S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  7286

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             March 27, 2009
                               ___________

Introduced  by M. of A. BOYLE -- read once and referred to the Committee
  on Aging

AN ACT to amend the elder law,  in  relation  to  establishing  an  EPIC
  spend-down program

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

  Section 1. Subdivision 3 of section 242 of the elder law is renumbered
subdivision 4 and a new subdivision 3 is added to read as follows:
  3. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, SENIORS
WHO DO NOT QUALIFY FOR EPIC BASED ON INCOME MAY  QUALIFY  FOR  THE  EPIC
SPEND-DOWN  PROGRAM  IF  CERTAIN  ELIGIBILITY  REQUIREMENTS  ESTABLISHED
PURSUANT TO PARAGRAPHS (A) AND (B) OF THIS SUBDIVISION ARE MET.
  (A) ANY UNMARRIED RESIDENT WHO IS AT LEAST SIXTY-FIVE YEARS OF AGE AND
WHOSE INCOME FOR THE CALENDAR YEAR IMMEDIATELY PRECEDING  THE  EFFECTIVE
DATE  OF  ANNUAL  COVERAGE  FOR THE PERIOD BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND TEN, IS MORE THAN THIRTY-FIVE THOUSAND DOLLARS,  BUT
DOES NOT EXCEED THE SUM OF FORTY THOUSAND DOLLARS, SHALL QUALIFY FOR THE
EPIC  SPEND-DOWN  PROGRAM  PROVIDED THAT SUCH INDIVIDUAL SPENDS AT LEAST
FIVE THOUSAND DOLLARS IN  OUT-OF-POCKET  PHARMACEUTICAL  EXPENSES  WHICH
SHALL  BE  DOCUMENTED ON FORMS PRESCRIBED BY THE COMMISSIONER OF HEALTH.
AFTER THE INITIAL DETERMINATION OF ELIGIBILITY, EACH ELIGIBLE INDIVIDUAL
MUST REAPPLY ANNUALLY FOR CONTINUED ELIGIBILITY.
  (B) ANY MARRIED RESIDENT WHO IS AT LEAST SIXTY-FIVE YEARS OF  AGE  AND
WHOSE  INCOME  FOR THE CALENDAR YEAR IMMEDIATELY PRECEDING THE EFFECTIVE
DATE OF ANNUAL COVERAGE FOR THE PERIOD BEGINNING  ON  OR  AFTER  JANUARY
FIRST,  TWO  THOUSAND TEN, IS MORE THAN FIFTY THOUSAND DOLLARS, BUT DOES
NOT EXCEED THE SUM OF FIFTY-FIVE THOUSAND DOLLARS, SHALL QUALIFY FOR THE
EPIC SPEND-DOWN PROGRAM IF SUCH INDIVIDUAL SPENDS AT LEAST TEN  THOUSAND
DOLLARS  IN  OUT-OF-POCKET  PHARMACEUTICAL EXPENSES WHICH SHALL BE DOCU-
MENTED ON FORMS PRESCRIBED BY THE  COMMISSIONER  OF  HEALTH.  AFTER  THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09338-01-9

              

A. 7286                             2

INITIAL  DETERMINATION  OF  ELIGIBILITY,  EACH  ELIGIBLE INDIVIDUAL MUST
REAPPLY ANNUALLY FOR CONTINUED ELIGIBILITY.
  (C)  INDIVIDUALS  WHO  MEET  THE  REQUIREMENTS  OF THE EPIC SPEND-DOWN
PROGRAM SHALL BE ELIGIBLE FOR PROGRAM BENEFITS  AS  IF  THE  INDIVIDUALS
QUALIFIED  FOR  THE HIGHEST INCOME LEVEL UNDER THE CATASTROPHIC COVERAGE
PURSUANT TO SUBDIVISION TWO OF THIS  SECTION  AND  SECTION  TWO  HUNDRED
FORTY-EIGHT  OF  THIS  TITLE.  FOR  THE PURPOSES OF THIS SUBDIVISION ALL
DEDUCTIBLE REQUIREMENTS SHALL BE WAIVED FOR ELIGIBLE INDIVIDUALS.
  (D) FOR THE PURPOSES OF THIS  SUBDIVISION,  "OUT-OF-POCKET  PHARMACEU-
TICAL  EXPENSES"  MEANS  PHARMACEUTICAL  COSTS  THAT  WOULD OTHERWISE BE
COVERED BY THE EPIC PROGRAM IF SUCH INDIVIDUAL OR INDIVIDUALS WOULD HAVE
MET THE ORIGINAL INCOME REQUIREMENTS OF THIS SECTION.
  (E) THE COMMISSIONER OF HEALTH IS HEREBY DIRECTED TO DEVELOP A  STAND-
ARDIZED  FORM  TO  BE  PROVIDED  TO ELIGIBLE PERSONS FOR THE PURPOSES OF
LEGAL DOCUMENTATION AND VERIFICATION  OF  OUT-OF-POCKET  EXPENSES.  SUCH
FORM SHALL BE AFFIXED TO THE EPIC APPLICATION.
  S 2. This act shall take effect on January 1, 2010.