EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD12371-03-9
S. 58--B 2 A. 158--B
reform, in relation to reimbursements; to amend the public health law
and part C of chapter 58 of the laws of 2007 amending the social
services law and other laws relating to enacting the major components
of legislation necessary to implement the health and mental hygiene
budget for the 2007-2008 state fiscal year, in relation to rates of
payment by state governmental agencies; to amend chapter 629 of the
laws of 1986, amending the social services law relating to establish-
ing 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 provider 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; to amend
chapter 519 of the laws of 1999, amending the alcoholic beverage
control law and the public health law relating to the sale of alcohol
and tobacco products to minors, in relation to the effectiveness ther-
eof; and to amend chapter 58 of the laws of 2008 amending the social
services law and the public health law relating to adjustments of
rates and the public health law, in relation to hospitals and the
distribution of monies; providing for rates of payment by state agen-
cies for certain health care services; to amend the public health law,
in relation to assessments on general hospitals and patient service
payments; to amend chapter 703 of the laws of 1988 relating to enact-
ing the expanded health care coverage act of nineteen hundred eighty-
eight and amending the insurance law and other laws relating to
expanded health care and catastrophic health care coverage, in
relation to extending certain provisions thereof; to amend part G of
chapter 56 of the laws of 2000, amending the public health law relat-
ing to the sale and possession of hypodermic syringes and needles, in
relation to making permanent the expanded syringe access demonstration
program; and to amend chapter 659 of the laws of 1997, constituting
the long term care integration and finance act of 1997, in relation to
extending the effectiveness thereof; and to repeal certain provisions
of part G of chapter 56 of the laws of 2000 amending the public health
law and other laws relating to the sale and possession of hypodermic
syringes and needles relating to the effectiveness thereof (Part B);
to amend the public health law, in relation to payment by governmental
agencies for general hospital inpatient services, inpatient medical
S. 58--B 3 A. 158--B
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 commissioners 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 methodology; to amend the social
services law, in relation to establishing the statewide patient-cen-
tered medical home; to amend the public health law, in relation to
establishing the Adirondack medical home multipayor demonstration
program; to amend the social services law, in relation to medicaid
coverage of smoking cessation, cardiac rehabilitation services and
substance abuse intervention; to amend the social services law, in
relation to the primary care case management program; to amend the
public health law, in relation to establishing the state electronic
health records loan 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 public health law, in relation to
defining certain terms and designating pharmaceutical manufacturers;
to amend the social services law, in relation to directing the commis-
sioner of health to negotiate pharmaceutical rebates, retrospective
and prospective 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
social services law, in relation to electronic transmission of
prescriptions; to amend the social services law, in relation to eligi-
bility 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 public health law, in relation to
fees for the establishment of hospitals, approval of the construction
of hospitals, licensure of home care services agencies, the establish-
ment of certified home health agencies, changes in the ownership of a
home health agency hospice construction, distribution of the profes-
sional education pools, the general hospital indigent care pool and
the comprehensive diagnostic and treatment centers indigent care
program; to amend the elder law, in relation to the program for elder-
ly pharmaceutical insurance coverage; to amend the insurance law, in
relation to examinations and appraisals of authorized insurers and
employee welfare funds; 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 telemedicine demonstration program; to repeal certain
provisions of chapter 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, eligibility for medical assistance; to repeal certain
provisions of the elder law relating to the program for elderly phar-
maceutical insurance coverage; and providing for the repeal of certain
provisions upon the expiration thereof; to repeal a certain provision
of the insurance law relating to records made available by corpo-
S. 58--B 4 A. 158--B
rations (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 amend chapter 109 of the laws of 2006, amending the social services
law and other laws relating to Medicaid reimbursement rate settings,
in relation to establishing a workgroup pertaining to Medicaid
reimbursement rate-setting for residential health care facilities for
future periods and providing for periodic reports by such group; to
amend the social services law, in relation to assisted living
programs, to payment for AIDS home care programs, to establishing
regional long-term care assessment centers, and in relation to Medi-
caid extended coverage for the partnership for long-term care program;
to amend the social services law, in relation to the consumer directed
personal assistance program; to amend chapter 58 of the laws of 2007,
amending the social services law and the public health law relating to
adjustments of rates, in relation to determination of eligibility; to
amend chapter 58 of the laws of 2008, amending the social services law
and the public health law relating to adjustments of rates, in
relation to determination of eligibility; 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; and authorizing the commissioner of
health to expend certain funds to improve the working conditions of
certain pediatric facilities (Part D); Intentionally omitted (Part E);
in relation to the establishment of the authority of the office of
mental health to reduce inpatient capacity through the closure of such
wards or through the conversion of beds to develop transitional place-
ment programs, notwithstanding certain provisions of the mental
hygiene law (Part F); Intentionally omitted (Part G); to amend the
mental hygiene law, in relation to civil commitment of sex offenders
(Part H); Intentionally omitted (Part I); to amend the mental hygiene
law, in relation to the consolidation of certain developmental disa-
bilities services officers (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); Intentionally omitted (Part M); to amend chapter
119 of the laws of 1997 authorizing the department of health to estab-
lish 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); authorizing the commissioner
of mental health and the city of New York to extend the lease of
certain portions of Ward's Island; and to amend the administrative
code of the city of New York, in relation to permitting the extension
of such lease for a period not to exceed fifty years for the continued
purposes of the Manhattan psychiatric center and the Kirby forensic
psychiatric center and related programs (Part O); Intentionally omit-
ted (Part P); Intentionally omitted (Part Q); and to amend the social
services law, in relation to recertification for medical assistance
for a recipient of medicaid waiver services authorized by the office
of mental retardation and developmental disabilities (Part R)
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
S. 58--B 5 A. 158--B
Section 1. This act enacts into law major components of legislation
which are necessary to implement the state fiscal plan for the 2009-2010
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. Subdivisions 9 and 10 of section 225 of the public health
law, subdivision 9 as added by chapter 612 of the laws of 1990, and
subdivision 10 as added by chapter 446 of the laws of 1991, are amended
to read as follows:
9. Notwithstanding the provisions of any general, special or local law
to the contrary, in cities having a population of one million or more,
the sanitary code shall provide that any installation, service, mainte-
nance, testing, repair or modification of a backflow prevention device
or any related work shall be performed in conformance with the plumbing
code of any such city. All employees of a licensed plumber who perform
testing of backflow prevention devices shall satisfactorily complete an
approved course in backflow prevention device testing. NOTHING IN THIS
SUBDIVISION SHALL REQUIRE THE COMMISSIONER TO CERTIFY THE COMPLETION OF
SUCH APPROVED COURSE BY SUCH EMPLOYEES. For the purposes of this subdi-
vision, "backflow prevention device" means an acceptable air gap,
reduced pressure zone device, double check valve assembly or equivalent
protective device acceptable to the commissioner that is designed to
prevent or contain potential contamination of a public water system by
means of cross-connection control.
10. Notwithstanding the provisions of any general, special or local
law to the contrary, the sanitary code of the state of New York shall
provide that in any county, city having a population of less than one
million, town or village having a plumbing code, the installation,
service, maintenance, testing, repair or modification of a backflow
prevention device or any related work shall be performed in accordance
with such plumbing code. A person licensed under such plumbing code and
any of his employees who perform testing of backflow prevention devices
shall satisfactorily complete a course in backflow prevention device
testing that has been approved by the department. NOTHING IN THIS
SUBDIVISION SHALL REQUIRE THE COMMISSIONER TO CERTIFY THE COMPLETION OF
SUCH APPROVED COURSE BY SUCH LICENSEE OR EMPLOYEES. For the purposes of
this subdivision, "backflow prevention device" means an acceptable air
gap, reduced pressure zone device, double check valve assembly or equiv-
alent protective device acceptable to the commissioner that is designed
to prevent or contain potential contamination of a public water system
by means of cross-connection control.
S 2. Subdivision 4 of section 1352 of the public health law, as added
by chapter 635 of the laws of 2007, is amended to read as follows:
4. [The] TO THE EXTENT THAT FUNDS ARE AVAILABLE FOR THE PURPOSES SET
FORTH IN THIS SUBDIVISION, THE commissioner shall require that the
following food service establishments: restaurants, bars, membership
organizations, fraternal organizations, and private clubs, excepting
S. 58--B 6 A. 158--B
establishments licensed pursuant to section sixty-four-a of the alcohol-
ic beverage control law, that are not regulated by the department of
agriculture and markets, at all times have in their employment at least
one individual who has been trained and certified by an organization,
approved by the commissioner, which specializes in and provides instruc-
tion concerning the safe and proper handling, preparation, cooking,
storage, serving, delivery, removal and disposal of food. Attendance at
any course established pursuant to this section shall be in person,
through distance learning methods, or through an Internet based online
program. Such training shall meet the standards set forth by the commis-
sioner pursuant to section thirteen hundred fifty-five of this title,
either: (a) pursuant to a program approved by the commissioner under
such section, or (b) pursuant to a course that shall address but not be
limited to the following topics:
(i) Contamination, food allergies and foodborne illness.
(ii) Purchasing and receiving safe food.
(iii) Keeping food safe in storage.
(iv) Protecting food during preparation.
(v) Protecting food during service.
(vi) Sanitary facilities and equipment.
(vii) Cleaning and sanitizing.
(viii) Integrated pest management.
(ix) Food-safety regulations and standards.
(x) Employee food-safety training.
The commissioner shall allow a licensee a period of up to thirty days
to come into compliance with this subdivision where an employee who has
been certified as having completed the approved food safety training
program separates from his or her place of employment.
S 3. 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 WHERE INSPECTIONS OTHERWISE OCCUR UNDER THE
STATE UNIFORM FIRE PREVENTION AND BUILDING CODE, RESPOND TO COMPLAINTS
RELATING TO HOTELS, BOARDING HOUSES AND TEMPORARY RESIDENCES AS DEFINED
IN THE STATE SANITARY CODE AND INSPECT SUCH FACILITIES WHEN OTHERWISE
NECESSARY;
S 4. 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
S. 58--B 7 A. 158--B
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-
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; (D) A MECHANISM TO PROVIDE EDUCA-
TION 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; AND (E) A MECH-
ANISM AND OUTREACH EFFORTS TO PROVIDE HOUSING INSPECTIONS FOR LEAD
HAZARDS UPON REQUEST. 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 MUNICIPAL 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
AND MAY, WHEN QUALIFIED STAFF EXISTS, DESIGNATE THE LOCAL HOUSING MAIN-
TENANCE CODE ENFORCEMENT AGENCY IN WHICH THE COMMUNITY OF CONCERN IS
LOCATED AS AN AGENCY AUTHORIZED TO ADMINISTER THE PROVISIONS OF THIS
TITLE PURSUANT TO SUBDIVISION ONE OF SECTION THIRTEEN HUNDRED
SEVENTY-FIVE OF THIS TITLE. 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
S. 58--B 8 A. 158--B
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. FUNDING PROVIDED FOR THIS PROGRAM SHALL BE
USED FOR THE ACTIVITIES DESCRIBED IN THIS SECTION AND SHALL NOT BE USED
FOR OTHER ACTIVITIES REQUIRED BY THIS TITLE.
S 5. 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-
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 6. 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 7. 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:
S. 58--B 9 A. 158--B
(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 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,] THIRD PARTY PAYER 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
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] THIRD PARTY
PAYER, [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.
S. 58--B 10 A. 158--B
(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 "THIRD PARTY PAYER" SHALL MEAN HEALTH MAINTENANCE ORGAN-
IZATIONS CERTIFIED UNDER ARTICLE FORTY-FOUR OF THIS CHAPTER, HEALTH
SERVICE CORPORATIONS LICENSED PURSUANT TO ARTICLE FORTY-THREE OF THE
INSURANCE LAW, SELF-INSURED PLANS THAT PAY FOR HEALTH CARE SERVICES,
HEALTH INSURANCE COMPANIES SUBJECT TO ARTICLE THIRTY-TWO OF THE INSUR-
ANCE 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' COMPENSATION
LAW.
(G) FOR PURPOSES OF THIS SECTION THE TERM "WIC PROGRAM" SHALL MEAN 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).
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;
S. 58--B 11 A. 158--B
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
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-
S. 58--B 12 A. 158--B
teen hundred ninety-four, section [11.04] 11.07 of title twenty-four of
volume eight of the compilation of the rules of the city of New York and
administered 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
commissioner 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 OF THIS SECTION 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.
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
S. 58--B 13 A. 158--B
(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] THIRD PARTY PAYER for performing quality assurance,
accountability and outreach, relating to enrollees covered by the
[health maintenance organization] THIRD PARTY PAYER; (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
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.
S. 58--B 14 A. 158--B
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 8. Intentionally omitted.
S 9. Intentionally omitted.
S 10. Intentionally omitted.
S 11. Intentionally omitted.
S 12. Intentionally omitted.
S 13. Subdivisions 3, 4, 5 and 7 of section 217-a of the elder law, as
added by section 23 of part B of chapter 58 of the laws of 2004, are
amended to read as follows:
3. The commissioner of health, the superintendent of insurance and the
director of the office for the aging shall appoint a state program coor-
dinator to implement, administer and supervise the long term care insur-
ance education and outreach program, and coordinate the development of
the educational and informational materials. The state program coordina-
tor shall be [a full time] AN employee of the office for the aging who
shall be selected from among individuals with expertise and experience
in the fields of long term care insurance, and with other qualifications
determined by the commissioner of health, the superintendent of insur-
ance and the director of the office for the aging to be appropriate for
the position. The state program coordinator shall, WITHIN AMOUNTS AVAIL-
ABLE, personally or through authorized representatives, be responsible
for training staff persons of the program, including staff persons of
the long term care insurance resource centers, and shall provide for the
collection and dissemination of timely and accurate long term care
insurance information to said staff persons.
4. The long term care insurance education and outreach program shall
[at a minimum], WITHIN AMOUNTS AVAILABLE, consist of the following
elements which shall be provided by the office for the aging:
(a) educational and informational materials in print, audio, visual,
electronic or other media;
(b) public service announcements, advertisements, media campaigns,
workshops, mass mailings, conferences or presentations;
(c) establishment of a toll-free telephone hotline and electronic
services to provide information; and
(d) establishment of long term care insurance resource centers within
each area agency on aging.
S. 58--B 15 A. 158--B
5. Long term care insurance resource centers shall, [at a minimum]
WITHIN AMOUNTS AVAILABLE, provide the general public with the following
items or services:
(a) educational and informational materials in print, audio, visual,
electronic or other media;
(b) public service announcements, advertisements, media campaigns,
workshops, mass mailings, conferences or presentations; and
(c) counseling, information, referral services, and direct assistance
in choosing and obtaining long term care insurance. Direct assistance
shall, WITHIN AMOUNTS AVAILABLE, include but not be limited to assist-
ance with the following:
(i) planning for the financing of long term care;
(ii) understanding policy options, benefits and appeal rights;
(iii) obtaining the coverage needed and the appropriate benefits; and
(iv) avoiding or reporting illegal billing, fraudulent practices or
scams.
Each long term care insurance resource center shall be responsible,
WITHIN AMOUNTS AVAILABLE, for providing a sufficient number of staff
positions (including volunteers) necessary to provide and carry out the
services of the long term care insurance education and outreach program,
provided that at least one position shall be filled by an individual who
is employed full time and paid by the area agency on aging. The long
term care insurance resource center shall be responsible for ensuring
that its staff persons have no conflict of interest in providing the
services described in subdivision four of this section.
7. The department of health shall produce, POST ON ITS WEBSITE, make
available to others for reproduction, or contract with others to develop
such materials [mentioned in] REQUIRED BY this section [as the coordina-
tor deems appropriate]. The material produced pursuant to this section
shall be culturally and linguistically appropriate for the communities
served by the long term care insurance resource centers. These materials
shall be made available to the public free of charge.
S 14. This act shall take effect immediately.
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 THIRTY-FIVE HUNDREDTHS OF ONE PERCENT OF EACH AGEN-
CY'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 APRIL 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-
S. 58--B 16 A. 158--B
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
THIRTY-FIVE HUNDREDTHS 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 APRIL 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
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
THIRTY-FIVE HUNDREDTHS 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 APRIL 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 July 1, 2009 pursuant to P.L. 110-252,
S. 58--B 17 A. 158--B
as amended by P.L. 111-5, 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) and a regulation subject to a moratorium in effect until
June 30, 2009 pursuant to P.L. 111-5, specifically: final regulation
concerning outpatient hospital facility services published November 7,
2008 (73 Federal Register 66187).
S 6. Intentionally omitted.
S 7. Intentionally omitted.
S 8. Intentionally omitted.
S 9. Intentionally omitted.
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 FOR THE STATE FISCAL YEAR BEGINNING APRIL FIRST, TWO
THOUSAND TEN AND FOR THE STATE FISCAL YEAR BEGINNING APRIL FIRST, TWO
THOUSAND ELEVEN. The amount allocated to each eligible public residen-
tial health care facility for this period shall be computed in accord-
ance with the provisions of paragraph (f) of this subdivision, provided,
however, that patient days shall be utilized for such computation
reflecting actual reported data for two thousand three and each repre-
sentative succeeding year as applicable.
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:
S. 58--B 18 A. 158--B
(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 FOR THE STATE
FISCAL YEAR BEGINNING APRIL 1, 2009 THROUGH MARCH 31, 2010, AND FOR THE
STATE FISCAL YEAR BEGINNING APRIL 1, 2010 THROUGH MARCH 31, 2011, the
department of health is authorized to pay public general hospitals, as
defined in subdivision 10 of section 2801 of the public health law,
operated by the state of New York or by the state university of New York
or by a county, which shall not include a city with a population of over
one million, of the state of New York, and those public general hospi-
tals located in the county of Westchester, the county of Erie or the
county of Nassau, additional payments for inpatient hospital services as
medical assistance payments pursuant to title 11 of article 5 of the
social services law for patients eligible for federal financial partic-
ipation under title XIX of the federal social security act in medical
assistance pursuant to the federal laws and regulations governing
disproportionate share payments to hospitals up to one hundred percent
of each such public general hospital's medical assistance and uninsured
patient losses after all other medical assistance, including dispropor-
tionate share payments to such public general hospital for 1996, 1997,
1998, and 1999, based initially for 1996 on reported 1994 reconciled
data as further reconciled to actual reported 1996 reconciled data, and
for 1997 based initially on reported 1995 reconciled data as further
reconciled to actual reported 1997 reconciled data, for 1998 based
initially on reported 1995 reconciled data as further reconciled to
actual reported 1998 reconciled data, for 1999 based initially on
reported 1995 reconciled data as further reconciled to actual reported
1999 reconciled data, for 2000 based initially on reported 1995 recon-
ciled data as further reconciled to actual reported 2000 data, for 2001
based initially on reported 1995 reconciled data as further reconciled
to actual reported 2001 data, for 2002 based initially on reported 2000
reconciled data as further reconciled to actual reported 2002 data, and
for state fiscal years beginning on April 1, 2005, based initially on
reported 2000 reconciled data as further reconciled to actual reported
data for 2005, and for state fiscal years beginning on April 1, 2006,
based initially on reported 2000 reconciled data as further reconciled
to actual reported data for 2006 [and], for state fiscal years beginning
on and after April 1, 2007 THROUGH MARCH 31, 2009, based initially on
reported 2000 reconciled data as further reconciled to actual reported
data for 2007, FOR STATE FISCAL YEARS BEGINNING ON AND AFTER APRIL 1,
2009, BASED INITIALLY ON REPORTED 2007 RECONCILED DATA, ADJUSTED FOR
AUTHORIZED MEDICAID RATE CHANGES APPLICABLE TO THE STATE FISCAL YEAR,
AND AS FURTHER RECONCILED TO ACTUAL REPORTED DATA FOR 2009, and to actu-
al reported data for each respective succeeding year. The payments may
be added to rates of payment or made as aggregate payments to an eligi-
ble public general hospital.
S. 58--B 19 A. 158--B
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 UP TO FOUR HUNDRED TWENTY MILLION
DOLLARS ANNUALLY FOR THE STATE FISCAL YEAR BEGINNING APRIL 1, 2009
THROUGH MARCH 31, 2010, AND FOR THE STATE FISCAL YEAR BEGINNING APRIL 1,
2010 THROUGH MARCH 31, 2011 AND UP TO ONE HUNDRED TWENTY MILLION DOLLARS
ANNUALLY FOR THE STATE FISCAL YEAR BEGINNING APRIL 1, 2011, AND ANNUALLY
THEREAFTER, as medical assistance payments pursuant to title 11 of arti-
cle 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 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 assistance, 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, FOR PAYMENTS MADE DURING THE STATE FISCAL YEAR ENDING
ON AND AFTER MARCH 31, 2010, BASED INITIALLY ON REPORTED 2007 RECONCILED
DATA, ADJUSTED FOR AUTHORIZED MEDICAID RATE CHANGES APPLICABLE TO THE
STATE FISCAL YEAR, AND AS FURTHER RECONCILED TO ACTUAL REPORTED 2009
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
S. 58--B 20 A. 158--B
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,
(b) sections four through ten shall expire on June 30, [2009] 2011,
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 THROUGH MARCH 31, 2011;
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 THROUGH MARCH 31, 2011.
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
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
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, the reimbursable inpa-
tient operating cost component of case based rates of payment per diag-
nosis-related group, excluding any operating cost components related to
direct and indirect expenses of graduate medical education, 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 pursuant to subpara-
graph (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
S. 58--B 21 A. 158--B
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 THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, 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 pursuant to subparagraph (ii) of para-
graph (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 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
ELEVEN, for purposes of reimbursement of inpatient hospital services for
patients eligible for payments made by state governmental agencies, the
average reimbursable inpatient operating cost per discharge of a general
hospital shall, to encourage improved productivity 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 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, 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:
S. 58--B 22 A. 158--B
(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 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
ELEVEN, as the result of (A) eighty-nine million dollars on an annual-
ized 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 THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, from the statewide average case
mix for the period January first, nineteen hundred ninety-six through
December thirty-first, nineteen hundred ninety-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, nine-
teen 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 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,
S. 58--B 23 A. 158--B
AND ON AND AFTER APRIL 1, 2009 THROUGH MARCH 31, 2011, shall reflect no
trend factor projections 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 THROUGH SEPTEMBER 30, 2011, 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 THROUGH SEPTEMBER 30, 2011,
provided however that, subject to the approval of the director of the
budget, such rates may be adjusted to include expenditures 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 THROUGH MARCH 31, 2011;
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
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 THROUGH MARCH 31, 2011 shall reflect no trend factor
projections or adjustments for the period April 1, 1996, through March
31, 1997.
2. The commissioner of health shall adjust such rates of payment to
reflect the exclusion pursuant to this section of such specified trend
factor projections or adjustments.
S. 58--B 24 A. 158--B
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 THROUGH
MARCH 31, 2011 for inpatient 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, FEBRUARY 1, 2010, AND FEBRUARY
1, 2011 the commissioner of health shall calculate the result of the
statewide total of residential health care facility days of care
provided to beneficiaries of title XVIII of the federal social security
act (medicare), divided by the sum of such days of care plus days of
care provided to residents eligible for payments pursuant to title 11 of
article 5 of the social services law minus the number of days provided
to residents receiving hospice care, expressed as a percentage, for the
period commencing January 1, through November 30, of the prior year
respectively, based on such data for such period. This value shall be
called the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and],
2009, 2010 AND 2011 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, 2010 AND 2011 statewide target percentages are
not for each year at least three percentage points higher than the
statewide base percentage, the commissioner of health shall determine
the percentage by which the statewide target percentage for each year is
not at least three percentage points higher than the statewide base
percentage. The percentage calculated pursuant to this paragraph shall
be called the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008 [and], 2009, 2010 AND 2011 statewide reduction percentage
S. 58--B 25 A. 158--B
respectively. If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008 [and], 2009, 2010 AND 2011 statewide target percentage
for the respective year is at least three percentage points higher than
the statewide base percentage, the statewide reduction percentage for
the respective year shall be zero.
