDIVISION TWELVE OF
THIS SECTION ON JANUARY FIRST, TWO THOUSAND TEN, THE PROVISIONS OF PARA-
GRAPH (A) OF THIS SUBDIVISION SHALL BE DEEMED NULL AND VOID FOR PERIODS
ON AND AFTER JANUARY FIRST, TWO THOUSAND TEN.
S 24. Section 2808 of the public health law is amended by adding a new
subdivision 25 to read as follows:
S. 58--A 153 A. 158--A
25. (A) THE COMMISSIONER IS AUTHORIZED TO ESTABLISH A QUALITY OF CARE
INCENTIVE POOL FOR ELIGIBLE RESIDENTIAL HEALTH CARE FACILITIES AND
INCREASE MEDICAID RATES OF PAYMENT FOR SUCH ELIGIBLE FACILITIES FROM
THIS POOL. UP TO FIFTY MILLION DOLLARS IN SUCH INCREASED MEDICAID
PAYMENTS WILL BE MADE AVAILABLE FOR DISTRIBUTION FOR THE STATE FISCAL
YEAR BEGINNING APRIL FIRST, TWO THOUSAND NINE AND UP TO ONE HUNDRED
TWENTY-FIVE MILLION DOLLARS WILL BE AVAILABLE FOR STATE FISCAL YEAR
BEGINNING APRIL FIRST, TWO THOUSAND TEN. PAYMENTS WILL BE DETERMINED BY
THE COMMISSIONER BY APPLYING CRITERIA, INCLUDING, BUT NOT LIMITED TO,
THE QUALITY COMPONENTS OF THE MINIMUM DATA SET REQUIRED UNDER FEDERAL
LAW, STAFFING AND SURVEY INFORMATION AND OTHER FACILITY DATA.
(B) FACILITIES THAT FALL WITHIN ONE OR MORE OF THE CATEGORIES BELOW
DURING A REVIEW PERIOD WILL BE EXCLUDED FROM AWARD ELIGIBILITY:
(I) ANY RESIDENTIAL HEALTH CARE FACILITY THAT IS CURRENTLY DESIGNATED
BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AS A "SPECIAL FOCUS
FACILITY";
(II) ANY RESIDENTIAL HEALTH CARE FACILITY FOR WHICH THE DEPARTMENT HAS
ISSUED A FINDING OF IMMEDIATE JEOPARDY DURING THE MOST RECENTLY
COMPLETED FEDERAL FISCAL YEAR;
(III) ANY RESIDENTIAL HEALTH CARE FACILITY THAT HAS RECEIVED A CITA-
TION FOR SUBSTANDARD QUALITY OF CARE IN THE AREAS OF QUALITY OF LIFE,
QUALITY OF CARE, RESIDENT BEHAVIOR, AND/OR FACILITY PRACTICES DURING THE
MOST RECENTLY COMPLETED FEDERAL FISCAL YEAR;
(IV) ANY RESIDENTIAL HEALTH CARE FACILITY THAT IS PART OF A CONTINUING
CARE RETIREMENT COMMUNITY;
(V) ANY RESIDENTIAL HEALTH CARE FACILITY THAT OPERATES AS A TRANSI-
TIONAL CARE UNIT; AND
(VI) ANY OTHER EXCLUSIONS AS DEEMED APPROPRIATE BY THE COMMISSIONER.
(C) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF ANY LAW OR REGU-
LATION TO THE CONTRARY, IN THE EVENT THAT THE TOTAL AMOUNT OF FUNDING
ALLOCATED FOR A PARTICULAR FISCAL YEAR IS NOT DISTRIBUTED, FUNDS SHALL
BE RESERVED AND ACCUMULATED FROM YEAR TO YEAR SO THAT ANY FUNDS REMAIN-
ING AT THE END OF A PARTICULAR FISCAL YEAR WILL BE AVAILABLE FOR
DISTRIBUTION DURING THE FOLLOWING FISCAL YEAR.
(D) THE COMMISSIONER MAY PROMULGATE ANY REGULATIONS, INCLUDING EMER-
GENCY REGULATIONS, NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS
SECTION.
S 25. Section 3614 of the public health law is amended by adding a new
subdivision 13 to read as follows:
13. (A) SUBJECT TO THE AVAILABILITY OF FUNDS, THE COMMISSIONER SHALL
ESTABLISH A QUALITY OF CARE INCENTIVE POOL OF UP TO TWENTY MILLION
DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TEN AND UP TO TWENTY MILLION DOLLARS FOR THE
PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND ELEVEN FOR PAYMENTS TO ELIGIBLE CERTIFIED HOME HEALTH AGENCIES
THAT MEET QUALITY MEASURES, AS ESTABLISHED BY THE COMMISSIONER. SUCH
PAYMENTS SHALL BE MADE IN THE FORM OF ADJUSTMENTS TO MEDICAL ASSISTANCE
RATES OF PAYMENT FOR SERVICES PROVIDED BY ELIGIBLE CERTIFIED HOME HEALTH
AGENCIES MEETING SUCH QUALITY MEASURES.
(B) TO BE ELIGIBLE FOR SUCH RATE ADJUSTMENTS, A CERTIFIED HOME HEALTH
AGENCY MUST HAVE, DURING A FIFTEEN MONTH PERIOD PRIOR TO PAYMENT,
PROVIDED SERVICES TO MEDICAID RECIPIENTS, AS REPORTED ON THE AGENCY'S
COST REPORTS; PROVIDED, HOWEVER, THAT AN AGENCY THAT HAS CHANGED OWNER-
SHIP DURING THIS SAME PERIOD SHALL NOT BE ELIGIBLE. AN ELIGIBLE CERTI-
FIED HOME HEALTH AGENCY MUST SUBMIT SUCH REPORTS AND DATA AS THE COMMIS-
SIONER MAY REQUIRE AND MUST NOT HAVE RECEIVED A CONDITION LEVEL
S. 58--A 154 A. 158--A
DEFICIENCY OF NON-COMPLIANCE DURING THE MOST RECENTLY COMPLETED RECER-
TIFICATION SURVEY. THE COMMISSIONER MAY EXCLUDE ANY AGENCY FROM ELIGI-
BILITY FOR SUCH RATE ADJUSTMENTS ON SUCH OTHER BASIS AS THE COMMISSIONER
DEEMS APPROPRIATE.
(C) THE COMMISSIONER MAY ADOPT REGULATIONS, INCLUDING EMERGENCY REGU-
LATIONS, TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
S 26. The public health law is amended by adding a new article 28-C-1
to read as follows:
ARTICLE 28-C-1
LONG-TERM CARE NURSING INITIATIVE DEMONSTRATION
PROJECTS
SECTION 2893. LONG-TERM NURSING INITIATIVE DEMONSTRATION PROJECTS.
S 2893. LONG-TERM CARE NURSING INITIATIVE DEMONSTRATION PROJECTS. 1.
SCHOLARSHIP DEMONSTRATION PROJECT. (A) ON OR AFTER APRIL FIRST, TWO
THOUSAND NINE, THE COMMISSIONER, IN CONSULTATION WITH THE PRESIDENT OF
THE HIGHER EDUCATION SERVICES CORPORATION, IS AUTHORIZED TO ESTABLISH
SCHOLARSHIP AWARDS FOR THE PROFESSIONAL STUDY OF NURSING BY NEW YORK
STATE RESIDENTS AT SCHOOLS APPROVED BY THE COMMISSIONER. EACH RECIPIENT
OF A SCHOLARSHIP AWARD SHALL BE ENTITLED TO A YEARLY PAYMENT NOT TO
EXCEED EIGHT THOUSAND DOLLARS OR THE ACTUAL COST OF TUITION AND OTHER
RELATED EDUCATIONAL EXPENSES, WHICHEVER IS LOWER, FOR A MAXIMUM OF TWO
YEARS, WHILE IN ATTENDANCE AT AN APPROVED NURSING SCHOOL. AWARDS SHALL
BE CONDITIONED UPON THE AGREEMENT OF THE SCHOLARSHIP HOLDER TO PRACTICE
NURSING IN THE FIELD OF LONG-TERM CARE IN NEW YORK FOR A PERIOD OF ONE
YEAR FOR EACH YEAR AN AWARD IS RECEIVED, UP TO A MAXIMUM OF TWO YEARS.
