[ ] is old law to be omitted.
LBD12671-01-0
S. 6608 2 A. 9708
dontia, covering persons declaring to be a citizen for child health
insurance; to amend the public health law, the social services law and
the tax law, in relation to imposing parental fees in the early inter-
vention program; to amend the public health law and the social
services law, in relation to establishing express lane eligibility for
child health insurance and co-payments for certain individuals
enrolled in family health plus plans; to amend the public health law
and the education law, in relation to interactions between pharmaceu-
tical companies and health care professionals; to amend the public
health law, in relation to general hospital reimbursement rate peri-
ods; to amend the public health law, in relation to a physician loan
repayment program and in relation to transitional care units; to amend
part B of chapter 58 of the laws of 2005, amending the public health
law and other laws relating to implementing the state fiscal plan for
the 2005-2006 state fiscal year, in relation to the expiration there-
of; to amend the social services law, in relation to eligibility for
medical assistance; to amend the public health law, in relation to
general hospital reimbursement rate periods; to amend the social
services law, in relation to coverage of certain treatment for indi-
viduals at risk of substance abuse; to amend section 17 of part C of
chapter 58 of the laws of 2005 amending the public health law and
other laws relating to implementing the state fiscal plan for the
2005-2006 state fiscal year, in relation to extending coverage for
specialty outpatient services; to amend the public health law, in
relation to violations of health laws or regulations, penalties and
injunctions; to amend part C of chapter 58 of the laws of 2005 amend-
ing the tax law and other laws relating to implementing the state
fiscal plan for the 2005-06 state fiscal year, in relation to Medicaid
fraud and abuse; to amend the public health law, in relation to audits
of service providers; to amend the public health law, in relation to
hospital mortgage loan construction; to amend chapter 392 of the laws
of 1973 constituting the New York medical care facilities finance
agency act, in relation to special hospital project bonds and secured
hospital projects reserve funds and appropriations; to amend the
social services law, in relation to documentation and eligibility
under the medical assistance program; permitting the commissioner of
health to enter into contracts for the purpose of conducting audits of
hospital costs; to amend the public health law, in relation to
reimbursements to certain diagnostic and treatment and ambulatory care
centers; to amend the social services law, in relation to providing
smoking cessation counseling services to adolescents to the age of
nineteen; to amend part A of chapter 57 of the laws of 2006 amending
the social services law relating to medically fragile children, in
relation to the effectiveness of provisions; to amend the social
services law, in relation to participation in certain federal medical
assistance programs; to amend chapter 33 of the laws of 1998 amending
the social services law relating to authorizing payment of Medicare
part B premiums for certain Medicaid recipients, in relation to making
the provisions of such chapter permanent; to repeal paragraph (f) of
subdivision 9 of section 367-a of the social services law relating to
payment of prescription drugs; and providing for the repeal of certain
provisions upon expiration thereof (Part B); to amend the public
health law and the social services law, in relation to residential
health care facilities; to amend chapter 58 of the laws of 2009,
amending the public health law and other laws relating to Medicaid
reimbursements to residential health care facilities inpatient
S. 6608 3 A. 9708
services, in relation to such reimbursements; 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 such
rate settings; to amend the social services law, in relation to
personal care services and the nursing home transition and diversion
program; to amend the social services law, in relation to creating the
county long term care financing demonstration program; to amend the
public health law, in relation to requiring a study of resident data,
in relation to matters regarding fiscal solvency, in relation to
certificates of authority, in relation to reporting requirements and
in relation to the voluntary residential health care facility right-
sizing demonstration program (Part C); to amend the insurance law, in
relation to prior approval of health insurance premium rates (Part D);
to amend the mental hygiene law, in relation to the receipt of federal
and state benefits received by patients receiving care in facilities
operated by an office of the department of mental hygiene (Part E); to
repeal chapter 119 of the laws of 2007, directing the commissioner of
mental health to study, evaluate and report on the unmet mental health
service needs of traditionally underserved populations (Part F); to
amend the mental hygiene law, in relation to electronic court appear-
ance in relation to article 10 of the mental hygiene law (Part G); in
relation to authorizing the office of mental health to close patient
wards and establish transitional placement programs, notwithstanding
the provisions of section 7.17 or section 41.55 of the mental hygiene
law; to amend chapter 62 of the laws of 2003 amending the mental
hygiene law and the state finance law relating to the community mental
health support and workforce reinvestment program, the membership of
subcommittees for mental health of community services boards and the
duties of such subcommittees and creating the community mental health
and workforce reinvestment account, in relation to the effectiveness
thereof; to amend the mental hygiene law, in relation to community
mental health support and workforce reinvestment program; and repeal-
ing certain provisions of the mental hygiene law relating thereto
(Part H); in relation to the recovery of exempt income by the office
of mental health for community residences and family-based treatment
programs (Part I); to amend the mental hygiene law, in relation to
payments made by the office of mental retardation and developmental
disabilities and the office of mental health to operators of family
care homes and to increasing the number of days that substitute care-
takers may be provided to family care homes by the office of mental
retardation and developmental disabilities and the office of mental
health, and in relation to payments made to the operators of community
residential facilities for the needs of persons with mental retarda-
tion or other developmental disabilities residing therein (Part J); to
amend the mental hygiene law, in relation to discrete units of a
hospital or other facility possessing an operating certificate for the
purpose of providing residential or non-residential chemical depend-
ence services (Part K); to amend the mental hygiene law and the vehi-
cle and traffic law, in relation to the transfer of the alcohol and
drug rehabilitation program from the department of motor vehicles to
the office of alcoholism and substance abuse services (Part L); to
amend the mental hygiene law, in relation to unified services; and
repealing certain provisions of such law relating thereto (Part M);
and to amend chapter 57 of the laws of 2006, relating to establishing
a cost of living adjustment for designated human services programs, in
S. 6608 4 A. 9708
relation to foregoing such adjustment during the 2010-2011 state
fiscal year (Part N)
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. This act enacts into law major components of legislation
which are necessary to implement the state fiscal plan for the 2010-2011
state fiscal year. Each component is wholly contained within a Part
identified as Parts A through N. 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 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. Paragraph (a) of subdivision 3 of section 2559 of the
public health law, as amended by chapter 231 of the laws of 1993, is
amended to read as follows:
(a) [Providers of] PAYMENT FOR early intervention services and trans-
portation services shall in the first instance and where [applicable]
AVAILABLE, [seek payment] BE SOUGHT from all third party payors includ-
ing governmental agencies prior to claiming payment from a given munici-
pality for services rendered to eligible children[, provided that].
EXCEPT AS PROVIDED IN SUBPARAGRAPH (I) OF THIS PARAGRAPH, for the
purpose of seeking payment from the medical assistance program or from
other third party payors, the municipality shall be deemed the provider
of such early intervention services to the extent that the provider has
promptly furnished to the municipality adequate and complete information
necessary to support the municipality billing, and provided further that
the obligation to seek payment shall not apply to a payment from a third
party payor who is not prohibited from applying such payment, and will
apply such payment, to an annual or lifetime limit specified in the
insured's policy.
(I) EARLY INTERVENTION PROGRAM PROVIDERS WHO RECEIVED PAYMENT OF FIVE
HUNDRED THOUSAND DOLLARS OR MORE AS DETERMINED PURSUANT TO SUBPARAGRAPH
(II) OF THIS PARAGRAPH FOR EARLY INTERVENTION SERVICES PROVIDED TO
ELIGIBLE CHILDREN THAT WERE COVERED SERVICES UNDER THE MEDICAL ASSIST-
ANCE PROGRAM, SHALL IN THE FIRST INSTANCE AND WHERE AVAILABLE, SEEK
PAYMENT FROM THE MEDICAL ASSISTANCE PROGRAM OR AN INSURANCE POLICY OR
PLAN FOR THOSE CHILDREN COVERED UNDER BOTH THE MEDICAL ASSISTANCE
PROGRAM AND AN INSURANCE POLICY OR PLAN, PRIOR TO CLAIMING PAYMENT FROM
A MUNICIPALITY FOR SERVICES RENDERED TO SUCH CHILDREN.
(II) THE COMMISSIONER SHALL DETERMINE WHICH PROVIDERS RECEIVED PAYMENT
OF FIVE HUNDRED THOUSAND DOLLARS OR MORE FOR EARLY INTERVENTION SERVICES
THAT WERE COVERED UNDER THE MEDICAL ASSISTANCE PROGRAM BASED UPON THE
MOST RECENT YEAR FOR WHICH COMPLETE INFORMATION EXISTS. THE COMMISSIONER
SHALL NOTIFY A PROVIDER AT LEAST THIRTY DAYS PRIOR TO THE DATE THE
PROVIDER SHALL BE REQUIRED TO BILL FOR SERVICES IN ACCORDANCE WITH
SUBPARAGRAPH (I) OF THIS PARAGRAPH.
S. 6608 5 A. 9708
(III) PARENTS SHALL PROVIDE AND MUNICIPALITIES SHALL OBTAIN INFORMA-
TION ON ANY PLAN OF INSURANCE UNDER WHICH AN ELIGIBLE CHILD HAS COVER-
AGE.
S 2. Section 3235-a of the insurance law, as added by section 3 of
part C of chapter 1 of the laws of 2002, is amended to read as follows:
S 3235-a. Payment for early intervention services. (a) No policy of
accident and health insurance, including contracts issued pursuant to
article forty-three of this chapter, shall exclude coverage for other-
wise covered services [solely on the basis that the services constitute
early intervention program services] THAT ARE PROVIDED UNDER THE EARLY
INTERVENTION PROGRAM under title two-A of article twenty-five of the
public health law.
(b) Where a policy of accident and health insurance, including a
contract issued pursuant to article forty-three of this chapter,
provides coverage for [an] A SERVICE THAT IS PROVIDED TO AN INSURED
UNDER THE early intervention program [service], such coverage shall not
be applied against any maximum annual or lifetime monetary limits set
forth in such policy or contract. Visit limitations and other terms and
conditions of the policy will continue to apply to COVERED SERVICES
PROVIDED UNDER THE early intervention [services] PROGRAM. However, any
visits used for COVERED SERVICES PROVIDED UNDER THE early intervention
program [services] shall not reduce the number of visits otherwise
available under the policy or contract for such services. WHERE SUCH
POLICY OR CONTRACT PROVIDES COVERAGE FOR A SERVICE PROVIDED TO THE
INSURED UNDER THE EARLY INTERVENTION PROGRAM, THE INDIVIDUALIZED FAMILY
SERVICES PLAN AS DEFINED IN SECTION TWENTY-FIVE HUNDRED FORTY-ONE OF THE
PUBLIC HEALTH LAW AND CERTIFIED BY THE EARLY INTERVENTION OFFICIAL OR
SUCH OFFICIAL'S DESIGNEE, SHALL BE DEEMED TO MEET ANY PRECERTIFICATION,
PREAUTHORIZATION AND MEDICAL NECESSITY REQUIREMENTS IMPOSED ON BENEFITS
UNDER THE POLICY OR CONTRACT, PROVIDED, HOWEVER, THAT THE EARLY INTER-
VENTION OFFICIAL SHALL REMOVE OR REDACT ANY INFORMATION CONTAINED ON THE
INSURED'S INDIVIDUALIZED FAMILY SERVICE PLAN THAT IS NOT REQUIRED BY THE
INSURER FOR PAYMENT PURPOSES. PAYMENT FOR A SERVICE COVERED UNDER THE
POLICY OR CONTRACT THAT IS PROVIDED UNDER THE EARLY INTERVENTION PROGRAM
SHALL BE AT RATES ESTABLISHED BY THE COMMISSIONER OF HEALTH FOR SUCH
SERVICE PURSUANT TO REGULATIONS.
(C) NO INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION ISSUED A
CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS CHAP-
TER SHALL DENY PAYMENT OF A CLAIM SUBMITTED FOR A SERVICE COVERED UNDER
THE INSURER'S POLICY OR CONTRACT AND PROVIDED UNDER THE EARLY INTER-
VENTION PROGRAM BASED UPON THE FOLLOWING:
(I) THE LOCATION WHERE SERVICES ARE PROVIDED;
(II) THE DURATION OF THE INSURED'S CONDITION AND/OR THAT THE INSURED'S
CONDITION IS NOT AMENABLE TO SIGNIFICANT IMPROVEMENT WITHIN A CERTAIN
PERIOD OF TIME AS SPECIFIED IN THE POLICY;
(III) THAT THE PROVIDER OF SERVICES IS NOT A PARTICIPATING PROVIDER IN
THE INSURER'S NETWORK; OR
(IV) THE ABSENCE OF A PRIMARY CARE REFERRAL.
[(c)] (D) Any right of subrogation to benefits which a municipality is
entitled in accordance with paragraph (d) of subdivision three of
section twenty-five hundred fifty-nine of the public health law shall be
valid and enforceable to the extent benefits are available under any
accident and health insurance policy. The right of subrogation does not
attach to insurance benefits paid or provided under any accident and
health insurance policy prior to receipt by the insurer of written
S. 6608 6 A. 9708
notice from the municipality. UPON THE INSURER'S RECEIPT OF WRITTEN
NOTICE FROM THE MUNICIPALITY, THE INSURER SHALL PROVIDE THE MUNICIPALITY
WITH INFORMATION ON THE EXTENT OF BENEFITS AVAILABLE TO AN INSURED UNDER
THE POLICY OR CONTRACT.
[(d)] (E) No insurer, including a health maintenance organization
issued a certificate of authority under article forty-four of the public
health law and a corporation organized under article forty-three of this
chapter, shall refuse to issue an accident and health insurance policy
or contract or refuse to renew an accident and health insurance policy
or contract solely because the applicant or insured is receiving
services under the early intervention program.
S 3. The public health law is amended by adding a new section 2557-a
to read as follows:
S 2557-A. PARENTAL PARTICIPATION IN PAYMENT FOR EARLY INTERVENTION
SERVICES. 1. PARENTAL PARTICIPATION IN THE PAYMENT FOR EARLY INTER-
VENTION SERVICES SHALL BE ESTABLISHED ANNUALLY ON A PROSPECTIVE BASIS
BASED ON A SLIDING SCHEDULE OF FEES AS SET FORTH IN SUBDIVISION THREE OF
THIS SECTION. THE FEE SHALL BE PAID PROSPECTIVELY ON A QUARTERLY BASIS
TO THE COMMISSIONER AND SHALL BE DEPOSITED INTO THE EARLY INTERVENTION
PROGRAM ACCOUNT ESTABLISHED IN SECTION NINETY-NINE-T OF THE STATE
FINANCE LAW. AFTER PAYING THE COSTS OF THE STATE'S ADMINISTRATION OF
PARENTAL PARTICIPATION, THE COMMISSIONER SHALL PAY EACH MUNICIPALITY A
PORTION OF THE PARENTAL FEES COLLECTED IN ACCORDANCE WITH THIS SECTION
FROM PARENTS OF ELIGIBLE CHILDREN FOR WHICH THE MUNICIPALITY HAS FINAN-
CIAL RESPONSIBILITY IN AN AMOUNT EQUAL TO THE MUNICIPALITY'S PROPOR-
TIONAL SHARE OF COSTS OF EARLY INTERVENTION SERVICES. NO PARENTAL FEES
MAY BE CHARGED FOR IMPLEMENTING CHILD FIND, EVALUATION AND ASSESSMENT,
SERVICE COORDINATION, DEVELOPMENT, REVIEW, AND EVALUATION OF INDIVIDUAL-
IZED FAMILY SERVICES PLANS, OR THE IMPLEMENTATION OF PROCEDURAL SAFE-
GUARDS AND OTHER ADMINISTRATIVE COMPONENTS OF THE EARLY INTERVENTION
SYSTEM.
2. PARENTS SHALL PAY A QUARTERLY FEE DETERMINED PURSUANT TO THE SCHED-
ULE OF FEES SET FORTH IN SUBDIVISION THREE OF THIS SECTION FOR EACH
CHILD IN THE FAMILY RECEIVING EARLY INTERVENTION SERVICES. IF A PARENT
HAS MORE THAN THREE CHILDREN RECEIVING SERVICES IN THE EARLY INTER-
VENTION PROGRAM, THE PARENTAL FEE SHALL BE LIMITED TO THE QUARTERLY FEE
CHARGED FOR PARENTS WHO HAVE THREE CHILDREN RECEIVING SERVICES IN THE
EARLY INTERVENTION PROGRAM. PARENTAL FEES SHALL APPLY WITHOUT REGARD TO
WHETHER PAYMENT FOR SERVICES IS AVAILABLE THROUGH THIRD PARTY INSURANCE.
3. PARENTAL FEES FOR THE EARLY INTERVENTION PROGRAM SHALL BE AS
FOLLOWS:
GROSS HOUSEHOLD INCOME PARENTAL FEE PER CHILD
/PER QUARTER
251% OF FEDERAL POVERTY LEVEL (FPL) TO 400% FPL $45.00
401% FPL TO 600% FPL $90.00
601% FPL TO 700% FPL $180.00
701% FPL TO 800% FPL $270.00
801% FPL TO 900% FPL $360.00
901% FPL TO 1000% FPL $450.00
1001% FPL AND ABOVE $540.00
4. A PARENT SHALL PROVIDE DOCUMENTATION AS SPECIFIED IN PARAGRAPH (A)
OF THIS SUBDIVISION, AS NECESSARY AND SUFFICIENT TO DETERMINE THE
PARENTAL FEE UNDER THIS SECTION. IF A PARENT FAILS TO PROVIDE DOCUMENTA-
TION SUFFICIENT TO DETERMINE THE GROSS HOUSEHOLD INCOME, IT SHALL BE
PRESUMED THAT THE PARENT FALLS WITHIN THE HIGHEST GROSS HOUSEHOLD INCOME
BRACKET FOR THE PURPOSES OF ESTABLISHING THE PARENTAL FEE OBLIGATION.
S. 6608 7 A. 9708
THE COMMISSIONER MAY VERIFY THE ACCURACY OF SUCH INCOME INFORMATION
PROVIDED BY THE PARENT BY MATCHING IT AGAINST INCOME INFORMATION
CONTAINED IN DATABASES TO WHICH THE COMMISSIONER HAS ACCESS, INCLUDING
THE STATE'S WAGE REPORTING SYSTEM PURSUANT TO SUBDIVISION FIVE OF
SECTION ONE HUNDRED SEVENTY-ONE-A OF THE TAX LAW AND BY MEANS OF AN
INCOME VERIFICATION PERFORMED PURSUANT TO A COOPERATIVE AGREEMENT WITH
THE DEPARTMENT OF TAXATION AND FINANCE.
(A) INCOME DOCUMENTATION SHALL INCLUDE, BUT NOT BE LIMITED TO, ONE OR
MORE OF THE FOLLOWING FOR EACH PARENT AND LEGALLY RESPONSIBLE ADULT WHO
IS A MEMBER OF THE HOUSEHOLD AND WHOSE INCOME IS AVAILABLE TO THE CHILD
AND FAMILY:
(I) CURRENT ANNUAL INCOME TAX RETURNS;
(II) PAYCHECK STUBS;
(III) WRITTEN DOCUMENTATION OF INCOME FROM ALL EMPLOYERS; AND
(IV) OTHER DOCUMENTATION OF INCOME (EARNED OR UNEARNED) AS DETERMINED
BY THE COMMISSIONER, PROVIDED, HOWEVER, SUCH DOCUMENTATION SHALL SET
FORTH THE SOURCE OF SUCH INCOME.
(B) ANY INCOME VERIFICATION RESPONSE BY THE DEPARTMENT OF TAXATION AND
FINANCE PURSUANT TO THIS SUBDIVISION SHALL NOT BE A PUBLIC RECORD AND
SHALL NOT BE RELEASED BY THE COMMISSIONER. INFORMATION DISCLOSED PURSU-
ANT TO THIS SUBDIVISION SHALL BE LIMITED TO INFORMATION NECESSARY FOR
VERIFICATION. INFORMATION SO DISCLOSED SHALL BE KEPT CONFIDENTIAL.
