S T A T E O F N E W Y O R K
________________________________________________________________________
884
2009-2010 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2009
___________
Introduced by M. of A. GOTTFRIED, ENGLEBRIGHT, JACOBS, PAULIN,
N. RIVERA, CAHILL, CHRISTENSEN, PERRY, BENJAMIN, ARROYO, GREENE,
HEASTIE, KOON -- Multi-Sponsored by -- M. of A. BING, BRADLEY, BREN-
NAN, COLTON, DESTITO, DINOWITZ, EDDINGTON, GLICK, GUNTHER, JOHN, KELL-
NER, LIFTON, V. LOPEZ, LUPARDO, McENENY, MILLMAN, PHEFFER, SWEENEY,
TITUS, WEISENBERG -- read once and referred to the Committee on Health
AN ACT to amend the public health law and the social services law, in
relation to medicaid payment for co-payments due under Medicare Part D
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 7 of section 273 of the public health law, as
amended by section 7 of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
7. No prior authorization under the preferred drug program shall be
required when a prescriber prescribes a drug on the preferred drug list,
OR WHEN MEDICAL ASSISTANCE PAYMENT IS MADE, UNDER PARAGRAPH (G) OF
SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THE SOCIAL
SERVICES LAW SOLELY FOR THE CO-PAYMENT FOR PRESCRIPTIONS PROVIDED UNDER
PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT; provided,
however, that the commissioner may identify [such] a drug for which
prior authorization is required pursuant to the provisions of the clin-
ical drug review program established under section two hundred seventy-
four of this article.
S 2. Subparagraph (ii) of paragraph (f) of subdivision 6 of section
367-a of the social services law, as amended by section 42 of part C of
chapter 58 of the laws of 2005, is amended to read as follows:
(ii) In the year commencing April first, two thousand five and for
each year thereafter, no recipient shall be required to pay more than a
total of two hundred dollars in co-payments, INCLUDING THOSE required by
this subdivision[, nor] AND, FOR RECIPIENTS ELIGIBLE FOR COVERAGE UNDER
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00354-01-9
A. 884 2
PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT (REFERRED TO IN
THIS SECTION AS "MEDICARE PART D"), THOSE CO-PAYMENTS REQUIRED BY MEDI-
CARE PART D. NOR shall reductions in payments as a result of such
co-payments exceed two hundred dollars for any recipient. THE COMMIS-
SIONER OF HEALTH SHALL CREATE A SYSTEM TO INCORPORATE CO-PAYMENTS BILLED
TO A RECIPIENT UNDER MEDICARE PART D TOWARDS THE RECIPIENT'S TOTAL ANNU-
AL CO-PAYMENTS UNDER MEDICAL ASSISTANCE. AS PART OF THIS SYSTEM, PHAR-
MACISTS SHALL RECORD ALL CO-PAYMENTS DUE UNDER MEDICARE PART D FROM SUCH
RECIPIENTS WITH THE MEDICAL ASSISTANCE PROGRAM, THROUGH THE MEDICAL
ASSISTANCE ELECTRONIC BILLING SYSTEM. THE COMMISSIONER OF HEALTH SHALL
INCLUDE THE CO-PAYMENTS BILLED UNDER MEDICARE PART D ALONG WITH THE
CO-PAYMENTS REQUIRED UNDER THIS SUBDIVISION IN DETERMINING WHEN THE
RECIPIENT'S TOTAL ANNUAL CO-PAYMENTS HAVE REACHED TWO HUNDRED DOLLARS.
S 3. 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, FOR RECIPIENTS ELIGIBLE FOR COVERAGE UNDER PART D OF
TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT (REFERRED TO IN THIS
SECTION AS "MEDICARE PART D"), PAYMENT OF THE CO-PAYMENT FOR DRUGS
PROVIDED BY A MEDICARE PART D PLAN, AFTER THE INDIVIDUAL HAS REACHED THE
ANNUAL CAP ON CO-PAYMENTS AS DEFINED IN SUBPARAGRAPH (II) OF PARAGRAPH
(F) OF SUBDIVISION SIX OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS
TITLE, 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 or alterna-
tives 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; medical assistance shall not include
any drug provided on other than an in-patient basis for which a recipi-
ent 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 depart-
ment regulations in accordance with standards established by the secre-
tary 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 4. This act shall take effect on the first of April next succeeding
the date on which it shall have become a law; provided, however, that
the amendments to subdivision 7 of section 273 of the public health law
A. 884 3
made by section one of this act shall not affect the repeal of such
section and shall be deemed repealed therewith; and provided, further,
that the amendments to subparagraph (ii) of paragraph (f) of subdivision
6 of section 367-a of the social services law made by section two of
this act shall not affect the repeal of such paragraph and shall be
deemed repealed therewith.