THE COMMISSIONER SHALL DEFINE ELIGIBILITY CRITERIA FOR THE AWARDS,
INCLUDING BUT NOT LIMITED TO THE TYPE OF LONG-TERM CARE SERVICE
REQUIRED.
(B) IF A RECIPIENT FAILS TO COMPLY FULLY WITH THE CONDITIONS IN PARA-
GRAPH (A) OF THIS SUBDIVISION, THE RECIPIENT SHALL BE RESPONSIBLE FOR
REPAYMENT OF ONE HUNDRED PERCENT OF THE YEARLY PAYMENT RECEIVED FOR EACH
YEAR OR PART THEREOF THAT THE RECIPIENT FAILS TO PRACTICE IN THE FIELD
OF LONG-TERM CARE, PLUS INTEREST AT A RATE TO BE DETERMINED BY THE
COMMISSIONER BUT NOT LESS THAN THE RATE OF INTEREST SET BY THE COMMIS-
SIONER OF TAXATION AND FINANCE WITH RESPECT TO UNDERPAYMENTS OF PERSONAL
INCOME TAX PURSUANT TO SECTION SIX HUNDRED EIGHTY-FOUR OF THE TAX LAW.
ANY AMOUNT WHICH IS REQUIRED TO BE REPAID UNDER THIS SUBDIVISION SHALL
BE PAID WITHIN THE FIVE-YEAR PERIOD BEGINNING ON THE DATE THAT THE
RECIPIENT FAILS TO COMPLY WITH THE CONDITIONS IN PARAGRAPH (A) OF THIS
SUBDIVISION. ANY REPAYMENT OBLIGATION SHALL BE CANCELED UPON THE DEATH
OF THE RECIPIENT.
(C) THE COMMISSIONER MAY POSTPONE, CHANGE OR WAIVE THE SERVICE OBLI-
GATION AND REPAYMENT AMOUNTS SET FORTH IN PARAGRAPHS (A) AND (B) OF THIS
SUBDIVISION IN INDIVIDUAL CIRCUMSTANCES WHERE THERE IS COMPELLING NEED
OR HARDSHIP.
(D) A RECIPIENT OF AN AWARD SHALL REPORT ANNUALLY, ON PRESCRIBED
FORMS, AS TO THE PERFORMANCE OF THE REQUIRED SERVICES, COMMENCING WITH
THE CALENDAR YEAR IN WHICH THE RECIPIENT BEGINS TO PRACTICE NURSING IN
THE FIELD OF LONG-TERM CARE AND CONTINUING UNTIL THE RECIPIENT SHALL
HAVE COMPLETED, OR UNTIL IT IS DETERMINED THAT HE OR SHE SHALL NOT BE
OBLIGATED TO COMPLETE, THE REQUIRED SERVICES. IF THE RECIPIENT SHALL
FAIL TO FILE ANY REPORT REQUIRED HEREUNDER WITHIN THIRTY DAYS OF WRITTEN
NOTICE TO THE RECIPIENT, MAILED TO THE ADDRESS SHOWN ON THE LAST APPLI-
CATION FOR AN AWARD OR LAST REPORT FILED, WHICHEVER IS LATER, A FINE OF
UP TO ONE THOUSAND DOLLARS MAY BE IMPOSED. THE REPORTING REQUIREMENT MAY
S. 58--A 155 A. 158--A
BE WAIVED OR EXCUSED, AND/OR ANY FINE REDUCED OR WAIVED, FOR GOOD CAUSE
SHOWN.
2. LOAN REPAYMENT DEMONSTRATION PROJECT. (A) ON OR AFTER APRIL FIRST,
TWO THOUSAND NINE, THE COMMISSIONER, IN CONSULTATION WITH THE PRESIDENT
OF THE HIGHER EDUCATION SERVICES CORPORATION, IS AUTHORIZED TO MAKE LOAN
REPAYMENT AWARDS TO INDIVIDUALS WHO PRACTICE NURSING IN THE FIELD OF
LONG-TERM CARE IN NEW YORK STATE. SUCH NURSES SHALL BE ELIGIBLE FOR A
YEARLY LOAN REPAYMENT AWARD OF UP TO EIGHT THOUSAND DOLLARS FOR EACH
YEAR OF PRACTICE IN THE FIELD OF LONG-TERM CARE, FOR A MAXIMUM OF TWO
YEARS. THE COMMISSIONER SHALL DEFINE ELIGIBILITY CRITERIA FOR THE
AWARDS, INCLUDING BUT NOT LIMITED TO THE TYPE OF LONG-TERM CARE SERVICE
REQUIRED.
(B) LOAN REPAYMENT AWARDS MADE PURSUANT TO PARAGRAPH (A) OF THIS
SUBDIVISION SHALL NOT EXCEED THE TOTAL QUALIFYING OUTSTANDING STUDENT
LOAN DEBT OF THE NURSE FOR TUITION AND RELATED EDUCATIONAL EXPENSES
INCURRED AT SCHOOLS APPROVED BY THE COMMISSIONER, MADE BY OR GUARANTEED
BY THE FEDERAL OR STATE GOVERNMENT, OR MADE BY A LENDING OR EDUCATIONAL
INSTITUTION APPROVED UNDER TITLE IV OF THE FEDERAL HIGHER EDUCATION ACT.
LOAN REPAYMENT AWARDS SHALL BE USED SOLELY TO REPAY SUCH OUTSTANDING
DEBT.
(C) A RECIPIENT OF AN AWARD SHALL REPORT ANNUALLY, ON PRESCRIBED
FORMS, THE PERFORMANCE OF THE REQUIRED SERVICES, COMMENCING WITH THE
CALENDAR YEAR IN WHICH THE RECIPIENT BEGINS TO PRACTICE NURSING IN THE
FIELD OF LONG-TERM CARE UNTIL THE RECIPIENT SHALL HAVE COMPLETED, OR
UNTIL IT IS DETERMINED THAT HE OR SHE SHALL NOT BE OBLIGATED TO
COMPLETE, THE REQUIRED SERVICES. LOAN REPAYMENT AWARDS SHALL BE MADE
YEARLY, AFTER THE RECIPIENT HAS COMPLETED EACH YEAR OF QUALIFYING PRAC-
TICE AND FILED THE PERFORMANCE REPORT DESCRIBED HEREIN. THE REPORTING
REQUIREMENT MAY BE WAIVED OR EXCUSED FOR GOOD CAUSE SHOWN.
S 27. The education law is amended by adding a new section 679-f to
read as follows:
S 679-F. LONG-TERM CARE NURSING INITIATIVE DEMONSTRATION PROJECTS. 1.
LONG-TERM CARE NURSING INITIATIVE SCHOLARSHIP AND LOAN-REPAYMENT AWARDS
MAY BE MADE IN ACCORDANCE WITH THE STANDARDS ENUMERATED IN SECTION TWEN-
TY-EIGHT HUNDRED NINETY-THREE OF THE PUBLIC HEALTH LAW.
2. THE PRESIDENT SHALL BE RESPONSIBLE FOR THE ADMINISTRATION OF THE
AWARDS TO THE EXTENT DETERMINED IN CONSULTATION WITH THE COMMISSIONER OF
HEALTH.