5. AT THE WRITTEN REQUEST OF THE PARENT, THE PARENTAL FEE OBLIGATION
MAY BE ADJUSTED PROSPECTIVELY AT ANY POINT DURING THE YEAR UPON PROOF OF
A CHANGE IN HOUSEHOLD GROSS INCOME. AT THE WRITTEN REQUEST OF THE
PARENT, WHEN THE CHILD IS NO LONGER ELIGIBLE TO RECEIVE SERVICES UNDER
THE EARLY INTERVENTION PROGRAM, THE DEPARTMENT SHALL RECONCILE THE
PARENTAL FEE AND, IF APPLICABLE, RETURN A PRO-RATA PORTION OF THE FEE
FOR THE FINAL QUARTER IN WHICH THE CHILD RECEIVED SERVICES.
6. (A) PARENT PARTICIPATION FEES SHALL BE DUE ON THE FIRST DAY OF EACH
QUARTER. THE COMMISSIONER SHALL PROVIDE A BILL TO THE PARENT FOR THE
PARENT PARTICIPATION FEE THIRTY DAYS PRIOR TO THE FIRST DAY OF THE QUAR-
TER IN WHICH THE FEE IS DUE. THE BILL SHALL SET FORTH THE AMOUNT OF THE
FEE AND ITS DUE DATE. PROVIDED, HOWEVER, UPON AN ELIGIBLE CHILD'S
ENTRANCE INTO THE PROGRAM, THE FEE SHALL BE DUE THIRTY DAYS AFTER ISSU-
ANCE OF THE INITIAL BILL, AND THE AMOUNT OF THE FEE SHALL BE ADJUSTED ON
A PRO-RATA BASIS TO REFLECT THE DATE OF THE INITIAL INDIVIDUALIZED FAMI-
LY SERVICE PLAN MEETING.
(B) IF PAYMENT HAS NOT BEEN RECEIVED WITHIN FIFTEEN DAYS OF ITS DUE
DATE, THE COMMISSIONER SHALL PROVIDE A NOTICE TO THE PARENT REQUESTING
PAYMENT BE MADE. THE NOTICE SHALL ALSO STATE THAT FAILURE TO PAY THE
FEE WITHIN FIFTEEN DAYS FROM ISSUANCE OF THE NOTICE SHALL RESULT IN THE
LOSS OF SERVICES AND ELIGIBILITY FOR THE PROGRAM.
(C) IF PAYMENT HAS NOT BEEN RECEIVED WITHIN THIRTY DAYS OF ITS DUE
DATE OR AN AGREEMENT HAS NOT BEEN REACHED BETWEEN THE COMMISSIONER AND
THE PARENT IN RELATION TO THE PARENT'S PAYMENT OF THE PAST DUE FEE, THE
CHILD'S ELIGIBILITY FOR THE PROGRAM SHALL CEASE, EXCEPT FOR THOSE
SERVICES SET FORTH IN SUBDIVISION ONE OF THIS SECTION FOR WHICH NO
PARENTAL FEE MAY BE CHARGED. THE COMMISSIONER SHALL NOTIFY THE MUNICI-
PALITY THAT THE CHILD AND FAMILY ARE NO LONGER ELIGIBLE AND THAT
SERVICES SHOULD CEASE WITHIN FIFTEEN DAYS OF SUCH NOTICE TO THE MUNICI-
PALITY. THE MUNICIPALITY SHALL NOTIFY ALL PROVIDERS CURRENTLY PROVIDING
SERVICES TO THE CHILD THAT THE CHILD IS NO LONGER AUTHORIZED TO RECEIVE
SERVICES.
7. THE INABILITY OF THE PARENT OF AN ELIGIBLE CHILD TO PAY PARENTAL
FEES DUE TO CATASTROPHIC CIRCUMSTANCES OR EXTRAORDINARY EXPENSES SHALL
S. 6608 8 A. 9708
NOT RESULT IN THE DENIAL OF SERVICES TO THE CHILD OR THE CHILD'S FAMILY.
IN SUCH A CIRCUMSTANCE:
(A) A PARENT MUST SUBMIT TO THE COMMISSIONER DOCUMENTATION OF THE
PARENT'S EXTRAORDINARY EXPENSES OR OTHER CATASTROPHIC CIRCUMSTANCES. THE
PARENT SHALL SUBMIT DOCUMENTATION OF ONE OF THE FOLLOWING:
(I) OUT-OF-POCKET MEDICAL EXPENSES IN EXCESS OF FIFTEEN PERCENT OF
GROSS INCOME; OR
(II) OTHER EXTRAORDINARY EXPENSES OR CATASTROPHIC CIRCUMSTANCES CAUS-
ING DIRECT OUT-OF-POCKET LOSSES IN EXCESS OF FIFTEEN PERCENT OF GROSS
INCOME.
(B) THE COMMISSIONER SHALL DETERMINE WHETHER THE PARENTAL FEE OBLI-
GATION SHALL BE REDUCED, FORGIVEN, OR SUSPENDED WITHIN TEN BUSINESS DAYS
AFTER RECEIPT OF THE PARENT'S REQUEST AND SUPPORTING DOCUMENTATION.
(C) A PARENT WHO DISAGREES WITH THE DETERMINATION SHALL HAVE THE RIGHT
TO CONTEST SUCH DETERMINATION IN ACCORDANCE WITH SECTION TWENTY-FIVE
HUNDRED FORTY-NINE OF THIS TITLE. IF A PARENT SUBMITS A WRITTEN REQUEST
FOR A MEDIATION OR HEARING TO CONTEST THE COMMISSIONER'S DETERMINATION,
EARLY INTERVENTION SERVICES SHALL NOT BE SUSPENDED FOR NONPAYMENT OF THE
PARENTAL FEE PENDING RESOLUTION OF THE DUE PROCESS PROCEEDING.
S 4. The state finance law is amended by adding a new section 99-t to
read as follows:
S 99-T. EARLY INTERVENTION PROGRAM ACCOUNT. 1. THERE IS HEREBY ESTAB-
LISHED IN THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSION-
ER OF THE DEPARTMENT OF TAXATION AND FINANCE AN ACCOUNT IN THE MISCELLA-
NEOUS SPECIAL REVENUE FUND TO BE KNOWN AS THE "EARLY INTERVENTION
PROGRAM ACCOUNT".
2. SUCH ACCOUNT SHALL CONSIST OF MONIES RECEIVED FROM EARLY INTER-
VENTION FEES.
3. MONIES OF THE ACCOUNT, WHEN ALLOCATED, SHALL BE AVAILABLE TO THE
DEPARTMENT OF HEALTH FOR EARLY INTERVENTION PROGRAM ADMINISTRATIVE COSTS
FOR THE STATE SHARE FOR REIMBURSEMENT OF EARLY INTERVENTION SERVICES,
AND FOR PAYMENT OF A MUNICIPALITY'S SHARE OF PARENTAL FEES IN ACCORDANCE
WITH SUBDIVISION ONE OF SECTION TWENTY-FIVE HUNDRED FIFTY-SEVEN-A OF THE
PUBLIC HEALTH LAW.
S 5. The title heading of title 1-A of article 24 of the public health
law, as amended by chapter 300 of the laws of 1995, is amended to read
as follows:
[BREAST] CANCER DETECTION AND EDUCATION PROGRAM[; OVARIAN CANCER
INFORMATION PROGRAM]
S 6. Section 2405 of the public health law, as added by chapter 328 of
the laws of 1989, subdivision 1 as amended by chapter 554 of the laws of
2002 and paragraphs (a) and (d) of subdivision 2 as amended by chapter
515 of the laws of 2003, is amended to read as follows:
S 2405. [Breast cancer] CANCER detection and education program; estab-
lishment. 1. There is hereby created within the department the [breast]
cancer detection and education program, also known as the [healthy women
partnership] CANCER SERVICES PROGRAM. This program is established to
promote screening and detection of [breast] cancer among unserved or
underserved populations, to educate the public regarding [breast] cancer
and the benefits of early detection, and to provide counseling and
referral services. For purposes of this section, "unserved or under-
served populations" shall mean persons having inadequate access and
financial resources to obtain [breast] cancer screening and detection
services, including persons who lack health insurance or whose health
insurance coverage is inadequate or who cannot meet their deductible
S. 6608 9 A. 9708
obligations for purposes of accessing coverage under their health insur-
ance.
2. The program shall include:
(a) establishment of a statewide public education and outreach
campaign to publicize [breast] EVIDENCE BASED cancer detection and
education services, such campaign shall include: general community
education, outreach to specific underserved populations, EVIDENCE BASED
clinical [breast] cancer screening services [and follow-up care, infor-
mation on the extent of coverage for such services by health insurance,
the medical assistance program and other public and private programs],
and an informational summary that shall include an explanation of the
importance of clinical [breast] examinations[, breast-self-examinations
and mammography,] AND what to expect during [a] clinical [breast exam-
ination] EXAMINATIONS and [mammography, and how to perform breast-self-
examinations] CANCER SCREENING SERVICES;
(b) provision of grants to approved organizations under section twen-
ty-four hundred six of this title;
(c) compilation of data concerning the [breast] cancer detection and
education program and dissemination of the data to the public; and
(d) development of professional education programs including the bene-
fits of early detection of [breast] cancer[,] AND clinical [breast]
examinations [and breast-self-examinations], the recommended frequency
of clinical [breast] examinations[, breast-self-examinations,] and
[mammography] CANCER SCREENING SERVICES, and professionally recognized
best practices guidelines.
S 7. Subdivisions 2 and 3 of section 2406 of the public health law are
REPEALED.
S 8. Section 2409 of the public health law, as added by chapter 275 of
the laws of 1995, is REPEALED.
S 9. Subdivisions 2 and 3 of section 95-a of the state finance law, as
added by chapter 275 of the laws of 1995, are amended to read as
follows:
2. Such fund shall consist of all monies appropriated [for the purpose
of] TO such fund and any grant, gift or bequest made to the [breast
cancer detection and education program advisory council] FUND.
3. Monies of the fund shall be available [to the breast cancer
detection and education program advisory council] for the purposes of
the [New York state innovation in breast] cancer [early] detection and
[research awards] EDUCATION program, pursuant to section twenty-four
hundred [nine] FIVE of the public health law.
S 9-a. Subdivision 3-a of section 2407 of the public health law is
REPEALED.
S 10. Subdivisions 1, 4, 5 and 6 of section 2406 of the public health
law, subdivision 1 as amended by chapter 176 of the laws of 2006, subdi-
vision 4 as amended and subdivision 5 as renumbered by chapter 334 of
the laws of 1990, subdivision 5 as added by chapter 328 of the laws of
1989, and subdivision 6 as added by chapter 323 of the laws of 1995, are
amended to read as follows:
1. The commissioner[, in consultation with the breast cancer detection
and education program advisory council established pursuant to section
twenty-four hundred seven of this title,] shall make grants within the
amounts appropriated to approved organizations[, as defined in subdivi-
sion three of this section,] for the provision of services relating to
the EVIDENCE BASED screening and detection of [breast] cancer as part of
this program. Such services shall include but not be limited to:
S. 6608 10 A. 9708
(a) promotion and provision of early detection of [breast] cancer,
including [mammography,] clinical [examination, and breast self-examina-
tion] EXAMINATIONS AND CANCER SCREENING SERVICES;
(b) provision of counseling and information on treatment options and
referral for appropriate medical treatment;
(c) dissemination of information to unserved and underserved popu-
lations, to the general public and to health care professionals concern-
ing [breast] cancer, the benefits of early detection and treatment, and
the availability of [breast] cancer screening services;
(d) identification of local [breast] cancer screening services within
the approved organization's region;
(e) provision of information, counseling and referral services to
individuals diagnosed with [breast] cancer; and
(f) provision of information regarding the availability of medical
assistance, including medical assistance under paragraph (v) of subdivi-
sion four of section three hundred sixty-six of the social services law,
to an individual who requires treatment for [breast, cervical, colon or
prostate] cancer.
[4.] 2. The commissioner[, in consultation with the breast cancer
detection and education program advisory council,] shall give notice and
provide opportunity [for organizations described in subdivision three of
this section] to submit applications to provide [breast] cancer
detection and education programs. In order to be considered for a grant
to provide [breast] cancer detection and education programs, applicants
must show evidence of the following:
(a) ability to provide and to ensure consistent and quality [breast]
cancer detection services;
(b) expertise in [breast] cancer detection and treatment;
(c) capacity to coordinate services with physicians, hospitals and
other appropriate local institutions or agencies;
(d) ability to provide [breast] cancer detection and education
services to unserved or underserved populations; and
(e) ability to implement a [breast] cancer detection and education
program in accordance with the standards specified in subdivision [five]
THREE of this section.
Applications shall be made on forms provided by the commissioner. [The
breast cancer detection and education program advisory council shall
review and evaluate applications and make recommendations to the commis-
sioner for approval of grants to organizations to provide breast cancer
detection and education programs.]
[5.] 3. The commissioner[, in consultation with the breast cancer
detection and education program advisory council,] shall develop stand-
ards for the implementation of [breast] cancer detection and education
programs by approved organizations which shall ensure the following:
(a) integration of the approved organization with existing health care
providers;
(b) maximizing third party reimbursement;
(c) provision of services to unserved or underserved populations.
[6.] 4. Within the amounts of state or federal funds appropriated for
[cervical] cancer early detection and diagnosis, approved organizations
may be authorized by the department to provide such services for popu-
lations served pursuant to this title. Early detection services shall
include, but not be limited to, complete [pelvic] examinations, [pap
smears,] EVIDENCE BASED SCREENING, patient education, counseling,
follow-up and referral.
S. 6608 11 A. 9708
S 11. Section 2406-a of the public health law, as added by chapter
623 of the laws of 2007, is amended to read as follows:
S 2406-a. Grants to community-based organizations. 1. The commission-
er[, in consultation with the breast and cervical cancer detection and
education program advisory council established pursuant to section twen-
ty-four hundred seven of this title,] shall make grants within any such
amount as may be appropriated specifically for community-based organiza-
tions for the provision of counseling, education and outreach programs
for persons diagnosed with breast cancer.
2. For the purposes of this section, "community-based organizations"
shall mean grass roots, free-standing organizations in which breast
cancer survivors hold significant decision-making responsibility, and
which offer a broad range of breast cancer education and support
services free of charge.
3. The commissioner[, in consultations with the breast and cervical
cancer detection and education program advisory council,] shall provide
notice and opportunity for community-based organizations to submit
applications to provide post-diagnosis breast cancer counseling, educa-
tion and outreach programs. Such applications shall be on forms estab-
lished by the commissioner. [The breast and cervical cancer detection
and education program advisory council shall review and evaluate appli-
cations submitted pursuant to this subdivision and shall make recommen-
dations thereon to the commissioner for approval of grants to communi-
ty-based organizations for the provision of post-diagnosis breast cancer
counseling, education and outreach programs.]
S 12. Section 1 of chapter 462 of the laws of 1996, relating to estab-
lishing a quality incentive payment program, is REPEALED.
S 13. Paragraph (bbb) 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:
(bbb) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of awarding grants to operators of adult homes, enriched housing
programs and residences through the enhancing abilities and life experi-
ence (EnAbLe) program to provide for the installation, operation and
maintenance of air conditioning in resident rooms, consistent with this
paragraph, in an amount up to two million dollars for the period April
first, two thousand six through March thirty-first, two thousand seven,
up to three million eight hundred thousand dollars for the period April
first, two thousand seven through March thirty-first, two thousand
eight, up to three million eight hundred thousand dollars for the period
April first, two thousand eight through March thirty-first, two thousand
nine, AND up to three million eight hundred thousand dollars for the
period April first, two thousand nine through March thirty-first, two
thousand ten[, and up to three million eight hundred thousand dollars
for the period April first, two thousand ten through March thirty-first,
two thousand eleven]. Residents shall not be charged utility cost for
the use of air conditioners supplied under the EnAbLe program. All such
air conditioners must be operated in occupied resident rooms consistent
with requirements applicable to common areas.
S 13-a. Subdivision 1 of section 2807-v of the public health law is
amended by adding a new paragraph (iii) to read as follows:
(III) FUNDS SHALL BE RESERVED AND ACCUMULATED FROM YEAR TO YEAR AND
SHALL BE AVAILABLE, INCLUDING INCOME FROM INVESTED FUNDS, FOR PURPOSES
OF AWARDING GRANTS TO OPERATORS OF ADULT HOMES, ENRICHED HOUSING
PROGRAMS AND RESIDENCES FOR QUALITY IMPROVEMENTS IN ADULT HOMES,
S. 6608 12 A. 9708
ENRICHED HOUSING PROGRAMS AND RESIDENCES, IN AN AMOUNT UP TO FOUR
MILLION THREE HUNDRED ELEVEN THOUSAND SEVEN HUNDRED DOLLARS FOR THE
PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND ELEVEN.
S 14. Section 217 of the elder law is REPEALED.
S 14-a. Subparagraph 1 of paragraph (a) of subdivision 2 of section
214 of the elder law is amended to read as follows:
(1) a statement of goals and objectives for addressing the needs of
elderly persons in the county, an assessment of the needs of elderly
persons residing in the county, a description of public and private
resources that currently provide community services to elderly persons
within the county, a description of intended actions to consolidate and
coordinate existing community services administered by county govern-
ment, [a description of the intended actions to coordinate congregate
services programs for the elderly operated within the county pursuant to
section two hundred seventeen of this title with other community
services for the elderly,] a description of the means to coordinate
other community services for elderly persons in the county with those
administered by county government, and a statement of the priorities for
the provision of community services during the program period covered by
such plan;
S 15. Section 2799-f of the public health law, as added by chapter 114
of the laws of 2004, is amended to read as follows:
S 2799-f. Comprehensive care centers for eating disorders; estab-
lished. [1.] The commissioner shall [facilitate the development, and]
provide for the public identification[,] of comprehensive care centers
for persons with eating disorders[. The development and identification
of such centers shall be] for the purposes of:
[(a)] 1. Promoting the [development and] operation of a continuum of
comprehensive, coordinated care for persons with eating disorders;
[(b)] 2. Promoting ready access to information, referral and treatment
services on eating disorders for consumers, health practitioners,
providers and insurers, with access in every region of the state;
[(c)] 3. Promoting community education, prevention and patient entry
into care; and
[(d)] 4. Promoting and coordinating regional and statewide research
efforts into effective methods of education, prevention and treatment,
including research on the various models of care.
[2. In order to identify such comprehensive care centers, the commis-
sioner shall issue a request for applications ("hereinafter referred to
in this section as RFA"). The form and content of such RFA shall be
prepared with input from individuals and organizations who at a minimum
are representative of health care practitioners and providers with
expertise in the care of persons with eating disorders as well as from
persons and families with experience in the diagnosis and treatment of
these disorders. Such RFA shall be issued not later than one hundred
twenty days following the effective date of this article.]
S 16. Paragraph (d) of subdivision 1 of section 2799-g of the public
health law, as added by chapter 114 of the laws of 2004, is amended to
read as follows:
(d) The applicant meets such additional criteria as [is specified in
the RFA] ARE ESTABLISHED BY THE COMMISSIONER.
S 17. Subdivision 2 of section 2799-h of the public health law, as
added by chapter 114 of the laws of 2004, is amended to read as follows:
2. The commissioner's [written notice to applicants, which shall be
provided no later than ninety days following the receipt of a satisfac-
S. 6608 13 A. 9708
tory application, shall identify the applicant as a state-identified]
IDENTIFICATION OF A comprehensive care center for eating disorders under
this article[, provided however that such notice] shall be valid for not
more than a two year period from the date of issuance. The commissioner
may reissue such [written notices] IDENTIFICATIONS for subsequent peri-
ods of up to two years, provided that the comprehensive care center has
notified the commissioner of any material changes in structure or opera-
tion based on its original [RFA submission] APPLICATION, or since its
last written notice by the commissioner, and that the commissioner is
satisfied that the center continues to meet the criteria required pursu-
ant to this article.
S 18. Sections 2799-j and 2799-l of the public health law are
REPEALED.
S 19. Section 95-e of the state finance law, as added by chapter 114
of the laws of 2004, is REPEALED.