S 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, 2010 AND 2011 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, 2010 AND 2011 statewide aggregate reduction amount. If the 1998
and the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and],
2009, 2010 AND 2011 statewide reduction percentage shall be zero respec-
tively, there shall be no 1998, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008 [and], 2009, 2010 AND 2011 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, 2010 AND 2011 statewide aggregate
reduction amounts shall for each year be allocated by the commissioner
of health among residential health care facilities that are eligible to
provide services to beneficiaries of title XVIII of the federal social
security act (medicare) and residents eligible for payments pursuant to
title 11 of article 5 of the social services law on the basis of the
extent of each facility's failure to achieve a two percentage points
increase in the 1996 target percentage, a three percentage point
increase in the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008 [and], 2009, 2010 AND 2011 target percentage and a two and
one-quarter percentage point increase in the 1999 target percentage for
each year, compared to the base percentage, calculated on a facility
specific basis for this purpose, compared to the statewide total of the
extent of each facility's failure to achieve a two percentage points
increase in the 1996 and a three percentage point increase in the 1997
and a three percentage point increase in the 1998 and a two and one-
quarter percentage point increase in the 1999 target percentage and a
three percentage point increase in the 2000, 2001, 2002, 2003, 2004,
2005, 2006, 2007, 2008 [and], 2009, 2010 AND 2011 target percentage
compared to the base percentage. These amounts shall be called the 1996,
1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008
[and], 2009, 2010 AND 2011 facility specific reduction amounts respec-
tively.
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
S. 58--B 26 A. 158--B
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 THE 2010 TARGET PERIOD SHALL MEAN JANUARY 1, 2010 THROUGH
NOVEMBER 30, 2010 AND THE 2011 TARGET PERIOD SHALL MEAN JANUARY 1, 2011
THROUGH NOVEMBER 30, 2011.
2. (a) Prior to February 1, 1997, for each regional group the commis-
sioner of health shall calculate the 1996 medicaid revenue percentages
for the period commencing August 1, 1996 to the last date for which such
data is available and reasonably accurate.
(b) Prior to February 1, 1998, prior to February 1, 1999, prior to
February 1, 2000, prior to February 1, 2001, prior to February 1, 2002,
prior to February 1, 2003, prior to February 1, 2004, prior to February
1, 2005, prior to February 1, 2006, [and] prior to February 1, 2007,
[and] prior to February 1, 2008 [and], prior to February 1, 2009, PRIOR
TO FEBRUARY 1, 2010 AND PRIOR TO FEBRUARY 1, 2011 for each regional
group the commissioner of health shall calculate the prior year's medi-
caid 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:
S. 58--B 27 A. 158--B
(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, 2010 AND 2011 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 percent-
age 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, 2010 AND 2011 taking into
account regional and program differences in utilization of medicaid and
medicare services, for the following regional groups shall be equal to
for each such year:
(i) one and one-tenth percentage points for CHHAs located within the
downstate region;
(ii) six-tenths of one percentage point for CHHAs located within the
upstate region;
(iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
(iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
(c) For each regional group, the 1999 target medicaid revenue percent-
age shall be calculated by subtracting the 1999 medicaid revenue
reduction percentage from the base period medicaid revenue percentage.
The 1999 medicaid revenue reduction percentages, taking into account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
(i) eight hundred twenty-five thousandths (.825) of one percentage
point for CHHAs located within the downstate region;
(ii) forty-five hundredths (.45) of one percentage point for CHHAs
located within the upstate region;
(iii) one and thirty-five hundredths percentage points (1.35) for
LTHHCPs located within the downstate region; and
(iv) one and two hundred seventy-five thousandths percentage points
(1.275) for LTHHCPs located within the upstate region.
5. (a) For each regional group, if the 1996 medicaid revenue percent-
age is not equal to or less than the 1996 target medicaid revenue
percentage, the commissioner of health shall compare the 1996 medicaid
revenue percentage to the 1996 target medicaid revenue percentage to
determine the amount of the shortfall which, when divided by the 1996
medicaid revenue reduction percentage, shall be called the 1996
reduction factor. These amounts, expressed as a percentage, shall not
exceed one hundred percent. If the 1996 medicaid revenue percentage is
equal to or less than the 1996 target medicaid revenue percentage, the
1996 reduction factor shall be zero.
(b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008 [and], 2009, 2010 AND 2011 for each regional group, if the
medicaid revenue percentage for the respective year is not equal to or
less than the target medicaid revenue percentage for such respective
year, the commissioner of health shall compare such respective year's
medicaid revenue percentage to such respective year's target medicaid
S. 58--B 28 A. 158--B
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, 2010 AND 2011 for each regional group, the reduction
factor for the respective year shall be multiplied by the following
amounts to determine each regional group's applicable state share
reduction amount for such respective year:
(i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;
(ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
(iii) one million two hundred seventy thousand dollars ($1,270,000)
for LTHHCPs located within the downstate region; and
(iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
located within the upstate region.
For each regional group reduction, if the reduction factor for a
particular year shall be zero, there shall be no state share reduction
amount for such year.
(c) For each regional group, the 1999 reduction factor shall be multi-
plied by the following amounts to determine each regional group's appli-
cable 1999 state share reduction amount:
(i) one million seven hundred ninety-two thousand five hundred dollars
($1,792,500) for CHHAs located within the downstate region;
(ii) five hundred sixty-two thousand five hundred dollars ($562,500)
for CHHAs located within the upstate region;
(iii) nine hundred fifty-two thousand five hundred dollars ($952,500)
for LTHHCPs located within the downstate region; and
(iv) four hundred forty-two thousand five hundred dollars ($442,500)
for LTHHCPs located within the upstate region.
For each regional group reduction, if the 1999 reduction factor shall
be zero, there shall be no 1999 state share reduction amount.
7. (a) For each regional group, the 1996 state share reduction amount
shall be allocated by the commissioner of health among CHHAs and LTHHCPs
on the basis of the extent of each CHHA's and LTHHCP's failure to
achieve the 1996 target medicaid revenue percentage, calculated on a
provider specific basis utilizing revenues for this purpose, expressed
as a proportion of the total of each CHHA's and LTHHCP's failure to
achieve the 1996 target medicaid revenue percentage within the applica-
S. 58--B 29 A. 158--B
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, 2010 AND 2011 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 medi-
caid revenue percentage for the applicable year, calculated on a provid-
er 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 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 calculation pursuant
to paragraph (b) or (c) of subdivision 6 of this section. This amount
shall be called the provider specific state share reduction amount for
the applicable year.
8. (a) The 1996 provider specific state share reduction amount shall
be due to the state from each CHHA and LTHHCP and may be recouped by the
state by March 31, 1997 in a lump sum amount or amounts from payments
due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
social services law.
(b) The provider specific state share reduction amount for 1997, 1998,
1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and], 2009,
2010 AND 2011 respectively, shall be due to the state from each CHHA and
LTHHCP and each year the amount due for such year may be recouped by the
state by March 31 of the following year in a lump sum amount or amounts
from payments due to the CHHA and LTHHCP pursuant to title 11 of article
5 of the social services law.
9. CHHAs and LTHHCPs shall submit such data and information at such
times as the commissioner of health may require for purposes of this
section. The commissioner of health may use data available from third-
party payors.
10. On or about June 1, 1997, for each regional group the commissioner
of health shall calculate for the period August 1, 1996 through March
31, 1997 a medicaid revenue percentage, a reduction factor, a state
share reduction amount, and a provider specific state share reduction
amount in accordance with the methodology provided in paragraph (a) of
subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
sion 6 and paragraph (a) of subdivision 7 of this section. The provider
specific state share reduction amount calculated in accordance with this
subdivision shall be compared to the 1996 provider specific state share
reduction amount calculated in accordance with paragraph (a) of subdivi-
sion 7 of this section. Any amount in excess of the amount determined in
accordance with paragraph (a) of subdivision 7 of this section shall be
due to the state from each CHHA and LTHHCP and may be recouped in
accordance with paragraph (a) of subdivision 8 of this section. If the
amount is less than the amount determined in accordance with paragraph
(a) of subdivision 7 of this section, the difference shall be refunded
to the CHHA and LTHHCP by the state no later than July 15, 1997. CHHAs
and LTHHCPs shall submit data for the period August 1, 1996 through
March 31, 1997 to the commissioner of health by April 15, 1997.
11. If a CHHA or LTHHCP fails to submit data and information as
required for purposes of this section:
S. 58--B 30 A. 158--B
(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 THROUGH MARCH 31, 2011;
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
and after April 1, 2000 through March 31, 2003 and on and after April 1,
2003 through March 31, 2007, and on and after April 1, 2007 through
March 31, 2009, AND ON AND AFTER APRIL 1, 2009 THROUGH MARCH 31, 2011.
S 34. Intentionally omitted.
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, 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--B 31 A. 158--B
(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. Intentionally omitted.
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, and shall expire and be of
no further effect on September 1, 2009];
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 2. This act shall take effect immediately[ and shall be deemed
repealed on July 31, 2009].
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].
S. 58--B 32 A. 158--B
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 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND ELEV-
EN, 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 provid-
ers of services.
S 46-a. Section 365-a of the social services law is amended by adding
a new subdivision 8 to read as follows:
8. WHEN A NON-GOVERNMENTAL ENTITY IS AUTHORIZED BY THE DEPARTMENT
PURSUANT TO CONTRACT OR SUBCONTRACT TO MAKE PRIOR AUTHORIZATION OR PRIOR
APPROVAL DETERMINATIONS THAT MAY BE REQUIRED FOR ANY ITEM OF MEDICAL
ASSISTANCE, A RECIPIENT MAY CHALLENGE ANY ACTION TAKEN OR FAILURE TO ACT
IN CONNECTION WITH A PRIOR AUTHORIZATION OR PRIOR APPROVAL DETERMINATION
AS IF SUCH DETERMINATION WERE MADE BY A GOVERNMENT ENTITY, AND SHALL BE
ENTITLED TO THE SAME MEDICAL ASSISTANCE BENEFITS AND STANDARDS AND TO
THE SAME NOTICE AND PROCEDURAL DUE PROCESS RIGHTS, INCLUDING A RIGHT TO
A FAIR HEARING AND AID CONTINUING PURSUANT TO SECTION TWENTY-TWO OF THIS
CHAPTER, AS IF THE PRIOR AUTHORIZATION OR PRIOR APPROVAL DETERMINATION
WERE MADE BY A GOVERNMENT ENTITY.
S 47. Section 11 of part C of chapter 58 of the laws of 2008 amending
the social services law and the public health law relating to adjust-
ments of rates, as amended by section 1 of part I of chapter 2 of the
laws of 2009, is amended to read as follows:
S 11. 1. Notwithstanding paragraph (c) of subdivision 10 of section
2807-c of the public health law, subdivision 2-b of section 2808 of the
public health law, section 21 of chapter 1 of the laws of 1999, and any
other contrary provision of law, but subject to subparagraph (iii) of
paragraph [(b)] (A) of subdivision 33 of section 2807-c of the public
health law, in determining rates of payments by state governmental agen-
S. 58--B 33 A. 158--B
cies effective for services provided on and after April 1, 2008, for
inpatient and outpatient services provided by general hospitals, for
inpatient services and adult day health care outpatient services
provided by residential health care facilities pursuant to article 28 of
the public health law, except for residential health care facilities
that provide extensive nursing, medical, psychological and counseling
support services to children, for home health care services provided
pursuant to article 36 of the public health law by certified home health
agencies and long term home health care programs, other than for
services provided to home care patients diagnosed with AIDS as deter-
mined by applicable regulations, and personal care services provided
pursuant to paragraph (e) of subdivision two of section 365-a of the
social services law, the commissioner of health shall apply a trend
factor projection equal to sixty-five percent of the otherwise applica-
ble trend factor projection attributable to the period January 1, 2008
through December 31, 2008 in accordance with paragraph (c) of subdivi-
sion 10 of section 2807-c of the public health law, provided, however,
that for rates of payment effective for services provided on and after
January 1, 2009, the final trend factor projections attributable to the
2008 calendar year period shall be further adjusted such that any
increase to the average trend factor projections for the period April 1,
2008 through December 31, 2008 shall be reduced, on an annualized basis,
by one and three tenths percentage points AND PROVIDED FURTHER, HOWEVER,
THAT ON AND AFTER APRIL 1, 2009, SUCH TREND FACTOR PROJECTIONS, INCLUD-
ING SERVICES PROVIDED TO HOME CARE PATIENTS DIAGNOSED WITH AIDS AS
DETERMINED BY APPLICABLE REGULATIONS, SHALL BE FURTHER REDUCED TO ZERO,
and provided further, however, no retroactive adjustment to such 2008
trend factor projection shall be made for the period April 1, 2008
through December 31, 2008 pursuant to subparagraph 3 of paragraph (c) of
subdivision 10 of section 2807-c of the public health law AND PROVIDED
FURTHER, HOWEVER, THAT FOR RATES OF PAYMENT FOR ASSISTED LIVING PROGRAM
SERVICES PROVIDED ON AND AFTER APRIL 1, 2009, TREND FACTOR PROJECTIONS
ATTRIBUTABLE TO THE 2008 CALENDAR YEAR SHALL BE REDUCED TO ZERO, AND
FURTHER PROVIDED, HOWEVER, THAT FOR RATES OF PAYMENT FOR PERSONAL CARE
SERVICES PROVIDED ON AND AFTER APRIL 1, 2009, IN THOSE SOCIAL SERVICES
DISTRICTS, INCLUDING NEW YORK CITY, WHOSE RATES OF PAYMENT FOR SUCH
SERVICES ARE ISSUED BY SUCH SOCIAL SERVICES DISTRICTS PURSUANT TO A
RATE-SETTING EXEMPTION ISSUED BY THE COMMISSIONER OF HEALTH TO SUCH
SOCIAL SERVICES DISTRICTS IN ACCORDANCE WITH APPLICABLE REGULATIONS,
TREND FACTOR PROJECTIONS ATTRIBUTABLE TO THE 2008 CALENDAR YEAR SHALL BE
REDUCED TO ZERO.
S 48. Notwithstanding paragraph (c) of subdivision 10 of section
2807-c of the public health law, subdivision 2-b of section 2808 of the
public health law, section 21 of chapter 1 of the laws of 1999, section
5 of part F of chapter 497 of the laws of 2008 and any other contrary
provision of law, in determining rates of payments by state governmental
agencies effective for services provided on and after [January] APRIL 1,
2009, for inpatient and outpatient services provided by general hospi-
tals, for inpatient services and adult day health care outpatient
services provided by residential health care facilities pursuant to
article 28 of the public health law, except for residential health care
facilities that provide extensive nursing, medical, psychological and
counseling support services to children, for home health care services
provided pursuant to article 36 of the public health law by certified
home health agencies, long term home health care programs and AIDS home
care programs, and for personal care services provided pursuant to
S. 58--B 34 A. 158--B
section 367-i of the social services law, the commissioner of health
shall apply zero trend factor projections attributable to the 2009
calendar year in accordance with paragraph (c) of subdivision 10 of
section 2807-c of the public health law, provided, however, that such
zero trend factor projections for such 2009 calendar year shall also be
applied to rates of payment for personal care services provided in those
local social services districts, including New York city, whose rates of
payment for such services are established by such local social services
districts pursuant to a rate-setting exemption issued by the commission-
er of health to such local social services districts in accordance with
applicable regulations, and provided further, however, that for rates of
payment for assisted living program services provided on and after
[January] APRIL 1, 2009, trend factor projections attributable to the
2009 calendar year shall be established at zero percent.
2. The commissioner of health shall adjust rates of payment to reflect
the exclusion pursuant to this section of such specified trend factor
projections or adjustments.
S 49. Paragraph (a) of subdivision 2 of section 2807-d of the public
health law is amended by adding a new subparagraph (vi) to read as
follows:
(VI) NOTWITHSTANDING ANY CONTRARY PROVISIONS OF THIS PARAGRAPH OR ANY
OTHER PROVISION OF LAW OR REGULATION, FOR GENERAL HOSPITALS THE ASSESS-
MENT SHALL BE THIRTY-FIVE HUNDREDTHS OF ONE PERCENT OF EACH GENERAL
HOSPITAL'S GROSS RECEIPTS RECEIVED FROM ALL PATIENT CARE SERVICES AND
OTHER OPERATING INCOME ON A CASH BASIS FOR PERIODS ON AND AFTER APRIL
FIRST, TWO THOUSAND NINE, FOR HOSPITAL OR HEALTH-RELATED SERVICES,
INCLUDING, BUT NOT LIMITED TO INPATIENT SERVICES, OUTPATIENT SERVICES,
EMERGENCY SERVICES, REFERRED AMBULATORY SERVICES AND AMBULATORY SURGICAL
SERVICES, BUT NOT INCLUDING RESIDENTIAL HEALTH CARE FACILITIES SERVICES
OR HOME HEALTH CARE SERVICES.
S 50. Paragraphs (b), (c), (d) and (e) of subdivision 2 of section
2807-j of the public health law, as amended by section 41 of part B of
chapter 58 of the laws of 2005, are amended to read as follows:
(b) The total percentage allowance for each payor, other than govern-
mental agencies, or health maintenance organizations for services
provided to subscribers eligible for medical assistance pursuant to
title eleven of article five of the social services law, or approved
organizations for services provided to subscribers eligible for the
family health plus program pursuant to title eleven-D of article five of
the social services law, and other than payments for a patient that has
no third-party coverage in whole or in part for services provided by a
designated provider of services, shall be:
(i) the sum of (A) eight and eighteen-hundredths percent, provided,
however, that for services provided on and after July first, two thou-
sand three, the percentage shall be eight and eighty-five hundredths
percent, and further provided that for services provided on and after
January first, two thousand six, the percentage shall be eight and nine-
ty-five hundredths percent, AND FURTHER PROVIDED THAT FOR SERVICES
PROVIDED ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, THE PERCENTAGE
SHALL BE NINE AND SIXTY-THREE HUNDREDTHS PERCENT, plus (B) twenty-four
percent, provided, however, that for services provided on and after July
first, two thousand three, the percentage shall be twenty-five and nine-
ty-seven hundredths percent, and further provided that for services
provided on and after January first, two thousand six, the percentage
shall be twenty-six and twenty-six hundredths percent, AND FURTHER
PROVIDED THAT FOR SERVICES PROVIDED ON AND AFTER APRIL FIRST, TWO THOU-
S. 58--B 35 A. 158--B
SAND NINE, THE PERCENTAGE SHALL BE TWENTY-EIGHT AND TWENTY-SEVEN
HUNDREDTHS PERCENT, and plus (C) for a specified third-party payor as
defined in subdivision one-a of section twenty-eight hundred seven-s of
this article the percentage allowance applicable for a general hospital
for inpatient hospital services pursuant to subdivision two of section
twenty-eight hundred seven-s of this article;
(ii) unless (A) an election in accordance with paragraph (a) of subdi-
vision five of this section to pay the allowance directly to the commis-
sioner or the commissioner's designee is in effect for a third-party
payor, and in addition (B) for a specified third-party payor an election
to pay the assessment in accordance with section twenty-eight hundred
seven-t of this article is in effect.
(c) If an election in accordance with subdivision five of this section
is in effect for a third-party payor and in addition in accordance with
section twenty-eight hundred seven-t of this article for a specified
third-party payor, the total percentage allowance factor shall be
reduced to eight and eighteen-hundredths percent, provided, however,
that for services provided on and after July first, two thousand three
the total percentage allowance factor shall be reduced to eight and
eighty-five hundredths percent, and further provided that for services
provided on and after January first, two thousand six, the total
percentage allowance factor shall be reduced to eight and ninety-five
hundredths percent, AND FURTHER PROVIDED THAT FOR SERVICES PROVIDED ON
AND AFTER APRIL FIRST, TWO THOUSAND NINE, THE TOTAL PERCENTAGE ALLOWANCE
FACTOR SHALL BE REDUCED TO NINE AND SIXTY-THREE HUNDREDTHS PERCENT.
(d) The total percentage allowance for payments by governmental agen-
cies, as determined in accordance with paragraphs (a) and (a-1) of
subdivision one of section twenty-eight hundred seven-c of this article
as in effect on December thirty-first, nineteen hundred ninety-six, or
health maintenance organizations for services provided to subscribers
eligible for medical assistance pursuant to title eleven of article five
of the social services law, or approved organizations for services
provided to subscribers eligible for the family health plus program
pursuant to title eleven-D of article five of the social services law,
shall be five and ninety-eight-hundredths percent, provided, however,
that for services provided on and after July first, two thousand three
the total percentage allowance shall be six and forty-seven hundredths
percent, and further provided that for services provided on and after
January first, two thousand six, the total percentage allowance shall be
six and fifty-four hundredths percent, AND FURTHER PROVIDED THAT FOR
SERVICES PROVIDED ON AND AFTER APRIL FIRST, TWO THOUSAND NINE, THE TOTAL
PERCENTAGE ALLOWANCE SHALL BE SEVEN AND FOUR HUNDREDTHS PERCENT.
(e) The total percentage allowance for payments for services provided
by designated providers of services for which there is no third-party
coverage in whole or in part shall be eight and eighteen-hundredths
percent, provided, however, that for services provided on and after July
first, two thousand three the total percentage allowance shall be eight
and eighty-five hundredths percent, and further provided that for
services provided on and after January first, two thousand six, the
total percentage allowance shall be eight and ninety-five hundredths
percent, AND FURTHER PROVIDED THAT FOR SERVICES PROVIDED ON AND AFTER
APRIL FIRST, TWO THOUSAND NINE, THE TOTAL PERCENTAGE ALLOWANCE SHALL BE
NINE AND SIXTY-THREE HUNDREDTHS PERCENT. This paragraph shall not apply
to patient deductibles and coinsurance amounts.
S. 58--B 36 A. 158--B
S 51. Clause (A) of subparagraph (i) of paragraph (b) of subdivision 1
of section 2807-1 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:
(A) an amount not to exceed six million dollars on an annualized basis
for the periods January first, nineteen hundred ninety-seven through
December thirty-first, nineteen hundred ninety-nine; up to six million
dollars for the period January first, two thousand through December
thirty-first, two thousand; up to five million dollars for the period
January first, two thousand one through December thirty-first, two thou-
sand one; up to four million dollars for the period January first, two
thousand two through December thirty-first, two thousand two; up to two
million six hundred thousand dollars for the period January first, two
thousand three through December thirty-first, two thousand three; up to
one million three hundred thousand dollars for the period January first,
two thousand four through December thirty-first, two thousand four; up
to six hundred seventy thousand dollars for the period January first,
two thousand five through June thirtieth, two thousand five; up to one
million three hundred thousand dollars for the period April first, two
thousand six through March thirty-first, two thousand seven; and up to
one million three hundred thousand dollars annually for the period April
first, two thousand seven through March thirty-first, two thousand
[eleven] NINE, shall be allocated to individual subsidy programs; and
S 52. Paragraph (e) of subdivision 2 of section 4 of section 1 of
chapter 703 of the laws of 1988, relating to enacting the expanded
health care coverage act of nineteen hundred eighty-eight and amending
the insurance law and other laws relating to expanded health care and
catastrophic health care coverage, as amended by section 20 of part B of
chapter 58 of the laws of 2008, is amended to read as follows:
(e) Applications for enrollment in the individual subsidy program will
not be accepted on and after January first, two thousand one; provided,
however, individuals and families who are otherwise eligible to receive
benefits under such program and are enrolled prior to January first, two
thousand one, may remain enrolled in such program until March thirty-
first, two thousand [eleven] NINE.
S 53. Subdivision 1 of section 368-a of the social services law is
amended by adding a new paragraph (z) to read as follows:
(Z) ONE HUNDRED PERCENT OF THE AMOUNT EXPENDED FOR HEALTH CARE
SERVICES DESCRIBED IN SECTIONS THREE HUNDRED SIXTY-EIGHT-D AND THREE
HUNDRED SIXTY-EIGHT-E OF THIS TITLE, AFTER FIRST DEDUCTING THEREFROM ANY
FEDERAL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT THEREOF.
S 54. Section 368-d of the social services law, as amended by chapter
82 of the laws of 1995, is amended to read as follows:
S 368-d. Reimbursement to public school districts and state
operated/state supported schools which operate pursuant to article
eighty-five, eighty-seven or eighty-eight of the education law.
1. The department OF HEALTH shall review claims for expenditures made
by or on behalf of local public school districts, and state
operated/state supported schools which operate pursuant to article
eighty-five, eighty-seven or eighty-eight of the education law, for
medical care, services and supplies which are furnished to children with
handicapping conditions or such children suspected of having handicap-
ping conditions, as such children are defined in the education law. If
approved by the department, payment for such medical care, services and
supplies which would otherwise qualify for reimbursement under this
title and which are furnished in accordance with this title and the
regulations of the department to such children, shall be made in accord-
S. 58--B 37 A. 158--B
ance with the department's approved medical assistance fee schedules by
payment to such local public school district, and state operated/state
supported schools which operate pursuant to article eighty-five, eight-
y-seven or eighty-eight of the education law, which furnished the care,
services or supplies either directly or by contract[, of the amount of
any federal funds properly received or to be received on account of such
expenditures].