S 28. The social services law is amended by adding a new section 367-v
to read as follows:
S 367-V. CASH AND COUNSELING DEMONSTRATION PROGRAM. 1. THE COMMISSION-
ER IS AUTHORIZED TO ESTABLISH A CASH AND COUNSELING DEMONSTRATION
PROGRAM FOR THE PROVISION TO UP TO ONE THOUSAND PERSONS OF SELF-DIRECTED
PERSONAL ASSISTANCE SERVICES IN UP TO TEN COUNTIES CHOSEN BY THE COMMIS-
SIONER BASED UPON THE DEMOGRAPHIC AND GEOGRAPHIC FEATURES OF SUCH COUN-
TIES. FOR PURPOSES OF THIS SECTION, THE TERM "SELF-DIRECTED PERSONAL
ASSISTANCE SERVICES" MEANS PERSONAL CARE AND RELATED SERVICES AS DEFINED
IN THIS SECTION THAT ARE PROVIDED TO AN ELIGIBLE PERSON UNDER SUCH
PROGRAM. THE PROGRAM PERMITS PARTICIPANTS RECEIVING SELF-DIRECTED
PERSONAL ASSISTANCE SERVICES TO PLAN AND MANAGE THE SERVICES WITH COUN-
SELING AND MANAGEMENT SUPPORT AND TO USE THE FUNDS IN HIS OR HER INDI-
VIDUALIZED BUDGET TO ACQUIRE ITEMS THAT INCREASE INDEPENDENCE OR SUBSTI-
TUTE FOR HUMAN ASSISTANCE WITH PERSONAL CARE. THE COMMISSIONER IS
AUTHORIZED TO FILE SUCH STATE PLAN AMENDMENTS AND WAIVERS OF THE FEDERAL
SOCIAL SECURITY ACT AS MAY BE NEEDED TO OBTAIN FEDERAL FINANCIAL PARTIC-
IPATION IN THE COSTS OF SUCH PROGRAM.
S. 58--A 156 A. 158--A
2. (A) ALL ELIGIBLE PERSONS, RESIDING IN THE COUNTIES IDENTIFIED IN
SUBDIVISION ONE OF THIS SECTION, RECEIVING PERSONAL CARE SHALL BE
PROVIDED NOTICE OF THE AVAILABILITY OF THE PROGRAM AND SHALL HAVE THE
OPPORTUNITY TO APPLY FOR PARTICIPATION IN THE PROGRAM. FOR PURPOSES OF
THIS SECTION, AN "ELIGIBLE PERSON" IS A PERSON EIGHTEEN YEARS OF AGE OR
OLDER WHO:
(I) IS ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS TITLE;
(II) IS ELIGIBLE FOR PERSONAL CARE SERVICES UNDER THIS TITLE;
(III) IS DETERMINED BY THE SOCIAL SERVICES DISTRICT, PURSUANT TO AN
ASSESSMENT, AS BEING SELF-DIRECTING IN REGARD TO PARTICIPATION IN COUN-
SELING AND FISCAL MANAGEMENT OF THEIR PLAN AND BUDGET AND AS BEING CAPA-
BLE TO EXERCISE CHOICE AND CONTROL OVER THE BUDGET, PLANNING AND
PURCHASE OF SELF-DIRECTED PERSONAL ASSISTANCE SERVICES; AND
(IV) MEETS SUCH OTHER CRITERIA, AS MAY BE ESTABLISHED BY THE COMMIS-
SIONER, WHICH THE COMMISSIONER DEEMS NECESSARY TO EFFECTIVELY IMPLEMENT
THE OBJECTIVES OF THIS SECTION.
(B) A PERSON SHALL BE INELIGIBLE FOR PARTICIPATION IN THIS PROGRAM
WHILE HE OR SHE IS RECEIVING PERSONAL CARE SERVICES, OTHER THAN PERSONAL
EMERGENCY RESPONSE SERVICES, UNDER PARAGRAPH (E) OF SUBDIVISION TWO OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE; OR IS A PARTICIPANT IN
EITHER THE CONSUMER-DIRECTED PERSONAL ASSISTANCE PROGRAM UNDER SECTION
THREE HUNDRED SIXTY-FIVE-F OF THIS TITLE OR A HOME AND COMMUNITY-BASED
WAIVER PROGRAM ESTABLISHED UNDER PARAGRAPH (C) OF SECTION NINETEEN
HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT; OR IS AN ENROLLEE IN
A MANAGED LONG-TERM CARE PLAN OR AN APPROVED MANAGED LONG-TERM CARE
DEMONSTRATION UNDER PARAGRAPH (O) OF SUBDIVISION TWO OF SECTION THREE
HUNDRED SIXTY-FIVE-A OF THIS TITLE.
3. THE DEPARTMENT IS AUTHORIZED TO CONTRACT WITH AN ENTITY TO PROVIDE
PROGRAM PARTICIPANTS WITH ASSISTANCE IN DEVELOPING A SERVICE PLAN AND AN
INDIVIDUALIZED BUDGET, AND TO ASSUME RESPONSIBILITY FOR ALL TASKS
RELATED TO PROCESSING TIMESHEETS AND PAYROLL FUNCTIONS.
4. (A) THE LOCAL DEPARTMENTS OF SOCIAL SERVICES IN THE TEN COUNTIES
CHOSEN BY THE COMMISSIONER PURSUANT TO SUBDIVISION ONE OF THIS SECTION
SHALL INFORM EACH ELIGIBLE PERSON OF OTHER FEASIBLE ALTERNATIVES INCLUD-
ING PERSONAL CARE UNDER PARAGRAPH (E) OF SUBDIVISION TWO OF SECTION
THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE OR THE CONSUMER-DIRECTED
PERSONAL ASSISTANCE PROGRAM UNDER SECTION THREE HUNDRED SIXTY-FIVE-F OF
THIS TITLE. THE RESPONSIBILITIES OF THE LOCAL DEPARTMENTS OF SOCIAL
SERVICES SHALL INCLUDE, BUT ARE NOT LIMITED TO, DETERMINING WHETHER THE
INDIVIDUAL IS AN ELIGIBLE PERSON; ASSESSING EACH ELIGIBLE PERSON'S FUNC-
TIONAL NEEDS; APPROVING THE NUMBER OF HOURS OF PERSONAL CARE SERVICES;
AND, UPON DISENROLLMENT OF A PARTICIPANT FROM THIS PROGRAM, ASSISTING
WITH TRANSITION TO THE PERSONAL CARE SERVICES AVAILABLE UNDER PARAGRAPH
(E) OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS
TITLE OR THE CONSUMER-DIRECTED PERSONAL ASSISTANCE PROGRAM UNDER SECTION
THREE HUNDRED SIXTY-FIVE-F OF THIS TITLE IF THE PERSON IS DETERMINED TO
CONTINUE TO NEED PERSONAL CARE SERVICES.
(B) THE ENTITY WITH WHICH THE DEPARTMENT HAS CONTRACTED FOR THE ADMIN-
ISTRATION OF THIS PROGRAM SHALL BE RESPONSIBLE FOR THE PERFORMANCE OF
CERTAIN ACTIVITIES SUPPORTING PROGRAM PARTICIPANTS WHICH MAY INCLUDE,
BUT SHALL NOT BE LIMITED TO: ASSISTING THE ELIGIBLE PERSON WITH THE
DEVELOPMENT OF HIS OR HER SERVICE PLAN; PROVIDING TRAINING AND ONGOING
TECHNICAL SUPPORT TO THE ELIGIBLE PERSON WITH REGARD TO THE PERFORMANCE
OF HIS OR HER RESPONSIBILITIES AS A PARTICIPANT IN THE PROGRAM; PROVID-
ING RECORDKEEPING SERVICES; RETAINING THE FUNDS FOR THE INDIVIDUALIZED
BUDGETS ESTABLISHED FOR EACH ELIGIBLE PERSON; PROCESSING EMPLOYMENT AND
S. 58--A 157 A. 158--A
TAX INFORMATION; REVIEWING RECORDS TO ENSURE CORRECTNESS; WRITING AND
DELIVERING PAYCHECKS; AND ASSISTING ELIGIBLE PERSONS IN OBTAINING
REQUIRED INSURANCE POLICIES.