S 20. Intentionally omitted.
S 21. Intentionally omitted.
S 22. Intentionally omitted.
S 23. Intentionally omitted.
S 24. Intentionally omitted.
S 25. Intentionally omitted.
S 26. Section 207 of the public health law, as added by chapter 414 of
the laws of 2005, subdivision 1 as amended by chapter 471 of the laws of
2007, paragraph (f) of subdivision 1 as added by chapter 570 of the laws
of 2008 and paragraph (f) of subdivision 1 as added by chapter 573 of
the laws of 2008, is amended to read as follows:
S 207. Health care and wellness education and outreach program. 1.
There is hereby created within the department the health care and well-
ness education and outreach program. The department [shall] MAY conduct
education and outreach programs for consumers, patients, and health care
providers relating to any health care matters the commissioner deems
appropriate and:
(a) Various health conditions, diseases and health care procedures and
treatment options, INCLUDING BUT NOT LIMITED TO THOSE FOR BREAST, CERVI-
CAL, COLORECTAL, PROSTATE, TESTICULAR, SKIN, AND OVARIAN CANCER, SHAKEN
BABY SYNDROME, AND REFLEX SYMPATHETIC DYSTROPHY.
(b) Recommended preventative and wellness practices and services,
including EVIDENCE BASED age and gender appropriate testing and screen-
ing exams and immunization schedules.
(c) Lymphedema, an abnormal swelling of the extremities including the
causes and symptoms of lymphedema, the value of early detection, possi-
ble options for treatment including their benefits and risks, and other
relevant information and the recommendation that hospitals treating
breast cancer patients implement a lymphedema alert program by placing a
bright pink wristband on the patient's affected arm.
(d) The need and importance of organ and tissue donation, including
information about being registered as an organ and tissue donor and
executing documents of gift under article forty-three of this chapter.
(e) The need and importance for consumers and patients to have an
advance directive, particularly a health care proxy, and the need and
importance for health care providers to play a leadership role in
discussing end-of-life care preferences and values with patients and to
provide patients with health care proxy forms.
(f) Uterine fibroids, an abnormal growth that occurs in the uterus,
including the causes and symptoms of uterine fibroids, the value of
early detection, possible options for treatment including their benefits
S. 6608 14 A. 9708
and risks, information on the elevated risk for minority women and other
relevant information.
[(f)] (G) Improving birth outcomes, including the importance of
preconceptional care, early prenatal care, considerations of health
risks during pregnancy, considerations of benefits and risks of labor
and delivery options including, but not limited to, vaginal and cesarean
section delivery, elective or repeat cesarean sections, and appropriate
use of drugs during delivery.
2. Programs under this section, dealing with one or more subjects, may
include but not be limited to any of the following elements:
(a) educational and informational materials in print, audio, visual,
electronic or other media;
(b) public service announcements and advertisements; and
(c) establishment of toll-free telephone hotlines and electronic
services to provide information.
3. The department [shall] MAY produce, make available to others for
reproduction, or contract with others to develop such materials
mentioned in this section as the commissioner deems appropriate. These
materials shall be made available to the public free of charge as appro-
priate or for a fee under certain circumstances. The commissioner may
require where appropriate any health care provider to make these materi-
als available to patients.
4. In exercising any of his or her powers under this section, the
commissioner [shall] MAY consult with appropriate health care profes-
sionals, providers, consumers, and patients or organizations represent-
ing them.
5. The commissioner [shall] MAY ensure that all information and mate-
rials produced pursuant to this section are maintained and updated to
reflect best practice recommendations.
6. The commissioner may appoint as appropriate advisory councils
relating to various matters that are or are proposed to be the subjects
of programs under this section. All such councils shall include repre-
sentation of health care professionals, providers, consumers, patients
and other appropriate interests. The members of the councils shall
receive no compensation for their services, but shall be allowed their
actual and necessary expenses incurred in performance of their duties.
7. In addition to state funds appropriated for programs under this
section, the commissioner may accept grants from public or private
sources for these programs. The commissioner, in administering this
section, shall seek to coordinate the department's programs with other
public and private programs, and may undertake joint or cooperative
programs with other public or private entities.
8. The commissioner may make rules and regulations necessary and
appropriate for implementation of this section.
S 27. Paragraph (m) of subdivision 1 of section 201 of the public
health law, as amended by section 3 of part A of chapter 58 of the laws
of 2009, 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], IN RELATION to hotels, boarding houses and temporary resi-
dences as defined in the state sanitary code [and], inspect such facili-
ties (I) WHERE INSPECTIONS DO NOT OTHERWISE OCCUR UNDER THE STATE
S. 6608 15 A. 9708
UNIFORM FIRE PREVENTION AND BUILDING CODE, (II) TO RESPOND TO
COMPLAINTS, OR (III) when otherwise necessary;
S 28. Article 43-C of the public health law is REPEALED.
S 29. Section 2745 of the public health law is REPEALED.
S 30. Paragraph (c) of subdivision 3 of section 242 of the elder law,
as amended by section 4 of part A of chapter 58 of the laws of 2005, is
amended to read as follows:
(c) The fact that some of an individual's prescription drug expenses
are paid or reimbursable under the provisions of the medicare program
shall not disqualify an individual, if he or she is otherwise eligible,
from receiving assistance under this title. [In such cases, the state
shall pay the portion of the cost of those prescriptions for qualified
drugs for which no payment or reimbursement is made by the medicare
program or any federally funded prescription drug benefit, less the
participant's co-payment required on the amount not paid by the medicare
program. In addition, the participant registration fee charged to eligi-
ble program participants for comprehensive coverage pursuant to section
two hundred forty-seven of this title shall be waived for the portion of
the annual coverage period that the participant is also enrolled as a
transitional assistance beneficiary in the medicare prescription drug
discount card program, authorized pursuant to title XVIII of the federal
social security act, provided that: (i) any sponsor of such drug
discount card program has signed an agreement to complete coordination
of benefit functions with EPIC, and has been endorsed by the EPIC panel;
or (ii) any exclusive sponsor of such drug discount card program author-
ized pursuant to title XVIII of the federal social security act that
limits the participants to the medicare prescription drug discount card
program sponsored by such exclusive sponsor, shall coordinate benefits
available under such discount card program with EPIC.] HOWEVER, EXCEPT
FOR DRUGS EXCLUDED FROM MEDICARE COVERAGE IN ACCORDANCE WITH SECTION
1860D-2 OF THE FEDERAL SOCIAL SECURITY ACT, SUCH ASSISTANCE SHALL BE
LIMITED TO PRESCRIPTION DRUGS COVERED BY THE INDIVIDUAL'S MEDICARE PLAN.
IN SUCH CASES, THE STATE SHALL COVER THE AMOUNT THAT IS THE RESPONSIBIL-
ITY OF THE INDIVIDUAL UNDER THE MEDICARE PLAN BENEFIT, SUBJECT TO THE
INDIVIDUAL'S COST-SHARING RESPONSIBILITY UNDER SECTIONS TWO HUNDRED
FORTY-SEVEN OR TWO HUNDRED FORTY-EIGHT OF THIS TITLE ON SUCH AMOUNT. The
participant registration fee charged to eligible program participants
for comprehensive coverage pursuant to section two hundred forty-seven
of this title shall be waived for the portion of the annual coverage
period that the participant is also enrolled as a full subsidy individ-
ual in a prescription drug or MA-PD plan under Part D of title XVIII of
the federal social security act.
S 31. Paragraphs (f), (g) and (h) of subdivision 3 of section 242 of
the elder law, as added by section 3 of part B of chapter 58 of the laws
of 2007, are amended to read as follows:
(f) As a condition of [continued] eligibility for benefits under this
title, if a program participant is eligible for Medicare part D drug
coverage under section 1860D of the federal social security act, the
participant is required to enroll in Medicare part D at the first avail-
able enrollment period and to maintain such enrollment. This requirement
shall be waived if such enrollment would [result in significant addi-
tional financial liability by the participant, including, but not limit-
ed to, individuals in a Medicare advantage plan whose cost sharing would
be increased, or if such enrollment would] result in the loss of any
health coverage through a union or employer plan for the participant,
the participant's spouse or other dependent. The elderly pharmaceutical
S. 6608 16 A. 9708
insurance coverage program shall provide premium assistance for all
participants enrolled in Medicare part D as follows:
(i) for participants with comprehensive coverage under section two
hundred forty-seven of this title, the elderly pharmaceutical insurance
coverage program shall pay for the portion of the part D monthly premium
that is the responsibility of the participant. Such payment shall be
limited to the low-income benchmark premium amount established by the
federal centers for Medicare and Medicaid services and any other amount
which such agency establishes under its de minimus premium policy[,
except that such payments made on behalf of participants enrolled in a
Medicare advantage plan may exceed the low-income benchmark premium
amount if determined to be cost effective to the program].
(ii) for participants with catastrophic coverage under section two
hundred forty-eight of this title, the elderly pharmaceutical insurance
coverage program shall credit the participant's annual personal covered
drug expenditure amount required under this title by an amount equal to
the annual low-income benchmark premium amount established by the
centers for Medicare and Medicaid services, prorated for the remaining
portion of the participant's elderly pharmaceutical insurance coverage
program coverage period. The elderly pharmaceutical insurance coverage
program shall, at appropriate times, notify participants with
catastrophic coverage under section two hundred forty-seven of this
title of their right to coordinate the annual coverage period with that
of Medicare part D, along with the possible advantages and disadvantages
of doing so.
(g) The elderly pharmaceutical insurance coverage program is author-
ized and directed to conduct an enrollment program to facilitate, in as
prompt and streamlined a fashion as possible, the enrollment into Medi-
care part D of program participants who are required by the provisions
of this section to enroll in part D. [Provided, however, that a partic-
ipant shall not be prevented from receiving his or her drugs immediately
at the pharmacy under the elderly pharmaceutical insurance coverage
program as a result of such participant's enrollment in Medicare part
D.]
(h) In order to maximize prescription drug coverage under Medicare
part D, the elderly pharmaceutical insurance coverage program is author-
ized to represent program participants under this title in the pursuit
of such coverage. Such representation [shall not result in any addi-
tional financial liability on behalf of such program participants and]
shall include, but not be limited to, the following actions:
(i) application for the premium and cost-sharing subsidies on behalf
of eligible program participants;
(ii) enrollment in a prescription drug plan or MA-PD plan; the elderly
pharmaceutical insurance coverage program shall provide program partic-
ipants with prior written notice of, and the opportunity to decline such
facilitated enrollment subject, however, to the provisions of paragraph
(f) of this subdivision;
(iii) pursuit of appeals, grievances, or coverage determinations.
S 32. Subdivision 6 of section 250 of the elder law is REPEALED.
S 33. Subparagraph 5 of paragraph (b) of subdivision 3 of section 602
of the public health law, as added by chapter 901 of the laws of 1986,
is amended to read as follows:
(5) environmental health, which shall include activities that promote
health and prevent illness by ensuring sanitary conditions in water
supplies, food service establishments, and other permit sites, and by
S. 6608 17 A. 9708
[abating] ASSURING THE ABATEMENT OF public health nuisances BY RESPONSI-
BLE PARTIES.
The commissioner shall promulgate rules and regulations that define
the specific activities within each of the five categories. The commis-
sioner prior to promulgation of rules and regulations defining the
nature of the specific activities, shall consult with the public health
council and county health commissioners, boards and public health direc-
tors. The list of specific activities may be altered by the commissioner
as necessary and after his consultation with the council, commissioners,
boards and public health directors named herein.
S 34. Section 677 of the county law is amended by adding a new subdi-
vision 9 to read as follows:
9. WHEN REQUIRED FOR OFFICIAL PURPOSES OF THE STATE DEPARTMENT OF
HEALTH, THE STATE COMMISSIONER OF HEALTH OR HIS OR HER DESIGNEE MAY
REQUEST COPIES OF ALL REPORTS AND RECORDS RELATED TO A DEATH, INCLUDING
BUT NOT LIMITED TO AUTOPSY REPORTS AND TOXICOLOGY REPORTS. UPON RECEIPT
OF THE WRITTEN REQUEST OF THE STATE COMMISSIONER OF HEALTH OR HIS OR HER
DESIGNEE, A CORONER, CORONER'S PHYSICIAN OR MEDICAL EXAMINER, SHALL,
WITHIN THREE BUSINESS DAYS OF THEIR COMPLETION, PROVIDE TO SUCH COMMIS-
SIONER OR HIS OR HER DESIGNEE A COPY OF ALL REPORTS AND RECORDS, INCLUD-
ING BUT NOT LIMITED TO AUTOPSY REPORTS AND TOXICOLOGY REPORTS, RELATED
TO THE DEATH.
S 35. Article 27-I of the public health law is REPEALED.
S 36. Paragraph (a) of subdivision 5 of section 2819 of the public
health law, as amended by chapter 239 of the laws of 2005, is amended to
read as follows:
(a) Subject to paragraph (c) of this subdivision, on or before [May]
SEPTEMBER first of each year the commissioner shall submit a report to
the governor and the legislature, which shall simultaneously be
published in its entirety on the department's web site, that includes,
but is not limited to, hospital acquired infection rates adjusted for
the potential differences in risk factors for each reporting hospital,
an analysis of trends in the prevention and control of hospital acquired
infection rates in hospitals across the state, regional and, if avail-
able, national comparisons for the purpose of comparing individual
hospital performance, and a narrative describing lessons for safety and
quality improvement that can be learned from leadership hospitals and
programs.
S 37. Section 2995-a of the public health law is amended by adding a
new subdivision 1-a to read as follows:
1-A. EACH PHYSICIAN LICENSED AND REGISTERED TO PRACTICE IN THIS STATE
SHALL WITHIN ONE HUNDRED TWENTY DAYS OF THE EFFECTIVE DATE OF THIS
SUBDIVISION AND UPON ENTERING OR UPDATING HIS OR HER PROFILE INFORMA-
TION:
(A) REGISTER AND MAINTAIN AN ACCOUNT WITH THE DEPARTMENT'S HEALTH
PROVIDER NETWORK AND ANY SUCCESSOR ELECTRONIC SYSTEM ESTABLISHED TO
FACILITATE COMMUNICATIONS BETWEEN THE DEPARTMENT AND LICENSED HEALTH
CARE PROVIDERS; OR
(B) PROVIDE AN E-MAIL ADDRESS TO THE DEPARTMENT WHICH SHALL BE USED BY
THE DEPARTMENT TO COMMUNICATE WITH THE PHYSICIAN. LICENSEES SHALL
PROVIDE NOTICE TO THE DEPARTMENT OF CHANGED E-MAIL ADDRESSES WITHIN
THIRTY DAYS OF THE CHANGE. LICENSEE E-MAIL ADDRESSES SHALL BE CONFIDEN-
TIAL AND SHALL NOT BE PUBLISHED AS PART OF THE LICENSEE'S PROFILE. THE
E-MAIL ADDRESSES MAY BE USED FOR DEPARTMENT PURPOSES ONLY.
S 38. The public health law is amended by adding a new section 2816-a
to read as follows:
S. 6608 18 A. 9708
S 2816-A. CARDIAC SERVICES INFORMATION. 1. DEFINITIONS. FOR THE
PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING
MEANINGS:
(A) "CARDIAC SERVICES INFORMATION" SHALL MEAN THE DEMOGRAPHIC, CLIN-
ICAL, PROCEDURAL AND OUTCOME INFORMATION COLLECTED FROM HOSPITALS AND
MAINTAINED BY THE DEPARTMENT REGARDING PATIENTS WHO HAVE BEEN DIAGNOSED
OR TREATED FOR CARDIAC DISEASE OR CONDITIONS.
(B) "CARDIAC DATA SET" SHALL MEAN A SUBSET OF CARDIAC SERVICES INFOR-
MATION CONSISTING OF DATA ELEMENTS RELEVANT TO A RESEARCH PROJECT.
2. NOTWITHSTANDING ARTICLES SIX AND SIX-A OF THE PUBLIC OFFICERS LAW,
THE COMMISSIONER MAY COLLECT AND MAINTAIN CARDIAC SERVICES INFORMATION
AND PREPARE AND RELEASE CARDIAC DATA SETS FOR USE IN RESEARCH PROJECTS
AS SET FORTH IN THIS SUBDIVISION. ANY CARDIAC DATA SET RELEASED SHALL
CONTAIN THE MINIMUM AMOUNT OF PERSONALLY IDENTIFIABLE INFORMATION WHICH
THE COMMISSIONER DETERMINES IS NECESSARY TO CONDUCT THE RESEARCH PROJECT
PROVIDED, HOWEVER, THAT NO CARDIAC DATA SET SHALL BE RELEASED THAT
CONTAINS PATIENT NAMES, SOCIAL SECURITY NUMBERS, OR OTHER DATA ELEMENTS
THAT DIRECTLY IDENTIFY ANY PATIENT.
3. THE COMMISSIONER MAY RELEASE CARDIAC DATA SETS FOR RESEARCH
PROJECTS BASED ON THE FOLLOWING FACTORS:
(A) THE RESEARCH PROJECT'S POTENTIAL CONTRIBUTION TO IMPROVING THE
QUALITY OF CARE AND OUTCOMES EXPERIENCED BY PATIENTS RECEIVING CARDIAC
SERVICES, THE APPROPRIATENESS OF CARDIAC SERVICES, ACCESS TO CARDIAC
SERVICES, AND/OR THE COST EFFECTIVENESS OF CARDIAC SERVICES;
(B) THE TECHNICAL FEASIBILITY OF PREPARING THE CARDIAC DATA SET
REQUESTED;
(C) THE SCIENTIFIC MERIT OF THE RESEARCH PROJECT;
(D) THE EXPERIENCE AND QUALIFICATIONS OF THE RESEARCHERS;
(E) THE RESEARCH PROJECT'S FEASIBILITY;
(F) THE APPLICANT'S CAPACITY AND AGREEMENT TO PROTECT THE CONFIDEN-
TIALITY OF THE DATA;
(G) THE RESEARCH PROJECT'S COMPLIANCE WITH APPLICABLE STATE AND FEDER-
AL LAWS, POLICIES AND REGULATIONS GOVERNING THE PROTECTION OF HUMAN
SUBJECTS; AND
(H) SUCH OTHER CRITERIA AS THE COMMISSIONER DEVELOPS IN CONSULTATION
WITH EXPERTS IN CARDIAC SERVICES.
4. ANY RESEARCHER AUTHORIZED BY THE COMMISSIONER TO ACCESS A CARDIAC
DATA SET SHALL:
(A) MAINTAIN THE SECURITY AND CONFIDENTIALITY OF THE INFORMATION;
(B) NOT DISCLOSE THE CARDIAC DATA SET, OR ANY PORTION THEREOF, UNLESS
SPECIFICALLY PERMITTED TO DO SO BY THE COMMISSIONER;
(C) RESTRICT THE USE OF THE DATA TO THE SPECIFIC RESEARCH PROJECT
APPROVED BY THE COMMISSIONER;
(D) DESTROY, AND DOCUMENT THE DESTRUCTION OF, THE DATA WITHIN A TIME
PERIOD SPECIFIED BY THE COMMISSIONER; AND
(E) EXECUTE AND COMPLY WITH A CARDIAC SERVICES DATA USE AGREEMENT,
WHICH INCLUDES BUT IS NOT LIMITED TO PROVISIONS RESTRICTING THE USE AND
DISCLOSURE OF THE DATA.
5. THE COMMISSIONER SHALL CHARGE A FEE FOR EACH CARDIAC DATA SET
RELEASED. SUCH FEE SHALL BE PAYABLE TO THE DEPARTMENT, PRIOR TO THE
RELEASE OF ANY CARDIAC DATA SET, FOR DEPOSIT INTO THE GENERAL FUND.
6. THE COMMISSIONER MAY PROMULGATE AND ENFORCE SUCH RULES AND REGU-
LATIONS AS HE OR SHE DEEMS NECESSARY TO EFFECTUATE THE PURPOSES OF THIS
SECTION.