2. Claims for payment under this section shall be made in such form
and manner, at such times, and for such periods as the department may
require.
3. [The department's liability for payment for expenditures by or on
behalf of local public school districts, and state operated/state
supported schools which operate pursuant to article eighty-five, eight-
y-seven or eighty-eight of the education law, for services furnished to
children under this section shall be limited solely to payment of the
federal funds received, or to be received, on account of such expendi-
tures. In the event of any subsequent disallowances or recoupment of
such funds by a federal governmental agency, upon notification by the
commissioner, the comptroller shall withhold or cause to be withheld the
amount of such disallowance or recoupment from moneys otherwise due the
local public school district, and state operated/state supported schools
which operate pursuant to article eighty-five, eighty-seven or eighty-
eight of the education law, as state aid pursuant to any provision of
the education law, and the comptroller shall transfer such amount to the
credit of the department of social services medical assistance program
local assistance account] THE PROVISIONS OF THIS SECTION SHALL BE OF NO
FORCE AND EFFECT UNLESS ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND
REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION
IN THE COSTS OF HEALTH CARE SERVICES PROVIDED PURSUANT TO THIS SECTION.
S 55. Section 368-e of the social services law, as added by chapter
558 of the laws of 1989, subdivision 1 as amended by chapter 631 of the
laws of 1997, is amended to read as follows:
S 368-e. Reimbursement to counties for pre-school children with handi-
capping conditions. 1. The department OF HEALTH shall review claims for
expenditures made by counties and the city of New York for medical care,
services and supplies which are furnished to preschool children with
handicapping conditions or such preschool children suspected of having
handicapping conditions, as such children are defined in the education
law. If approved by the department, payment for such medical care,
services and supplies which would otherwise qualify for reimbursement
under this title and which are furnished in accordance with this title
and the regulations of the department to such children, shall be made in
accordance with the department's approved medical assistance fee sched-
ules by payment to such county or city which furnished the care,
services or supplies either directly or by contract[, of the amount of
any federal funds properly received or to be received on account of such
expenditures]. Notwithstanding any provisions of law, rule or regulation
to the contrary, any clinic or diagnostic and treatment center licensed
under article twenty-eight of the public health law, which as determined
by the state education department, in conjunction with the department of
health, has a less than arms length relationship with the provider
approved under section forty-four hundred ten of the education law
shall, subject to the approval of the department and based on standards
developed by the department, be authorized to directly submit such
claims for medical assistance, services or supplies so furnished for any
period beginning on or after July first, nineteen hundred ninety-seven.
S. 58--B 38 A. 158--B
The actual full cost of the individualized education program (IEP)
related services incurred by the clinic shall be reported on the New
York State Consolidated Fiscal Report in the education law section
forty-four hundred ten program cost center in which the student is
placed and the associated medical assistance revenue shall be reported
in the same manner.
2. Claims for payment under this section shall be made in such form
and manner, at such times, and for such periods as the department may
require.
[3. The department's liability for payment for expenditures by or on
behalf of such county or the city of New York for services furnished to
preschool children under this section shall be limited solely to payment
of the federal funds received, or to be received, on account of such
expenditures. In the event of any subsequent disallowances or recoupment
of such funds by a federal governmental agency, the commissioner shall
withhold such amount from any moneys otherwise due the county or city of
New York under this chapter] THE PROVISIONS OF THIS SECTION SHALL BE OF
NO FORCE AND EFFECT UNLESS ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND
REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION
IN THE COSTS OF HEALTH CARE SERVICES PROVIDED PURSUANT TO THIS SECTION.
S 56. Subdivision 1 of section 368-e of the social services law, as
amended by chapter 474 of the laws of 1996, is amended to read as
follows:
1. The department OF HEALTH shall review claims for expenditures made
by counties and the city of New York for medical care, services and
supplies which are furnished to preschool children with handicapping
conditions or such preschool children suspected of having handicapping
conditions, as such children are defined in the education law. If
approved by the department, payment for such medical care, services and
supplies which would otherwise qualify for reimbursement under this
title and which are furnished in accordance with this title and the
regulations of the department to such children, shall be made in accord-
ance with the department's approved medical assistance fee schedules by
payment to such county or city which furnished the care, services or
supplies either directly or by contract[, of the amount of any federal
funds properly received or to be received on account of such expendi-
tures]. Notwithstanding any provisions of law, rule or regulation to the
contrary, any clinic or diagnostic and treatment center licensed under
article twenty-eight of the public health law, or articles sixteen and
thirty-one of the mental hygiene law, which submitted a claim for such
reimbursement payments on or before June thirtieth, nineteen hundred
ninety-five, shall, subject to the approval of the department and based
on standards developed by the department, continue to be authorized to
directly submit such claims for medical assistance, services or supplies
so furnished for any period thereafter until March thirty-first, nine-
teen hundred ninety-seven or such later date as the commissioner shall
authorize pursuant to regulation.
S 57. Section 5 of part G of chapter 56 of the laws of 2000, amending
the public health law and other laws relating to the sale and possession
of hypodermic syringes and needles, as amended by section 28 of part C
of chapter 56 of the laws of 2007, is REPEALED.
S 57-a. Section 5 of part G of chapter 56 of the laws of 2000, amend-
ing the public health law, and other laws relating to the sale and
possession of hypodermic syringes and needles, as amended by section 9
of part B of chapter 58 of the laws of 2007, is amended to read as
follows:
S. 58--B 39 A. 158--B
S 5. This act shall take effect January 1, 2001 [and shall remain in
full force and effect until September 1, 2011 when upon such date the
provisions of this act shall be deemed repealed]; provided, however,
that effective immediately the commissioner of health is authorized to
promulgate any rules and regulations necessary for the timely implemen-
tation of this act on such effective date.
S 58. Section 88 of chapter 659 of the laws of 1997, constituting the
long term care integration and finance act of 1997, as amended by
section 22-a of part C of chapter 58 of the laws of 2007, is amended to
read as follows:
S 88. Notwithstanding any provision of law to the contrary, all oper-
ating demonstrations, as such term is defined in paragraph [(d)] (C) of
subdivision 1 of section 4403-f of the public health law as added by
section eighty-two of this act, due to expire prior to January 1, 2001
shall be deemed to expire on December 31, [2009] 2011.
S 59. This act shall take effect immediately; provided however that
sections fifty-three through fifty-six of this act shall take effect
July 1, 2009 and shall apply to services provided on and after such
date; 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; provided that the amendments to
section 2807-j of the public health law made by section fifty of this
act shall not affect the expiration of such section and shall be deemed
to expire therewith; and provided that the amendments to subdivision 1
of section 368-e of the social services law made by section fifty-five
of this act shall be subject to the expiration and reversion of such
subdivision pursuant to chapter 631 of the laws of 1997, as amended,
when upon such date the provisions of section fifty-six of this act
shall take effect.
PART C
Section 1. Legislative intent. 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
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.
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
2807-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
S. 58--B 40 A. 158--B
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
less than one hundred fifty-four million five hundred thousand dollars,
PROVIDED FURTHER, HOWEVER, THAT, NOTWITHSTANDING ANY CONTRARY PROVISION
OF LAW, AS DETERMINED BY THE COMMISSIONER, TO THE EXTENT THAT A CHAPTER
OF THE LAWS OF TWO THOUSAND NINE IS NOT ENACTED RESULTING IN SUCH AN
AGGREGATE ANNUAL 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 EACH STATE FISCAL YEAR THEREAFTER;
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 DECEMBER FIRST, TWO THOUSAND NINE SHALL BE IN
ACCORDANCE WITH THE FOLLOWING:
(A) FOR PERIODS ON AND AFTER DECEMBER FIRST, TWO THOUSAND NINE THE
OPERATING 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 JULY FIRST, TWO THOUSAND NINE 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, COSTS RELATED TO
PATIENT TRANSFERS, AND OTHER NON-COMPARABLE COSTS AS DETERMINED BY THE
COMMISSIONER, SUCH STATEWIDE BASE PRICES MAY BE PERIODICALLY ADJUSTED TO
REFLECT CHANGES IN PROVIDER CODING PATTERNS AND CASE-MIX AND SUCH OTHER
FACTORS AS MAY BE DETERMINED BY THE COMMISSIONER;
(II) ONLY THOSE TWO THOUSAND FIVE BASE YEAR COSTS WHICH RELATE TO THE
COST OF SERVICES PROVIDED TO MEDICAID INPATIENTS, AS DETERMINED BY THE
APPLICABLE RATIO OF COSTS TO CHARGES METHODOLOGY, SHALL BE UTILIZED FOR
RATE-SETTING PURPOSES;
(III) SUCH RATES SHALL REFLECT THE APPLICATION OF HOSPITAL SPECIFIC
WAGE EQUALIZATION FACTORS REFLECTING DIFFERENCES IN WAGE RATES;
(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;
S. 58--B 41 A. 158--B
(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
INLIER PAYMENTS INCREASED BY AN AMOUNT EQUAL TO THE AVERAGE OF COST
OUTLIER PAYMENTS FOR COMPARABLE HOSPITALS OR BY A METHODOLOGY THAT USES
A STATEWIDE OR REGIONAL RATIO OF COST TO CHARGES APPLIED TO STATEWIDE OR
REGIONAL COMPARABLE CHARGES FOR THOSE CASES DETERMINED BY THE COMMIS-
SIONER;
(X) SUCH REGULATIONS SHALL PROVIDE FOR ADMINISTRATIVE RATE APPEALS,
BUT ONLY WITH REGARD TO: (A) THE CORRECTION OF COMPUTATIONAL ERRORS OR
OMISSIONS OF DATA, INCLUDING WITH REGARD TO THE HOSPITAL SPECIFIC COMPU-
TATIONS PERTAINING TO GRADUATE MEDICAL EDUCATION, WAGE EQUALIZATION
FACTOR ADJUSTMENTS, AND (B) CAPITAL COST REIMBURSEMENT;
(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 NOVEMBER THIRTIETH, TWO THOUSAND NINE,
REFLECT CASE BASED PAYMENT PER DIAGNOSIS-RELATED GROUP OR WHOSE INPA-
TIENT REIMBURSEMENT IS, FOR PERIODS ON AND AFTER JULY FIRST, TWO THOU-
SAND NINE, GOVERNED BY THE PROVISIONS OF PARAGRAPHS (E-1) OR (E-2) OF
SUBDIVISION 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 DECEMBER FIRST, TWO THOUSAND NINE AND SUBJECT TO
THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, MAKE ADDITIONAL
S. 58--B 42 A. 158--B
ADJUSTMENTS TO THE INPATIENT RATES OF PAYMENT OF ELIGIBLE GENERAL HOSPI-
TALS, 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 WITH MEDICAID DISCHARGES
EQUAL TO OR GREATER THAN SEVENTEEN AND ONE-HALF PERCENT FOR TWO THOUSAND
SEVEN.
(II) FUNDS DISTRIBUTED PURSUANT TO THIS PARAGRAPH SHALL BE ALLOCATED
TO ELIGIBLE HOSPITALS PURSUANT TO A FORMULA SUCH THAT, TO THE EXTENT OF
FUNDS AVAILABLE, NO HOSPITAL'S REDUCTION IN MEDICAID INPATIENT REVENUE
AS A RESULT OF THE APPLICATION OF THE PROVISIONS OF PARAGRAPHS (A) AND
(B) OF THIS SUBDIVISION EXCEEDS A PERCENTAGE REDUCTION 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 DECEMBER FIRST, TWO THOUSAND NINE THROUGH MARCH
THIRTY-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 THIRTY-THREE MILLION FIVE HUNDRED
THOUSAND 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 BE ADDED TO RATES
OF PAYMENTS AND NOT BE SUBJECT TO RETROACTIVE ADJUSTMENT OR RECONCIL-
IATION.
(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
SEVENTY-FIVE MILLION DOLLARS FOR THE PERIOD DECEMBER FIRST, TWO THOUSAND
NINE THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TEN, AND NO LESS THAN TWO
HUNDRED TWENTY-FIVE MILLION DOLLARS FOR THE PERIOD APRIL FIRST, TWO
THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN AND EACH
STATE FISCAL YEAR THEREAFTER, PROVIDED, HOWEVER, THAT SUCH REDUCTIONS
SHALL BE IN ADDITION TO THE REDUCTIONS REQUIRED PURSUANT TO SUBPARAGRAPH
(II) OF PARAGRAPH (A) OF SUBDIVISION THIRTY-THREE OF THIS SECTION.
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-
S. 58--B 43 A. 158--B
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
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] ONE HUNDRED SIXTY-THREE
million [five] ONE hundred FORTY-FIVE thousand dollars for the period
April first, two thousand nine through [March thirty-first] NOVEMBER
THIRTIETH, two thousand [ten; two hundred forty-three million five
hundred thousand dollars for the period April first, two thousand ten
through March thirty-first, two thousand eleven] NINE.
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
S. 58--B 44 A. 158--B
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;
(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] FORTY-EIGHT million [one] SEVEN hundred [fifty]
TWENTY-ONE thousand dollars for the period January first, two thousand
nine through [December thirty-first] NOVEMBER 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;
S. 58--B 45 A. 158--B
(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
(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 million] FOURTEEN MILLION SEVEN HUNDRED THOUSAND dollars
for the period January first, two thousand nine through [December thir-
ty-first] NOVEMBER THIRTIETH, two thousand 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
S. 58--B 46 A. 158--B
(ii) two million [five hundred thousand] TWO HUNDRED NINETY-TWO THOU-
SAND dollars for the period January first, two thousand nine through
[December thirty-first] NOVEMBER 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) 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] TWENTY-TWO million dollars for the period
January first, two thousand nine through [December thirty-first] NOVEM-
BER 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] NOVEMBER THIRTIETH, two thousand [eleven]
NINE, funds within amounts appropriated shall be transferred and depos-
ited and credited to the credit of the state special revenue funds -
other, HCRA transfer fund, medical assistance account, for purposes of
S. 58--B 47 A. 158--B
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-
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 million [five hundred] TWO HUNDRED EIGHT thousand dollars
for the period January first, two thousand nine through [December thir-
ty-first] NOVEMBER 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 (1) 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
S. 58--B 48 A. 158--B
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] MARCH THIRTY-FIRST, 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)]
(IV) of this paragraph;
(ii) for the period [January] APRIL first, two thousand [ten] NINE
through [December] MARCH thirty-first, two thousand ten, [fifty] THIR-
TY-SEVEN AND FIVE TENTHS 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 thousand seven, as adjusted
for inflation pursuant to paragraph (c) of subdivision ten of this
section, as otherwise modified by any applicable statutes, and [fifty]
SIXTY-TWO AND FIVE TENTHS 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 accord-
ance with the provisions of subparagraph [(v)] (IV) of this paragraph;
(iii) [for the period January first, two thousand eleven through
December thirty-first, two thousand eleven, twenty-five 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 thousand seven, as adjusted for inflation pursuant to para-
graph (c) of subdivision ten of this section, as otherwise modified by
any applicable 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] APRIL first, two thousand
[twelve] TEN, 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)] (IV)
of this paragraph.
[(v)] (IV) rates of payment computed in accordance with this paragraph
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.
S. 58--B 49 A. 158--B
(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 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 eleventh 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, 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;
(VIII) Western, consisting of the counties of Allegany, Cattaraugus,
Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.
S. 58--B 50 A. 158--B
(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 DECEMBER FIRST, TWO
THOUSAND NINE, BE IN ACCORDANCE WITH THE FOLLOWING:
(I) FOR RATE PERIODS ON AND AFTER DECEMBER FIRST, TWO THOUSAND NINE,
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.
(II) 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.
(III) 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 DECEMBER 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 JULY FIRST, TWO THOUSAND NINE 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, BUT NOT INCLUDING
REPORTED DIRECT MEDICAL EDUCATION COST, 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 FACILITY IS LOCATED,
S. 58--B 51 A. 158--B
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 JULY FIRST, TWO THOUSAND NINE 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 JULY FIRST, TWO
THOUSAND NINE 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 AS OF DECEMBER
THIRTY-FIRST, TWO THOUSAND EIGHT, FOR WHICH A DISCRETE INSTITUTIONAL
COST REPORT WAS FILED FOR THE TWO THOUSAND SEVEN CALENDAR YEAR, AND
WHICH HAS REPORTED MEDICAID DISCHARGES GREATER THAN FIFTY PERCENT OF
TOTAL DISCHARGES IN SUCH COST REPORT, SHALL BE DETERMINED IN ACCORDANCE
WITH THE FOLLOWING:
(A) THE OPERATING COST COMPONENT OF SUCH RATES SHALL REFLECT THE USE
OF TWO THOUSAND SEVEN OPERATING COSTS AS REPORTED BY EACH FACILITY TO
THE DEPARTMENT PRIOR TO JULY FIRST, TWO THOUSAND NINE AND AS ADJUSTED
FOR THE INFLATION PURSUANT TO PARAGRAPH (C) OF SUBDIVISION TEN OF THIS
SECTION, AS OTHERWISE MODIFIED BY ANY APPLICABLE STATUTES, AND AS
FURTHER ADJUSTED AS THE COMMISSIONER DEEMS APPROPRIATE, INCLUDING TRAN-
SITION ADJUSTMENTS. SUCH RATES SHALL BE DETERMINED ON A PER CASE BASIS
OR PER DIEM BASIS, AS SET FORTH IN REGULATIONS PROMULGATED BY THE
COMMISSIONER.
(B) THE OPERATING COMPONENT OF OUTPATIENT SPECIALTY RATES OF HOSPITALS
SUBJECT TO THIS SUBPARAGRAPH SHALL REFLECT THE USE OF TWO THOUSAND SEVEN
OPERATING COSTS AS REPORTED TO THE DEPARTMENT PRIOR TO DECEMBER FIRST,
TWO THOUSAND EIGHT, AND SHALL INCLUDE SUCH ADJUSTMENTS AS THE COMMIS-
SIONER DEEMS APPROPRIATE.
(C) THE BASE PERIOD REPORTED OPERATING COSTS USED TO ESTABLISH INPA-
TIENT AND OUTPATIENT RATES DETERMINED PURSUANT TO THIS SUBPARAGRAPH
SHALL BE UPDATED NO LESS FREQUENTLY THAN EVERY TWO YEARS AND EACH SUCH
HOSPITAL SHALL SUBMIT SUCH ADDITIONAL DATA AS THE COMMISSIONER MAY
REQUIRE TO ASSIST IN THE DEVELOPMENT OF AMBULATORY PATIENT GROUPS (APGS)
RATES FOR SUCH HOSPITALS' OUTPATIENT SPECIALTY SERVICES.
(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.
S. 58--B 52 A. 158--B
(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.
(IX) THE OPERATING COST COMPONENT OF INPATIENT MEDICAID RATES SUBJECT
TO SUBPARAGRAPHS (I), (II) AND (III) OF THIS PARAGRAPH SHALL, WITH
REGARD TO ALTERNATIVE LEVEL OF CARE (ALC) DAYS OF CARE BE SUBJECT TO
COMPUTATION PURSUANT TO PARAGRAPH (H) OF THIS SUBDIVISION.
S 13-a. 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]
NOVEMBER 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 inpa-
tient services as of April first, two thousand seven through March thir-
ty-first, two thousand eight and which have medicaid inpatient
discharges percentages equal to or greater than thirty-five percent.
This percentage 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 allocated 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 feder-
al 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 voluntary 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 allocated proportionally based on the amount of money
the hospital had received in two thousand six.
S 13-b. The commissioner is hereby authorized to seek through a feder-
al waiver, or through the extension of a federal waiver, enhanced feder-
al financial participation in excess of that authorized by the American
Recovery and Reinvestment Act, in order to support state reform activ-
S. 58--B 53 A. 158--B
ities, including reimbursement reform, enacted by the legislature to
promote patient centered care and improve access to and quality of
primary and ambulatory care.
S 13-c. Subdivision 4-c of section 2807-p of the public health law, as
amended by section 28-a of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
4-c. Notwithstanding any provision of law to the contrary, the commis-
sioner shall make additional payments for uncompensated care to volun-
tary non-profit diagnostic and treatment centers that are eligible for
distributions under subdivision four of this section in the following
amounts: for the period June first, two thousand six through December
thirty-first, two thousand six, in the amount of seven million five
hundred thousand dollars, for the period January first, two thousand
seven through December thirty-first, two thousand seven, seven million
five hundred thousand dollars, for the period January first, two thou-
sand eight through December thirty-first, two thousand eight, seven
million five hundred thousand dollars, for the period January first, two
thousand nine through December thirty-first, two thousand nine, [seven]
FIFTEEN million five hundred thousand dollars, for the period January
first, two thousand ten through December thirty-first, two thousand ten,
seven million five hundred thousand dollars, and for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven, in the amount of one million eight hundred seventy-five thousand
dollars, provided, however, that for periods on and after January first,
two thousand eight, such additional payments shall be distributed to
voluntary, non-profit diagnostic and treatment centers and to public
diagnostic and treatment centers in accordance with paragraph (g) of
subdivision four of this section. In the event that federal financial
participation is available for rate adjustments pursuant to this
section, the commissioner shall make such payments as additional adjust-
ments to rates of payment for voluntary non-profit diagnostic and treat-
ment centers that are eligible for distributions under subdivision
four-a of this section in the following amounts: for the period June
first, two thousand six through December thirty-first, two thousand six,
fifteen million dollars in the aggregate, and for the period January
first, two thousand seven through June thirtieth, two thousand seven,
seven million five hundred thousand dollars in the aggregate. The
amounts allocated pursuant to this paragraph shall be aggregated with
and distributed pursuant to the same methodology applicable to the
amounts allocated to such diagnostic and treatment centers for such
periods pursuant to subdivision four of this section if federal finan-
cial participation is not available, or pursuant to subdivision four-a
of this section if federal financial participation is available.
Notwithstanding section three hundred sixty-eight-a of the social
services law, there shall be no local share in a medical assistance
payment adjustment under this subdivision.
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] NOVEMBER THIRTIETH, two thousand nine, seventy-
five percent of such rates of payment for each general hospital's outpa-
tient services 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
S. 58--B 54 A. 158--B
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] DECEMBER first, two thousand [ten] NINE
through December thirty-first, two thousand ten, fifty 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 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 para-
graph (e) of this subdivision;
(iii) for the period January first, two thousand eleven through Decem-
ber thirty-first, 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 first, two thousand twelve, 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] FIRST, 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 commission-
er, 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 first, two thousand ten through December
thirty-first, two thousand ten, fifty percent of such rates for each
facility shall reflect the average Medicaid payment per claim, as deter-
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 fifty percent of such rates of payment shall, for the
operating cost component, reflect the utilization of the ambulatory
S. 58--B 55 A. 158--B
patient groups reimbursement methodology described in paragraph (e) of
this subdivision;
(iii) for the period January first, two thousand eleven through Decem-
ber thirty-first, 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 facili-
ty 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 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 para-
graph (e) of this subdivision; and
(iv) for periods on and after January first, two thousand twelve, 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
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
S. 58--B 56 A. 158--B
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 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,
S. 58--B 57 A. 158--B
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. Intentionally omitted.
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
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
S. 58--B 58 A. 158--B
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 December 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. Section 2 of the social services law is amended by adding a new
subdivision 38 to read as follows:
38. WHEN USED IN THIS CHAPTER, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS, UNLESS OTHERWISE EXPRESSLY STATED OR UNLESS THE
CONTEXT OR SUBJECT MATTER REQUIRES A DIFFERENT INTERPRETATION:
(A) "MEDICAID" OR "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
FIVE OF THIS CHAPTER AND THE PROGRAM THEREUNDER.
(B) "FAMILY HEALTH PLUS" MEANS TITLE ELEVEN-D OF ARTICLE FIVE OF THIS
CHAPTER AND THE PROGRAM THEREUNDER.
(C) "CHILD HEALTH PLUS" MEANS TITLE ONE-A OF ARTICLE TWENTY-FIVE OF
THE PUBLIC HEALTH LAW AND THE PROGRAM THEREUNDER.