(C) THE PARTICIPANT SHALL BE RESPONSIBLE FOR: DEVELOPING A SERVICE
PLAN WITH THE ASSISTANCE OF A BUDGET COUNSELOR EMPLOYED BY THE ENTITY
WITH WHICH THE DEPARTMENT HAS CONTRACTED TO ADMINISTER THIS PROGRAM,
WHICH SERVICE PLAN SHALL BE SUBJECT TO THE APPROVAL OF THE BUDGET COUN-
SELOR; DEVELOPING A JOB DESCRIPTION FOR HIS OR HER PROVIDERS; SELECTING
AND EMPLOYING PROVIDERS; TRAINING PROVIDERS; ENDING THE EMPLOYMENT OF AN
UNSATISFACTORY PROVIDER; AND SUBMITTING TO THE FISCAL AGENT EMPLOYED BY
THE CONTRACTOR ANY INFORMATION NECESSARY FOR PROVIDER PAYMENTS, TAX
REQUIREMENTS AND ANY BACKGROUND SCREENING THAT MAY BE REQUESTED BY THE
PARTICIPANT. A PARTICIPANT MAY EMPLOY FAMILY MEMBERS, EXCEPT FOR A
SPOUSE, PARENT OR STEP-PARENT, TO PROVIDE PERSONAL CARE OR RELATED
SERVICES.
5. THIS SECTION SHALL BE EFFECTIVE IF, TO THE EXTENT THAT, AND AS LONG
AS, FEDERAL FINANCIAL PARTICIPATION IS AVAILABLE FOR EXPENDITURES
INCURRED UNDER THIS SECTION.
S 29. Section 3614 of the public health law is amended by adding a new
subdivision 1-a to read as follows:
1-A. NOTWITHSTANDING SUBDIVISION ONE OF THIS SECTION, ON AND AFTER
JANUARY FIRST, TWO THOUSAND TEN, HOME HEALTH SERVICES UNDER SECTION
THREE HUNDRED SIXTY-FIVE-A OF THE SOCIAL SERVICES LAW PROVIDED BY HOME
HEALTH AIDES AS DEFINED IN SUBDIVISION FOUR OF SECTION THIRTY-SIX
HUNDRED TWO OF THIS ARTICLE SHALL BE PROVIDED DIRECTLY BY THE CERTIFIED
HOME HEALTH AGENCY PROVIDER, LONG-TERM HOME HEALTH CARE PROGRAM PROVIDER
OR AIDS HOME CARE PROGRAM PROVIDER THROUGH SUCH PROVIDERS' EMPLOYEES.
S 30. Paragraph (a) of subdivision 1 of section 367-f of the social
services law, as amended by section 51 of part C of chapter 58 of the
laws of 2005, is amended to read as follows:
(a) "Medicaid extended coverage" shall mean eligibility for medical
assistance (i) without regard to the resource requirements of section
three hundred sixty-six of this title, or in the case of an individual
covered under an insurance policy or certificate described in subdivi-
sion two of this section that provided a residential health care facili-
ty benefit less than three years in duration, without consideration of
an amount of resources equivalent to the value of benefits received by
the individual under such policy or certificate, as determined under the
rules of the partnership for long-term care program[, and]; (ii) without
regard to the recovery of medical assistance from the estates of indi-
viduals and the imposition of liens on the homes of persons pursuant to
section three hundred sixty-nine of this title, with respect to
resources exempt from consideration pursuant to subparagraph (i) of this
paragraph; provided, however, that nothing [herein] IN THIS SECTION
shall prevent the imposition of a lien or recovery against property of
an individual on account of medical assistance incorrectly paid; AND
(III) BASED ON AN INCOME ELIGIBILITY STANDARD FOR MARRIED COUPLES EQUAL
TO THE AMOUNT OF THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE DEFINED
IN PARAGRAPH (H) OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-SIX-C
OF THIS TITLE, AND FOR SINGLE INDIVIDUALS EQUAL TO ONE-HALF OF SUCH
AMOUNT; PROVIDED, HOWEVER, THAT THE COMMISSIONER OF HEALTH SHALL NOT BE
REQUIRED TO IMPLEMENT THE PROVISIONS OF THIS SUBPARAGRAPH IF THE USE OF
SUCH INCOME ELIGIBILITY STANDARDS WILL RESULT IN A LOSS OF FEDERAL
FINANCIAL PARTICIPATION IN THE COSTS OF MEDICAID EXTENDED COVERAGE
FURNISHED IN ACCORDANCE WITH SUBPARAGRAPHS (I) AND (II) OF THIS PARA-
GRAPH.
S. 58--A 158 A. 158--A
S 31. 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
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 32. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of section
2807 of the public health law and section 18 of chapter 2 of the laws of
1988, as they relate to time frames for notice, approval or certif-
ication of rates of payment, are hereby suspended and shall, for
purposes of implementing the provisions of this act, be deemed to have
been without any force or effect from and after November 1, 2007 for
such rates effective for the period January 1, 2008 through December 31,
2008.
S 33. 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 34. This act shall take effect on March 1, 2009; provided, however,
that:
1. section twenty-one of this act shall take effect October 1, 2009;
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 insurance 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 insurance and any
appropriate council is authorized to adopt or amend or promulgate 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
insurance or any council to adopt or amend or promulgate regulations
implementing this act;
7. the amendments to section 4403-f of the public health law made by
sections twenty-two, twenty-two-a, twenty-two-b and twenty-two-c of this
act shall not affect the repeal of such section and shall expire and be
deemed repealed therewith;
8. a. notwithstanding any contrary provision of law, in the event
sections two and ten of this act are not enacted into law then the
provisions of sections three through six, seven, eleven through four-
teen, twenty-four, and twenty-six through twenty-eight of this act shall
be deemed null and void and of no effect; and
S. 58--A 159 A. 158--A
b. notwithstanding any contrary provision of law, in the event
sections seventeen, twenty-three and twenty-three-a of this act are not
enacted into law then the provisions of sections twenty-five, and twen-
ty-eight of this act shall be deemed null and void and of no effect;
9. the amendments to subdivision 5 of section 3614 of the public
health law made by section eighteen of this act shall not affect the
expiration of such subdivision and shall expire therewith;
10. the amendments to paragraph (k) of subdivision 2 of section 365-a
of the social services law made by section twenty-one of this act shall
not affect the expiration of such paragraph and shall expire therewith;
and
11. article 28-C-1 of the public health law and section 679-f of the
education law added by sections twenty-six and twenty-seven of this act
shall expire April 1, 2012.
PART E
Section 1. Section 31 of part E of chapter 58 of the laws of 1998,
relating to the determination of state aid for the long-term sheltered
employment program, is amended to read as follows:
S 31. Notwithstanding any other provision of law to the contrary, for
each state fiscal year commencing on or after April 1, 1998, up to one
thousand dollars of income as determined by the commissioner of the
office of mental retardation and developmental disabilities and approved
by the director of the budget, provided through the long term sheltered
employment program, pursuant to subdivision 2 of section 1004-a of the
education law, on behalf of eligible clients, [shall] MAY be regarded as
exempt income and not recognized or included in the determination of
state aid granted to local governments, and the local government share
of operating costs pursuant to article 41 of the mental hygiene law,
PROVIDED THAT STATE FUNDING IS AVAILABLE FOR THIS PURPOSE AS CERTIFIED
BY THE DIRECTOR OF THE BUDGET OR HIS OR HER DESIGNEE.
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART F
Section 1. Notwithstanding the provisions of subdivision (e) of
section 7.17 or section 41.55 of the mental hygiene law, or any other
law to the contrary, the office of mental health is authorized to imple-
ment measures designed to ensure the efficient operation of hospitals
operated by the office of mental health which may include the closure of
wards, and to develop one or more transitional placement programs to
provide supervised housing, and necessary outpatient and support
services to individuals with mental illness, who have been discharged
from hospitals operated by the office of mental health, and who have
been determined by the office of mental health to be able to be appro-
priately served in such less restrictive setting.