S 39. Paragraph (iv) of subdivision 4 of section 1 of part C of chap-
ter 57 of the laws of 2006, relating to establishing a cost of living
S. 6608 19 A. 9708
adjustment for designated human services programs, as amended by section
7 of part F of chapter 497 of the laws of 2008, is amended to read as
follows:
(iv) Programs eligible for the cost of living adjustments under the
auspice of the department of health include: [HIV/AIDS adolescent
services/ACT for youth; HIV/AIDS adolescent service/general; HIV/AIDS
adolescent services/schools; HIV/AIDS clinical education; HIV/AIDS clin-
ical guidelines development; HIV/AIDS clinical scholars; HIV/AIDS clin-
ical trials experimental treatment; HIV/AIDS community development
initiative; HIV/AIDS community HIV prevention and primary care; HIV/AIDS
community services programs; HIV/AIDS criminal justice; HIV/AIDS educa-
tion and training; HIV/AIDS evaluation and research; HIV/AIDS expanded
syringe access program; HIV/AIDS families in transition; HIV/AIDS family
centered care; HIV/AIDS harm reduction/general; HIV/AIDS harm
reduction/syringe exchange; HIV/AIDS HIV health care and support
services for women and kids; HIV/AIDS HIV prevention/primary
care/support services for substance abusers; HIV/AIDS homeless shelters;
HIV/AIDS legal services and advocacy; HIV/AIDS lesbian, gay, bisexual,
transgender/adolescent; HIV/AIDS lesbian, gay, bisexual, transgender/
general; HIV/AIDS lesbian, gay, bisexual, transgender/substance use;
HIV/AIDS multiple service agency; HIV/AIDS nutritional services;
HIV/AIDS pediatric centers of excellence; HIV/AIDS permanency planning;
HIV/AIDS racial and ethnic minority; HIV/AIDS social day care; HIV/AIDS
specialized care centers for youth; HIV/AIDS specialty; HIV/AIDS
supportive housing; HIV/AIDS treatment adherence; HIV/AIDS women's
services/general; HIV/AIDS women's services/peer; HIV/AIDS women's
services/supportive services; HIV/AIDS youth access program,] REGIONAL
AND TARGETED HIV, STD AND HEPATITIS C SERVICES; HIV, STD AND HEPATITIS C
PREVENTION; HIV HEALTH CARE AND SUPPORTIVE SERVICES; HEPATITIS C
PROGRAMS; HIV, STD AND HEPATITIS C CLINICAL AND PROVIDER EDUCATION
PROGRAMS; office of minority health; center for community health
program; red cross emergency preparedness; nutrition outreach and educa-
tion; obesity prevention AND DIABETES RELATED PROGRAMS; women, infants,
and children; hunger prevention and nutrition assistance; Indian health;
asthma; prenatal care assistance program; rape crisis; [health and human
services sexuality related; maternity/early childhood foundation;]
comprehensive adolescent pregnancy prevention; family planning; school
health; sudden infant death syndrome; childhood lead poisoning
prevention; [enhanced services for kids; act for youth;] children with
special health care needs; regional perinatal [data] centers; migrant
health; dental services; osteoporosis prevention; [eating disorders;]
cancer services PROGRAMS; [cancer registry;] healthy heart; alzheimer's
disease assistance centers; alzheimer's disease - research and educa-
tion; [diabetes screening, education and prevention;] tobacco control;
rabies; tick-borne DISEASE; immunization; universal prenatal and post-
partum home visitation public health campaign; sexually transmitted
disease; and tuberculosis control.
S 40. Subdivision 18-a of section 206 of the public health law, as
added by section 74 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
18-a. (A) Health information technology demonstration program. [1.]
(I) The commissioner is authorized to issue grant funding to one or more
organizations broadly representative of physicians licensed in this
state, from funds made available for the purpose of funding research and
demonstration projects under [subdivision two of this section] SUBPARA-
GRAPH (II) OF THIS PARAGRAPH designed to promote the development of
S. 6608 20 A. 9708
electronic health information exchange technologies in order to facili-
tate the adoption of interoperable health records.
[2.] (II) Project funding shall be disbursed to projects pursuant to a
request for proposals based on criteria relating to promoting the effi-
cient and effective delivery of quality physician services. Demon-
stration projects eligible for funding under this [section] PARAGRAPH
shall include, but not be limited to:
[(a)] (A) efforts to incentivize electronic health record adoption;
[(b)] (B) interconnection of physicians through regional collab-
orations;
[(c)] (C) efforts to promote personalized health care and consumer
choice;
[(d)] (D) efforts to enhance health care outcomes and health status
generally through interoperable public health surveillance systems and
streamlined quality monitoring.
[3.] (III) The department shall issue a report to the governor, the
temporary president of the senate and the speaker of the assembly within
one year following the issuance of the grants. Such report shall
contain, at a minimum, the following information: the demonstration
projects implemented pursuant to this [section] PARAGRAPH, their date of
implementation, their costs and the appropriateness of a broader appli-
cation of the health information technology program to increase the
quality and efficiency of health care across the state.
(B) THE COMMISSIONER SHALL MAKE SUCH RULES AND REGULATIONS AS MAY BE
NECESSARY TO IMPLEMENT FEDERAL POLICIES AND DISBURSE FUNDS AS REQUIRED
BY THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 AND TO PROMOTE THE
DEVELOPMENT OF A STATEWIDE HEALTH INFORMATION NETWORK OF NEW YORK
(SHIN-NY) TO ENABLE WIDESPREAD INTEROPERABILITY AMONG DISPARATE HEALTH
INFORMATION SYSTEMS, INCLUDING ELECTRONIC HEALTH RECORDS, PERSONAL
HEALTH RECORDS AND PUBLIC HEALTH INFORMATION SYSTEMS, WHILE PROTECTING
PRIVACY AND SECURITY. SUCH RULES AND REGULATIONS SHALL INCLUDE, BUT NOT
BE LIMITED TO, REQUIREMENTS FOR ORGANIZATIONS COVERED BY 42 U.S.C. 17938
OR ANY OTHER ORGANIZATIONS THAT EXCHANGE HEALTH INFORMATION THROUGH THE
SHIN-NY.
S 41. This act shall take effect April 1, 2010, provided however that:
(a) section three of this act shall take effect March 1, 2011;
(b) sections thirty, thirty-two and thirty-seven of this act and the
amendments to paragraph (g) of subdivision 3 of section 242 of the elder
law made by section thirty-one of this act shall take effect July 1,
2010;
(c) the amendments to paragraphs (f) and (h) of subdivision 3 of
section 242 of the elder law made by section thirty-one of this act
shall take effect January 1, 2011;
(d) section thirty-eight of this act shall take effect on the one
hundred eightieth day after it shall have become a law; and
(e) the amendments to section 1 of part C of chapter 57 of the laws of
2006 made by section thirty-nine of this act shall not affect the repeal
of such section and shall be deemed repealed therewith.
PART B
Section 1. 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, in determining rates of
payments by state governmental agencies effective for services provided
S. 6608 21 A. 9708
on and after April 1, 2010, 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, long term home health care
programs and AIDS home care programs, and for personal care services
provided pursuant to section 365-a of the social services law, the
commissioner of health shall apply zero trend factor projections attrib-
utable to the 2010 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 2010 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 commissioner 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 April 1, 2010, trend factor
projections attributable to the 2010 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 2. Subparagraph (vi) of paragraph (a) of subdivision 2 of section
2807-d of the public health law, as added by section 49 of part B of
chapter 58 of the laws of 2009, is amended 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, PROVIDED, HOWEVER, THAT FOR PERIODS ON AND
AFTER APRIL FIRST, TWO THOUSAND TEN, SUCH ASSESSMENT FOR SUCH SERVICES
SHALL BE SEVENTY-FIVE HUNDREDTHS OF ONE PERCENT OF EACH SUCH GENERAL
HOSPITAL'S GROSS RECEIPTS, PROVIDED FURTHER, HOWEVER, THAT AMOUNTS IN
EXCESS OF THIRTY-FIVE HUNDREDTHS OF ONE PERCENT SHALL BE ASSESSED ONLY
WITH REGARD TO GROSS RECEIPTS FOR INPATIENT CARE SERVICES AND OTHER
OPERATING INCOME ON A CASH BASIS AND SHALL NOT BE ASSESSED WITH REGARD
TO GROSS RECEIPTS FOR OUTPATIENT SERVICES.
S 3. Subparagraph (v) of paragraph (b) of subdivision 35 of section
2807-c of the public health law, as added by section 2 of part C of
chapter 58 of the laws of 2009, is amended to read as follows:
(v) Such regulations [may] SHALL incorporate quality related measures
pertaining to potentially preventable complications and re-admissions;
PROVIDED THAT RATE ADJUSTMENTS MADE IN ACCORDANCE WITH A METHODOLOGY
SPECIFIED IN SUCH REGULATIONS SHALL RESULT IN AN AGGREGATE REDUCTION IN
MEDICAID PAYMENTS OF NO LESS THAN FORTY-NINE MILLION DOLLARS FOR THE
PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO
S. 6608 22 A. 9708
THOUSAND ELEVEN AND NO LESS THAN ONE HUNDRED EIGHT MILLION DOLLARS FOR
THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND TWELVE, NET OF ANY REINVESTMENT FOR HOSPITALS WITH IMPROVED
OR CONTINUED HIGH PERFORMANCE IN RELATION TO THE ESTABLISHED READMISSION
BENCHMARKS AND INITIATIVES FOR BEHAVIORAL HEALTH ADMISSION DIVERSION AND
POST-DISCHARGE LINKAGE PAYMENTS;
S 4. Subparagraph (xi) of paragraph (b) of subdivision 35 of section
2807-c of the public health law, as added by section 2 of part C of
chapter 58 of the laws of 2009, is amended to read as follows:
(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; PROVIDED THAT FOR THE PERIOD APRIL
FIRST, TWO THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND THIR-
TEEN, SUCH REGULATIONS SHALL SPECIFY A ONE PERCENTAGE POINT PER YEAR
REDUCTION IN THE INDIRECT GRADUATE MEDICAL EDUCATION PAYMENT PER
DISCHARGE AND THE AMOUNT OF INDIRECT GRADUATE MEDICAL EDUCATION EXCLUDED
FROM THE STATEWIDE BASE PRICE CALCULATED FOR THE PERIOD DECEMBER FIRST,
TWO THOUSAND NINE THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TEN. In addi-
tion, 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.
S 5. Subdivision 35 of section 2807-c of the public health law is
amended by adding a new paragraph (i) to read as follows:
(I) FOR DISCHARGES OCCURRING ON AND AFTER APRIL FIRST, TWO THOUSAND
TEN, AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION,
MEDICAID RATES FOR INPATIENT SERVICES FOR GENERAL HOSPITALS WHOSE RATES
ARE OTHERWISE SUBJECT TO THIS SUBDIVISION SHALL BE ADJUSTED IN ACCORD-
ANCE WITH THE FOLLOWING IN ORDER TO PROVIDE ADDITIONAL FUNDING FOR
OBSTETRICAL ACCESS AND QUALITY:
(I) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND ELEVEN AND EACH STATE FISCAL YEAR THEREAFTER,
SUCH RATES FOR ELIGIBLE GENERAL HOSPITALS SHALL BE ADJUSTED BY AN AGGRE-
GATE ANNUAL AMOUNT OF UP TO SEVENTY-TWO MILLION DOLLARS;
(II) SUCH ADJUSTMENTS SHALL BE MADE PROPORTIONATELY TO EACH ELIGIBLE
GENERAL HOSPITAL, WITH FIFTY PERCENT OF SUCH ADJUSTMENTS BASED ON EACH
SUCH HOSPITAL'S NUMBER OF REPORTED TWO THOUSAND SEVEN MEDICAID AND MEDI-
CAID MANAGED CARE CASE-MIX ADJUSTED OBSTETRICAL AND NEO-NATAL
DISCHARGES, AND FIFTY PERCENT OF SUCH ADJUSTMENTS BASED ON THE REGIONAL
COST PER DISCHARGE FOR SUCH CASES BASED UPON COST DATA AS REPORTED ON
LINE TWENTY-FIVE OF EXHIBIT EIGHTEEN OF THE TWO THOUSAND SIX COST REPORT
FILED PRIOR TO JANUARY FIRST, TWO THOUSAND NINE;
(III) PAYMENT OF SUCH ADJUSTMENTS FOR PERIODS ON AND AFTER APRIL
FIRST, TWO THOUSAND ELEVEN SHALL BE CONTINGENT UPON AN OTHERWISE ELIGI-
BLE GENERAL HOSPITAL'S CERTIFICATION TO THE COMMISSIONER THAT IT HAS
IMPLEMENTED OR HAS A DOCUMENTED PLAN, INCLUDING TIME-LINES, FOR IMPLE-
MENTING A COMPREHENSIVE AND SYSTEMATIC PERINATAL PATIENT SAFETY PROGRAM
WHICH IS IN CONFORMITY WITH PUBLISHED DEPARTMENT GUIDELINES, WHICH MAY
INCLUDE, BUT NOT BE LIMITED TO, SIMULATOR TRAINING, CREW RESOURCE
MANAGEMENT TRAINING, ELECTRONIC FETAL MONITORING EDUCATION, PEER REVIEW,
PARTICIPATION IN REGIONAL PERINATAL NETWORKS, FULL-TIME AVAILABILITY OF
MATERNAL FETAL MEDICINE SPECIALISTS, FULL-TIME AVAILABILITY OF INHOUSE
OBSTETRICIANS FOR LABOR AND DELIVERY, FULL PARTICIPATION IN THE DEPART-
MENT'S MATERNAL MORTALITY REVIEW PROGRAM, ESTABLISHMENT OF A MATERNAL
HEMORRHAGE EMERGENCY TEAM WITH PROTOCOLS AND DRILLS, A PROGRAM TO
CONVERT TO ELECTRONIC MEDICAL RECORDS WITHIN TWO YEARS, CURRENT ACTIVE
BOARD CERTIFICATION FOR STAFF OBSTETRICIANS ON STAFF FOR MORE THAN ONE
S. 6608 23 A. 9708
YEAR, AN ONGOING PROGRAM TO IMPLEMENT A FULLY INTEGRATED LONGITUDINAL
COMPUTERIZED PATIENT TRACKING SYSTEM FOR OBSTETRICAL PATIENTS AT BOTH
THE HOSPITAL AND AT THE PRIVATE OFFICES OF ATTENDING OBSTETRICIANS, AND
A PROGRAM TO REVIEW AND IMPROVE PATIENT SAFETY STANDARDS ON AN ONGOING
BASIS.
S 6. Notwithstanding any contrary provision of law, in the event the
amendment to subparagraph (xi) of paragraph (b) of subdivision 35 of
section 2807-c of the public health law, reducing indirect graduate
medical education payments per discharge to teaching hospitals, is not
enacted into law by a chapter of the laws of 2010, then the provision of
this act amending subdivision 35 of section 2807-c of the public health
law by adding a new paragraph (i), and the provisions of this act amend-
ing paragraphs (d) and (e) of subdivision 5-a of section 2807-m of the
public health law, shall be null and void and of no effect, provided,
however, that funds made available by the provisions of the amendment to
subparagraph (xi) of paragraph (b) of subdivision 35 of section 2807-c
of the public health law which are not otherwise made available in
connection with the implementation of amendments described herein to
sections 2807-m and paragraph (i) of subdivision 35 of section
2807-c(35)(i) of the public health law, shall be made available for the
statewide base price amounts computed pursuant to subdivision 35 of
section 2807-c of the public health law.
S 7. Section 2807-k of the public health law is amended by adding a
new subdivision 5-c to read as follows:
5-C. 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 PROVISIONS OF PARAGRAPH
(D) OF SUBDIVISION FIVE-A OF THIS SECTION AND TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, FOR PERIODS ON AND AFTER JANUARY FIRST,
TWO THOUSAND TEN, ALL FUNDS AVAILABLE FOR DISTRIBUTION PURSUANT TO THIS
SECTION AND SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE, AND AS
HEREINAFTER DESCRIBED SHALL BE RESERVED AND SET ASIDE AND DISTRIBUTED IN
ACCORDANCE WITH THE FOLLOWING:
(A) FOR THE PERIOD JANUARY FIRST, TWO THOUSAND TEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND TEN, PAYMENTS PURSUANT TO THIS SECTION SHALL BE
MADE IN AMOUNTS REFLECTING TWENTY-FIVE PERCENT OF THE DISTRIBUTIONS
OTHERWISE AUTHORIZED PURSUANT TO THE PROVISIONS OF THIS SECTION, OTHER
THAN THIS SUBDIVISION, AND SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS
ARTICLE.
(B) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TEN THROUGH DECEMBER
THIRTY-FIRST, TWO THOUSAND TEN, PAYMENTS TOTALING SEVEN HUNDRED
FORTY-SEVEN MILLION DOLLARS SHALL BE MADE AS FOLLOWS:
(I) MEDICAID DSH PAYMENTS TO MAJOR PUBLIC GENERAL HOSPITALS, INCLUDING
HOSPITALS OPERATED BY PUBLIC BENEFIT CORPORATIONS, SHALL BE MADE IN
AMOUNTS REFLECTING SEVENTY-FIVE PERCENT OF THE PROJECTED DISTRIBUTIONS
OTHERWISE AUTHORIZED FOR SUCH FACILITIES PURSUANT TO THE PROVISIONS OF
THIS SECTION, OTHER THAN THIS SUBDIVISION.
(II) EIGHTEEN MILLION SEVEN HUNDRED FIFTY THOUSAND DOLLARS SHALL BE
DISTRIBUTED AS MEDICAID DSH PAYMENTS TO HOSPITALS ELIGIBLE FOR PAYMENTS
MADE PURSUANT TO SUBPARAGRAPH (IV) OF PARAGRAPH (A) OF SUBDIVISION
FIVE-B OF THIS SECTION BASED UPON EACH FACILITY'S PROPORTION OF UNIN-
SURED LOSSES, AS DEFINED IN PARAGRAPH (C) OF SUBDIVISION FIVE-A OF THIS
SECTION, TO SUCH LOSSES FOR ALL HOSPITALS ELIGIBLE FOR SUCH PAYMENTS.
(III) TWELVE MILLION DOLLARS SHALL BE DISTRIBUTED IN ACCORDANCE WITH
THE PROVISIONS OF SUBPARAGRAPH (III) OF PARAGRAPH (A) OF SUBDIVISION
FIVE-B OF THIS SECTION.
S. 6608 24 A. 9708
(IV) EIGHTEEN MILLION SEVEN HUNDRED FIFTY THOUSAND DOLLARS SHALL BE
DISTRIBUTED IN ACCORDANCE WITH THE PROVISIONS OF SUBPARAGRAPH (IV) OF
PARAGRAPH (A) OF SUBDIVISION FIVE-B OF THIS SECTION.
(V) THE BALANCE OF THE FUNDS IN THE POOL NOT OTHERWISE ALLOCATED
PURSUANT TO SUBPARAGRAPHS (I), (II), (III), (IV) AND (VI) OF THIS PARA-
GRAPH SHALL BE DISTRIBUTED PROPORTIONALLY AS MEDICAID DSH PAYMENTS TO
ELIGIBLE GENERAL HOSPITALS, OTHER THAN MAJOR PUBLIC GENERAL HOSPITALS,
ON THE BASIS OF EACH FACILITY'S UNCOMPENSATED CARE NEED SHARE, AS DETER-
MINED IN ACCORDANCE WITH THE SCALE SET FORTH IN SUBPARAGRAPH (VII) OF
THIS PARAGRAPH.