(D) "MEDICAID MANAGED CARE" MEANS MEDICAID PROVIDED UNDER SECTION
THREE HUNDRED SIXTY-FOUR-J OF THIS CHAPTER.
(E) "MEDICAID FEE-FOR-SERVICE" MEANS MEDICAID PROVIDED OTHER THAN
UNDER MEDICAID MANAGED CARE.
S 25. The social services law is amended by adding a new section 364-m
to read as follows:
S 364-M. STATEWIDE PATIENT CENTERED MEDICAL HOME PROGRAM. 1. 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 CONTINUITY AND COORDINATION OF HEALTH
SERVICES. THESE PROVIDERS WILL BE ELIGIBLE FOR ENHANCED PAYMENTS FOR
SERVICES PROVIDED TO: RECIPIENTS ELIGIBLE FOR MEDICAID FEE-FOR-SERVICE;
ENROLLEES ELIGIBLE FOR MEDICAID MANAGED CARE; ENROLLEES ELIGIBLE FOR AND
ENROLLED IN FAMILY HEALTH PLUS ORGANIZATIONS PURSUANT TO TITLE ELEVEN-D
OF THIS ARTICLE ("FAMILY HEALTH PLUS"); AND ENROLLEES ELIGIBLE FOR AND
ENROLLED IN CHILD HEALTH PLUS. AS USED IN THIS SECTION "CLINIC" MEANS A
GENERAL HOSPITAL PROVIDING OUTPATIENT CARE OR A DIAGNOSTIC AND TREATMENT
CENTER, LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW.
S. 58--B 59 A. 158--B
2. BY DECEMBER FIRST, TWO THOUSAND NINE, THE COMMISSIONER OF HEALTH
SHALL DEVELOP AND IMPLEMENT STANDARDS OF CERTIFICATION FOR PATIENT
CENTERED MEDICAL HOMES FOR MEDICAID FEE-FOR-SERVICE AND MEDICAID MANAGED
CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS PROGRAMS. IN DEVELOPING
SUCH STANDARDS, THE COMMISSIONER OF HEALTH SHALL: (A) CONSIDER EXISTING
STANDARDS DEVELOPED BY NATIONAL ACCREDITING AND PROFESSIONAL ORGANIZA-
TIONS; 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, PATIENT CENTERED MEDICAL 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 IN WHICH THE PATIENT IS ENROLLED TO PERMIT THE
COMMISSIONER OF HEALTH TO EVALUATE THE IMPACT OF PATIENT CENTERED
MEDICAL 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 PATIENT CENTERED MEDICAL 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 PATIENT CENTERED MEDICAL 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 PATIENT CENTERED MEDICAL 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 MEDICAL HOME MULTIPAYOR
DEMONSTRATION PROGRAM
SECTION 2959. ADIRONDACK MEDICAL HOME MULTIPAYOR DEMONSTRATION
PROGRAM.
S 2959. ADIRONDACK MEDICAL HOME MULTIPAYOR DEMONSTRATION PROGRAM. 1.
THE COMMISSIONER IS AUTHORIZED TO ESTABLISH AN ADIRONDACK MEDICAL HOME
MULTIPAYOR DEMONSTRATION PROGRAM AND MAY CERTIFY CERTAIN CLINICIANS AND
CLINICS IN THE UPPER NORTHEASTERN REGION OF NEW YORK AS MEDICAL HOMES
ELIGIBLE FOR ENHANCED PAYMENTS FOR SERVICES PROVIDED TO: RECIPIENTS
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
S. 58--B 60 A. 158--B
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
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 RELATING TO THE DEMONSTRATION PROGRAM TO ENCOURAGE COOPERATIVE,
COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS BETWEEN PAYORS OF HEALTH CARE
SERVICES AND HEALTH CARE SERVICES PROVIDERS WHO MIGHT OTHERWISE BE
COMPETITORS, UNDER THE ACTIVE SUPERVISION 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 RELATING TO THE DEMONSTRATION
PROGRAM, AND PROVIDE STATE ACTION IMMUNITY UNDER THE STATE AND FEDERAL
ANTITRUST LAWS WITH RESPECT TO THE PLANNING, IMPLEMENTATION AND OPERA-
TION OF THE ADIRONDACK MEDICAL HOME MULTIPAYOR DEMONSTRATION PROGRAM AND
PAYORS OF MEDICAL 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, FOR PURPOSE OF THE DEMONSTRATION PROGRAM, IS
AUTHORIZED TO PARTICIPATE IN, ACTIVELY SUPERVISE, FACILITATE AND APPROVE
A PRIMARY CARE MEDICAL HOME COLLABORATIVE 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 PARTIC-
IPATE; (B) PRACTICE STANDARDS FOR THE MEDICAL HOME CONSISTENT WITH
EXISTING STANDARDS DEVELOPED BY NATIONAL ACCREDITING AND PROFESSIONAL
ORGANIZATIONS INCLUDING THE JOINT PRINCIPLES OF THE AMERICAN COLLEGE OF
PHYSICIANS ("ACP"), THE AMERICAN ACADEMY OF FAMILY PHYSICIANS ("AAFP"),
THE AMERICAN ACADEMY OF PEDIATRICS ("AAP"), THE AMERICAN OSTEOPATHIC
ASSOCIATION ("AOA"), AND AS FURTHER DEFINED BY "PATIENT CENTERED MEDICAL
HOME," AS REPRESENTED IN CERTIFICATION PROGRAMS DEVELOPED BY THE
NATIONAL COMMITTEE FOR QUALITY ASSURANCE ("NCQA"); (C) METHODOLOGIES BY
WHICH PAYORS WILL PROVIDE ENHANCED RATES OF PAYMENT TO CERTIFIED MEDICAL
HOMES; AND (D) METHODOLOGIES TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES
THAT MEET SPECIFIC PROCESS OR OUTCOME STANDARDS ESTABLISHED BY THE
ADIRONDACK MEDICAL HOME COLLABORATIVE.
4. PATIENT AND HEALTH CARE SERVICES PROVIDER PARTICIPATION IN THE
ADIRONDACK MEDICAL 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
MEDICAL 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.
S. 58--B 61 A. 158--B
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 MEDICAL HOMES UNDER THIS TITLE;
AND
(B) TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT MEET SPECIFIC
PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER, IN CONSULTA-
TION WITH THE ADIRONDACK MEDICAL 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 PREGNANT WOMEN ON ANY
DAY OF 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, AND REFERRAL TO TREATMENT IN HOSPI-
TAL EMERGENCY DEPARTMENTS OF INDIVIDUALS AT RISK FOR SUBSTANCE ABUSE
INCLUDING REFERRAL TO THE APPROPRIATE LEVEL OF INTERVENTION AND TREAT-
MENT IN A COMMUNITY SETTING; PROVIDED, HOWEVER, THAT THE PROVISIONS OF
THIS PARAGRAPH RELATING TO SCREENING, BRIEF INTERVENTION, AND REFERRAL
TO TREATMENT SERVICES SHALL NOT TAKE EFFECT UNLESS ALL NECESSARY
APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE
FEDERAL FINANCIAL PARTICIPATION IN SUCH COSTS.
S 28. Intentionally omitted.
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 hospital's 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. Intentionally omitted.
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
S. 58--B 62 A. 158--B
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
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
S. 58--B 63 A. 158--B
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]. FOR THE PURPOSE OF IMPLEMENTING AND
ADMINISTERING THE PRIMARY CARE CASE MANAGEMENT PROGRAMS, THE COMMISSION-
ER MAY contract with private not-for-profit and public agencies AS
DEFINED IN GUIDELINES ESTABLISHED BY THE COMMISSIONER for the management
AND ADMINISTRATION of [these plans provided, however, that such
contracts shall require prior approval by the commissioner] THE PRIMARY
CARE CASE MANAGEMENT PROGRAM.
(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
MEDICAID MANAGED CARE, [as defined in section three hundred sixty-six of
this chapter,] TO PARTICIPATE IN MEDICAID MANAGED CARE may [voluntarily]
participate in a [physician] PRIMARY CARE case management program,
subject to the availability of such a program within the applicable
social services district, except for individuals: (i) REQUIRED BY MEDI-
CAID MANAGED CARE TO BE 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 reimbursed demonstration or pilot project,
or (iii) receiving services as an inpatient from a nursing home or
intermediate care facility or residential services from a child care
agency or services from a long term home health care program.
S. 58--B 64 A. 158--B
(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].
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. The public health law is amended by adding a new section 2821 to
read as follows:
S 2821. STATE ELECTRONIC HEALTH RECORDS (EHR) LOAN PROGRAM. 1. DEFI-
NITIONS. AS USED IN THIS SECTION, THE FOLLOWING WORDS AND PHRASES SHALL
HAVE THE FOLLOWING MEANINGS UNLESS A DIFFERENT MEANING IS PLAINLY
REQUIRED BY THE CONTEXT:
(A) "AUTHORITY" SHALL MEAN THE DORMITORY AUTHORITY OF THE STATE OF NEW
YORK CREATED BY TITLE FOUR OF ARTICLE EIGHT OF THE PUBLIC AUTHORITIES
LAW WHICH HAS SUCCEEDED TO THE POWERS, FUNCTIONS AND DUTIES OF THE
MEDICAL CARE FACILITIES FINANCE AGENCY PURSUANT TO CHAPTER EIGHTY-THREE
OF THE LAWS OF NINETEEN HUNDRED NINETY-FIVE.
(B) "ELIGIBLE HEALTH CARE PROVIDER" SHALL MEAN ANY HEALTH CARE PROVID-
ER ORGANIZED UNDER THE LAWS OF THIS STATE ELIGIBLE TO RECEIVE FEDERAL
FUNDS, WHICH HAS BEEN APPROVED FOR PARTICIPATION IN THIS PROGRAM BY THE
COMMISSIONER.
(C) "EHR LOAN FUND" SHALL MEAN THE CERTIFIED ELECTRONIC HEALTH RECORDS
TECHNOLOGY LOAN FUND AUTHORIZED TO BE ESTABLISHED BY THE AUTHORITY
PURSUANT TO THIS SECTION.
2. THE AUTHORITY SHALL ESTABLISH THE EHR LOAN FUND. FUNDS SHALL BE
TRANSFERRED OR APPROPRIATED TO THE AUTHORITY FOR DEPOSIT IN THE EHR LOAN
FUND AS AUTHORIZED PURSUANT TO ANY PROVISION OF LAW. FUNDS IN THE EHR
LOAN FUND SHALL BE HELD BY THE AUTHORITY PURSUANT TO THIS SECTION AS
CUSTODIAN, ADMINISTERED BY THE AUTHORITY PURSUANT TO AN AGREEMENT WITH
THE COMMISSIONER AND INVESTED BY THE AUTHORITY IN ACCORDANCE WITH THE
INVESTMENT GUIDELINES OF THE AUTHORITY. ALL INVESTMENT INCOME SHALL BE
CREDITED TO, AND ANY REPAYMENTS OF LOANS AS HEREINAFTER PROVIDED SHALL
BE DEPOSITED IN, THE EHR LOAN FUND, AND SPENT THEREFROM ONLY FOR THE
PURPOSES SET FORTH IN THIS SECTION.
3. THE COMMISSIONER AND THE AUTHORITY SHALL ENTER INTO AN AGREEMENT,
SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE DIVISION OF THE BUDGET,
FOR THE PURPOSE OF ADMINISTERING THE MONEYS IN THE EHR LOAN FUND IN A
MANNER THAT WILL BENEFIT THE PUBLIC HEALTH BY ENCOURAGING IMPROVEMENTS
IN THE HEALTH CARE DELIVERY SYSTEM THROUGH THE USE OF INFORMATION TECH-
NOLOGY IN THE STATE. SUCH AGREEMENT SHALL INCLUDE, BUT NOT BE LIMITED
TO, THE FOLLOWING PROVISIONS:
S. 58--B 65 A. 158--B
(A) FOR THE RECEIPT, MANAGEMENT AND EXPENDITURE OF FUNDS HELD IN THE
EHR LOAN FUND BY THE AUTHORITY;
(B) FOR THE DEVELOPMENT OF PROGRAM COMPONENTS, INCLUDING BUT NOT
LIMITED TO PROVIDER ELIGIBILITY AND TERMS AND CONDITIONS OF LOANS, AND
FOR THE DEVELOPMENT AND IMPLEMENTATION OF STRATEGIC PLANS FOR ELIGIBLE
HEALTH CARE PROVIDERS, ADDRESSING THE DEVELOPMENT OF MEANINGFUL ELEC-
TRONIC HEALTH RECORD IMPROVEMENTS, INCLUDING STRATEGIES FOR FACILITATING
THE PURCHASE OF CERTIFIED ELECTRONIC HEALTH RECORDS TECHNOLOGY, ENHANC-
ING THE UTILIZATION OF CERTIFIED ELECTRONIC HEALTH RECORDS TECHNOLOGY,
TRAINING PERSONNEL IN THE USE OF SUCH TECHNOLOGY AND SUPPORTING THE
SECURE EXCHANGE OF ELECTRONIC HEALTH INFORMATION TO AND FROM ELECTRONIC
HEALTH RECORDS; AND
(C) OTHER REQUIREMENTS SET FORTH BY THE SECRETARY OF THE UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES WITH RESPECT TO THE STATE EHR
LOAN FUND FOR THE EXPENDITURE BY THE AUTHORITY FROM THE EHR LOAN FUND TO
REIMBURSE THE AUTHORITY AND THE DEPARTMENT FOR THE COST OF ADMINISTERING
THE LOAN FUND.
4. ANY ELIGIBLE HEALTH CARE PROVIDER MAY APPLY FOR EHR LOAN FUNDS TO
THE EXTENT SUCH FUNDS ARE DERIVED FROM DEPOSITS MADE PURSUANT TO LAW BY
THE STATE. THE COMMISSIONER AND THE AUTHORITY SHALL CONSIDER THE EXTENT
TO WHICH AN ELIGIBLE HEALTH CARE PROVIDER CAN PROVIDE MATCHING FUNDS
THAT MAY BE REQUIRED BY LAW.
5. TO THE EXTENT FUNDS ARE AVAILABLE FROM AN ELIGIBLE HEALTH CARE
PROVIDER, EXPENDITURES FROM THE EHR LOAN FUND SHALL BE REPAID TO THE EHR
LOAN FUND FROM REPAYMENTS RECEIVED BY THE AUTHORITY, FROM AN ELIGIBLE
HEALTH CARE PROVIDER PURSUANT TO THE TERMS OF ANY FINANCING AGREEMENT,
MORTGAGE OR LOAN DOCUMENT PERMITTING THE RECOVERY FROM THE ELIGIBLE
HEALTH CARE PROVIDER OF SUCH EXPENDITURES. THE AUTHORITY SHALL RECORD
THE ACCOUNT FOR ALL SUCH PAYMENTS, WHICH SHALL BE DEPOSITED IN THE EHR
LOAN FUND ACCOUNT.
6. LOANS FROM THE EHR LOAN FUND SHALL BE MADE PURSUANT TO AN AGREEMENT
WITH THE ELIGIBLE HEALTH CARE PROVIDER SPECIFYING THE TERMS THEREOF,
INCLUDING REPAYMENT TERMS. THE AUTHORITY SHALL RECORD AND ACCOUNT FOR
ALL SUCH REPAYMENTS, WHICH SHALL BE DEPOSITED IN THE EHR LOAN FUND. THE
AUTHORITY SHALL REPORT ANNUALLY TO THE DIRECTOR OF THE DIVISION OF BUDG-
ET, THE CHAIR OF THE SENATE FINANCE COMMITTEE AND THE CHAIR OF THE
ASSEMBLY WAYS AND MEANS COMMITTEE, ON THE TRANSACTIONS IN THE EHR LOAN
FUND, INCLUDING BUT NOT LIMITED TO DEPOSITS TO THE FUND, LOANS MADE FROM
THE FUND, INVESTMENT INCOME, AND THE BALANCE ON HAND AS OF THE END OF
EACH YEAR.
7. THE COMMISSIONER IS AUTHORIZED, WITH THE ASSISTANCE AND COOPERATION
OF THE AUTHORITY, TO PROVIDE A PROGRAM OF TECHNICAL ASSISTANCE FOR
ELIGIBLE HEALTH CARE PROVIDERS.
8. THE COMMISSIONER MAY PROMULGATE REGULATIONS, INCLUDING EMERGENCY
REGULATIONS, TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
S 32. The commissioner is hereby authorized to submit such applica-
tions, strategic plans, reports to, and to comply with other require-
ments specified by, the federal secretary of health and human services
in order to obtain federal funding for the certified EHR technology loan
program.
S 33. Section 2818 of the public health law is amended by adding two
new subdivisions 4 and 5 to read as follows:
4. NOTWITHSTANDING THE PROVISIONS OF SUBDIVISION ONE OF THIS SECTION,
THE COMMISSIONER AND THE DIRECTOR OF THE DORMITORY AUTHORITY MAY AWARD,
IN AN AMOUNT NOT TO EXCEED TWENTY-FIVE MILLION DOLLARS OF THE HEALTH
CARE SYSTEM IMPROVEMENT CAPITAL GRANT PROGRAM ALLOCATED IN ANY GIVEN
S. 58--B 66 A. 158--B
FISCAL YEAR, GRANTS TO ELIGIBLE APPLICANTS WITHOUT THE PROCESS SET FORTH
IN SUBDIVISION ONE OF THIS SECTION TO PROVIDE NECESSARY RESTRUCTURING
SUPPORT TO HOSPITALS FOR TRANSITION TO A NEW REIMBURSEMENT METHODOLOGY.
(A) WITH RESPECT TO THE PROCESS FOR THE AWARDING OF SUCH FUNDS WITHOUT
THE PROCESS SET FORTH IN SUBDIVISION ONE OF THIS SECTION, THE COMMIS-
SIONER AND DIRECTOR OF THE DORMITORY AUTHORITY SHALL DETERMINE ELIGIBLE
AWARDEES BASED SOLELY ON AN APPLICANT'S ABILITY TO MEET THE FOLLOWING
CRITERIA:
(I) HAVE A LOSS OF OPERATIONS FOR EACH OF THE THREE CONSECUTIVE
PRECEDING YEARS AS EVIDENCE BY AUDITED FINANCIAL STATEMENTS; AND
(II) HAVE A NEGATIVE FUND BALANCE OR NEGATIVE EQUITY POSITION IN EACH
OF THE THREE PRECEDING YEARS AS EVIDENCE BY AUDITED FINANCIAL STATE-
MENTS; AND
(III) HAVE A CURRENT RATIO OF LESS THAN 1AGING FOR EACH OF THREE
CONSECUTIVE PRECEDING DAYS; OR
(IV) BE DEEMED TO THE SATISFACTION OF THE COMMISSIONER TO BE A PROVID-
ER THAT FULFILLS AN UNMET HEALTH CARE NEED FOR THE COMMUNITY AS DETER-
MINED BY THE DEPARTMENT THROUGH CONSIDERATION OF THE VOLUME OF MEDICAID
AND MEDICALLY INDIGENT PATIENTS SERVED; THE SERVICE VOLUME AND MIX,
INCLUDING BUT NOT LIMITED TO MATERNITY, PEDIATRICS, TRAUMA, BEHAVIOR AND
NEUROBEHAVIORAL, VENTILATOR, AND EMERGENCY ROOM VOLUME; AND, THE SIGNIF-
ICANCE OF THE INSTITUTION IN ENSURING HEALTH CARE SERVICES ACCESS AS
MEASURED BY MARKET SHARE WITHIN THE REGION; OR
(V) BE DEEMED TO THE SATISFACTION OF THE COMMISSIONER TO HAVE INCURRED
OPERATING LOSSES RESULTING FROM THE IMPLEMENTATION OF REIMBURSEMENT RATE
REFORMS AND OTHER REDUCTIONS ENACTED BY A CHAPTER OF THE LAWS OF TWO
THOUSAND NINE, TO PROVIDE FOR THE CONTINUED FINANCIAL VIABILITY OF THE
APPLICANT.
(B) PRIOR TO AN AWARD BEING GRANTED TO AN ELIGIBLE APPLICANT WITHOUT A
COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS, THE COMMISSIONER AND
THE DIRECTOR OF THE DORMITORY AUTHORITY SHALL NOTIFY THE CHAIR OF THE
SENATE FINANCE COMMITTEE, THE CHAIR OF THE ASSEMBLY WAYS AND MEANS
COMMITTEE AND THE DIRECTOR OF THE BUDGET OF THE INTENT TO GRANT SUCH AN
AWARD. SUCH NOTICE SHALL INCLUDE INFORMATION REGARDING HOW THE ELIGIBLE
APPLICANT MEETS CRITERIA ESTABLISHED PURSUANT TO THIS SECTION.
5. (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;
S. 58--B 67 A. 158--B
(V) SECURING FINANCING FOR FACILITIES IN A MANNER THAT IMPROVES THE
PRIMARY AND AMBULATORY CARE SYSTEM INCLUDING PROGRAMS UNDERTAKEN IN
COLLABORATION WITH A LOCAL DEVELOPMENT CORPORATION INCORPORATED PURSUANT
TO SECTIONS FOUR HUNDRED ONE AND ONE THOUSAND FOUR HUNDRED ELEVEN OF THE
NOT-FOR-PROFIT CORPORATION LAW TO FOSTER THE DEVELOPMENT AND EXPANSION
OF HIGH QUALITY, COST EFFECTIVE PRIMARY HEALTH CARE SERVICES AND RELATED
AMBULATORY CARE AND ANCILLARY SERVICES BENEFITING MEDICALLY UNDERSERVED
COMMUNITIES, PRINCIPALLY IN THE STATE, TO INCREASE ACCESS OF COMMUNITY
RESIDENTS TO SUCH SERVICES, TO IMPROVE THE HEALTH STATUS OF SUCH RESI-
DENTS AND TO LESSEN THE BURDENS OF GOVERNMENT AND ACT IN THE PUBLIC
INTEREST; 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
$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. Subdivisions 5 and 7 of section 270 of the public health law, as
added by section 10 of part C of chapter 58 of the laws of 2005, are
amended and a new subdivision 14 is added to read as follows:
5. "Non preferred drug" means a prescription drug that is [in a thera-
peutic class that is] included in the preferred drug program and is not
one of the drugs on the preferred drug list [in that class] BECAUSE IT
IS EITHER: (A) IN A THERAPEUTIC CLASS THAT IS INCLUDED IN THE PREFERRED
DRUG PROGRAM AND IS NOT ONE OF THE DRUGS ON THE PREFERRED DRUG LIST IN
THAT CLASS OR (B) MANUFACTURED BY A PHARMACEUTICAL MANUFACTURER WITH
WHOM THE COMMISSIONER IS NEGOTIATING OR HAS NEGOTIATED A MANUFACTURER
AGREEMENT AND IS NOT A PREFERRED DRUG UNDER A MANUFACTURER AGREEMENT.
7. "Preferred drug" means a prescription drug that is EITHER (A) in a
therapeutic class that is included in the preferred drug program and is
one of the drugs on the preferred drug list in that class OR (B) A
PREFERRED DRUG UNDER A MANUFACTURER AGREEMENT.
14. "MANUFACTURER AGREEMENT" MEANS AN AGREEMENT BETWEEN THE COMMIS-
SIONER AND A PHARMACEUTICAL MANUFACTURER UNDER PARAGRAPH (B) OF SUBDIVI-
SION ELEVEN OF SECTION TWO HUNDRED SEVENTY-TWO OF THIS ARTICLE.
S 36. Subdivision 11 of section 272 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:
11. (A) The commissioner shall provide an opportunity for pharmaceu-
tical manufacturers to provide supplemental rebates to the state public
S. 58--B 68 A. 158--B
health [plan] PLANS FOR DRUGS WITHIN A THERAPEUTIC CLASS; such supple-
mental rebates shall be taken into consideration by the committee and
the commissioner in determining the cost-effectiveness of drugs within a
therapeutic class under the state public health plans.