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART G
Section 1. Section 9 of chapter 420 of the laws of 2002 amending the
education law relating to the profession of social work, as amended by
chapter 433 of the laws of 2003, is amended to read as follows:
S. 58--A 160 A. 158--A
S 9. Nothing in this act shall prohibit or limit the activities or
services on the part of any person in the employ of a program or service
operated, regulated, funded, or approved by the department of mental
hygiene or the office of children and family services, or a local
[government] GOVERNMENTAL unit as that term is defined in article 41 of
the mental hygiene law or a social services district as defined in
section 61 of the social services law, provided, however, this section
shall not authorize the use of any title authorized pursuant to article
154 of the education law, except that this section shall be deemed
repealed on [January 1, 2010] JANUARY 1, 2014.
S 2. Section 17-a of chapter 676 of the laws of 2002 amending the
education law relating to defining the practice of psychology, as
amended by chapter 419 of the laws of 2003, is amended to read as
follows:
S 17-a. Nothing in this act shall prohibit or limit the activities or
services on the part of any person in the employ of a program or service
operated, regulated, funded, or approved by the department of mental
hygiene or the office of children and family services, or a local
[government] GOVERNMENTAL unit as that term is defined in article 41 of
the mental hygiene law or a social services district as defined in
section 61 of the social services law, provided, however, this section
shall not authorize the use of any title authorized pursuant to article
153 or 163 of the education law, except as otherwise provided by such
articles, except that this section shall be deemed repealed on [January
1, 2010] JANUARY 1, 2014.
S 3. This act shall take effect on March 1, 2009.
PART H
Section 1. Subdivision (k) of section 10.06 of the mental hygiene law,
as added by chapter 7 of the laws of 2007, is amended to read as
follows:
(k) At the conclusion of the hearing, the court shall determine wheth-
er there is probable cause to believe that the respondent is a sex
offender requiring civil management. If the court determines that proba-
ble cause has not been established, the court shall issue an order
dismissing the petition, and the respondent's release shall be in
accordance with other applicable provisions of law. If the court deter-
mines that probable cause has been established: (i) the court shall
order that the respondent be committed to a secure treatment facility
designated by the commissioner for care, treatment and control upon his
or her release, PROVIDED, HOWEVER, THAT A RESPONDENT WHOSE RELEASE DATE
HAS PASSED MAY CONSENT TO REMAIN IN AND BE CONFINED AT A FACILITY MAIN-
TAINED BY THE DEPARTMENT OF CORRECTIONAL SERVICES PENDING THE OUTCOME OF
THE PROCEEDINGS UNDER THIS ARTICLE, AND PROVIDED FURTHER THAT A RESPOND-
ENT WHO IS UNDER THE SUPERVISION OF THE DIVISION OF PAROLE AT THE TIME
OF THE PROBABLE CAUSE DETERMINATION MAY, AT THE DISCRETION OF THE COURT,
BE CONTINUED ON PAROLE SUPERVISION UNDER THE SAME OR MODIFIED CONDITIONS
OF SUPERVISION; (ii) the court shall set a date for trial in accordance
with subdivision (a) of section 10.07 of this article; [and] (iii) the
respondent shall not be released FROM CUSTODY OR PAROLE SUPERVISION
pending the completion of such trial; AND (IV) WHERE THE RESPONDENT HAS
BEEN PLACED UNDER THE JURISDICTION OF THE DIVISION OF PAROLE, HE OR SHE
MAY BE RETAKEN AND TEMPORARILY DETAINED IN ACCORDANCE WITH SUBDIVISION
THREE OF SECTION TWO HUNDRED FIFTY-NINE-I OF THE EXECUTIVE LAW. WHERE A
RESPONDENT IS RETAKEN AND TEMPORARILY DETAINED PURSUANT TO SUBDIVISION
S. 58--A 161 A. 158--A
THREE OF SECTION TWO HUNDRED FIFTY-NINE-I OF THE EXECUTIVE LAW AND SUCH
RESPONDENT HAS SATISFIED THE FULL TERM OF HIS OR HER SENTENCE OR AGGRE-
GATED SENTENCES, THE COURT MAY THEREAFTER DIRECT THAT THE RESPONDENT
REMAIN IN LOCAL CUSTODY OR BE RETURNED TO THE JURISDICTION OF THE DIVI-
SION OF PAROLE PENDING COMPLETION OF THE TRIAL. WHERE APPROPRIATE, THE
COURT MAY ORDER THAT THE RESPONDENT BE COMMITTED TO A SECURE TREATMENT
FACILITY DESIGNATED BY THE COMMISSIONER FOR CARE, TREATMENT AND CONTROL
PENDING COMPLETION OF THE TRIAL.
S 2. Section 10.08 of the mental hygiene law is amended by adding a
new subdivision (i) to read as follows:
(I) AT ANY PROCEEDING CONDUCTED PURSUANT TO THIS ARTICLE, THE RESPOND-
ENT OR ANY WITNESS SHALL BE PERMITTED, UPON GOOD CAUSE SHOWN, TO MAKE AN
ELECTRONIC APPEARANCE IN THE COURT BY MEANS OF AN INDEPENDENT AUDIO-VI-
SUAL SYSTEM, AS THAT TERM IS DEFINED IN SUBDIVISION ONE OF SECTION
182.10 OF THE CRIMINAL PROCEDURE LAW, FOR PURPOSES OF A COURT APPEARANCE
OR FOR GIVING TESTIMONY. GOOD CAUSE SHALL INCLUDE, BUT NOT BE LIMITED
TO, THE FACT THAT A WITNESS IS CURRENTLY EMPLOYED BY THE STATE AT A
SECURE TREATMENT FACILITY OR ANOTHER WORK LOCATION, UNLESS THERE ARE
COMPELLING CIRCUMSTANCES REQUIRING THE WITNESS'S PERSONAL PRESENCE AT
THE COURT PROCEEDING. FOR PURPOSES OF THIS SUBDIVISION, AN "ELECTRONIC
APPEARANCE" MEANS AN APPEARANCE AT WHICH A PARTICIPANT IS NOT PRESENT IN
THE COURT, BUT IN WHICH (I) ALL OF THE PARTICIPANTS ARE ABLE TO SEE AND
HEAR THE SIMULTANEOUS REPRODUCTIONS OF THE VOICES AND IMAGES OF THE
JUDGE, COUNSEL, RESPONDENT OR ANY OTHER APPROPRIATE PARTICIPANT, AND
(II) COUNSEL IS PRESENT WITH THE RESPONDENT OR THE RESPONDENT AND COUN-
SEL ARE ABLE TO SEE AND HEAR EACH OTHER AND ENGAGE IN PRIVATE CONVERSA-
TION. WHEN A RESPONDENT OR A WITNESS MAKES AN ELECTRONIC APPEARANCE, THE
COURT STENOGRAPHER SHALL RECORD ANY STATEMENTS IN THE SAME MANNER AS IF
THE RESPONDENT OR WITNESS HAD MADE A PERSONAL APPEARANCE.
S 3. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART I
Section 1. Section 29.23 of the mental hygiene law is amended to read
as follows:
S 29.23 Powers with respect to property of patients.
The commissioner may authorize the directors of department facilities,
to receive or obtain funds or other personal property, excepting jewel-
ry, due or belonging to a patient who has no [committee] GUARDIAN
AUTHORIZED TO RECEIVE SUCH FUNDS OR PROPERTY, up to an amount or value
not exceeding five thousand dollars EXCEPTING FEDERAL OR STATE BENEFITS
PAID TO THE DIRECTOR AS REPRESENTATIVE PAYEE; and also from [a commit-
tee] SUCH GUARDIAN upon his discharge when the final order so provides
where the balance remaining in the hands of such [committee] GUARDIAN
does not exceed such amount. Such personal property, excepting jewelry,
other than moneys shall be retained by the director for the benefit of
the patient for whom received until sold as hereinafter provided.