(VI) SEVENTY-FIVE MILLION DOLLARS SHALL BE DISTRIBUTED AS MEDICAID DSH
PAYMENTS TO ELIGIBLE GENERAL HOSPITALS, OTHER THAN MAJOR PUBLIC GENERAL
HOSPITALS, PURSUANT TO A FORMULA SUCH THAT, TO THE EXTENT OF FUNDS
AVAILABLE, NO ELIGIBLE GENERAL HOSPITAL'S REDUCTION IN PAYMENTS AS A
RESULT OF THE APPLICATION OF THE PROVISIONS OF THIS SUBDIVISION EXCEEDS,
ON AN ANNUALIZED BASIS, A PERCENTAGE REDUCTION, AS DETERMINED BY THE
COMMISSIONER, FROM THE PROJECTED DISTRIBUTIONS SUCH HOSPITAL WOULD HAVE
RECEIVED PURSUANT TO THIS SECTION, OTHER THAN THIS SUBDIVISION, AND
SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE FOR THE TWO THOU-
SAND TEN CALENDAR YEAR. SUCH PAYMENTS SHALL BE DISTRIBUTED TO ELIGIBLE
GENERAL HOSPITALS ON A PROPORTIONAL BASIS, BASED ON THE DEGREE OF EACH
SUCH GENERAL HOSPITAL'S PROJECTED REDUCTION IN DISTRIBUTION.
(VII) THE SCALE UTILIZED FOR DEVELOPMENT OF EACH ELIGIBLE GENERAL
HOSPITAL'S UNCOMPENSATED CARE NEED SHARE PAYMENT AMOUNT, AS COMPUTED IN
ACCORDANCE WITH THE PROVISIONS OF PARAGRAPH (C) OF SUBDIVISION FIVE-A OF
THIS SECTION, SHALL BE AS FOLLOWS, PROVIDED, HOWEVER, THAT THE REDUCTION
DESCRIBED IN SUBPARAGRAPH (III) OF PARAGRAPH (C) OF SUBDIVISION FIVE-A
OF THIS SECTION SHALL BE COMPUTED AS TEN PERCENT:
PERCENTAGE OF REIMBURSEMENT
ATTRIBUTABLE TO THAT PORTION
UNCOMPENSATED NEED PERCENTAGE OF UNCOMPENSATED NEED
0 - 4% 70%
4 - 6% 80%
6+% 90%
(C) FOR THE TWO THOUSAND ELEVEN CALENDAR YEAR AND EACH CALENDAR YEAR
THEREAFTER, PAYMENTS TOTALING NINE HUNDRED NINETY-SIX MILLION DOLLARS
SHALL BE MADE AS FOLLOWS:
(I) MEDICAID DSH PAYMENTS TO MAJOR PUBLIC GENERAL HOSPITALS, INCLUDING
HOSPITALS OPERATED BY PUBLIC BENEFIT CORPORATIONS, SHALL BE MADE IN
AMOUNTS EQUAL TO THE PROJECTED DISTRIBUTIONS THAT WOULD HAVE BEEN MADE
TO SUCH FACILITIES PURSUANT TO THE PROVISIONS OF THIS SECTION, OTHER
THAN THIS SUBDIVISION, FOR THE TWO THOUSAND TEN CALENDAR YEAR.
(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 SUBDIVISION FIVE-B OF THIS SECTION BASED
UPON EACH FACILITY'S PROPORTION OF UNINSURED LOSSES, AS DEFINED IN PARA-
GRAPH (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 SUBDIVISION
FIVE-B OF THIS SECTION.
(IV) TWENTY-FIVE MILLION DOLLARS SHALL BE DISTRIBUTED IN ACCORDANCE
WITH THE PROVISIONS OF SUBPARAGRAPH (IV) OF PARAGRAPH (A) OF SUBDIVISION
FIVE-B OF THIS SECTION.
(V) THE BALANCE OF THE FUNDS NOT OTHERWISE ALLOCATED BY SUBPARAGRAPHS
(I), (II), (III), (IV) AND (VI) OF THIS PARAGRAPH, SHALL BE DISTRIBUTED
S. 6608 25 A. 9708
PROPORTIONALLY AS MEDICAID DSH PAYMENTS TO ELIGIBLE GENERAL HOSPITALS,
OTHER THAN MAJOR PUBLIC GENERAL HOSPITALS, ON THE BASIS OF EACH FACILI-
TY'S UNCOMPENSATED CARE NEED SHARE, AS DETERMINED IN ACCORDANCE WITH THE
SCALE SET FORTH IN SUBPARAGRAPH (VII) OF PARAGRAPH (B) OF THIS SUBDIVI-
SION.
(VI) FIFTY MILLION DOLLARS SHALL BE DISTRIBUTED AS MEDICAID DSH
PAYMENTS TO ELIGIBLE GENERAL HOSPITALS, OTHER THAN MAJOR PUBLIC GENERAL
HOSPITALS, IN ACCORDANCE WITH THE METHODOLOGY SET FORTH IN SUBPARAGRAPH
(VI) OF PARAGRAPH (B) OF THIS SUBDIVISION, PROVIDED, HOWEVER, THAT FOR
THE TWO THOUSAND TWELVE CALENDAR YEAR SUCH PAYMENTS SHALL BE TWENTY-FIVE
MILLION DOLLARS, AND PROVIDED FURTHER, HOWEVER, THAT FOR THE TWO THOU-
SAND THIRTEEN CALENDAR YEAR AND EACH CALENDAR YEAR THEREAFTER SUCH
PAYMENTS SHALL BE ZERO.
S 8. Intentionally omitted.
S 9. 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 12
of part B of chapter 58 of the laws of 2009, is amended to read as
follows:
(a) Notwithstanding any inconsistent provision of law or regulation to
the contrary, effective beginning August 1, 1996, for the period April
1, 1997 through March 31, 1998, April 1, 1998 for the period April 1,
1998 through March 31, 1999, August 1, 1999, for the period April 1,
1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
through March 31, 2001, April 1, 2001, for the period April 1, 2001
through March 31, 2002, April 1, 2002, for the period April 1, 2002
through March 31, 2003, and for the state fiscal year beginning April 1,
2005 through March 31, 2006, and for the state fiscal year beginning
April 1, 2006 through March 31, 2007, and for the state fiscal year
beginning April 1, 2007 through March 31, 2008, and for the state fiscal
year beginning April 1, 2008 through March 31, 2009, and 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-
S. 6608 26 A. 9708
ciled data as further reconciled to actual reported 2000 data, for 2001
based initially on reported 1995 reconciled data as further reconciled
to actual reported 2001 data, for 2002 based initially on reported 2000
reconciled data as further reconciled to actual reported 2002 data, and
for state fiscal years beginning on April 1, 2005, based initially on
reported 2000 reconciled data as further reconciled to actual reported
data for 2005, and for state fiscal years beginning on April 1, 2006,
based initially on reported 2000 reconciled data as further reconciled
to actual reported data for 2006, for state fiscal years beginning on
and after April 1, 2007 through March 31, 2009, based initially on
reported 2000 reconciled data as further reconciled to actual reported
data for 2007 AND 2008, RESPECTIVELY, for state fiscal years beginning
on and after April 1, 2009, based initially on reported 2007 reconciled
data, adjusted for authorized Medicaid rate changes applicable to the
state fiscal year, and as further reconciled to actual reported data for
2009, FOR STATE FISCAL YEARS BEGINNING ON AND AFTER APRIL 1, 2010, BASED
INITIALLY ON REPORTED RECONCILED DATA FROM THE BASE YEAR TWO YEARS PRIOR
TO THE PAYMENT YEAR, ADJUSTED FOR AUTHORIZED MEDICAID RATE CHANGES
APPLICABLE TO THE STATE FISCAL YEAR, AND FURTHER RECONCILED TO ACTUAL
REPORTED DATA FROM SUCH PAYMENT YEAR, and to actual reported data for
each respective succeeding year. The payments may be added to rates of
payment or made as aggregate payments to an eligible public general
hospital.
S 10. 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 13
of part B of chapter 58 of the laws of 2009, 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, 2009 THROUGH MARCH 31, 2010, AND FOUR HUNDRED TWENTY MILLION DOLLARS,
AS FURTHER INCREASED BY UP TO THE MAXIMUM PAYMENT AMOUNTS PERMITTED
UNDER SECTIONS 1923(F) AND 1923(G) OF THE FEDERAL SOCIAL SECURITY ACT,
AS DETERMINED BY THE COMMISSIONER OF HEALTH AFTER APPLICATION OF ALL
OTHER DISPROPORTIONATE SHARE HOSPITAL PAYMENTS AUTHORIZED BY STATE LAW,
for the state fiscal year beginning April 1, 2010 through March 31, 2011
and up to one hundred twenty million dollars, AS FURTHER INCREASED BY UP
TO THE MAXIMUM PAYMENT AMOUNTS PERMITTED UNDER SECTIONS 1923(F) AND
1923(G) OF THE FEDERAL SOCIAL SECURITY ACT, AS DETERMINED BY THE COMMIS-
SIONER OF HEALTH AFTER APPLICATION OF ALL OTHER DISPROPORTIONATE SHARE
HOSPITAL PAYMENTS AUTHORIZED BY STATE LAW, annually for the state fiscal
year beginning April 1, 2011, and annually thereafter, as medical
assistance payments pursuant to title 11 of article 5 of the social
S. 6608 27 A. 9708
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 recon-
ciled to actual reported 2002 or 2003 data, for payments made during the
state fiscal year ending on [and after] March 31, 2006, based initially
on reported 2000 reconciled data as further reconciled to actual
reported 2005 or 2006 data, for payments made during the state fiscal
year ending on [and after] March 31, 2007, based initially on reported
2000 reconciled data as further reconciled to actual reported 2006 or
2007 data, for payments made during the state fiscal years ending on
[and after] March 31, 2008, based initially on reported 2000 reconciled
data as further reconciled to actual reported 2007 or 2008 data, AND
ACTUAL REPORTED 2008 OR 2009 DATA, RESPECTIVELY, 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 OR 2010 data, FOR PAYMENTS
MADE DURING THE STATE FISCAL YEAR ENDING ON MARCH 31, 2011, BASED
INITIALLY ON REPORTED RECONCILED DATA FROM THE BASE YEAR TWO YEARS PRIOR
TO THE PAYMENT YEAR, ADJUSTED FOR AUTHORIZED MEDICAID RATE CHANGES
APPLICABLE TO THE STATE FISCAL YEAR, AND AS FURTHER RECONCILED TO ACTUAL
REPORTED DATA FROM SUCH PAYMENT YEAR, and to actual reported data for
each respective succeeding year. The payments may be added to rates of
payment or made as aggregate payments to an eligible public general
hospital.
S 11. Subdivision 8 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:
8. The commissioner shall provide notice of any recommendations devel-
oped by the committee regarding the preferred drug program, at least
[thirty] FIVE days before any final determination by the commissioner,
by making such information available on the department's website. Such
public notice shall include: a summary of the deliberations of the
committee; a summary of the positions of those making public comments at
meetings of the committee; the response of the committee to those
comments, if any; and the findings and recommendations of the committee.
S 12. Paragraph (g) of subdivision 4 of section 365-a of the social
services law, as amended by section 61 of part C of chapter 58 of the
laws of 2007, is amended to read as follows:
(g) for eligible persons who are also beneficiaries under part D of
title XVIII of the federal social security act, drugs which are denomi-
nated as "covered part D drugs" under section 1860D-2(e) of such act[;
provided however that, for purposes of this paragraph, "covered part D
drugs" shall not mean atypical anti-psychotics, anti-depressants, anti-
S. 6608 28 A. 9708
retrovirals used in the treatment of HIV/AIDS, or anti-rejection drugs
used for the treatment of organ and tissue transplants].
S 13. Subparagraph (ii) of paragraph (b) of subdivision 9 of section
367-a of the social services law, as amended by section 4 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
(ii) if the drug dispensed is a multiple source prescription drug or a
brand-name prescription drug for which no specific upper limit has been
set by such federal agency, the lower of the estimated acquisition cost
of such drug to pharmacies, or the dispensing pharmacy's usual and
customary price charged to the general public. For sole and multiple
source brand name drugs, estimated acquisition cost means the average
wholesale price of a prescription drug based upon the package size
dispensed from, as reported by the prescription drug pricing service
used by the department, less sixteen and twenty-five one hundredths
percent thereof, and updated monthly by the department[; or, for a
specialized HIV pharmacy, as defined in paragraph (f) of this subdivi-
sion, acquisition cost means the average wholesale price of a
prescription drug based upon the package size dispensed from, as
reported by the prescription drug pricing service used by the depart-
ment, less twelve percent thereof, and updated monthly by the depart-
ment]. For multiple source generic drugs, estimated acquisition cost
means the lower of the average wholesale price of a prescription drug
based on the package size dispensed from, as reported by the
prescription drug pricing service used by the department, less twenty-
five percent thereof, or the maximum acquisition cost, if any, estab-
lished pursuant to paragraph (e) of this subdivision[; or, for a
specialized HIV pharmacy, as defined in paragraph (f) of this subdivi-
sion, acquisition cost means the lower of the average wholesale price of
a prescription drug based on the package size dispensed from, as
reported by the prescription drug pricing service used by the depart-
ment, less twelve percent thereof, or the maximum acquisition cost, if
any, established pursuant to paragraph (e) of this subdivision].
S 14. Paragraph (f) of subdivision 9 of section 367-a of the social
services law is REPEALED.
S 15. Subdivision 2 of section 365-a of the social services law is
amended by adding a new paragraph (v) to read as follows:
(V) ADMINISTRATION OF VACCINATIONS IN A PHARMACY BY A CERTIFIED PHAR-
MACIST WITHIN HIS OR HER SCOPE OF PRACTICE.
S 16. Section 2807-j of the public health law is amended by adding a
new subdivision 13 to read as follows:
13. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS SECTION OR
ANY OTHER CONTRARY PROVISION OF LAW, FOR PERIODS ON AND AFTER OCTOBER
FIRST, TWO THOUSAND TEN, EACH THIRD PARTY PAYOR WHICH HAS ENTERED INTO
AN ELECTION AGREEMENT WITH THE COMMISSIONER PURSUANT TO SUBDIVISION FIVE
OF THIS SECTION SHALL, AS A CONDITION OF SUCH ELECTION, PAY TO THE
COMMISSIONER OR THE COMMISSIONER'S DESIGNEE, A PERCENTAGE SURCHARGE
EQUAL TO THE SURCHARGE PERCENT SET FORTH IN PARAGRAPH (C) OF SUBDIVISION
TWO OF THIS SECTION FOR THE SAME PERIOD AND APPLIED TO ALL PAYMENTS MADE
BY SUCH THIRD PARTY PAYORS FOR PATIENT CARE SERVICES PROVIDED WITHIN THE
STATE OF NEW YORK BY PHYSICIANS IN PHYSICIAN OFFICES OR IN URGENT CARE
FACILITIES THAT ARE NOT OTHERWISE LICENSED PURSUANT TO THIS ARTICLE AND
WHICH ARE BILLED AS SURGERY OR RADIOLOGY SERVICES IN ACCORDANCE WITH THE
CURRENT PROCEDURE TERMINOLOGY, FOURTH EDITION, AS PUBLISHED BY THE AMER-
ICAN MEDICAL ASSOCIATION.
(B) SUCH PAYMENTS SHALL BE MADE AND REPORTED AT THE SAME TIME AND IN
THE SAME MANNER AS THE PAYMENTS AND REPORTS WHICH ARE OTHERWISE SUBMIT-
S. 6608 29 A. 9708
TED BY EACH THIRD PARTY PAYOR TO THE COMMISSIONER OR THE COMMISSIONER'S
DESIGNEE IN ACCORDANCE WITH THIS SECTION. SUCH PAYMENTS SHALL BE SUBJECT
TO AUDIT BY THE COMMISSIONER IN THE SAME MANNER AS THE OTHER PAYMENTS
OTHERWISE SUBMITTED AND REPORTED PURSUANT TO THIS SECTION. THE COMMIS-
SIONER MAY TAKE ALL MEASURES TO COLLECT DELINQUENT PAYMENTS DUE PURSUANT
TO THIS SUBDIVISION AS ARE OTHERWISE PERMITTED WITH REGARD TO DELINQUENT
PAYMENTS DUE PURSUANT TO OTHER SUBDIVISIONS OF THIS SECTION.
(C) SURCHARGES PURSUANT TO THIS SUBDIVISION SHALL NOT APPLY TO
PAYMENTS MADE BY THIRD PARTY PAYORS FOR SERVICES PROVIDED TO PATIENTS
INSURED BY MEDICAID OR BY THE CHILD HEALTH PLUS PROGRAM OR TO ANY
PATIENT IN A CATEGORY THAT IS EXEMPT FROM SURCHARGE OBLIGATIONS ASSESSED
PURSUANT TO SUBDIVISIONS ONE THROUGH TWELVE OF THIS SECTION.
S 17. Subparagraphs (vii) and (viii) of paragraph (uu) of subdivision
1 of section 2807-v of the public health law, as amended by section 120
of part C of chapter 58 of the laws of 2009, are amended to read as
follows:
(vii) [seven] ONE million [five] EIGHT hundred SEVENTY-FIVE thousand
dollars for the period January first, two thousand ten through [Decem-
ber] MARCH thirty-first, two thousand ten shall be available for disease
management demonstration programs[; and
(viii) one million eight hundred seventy-five thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven shall be available for disease management demon-
stration programs].
S 18. Intentionally omitted.
S 19. Intentionally omitted.
S 20. Intentionally omitted.
S 21. Paragraph (jj) 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:
(jj) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purposes of a grant program to improve access to infertility services,
treatments and procedures, from the tobacco control and insurance initi-
atives pool established for the period January first, two thousand two
through December thirty-first, two thousand two in the amount of nine
million one hundred seventy-five thousand dollars, for the period April
first, two thousand six through March thirty-first, two thousand seven
in the amount of five million dollars, for the period April first, two
thousand seven through March thirty-first, two thousand eight in the
amount of five million dollars, for the period April first, two thousand
eight through March thirty-first, two thousand nine in the amount of
five million dollars, AND for the period April first, two thousand nine
through March thirty-first, two thousand ten in the amount of five
million dollars, and for the period April first, two thousand ten
through March thirty-first, two thousand eleven in the amount of [five]
TWO million TWO HUNDRED THOUSAND dollars.
S 22. Subparagraphs (vii) and (viii) of paragraph (qq) 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:
(vii) up to [five million] FOUR HUNDRED EIGHTY-EIGHT THOUSAND dollars
for the period January first, two thousand ten through [December] MARCH
thirty-first, two thousand ten; of such funds [one million nine] FOUR
hundred [fifty] EIGHTY-EIGHT thousand dollars shall be made available to
the department for the purpose of developing, implementing and adminis-
S. 6608 30 A. 9708
tering the long-term care insurance education and outreach program [and
three million fifty thousand dollars shall be made available to the
office for the aging for the purpose of providing the long-term care
insurance resource centers with the necessary resources to carry out
their operations; and
(viii) up to one million two hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven; of such funds four hundred eighty-seven thousand
five hundred dollars shall be made available to the department for the
purpose of developing, implementing and administering the long-term care
insurance education and outreach program and seven hundred sixty-two
thousand five hundred dollars shall be made available to the office for
the aging for the purpose of providing the long-term care insurance
resource centers with the necessary resources to carry out their oper-
ations].
S 23. Subparagraphs (xi) and (xii) of paragraph (j) of subdivision 1
of section 2807-v of the public health law, as amended by section 5 of
part B of chapter 58 of the laws of 2008, are amended to read as
follows:
(xi) up to [ninety-four] EIGHTY-THREE million [one] TWO hundred
[fifty] SEVENTY-FIVE thousand dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; and
(xii) up to [twenty-three] NINETEEN million [five] NINE hundred [thir-
ty-seven] TWELVE thousand dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven.