(B) THE COMMISSIONER MAY DESIGNATE A PHARMACEUTICAL MANUFACTURER AS
ONE WITH WHOM THE COMMISSIONER IS NEGOTIATING OR HAS NEGOTIATED A
MANUFACTURER AGREEMENT, AND ALL OF THE DRUGS IT MANUFACTURES OR MARKETS
SHALL BE INCLUDED IN THE PREFERRED DRUG PROGRAM. THE COMMISSIONER MAY
NEGOTIATE DIRECTLY WITH A PHARMACEUTICAL MANUFACTURER FOR REBATES RELAT-
ING TO ANY OR ALL OF THE DRUGS IT MANUFACTURES OR MARKETS. A MANUFACTUR-
ER AGREEMENT SHALL DESIGNATE ANY OR ALL OF THE DRUGS MANUFACTURED OR
MARKETED BY THE PHARMACEUTICAL MANUFACTURER AS BEING PREFERRED OR NON
PREFERRED DRUGS. WHEN A PHARMACEUTICAL MANUFACTURER HAS BEEN DESIGNATED
BY THE COMMISSIONER UNDER THIS PARAGRAPH BUT HAS NOT REACHED A MANUFAC-
TURER AGREEMENT WITH THE PHARMACEUTICAL MANUFACTURER, THEN ALL OF THE
DRUGS MANUFACTURED OR MARKETED BY THE PHARMACEUTICAL MANUFACTURER SHALL
BE NON PREFERRED DRUGS. HOWEVER, NOTWITHSTANDING THIS PARAGRAPH, ANY
DRUG THAT IS SELECTED TO BE ON THE PREFERRED DRUG LIST UNDER PARAGRAPH
(B) OF SUBDIVISION TEN OF THIS SECTION ON GROUNDS THAT IT IS SIGNIF-
ICANTLY MORE CLINICALLY EFFECTIVE AND SAFER THAN OTHER DRUGS IN ITS
THERAPEUTIC CLASS SHALL BE A PREFERRED DRUG.
[Such supplemental] (C) SUPPLEMENTAL rebates UNDER THIS SUBDIVISION
shall be in addition to those required by applicable federal law and
subdivision seven of section three hundred sixty-seven-a of the social
services law. In order to be considered in connection with the preferred
drug program, such supplemental rebates shall apply to the drug products
dispensed under the Medicaid program and the EPIC program. The commis-
sioner is prohibited from approving alternative rebate demonstrations,
value added programs or guaranteed savings from other program benefits
as a substitution for supplemental rebates.
S 37. Subdivision 1 of section 273 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:
1. For the purposes of this article, a prescription drug shall be
considered to be not on the preferred drug list if it is [in a therapeu-
tic class that is included on the preferred drug list and is not one of
the drugs on the preferred list in that class] A NON PREFERRED DRUG.
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. Subdivision 3 of section 369-cc of the social services law, as
added by chapter 632 of the laws of 1992, is amended, and a new subdivi-
sion 4 is added to read as follows:
3. The prospective DUR program shall be based on the guidelines estab-
lished by the DUR board not in conflict with education or social
services laws and shall provide that prior to the prescription being
filled or delivered, a review will be conducted by the pharmacist at the
point of sale to screen for potential drug therapy problems resulting
from:
(a) Therapeutic duplication;
(b) Drug-drug interactions;
(c) Incorrect dosage/duration of treatment;
(d) Drug-allergy interactions;
(e) Clinical abuse/misuse.
S. 58--B 69 A. 158--B
In conducting the prospective DUR, the pharmacist may not alter the
prescribed outpatient drug therapy without the consent of the [physi-
cian] PRESCRIBER who prescribed that therapy.
4. (A) 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
CLINICAL EFFECTIVENESS, SAFETY, AND COST EFFECTIVENESS. PRIOR AUTHORI-
ZATION UNDER THIS PARAGRAPH SHALL BE OBTAINED UNDER SECTION TWO HUNDRED
SEVENTY-THREE OF THE PUBLIC HEALTH LAW.
(B) THE COMMISSIONER, THROUGH THE PROSPECTIVE DUR PROGRAM, MAY FROM
TIME TO TIME LIMIT THE QUANTITY, FREQUENCY, AND DURATION OF DRUG THERA-
PY, USING GUIDELINES DEVELOPED BY THE DUR BOARD. THE DUR BOARD SHALL
DEVELOP CLINICAL PRESCRIBING GUIDELINES RELATING TO QUANTITY, FREQUENCY,
AND DURATION OF DRUG THERAPY FOR THE COMMISSIONER'S USE UNDER THIS PARA-
GRAPH. IN ESTABLISHING THESE GUIDELINES, THE BOARD SHALL CONSIDER CLIN-
ICAL EFFECTIVENESS, SAFETY, AND COST EFFECTIVENESS. PRIOR AUTHORIZATION
UNDER THIS PARAGRAPH SHALL BE OBTAINED UNDER SECTION TWO HUNDRED SEVEN-
TY-THREE OF THE PUBLIC HEALTH LAW. EXCEPTIONS TO ANY PRIOR AUTHORIZATION
IMPOSED AS A RESULT OF THESE GUIDELINES SHALL INCLUDE, BUT NEED NOT BE
LIMITED TO, PROVISION FOR EMERGENCY CIRCUMSTANCES WHERE A MEDICAL CONDI-
TION REQUIRES ALLEVIATION OF SEVERE PAIN OR WHICH THREATENS TO CAUSE
DISABILITY OR TO TAKE A LIFE IF NOT PROMPTLY TREATED.
S 40. Intentionally omitted.
S 41. Intentionally omitted.
S 42. Intentionally omitted.
S 43. Intentionally omitted.
S 44. Intentionally omitted.
S 45. Intentionally omitted.
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, UNLESS PRIOR AUTHORIZATION IS OBTAINED
UNDER SECTION TWO HUNDRED SEVENTY-THREE OF THE PUBLIC HEALTH LAW;
S. 58--B 70 A. 158--B
S 46-a. Paragraph (a-2) of subdivision 4 of section 365-a of the
social services law, as added by section 12 of part C of chapter 58 of
the laws of 2005, is amended to read as follows:
(a-2) drugs which may not be dispensed without a prescription as
required by section sixty-eight hundred ten of the education law, and
which are [non-preferred] NON PREFERRED drugs [in a therapeutic class
subject to the preferred drug program] pursuant to section two hundred
seventy-two of the public health law, or the clinical drug review
program under section two hundred seventy-four of the public health law,
unless prior authorization is granted or not required;
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-1) 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-1) 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)(I) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO PAY FINANCIAL
INCENTIVES 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. (II) 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. (III) THE PROVISIONS OF THIS
PARAGRAPH SHALL NOT TAKE EFFECT UNLESS ALL NECESSARY APPROVALS UNDER
FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINAN-
CIAL PARTICIPATION IN THE COSTS OF SERVICES PROVIDED UNDER THIS PARA-
GRAPH.
S 50. Intentionally omitted.
S 51. Intentionally omitted.
S 52. Intentionally omitted.
S. 58--B 71 A. 158--B
S 53. Intentionally omitted.
S 54. Intentionally omitted.
S 55. Intentionally omitted.
S 56. Intentionally omitted.
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, clauses (ii) and (iii) of subparagraph 1 as amended by
section 60 of part C of chapter 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
S. 58--B 72 A. 158--B
payments[, or (B) 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
(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-
S. 58--B 73 A. 158--B
garded an additional amount of resources equal to the difference between
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
S. 58--B 74 A. 158--B
may be satisfied as to the applicant's or recipient's eligibility there-
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--B 75 A. 158--B
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--B 76 A. 158--B
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, as amended by chapter 59 of the laws of 1993, 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--B 77 A. 158--B
(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 fund services to uninsured persons and/or 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 subdivision two of
S. 58--B 78 A. 158--B
section 369-ee of the social services law. Such waiver 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 voluntarily elect to participate in
such program to fund services to uninsured persons and/or expand family
health plus coverage may have the non-federal share of the payment
amounts described in subdivision one of this section, or a portion ther-
eof, redirected by the commissioner of health to support the non-federal
share of payments associated with such program to fund services to unin-
sured persons and/or expand family health plus coverage. Such elections
may be revoked effective 6 months after such local social services
district provides notice of revocation. Such elections by each social
services district shall be subject to the approval of the commissioner
of health and with the consent of the public hospitals which are located
within each such social services district and which are otherwise eligi-
ble to receive such redirected payments.
3. The non-federal share payment obligations of social services
districts that voluntarily elect to participate in such program to fund
services to uninsured persons and/or expand 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 voluntarily elect to
participate in such program to fund services to uninsured persons and/or
expand family health plus coverage shall be established as follows: (a)
50 percent of the amount actually expended in state fiscal year
2007-2008 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 program to fund services to
uninsured persons and/or expand 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
S. 58--B 79 A. 158--B
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
portion of such payment obligations to be utilized for such program to
fund services to uninsured persons and/or expand 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 to fund services to the uninsured and/or
expand 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. Subdivision 24 of section 206 of the public health law, as
added by section 39 of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
24. Notwithstanding any inconsistent provision of law to the contrary,
the commissioner is authorized to receive applications and to determine
initial and continuing eligibility for enrollment under the child health
plus program established under title I-A of article twenty-five of this
chapter, the medical assistance program established under title eleven
of article five of the social services law, and the family health plus
program established under title eleven-D of such article. The commis-
sioner may exercise such authority with respect to all residents, or a
subset of residents, of one or more local social services districts. The
commissioner is authorized to enter into one or more contracts, which
contracts shall be procured on a competitive basis pursuant to a request
for proposal process, for the purpose of exercising his or her authority
under this subdivision. STATE EMPLOYEES SHALL SUPERVISE AND PROVIDE
OVERSIGHT AND QUALITY ASSURANCE MONITORING OF CONTRACT STAFF ACTIVITIES.
PROVIDED FURTHER, THE DEPARTMENT SHALL ENDEAVOR TO USE STATE EMPLOYEES
IN EXERCISING THE COMMISSIONER'S AUTHORITY UNDER THIS SUBDIVISION.
S 70. Intentionally omitted.
S 71. Intentionally omitted.
S 72. Intentionally omitted.
S 72-a. 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
S. 58--B 80 A. 158--B
OR ALASKAN NATIVES, AS DEFINED BY THE U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES, WHOSE FAMILY GROSS HOUSEHOLD INCOME IS LESS THAN TWO
HUNDRED FIFTY-ONE PERCENT OF THE NON-FARM FEDERAL POVERTY LEVEL; AND
(II) NINE DOLLARS PER MONTH FOR EACH ELIGIBLE CHILD WHOSE FAMILY GROSS
HOUSEHOLD INCOME IS BETWEEN ONE HUNDRED SIXTY PERCENT AND TWO HUNDRED
TWENTY-TWO PERCENT OF THE NON-FARM FEDERAL POVERTY LEVEL, BUT NO MORE
THAN TWENTY-SEVEN DOLLARS PER MONTH PER FAMILY; AND
(III) FIFTEEN DOLLARS PER MONTH FOR EACH ELIGIBLE CHILD WHOSE FAMILY
GROSS HOUSEHOLD INCOME IS BETWEEN TWO HUNDRED TWENTY-THREE PERCENT AND
TWO HUNDRED FIFTY PERCENT OF THE NON-FARM FEDERAL POVERTY LEVEL, BUT NO
MORE THAN FORTY-FIVE DOLLARS PER MONTH PER FAMILY; AND
(IV) THIRTY DOLLARS PER MONTH FOR EACH ELIGIBLE CHILD WHOSE FAMILY
GROSS HOUSEHOLD INCOME IS BETWEEN TWO HUNDRED FIFTY-ONE PERCENT AND
THREE HUNDRED PERCENT OF THE NON-FARM FEDERAL POVERTY LEVEL, BUT NO MORE
THAN NINETY DOLLARS PER MONTH PER FAMILY;
(V) FORTY-FIVE DOLLARS PER MONTH FOR EACH ELIGIBLE CHILD WHOSE FAMILY
GROSS HOUSEHOLD INCOME IS BETWEEN THREE HUNDRED ONE PERCENT AND THREE
HUNDRED FIFTY PERCENT OF THE NON-FARM FEDERAL POVERTY LEVEL, BUT NO MORE
THAN ONE HUNDRED THIRTY-FIVE DOLLARS PER MONTH PER FAMILY; AND
(VI) SIXTY DOLLARS PER MONTH FOR EACH ELIGIBLE CHILD WHOSE FAMILY
GROSS HOUSEHOLD INCOME IS BETWEEN THREE HUNDRED FIFTY-ONE PERCENT AND
FOUR HUNDRED PERCENT OF THE NON-FARM FEDERAL POVERTY LEVEL, BUT NO MORE
THAN ONE HUNDRED EIGHTY DOLLARS PER MONTH PER FAMILY.
S 73. Intentionally omitted.
S 74. Intentionally omitted.
S 75. Intentionally omitted.
S 76. Intentionally omitted.
S 77. Intentionally omitted.
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. Intentionally omitted.
S 80. Intentionally omitted.
S 81. Intentionally omitted.
S 82. Intentionally omitted.
S 83. Intentionally omitted.
S 84. Intentionally omitted.
S 85. Intentionally omitted.
S 86. 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
S. 58--B 81 A. 158--B
(IV) FOR ALL OTHER DIAGNOSTIC
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-
S. 58--B 82 A. 158--B
SION SIXTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A OF THIS ARTICLE,
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--B 83 A. 158--B
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] THIRTY-SIX hundred five of
this [chapter] ARTICLE relative to licensure or subdivision two of
section [three thousand six] THIRTY-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 THIRTY-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
approval by the public health council in accordance with the provisions
S. 58--B 84 A. 158--B
of subdivision four of section [three thousand six] THIRTY-SIX hundred
five of this [chapter] ARTICLE relative to licensure or subdivision two
of section [three thousand six] THIRTY-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 THIRTY-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--B 85 A. 158--B
(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--B 86 A. 158--B
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--B 87 A. 158--B
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--B 88 A. 158--B
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--B 89 A. 158--B
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 MAY FIRST, TWO THOU-
SAND NINE, FUNDS AS HEREINAFTER DESCRIBED SHALL BE RESERVED AND SET
ASIDE AND DISTRIBUTED IN ACCORDANCE WITH THE FOLLOWING:
(A) FOR THE PERIOD MAY FIRST, TWO THOUSAND NINE THROUGH DECEMBER THIR-
TY-FIRST, TWO THOUSAND NINE PAYMENTS SHALL BE MADE AS FOLLOWS:
S. 58--B 90 A. 158--B
(I) NINETY PERCENT OF FUNDS AVAILABLE FOR THE TWO THOUSAND NINE CALEN-
DAR YEAR PURSUANT TO PARAGRAPH (A-1) OF SUBDIVISION FOUR OF THIS SECTION
SHALL BE RESERVED AND SET ASIDE AND DISTRIBUTED AS MEDICAID DISPROPOR-
TIONATE SHARE (DSH) PAYMENTS TO THE SAME HOSPITALS AND IN THE SAME
PROPORTIONAL AMOUNTS AS RECEIVED PURSUANT TO SUCH PARAGRAPH (A-1) IN TWO
THOUSAND EIGHT;
(II) THREE HUNDRED SEVEN MILLION DOLLARS SHALL BE DISTRIBUTED AS MEDI-
CAID DSH PAYMENTS TO FACILITIES DESIGNATED BY THE DEPARTMENT AS TEACHING
HOSPITALS AS OF DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHT IN ACCORDANCE
WITH A SCHEDULE OF PAYMENTS TO BE SET FORTH IN REGULATIONS PROMULGATED
BY THE COMMISSIONER TO COMPENSATE SUCH FACILITIES FOR MEDICAID AND
SELF-PAY LOSSES REPORTED IN EACH FACILITY'S TWO THOUSAND SEVEN ANNUAL
COST REPORT;
(III) SIXTEEN MILLION DOLLARS SHALL BE PROPORTIONALLY DISTRIBUTED AS
MEDICAID DSH PAYMENTS TO NON-TEACHING HOSPITALS BASED UPON THEIR PROPOR-
TION OF UNINSURED LOSSES AS DEFINED IN PARAGRAPH (C) OF SUBDIVISION
FIVE-A OF THIS SECTION TO SUCH LOSSES OF ALL NON-TEACHING HOSPITALS ON A
STATEWIDE BASIS;
(IV) TWENTY-FIVE MILLION DOLLARS SHALL BE DISTRIBUTED AS MEDICAID DSH
PAYMENTS TO NON-MAJOR PUBLIC HOSPITALS HAVING MEDICAID DISCHARGES OF
FORTY PERCENT OR GREATER AS ESTABLISHED BY THE COMMISSIONER FROM DATA
REPORTED IN EACH HOSPITAL'S TWO THOUSAND SEVEN ANNUAL COST REPORT, IN
ACCORDANCE WITH A SCHEDULE TO BE SET FORTH IN REGULATIONS PROMULGATED BY
THE COMMISSIONER, TO COMPENSATE SUCH FACILITIES FOR PROJECTED MEDICAID
NET LOSSES, AS DETERMINED BY THE COMMISSIONER, STEMMING FROM MODIFICA-
TIONS TO MEDICAID PAYMENTS MADE PURSUANT TO A CHAPTER OF THE LAWS OF TWO
THOUSAND NINE.
(B) FOR ANNUAL PERIODS BEGINNING JANUARY FIRST, TWO THOUSAND TEN
PAYMENTS SHALL BE MADE AS FOLLOWS:
(I) TWO HUNDRED SIXTY-NINE MILLION FIVE HUNDRED THOUSAND DOLLARS SHALL
BE DISTRIBUTED AS MEDICAID DSH PAYMENTS TO NON-MAJOR PUBLIC TEACHING
HOSPITALS, AND SUCH DISTRIBUTIONS SHALL BE MADE ON A REGIONAL BASIS TO
COVER, WITHIN AMOUNTS AVAILABLE FOR EACH REGION, EACH ELIGIBLE FACILI-
TY'S PROPORTIONAL REGIONAL SHARE OF UNMET NEED FOR TWO THOUSAND SEVEN,
PROVIDED, HOWEVER, THAT SUCH REGIONS AND REGIONAL ALLOCATIONS AND THE
DEFINITION OF UNMET NEED SHALL BE SET FORTH IN REGULATIONS PROMULGATED
BY THE COMMISSIONER;
(II) TWENTY-FIVE MILLION DOLLARS SHALL BE DISTRIBUTED AS MEDICAID DSH
PAYMENTS TO HOSPITALS ELIGIBLE FOR PAYMENTS MADE PURSUANT TO SUBPARA-
GRAPH (IV) OF PARAGRAPH (A) OF THIS SUBDIVISION BASED UPON EACH FACILI-
TY'S PROPORTION OF UNINSURED LOSSES, AS DEFINED IN PARAGRAPH (C) OF
SUBDIVISION FIVE-A OF THIS SECTION, TO SUCH LOSSES FOR ALL HOSPITALS
ELIGIBLE FOR SUCH PAYMENTS;
(III) SIXTEEN MILLION DOLLARS SHALL BE DISTRIBUTED IN ACCORDANCE WITH
THE PROVISIONS OF SUBPARAGRAPH (III) OF PARAGRAPH (A) OF THIS SUBDIVI-
SION;
(IV) TWENTY-FIVE MILLION DOLLARS SHALL BE DISTRIBUTED IN ACCORDANCE
WITH THE PROVISIONS OF SUBPARAGRAPH (IV) OF PARAGRAPH (A) OF THIS SUBDI-
VISION;
(V) TWENTY-FOUR MILLION FIVE HUNDRED THOUSAND DOLLARS SHALL BE
DISTRIBUTED AS NON-MEDICAID GRANTS TO NON-MAJOR PUBLIC ACADEMIC MEDICAL
CENTERS PURSUANT TO A SCHEDULE TO BE SET FORTH IN REGULATIONS PROMULGAT-
ED BY THE COMMISSIONER, FOR FUNDING FOR THE FOLLOWING PURPOSES:
(A) QUALITY OF CARE STANDARDS LINKED TO THE ALL PATIENT REFINED (APR)
DRGS;
S. 58--B 91 A. 158--B
(B) BEST PRACTICES AND EVIDENCE-BASED GUIDELINES WITH PARTICULAR FOCUS
ON OBSTETRIC, PSYCHIATRIC AND OTHER HIGH RISK SPECIALTIES;
(C) INPATIENT PSYCHIATRIC CASE PAYMENT SYSTEM AND FINANCIAL INCENTIVES
TO DIVERT ADMISSIONS AND IMPROVE LINKAGES TO OUTPATIENT PROGRAMS;
(D) MEDICAL HOME STANDARDS AND INTEGRATED DELIVERY SYSTEMS WITH A
PARTICULAR FOCUS ON CHRONIC CARE PATIENTS SERVED IN ACADEMIC MEDICAL
CENTERS AND COMMUNITY-BASED SETTINGS; AND
(E) REFORMS TO RESIDENCY TRAINING CURRICULUM FOCUSING ON CULTURAL
COMPETENCY, QUALITY OF TRAINING PROGRAMS, AND PHYSICIAN SUPPLY IN NEEDED
SPECIALTIES AND GEOGRAPHIC AREAS.
S 101-a. Paragraph (a-1) of subdivision four of section 2807-k of the
public health law, as amended by section 1 of part OO of chapter 57 of
the laws of 2008, is amended to read as follows:
(a-1) From funds in the pool for each year, twenty-seven million
dollars shall be reserved on an annual basis for the periods January
first, two thousand through December thirty-first, two thousand ten, for
distribution in accordance with subdivision sixteen of this section,
provided, however, that payments on and after January first, two thou-
sand nine THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND NINE shall be
subject to the provisions of [subdivision] SUBDIVISIONS five-a AND
FIVE-B of this section, AND SHALL BE SUBJECT TO THE PROVISIONS OF SUBDI-
VISION FIVE-B OF THIS SECTION FOR PERIODS ON AND AFTER JANUARY FIRST,
TWO THOUSAND TEN.
S 101-b. Notwithstanding any contrary provision of law, if the commis-
sioner of health determines that federal financial participation will
not be available with regard to the provisions of subparagraph (ii) of
paragraph (a) of subdivision 5-b of section 2807-k of the public health
law, such commissioner may deem such provision null and void and instead
may allocate funds in accordance with the methodology set forth in
subparagraph (i) of paragraph (b) of subdivision 5-b of section 2807-k
of the public health law.
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
S. 58--B 92 A. 158--B
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 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. Intentionally omitted.
S 105. Intentionally omitted.
S 106. Intentionally omitted.
S 107. Intentionally omitted.
S 107-a. Intentionally omitted.
S 108. Intentionally omitted.
S. 58--B 93 A. 158--B
S 109. Intentionally omitted.
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
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. Intentionally omitted.
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
S. 58--B 94 A. 158--B
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. Intentionally omitted.
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. LIABLE THIRD PARTIES SHALL NOT DENY A CLAIM MADE BY A
SOCIAL SERVICES OFFICIAL OR THE DEPARTMENT IN CONFORMANCE WITH THIS
PARAGRAPH SOLELY ON THE BASIS OF THE DATE OF SUBMISSION OF THE CLAIM,
THE TYPE OR FORMAT OF THE CLAIM FORM, OR A FAILURE TO PRESENT PROPER
DOCUMENTATION AT THE POINT-OF-SALE THAT IS THE BASIS OF THE CLAIM. 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 confidentiality of all indi-
vidually identifiable information or records. Such carrier shall limit
the use of such information or record to the specific 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,
S. 58--B 95 A. 158--B
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-
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 117-a. Subsections (a), (b), (d) and (e) of section 320 of the
insurance law, subsection (e) as amended by chapter 601 of the laws of
2007, are amended and a new subsection (f) is added to read as follows:
(a) Every insurer [doing an insurance business in this state or any
pension fund, retirement system or other organization required by law to
make reports to, or which is subject to examination by, the insurance
department, except any corporation subject to article forty-three of
this chapter,] shall, upon request of the state department of social
services or of a local social services district for any records, or any
information contained in such records, pertaining to the coverage of any
individual for such individual's medical costs under any individual or
group policy or other obligation made by such organizations, or the
medical benefits paid by or claims made to such organizations pursuant
to such policy or other obligation in accordance with the limitations of
subsection (c) hereof, make the requested records or information avail-
able upon a certification by the department of social services or the
social services district that such individual is an applicant for or
recipient of medical assistance, or is a person who is legally responsi-
ble for such an applicant or recipient, pursuant to the social services
law.