FEDERAL BENEFITS, INCLUDING BENEFITS FOR WHICH THERE IS A STATE SHARE,
PAID TO THE DIRECTOR AS REPRESENTATIVE PAYEE, SHALL BE RETAINED BY THE
DIRECTOR AND USED IN ACCORDANCE WITH APPLICABLE FEDERAL LAW AND REGU-
LATIONS. Such funds and the proceeds of the sale of other personal prop-
erty so received shall be placed to the credit of the patient for whom
received and disbursed on the order of the director, to provide, in the
first instance, for luxuries, comforts, and necessities for such
patient, including burial expenses, and, if funds are thereafter avail-
S. 58--A 162 A. 158--A
able, for the support of such patient. The commissioner may authorize
directors, on behalf of any such patient, to give receipts, execute
releases and other documents required by law or court order, to endorse
checks and drafts, and to convert personal property excepting jewelry
into money by sale for an adequate consideration, and to execute bills
of sale or to permit such patient to do so, in order that the proceeds
may be deposited to the credit of such patient in accordance with the
provisions of this section.
Whenever, under the provisions of this section, the commissioner shall
authorize the director of a facility in the department to receive moneys
or other personal property excluding jewelry belonging to a patient
which are on deposit in any bank or other institution or which are due
to the person from any person or agency, such bank, institution, person,
or agency shall, upon the written request of the director, forthwith
turn over to such director from such moneys or personal property the
amount or value hereinbefore specified. Any moneys received by the
director of such facility shall be deposited by him in such bank or
trust company as shall be designated by the comptroller, except that the
commissioner may, in his discretion, invest so much thereof as he may
deem advisable in bonds issued by the United States government or any of
its agencies.
Moneys belonging to a patient received by the director of such facili-
ty pursuant to law shall be received by him in his official capacity as
such director and such receipt shall be deemed an exercise or perform-
ance by him of a power and duty duly conferred by this section.
S 2. Subdivision (e) of section 33.07 of the mental hygiene law, as
added by chapter 709 of the laws of 1986, is amended as follows:
(e) A mental hygiene facility which is a representative payee for a
patient pursuant to designation by the social security administration or
which assumes management responsibility over the funds of a patient,
shall maintain such funds in [a fiduciary capacity to the patient]
ACCORDANCE WITH APPLICABLE FEDERAL LAW AND REGULATIONS. The commission-
ers of mental health and mental retardation and developmental disabili-
ties [shall] ARE AUTHORIZED TO develop standards regarding the manage-
ment of patient funds.
S 3. This act shall take effect immediately, and shall be deemed to
have been in full force and effect on and after January 1, 2002.
PART J
Section 1. Subdivision (b) of section 13.17 of the mental hygiene law,
as amended by section 1 of part N of chapter 57 of the laws of 2000, is
amended to read as follows:
(b) There shall be in the office the developmental disabilities
services offices named below serving the areas either currently or
previously served by a school, for the care and treatment of the mental-
ly retarded and developmentally disabled and for research and teaching
in the science and skills required for the care and treatment of such
mentally retarded and developmentally disabled:
Bernard M. Fineson Developmental Disabilities Services Office
Brooklyn Developmental Disabilities Services Office
Broome Developmental Disabilities Services Office
Capital District Developmental Disabilities Services Office
Central New York Developmental Disabilities Services Office
Finger Lakes Developmental Disabilities Services Office
Institute for Basic Research in Developmental Disabilities
S. 58--A 163 A. 158--A
Hudson Valley Developmental Disabilities Services Office
Metro New York Developmental Disabilities Services Office
Long Island Developmental Disabilities Services Office
Sunmount Developmental Disabilities Services Office
Taconic Developmental Disabilities Services Office
Western New York Developmental Disabilities Services Office
Staten Island Developmental Disabilities Services Office
[Valley Ridge Center for Intensive Treatment]
The New York State Institute for Basic Research in Developmental Disa-
bilities is designated as an institute for the conduct of medical
research and other scientific investigation directed towards furthering
knowledge of the etiology, diagnosis, treatment and prevention of mental
retardation and developmental disabilities.
S 2. Notwithstanding any other provision of law to the contrary, the
head of the office of mental retardation and developmental disabilities
is authorized to consolidate the Valley Ridge Center for Intensive
Treatment and the Broome Developmental Disabilities Services Office. The
consolidated entity shall be known as the Broome Developmental Disabili-
ties Services Office.
S 3. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART K
Section 1. Subdivision (f) of section 19.17 of the mental hygiene law,
as amended by section 3 of part E of chapter 405 of the laws of 1999, is
amended to read as follows:
(f) There shall be in the office the facilities named below for the
care, treatment and rehabilitation of the mentally disabled and for
clinical research and teaching in the science and skills required for
the care, treatment and rehabilitation of such mentally disabled.
R.E. Blaisdell Addiction Treatment Center
Bronx Addiction Treatment Center
C.K. Post Addiction Treatment Center
Creedmoor Addiction Treatment Center
Dick Van Dyke Addiction Treatment Center
Kingsboro Addiction Treatment Center
[Manhattan Addiction Treatment Center]
McPike Addiction Treatment Center
Richard C. Ward Addiction Treatment Center
J.L. Norris Addiction Treatment Center
South Beach Addiction Treatment Center
St. Lawrence Addiction Treatment Center
Stutzman Addiction Treatment Center
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART L
Section 1. Subdivision 3-b of section 1 of part C of chapter 57 of the
laws of 2006, as added by section 2 of part I of chapter 58 of the laws
of 2008, establishing a cost of living adjustment for designated human
services programs, is amended and a new subdivision 3-b is added to read
as follows:
3-B. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, BEGINNING
APRIL 1, 2009 AND ENDING MARCH 31, 2010, THE COMMISSIONERS SHALL NOT
S. 58--A 164 A. 158--A
INCLUDE A COLA FOR THE PURPOSE OF ESTABLISHING RATES OF PAYMENTS,
CONTRACTS OR ANY OTHER FORM OF REIMBURSEMENT.
[3-b] 3-C. Notwithstanding any inconsistent provision of law, begin-
ning April 1, [2009] 2010 and ending March 31, [2012] 2013, the commis-
sioners 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 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2009; provided,
however, that the amendments to section 1 of part C of chapter 57 of the
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 M
Section 1. Section 1 of chapter 119 of the laws of 2007, relating to
directing the commissioner of mental health to study, evaluate and
report on the unmet mental health service needs of traditionally under-
served populations, is amended to read as follows:
Section 1. The commissioner of mental health shall [study, evaluate
and report on the unmet] IDENTIFY mental health service needs AND PROB-
LEMS of traditionally underserved populations IN A MANNER CONSISTENT
WITH THE REQUIREMENTS OF SUBDIVISION (B) OF SECTION 5.07 OF THE MENTAL
HYGIENE LAW AND SHALL ALSO INCLUDE THE FOLLOWING:
A. IDENTIFYING NEEDS AND PROBLEMS WHICH MUST BE ADDRESSED DURING THE
ENSUING FIVE YEARS;
B. RECOMMENDATIONS ON THE PROVISION OF STATE AND LOCAL MENTAL HEALTH
SERVICES BASED ON THE DEVELOPMENT OF BEST PRACTICES BY PROGRAMS PROMOT-
ING CULTURALLY AND LINGUISTICALLY COMPETENT MENTAL HEALTH SERVICES,
INCLUDING SERVICES TO RACIAL AND ETHNIC MINORITIES;
C. REVIEW OF EFFORTS UNDERTAKEN BY THE OFFICE OF MENTAL HEALTH TO
ADDRESS MENTAL HEALTH SERVICE NEEDS OF THESE POPULATIONS; AND
D. A DESCRIPTION OF THE INVOLVEMENT OF LOCAL GOVERNMENT MENTAL HEALTH
AUTHORITIES IN PLANNING AND DEVELOPING MENTAL HEALTH SERVICES FOR THESE
POPULATIONS.