S 24. Subparagraph (iv) of paragraph (c) 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:
(iv) distributions by the commissioner related to poison control
centers pursuant to subdivision seven of section twenty-five hundred-d
of this chapter, up to five million dollars for the period January
first, nineteen hundred ninety-seven through December thirty-first,
nineteen hundred ninety-seven, up to three million dollars on an annual-
ized basis for the periods during the period January first, nineteen
hundred ninety-eight through December thirty-first, nineteen hundred
ninety-nine, up to five million dollars annually for the periods January
first, two thousand through December thirty-first, two thousand two, up
to four million six hundred thousand dollars annually for the periods
January first, two thousand three through December thirty-first, two
thousand four, up to five million one hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand six annually, up to five million one hundred thousand
dollars annually for the period January first, two thousand seven
through December thirty-first, two thousand [ten,] NINE, UP TO THREE
MILLION SIX HUNDRED THOUSAND DOLLARS FOR THE PERIOD JANUARY FIRST, TWO
THOUSAND TEN THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND TEN, and up to
[one million two] SEVEN hundred seventy-five thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven; and
S 25. Clause (B) of subparagraph (i) of paragraph (b) of subdivision 2
of section 369 of the social services law, as amended by chapter 170 of
the laws of 1994, is amended to read as follows:
(B) from the estate of [an individual] A DECEDENT who was fifty-five
years of age or older when he or she received such assistance, OR FROM
THE RECIPIENT OF THE PROPERTY OF SUCH DECEDENT BY DISTRIBUTION OR BY
SURVIVAL.
S. 6608 31 A. 9708
S 25-a. Subdivision 6 of section 369 of the social services law, as
added by chapter 170 of the laws of 1994, is amended to read as follows:
6. For purposes of this section, the term "estate" means all OF AN
INDIVIDUAL'S real and personal property and other assets [included with-
in the individual's estate and] passing under the terms of a valid will
or by intestacy, AND ANY OTHER PROPERTY IN WHICH THE INDIVIDUAL HAD ANY
LEGAL TITLE OR INTEREST AT THE TIME OF DEATH, INCLUDING JOINTLY HELD
PROPERTY, RETAINED LIFE ESTATES, AND INTERESTS IN TRUSTS, TO THE EXTENT
OF SUCH INTERESTS.
S 26. Paragraph (d) of subdivision 1 of section 453 of the general
business law, as amended by chapter 557 of the laws of 2001, is amended
to read as follows:
(d) Moneys paid for such an agreement for an applicant or recipient of
supplemental security income benefits under section two hundred nine of
the social services law or of medical assistance under section three
hundred sixty-six of such law, OR MONEYS PAID BY SUCH AN APPLICANT OR
RECIPIENT FOR SUCH AN AGREEMENT FOR HIS OR HER FAMILY MEMBER, shall be
placed into a trust which shall be irrevocable but under which such
applicant/recipient reserves the right to select any funeral firm,
funeral director, undertaker, cemetery or any other person, firm or
corporation to whom such payment is made and to change such selection
any time to any type of funeral or any funeral firm, funeral director,
cemetery or any other person, firm or corporation to whom such payment
is made, located in the state of New York or any other state. Any such
change must be carried out within ten business days following receipt of
a request by the purchaser to the funeral firm, funeral director, ceme-
tery or any other person, firm or corporation to whom such payment is
made, with which such trust was established. This requirement is subject
to any limits set forth in federal law or regulation pertaining to
disregarded resources or income.
S 27. Paragraph (f) of subdivision 3 of section 453 of the general
business law, as added by chapter 660 of the laws of 1996, is amended to
read as follows:
(f) With respect to an agreement for an irrevocable trust fund pursu-
ant to section two hundred nine of the social services law OR PARAGRAPH
(D) OF SUBDIVISION ONE OF THIS SECTION, include the following statement
in the agreement in conspicuous print of at least twelve point type:
DISCLOSURE
NEW YORK LAW REQUIRES THIS AGREEMENT TO BE IRREVOCABLE FOR APPLICANTS
FOR [RECEIPT] AND RECIPIENTS OF SUPPLEMENTAL SECURITY BENEFITS UNDER
SECTION TWO HUNDRED NINE OF THE SOCIAL SERVICES LAW OR OF MEDICAL
ASSISTANCE UNDER SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES
LAW, AND FOR THE MONEYS PUT INTO A TRUST UNDER THIS AGREEMENT TO BE USED
ONLY FOR FUNERAL AND BURIAL EXPENSES. WHETHER THE AGREEMENT IS FOR YOUR
FUNERAL AND BURIAL EXPENSES OR FOR THOSE OF A FAMILY MEMBER, IF ANY
MONEY IS LEFT OVER AFTER YOUR FUNERAL AND BURIAL EXPENSES HAVE BEEN
PAID, IT WILL GO TO THE COUNTY. YOU MAY CHANGE YOUR CHOICE OF FUNERAL
HOME AT ANY TIME. IF THIS AGREEMENT IS FOR THE FUNERAL AND BURIAL
EXPENSES OF A FAMILY MEMBER, AFTER YOUR DEATH SUCH FAMILY MEMBER MAY
CHANGE THE CHOICE OF FUNERAL HOME AT ANY TIME.
S 28. Subdivision 6 of section 209 of the social services law, as
amended by chapter 660 of the laws of 1996, paragraphs (a) and (b) as
amended by chapter 317 of the laws of 2002, is amended to read as
follows:
6. (a) As applicable federal law, rules and regulations so provide, a
recipient of supplemental security income benefits or medical assistance
S. 6608 32 A. 9708
in the state of New York or any other state may establish an irrevocable
trust fund for the exclusive purpose of their OR A FAMILY MEMBER'S
funeral and burial. Such trust fund and any accumulated interest not
withdrawn by the recipient shall remain the responsibility of the funer-
al firm, funeral director, undertaker, cemetery or any other person,
firm or corporation to whom such payment is made to administer for
funeral and burial expenses of the recipient. Those persons who estab-
lish such a trust fund shall be given the opportunity to select the
funeral firm, funeral director, undertaker, cemetery or any other
person, firm or corporation to whom such payment is made of their choice
to provide for their OR A FAMILY MEMBER'S burial arrangements and to
change such selection at any time to any funeral firm, funeral director,
undertaker, cemetery or any other person, firm or corporation to whom
such payment is made, located either in the state of New York or any
other state. Any such change of funeral firm, funeral director, under-
taker, cemetery, or any other person, firm or corporation to whom such
payment is made, must be carried out within ten business days following
receipt of a request by the purchaser to the funeral firm, funeral
director, undertaker, cemetery, or any other person, firm or corporation
to whom such payment is made with which the current trust fund was
established. Funds in such trust fund shall be placed in an interest
bearing account pursuant to section four hundred fifty-three of the
general business law. Accumulated interest from such account shall not
be reported as "countable income" pursuant to section two hundred eight
of this title.
(b) An applicant for or a recipient of medical assistance in the state
of New York or any other state who enters into an agreement pursuant to
section four hundred fifty-three of the general business law FOR THEIR
OWN BENEFIT OR FOR THE BENEFIT OF A FAMILY MEMBER shall establish a
single irrevocable trust fund FOR EACH SUCH BENEFICIARY pursuant to
paragraph (a) of this subdivision.
(c) A funeral firm, funeral director, undertaker, cemetery, or any
other person, firm or corporation which makes an agreement for and
accepts payment for such an irrevocable trust fund, shall comply with
the provisions of section four hundred fifty-three of the general busi-
ness law, and shall include the following statement in any such agree-
ment in conspicuous print of at least twelve point type:
DISCLOSURE
NEW YORK LAW REQUIRES THIS AGREEMENT TO BE IRREVOCABLE FOR APPLICANTS
FOR [RECEIPT] AND RECIPIENTS OF SUPPLEMENTAL SECURITY BENEFITS UNDER
SECTION TWO HUNDRED NINE OF THE SOCIAL SERVICES LAW OR OF MEDICAL
ASSISTANCE UNDER SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES
LAW, AND FOR THE MONEYS PUT INTO A TRUST UNDER THIS AGREEMENT TO BE USED
ONLY FOR FUNERAL AND BURIAL EXPENSES. WHETHER THIS AGREEMENT IS FOR YOUR
FUNERAL AND BURIAL EXPENSES OR FOR THOSE OF A FAMILY MEMBER, IF ANY
MONEY IS LEFT OVER AFTER YOUR FUNERAL AND BURIAL EXPENSES HAVE BEEN
PAID, IT WILL GO TO THE COUNTY. YOU MAY CHANGE YOUR CHOICE OF FUNERAL
HOME AT ANY TIME. IF THIS AGREEMENT IS FOR THE FUNERAL AND BURIAL
EXPENSES OF A FAMILY MEMBER, AFTER YOUR DEATH SUCH FAMILY MEMBER MAY
CHANGE THE CHOICE OF FUNERAL HOME AT ANY TIME.
(d) Any promotional literature prepared after January first, nineteen
hundred ninety-seven by a funeral firm, funeral director, undertaker,
cemetery, or any other person, firm or corporation for prearranged
funeral and burial services must contain language disclosing the irrev-
ocable nature of burial trusts established BY OR for an applicant or
S. 6608 33 A. 9708
recipient of supplemental security income benefits or medical assist-
ance.
S 29. Paragraph (g) of subdivision 3 of section 453 of the general
business law, as added by chapter 660 of the laws of 1996, is amended to
read as follows:
(g) Any promotional literature prepared after January first, nineteen
hundred ninety-seven by a funeral firm, funeral director, undertaker,
cemetery, or any other person, firm or corporation for prearranged
funeral and burial services must contain language disclosing the irrev-
ocable nature of burial trusts established BY OR for an applicant or
recipient of supplemental security income benefits or medical assist-
ance.
S 30. Subdivision 6 of section 141 of the social services law, as
added by chapter 660 of the laws of 1996, is amended to read as follows:
6. If an applicant for or a recipient of public assistance or care or
of medical assistance under section two hundred nine or three hundred
sixty-six of this chapter [dies having established] ESTABLISHES an irre-
vocable trust for the payment of his or her funeral expenses, OR THOSE
OF A FAMILY MEMBER, under section four hundred fifty-three of the gener-
al business law, any funds remaining in such trust after the payment of
all funeral expenses must be paid over to the social services official
responsible for arranging for burials under this section in the local
government subdivision where the decedent resided.
S 31. Section 365-h of the social services law, as added by chapter
81 of the laws of 1995, subdivision 3 as amended by section 26 of part B
of chapter 1 of the laws of 2002, is amended to read as follows:
S 365-h. Provision and reimbursement of transportation costs. 1. The
local social services official AND, SUBJECT TO THE PROVISIONS OF SUBDI-
VISION FOUR OF THIS SECTION, THE COMMISSIONER OF HEALTH, shall have
responsibility for prior authorizing transportation of eligible persons
and for limiting the provision of such transportation to those recipi-
ents and circumstances where such transportation is essential, medically
necessary and appropriate to obtain medical care, services or supplies
otherwise available under this title.
2. In exercising this responsibility, the local social services offi-
cial AND, AS APPROPRIATE, THE COMMISSIONER OF HEALTH shall:
(a) make appropriate and economical use of transportation resources
available in the district in meeting the anticipated demand for trans-
portation within the district, including, but not limited to: transpor-
tation generally available free-of-charge to the general public or
specific segments of the general public, public transportation,
promotion of group rides, county vehicles, coordinated transportation,
and direct purchase of services; and
(b) maintain quality assurance mechanisms in order to ensure that (i)
only such transportation as is essential, medically necessary and appro-
priate to obtain medical care, services or supplies otherwise available
under this title is provided and (ii) no expenditures for taxi or livery
transportation are made when public transportation or lower cost trans-
portation is reasonably available to eligible persons.
3. In the event that coordination or other such cost savings measures
are implemented, the commissioner shall assure compliance with applica-
ble standards governing the safety and quality of transportation of the
population served.
4. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ASSUME RESPONSIBILITY
FROM A LOCAL SOCIAL SERVICES OFFICIAL FOR THE PROVISION AND REIMBURSE-
MENT OF TRANSPORTATION COSTS UNDER THIS SECTION. IF THE COMMISSIONER
S. 6608 34 A. 9708
ELECTS TO ASSUME SUCH RESPONSIBILITY, THE COMMISSIONER SHALL NOTIFY THE
LOCAL SOCIAL SERVICES OFFICIAL IN WRITING AS TO THE ELECTION, THE DATE
UPON WHICH THE ELECTION SHALL BE EFFECTIVE, AND SUCH INFORMATION AS TO
TRANSITION OF RESPONSIBILITIES AS THE COMMISSIONER DEEMS PRUDENT. THE
COMMISSIONER IS AUTHORIZED TO CONTRACT WITH A TRANSPORTATION MANAGER OR
MANAGERS THAT HAVE EXPERIENCE IN COORDINATING TRANSPORTATION SERVICES IN
NEW YORK STATE TO MANAGE THE PROVISION OF SERVICES UNDER THIS SECTION.
SUCH A CONTRACT OR CONTRACTS MAY INCLUDE, WITHOUT LIMITATION, RESPONSI-
BILITY FOR: REVIEW, APPROVAL AND PROCESSING OF TRANSPORTATION ORDERS;
MANAGEMENT OF THE APPROPRIATE LEVEL OF TRANSPORTATION BASED ON DOCU-
MENTED PATIENT MEDICAL NEED; AND DEVELOPMENT OF NEW TECHNOLOGIES AND
APPROACHES LEADING TO EFFICIENT TRANSPORTATION SERVICES. NOTWITHSTANDING
ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED TWELVE AND ONE
HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION ONE HUNDRED
FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW, THE COMMIS-
SIONER IS AUTHORIZED TO ENTER INTO A CONTRACT UNDER THIS SUBDIVISION
WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS.
S 32. Subdivision 7 of section 2510 of the public health law, as
amended by chapter 645 of the laws of 2005, is amended to read as
follows:
7. "Covered health care services" means: the services of physicians,
optometrists, nurses, nurse practitioners, midwives and other related
professional personnel which are provided on an outpatient basis,
including routine well-child visits; diagnosis and treatment of illness
and injury; inpatient health care services; laboratory tests; diagnostic
x-rays; prescription and non-prescription drugs and durable medical
equipment; radiation therapy; chemotherapy; hemodialysis; emergency room
services; hospice services; emergency, preventive and routine dental
care, [except orthodontia and] INCLUDING MEDICALLY NECESSARY ORTHODONTIA
BUT EXCLUDING cosmetic surgery; emergency, preventive and routine vision
care, including eyeglasses; speech and hearing services; and, inpatient
and outpatient mental health, alcohol and substance abuse services as
defined by the commissioner in consultation with the superintendent.
"Covered health care services" shall not include drugs, procedures and
supplies for the treatment of erectile dysfunction when provided to, or
prescribed for use by, a person who is required to register as a sex
offender pursuant to article six-C of the correction law, provided that
any denial of coverage of such drugs, procedures or supplies shall
provide the patient with the means of obtaining additional information
concerning both the denial and the means of challenging such denial.
S 33. Section 2511 of the public health law is amended by adding a new
subdivision 2-b to read as follows:
2-B. (A) EFFECTIVE JULY FIRST, TWO THOUSAND TEN, FOR PURPOSES OF
CLAIMING FEDERAL FINANCIAL PARTICIPATION UNDER PARAGRAPH NINE OF
SUBSECTION (C) OF SECTION TWENTY-ONE HUNDRED FIVE OF THE FEDERAL SOCIAL
SECURITY ACT, FOR INDIVIDUALS DECLARING TO BE CITIZENS AT INITIAL APPLI-
CATION, A HOUSEHOLD SHALL PROVIDE:
(I) THE SOCIAL SECURITY NUMBER FOR THE APPLICANT TO BE VERIFIED BY THE
COMMISSIONER IN ACCORDANCE WITH A PROCESS ESTABLISHED BY THE SOCIAL
SECURITY ADMINISTRATION PURSUANT TO FEDERAL LAW, OR
(II) DOCUMENTATION OF CITIZENSHIP AND IDENTITY OF THE APPLICANT
CONSISTENT WITH REQUIREMENTS UNDER THE MEDICAL ASSISTANCE PROGRAM, AS
SPECIFIED BY THE COMMISSIONER ON THE INITIAL APPLICATION.
(B) PENDING RECEIPT OF THE INFORMATION REQUIRED BY SUBPARAGRAPH (I) OF
PARAGRAPH (A) OF THIS SUBDIVISION, AN INITIAL APPLICATION SHALL CONTINUE
TO BE PROCESSED BY AN APPROVED ORGANIZATION OR ENROLLMENT FACILITATOR
S. 6608 35 A. 9708
AND A CHILD SHALL BE PRESUMPTIVELY ENROLLED IN THE PROGRAM IN ACCORDANCE
WITH PROCEDURES AND TIMEFRAMES CURRENTLY SPECIFIED IN CONTRACTS.
(C) THE COMMISSIONER IS AUTHORIZED TO IMPOSE THE SAME INFORMATION AND
DOCUMENTATION REQUIREMENTS AT ANNUAL RECERTIFICATION OF ENROLLEES ONLY
IF CLAIMING FEDERAL FINANCIAL PARTICIPATION FOR SUCH ENROLLEES BECOMES
CONTINGENT ON MEETING SUCH REQUIREMENTS.
S 34. Subparagraphs (i) and (ii) of paragraph (f) of subdivision 2 of
section 2511 of the public health law, subparagraph (i) as amended by
section 4 and subparagraph (ii) as amended by section 5 of part OO of
chapter 57 of the laws of 2008, are amended to read as follows:
(i) In order to establish income eligibility under this subdivision at
initial application, a household shall provide such documentation speci-
fied in subparagraph (iii) of this paragraph, as necessary and suffi-
cient to determine a child's financial eligibility for a subsidy payment
under this title. The commissioner may verify the accuracy of such
income information provided by the household by matching it against
income information contained in databases to which the commissioner has
access, including the state's wage reporting system pursuant to subdivi-
sion five of section one hundred seventy-one-a of the tax law and by
means of an income verification performed [by] PURSUANT TO A COOPERATIVE
AGREEMENT WITH the department of taxation and finance [pursuant to
subdivision four of section one hundred seventy-one-b of the tax law].
(ii) In order to establish income eligibility under this subdivision
at recertification, a household shall attest to all information regard-
ing the household's income that is necessary and sufficient to determine
a child's financial eligibility for a subsidy payment under this title
and shall provide the social security numbers for each parent and legal-
ly responsible adult who is a member of the household and whose income
is available to the child, subject to subparagraph (v) of this para-
graph. The commissioner may verify the accuracy of such income informa-
tion provided by the household by matching it against income information
contained in databases to which the commissioner has access, including
the state's wage reporting system and by means of an income verification
performed [by] PURSUANT TO A COOPERATIVE AGREEMENT WITH the department
of taxation and finance [pursuant to subdivision four of section one
hundred seventy-one-b of the tax law]. In the event that there is an
inconsistency between the income information attested to by the house-
hold and any information obtained by the commissioner from other sources
pursuant to this subparagraph, and such inconsistency is material to the
household's eligibility for a subsidy payment under this title, the
commissioner shall require the approved organization to obtain income
documentation from the household as specified in subparagraph (iii) of
this paragraph.
S 34-a. Paragraph (a) of subdivision 8 of section 366-a of the social
services law, as amended by section 45-c of part C of chapter 58 of the
laws of 2008, is amended to read as follows:
(a) Notwithstanding subdivisions two and five of this section, infor-
mation concerning income and resources of applicants for and recipients
of medical assistance may be verified by matching client information
with information contained in the wage reporting system established by
section one hundred seventy-one-a of the tax law and in similar systems
operating in other geographically contiguous states, by means of an
income verification performed [by] PURSUANT TO A MEMORANDUM OF UNDER-
STANDING WITH the department of taxation and finance [pursuant to subdi-
vision four of section one hundred seventy-one-b of the tax law,] and,
to the extent required by federal law, with information contained in the
S. 6608 36 A. 9708
non-wage income file maintained by the United States internal revenue
service, in the beneficiary data exchange maintained by the United
States department of health and human services, and in the unemployment
insurance benefits file. Such matching shall provide for procedures
which document significant inconsistent results of matching activities.
Nothing in this section shall be construed to prohibit activities the
department reasonably believes necessary to conform with federal
requirements under section one thousand one hundred thirty-seven of the
social security act.