(b) The superintendent and the commissioner of the state department of
social services shall enter into a cooperative agreement setting forth
mutually agreeable procedures for requesting and furnishing appropriate
information, not inconsistent with any law pertaining to the confiden-
tiality and privacy of records, which procedures shall include financial
arrangements as may be necessary to reimburse [insurance corporations or
other] insurers [doing or authorized to do an insurance business in this
state or any pension fund, retirement system or other organization
subject to the provisions of this section] for necessary costs incurred
in furnishing requested information, and the time and manner such proce-
dures are to become effective. Such procedures may be added to [the
cooperative agreement which was entered into between the superintendent
and the commissioner of social services pursuant to the provisions of
section four thousand three hundred eleven of this chapter or the proce-
dures may be added to] a new cooperative agreement which shall supersede
the agreement currently in existence between the superintendent and the
commissioner of social services.
(d) Not later than the date upon which the procedures agreed to pursu-
ant to subsection (b) hereof become effective, the superintendent shall
establish guidelines to assure that information relating to an individ-
ual certified to be an applicant for or recipient of medical assistance,
furnished to any [insurance corporation,] insurer, [pension fund,
retirement system or other organization subject to the provisions of
this section] is used only for the purpose of identifying the records or
information requested in such manner so as not to violate the confiden-
tiality provisions of the social services law.
(e) (1) Every insurer [doing an insurance business in this state or
any pension fund, retirement system or other organization required by
law to make reports to, or which is subject to examination by, the
S. 58--B 96 A. 158--B
department] shall, upon request of an authorized representative of the
state office of temporary and disability assistance, or a social
services district child support enforcement unit established pursuant to
section one hundred eleven-c of the social services law, enter into an
agreement with the state office of temporary and disability assistance
or a social services district to develop and operate a data match
system, using automated data exchanges to the maximum extent feasible,
in which each such insurer, pension fund, retirement system or other
organization shall provide for each calendar quarter the name, record
address, social security number or other taxpayer identification number,
and other identifying information for each individual who maintains a
demand deposit account, checking or negotiable withdrawal order account,
savings account, time deposit account, or money-market mutual fund
account at such institution and who owes past-due support, as identified
by the state office of temporary and disability assistance or a social
services district child support enforcement unit by name and social
security number or other taxpayer identification number. Nothing herein
shall be deemed to limit the authority of a local social services
district support collection unit pursuant to section one hundred
eleven-h of the social services law.
(2) No insurer[, pension fund, retirement system or other organiza-
tion] which discloses information pursuant to paragraph one of this
subsection, or discloses any financial record to the state office of
temporary and disability assistance or a social services district child
support enforcement unit for the purpose of enforcing a child support
obligation of such person, shall be liable under any law to any person
for such disclosure, or for any other action taken in good faith to
comply with paragraph one of this subsection.
(F) "INSURER", AS USED IN THIS SECTION, MEANS:
(1) (I) AN INSURER REQUIRED TO BE LICENSED TO DO AN INSURANCE BUSINESS
IN THIS STATE UNDER THIS CHAPTER, INCLUDING A CORPORATION SUBJECT TO
ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER;
(II) A PENSION FUND, RETIREMENT SYSTEM OR OTHER ORGANIZATION REQUIRED
BY LAW TO MAKE REPORTS TO, OR WHICH IS SUBJECT TO EXAMINATION BY, THE
SUPERINTENDENT;
(III) A HEALTH MAINTENANCE ORGANIZATION SUBJECT TO ARTICLE FORTY-FOUR
OF THE PUBLIC HEALTH LAW; OR
(IV) A SELF-FUNDED PLAN OR ANY OTHER INSURER WITH RESPECT TO ANY
MEDICAL CLAIM OR BENEFIT OF A RESIDENT OF THIS STATE; AND
(2) ANY PERSON OR OTHER ENTITY ACTING ON BEHALF OF AN INSURER AS
DESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION WITH RESPECT TO ANY
MEDICAL CLAIM OR BENEFIT OF A RESIDENT OF THIS STATE.
S 117-b. Subparagraph (C) of paragraph 3 of subsection (e) of section
3212 of the insurance law, as amended by chapter 822 of the laws of
1987, is amended to read as follows:
(C) 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
[two] THREE years from the date services for which benefits are provided
under the policy or contract are rendered. AN INSURER SHALL NOT DENY A
CLAIM MADE IN CONFORMANCE WITH PARAGRAPH (B) OF SUBDIVISION TWO OF
SECTION THREE HUNDRED SIXTY-SEVEN-A OF THE SOCIAL SERVICES LAW SOLELY ON
THE BASIS OF THE DATE OF SUBMISSION OF THE CLAIM, THE TYPE OR FORMAT OF
THE CLAIM FORM, OR A FAILURE TO PRESENT PROPER DOCUMENTATION AT THE
POINT-OF-SALE THAT IS THE BASIS OF THE CLAIM.
S 117-c. Section 4311 of the insurance law is REPEALED.
S. 58--B 97 A. 158--B
S 118. Intentionally omitted.
S 119. Intentionally omitted.
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. Intentionally omitted.
S 123. Intentionally omitted.
S 123-a. Intentionally omitted.
S 123-b. Intentionally omitted.
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;
S. 58--B 98 A. 158--B
(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;
(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 PLACE OF BUSINESS WITH GROSS SALES TOTALING LESS THAN ONE MILLION
DOLLARS; TWO THOUSAND FIVE HUNDRED DOLLARS FOR EACH RETAIL PLACE OF
BUSINESS WITH GROSS SALES TOTALING AT LEAST ONE MILLION DOLLARS BUT LESS
THAN TEN MILLION DOLLARS; AND FIVE THOUSAND DOLLARS FOR EACH RETAIL
PLACE OF BUSINESS 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
S. 58--B 99 A. 158--B
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
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 PLACE OF BUSINESS OR VENDING MACHINE WITH ZERO DOLLARS IN GROSS
SALES DURING THE PREVIOUS CALENDAR YEAR IS SUBJECT TO THE LOWEST APPLI-
CATION FEE REQUIRED BY SUCH SUBPARAGRAPHS. The department, within ten
days after receipt of an application for registration under this para-
graph and payment of the proper fee for application for registration,
[shall] WILL issue a registration certificate, as prescribed by the
commissioner, 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
S. 58--B 100 A. 158--B
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
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. The commissioner of health shall establish a home health care
reimbursement workgroup for the purposes of studying the home health
care reimbursement system. The commissioner of health is authorized to
appoint members to the workgroup, including representatives of certified
home health agencies, licensed home care services agencies, long term
home health care providers, hospice providers, consumers of home health
S. 58--B 101 A. 158--B
care services, local governments, labor organizations and other home
health care stakeholders.
Such study shall include but not be limited to an analysis of:
(a) the impact of episodic payments on high-utilization and outlier
thresholds, special needs populations, and dual eligible patients;
(b) the relationship between, or compatibility of, Medicare and Medi-
caid episodic payments;
(c) billing procedures related to cash flow of episodic payments;
(d) wage index factor adjustments; and
(e) subcontracting between certified home health agencies, long term
home health care agencies, and AIDS home care programs with licensed
home care services agencies.
The commissioner of health shall report to the temporary president of
the senate, the speaker of the assembly, the chairs of the senate
finance committee and assembly committee on ways and means, and the
chairs of the senate and assembly health committees. Such report shall
be submitted no later than December first, two thousand nine.
S 125-e. Section 364-j-2 of the social services law, as amended by
section 44-a of part C of chapter 58 of the laws of 2008, is amended to
read as follows:
S 364-j-2. Transitional supplemental payments. 1. As used in this
section, "covered provider" shall mean a voluntary not-for-profit health
care provider that is any of the following:
(a) a freestanding diagnostic and treatment center licensed under
article twenty-eight of the public health law that qualifies for a
distribution pursuant to section twenty-eight hundred seven-p of such
article, or section seven of chapter four hundred thirty-three of the
laws of nineteen hundred ninety-seven, or receives funding under section
three hundred thirty-three of the federal public health services act for
health care for the homeless; or
(b) a freestanding diagnostic and treatment center which operates an
approved program under the prenatal care assistance program established
pursuant to article twenty-five of the public health law; or
(c) a facility licensed under article twenty-eight of the public
health law that is sponsored by a university or dental school which has
been granted an operating certificate pursuant to article twenty-eight
of the public health law to provide dental services; or
(d) a freestanding family planning clinic licensed under article twen-
ty-eight of the public health law.
2. (a) Notwithstanding paragraphs (b) and (h) of subdivision two of
section twenty-eight hundred seven of the public health law, the commis-
sioner of health shall make supplemental payments of nine million eight
hundred twenty-four thousand dollars ($9,824,000), to covered providers
described in subdivision one of this section who are qualified providers
as described in paragraph (a) of subdivision three of this section,
based on adjustments to fee-for-service rates for the period February
first through March thirty-first, two thousand two and nine million
eight hundred twenty-four thousand dollars ($9,824,000) for the period
October first through December thirty-first, two thousand two and four
million nine hundred twelve thousand dollars ($4,912,000) for the period
October first through December thirty-first, two thousand three and an
additional amount of four million nine hundred twelve thousand dollars
($4,912,000) for the period October first through December thirty-first,
two thousand three and nine million eight hundred twenty-four thousand
dollars ($9,824,000) for the period April first through June thirtieth,
two thousand five, and nine million eight hundred twenty-four thousand
S. 58--B 102 A. 158--B
dollars ($9,824,000) for the period October first through December thir-
ty-first, two thousand six, and an additional nine million eight hundred
twenty-four thousand dollars ($9,824,000) for the period October first
through December thirty-first, two thousand six, and nine million eight
hundred twenty-four thousand dollars ($9,824,000) for the period October
first through December thirty-first, two thousand seven, as medical
assistance payments for services provided pursuant to this title for
persons eligible for federal financial participation under title XIX of
the federal social security act to reflect additional costs associated
with the transition to a managed care environment, and nine million
eight hundred twenty-four thousand dollars ($9,824,000) for the period
October first through December thirty-first, two thousand eight, AND
SEVEN MILLION THREE HUNDRED EIGHTY-EIGHT THOUSAND DOLLARS ($7,388,000)
FOR THE PERIOD OCTOBER FIRST THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND
NINE, as medical assistance payments for services provided pursuant to
this title for persons eligible for federal financial participation
under title XIX of the federal social security act to reflect additional
costs associated with the operation of electronic health record systems
that meet such standards as may be established by the commissioner of
health. There shall be no local share in these payments. The director of
the budget shall allocate the non-federal share of such payments from an
appropriation for the miscellaneous special revenue fund - 339 community
service provider assistance program account for the two thousand one--
two thousand two state fiscal year for adjustments for the period Febru-
ary first through March thirty-first, two thousand two. Adjustments for
the period October first, two thousand two through December thirty-
first, two thousand two shall be within amounts appropriated for the two
thousand two--two thousand three state fiscal year and adjustments for
the period October first, two thousand three through December thirty-
first, two thousand three shall be within amounts appropriated for the
two thousand three--two thousand four state fiscal year and adjustments
for the non-federal share of the additional amount of four million nine
hundred twelve thousand dollars ($4,912,000) for such period shall be
allocated by the director of the budget from an appropriation for main-
tenance undistributed general fund community projects fund - 007 account
for the two thousand three--two thousand four state fiscal year. The
director of the budget shall allocate the non-federal share of adjust-
ments for the period April first, two thousand five through June thirti-
eth, two thousand five from an appropriation for the maintenance undis-
tributed general fund community projects fund - 007 - cc account for the
two thousand four--two thousand five state fiscal year. The director of
the budget shall allocate the non-federal share of adjustments for the
period October first, two thousand six through December thirty-first,
two thousand six from an appropriation for the maintenance undistrib-
uted, general fund, community projects fund - 007-cc account for the two
thousand five--two thousand six state fiscal year. The director of the
budget shall allocate the non-federal share of the additional adjust-
ments for the period October first, two thousand six through December
thirty-first, two thousand six from such funds as may be made available
from an appropriation for the maintenance undistributed, general fund,
community projects fund - 007-cc account for the two thousand six--two
thousand seven state fiscal year. The director of the budget shall allo-
cate the non-federal share of the adjustments for the period October
first, two thousand seven through December thirty-first, two thousand
seven from an appropriation for the medical assistance program, general
fund, local assistance account - 001 for the two thousand seven--two
S. 58--B 103 A. 158--B
thousand eight state fiscal year. The director of the budget shall allo-
cate the non-federal share of the adjustments for the period October
first, two thousand eight through December thirty-first, two thousand
eight from an appropriation for the medical assistance program, general
fund, local assistance account - 001 for the two thousand eight--two
thousand nine state fiscal year. THE DIRECTOR OF THE BUDGET SHALL ALLO-
CATE THE NON-FEDERAL SHARE OF THE ADJUSTMENTS FOR THE PERIOD OCTOBER
FIRST, TWO THOUSAND NINE THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND
NINE FROM AN APPROPRIATION FOR THE MEDICAL ASSISTANCE PROGRAM, GENERAL
FUND, LOCAL ASSISTANCE ACCOUNT - 001 FOR THE TWO THOUSAND NINE--TWO
THOUSAND TEN STATE FISCAL YEAR. Such adjustments to fee for service
rates shall not be subject to subsequent adjustment or reconciliation.
Alternatively, such payments may be made as aggregate payments to eligi-
ble providers.
(a-1) Notwithstanding the provisions of paragraph (a) of this subdivi-
sion, for facilities licensed under article twenty-eight of the public
health law that are sponsored by a university or dental school which has
been granted an operating certificate pursuant to article twenty-eight
of the public health law and which provides dental services as its prin-
cipal mission, two hundred twenty-four thousand dollars ($224,000) in
the aggregate for use pursuant to this section shall be allocated for
distribution to such facilities pursuant to the methodology described in
paragraph (b) of subdivision two and subparagraph (i) of paragraph (b)
of subdivision four of section two thousand eight hundred seven-p of the
public health law for services provided for the period February first,
two thousand two through March thirty-first, two thousand two to persons
eligible for federal financial participation under title XIX of the
federal social security act, provided, however, that the amount paid
pursuant to this paragraph for each such facility shall equal the facil-
ity's proportional share of the total nominal payment amounts calculated
under this section of all such facilities multiplied by the total funds
allocated for such payments. There shall be no local share in these
payments. The director of the budget shall allocate the non-federal
share of such payments from an appropriation for the miscellaneous
special revenue fund - 339 community service provider assistance program
account for the two thousand one--two thousand two state fiscal year.
Such adjustments to fee for service rates shall not be subject to subse-
quent adjustment or reconciliation. Alternatively, such payments may be
made as aggregate payments to eligible providers.
(a-2) (i) Notwithstanding the provisions of paragraph (a) of this
subdivision, for facilities licensed under article twenty-eight of the
public health law that are sponsored by a university or dental school
which has been granted an operating certificate pursuant to article
twenty-eight of the public health law and which provides dental services
as its principal mission, two hundred twenty-four thousand dollars
($224,000) in the aggregate of the amount appropriated for the two thou-
sand two--two thousand three state fiscal year for use pursuant to this
section shall be allocated for the period October first through December
thirty-first, two thousand two and one hundred twelve thousand dollars
($112,000) in the aggregate of the amount appropriated for the two thou-
sand three--two thousand four state fiscal year, and an additional
amount of one hundred twelve thousand dollars ($112,000) in the aggre-
gate for use pursuant to this section shall be allocated for the period
October first through December thirty-first, two thousand three and two
hundred twenty-four thousand dollars ($224,000) in the aggregate of the
amount appropriated for the two thousand four--two thousand five state
S. 58--B 104 A. 158--B
fiscal year shall be allocated for the period April first, two thousand
five through June thirtieth, two thousand five, and two hundred twenty-
four thousand dollars ($224,000) in the aggregate of the amount appro-
priated for the two thousand five--two thousand six state fiscal year
shall be allocated for the period October first, two thousand six
through December thirty-first, two thousand six, and an additional two
hundred twenty-four thousand dollars ($224,000) in the aggregate of the
amount appropriated for the two thousand six--two thousand seven state
fiscal year shall be allocated for the period October first, two thou-
sand six through December thirty-first, two thousand six, and two
hundred twenty-four thousand dollars ($224,000) in the aggregate of the
amount appropriated for the two thousand seven--two thousand eight state
fiscal year shall be allocated for the period October first, two thou-
sand seven through December thirty-first, two thousand seven, and two
hundred twenty-four thousand DOLLARS ($224,000) in the aggregate of the
amount appropriated for the two thousand eight--two thousand nine state
fiscal year shall be allocated for the period October first, two thou-
sand eight through December thirty-first, two thousand eight AND TWO
HUNDRED TWENTY-FOUR THOUSAND DOLLARS ($224,000) IN THE AGGREGATE OF THE
AMOUNT APPROPRIATED FOR THE TWO THOUSAND NINE--TWO THOUSAND TEN STATE
FISCAL YEAR SHALL BE ALLOCATED FOR THE PERIOD OCTOBER FIRST, TWO THOU-
SAND NINE THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND NINE for distrib-
ution to such facilities pursuant to subparagraphs (ii) and (iii) of
this paragraph. Adjustments for the non-federal share of the additional
amount of one hundred twelve thousand dollars ($112,000) for the period
October first, two thousand three through December thirty-first, two
thousand three shall be allocated by the director of the budget from an
appropriation for maintenance undistributed general fund community
projects fund - 007 account for the two thousand three--two thousand
four state fiscal year. The non-federal share of adjustments for the
period April first, two thousand five through June thirtieth, two thou-
sand five shall be allocated by the director of the budget from an
appropriation for the maintenance undistributed general fund community
projects fund - 007 account for the two thousand four--two thousand five
state fiscal year. The non-federal share of adjustments for the period
October first, two thousand six through December thirty-first, two thou-
sand six shall be allocated by the director of the budget from an appro-
priation for the maintenance undistributed, general fund, community
projects fund - 007-cc account for the two thousand five--two thousand
six state fiscal year. The non-federal share of the additional adjust-
ments for the period October first, two thousand six through December
thirty-first, two thousand six shall, subject to the availability of
funds, be allocated by the director of the budget from the medical
assistance local assistance appropriation for the two thousand six--two
thousand seven state fiscal year. The non-federal share of the adjust-
ments for the period October first, two thousand seven through December
thirty-first, two thousand seven shall be allocated by the director of
the budget from an appropriation for the medical assistance program,
general fund, local assistance account - 001 for the two thousand
seven--two thousand eight state fiscal year. The non-federal share of
the adjustments for the period October first, two thousand eight through
December thirty-first, two thousand eight shall be allocated by the
director of the budget from an appropriation for the medical assistance
program, general fund, local assistance account - 001 for the two thou-
sand eight--two thousand nine state fiscal year. THE NON-FEDERAL SHARE
OF THE ADJUSTMENTS FOR THE PERIOD OCTOBER FIRST, TWO THOUSAND NINE
S. 58--B 105 A. 158--B
THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND NINE SHALL BE ALLOCATED BY
THE DIRECTOR OF THE BUDGET FROM AN APPROPRIATION FOR THE MEDICAL ASSIST-
ANCE PROGRAM, GENERAL FUND, LOCAL ASSISTANCE ACCOUNT - 001 FOR THE TWO
THOUSAND NINE--TWO THOUSAND TEN STATE FISCAL YEAR.
(ii) Forty percent shall be allocated for equal distribution to such
facilities, reduced by the amount, if any, that a distribution exceeds
forty percent of a facility's uncompensated care need as defined in
paragraph (b) of subdivision two of section two thousand eight hundred
seven-p of the public health law. Any funds allocated but not distrib-
uted in accordance with this subparagraph shall be added to those
amounts distributed in accordance with subparagraph (iii) of this para-
graph.
(iii) Sixty percent, plus any funds allocated and not distributed in
accordance with subparagraph (ii) of this paragraph, shall be allocated
for distribution to such facilities pursuant to the methodology
described in paragraph (b) of subdivision two and subparagraph (i) of
paragraph (b) of subdivision four of section two thousand eight hundred
seven-p of the public health law, provided, however, that the amount
paid pursuant to this allocation for each such facility shall equal the
facility's proportional share of the total nominal payment amounts
calculated under this section of all such facilities multiplied by the
total funds allocated for such payments.
(iv) There shall be no local share in these payments.
(b) Notwithstanding the provisions of subdivision one of section three
hundred sixty-eight-a of this title, there shall be paid to each social
services district the full amount expended on behalf of the department
of health for medical assistance furnished pursuant to the provisions of
this section, after first deducting therefrom any federal funds properly
received or to be received on account thereof.
3. (a) For periods prior to January first, two thousand eight, a
covered provider described in subdivision one of this section shall be
qualified to receive a supplemental payment only if its number of medi-
caid visits for patient care services in the base year described in
subparagraph (ii) of paragraph (b) of this subdivision equals or exceeds
twenty-five percent of its total number of visits for patient care
services and its number of medicaid visits for patient care services for
medicaid managed care enrollees equals or exceeds three percent of its
total number of medicaid visits during the base year. For periods on and
after January first, two thousand eight, a covered provider described in
subdivision one of this section shall be qualified to receive a supple-
mental payment only if it has in place during such period an operational
electronic health record system that meets such standards as may be
established by the commissioner of health and its number of medicaid
visits for patient care services in the base year described in subpara-
graph (ii) of paragraph (b) of this subdivision equals or exceeds twen-
ty-five percent of its total number of visits for patient care services
during the base year or its number of medicaid visits combined with its
number of uninsured visits for patient care services in the base year
described in subparagraph (ii) of paragraph (b) of this subdivision
equals or exceeds thirty percent of its total number of visits for
patient care services during the base year.
(b) (i) For periods prior to January first, two thousand eight, each
qualified provider described in paragraph (a) of this subdivision shall
receive a supplemental payment equal to such provider's proportional
share of the total funds allocated pursuant to this section, based upon
the ratio of its visits from medical assistance recipients enrolled in
S. 58--B 106 A. 158--B
managed care during the base year to the total number of visits to all
such qualified providers by medical assistance recipients enrolled in
managed care during the base year. For periods on and after January
first, two thousand eight, each qualified provider described in para-
graph (a) of this subdivision shall receive a supplemental payment equal
to such provider's proportional share of the total funds allocated
pursuant to this section, based upon the ratio of its visits from
medical assistance recipients during the base year to the total number
of visits from medical assistance recipients to all such qualified
providers during the base year.
(ii) For periods prior to January first, two thousand eight, for
purposes of the calculation described in this subdivision, the base year
will be two thousand, and the commissioner of health shall utilize data
as reported on the 2000 AHCF-1 cost report initially submitted by
covered providers to the department of health on or about August seven-
teenth, two thousand one. For periods on and after January first, two
thousand eight, for purposes of the calculation described in this subdi-
vision, the base year will be two years prior to the grant year, and the
commissioner of health shall utilize data as reported on AHCF-1 cost
report submitted by covered providers to the department of health for
such base year.
4. Payments made pursuant to this section shall constitute additional
reimbursement to qualified providers and shall not be used to reduce
levels of other funding provided to qualified providers by governmental
agencies.
5. (a) The commissioner of health shall make medical assistance
payments to qualified providers from funds made available pursuant to
the provisions of this section contingent upon the receipt of all feder-
al approvals necessary and subject to the availability of federal finan-
cial participation under title XIX of the federal social security act
for the transitional supplemental payments. In the event such federal
approval is not received prior to March thirty-first, two thousand two,
for adjustments for the period February first, two thousand two through
March thirty-first, two thousand two and prior to October first, two
thousand two for adjustments for the period October first, two thousand
two through December thirty-first, two thousand two and prior to October
first, two thousand three for adjustments for the period October first,
two thousand three through December thirty-first, two thousand three,
and prior to October first, two thousand five for adjustments for the
period April first, two thousand five through June thirtieth, two thou-
sand five, and prior to October first, two thousand six for adjustments
for the period October first, two thousand six through December thirty-
first, two thousand six, and prior to October first, two thousand seven
for adjustments for the period October first, two thousand seven through
December thirty-first, two thousand seven, and prior to October first,
two thousand eight for adjustments for the period October first, two
thousand eight through December thirty-first, two thousand eight, AND
PRIOR TO OCTOBER FIRST, TWO THOUSAND NINE FOR ADJUSTMENTS FOR THE PERIOD
OCTOBER FIRST, TWO THOUSAND NINE THROUGH DECEMBER THIRTY-FIRST, TWO
THOUSAND NINE, the commissioner of health shall make medical assistance
payments to qualified providers consisting of the state share amount
available for purposes of this section and apportioned in accordance
with subdivisions two and three of this section. In the event such
federal approval is denied, such state share amount payments shall be
deemed to be grants to such qualified providers and such qualified
S. 58--B 107 A. 158--B
providers shall not be eligible to receive any other payments pursuant
to this section.