[Such study and evaluation shall identify those populations with high
rates of unmet mental health service needs, including but not limited
to: racial and ethnic minorities, persons with limited English profi-
ciency, persons with unmet housing needs, high-risk demographic popu-
lations (children, adolescents, young adults and the elderly), persons
with criminal justice contact, and those lacking sufficient mental
health care coverage.] Such commissioner shall report, on or before
October 1, 2010 AND ANNUALLY THEREAFTER, his or her findings and recom-
mendations [to improve service delivery to these populations, including
an analysis of promising practices that support cultural and linguistic
competence in the provision of mental health services in the state. Such
report shall be submitted] REQUIRED BY THIS ACT, to the governor, the
temporary president of the senate, the speaker of the assembly, the
chair of the senate committee on mental health and developmental disa-
bilities and the chair of the assembly committee on mental health. SUCH
REPORT SHALL BE CONSISTENT WITH THE REQUIREMENTS OF SUBDIVISION (B) OF
SECTION 5.07 OF THE MENTAL HYGIENE LAW, EITHER AS A PART OF THE STATE-
WIDE COMPREHENSIVE FIVE-YEAR PLAN FOR THE PROVISION OF STATE AND LOCAL
S. 58--A 165 A. 158--A
SERVICES FOR PERSONS WITH MENTAL ILLNESS, REQUIRED UNDER THAT SECTION,
OR AS A SEPARATE DOCUMENT, AT THE DISCRETION OF THE COMMISSIONER.
S 2. Subdivision (e) of section 41.55 of the mental hygiene law, as
amended by section 1 of part N-1 of chapter 63 of the laws of 2003, is
amended to read as follows:
(e) The amount of community mental health support and workforce rein-
vestment funds for the office of mental health shall be determined in
the annual budget and shall include the amount of actual state oper-
ations general fund appropriation reductions, including personal service
savings and other than personal service savings directly attributed to
each child and adult non-geriatric inpatient bed closure. For the
purposes of this section a bed shall be considered to be closed upon the
elimination of funding for such beds in the executive budget. The
appropriation reductions as a result of inpatient bed closures shall be
no less than seventy thousand dollars per bed on a full annual basis, as
annually recommended by the commissioner, subject to the approval of the
director of the budget, in the executive budget request prior to the
fiscal year for which the executive budget is being submitted. [The
commissioner shall report to the governor, the temporary president of
the senate and the speaker of the assembly no later than October first,
two thousand three, and annually thereafter, with an explanation of the
methodologies used to calculate the per bed closure savings.] The meth-
odologies shall be developed by the commissioner and the director of the
budget. In no event shall the full annual value of community mental
health support and workforce reinvestment programs attributable to beds
closed as a result of net inpatient census decline exceed the twelve
month value of the office of mental health state operations general fund
reductions resulting from such census decline. Such reinvestment amount
shall be made available in the same proportion by which the office of
mental health's state operations general fund appropriations are reduced
each year as a result of child and adult non-geriatric inpatient bed
closures due to census decline.
S 3. Subdivisions (h) and (1) of section 41.55 of the mental hygiene
law are REPEALED.
S 4. 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 5. Subdivision (c) of section 7.15 of the mental hygiene law is
REPEALED.
S 6. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009; provided,
however, that the amendments to section 41.55 of the mental hygiene law,
made by section two of this act, shall not affect the repeal of such
section and shall be deemed repealed therewith.
PART N
Section 1. Section 3 of chapter 119 of the laws of 1997 authorizing
the department of health to establish certain payments to general hospi-
tals, as amended by section 1 of part H of chapter 57 of the laws of
2006, is amended to read as follows:
S 3. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 1997. This act
shall expire April 1, [2009] 2012.
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, 2009.
S. 58--A 166 A. 158--A
PART O
Section 1. The commissioner of mental health and the city of New York
are hereby authorized to extend for a period not exceeding fifty years
the lease of certain portions of Ward's Island authorized by chapter 2
of the laws of 1896, as amended by chapter 380 of the laws of 1900,
chapter 139 of the laws of 1908, chapter 696 of the laws of 1913, chap-
ter 101 of the laws of 1952, chapter 491 of the laws of 1952, and chap-
ter 524 of the laws of 1962 for the purposes of the Manhattan psychiat-
ric center, the Kirby forensic psychiatric center and the promotion of
the public health, welfare and safety.
S 2. Section 18-130 of the administrative code of the city of New York
is amended by adding a new subdivision g to read as follows:
G. NOTWITHSTANDING THE PROVISIONS OF SUBDIVISIONS B, C, D, E, AND F OF
THIS SECTION, OR OF ANY OTHER LAW, GENERAL, SPECIAL, OR LOCAL, IN ORDER
THAT THE STATE MAY RECONSTRUCT, MODERNIZE AND REBUILD SOME OR ALL OF THE
BUILDINGS AND FACILITIES OF THE MANHATTAN PSYCHIATRIC CENTER AND THE
KIRBY FORENSIC PSYCHIATRIC CENTER ON WARD'S ISLAND, AND CONTINUE TO
MAINTAIN SAID HOSPITALS, SO AS TO FURNISH MODERN FACILITIES FOR TREAT-
MENT AND CARE OF MENTAL PATIENTS OF THE METROPOLITAN DISTRICT AND TO
BENEFIT THE HEALTH, WELFARE AND SAFETY OF ITS RESIDENTS, THE CITY OF NEW
YORK, ACTING BY THE MAYOR ALONE, IS HEREBY AUTHORIZED TO ENTER INTO AN
AGREEMENT FOR THE RENEWAL OR FURTHER EXTENSION OF THE LEASE EXECUTED
BETWEEN THE CITY OF NEW YORK AND THE STATE OF NEW YORK PURSUANT TO THE
PROVISIONS OF CHAPTER ONE HUNDRED ONE OF THE LAWS OF NINETEEN HUNDRED
SIXTY-TWO, FOR A PERIOD NOT EXCEEDING FIFTY YEARS BEYOND ITS PRESENT
TERMINATION DATE WITH RESPECT TO ANY OF THE LANDS NOW OCCUPIED BY OR
USED IN CONNECTION WITH THE MANHATTAN PSYCHIATRIC CENTER, THE KIRBY
FORENSIC PSYCHIATRIC CENTER AND RELATED PROGRAMS. NEITHER THE PROVISIONS
OF SECTION ONE HUNDRED NINETY-SEVEN-C OF THE NEW YORK CITY CHARTER,
RELATING TO A UNIFORM LAND USE PROCEDURE, NOR THE PROVISIONS OF ANY
OTHER LOCAL LAW OF LIKE OR SIMILAR IMPORT SHALL APPLY TO THE RENEWAL OR
EXTENSION OF SAID LEASE.
S 3. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART P
Section 1. Section 19.07 of the mental hygiene law is amended by
adding a new subdivision (h) to read as follows:
(H) THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES SHALL DEVEL-
OP AN ALCOHOL AND DRUG REHABILITATION PROGRAM, CONSISTENT WITH THE
PROVISIONS OF SECTION ELEVEN HUNDRED NINETY-SIX OF THE VEHICLE AND TRAF-
FIC LAW FOR THE PROVISION OF CHEMICAL DEPENDENCY PREVENTION, EDUCATION,
EVALUATION AND TREATMENT TO PERSONS REFERRED AS A RESULT OF A VIOLATION
OF SECTIONS ELEVEN HUNDRED NINETY-TWO AND ELEVEN HUNDRED NINETY-TWO-A OF
THE VEHICLE AND TRAFFIC LAW. THE COMMISSIONER OF THE OFFICE OF ALCOHOL-
ISM AND SUBSTANCE ABUSE SERVICES SHALL ADOPT STANDARDS, RULES AND REGU-
LATIONS, AND ESTABLISH FEES NECESSARY TO IMPLEMENT THE PROVISIONS OF
THIS SUBDIVISION.