S 34-b. Subdivision 4 of section 171-b of the tax law, as amended by
section 45-e of part C of chapter 58 of the laws of 2008, is amended to
read as follows:
(4) The commissioner is authorized and directed to enter into an
agreement with the commissioner of health which shall set forth the
procedures by which the commissioner shall (a) [verify] FACILITATE THE
VERIFICATION OF income eligibility for subsidized health insurance
coverage under the child health insurance plan pursuant to subparagraphs
(i) and (ii) of paragraph (f) of subdivision two of section two thousand
five hundred eleven of the public health law, and for the medical
assistance and family health plus programs pursuant to subdivision eight
of section three hundred sixty-six-a and paragraphs (b) and (d) of
subdivision two of section three hundred sixty-nine-ee of the social
services law, AND FOR IMPOSING PARENTAL FEES IN THE EARLY INTERVENTION
PROGRAM PURSUANT TO SUBDIVISION FOUR OF SECTION TWENTY-FIVE HUNDRED
FIFTY-SEVEN-A OF THE PUBLIC HEALTH LAW, AS ADDED BY A CHAPTER OF THE
LAWS OF TWO THOUSAND TEN, as specified by the commissioner of health and
agreed to by the commissioner, and (b) shall provide the information
required by subdivision two-a of section two thousand five hundred elev-
en of the public health law.
S 34-c. Subdivision 5 of section 171-a of the tax law, as amended by
section 2 of part A of chapter 58 of the laws of 2005, is amended to
read as follows:
5. Notwithstanding any provision of law to the contrary, the commis-
sioner shall enter into a cooperative agreement with the department of
health, which agreement shall provide for the utilization of information
obtained pursuant to subdivision one of this section, for the purpose of
verifying eligibility for child health insurance plan subsidy payments
and required premium payments under sections two thousand five hundred
ten and two thousand five hundred eleven of the public health law, [and]
for the purpose of verifying eligibility for the program for elderly
pharmaceutical insurance coverage under title three of article two of
the elder law, AND FOR THE PURPOSE OF IMPOSING PARENTAL FEES UNDER THE
EARLY INTERVENTION PROGRAM PURSUANT TO SECTION TWENTY-FIVE HUNDRED
FIFTY-SEVEN-A OF THE PUBLIC HEALTH LAW, AS ADDED BY A CHAPTER OF THE
LAWS OF TWO THOUSAND TEN, when requested by the department of health.
S 34-d. Paragraph 3 of subsection (e) of section 697 of the tax law,
as amended by section 4 of part V of chapter 57 of the laws of 2009, is
amended to read as follows:
(3) Nothing herein shall be construed to prohibit the department, its
officers or employees from furnishing information to the office of
temporary and disability assistance relating to the payment of the cred-
it for certain household and dependent care services necessary for gain-
ful employment under subsection (c) of section six hundred six of this
article and the earned income credit under subsection (d) of section six
hundred six of this article, or pursuant to a local law enacted by a
city having a population of one million or more pursuant to subsection
S. 6608 37 A. 9708
(f) of section thirteen hundred ten of this chapter, only to the extent
necessary to calculate qualified state expenditures under paragraph
seven of subdivision (a) of section four hundred nine of the federal
social security act or to document the proper expenditure of federal
temporary assistance for needy families funds under section four hundred
three of such act. The office of temporary and disability assistance may
redisclose such information to the United States department of health
and human services only to the extent necessary to calculate such quali-
fied state expenditures or to document the proper expenditure of such
federal temporary assistance for needy families funds. Nothing herein
shall be construed to prohibit the delivery by the commissioner to a
commissioner of jurors, appointed pursuant to section five hundred four
of the judiciary law, or, in counties within cities having a population
of one million or more, to the county clerk of such county, of a mailing
list of individuals to whom income tax forms are mailed by the commis-
sioner for the sole purpose of compiling a list of prospective jurors as
provided in article sixteen of the judiciary law. Provided, however,
such delivery shall only be made pursuant to an order of the chief
administrator of the courts, appointed pursuant to section two hundred
ten of the judiciary law. No such order may be issued unless such chief
administrator is satisfied that such mailing list is needed to compile a
proper list of prospective jurors for the county for which such order is
sought and that, in view of the responsibilities imposed by the various
laws of the state on the department, it is reasonable to require the
commissioner to furnish such list. Such order shall provide that such
list shall be used for the sole purpose of compiling a list of prospec-
tive jurors and that such commissioner of jurors, or such county clerk,
shall take all necessary steps to insure that the list is kept confiden-
tial and that there is no unauthorized use or disclosure of such list.
Furthermore, nothing herein shall be construed to prohibit the delivery
to a taxpayer or his or her duly authorized representative of a certi-
fied copy of any return or report filed in connection with his or her
tax or to prohibit the publication of statistics so classified as to
prevent the identification of particular reports or returns and the
items thereof, or the inspection by the attorney general or other legal
representatives of the state of the report or return of any taxpayer or
of any employer filed under section one hundred seventy-one-h of this
chapter, where such taxpayer or employer shall bring action to set aside
or review the tax based thereon, or against whom an action or proceeding
under this chapter or under this chapter and article eighteen of the
labor law has been recommended by the commissioner, the commissioner of
labor with respect to unemployment insurance matters, or the attorney
general or has been instituted, or the inspection of the reports or
returns required under this article by the comptroller or duly desig-
nated officer or employee of the state department of audit and control,
for purposes of the audit of a refund of any tax paid by a taxpayer
under this article, or the furnishing to the state department of labor
of unemployment insurance information obtained or derived from quarterly
combined withholding, wage reporting and unemployment insurance returns
required to be filed by employers pursuant to paragraph four of
subsection (a) of section six hundred seventy-four of this article, for
purposes of administration of such department's unemployment insurance
program, employment services program, federal and state employment and
training programs, employment statistics and labor market information
programs, worker protection programs, federal programs for which the
department has administrative responsibility or for other purposes
S. 6608 38 A. 9708
deemed appropriate by the commissioner of labor consistent with the
provisions of the labor law, and redisclosure of such information in
accordance with the provisions of sections five hundred thirty-six and
five hundred thirty-seven of the labor law or any other applicable law,
or the furnishing to the state office of temporary and disability
assistance of information obtained or derived from New York state
personal income tax returns as described in paragraph (b) of subdivision
two of section one hundred seventy-one-g of this chapter for the purpose
of reviewing support orders enforced pursuant to title six-A of article
three of the social services law to aid in the determination of whether
such orders should be adjusted, or the furnishing of information
obtained from the reports required to be submitted by employers regard-
ing newly hired or re-hired employees pursuant to section one hundred
seventy-one-h of this chapter to the state office of temporary and disa-
bility assistance, the state department of health, the state department
of labor and the workers' compensation board for purposes of adminis-
tration of the child support enforcement program, verification of indi-
viduals' eligibility for one or more of the programs specified in
subsection (b) of section eleven hundred thirty-seven of the federal
social security act and for other public assistance programs authorized
by state law, and administration of the state's employment security and
workers' compensation programs, and to the national directory of new
hires established pursuant to section four hundred fifty-three-A of the
federal social security act for the purposes specified in such section,
or the furnishing to the state office of temporary and disability
assistance of the amount of an overpayment of income tax and interest
thereon certified to the comptroller to be credited against past-due
support pursuant to section one hundred seventy-one-c of this chapter
and of the name and social security number of the taxpayer who made such
overpayment, or the disclosing to the commissioner of finance of the
city of New York, pursuant to section one hundred seventy-one-l of this
chapter, of the amount of an overpayment and interest thereon certified
to the comptroller to be credited against a city of New York tax warrant
judgment debt and of the name and social security number of the taxpayer
who made such overpayment, or the furnishing to the New York state high-
er education services corporation of the amount of an overpayment of
income tax and interest thereon certified to the comptroller to be cred-
ited against the amount of a default in repayment of any education loan
debt, including judgments, owed to the federal or New York state govern-
ment that is being collected by the New York state higher education
services corporation, and of the name and social security number of the
taxpayer who made such overpayment, or the furnishing to the state
department of health of the information required by paragraph (f) of
subdivision two and subdivision two-a of section two thousand five
hundred eleven of the public health law and by subdivision eight of
section three hundred sixty-six-a and paragraphs (b) and (d) of subdivi-
sion two of section three hundred sixty-nine-ee of the social services
law, AND BY SUBDIVISION FOUR OF SECTION TWENTY-FIVE HUNDRED FIFTY-SEV-
EN-A OF THE PUBLIC HEALTH LAW, AS ADDED BY A CHAPTER OF THE LAWS OF TWO
THOUSAND TEN, or the furnishing to the state university of New York or
the city university of New York respectively or the attorney general on
behalf of such state or city university the amount of an overpayment of
income tax and interest thereon certified to the comptroller to be cred-
ited against the amount of a default in repayment of a state university
loan pursuant to section one hundred seventy-one-e of this chapter and
of the name and social security number of the taxpayer who made such
S. 6608 39 A. 9708
overpayment, or the disclosing to a state agency, pursuant to section
one hundred seventy-one-f of this chapter, of the amount of an overpay-
ment and interest thereon certified to the comptroller to be credited
against a past-due legally enforceable debt owed to such agency and of
the name and social security number of the taxpayer who made such over-
payment, or the furnishing of employee and employer information obtained
through the wage reporting system, pursuant to section one hundred
seventy-one-a of this chapter, as added by chapter five hundred forty-
five of the laws of nineteen hundred seventy-eight, to the state office
of temporary and disability assistance, the department of health or to
the state office of the medicaid inspector general for the purpose of
verifying eligibility for and entitlement to amounts of benefits under
the social services law or similar law of another jurisdiction, locating
absent parents or other persons legally responsible for the support of
applicants for or recipients of public assistance and care under the
social services law and persons legally responsible for the support of a
recipient of services under section one hundred eleven-g of the social
services law and, in appropriate cases, establishing support obligations
pursuant to the social services law and the family court act or similar
provision of law of another jurisdiction for the purpose of evaluating
the effect on earnings of participation in employment, training or other
programs designed to promote self-sufficiency authorized pursuant to the
social services law by current recipients of public assistance and care
and by former applicants and recipients of public assistance and care,
(except that with regard to former recipients, information which relates
to a particular former recipient shall be provided with client identify-
ing data deleted), to the state office of temporary and disability
assistance for the purpose of determining the eligibility of any child
in the custody, care and custody or custody and guardianship of a local
social services district or of the office of children and family
services for federal payments for foster care and adoption assistance
pursuant to the provisions of title IV-E of the federal social security
act by providing information with respect to the parents, the steppar-
ents, the child and the siblings of the child who were living in the
same household as such child during the month that the court proceedings
leading to the child's removal from the household were initiated, or the
written instrument transferring care and custody of the child pursuant
to the provisions of section three hundred fifty-eight-a or three
hundred eighty-four-a of the social services law was signed, provided
however that the office of temporary and disability assistance shall
only use the information obtained pursuant to this subdivision for the
purpose of determining the eligibility of such child for federal
payments for foster care and adoption assistance pursuant to the
provisions of title IV-E of the federal social security act, and to the
state department of labor, or other individuals designated by the
commissioner of labor, for the purpose of the administration of such
department's unemployment insurance program, employment services
program, federal and state employment and training programs, employment
statistics and labor market information programs, worker protection
programs, federal programs for which the department has administrative
responsibility or for other purposes deemed appropriate by the commis-
sioner of labor consistent with the provisions of the labor law, and
redisclosure of such information in accordance with the provisions of
sections five hundred thirty-six and five hundred thirty-seven of the
labor law, or the furnishing of information, which is obtained from the
wage reporting system operated pursuant to section one hundred seventy-
S. 6608 40 A. 9708
one-a of this chapter, as added by chapter five hundred forty-five of
the laws of nineteen hundred seventy-eight, to the state office of
temporary and disability assistance so that it may furnish such informa-
tion to public agencies of other jurisdictions with which the state
office of temporary and disability assistance has an agreement pursuant
to paragraph (h) or (i) of subdivision three of section twenty of the
social services law, and to the state office of temporary and disability
assistance for the purpose of fulfilling obligations and responsibil-
ities otherwise incumbent upon the state department of labor, under
section one hundred twenty-four of the federal family support act of
nineteen hundred eighty-eight, by giving the federal parent locator
service, maintained by the federal department of health and human
services, prompt access to such information as required by such act, or
to the state department of health to verify eligibility under the child
health insurance plan pursuant to subdivisions two and two-a of section
two thousand five hundred eleven of the public health law, to verify
eligibility under the medical assistance and family health plus programs
pursuant to subdivision eight of section three hundred sixty-six-a and
paragraphs (b) and (d) of subdivision two of section three hundred
sixty-nine-ee of the social services law, and to verify eligibility for
the program for elderly pharmaceutical insurance coverage under title
three of article two of the elder law, AND FOR PURPOSES OF IMPOSING
PARENTAL FEES UNDER THE EARLY INTERVENTION PROGRAM PURSUANT TO SECTION
TWENTY-FIVE HUNDRED FIFTY-SEVEN-A OF THE PUBLIC HEALTH LAW, AS ADDED BY
A CHAPTER OF THE LAWS OF TWO THOUSAND TEN, or to the office of voca-
tional and educational services for individuals with disabilities of the
education department, the commission for the blind and visually hand-
icapped and any other state vocational rehabilitation agency, for
purposes of obtaining reimbursement from the federal social security
administration for expenditures made by such office, commission or agen-
cy on behalf of disabled individuals who have achieved economic self-
sufficiency or to the higher education services corporation for the
purpose of assisting the corporation in default prevention and default
collection of education loan debt, including judgments, owed to the
federal or New York state government; provided, however, that such
information shall be limited to the names, social security numbers, home
and/or business addresses, and employer names of defaulted or delinquent
student loan borrowers.
Provided, however, that with respect to employee information the
office of temporary and disability assistance shall only be furnished
with the names, social security account numbers and gross wages of those
employees who are (A) applicants for or recipients of benefits under the
social services law, or similar provision of law of another jurisdiction
(pursuant to an agreement under subdivision three of section twenty of
the social services law) or, (B) absent parents or other persons legally
responsible for the support of applicants for or recipients of public
assistance and care under the social services law or similar provision
of law of another jurisdiction (pursuant to an agreement under subdivi-
sion three of section twenty of the social services law), or (C) persons
legally responsible for the support of a recipient of services under
section one hundred eleven-g of the social services law or similar
provision of law of another jurisdiction (pursuant to an agreement under
subdivision three of section twenty of the social services law), or (D)
employees about whom wage reporting system information is being
furnished to public agencies of other jurisdictions, with which the
state office of temporary and disability assistance has an agreement
S. 6608 41 A. 9708
pursuant to paragraph (h) or (i) of subdivision three of section twenty
of the social services law, or (E) employees about whom wage reporting
system information is being furnished to the federal parent locator
service, maintained by the federal department of health and human
services, for the purpose of enabling the state office of temporary and
disability assistance to fulfill obligations and responsibilities other-
wise incumbent upon the state department of labor, under section one
hundred twenty-four of the federal family support act of nineteen
hundred eighty-eight, and, only if, the office of temporary and disabil-
ity assistance certifies to the commissioner that such persons are such
applicants, recipients, absent parents or persons legally responsible
for support or persons about whom information has been requested by a
public agency of another jurisdiction or by the federal parent locator
service and further certifies that in the case of information requested
under agreements with other jurisdictions entered into pursuant to
subdivision three of section twenty of the social services law, that
such request is in compliance with any applicable federal law. Provided,
further, that where the office of temporary and disability assistance
requests employee information for the purpose of evaluating the effects
on earnings of participation in employment, training or other programs
designed to promote self-sufficiency authorized pursuant to the social
services law, the office of temporary and disability assistance shall
only be furnished with the quarterly gross wages (excluding any refer-
ence to the name, social security number or any other information which
could be used to identify any employee or the name or identification
number of any employer) paid to employees who are former applicants for
or recipients of public assistance and care and who are so certified to
the commissioner by the commissioner of the office of temporary and
disability assistance. Provided, further, that with respect to employee
information, the department of health shall only be furnished with the
information required pursuant to the provisions of paragraph (f) of
subdivision two and subdivision two-a of section two thousand five
hundred eleven of the public health law and subdivision eight of section
three hundred sixty-six-a and paragraphs (b) and (d) of subdivision two
of section three hundred sixty-nine-ee of the social services law, with
respect to those individuals whose eligibility under the child health
insurance plan, medical assistance program, and family health plus
program is to be determined pursuant to such provisions and with respect
to those members of any such individual's household whose income affects
such individual's eligibility and who are so certified to the commis-
sioner or by the department of health, AND THE INFORMATION REQUIRED
PURSUANT TO THE PROVISIONS OF SUBDIVISION FOUR OF SECTION TWENTY-FIVE
HUNDRED FIFTY-SEVEN-A OF THE PUBLIC HEALTH LAW, AS ADDED BY A CHAPTER OF
THE LAWS OF TWO THOUSAND TEN, WITH RESPECT TO THOSE INDIVIDUALS FOR
WHICH A PARENTAL FEE IS REQUIRED UNDER THE EARLY INTERVENTION PROGRAM
AND WITH RESPECT TO THOSE MEMBERS OF ANY SUCH INDIVIDUAL'S HOUSEHOLD
WHOSE INCOME IS USED TO DETERMINE THE PARENTAL FEE OBLIGATION.
Provided, further, that wage reporting information shall be furnished to
the office of vocational and educational services for individuals with
disabilities of the education department, the commission for the blind
and visually handicapped and any other state vocational rehabilitation
agency only if such office, commission or agency, as applicable, certi-
fies to the commissioner that such information is necessary to obtain
reimbursement from the federal social security administration for
expenditures made on behalf of disabled individuals who have achieved
S. 6608 42 A. 9708
self-sufficiency. Reports and returns shall be preserved for three years
and thereafter until the commissioner orders them to be destroyed.
S 35. Section 2511 of the public health law is amended by adding a new
subdivision 2-c to read as follows:
2-C. EXPRESS LANE ELIGIBILITY. (A) NOTWITHSTANDING ANY INCONSISTENT
PROVISION OF LAW, RULE OR REGULATION, THE COMMISSIONER IS AUTHORIZED TO
(I) ESTABLISH STANDARDS AND PROCEDURES FOR EXPRESS LANE ELIGIBILITY AND
ENROLLMENT IMPLEMENTED IN ACCORDANCE WITH SECTION 2107(E)(1)(B) OF THE
FEDERAL SOCIAL SECURITY ACT, INCLUDING BUT NOT LIMITED TO RELIANCE ON A
FINDING MADE BY AN EXPRESS LANE AGENCY, AS DEFINED IN SECTION
1902(E)(13)(F) OF THE FEDERAL SOCIAL SECURITY ACT, TO DETERMINE WHETHER
A CHILD MEETS ONE OR MORE OF THE ELIGIBILITY CRITERIA SET FORTH IN
SUBDIVISION TWO OF THIS SECTION; (II) SPECIFY SUCH STANDARDS AND PROCE-
DURES IN THE STATE CHILD HEALTH PLAN ESTABLISHED UNDER TITLE XXI OF THE
FEDERAL SOCIAL SECURITY ACT AND APPLICABLE CONTRACTS WITH APPROVED
ORGANIZATIONS AND ENROLLMENT FACILITATORS; AND (III) WAIVE ANY INFORMA-
TION AND DOCUMENTATION REQUIREMENTS SET FORTH IN THIS SECTION NECESSARY
TO IMPLEMENT EXPRESS LANE ELIGIBILITY PURSUANT TO STANDARDS AND PROCE-
DURES ESTABLISHED UNDER SUBPARAGRAPHS (I) AND (II) OF THIS PARAGRAPH;
PROVIDED, HOWEVER, THAT INFORMATION AND DOCUMENTATION REQUIRED PURSUANT
TO SUBDIVISION TWO-B OF THIS SECTION MAY NOT BE WAIVED.
(B) SUBJECT TO FEDERAL APPROVAL, SUCH STANDARDS AND PROCEDURES SHALL
SPECIFY THAT INFORMATION AND DOCUMENTATION REGARDING CITIZENSHIP AND
IMMIGRATION STATUS COLLECTED BY AN EXPRESS LANE AGENCY AND PROVIDED TO
THE COMMISSIONER FOR THE PURPOSE OF EXPRESS LANE ELIGIBILITY MAY BE USED
TO SATISFY THE REQUIREMENTS OF SUBDIVISION TWO-B OF THIS SECTION.