(b) The commissioner of health shall take all steps necessary and
shall use best efforts to secure federal financial participation under
title XIX of the social security act, for the purposes of this section,
including the prompt submission of appropriate amendments to the title
XIX state plan.
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
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 April 1, 2009; provided
that:
(a) sections fifteen, sixteen and sixteen-a shall be deemed to be in
effect on and after March 1, 2009;
(b) sections twenty-five, twenty-six-a, sixty-two and one hundred ten
through one hundred twelve of this act shall take effect July 1, 2009;
(c) sections thirty-eight, thirty-nine, forty-six, forty-seven and
forty-eight of this act shall take effect September 1, 2009;
(d) sections fifty-eight, fifty-nine, fifty-nine-a, fifty-nine-b,
fifty-nine-c and fifty-nine-d of this act shall take effect October 1,
2009;
(e) sections sixty, sixty-one, sixty-three through sixty-seven,
sixty-seven-a and sixty-seven-b of this act shall take effect April 1,
2010;
(f) section twenty-five of this act shall expire and be deemed
repealed April 1, 2013;
(g) section twenty-six-a 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;
S. 58--B 108 A. 158--B
(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;
(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 effective 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 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;
(p) 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;
(q) 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;
(q-1) the amendments made to subdivisions 5 and 7 of section 270 of
the public health law by section thirty-five of this act shall not
affect the repeal of such section and shall be deemed to repeal there-
with;
(q-2) the amendments made to subdivision 11 of section 272 of the
public health law by section thirty-six of this act shall not affect the
repeal of such section and shall be deemed to repeal therewith;
(q-3) the amendments made to subdivision 1 of section 273 of the
public health law by section thirty-seven of this act shall not affect
the repeal of such section and shall be deemed to repeal therewith;
(q-4) the amendments made to paragraph (a-2) of subdivision 4 of
section 365-a of the social services law by section forty-six-a of this
act shall not affect the repeal of such section and shall be deemed to
repeal therewith;
(r) 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;
(s) 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
S. 58--B 109 A. 158--B
affect the expiration of such section and shall be deemed to expire
therewith;
(t) 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; and
(u) section twenty-seven shall be deemed effective on and after Janu-
ary 1, 2010, provided, however, that with regard to smoking cessation
counseling services provided to pregnant women pursuant to paragraph (s)
of subdivision 2 of section 365-a of the social services law such
section twenty-seven shall be deemed effective on and after March 1,
2009, and with regard to screening, brief intervention, referral and
treatment provided pursuant to paragraph (u) of subdivision 2 of section
365-a of the social services law, such sections shall be deemed effec-
tive on and after April 1, 2009.
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. Notwithstanding paragraph (b) of subdivision 2-b of section 2808
of the public health law or any other contrary provision of law, with
regard to adjustments to medicaid rates of payment for inpatient
services provided by residential health care facilities for the period
April 1, 2009 through March 31, 2010, made pursuant to paragraph (b) of
subdivision 2-b of section 2808 of the public health law, the commis-
sioner of health and the director of the budget shall, upon a determi-
nation that such adjustments, including the application of adjustments
authorized by the provisions of paragraph (g) of subdivision 2-b of
section 2808 of the public health law, shall result in an aggregate
increase in total Medicaid rates of payment for such services for such
period that is less than or more than two hundred ten million dollars
($210,000,000), make such proportional adjustments to such rates as are
necessary to result in an increase of such aggregate expenditures of two
hundred ten million dollars ($210,000,000), and provided further, howev-
er, that the operating component of such rates for the period April 1,
2009 through March 31, 2010 shall not be subject to case mix adjustments
pursuant to subparagraph (ii) of paragraph (b) of subdivision 2-b of
section 2808 of the public health law, as otherwise scheduled pursuant
to such subparagraph for January of 2010, and provided further, however,
S. 58--B 110 A. 158--B
that notwithstanding subdivision 2-c of section 2808 of the public
health law or any other contrary provision of law, with regard to
adjustments to inpatient rates of payment made pursuant to subdivision
2-c of section 2808 of the public health law for inpatient services
provided by residential health care facilities for the period April 1,
2010 through March 31, 2011, the commissioner of health and the director
of the budget shall, upon a determination by such commissioner and such
director that such rate adjustments shall, prior to the application of
any applicable adjustment for inflation, result in an aggregate increase
in total Medicaid rates of payment for such services, make such propor-
tional adjustments to such rates as are necessary to reduce such total
aggregate rate adjustments such that the aggregate total reflects no
such increase. Adjustments made pursuant to this section shall not be
subject to subsequent correction or reconciliation.
S 3. Subparagraph (i) of paragraph (b) of subdivision 2-b of section
2808 of the public health law, as amended by section 3 of part I of
chapter 2 of the laws of 2009, is amended to read as follows:
(i) Subject to the provisions of subparagraphs (ii) through (xiv) of
this paragraph, for periods on and after April first, two thousand nine
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TEN the operating cost compo-
nent of rates of payment shall reflect allowable operating costs as
reported in each facility's cost report for the two thousand two calen-
dar year, as adjusted for inflation on an annual basis in accordance
with the methodology set forth in paragraph (c) of subdivision ten of
section twenty-eight hundred seven-c of this article, provided, however,
that for those facilities which do not receive a per diem add-on adjust-
ment pursuant to subparagraph (ii) of paragraph (a) of this subdivision,
rates shall be further adjusted to include the proportionate benefit, as
determined by the commissioner, of the expiration of the opening para-
graph and paragraph (a) of subdivision sixteen of this section and of
paragraph (a) of subdivision fourteen of this section, and provided
further that the operating cost component of rates of payment for those
facilities which did not receive a per diem adjustment in accordance
with subparagraph (ii) of paragraph (a) of this subdivision shall not be
less than the operating component such facilities received in the two
thousand eight rate period, as adjusted for inflation on an annual basis
in accordance with the methodology set forth in paragraph (c) of subdi-
vision ten of section twenty-eight hundred seven-c of this article and
further provided, however, that rates for facilities whose operating
cost component reflects base year costs subsequent to January first, two
thousand two shall have rates computed in accordance with this para-
graph, utilizing allowable operating costs as reported in such subse-
quent base year period, and trended forward to the rate year in accord-
ance with applicable inflation factors.
S 4. Subdivision 17-a of section 2808 of the public health law, as
amended by section 73 of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
17-a. Notwithstanding any inconsistent provision of law or regulation
to the contrary, for purposes of establishing rates of payment by
governmental agencies for residential health care facilities for
services provided on and after January first, nineteen hundred ninety-
eight, the regional direct and indirect input price adjustment factors
to be applied to any such facility's rate calculation shall be based
upon the utilization of either nineteen hundred eighty-three, nineteen
hundred eighty-seven or nineteen hundred ninety-three calendar year
financial and statistical data and for periods beginning April first,
S. 58--B 111 A. 158--B
two thousand four through March thirty-first, two thousand nine based on
either nineteen hundred eighty-three, nineteen hundred eighty-seven,
nineteen hundred ninety-three or two thousand one calendar year finan-
cial and statistical data; provided, however, the state share amount for
the utilization of two thousand one calendar year data shall be no more
than twenty-two million dollars on a pro rata basis per calendar year.
The determination of which calendar year's data to utilize shall be
based upon a methodology that ensures that the particular year chosen by
each facility results in a factor that yields no less reimbursement to
the facility than would result from the use of any of the other three
years' data. Such methodology shall utilize the nineteen hundred eight-
y-three and nineteen hundred eighty-seven regional direct and indirect
input price adjustment factor corridor percentages in existence on Janu-
ary first, nineteen hundred ninety-seven as well as nineteen hundred
ninety-three regional direct and indirect input price adjustment factor
corridor percentage in existence on January first, two thousand four as
well as a two thousand one regional direct and indirect input price
adjustment factor corridor percentage calculated in the same manner as
the nineteen hundred ninety-three direct and indirect input price
adjustment factor corridor percentages in existence on January first,
two thousand four; provided, however, for rate periods on and after
April first, two thousand nine, the regional input price adjustment
factors shall be based on the case mix predicted staffing for registered
nurses, licensed practical nurses, nurses' aides, licensed therapists
and therapist aides. For the rate period beginning April first, two
thousand nine through [December thirty-first, two thousand nine] MARCH
THIRTY-FIRST, TWO THOUSAND TEN, the regional direct and indirect input
price adjustment factors to be applied to a facility's rate calculation
shall be based upon the utilization of two thousand two calendar year
financial and statistical data. Such methodology shall utilize two thou-
sand two regional direct and indirect input price adjustment factor
corridor percentages calculated in the same manner as the two thousand
one regional direct and indirect input price adjustment factor corridor
percentages in existence on December thirty-first, two thousand six
except that every region shall receive a corridor to reflect the
region's actual variation subject to a maximum statewide average vari-
able corridor percentage of ten percent. [For the rate periods beginning
January first, two thousand ten through December thirty-first, two thou-
sand eleven, the regional direct and indirect input price adjustment
factors to be applied to a facility's rate calculation shall be based
upon the utilization of two thousand eight calendar year financial and
statistical data. Such methodology shall utilize two thousand eight
regional direct and indirect input price adjustment factor corridor
percentages calculated in the same manner as the two thousand two
regional direct and indirect input price adjustment factor corridor
percentages, with every region receiving a corridor to reflect the
region's actual variation subject to a maximum statewide average vari-
able corridor percentage of ten percent. For the three year period
beginning January first, two thousand twelve, the regional direct price
and indirect input price adjustment factors and the regional direct and
indirect input price adjustment factor corridor percentages shall be
based upon the utilization of financial and statistical data from the
base period used for the operating component of rates for the two thou-
sand twelve rate period pursuant to paragraph (f) of subdivision two-b
of this section.]
S. 58--B 112 A. 158--B
S 5. 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 BY RESIDENTIAL
HEALTH CARE FACILITIES ON AND AFTER APRIL FIRST, TWO THOUSAND TEN SHALL
BE DETERMINED IN ACCORDANCE WITH THE FOLLOWING:
(I) THE DIRECT AND INDIRECT COMPONENTS OF THE OPERATING COST COMPONENT
OF SUCH RATES WILL BE COMPUTED ON A REGIONAL BASIS, USING ALLOWABLE
OPERATING COSTS, AS DETERMINED BY THE COMMISSIONER, FROM TWO THOUSAND
SEVEN CERTIFIED COST REPORTS ON FILE WITH THE DEPARTMENT AS OF JANUARY
FIRST, TWO THOUSAND NINE, AS ADJUSTED FOR INFLATION IN ACCORDANCE WITH
APPLICABLE STATUTES.
(II) THE NON-COMPARABLE COMPONENT OF THE OPERATING COMPONENT OF SUCH
RATES SHALL BE COMPUTED ON A FACILITY SPECIFIC BASIS, USING ALLOWABLE
OPERATING COSTS, AS DETERMINED BY THE COMMISSIONER, FROM TWO THOUSAND
SEVEN CERTIFIED COST REPORT SUBMITTED BY EACH FACILITY AND ON FILE WITH
THE DEPARTMENT ON JANUARY FIRST, TWO THOUSAND NINE, AS ADJUSTED FOR
INFLATION IN ACCORDANCE WITH APPLICABLE STATUTES.
(III) THE CAPITAL COMPONENT OF RATES COMPUTED PURSUANT TO THIS SECTION
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.
(IV) 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 INTEN-
SITY, AS MAY BE ADJUSTED BY THE COMMISSIONER. SUCH ADJUSTMENTS SHALL BE
MADE SEMI-ANNUALLY IN EACH CALENDAR YEAR, AND BOTH THE ADJUSTMENTS AND
THE RELATED PATIENT CLASSIFICATIONS IN EACH FACILITY SHALL BE SUBJECT TO
AUDIT REVIEW IN ACCORDANCE WITH REGULATIONS PROMULGATED BY THE COMMIS-
SIONER.
(V) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW, RULE OR REGULATION, RATES OF PAYMENT
SHALL, EXCEPT FOR THE ESTABLISHMENT OF ANY REGIONAL PRICES, BE CALCU-
LATED UTILIZING THE NUMBER OF PATIENTS REPORTED IN EACH PATIENT CLASSI-
FICATION GROUP AND ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO TITLE
ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
(VI) NOTWITHSTANDING SUBPARAGRAPH (I) OF THIS PARAGRAPH, THE OPERATING
COST COMPONENT OF THE RATES, EFFECTIVE APRIL FIRST, TWO THOUSAND TEN FOR
THE FOLLOWING CATEGORIES OF FACILITIES, AS ESTABLISHED PURSUANT TO
APPLICABLE REGULATIONS, SHALL REFLECT THE RATES IN EFFECT FOR SUCH
FACILITIES ON MARCH THIRTY-FIRST, TWO THOUSAND TEN, AS ADJUSTED FOR
INFLATION IN ACCORDANCE WITH APPLICABLE STATUTES: (A) AIDS FACILITIES OR
DISCRETE AIDS UNITS WITHIN FACILITIES, (B) DISCRETE UNITS FOR RESIDENTS
RECEIVING CARE IN A LONG-TERM INPATIENT REHABILITATION PROGRAM FOR TRAU-
MATIC BRAIN INJURED PERSONS, (C) DISCRETE UNITS PROVIDING SPECIALIZED
PROGRAMS FOR RESIDENTS REQUIRING BEHAVIORAL INTERVENTIONS, (D) DISCRETE
UNITS FOR LONG-TERM VENTILATOR DEPENDENT RESIDENTS, AND (E) FACILITIES
OR DISCRETE UNITS WITHIN FACILITIES THAT PROVIDE EXTENSIVE NURSING,
MEDICAL, PSYCHOLOGICAL AND COUNSELING SUPPORT SERVICES SOLELY TO CHIL-
DREN. SUCH RATE SHALL REMAIN IN EFFECT UNTIL THE DEPARTMENT, IN CONSUL-
TATION WITH REPRESENTATIVES OF THE NURSING HOME INDUSTRY, AS SELECTED BY
S. 58--B 113 A. 158--B
THE COMMISSIONER, DEVELOPS A REGIONAL PRICING OR ALTERNATIVE METHODOLOGY
FOR DETERMINING SUCH RATES.
(VII) THE OPERATING COMPONENT OF RATES OF PAYMENT, AS ADJUSTED FOR
INFLATION IN ACCORDANCE WITH SUBPARAGRAPH (I) OF THIS PARAGRAPH, SHALL,
BY NO LATER THAN THE TWO THOUSAND THIRTEEN RATE PERIOD, 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. 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 COMPO-
NENTS 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 THIS PARA-
GRAPH.
(B) 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 PHYSI-
CIAN 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; AND
(III) EACH PATIENT WHO QUALIFIES FOR EXTENDED CARE AS A RESULT OF TRAU-
MATIC BRAIN INJURY AS DEFINED BY APPLICABLE REGULATIONS.
(C) THE COMMISSIONER MAY PROMULGATE REGULATIONS TO IMPLEMENT THE
PROVISIONS OF THIS SUBDIVISION.
(D) (I) SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
IPATION, THE COMMISSIONER IS AUTHORIZED TO ESTABLISH A QUALITY OF CARE
INCENTIVE POOL OR POOLS FOR ELIGIBLE RESIDENTIAL HEALTH CARE FACILITIES
AND INCREASE MEDICAID RATES OF PAYMENT FOR SUCH ELIGIBLE FACILITIES FROM
THIS POOL OR POOLS. WITHIN AMOUNTS AVAILABLE, PAYMENTS WILL BE DETER-
MINED BY THE COMMISSIONER BY APPLYING CRITERIA, INCLUDING, BUT NOT
LIMITED TO, THE QUALITY COMPONENTS OF THE MINIMUM DATA SET REQUIRED
UNDER FEDERAL LAW, SURVEY INFORMATION, DIRECT CARE STAFFING, INCLUDING
LABOR COSTS, AND OTHER FACILITY DATA.
(II) FACILITIES THAT FALL WITHIN ONE OR MORE OF THE CATEGORIES BELOW
DURING A REVIEW PERIOD WILL BE EXCLUDED FROM AWARD ELIGIBILITY:
(A) ANY RESIDENTIAL HEALTH CARE FACILITY THAT IS CURRENTLY DESIGNATED
BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AS A "SPECIAL FOCUS
FACILITY";
(B) ANY RESIDENTIAL HEALTH CARE FACILITY FOR WHICH THE DEPARTMENT HAS
ISSUED A FINDING OF IMMEDIATE JEOPARDY DURING THE MOST RECENTLY
COMPLETED FEDERAL FISCAL YEAR;
(C) ANY RESIDENTIAL HEALTH CARE FACILITY THAT HAS RECEIVED A CITATION
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;
(D) ANY RESIDENTIAL HEALTH CARE FACILITY THAT IS PART OF A CONTINUING
CARE RETIREMENT COMMUNITY;
(E) ANY RESIDENTIAL HEALTH CARE FACILITY THAT OPERATES AS A TRANSI-
TIONAL CARE UNIT; AND
(F) ANY OTHER EXCLUSIONS AS DEEMED APPROPRIATE BY THE COMMISSIONER.
(III) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION
TO THE CONTRARY, IN THE EVENT THAT THE TOTAL AMOUNT OF FUNDING ALLOCATED
S. 58--B 114 A. 158--B
FOR A PARTICULAR FISCAL YEAR IS NOT DISTRIBUTED, FUNDS SHALL BE RESERVED
AND ACCUMULATED FROM YEAR TO YEAR SO THAT ANY FUNDS REMAINING AT THE END
OF A PARTICULAR FISCAL YEAR WILL BE AVAILABLE FOR DISTRIBUTION DURING
THE FOLLOWING FISCAL YEAR.
(E) SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION AND
WITHIN AMOUNTS AVAILABLE, THE COMMISSIONER MAY MAKE TRANSITION ADJUST-
MENTS TO RATES OF PAYMENT FOR RESIDENTIAL HEALTH CARE FACILITIES FOR
STATE FISCAL YEARS BEGINNING APRIL FIRST, TWO THOUSAND TEN TO FACILITATE
IMPROVEMENTS IN RESIDENTIAL HEALTH CARE FACILITY 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 TWO YEARS PRIOR TO THE RATE YEAR AND WHICH, AS DETER-
MINED 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) 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.
(IV) 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
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.
(F) SUCH RATES SHALL BE ADJUSTED TO REFLECT APPROPRIATE COST DIFFEREN-
TIALS RELATED TO DIRECT CARE STAFFING. SUCH ADJUSTMENT MAY BE MADE TO
THE DIRECT COMPONENT OF THE OPERATING COST COMPONENT OF SUCH RATE,
THROUGH A QUALITY OF CARE INCENTIVE POOL PURSUANT TO PARAGRAPH (D) OF
THIS SUBDIVISION OR USING SUCH OTHER MECHANISM AS DEEMED APPROPRIATE BY
THE COMMISSIONER, AFTER CONSIDERATION OF ANY RECOMMENDATIONS AND
DISCUSSIONS OF THE WORKGROUP ESTABLISHED BY SECTION FORTY-EIGHT OF PART
C OF CHAPTER ONE HUNDRED NINE OF THE LAWS OF TWO THOUSAND SIX.
S 5-a. 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
S. 58--B 115 A. 158--B
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 APRIL 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 PURPOSE LATER THAN THE DUE DATE ESTABLISHED BY THE COMMIS-
SIONER.
S 6. Section 48 of part C of chapter 109 of the laws of 2006, amending
the social services law and other laws relating to Medicaid reimburse-
ment rate settings, as amended by section 65-a of part A of chapter 58
of the laws of 2007, is amended to read as follows:
S 48. Notwithstanding any contrary provision of law, the commissioner
of health shall, by no later than May 15, 2007, establish a workgroup
[to investigate and develop recommendations] pertaining to Medicaid
reimbursement rate-setting for residential health care facilities for
future periods, including, but not limited to, the following areas:
(a) [the appropriate reimbursement for capital costs for those facili-
ties which have received reimbursement reflecting one hundred percent of
capital depreciation] OPERATING COSTS THAT SHOULD BE CONSIDERED ALLOW-
ABLE IN THE DEVELOPMENT OF REGIONAL PRICES;
(b) [potential mechanisms for reimbursement of costs incurred by
facilities with regard to the employment of nursing staff provided by
independent companies] IDENTIFICATION OF APPROPRIATE COST DIFFERENTIALS
AMONG FACILITIES BASED ON FACTORS INCLUDING, BUT NOT LIMITED TO, SIZE,
AFFILIATION, LOCATION, PUBLIC VERSUS NON-PUBLIC, FACILITY LAYOUT,
CULTURE EXCHANGE INITIATIVES AND LABOR COSTS, INCLUDING THE MOST APPRO-
PRIATE MECHANISM TO ADJUST RATES OF PAYMENT TO REFLECT APPROPRIATE COST
DIFFERENTIALS RELATED TO DIRECT CARE STAFFING, INCLUDING ADJUSTMENTS TO
THE DIRECT COMPONENT OF THE OPERATING COST COMPONENT OF SUCH RATE,
ESTABLISHMENT OF A QUALITY CARE INCENTIVE POOL PURSUANT TO SUBDIVISION
(2-C) OF SECTION 2808 OF THE PUBLIC HEALTH LAW OR OTHER MECHANISMS;
(c) [reimbursement of costs related to insurance;
(d) conversion from the RUG II patient classification system to the
"minimum data set" (RUG-III) patient classification system;
(e)] reimbursement for facilities providing care to specialized popu-
lations with specialized care needs;
(D) THE RELATIONSHIP BETWEEN FACILITY SPENDING ON VARIOUS COSTS AND
QUALITY OF CARE AND PATIENT OUTCOMES;
(E) APPROPRIATE REGIONS TO BE UTILIZED;
(f) [corridors applicable to the statewide mean prices as utilized for
rate-setting purposes;
(g)] the reasons underlying the existing proportion of Medicaid
patients to non-Medicaid patients in New York facilities;
[(h)] (G) issues related to Medicare;
[(i)] (H) impact of planned rightsizing of the acute care system;
S. 58--B 116 A. 158--B
[(j)] (I) impact of planned rightsizing of nursing home system;
[(k)] (J) impact of using Medicaid only case mix; and
[(l)] (K) other issues as determined by the commissioner.
The members of the workgroup shall include department of health staff
and representatives of statewide associations representing the residen-
tial health care facility industry in New York, organizations represent-
ing employees, [and associations with less than a statewide membership
shall have the ability to present information to the workgroup and
participate in the discussions on the issues outlined in this section]
AND, BY MAY THIRTY-FIRST, TWO THOUSAND NINE, ADVOCATES FOR RESIDENTIAL
HEALTH CARE FACILITY RESIDENTS AND REPRESENTATIVES OF REGIONAL ASSOCI-
ATIONS REPRESENTING THE RESIDENTIAL HEALTH CARE FACILITY INDUSTRY IN NEW
YORK. THE WORKGROUP SHALL WORK IN CONSULTATION WITH THE ASSEMBLY AND
THE SENATE. The commissioner of health shall appoint the chair of the
workgroup [An initial report setting forth the workgroup's conclusions
and recommendations shall be submitted to the commissioner of health by
no later than January 1, 2008 and a subsequent report shall be submitted
to the commissioner of health no later than June 15, 2008. Thereafter
such workgroup shall continue until January 1, 2009, or as determined by
the commissioner of health.] AND DESIGNATE SUCH EMPLOYEES OF THE DEPART-
MENT OF HEALTH AS ARE REASONABLY NECESSARY TO PROVIDE NECESSARY DATA AND
SUPPORT SERVICES TO THE WORKGROUP. THE COMMISSIONER OF HEALTH SHALL
SUBMIT AN INTERIM REPORT SUMMARIZING THE WORKGROUP'S DELIBERATIONS AND
THE COMMISSIONER OF HEALTH'S RECOMMENDATIONS TO THE GOVERNOR, THE TEMPO-
RARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, AND THE
MINORITY LEADERS OF THE SENATE AND THE ASSEMBLY BY DECEMBER FIFTEENTH,
TWO THOUSAND NINE, AND A SUBSEQUENT REPORT SHALL BE SUBMITTED TO THESE
INDIVIDUALS NO LATER THAN FEBRUARY FIFTEENTH, TWO THOUSAND TEN. THE
WORKGROUP SHALL CONTINUE UNTIL DECEMBER THIRTY-FIRST, TWO THOUSAND TEN
TO EVALUATE THE IMPLEMENTATION OF THE NEW SYSTEM.