S 2. Subdivisions 1, 2, 3, 4 and 6 of section 1196 of the vehicle and
traffic law, subdivisions 1, 2, 3 and 6 as added by chapter 47 of the
laws of 1988, subdivision 4 as amended by chapter 196 of the laws of
1996, are amended to read as follows:
1. Program establishment. There is hereby established an alcohol and
drug rehabilitation program within the [department of motor vehicles]
S. 58--A 167 A. 158--A
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. The commissioner OF
THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES shall establish,
by regulation OR CONTRACT, the instructional and rehabilitative aspects
of the program. Such program shall [consist of at least fifteen hours
and] include, but need not be limited to, classroom instruction in areas
deemed suitable by the commissioner OF THE OFFICE OF ALCOHOLISM AND
SUBSTANCE ABUSE SERVICES. [No person shall be required to attend or
participate in such program or any aspect thereof for a period exceeding
eight months except upon the recommendation of the department of mental
hygiene or appropriate health officials administering the program on
behalf of a municipality.]
2. Curriculum. The form, content and method of presentation of the
various aspects of such program shall be established by the commissioner
OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. In the devel-
opment of the form, curriculum and content of such program, the commis-
sioner OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES may
consult with the commissioner of mental health, [the director of the
division of alcoholism and alcohol abuse, the director of the division
of substance abuse services] THE COMMISSIONER and any other state
department or agency and request and receive assistance from them. The
commissioner OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES is
also authorized to develop more than one curriculum and course content
for such program in order to meet the varying rehabilitative needs of
the participants.
3. Where available. A course in such program shall be available in at
least every county in the state, except where the commissioner OF THE
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES determines that there
is not a sufficient number of alcohol or drug-related traffic offenses
in a county to mandate the establishment of said course, and that
provisions be made for the residents of said county to attend a course
in another county where a course exists.
4. Eligibility. Participation in the program shall be limited to those
persons convicted of alcohol or drug-related traffic offenses or persons
who have been adjudicated youthful offenders for alcohol or drug-related
traffic offenses, or persons found to have been operating a motor vehi-
cle after having consumed alcohol in violation of section eleven hundred
ninety-two-a of this article, who choose to participate and who satisfy
the criteria and meet the requirements for participation as established
by this section and the regulations promulgated thereunder; provided,
however, in the exercise of discretion, the judge imposing sentence may
prohibit the defendant from enrolling in such program. The commissioner
[or deputy] OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES may
exercise discretion, to reject any person from participation referred to
such program and nothing herein contained shall be construed as creating
a right to be included in any course or program established under this
section. In addition, no person shall be permitted to take part in such
program if, during the five years immediately preceding commission of an
alcohol or drug-related traffic offense or a finding of a violation of
section eleven hundred ninety-two-a of this article, such person has
participated in a program established pursuant to this article or been
convicted of a violation of any subdivision of section eleven hundred
ninety-two of this article other than a violation committed prior to
November first, nineteen hundred eighty-eight, for which such person did
not participate in such program. In the exercise of discretion, the
commissioner [or a deputy] OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE
ABUSE SERVICES shall have the right to expel any participant from the
S. 58--A 168 A. 158--A
program who fails to satisfy the requirements for participation in such
program or who fails to satisfactorily participate in or attend any
aspect of such program. Notwithstanding any contrary provisions of this
chapter, satisfactory participation in and completion of a course in
such program shall result in the termination of any sentence of impri-
sonment that may have been imposed by reason of a conviction therefor;
provided, however, that nothing contained in this section shall delay
the commencement of such sentence.
6. Fees. The commissioner OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE
ABUSE SERVICES shall establish a schedule of fees to be paid by or on
behalf of each participant in the program, and may, from time to time,
modify same. Such fees shall defray the ongoing expenses of the program.
Provided, however, that pursuant to an agreement with the [department]
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, a municipality,
department thereof, or other agency may conduct a course in such program
with all or part of the expense of such course and program being borne
by such municipality, department or agency. In no event shall such fee
be refundable, either for reasons of the participant's withdrawal or
expulsion from such program or otherwise.
S 3. Paragraph (d) of subdivision 7 of section 1196 of the vehicle and
traffic law, as amended by chapter 309 of the laws of 1996, is amended
to read as follows:
(d) The commissioner shall require applicants for a conditional
license to pay a fee of seventy-five dollars for processing costs. Such
fees assessed under this subdivision shall be paid to the commissioner
for deposit to the general fund and shall be in addition to any fees
established by the commissioner OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES pursuant to subdivision six of this section to defray the costs
of the alcohol and drug rehabilitation program.
S 4. Notwithstanding any other provision of this act, the commissioner
of motor vehicles and the commissioner of the office of alcoholism and
substance abuse services shall enter into an agreement whereby the
department of motor vehicles will continue to operate the alcohol and
drug rehabilitation program pursuant to section eleven hundred ninety-
six of the vehicle and traffic law until October 1, 2009 whereupon the
commissioner of alcoholism and substance abuse services shall have
promulgated all rules and regulations necessary to implement the
provisions of this act.
S 5. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART Q
Section 1. Paragraph 2 of subdivision (a) of section 32.05 of the
mental hygiene law, as added by chapter 558 of the laws of 1999, is
amended to read as follows:
2. operation of a discrete unit of a hospital or other facility
possessing an operating certificate pursuant to article twenty-eight of
the public health law for the purpose of providing residential or non-
residential chemical dependence services, OR THE PROVISION OF CHEMICAL
DEPENDENCE CRISIS SERVICES IN AN AMOUNT THAT IS THE LESSER OF EITHER TWO
THOUSAND PATIENT DAYS PER YEAR, OR AN AMOUNT GREATER THAN TEN PERCENT OF
TOTAL PATIENT DAYS PER YEAR, AS DETERMINED BY THE COMMISSIONER, IN A
HOSPITAL OR OTHER FACILITY POSSESSING AN OPERATING CERTIFICATE PURSUANT
TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW; or
S. 58--A 169 A. 158--A
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after March 1, 2009.
PART R
Section 1. Paragraph (d) of subdivision 5 of section 366-a of the
social services law, as amended by section 49 of part C of chapter 58 of
the laws of 2008, is amended to read as follows:
(d) In order to establish place of residence and income eligibility
under this title at recertification, a recipient of assistance under
this title shall attest to place of residence and to all information
regarding the household's income that is necessary and sufficient to
determine such eligibility; provided, however, that this paragraph shall
not apply to persons described in subparagraph two of paragraph (a) of
subdivision one of section three hundred sixty-six of this title, or to
persons receiving long term care services, as defined in paragraph (b)
of subdivision two of this section; and provided, further, that a non-
applying legally responsible relative recertifying on behalf of a recip-
ient of assistance who is under the age of twenty-one years shall be
permitted to attest to household income under this paragraph only if the
social security numbers of all legally responsible relatives are
provided to the district. PROVIDED, HOWEVER, FOR PURPOSES OF RECERTIF-
ICATION FOR ASSISTANCE UNDER THIS TITLE FOR A RECIPIENT OF MEDICAID
WAIVER SERVICES PROVIDED OR AUTHORIZED BY THE OFFICE OF MENTAL RETARDA-
TION AND DEVELOPMENTAL DISABILITIES, BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND TEN, SUCH RECIPIENT MAY BE PERMITTED, AS DETERMINED
BY THE COMMISSIONER OF HEALTH, TO ATTEST TO PLACE OF RESIDENCE AND TO
ALL INFORMATION REGARDING THE HOUSEHOLD'S INCOME AND/OR RESOURCES THAT
ARE NECESSARY TO DETERMINE SUCH ELIGIBILITY.
S 2. This act shall take effect immediately, and be deemed to have
been in full force and effect on and after March 1, 2009.
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 R of this act shall be
as specifically set forth in the last section of such Parts.