S 6-a. 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 7. 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 (e) of subdivision 2-c of section twenty-eight hundred eight of
the public health law, the commissioner may deem such provision null and
void and instead may allocate funds pursuant to such subparagraph (ii)
proportionally, based on each eligible facility's relative share of
Medicaid days in the year two years prior to the distribution year.
S 8. 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:
S. 58--B 117 A. 158--B
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.
(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
S. 58--B 118 A. 158--B
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
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
S. 58--B 119 A. 158--B
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 THIRTY
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
subdivision one of section twenty-eight hundred seven-v of this [chap-
ter] ARTICLE. 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 PARA-
GRAPH, each qualifying facility's rate adjustment shall be proportion-
ately increased or decreased such that the total OF THE ANNUAL rate
adjustments made pursuant 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
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
S. 58--B 120 A. 158--B
(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 9. 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, two thousand 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 10. 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
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-
S. 58--B 121 A. 158--B
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 11. 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 APRIL FIRST, TWO THOUSAND NINE, NO NON-PUBLIC RESIDENTIAL
HEALTH CARE FACILITY, WHETHER OPERATED AS 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 ACCEPTA-
BLE TO THE DEPARTMENT BY CERTIFIED OR REGISTERED MAIL. IN REVIEWING SUCH
REQUESTS THE COMMISSIONER SHALL CONSIDER THE FACILITY'S OVERALL FINAN-
CIAL CONDITION, ANY INDICATIONS OF FINANCIAL DISTRESS, WHETHER THE
FACILITY IS DELINQUENT IN ANY PAYMENT OWED TO THE DEPARTMENT, WHETHER
THE FACILITY HAS BEEN CITED FOR IMMEDIATE JEOPARDY OR SUBSTANDARD QUALI-
TY OF CARE, AND SUCH OTHER FACTORS AS THE COMMISSIONER DEEMS APPROPRI-
ATE. 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 12. Notwithstanding any inconsistent provision of law or regulation,
effective April 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 13. Intentionally omitted.
S 14. Intentionally omitted.
S 15. Intentionally omitted.
S 16. 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-
ICATE OF THE NURSING HOME PROVIDING THAT CERTIFIED NURSING HOME BED,
PROVIDED FURTHER THAT NOTHING HEREIN SHALL BE INTERPRETED AS PROHIBITING
ANY ELIGIBLE APPLICANT FROM SUBMITTING AN APPLICATION FOR ANY ASSISTED
LIVING PROGRAM BED SO ADDED. 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
S. 58--B 122 A. 158--B
COMMISSIONER OF HEALTH SHALL ONLY AUTHORIZE THE ADDITION OF SIX THOUSAND
BEDS PURSUANT TO A FIVE YEAR PLAN.
S 17. Paragraph (a) of subdivision 6 of section 3614 of the public
health law, as 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 18. 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 APRIL 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
hygiene. Nothing in this section is intended to reduce a change in any
existing provision of law establishing maximum reimbursement rates.
S 19. Intentionally omitted.
S. 58--B 123 A. 158--B
S 20. 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 chap-
ter 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 21. 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 22. Intentionally omitted.
S 23. 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
S. 58--B 124 A. 158--B
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
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 24. 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.
S. 58--B 125 A. 158--B
(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 25. Intentionally omitted.
S 26. Intentionally omitted.
S 27. Intentionally omitted.
S 28. Intentionally omitted.
S 29. 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 A DEMONSTRATION PROGRAM, WHICH SHALL BE THREE
YEARS IN DURATION, UNDER WHICH THE DEPARTMENT SHALL DESIGNATE TWO LONG-
TERM CARE ASSESSMENT CENTERS, THE FIRST OF WHICH SHALL BE ESTABLISHED IN
A COUNTY WITHIN THE CITY OF NEW YORK AND THE SECOND OF WHICH WILL BE
ESTABLISHED IN ANOTHER REGION CONSISTING OF ONE OR MORE CONTIGUOUS COUN-
TIES ELSEWHERE IN THE STATE. SUCH CENTERS SHALL SERVE 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 CENTERS 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 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
S. 58--B 126 A. 158--B
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 CENTERS SHALL HAVE RESPONSI-
BILITY FOR REVIEWING DOCUMENTATION FROM A PERSON'S PHYSICIAN AND A
CERTIFIED HOME HEALTH AGENCY AND FOR MAKING THE DETERMINATION AS TO THE
CONTINUING NEED FOR HOME HEALTH SERVICES AUTHORIZED UNDER PARAGRAPH (D)
OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE
BEYOND SIXTY DAYS.
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.
6. WHEN A LONG-TERM CARE ASSESSMENT CENTER IS AUTHORIZED TO ASSESS
LONG-TERM CARE NEEDS OR AUTHORIZE SERVICES PURSUANT TO THIS SECTION, AN
APPLICANT OR RECIPIENT MAY CHALLENGE ANY ACTION TAKEN OR FAILURE TO ACT
IN CONNECTION THEREWITH AS IF SUCH ASSESSMENT OR AUTHORIZATION WERE MADE
BY A GOVERNMENT ENTITY, AND SHALL BE ENTITLED TO THE SAME MEDICAL
ASSISTANCE BENEFITS AND STANDARDS AND TO THE SAME NOTICE AND PROCEDURAL
DUE PROCESS RIGHTS, INCLUDING A RIGHT TO A FAIR HEARING AND AID CONTINU-
ING PURSUANT TO SECTION TWENTY-TWO OF THIS CHAPTER, AS IF THE ASSESSMENT
OR AUTHORIZATION WERE MADE BY A GOVERNMENT ENTITY.
7. THE COMMISSIONER OF HEALTH SHALL SUBMIT A REPORT BIANNUALLY TO THE
GOVERNOR, TEMPORARY PRESIDENT OF THE SENATE, SPEAKER OF THE ASSEMBLY AND
THE MINORITY LEADERS OF THE SENATE AND THE ASSEMBLY. SUCH REPORT SHALL
ALSO BE POSTED ON THE DEPARTMENT'S WEBSITE. SUCH REPORT SHALL INCLUDE,
BUT NOT BE LIMITED TO, AN ASSESSMENT OF THE PROJECT, AN ANALYSIS OF THE
LEVEL AND COSTS OF SERVICES MANAGED UNDER THE CONTRACTS, RECIPIENT
SATISFACTION AND OTHER MATTERS AS MAY BE PERTINENT. IN ADDITION, THE
COMMISSIONER SHALL CONVENE AN ANNUAL MEETING OF STAKEHOLDERS TO DISCUSS
IMPLEMENTATION OF THE DEMONSTRATION PROGRAM ESTABLISHED PURSUANT TO THIS
SECTION.
S 30. Intentionally omitted.
S 31. Intentionally omitted.
S 32. Intentionally omitted.
S 33. Intentionally omitted.
S 34. Intentionally omitted.
S 35. Intentionally omitted.
S 36. Intentionally omitted.
S 37. 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-
S. 58--B 127 A. 158--B
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 38. Subdivision 1 and the opening paragraph of subdivision 2 of
section 365-f of the social services law, subdivision 1 as added by
chapter 81 of the laws of 1995, the opening paragraph of subdivision 2
as amended by chapter 474 of the laws of 1996, are amended to read as
follows:
1. Purpose and intent. The consumer directed personal assistance
program is intended to permit chronically ill and/or physically disabled
individuals receiving home care services under the medical assistance
program greater flexibility and freedom of choice in obtaining such
services. The department shall[, upon request of a social services
district or group of districts,] REGULARLY MONITOR DISTRICT PARTIC-
IPATION IN THE PROGRAM BY REVIEWING THE IMPLEMENTATION PLANS SUBMITTED
PURSUANT TO THIS SECTION. THE DEPARTMENT SHALL PROVIDE GUIDANCE TO THE
DISTRICTS TO IMPROVE COMPLIANCE WITH IMPLEMENTATION PLANS AND PROMOTE
CONSISTENCY AMONG COUNTIES REGARDING APPROVED SERVICE LEVELS BASED ON
THE ASSESSMENTS REQUIRED BY THIS SECTION. IN ADDITION, THE DEPARTMENT
SHALL provide technical assistance and such other assistance as may be
necessary to assist such districts in assuring access to the program FOR
ELIGIBLE INDIVIDUALS.
All eligible individuals receiving home care shall be provided notice
of the availability of the program, AND NO LESS FREQUENTLY THAN ANNUALLY
THEREAFTER, and shall have the opportunity to apply for participation in
the program. [On or before October first, nineteen hundred ninety-six
each] EACH social services district shall file an implementation plan
with the commissioner of the department of health, WHICH SHALL BE
UPDATED ANNUALLY. SUCH UPDATES SHALL BE SUBMITTED NO LATER THAN NOVEMBER
THIRTIETH OF EACH YEAR. BEGINNING ON JUNE THIRTIETH, TWO THOUSAND NINE,
THE PLANS AND UPDATES SUBMITTED BY DISTRICTS SHALL REQUIRE THE APPROVAL
OF THE DEPARTMENT. IMPLEMENTATION PLANS SHALL INCLUDE DISTRICT ENROLL-
MENT TARGETS, DESCRIBE METHODS FOR THE PROVISION OF NOTICE AND ASSIST-
ANCE TO INTERESTED INDIVIDUALS ELIGIBLE FOR ENROLLMENT IN THE PROGRAM,
AND SHALL CONTAIN SUCH OTHER INFORMATION AS SHALL BE REQUIRED BY THE
DEPARTMENT. An "eligible individual", for purposes of this section is a
person who:
S. 58--B 128 A. 158--B
S 39. Section 2807-x of the public health law, as added by section 6
of part D of chapter 58 of the laws of 2004, the opening paragraph of
subdivision 1 as amended by chapter 745 of the laws of 2004, is amended
to read as follows:
S 2807-x. Grants for long term care demonstration projects. 1. The
commissioner shall establish [two] THREE demonstration projects to
develop, evaluate and implement programs to test new models for the
organization and delivery of long term care services to encourage commu-
nity based programs and smaller residential health care models in order
to promote consumer choice, improve the efficiency and appropriateness
of the use of state and federal resources and ensure the recruitment,
retention and training of health care staff to adequately meet the needs
of a community and residential long term care system. Notwithstanding
the provisions of section one hundred twelve of the state finance law or
any other inconsistent provision of the state finance law or any other
law, funds available for distribution pursuant to this section may be
allocated and distributed by the commissioner without a competitive bid
or request for proposal process.
(a) The following factors shall be considered in approving each demon-
stration project respectively:
(i) Residential health care demonstration project. (A) the extent to
which there is a reduction in the need for skilled nursing beds for a
facility that is eligible to replace its existing skilled nursing facil-
ity; (B) the potential to design and develop more appropriate smaller
residential health care facilities as an alternative to replacing an
existing skilled nursing facility; (C) the extent to which the quality,
efficiency and continuity of care will be promoted and provided for by
the development of integrated long-term care services in the community;
(D) the extent to which the project will provide training to health care
workers to appropriately staff new community based models of long term
care; (E) demonstrate the involvement and support of workforce in the
program redesign; (F) the development of a new long-term care reimburse-
ment methodology that encourages care in the least restrictive setting
and adequately reflects the resources needed to serve consumers in each
level of long term care; (G) and the incorporation of a research compo-
nent designed to evaluate the project.
(ii) Community based care demonstration project. (A) the extent to
which there is a reduction in the need for skilled nursing facility beds
on a countywide basis; (B) the development of a new system to inform
recently admitted residents of skilled nursing facilities of the avail-
ability of community long-term care options; (C) the extent to which the
discharge planning program from skilled nursing facilities will inform,
assist and maximize freedom of choice to consumers who choose to move
back to the community; (D) the extent to which the project will develop
community based long term care services, including funding for the
recruitment and retention of direct care health care workers necessary
to increase community based services; (E) the extent to which the
project will provide training to health care staff; and (F) the incorpo-
ration of a research component designed to evaluate the projects.
(III) MANAGED LONG TERM CARE PROJECT. (A) THE EXTENT TO WHICH A
CURRENT OPERATOR OF SKILLED NURSING FACILITIES POSSESSES THE NECESSARY
AUTHORIZATIONS THROUGH A RELATED ENTITY TO ASSUME RISK AND RECEIVE CAPI-
TATED PAYMENTS, PURSUANT TO TITLES 18 AND 19 OF THE FEDERAL SOCIAL SECU-
RITY ACT, FOR THE PURPOSE OF PROVIDING AND ARRANGING FOR THE CARE OF
INDIVIDUALS ELIGIBLE FOR ADMISSION TO A SKILLED NURSING FACILITY, (B)
THE EXTENT TO WHICH SUCH SERVICES TO INDIVIDUALS ELIGIBLE FOR BENEFITS
S. 58--B 129 A. 158--B
PURSUANT TO BOTH TITLES 18 AND 19 OF THE FEDERAL SOCIAL SECURITY ACT
WILL BE PROVIDED THROUGH THE CAPITATED RATE, (C) THE EXTENT TO WHICH THE
QUALITY, EFFICIENCY AND CONTINUITY OF CARE WILL BE PROMOTED AND PROVIDED
FOR BY THE DEVELOPMENT OF INTEGRATED LONG-TERM CARE SERVICES IN THE
COMMUNITY, (D) THE EXTENT TO WHICH THE PROJECT SPONSOR WILL DIRECTLY OR
INDIRECTLY IN ASSOCIATION WITH A JOINT LABOR MANAGEMENT PROGRAM, PROVIDE
FOR TRAINING OF HEALTH CARE WORKERS TO APPROPRIATELY STAFF COMMUNITY
BASED MODELS OF LONG-TERM CARE; AND (E) THE INCORPORATION OF A RESEARCH
COMPONENT DESIGNED TO EVALUATE THE PROJECT, WITH SPECIFIC REFERENCE TO
THE DETERMINATION OF COST SAVINGS TO THE STATE, THE QUALITY OF AND
SATISFACTION WITH SERVICES PROVIDED TO CONSUMERS AND THEIR FAMILIES AND
THE SATISFACTION OF DIRECT CARE WORKERS, WITH A REPORT OF THE PROJECT'S
PROGRESS AND FINDINGS SUBMITTED ANNUALLY TO THE COMMISSIONER.
2. The commissioner is authorized to waive, modify or suspend the
respective provisions of rules and regulations promulgated pursuant to
this chapter if the commissioner determines that such waiver is neces-
sary or appropriate for the successful implementation of a demonstration
project and when the health, safety, and general welfare of persons
receiving services under such demonstration project will not be impaired
as a result of such waiver, modification or suspension, PROVIDED HOWEV-
ER, THAT FOR THE MANAGED LONG TERM CARE PROJECT PURSUANT TO SUBPARAGRAPH
(III) OF PARAGRAPH (A) OF SUBDIVISION ONE OF THIS SECTION, THE METHOD
FOR SETTING THE CAPITATED RATE OF PAYMENT UNDER TITLE 19 OF THE FEDERAL
SOCIAL SECURITY ACT SHALL BE CONSISTENT WITH THE METHOD USED FOR ALL
MANAGED LONG TERM CARE PLANS AUTHORIZED UNDER SUBDIVISION EIGHT OF
SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW.
3. The commissioner is authorized to seek federal waivers pursuant to
titles XVIII and XIX of the federal social security act when such waiv-
ers are necessary to develop cost-effective long term care demonstration
projects.
S 40. Subdivision 6-a of section 93 of part C of chapter 58 of the
laws of 2007 amending the social services law and the public health law
relating to adjustments of rates, 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 THE AMEND-
MENTS MADE BY such section TO SUBDIVISION 4 OF SECTION 366-C OF THE
SOCIAL SERVICES LAW SHALL APPLY WITH RESPECT TO DETERMINING INITIAL AND
CONTINUING ELIGIBILITY FOR MEDICAL ASSISTANCE, INCLUDING THE CONTINUED
ELIGIBILITY OF RECIPIENTS ORIGINALLY DETERMINED ELIGIBLE PRIOR TO THE
EFFECTIVE DATE OF THIS ACT, AND PROVIDED FURTHER THAT SUCH AMENDMENTS
shall not apply to any person [as to whom] OR GROUP OF PERSONS IF IT IS
SUBSEQUENTLY DETERMINED BY THE CENTERS FOR MEDICARE AND MEDICAID
SERVICES OR BY A COURT OF COMPETENT JURISDICTION THAT MEDICAL ASSISTANCE
WITH federal financial participation is available for the costs of
services provided TO SUCH PERSON OR PERSONS under the provisions of
subdivision 4 of section 366-c of the social services law in effect
immediately prior to the effective date of this act.
S 41. Subdivision (m-1) of section 79 of part C of chapter 58 of the
laws of 2008 amending the social services law and the public health law
relating to adjustments of rates, is amended to read as follows:
(m-1) THE AMENDMENTS MADE BY section fifty-two of this act TO SUBDIVI-
SION 4 OF SECTION 366-C OF THE SOCIAL SERVICES LAW shall [not] apply
WITH RESPECT TO DETERMINING INITIAL AND CONTINUING ELIGIBILITY FOR
MEDICAL ASSISTANCE, INCLUDING THE CONTINUED ELIGIBILITY OF RECIPIENTS
ORIGINALLY DETERMINED ELIGIBLE PRIOR TO THE EFFECTIVE DATE OF THIS ACT;
AND PROVIDED FURTHER THAT SUCH AMENDMENTS SHALL NOT APPLY to any person
S. 58--B 130 A. 158--B
[as to whom] OR GROUP OF PERSONS IF IT IS SUBSEQUENTLY DETERMINED BY THE
CENTERS OF MEDICARE AND MEDICAID SERVICES OR BY A COURT COMPETENT JURIS-
DICTION THAT MEDICAL ASSISTANCE WITH federal financial participation is
available for the costs of services provided TO SUCH PERSON OR PERSONS
under the provisions of subdivision 4 of section 366-c of the social
services law in effect immediately prior to the effective date of this
act;
S 42. The closing paragraph of subdivision 4 of section 366-c of the
social services law, as amended by section 52 of part C of chapter 58 of
the laws of 2008, is amended to read as follows:
provided, however, that, to the extent required by federal law, the
terms of this subdivision shall not apply to persons who are receiving
care, services and supplies pursuant to the following waivers under
section 1915(c) of the federal social security act: the nursing facility
transition and diversion waiver authorized pursuant to subdivision six-a
of section three hundred sixty-six of this title; [and] the traumatic
brain injury waiver authorized pursuant to section twenty-seven hundred
forty of the public health law, THE LONG TERM HOME HEALTH CARE PROGRAM
WAIVER AUTHORIZED PURSUANT TO SECTION THREE HUNDRED SIXTY-SEVEN-C OF
THIS TITLE, AND THE HOME AND COMMUNITY BASED SERVICES WAIVER FOR PERSONS
WITH DEVELOPMENTAL DISABILITIES ADMINISTERED BY THE OFFICE OF MENTAL
RETARDATION AND DEVELOPMENTAL DISABILITIES PURSUANT TO AN AGREEMENT WITH
THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES.
S 43. Notwithstanding any inconsistent provisions of section 112 or
section 163 of the state finance law, section 2808-d of the public
health law, or any other provision of law or regulation to the contrary,
with regard to funds previously awarded by the commissioner of health
pursuant to section 2808-d of the public health law to residential
health care facilities that provide extensive nursing, medical, psycho-
logical and counseling support services to children and that have not
yet been spent, the commissioner of health may, with the agreement of
such facilities, authorize in writing the expenditure of such unspent
funds for the alternative purpose of improving the work environment of
such facilities, including through building improvement or replacement
facilities, in such manner as the commissioner of health deems appropri-
ate.
S 44. 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 45. 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 46. 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
S. 58--B 131 A. 158--B
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 47. This act shall take effect on April 1, 2009; provided, however,
that:
1. Intentionally omitted.
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. Intentionally omitted.
8. Intentionally omitted.
9. the amendments to subdivision 5 of section 3614 of the public
health law made by sections twenty-three and twenty-four of this act
shall not affect the expiration of such subdivision and shall expire
therewith;
10. Intentionally omitted.
11. Intentionally omitted.
12. the amendments to the closing paragraph of subdivision 4 of
section 366-c of the social services law made by section forty-two of
this act shall not affect the expiration of such subdivision and shall
be deemed expired therewith; provided, further, that the amendments to
the closing paragraph of subdivision 4 of section 366-c of the social
services law made by section forty-two of this act shall apply with
respect to determining initial and continuing eligibility for medical
assistance, including the continued eligibility of recipients originally
determined eligible prior to the effective date of this act; and
provided further that such changes shall not apply to any person or
group of persons if it is subsequently determined by the Centers for
Medicare and Medicaid services or a court of competent jurisdiction that
medical assistance with federal financial participation is available for
the cost of services provided to such person or persons under the
provisions of subdivision 4 of section 366-c of the social services law
in effect immediately prior to the effective date of this act.
PART E
Intentionally omitted.
S. 58--B 132 A. 158--B
PART F
Section 1. (a) 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 in state
fiscal year 2009-10 to reduce inpatient capacity in the aggregate by no
more than 450 beds, through closure of wards not to exceed 150 beds, or
through conversion of such beds to transitional placement programs,
provided, however, that nothing in this section shall be interpreted as
restricting the ability of the office of mental health to reduce inpa-
tient bed capacity beyond 450 beds in state fiscal year 2009-10, but
such reductions shall be subject to the provisions of subdivision (e) of
section 7.17 and section 41.55 of the mental hygiene law. Determinations
concerning the closure of such wards in fiscal year 2009-10 shall be
made by the office of mental health based on data related to inpatient
census, indicating nonutilization or under utilization of beds, and the
efficient operation of facilities. Determinations concerning the conver-
sion of such wards to transitional placement programs in fiscal year
2009-10 shall be made by the office of mental health based upon the
identification of patients who have received inpatient care and who are
clinically determined to be appropriate for a less restrictive level of
mental health treatment. The office of mental health shall provide
notice to the legislature as soon as possible, but no later than two
weeks prior to the anticipated closure or conversion of wards pursuant
to this act.
(b) For the purposes of this act, the term "transitional placement
program" shall be defined to include, but not limited to, a supervised
residential program that provides outpatient services, treatment and
training, and which supports the transition of patients to more inte-
grated community settings.
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.
PART G
Intentionally omitted.
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 WHO OTHERWISE WOULD
BE REQUIRED TO BE TRANSFERRED TO A SECURE TREATMENT FACILITY MAY, UPON A
WRITTEN CONSENT SIGNED BY THE RESPONDENT AND HIS OR HER COUNSEL, CONSENT
TO REMAIN IN THE CUSTODY OF THE DEPARTMENT OF CORRECTIONAL SERVICES
PENDING THE OUTCOME OF THE PROCEEDINGS UNDER THIS ARTICLE, AND THAT SUCH
S. 58--B 133 A. 158--B
CONSENT MAY BE REVOKED IN WRITING AT ANY TIME; (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 pending the
completion of such trial.
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.
PART I
Intentionally omitted.
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
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
commissioner of the office of mental retardation and developmental disa-
bilities is authorized to consolidate the Valley Ridge Center for Inten-
sive Treatment and the Broome Developmental Disabilities Services Office
for the purposes of administrative efficiencies, provided, however, that
the state shall continue to operate an intensive treatment facility at
the Valley Ridge site. The consolidated entity shall be known as the
Broome Developmental Disabilities 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 April 1, 2009.
PART K
S. 58--B 134 A. 158--B
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 April 1, 2009.
PART L
Section 1. Subdivision 3-b of section 1 of part C of chapter 57 of the
laws of 2006, establishing a cost of living adjustment for designated
human services programs, as added by section 2 of part I of chapter 58
of the laws of 2008, 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
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
Intentionally omitted.
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-
S. 58--B 135 A. 158--B
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.
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, 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 TREATMENT AND CARE OF PATIENTS WITH MENTAL ILLNESS OF THE
METROPOLITAN DISTRICT AND TO BENEFIT THE HEALTH, WELFARE AND SAFETY OF
ITS RESIDENTS, THE CITY OF NEW YORK 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
FIFTY-TWO AND CHAPTER FIVE HUNDRED TWENTY-FOUR 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 REVIEW 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 April 1, 2009.
PART P
Intentionally omitted.
PART Q
Intentionally omitted.
PART R
S. 58--B 136 A. 158--B
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 April 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.