(C) SUCH STANDARDS AND PROCEDURES SHALL ALSO INCLUDE A PROCESS FOR
DETERMINING ENROLLMENT ERROR RATES AND IMPLEMENTING CORRECTIVE ACTIONS
AS REQUIRED BY SECTION 1902(E)(13)(E) OF THE FEDERAL SOCIAL SECURITY
ACT.
S 36. Section 366-a of the social services law is amended by adding a
new subdivision 11 to read as follows:
11. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR
REGULATION, THE COMMISSIONER OF HEALTH IS AUTHORIZED TO (I) ESTABLISH
STANDARDS AND PROCEDURES FOR EXPRESS LANE ELIGIBILITY AND ENROLLMENT
IMPLEMENTED IN ACCORDANCE WITH SECTION 2107(E)(1)(B) OF THE FEDERAL
SOCIAL SECURITY ACT, INCLUDING BUT NOT LIMITED TO RELIANCE ON A FINDING
MADE BY AN EXPRESS LANE AGENCY, AS DEFINED IN SECTION 1902(E)(13)(F) OF
THE FEDERAL SOCIAL SECURITY ACT, TO DETERMINE WHETHER A CHILD MEETS ONE
OR MORE OF THE ELIGIBILITY CRITERIA FOR MEDICAL ASSISTANCE; (II) SPECIFY
SUCH STANDARDS AND PROCEDURES IN THE MEDICAL ASSISTANCE STATE PLAN
ESTABLISHED UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT; AND
(III) WAIVE ANY INFORMATION AND DOCUMENTATION REQUIREMENTS SET FORTH IN
THIS SECTION NECESSARY TO IMPLEMENT EXPRESS LANE ELIGIBILITY; PROVIDED,
HOWEVER, INFORMATION AND DOCUMENTATION REQUIRED PURSUANT TO SECTION ONE
HUNDRED TWENTY-TWO OF THIS CHAPTER MAY NOT BE WAIVED.
(B) SUBJECT TO FEDERAL APPROVAL, SUCH STANDARDS AND PROCEDURES SHALL
SPECIFY THAT INFORMATION AND DOCUMENTATION REGARDING CITIZENSHIP AND
IMMIGRATION STATUS COLLECTED BY AN EXPRESS LANE AGENCY AND PROVIDED TO
THE COMMISSIONER FOR THE PURPOSE OF EXPRESS LANE ELIGIBILITY MAY BE USED
TO SATISFY THE REQUIREMENTS OF SECTION ONE HUNDRED TWENTY-TWO OF THIS
CHAPTER.
(C) SUCH STANDARDS AND PROCEDURES SHALL ALSO INCLUDE A PROCESS FOR
DETERMINING ENROLLMENT ERROR RATES AND IMPLEMENTING CORRECTIVE ACTIONS
AS REQUIRED BY SECTION 1902(E)(13)(E) OF THE FEDERAL SOCIAL SECURITY
ACT.
S. 6608 43 A. 9708
(D) FOR PURPOSES OF A MEDICAL ASSISTANCE ELIGIBILITY DETERMINATION
MADE IN ACCORDANCE WITH THIS SUBDIVISION, A CHILD SHALL BE DEEMED TO
SATISFY THE INCOME ELIGIBILITY CRITERIA FOR MEDICAL ASSISTANCE IF AN
EXPRESS LANE AGENCY, AS DEFINED IN SECTION 1902(E)(13)(F) OF THE FEDERAL
SOCIAL SECURITY ACT AND SPECIFIED IN THE STANDARDS AND PROCEDURES ESTAB-
LISHED PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVISION, HAS DETERMINED
THAT: THE CHILD'S FAMILY HAS INCOME THAT DOES NOT EXCEED A SCREENING
THRESHOLD AMOUNT, AS DETERMINED BY THE COMMISSIONER OF HEALTH, EQUAL TO
A PERCENTAGE OF THE FEDERAL POVERTY LINE (AS DEFINED AND ANNUALLY
REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES)
THAT EXCEEDS BY THIRTY PERCENTAGE POINTS THE HIGHEST INCOME ELIGIBILITY
LEVEL APPLICABLE TO A FAMILY OF THE SAME SIZE UNDER THE MEDICAL ASSIST-
ANCE PROGRAM.
S 37. Section 369-ff of the social services law is amended by adding a
new subdivision 3-a to read as follows:
3-A. (A) INDIVIDUALS ENROLLED IN FAMILY HEALTH PLUS PLANS UNDER THIS
SECTION WHO ARE NOT OTHERWISE ELIGIBLE FOR FAMILY HEALTH PLUS UNDER
SECTION THREE HUNDRED SIXTY-NINE-EE OF THIS TITLE SHALL BE RESPONSIBLE
TO MAKE CO-PAYMENTS IN ACCORDANCE WITH THE TERMS OF PARAGRAPH (B) OF
THIS SUBDIVISION.
(B) CO-PAYMENTS SHALL BE CHARGED IN THE FOLLOWING AMOUNTS:
(I) THE CO-PAYMENT CHARGED FOR EACH DISCHARGE FOR INPATIENT CARE SHALL
BE ONE HUNDRED DOLLARS;
(II) THE CO-PAYMENT CHARGED FOR EACH EMERGENCY ROOM VISIT AND FOR EACH
OUTPATIENT SURGERY SHALL BE FIFTY DOLLARS;
(III) THE CO-PAYMENT CHARGED FOR EACH PRIMARY CARE PHYSICIAN OFFICE
VISIT, FOR EACH DENTAL SERVICE VISIT, FOR EACH LABORATORY SERVICE, FOR
EACH RADIOLOGY SERVICE, FOR EACH OUTPATIENT MENTAL HEALTH SERVICE, AND
FOR EACH OUTPATIENT SUBSTANCE ABUSE SERVICE SHALL BE TEN DOLLARS;
(IV) THE CO-PAYMENT CHARGED FOR EACH PHYSICIAN SPECIALIST SERVICE
OFFICE VISIT, FOR EACH PHYSICAL THERAPY SERVICE, FOR EACH OCCUPATIONAL
THERAPY SERVICE, FOR EACH SPEECH THERAPY SERVICE, FOR EACH HEARING
SERVICE, FOR EACH VISION SERVICE, AND FOR EACH PODIATRIC SERVICE SHALL
BE THIRTY-FIVE DOLLARS;
(V) THE CO-PAYMENT CHARGED FOR EACH GENERIC PRESCRIPTION DRUG
DISPENSED SHALL BE FIVE DOLLARS AND FOR EACH BRAND NAME PRESCRIPTION
DRUG DISPENSED SHALL BE FIFTEEN DOLLARS.
(C) EFFECTIVE JANUARY FIRST, TWO THOUSAND TWELVE, AND NOTWITHSTANDING
THE CO-PAYMENT AMOUNTS SET FORTH IN PARAGRAPH (B) OF THIS SECTION, THE
COMMISSIONER OF HEALTH IS AUTHORIZED TO AMEND SUCH CO-PAYMENT AMOUNTS
PURSUANT TO REGULATION.
S 38. The public health law is amended by adding a new section 279 to
read as follows:
S 279. INTERACTIONS BETWEEN PHARMACEUTICAL COMPANIES AND HEALTH CARE
PROFESSIONALS. 1. THIS SECTION SETS FORTH A CODE OF CONDUCT FOR ALL
PHARMACEUTICAL COMPANIES THAT SELL OR MARKET PRESCRIPTION DRUGS, BIOLOG-
ICS OR MEDICAL DEVICES IN THE STATE AND FOR ALL HEALTH CARE PROFES-
SIONALS PRACTICING IN THIS STATE TO WHOM SUCH DRUGS, BIOLOGICS OR
DEVICES ARE SOLD OR MARKETED. THESE PROVISIONS ARE INTENDED TO BENEFIT
PATIENTS, ENHANCE THE PRACTICE OF MEDICINE, AND ENSURE THAT THE
RELATIONSHIP BETWEEN PHARMACEUTICAL COMPANIES AND HEALTH CARE PROFES-
SIONALS DOES NOT INTERFERE WITH THE INDEPENDENT JUDGMENT OF SUCH PROFES-
SIONALS IN MAKING PRESCRIBING DECISIONS.
2. AS USED IN THIS SECTION:
(A) "BIOLOGIC" MEANS A VIRUS, THERAPEUTIC SERUM, TOXIN, ANTITOXIN,
VACCINE, BLOOD, BLOOD COMPONENT OR DERIVATIVE, ALLERGENIC PRODUCT, IMMU-
S. 6608 44 A. 9708
NOGLOBULIN PRODUCT, OR ANALOGOUS PRODUCT, AS DEFINED BY THE PUBLIC
HEALTH SERVICE ACT, APPLICABLE TO THE PREVENTION, TREATMENT, OR CURE OF
A DISEASE OR CONDITION OF HUMAN BEINGS AND REGULATED AS A DRUG UNDER THE
FEDERAL FOOD, DRUG, AND COSMETIC ACT.
(B) "BONA FIDE CONSULTING SERVICES" MEANS AN ARRANGEMENT WITH ONE OR
MORE HEALTH CARE PROFESSIONALS FOR THE PROVISION OF CONSULTING SERVICES
BY SUCH PROFESSIONAL OR PROFESSIONALS, WHERE THE ARRANGEMENT IS CHARAC-
TERIZED BY THE FOLLOWING FACTORS:
(I) A WRITTEN CONTRACT SPECIFIES THE NATURE OF THE CONSULTING SERVICES
TO BE PROVIDED AND THE BASIS FOR PAYMENT OF THOSE SERVICES;
(II) A LEGITIMATE NEED FOR THE SERVICES HAS BEEN CLEARLY IDENTIFIED IN
ADVANCE OF REQUESTING THE SERVICES AND ENTERING INTO THE PROSPECTIVE
CONSULTING ARRANGEMENT;
(III) THE CRITERIA FOR SELECTING CONSULTANTS ARE DIRECTLY RELATED TO
THE IDENTIFIED PURPOSE AND THE PERSONS RESPONSIBLE FOR SELECTING THE
CONSULTANTS HAVE THE EXPERTISE NECESSARY TO EVALUATE WHETHER THE PARTIC-
ULAR HEALTH CARE PROFESSIONALS MEET THOSE CRITERIA;
(IV) THE NUMBER OF HEALTH CARE PROFESSIONALS RETAINED IS NOT GREATER
THAN THE NUMBER REASONABLY NECESSARY TO ACHIEVE THE IDENTIFIED PURPOSE;
(V) THE RETAINING COMPANY MAINTAINS RECORDS CONCERNING AND MAKES
APPROPRIATE USE OF THE SERVICES PROVIDED BY CONSULTANTS; AND
(VI) THE VENUE AND CIRCUMSTANCES OF ANY MEETING WITH CONSULTANTS ARE
CONDUCIVE TO THE CONSULTING SERVICES AND ACTIVITIES RELATED TO THE
SERVICES ARE THE PRIMARY FOCUS OF THE MEETING.
(C) "CONFERENCE OR MEETING" MEANS ANY GATHERING:
(I) WHERE RESPONSIBILITY FOR AND CONTROL OVER THE SELECTION OF
CONTENT, FACULTY, EDUCATIONAL METHODS, MATERIALS, AND VENUE BELONGS TO
THE EVENT'S ORGANIZERS;
(II) WHICH IS HELD IN A VENUE THAT IS APPROPRIATE AND CONDUCIVE TO
INFORMATIONAL COMMUNICATION AND TRAINING ABOUT MEDICAL INFORMATION;
(III) WHICH IS PRIMARILY DEDICATED, IN BOTH TIME AND EFFORT, TO
PROMOTING OBJECTIVE SCIENTIFIC AND EDUCATIONAL ACTIVITIES AND DISCOURSE;
(IV) WHICH INCLUDES ONE OR MORE EDUCATIONAL PRESENTATIONS; AND
(V) WHICH HAS AS THE MAIN INCENTIVE FOR BRINGING ATTENDEES TOGETHER TO
FURTHER THEIR KNOWLEDGE ON THE TOPIC OR TOPICS BEING PRESENTED.
(D) "CONTINUING MEDICAL EDUCATION" MEANS COURSE WORK OR TRAINING
PROVIDED IN THE STATE TO HEALTH CARE PROFESSIONALS LICENSED HEALTH CARE
PROVIDERS AUTHORIZED BY LAW TO PRESCRIBE DRUGS, BIOLOGICS OR DEVICES,
WHICH PERTAINS TO THE PRACTICE OF THEIR PROFESSION AND FOR WHICH CONTIN-
UING MEDICAL EDUCATION OR CONTINUING PROFESSIONAL EDUCATION CREDITS MAY
BE AWARDED.
(E) "DRUGS" MEANS:
(I) ARTICLES RECOGNIZED IN THE OFFICIAL UNITED STATES PHARMACOPOEIA,
OFFICIAL HOMEOPATHIC PHARMACOPOEIA OF THE UNITED STATES, OR OFFICIAL
NATIONAL FORMULARY;
(II) ARTICLES INTENDED FOR USE IN THE DIAGNOSIS, CURE, MITIGATION,
TREATMENT OR PREVENTION OF DISEASE IN HUMANS;
(III) ARTICLES (OTHER THAN FOOD) INTENDED TO AFFECT THE STRUCTURE OR
ANY FUNCTION OF THE BODY OF HUMANS;
(IV) ARTICLES INTENDED FOR USE AS A COMPONENT OF ANY ARTICLE SPECIFIED
IN SUBPARAGRAPH (I), (II), OR (III) OF THIS PARAGRAPH, NOT INCLUDING
MEDICAL DEVICES OR THEIR COMPONENTS, PARTS OR ACCESSORIES.
(F) "FINANCIAL SUPPORT" MEANS ANYTHING WITH AN ECONOMIC VALUE, INCLUD-
ING BUT NOT LIMITED TO MONEY, GOODS AND SERVICES, OR A PROMISE OR AGREE-
MENT TO PROVIDE SUCH FINANCIAL SUPPORT IN THE FUTURE, REGARDLESS OF THE
FORM OF SUCH FINANCIAL SUPPORT, WHICH MAY INCLUDE BUT IS NOT LIMITED TO
S. 6608 45 A. 9708
PAYMENT, COMPENSATION, REIMBURSEMENT, REBATE, DISCOUNT, FEE REDUCTION,
GRANT, SCHOLARSHIP OR GIFT.
(G) "HEALTH CARE PROFESSIONAL" MEANS A PHYSICIAN, DENTIST, PHYSICIAN
ASSISTANT, SPECIALIST'S ASSISTANT, NURSE PRACTITIONER, MIDWIFE, OPTOME-
TRIST OR OTHER PERSON WHO IS LICENSED, REGISTERED OR CERTIFIED PURSUANT
TO TITLE EIGHT OF THE EDUCATION LAW AND IS AUTHORIZED UNDER SUCH TITLE
TO PRESCRIBE DRUGS OR MEDICAL DEVICES.
(H) "HOSPITAL SETTING" MEANS:
(I) A HOSPITAL, AS THAT TERM IS USED UNDER ARTICLE TWENTY-EIGHT OF
THIS CHAPTER;
(II) ACADEMIC MEDICAL CENTER; OR
(III) PHARMACEUTICAL OR MEDICAL DEVICE SPECIALIZED TRAINING FACILITY,
WHERE THE FACILITY, AS CERTIFIED TO THE DEPARTMENT BY THE PHARMACEUTICAL
OR MEDICAL DEVICE MANUFACTURING COMPANY, IS SPECIFICALLY DESIGNED TO
APPROXIMATE THE CONDITIONS OF A SURGICAL SUITE, OR THE CONDITIONS OF A
WORKING CLINICAL LABORATORY OR TO PROVIDE MEDICAL TRAINING ON LARGE AND
TECHNICAL MEDICAL DEVICES, SUCH AS SURGICAL EQUIPMENT, IMPLANTS, AND
IMAGING AND CLINICAL LABORATORY EQUIPMENT.
(I) "MEDICAL DEVICE" MEANS INSTRUMENTS, APPARATUS, AND CONTRIVANCES,
INCLUDING THEIR COMPONENTS, PARTS AND ACCESSORIES, WHICH ARE:
(I) RECOGNIZED IN THE OFFICIAL NATIONAL FORMULARY OR THE UNITED STATES
PHARMACOPEIA OR ANY SUPPLEMENT THERETO;
(II) INTENDED FOR USE IN THE DIAGNOSIS OF DISEASE OR OTHER CONDITIONS
OR IN THE CURE, MITIGATION, TREATMENT OR PREVENTION OF DISEASE, IN
PERSONS OR ANIMALS; OR
(III) INTENDED TO AFFECT THE STRUCTURE OR FUNCTION OF THE BODY OF A
PERSON OR ANIMAL, AND WHICH DOES NOT ACHIEVE ITS PRIMARY INTENDED
PURPOSES THROUGH CHEMICAL ACTION WITHIN OR ON SUCH BODY AND WHICH IS NOT
DEPENDENT UPON BEING METABOLIZED FOR THE ACHIEVEMENT OF ITS PRIMARY
INTENDED PURPOSES.
(J) "PHARMACEUTICAL COMPANY" MEANS:
(I) AN ENTITY THAT IS ENGAGED IN THE PRODUCTION, PREPARATION, PROPA-
GATION, COMPOUNDING, CONVERSION, OR PROCESSING OF PRESCRIPTION DRUGS,
BIOLOGICS, OR MEDICAL DEVICES, EITHER DIRECTLY OR INDIRECTLY, BY
EXTRACTION FROM SUBSTANCES OF NATURAL ORIGIN OR INDEPENDENTLY BY MEANS
OF CHEMICAL SYNTHESIS OR BY A COMBINATION OF EXTRACTION AND CHEMICAL
SYNTHESIS;
(II) AN ENTITY ENGAGED IN THE PACKAGING, REPACKAGING, LABELING, RELA-
BELING, OR DISTRIBUTION OF DRUGS; OR
(III) A PERSON WHO ENGAGES IN PHARMACEUTICAL DETAILING, PROMOTIONAL
ACTIVITIES, OR OTHER MARKETING OF PRESCRIPTION DRUGS, BIOLOGICS OR
MEDICAL DEVICES TO HEALTH CARE PROFESSIONALS IN THIS STATE ON BEHALF OF
AN ENTITY DESCRIBED IN SUBPARAGRAPHS (I) OR (II) OF THIS PARAGRAPH,
INCLUDING BUT NOT LIMITED TO FIELD SALES REPRESENTATIVES.
"PHARMACEUTICAL COMPANY" DOES NOT INCLUDE A LICENSED PHARMACIST TO THE
EXTENT HE OR SHE DISPENSES OR PREPARES FOR DISPENSING A PRESCRIPTION
DRUG, BIOLOGIC OR MEDICAL DEVICE.
(K) "PRESENTER" MEANS A HEALTH CARE PROFESSIONAL WHO CONDUCTS, TEACHES
OR PARTICIPATES, OTHER THAN SOLELY AS AN ATTENDEE, IN ANY ASPECT OF A
CONTINUING MEDICAL EDUCATION PROGRAM.
(L) "PROVIDER" MEANS A PERSON OR ENTITY THAT REPRESENTS TO ATTENDEES
OR POTENTIAL ATTENDEES THAT IT IS THE ORGANIZER, OR AN ORGANIZER, OF A
CONTINUING MEDICAL EDUCATION EVENT.
(M) "SPEAKER" MEANS ANY HEALTH CARE PROFESSIONAL ENGAGED BY A PHARMA-
CEUTICAL COMPANY TO PARTICIPATE IN EXTERNAL PROMOTIONAL PROGRAMS THAT
S. 6608 46 A. 9708
PROVIDE MEDICAL OR SCIENTIFIC INFORMATION TO OTHER HEALTH CARE PROFES-
SIONALS ON BEHALF OF THE COMPANY.
(N) "SPONSOR" MEANS A PHARMACEUTICAL COMPANY, OR A PERSON OR ENTITY
ACTING ON BEHALF OF A PHARMACEUTICAL COMPANY, THAT PROVIDES FINANCIAL
SUPPORT TO A PROVIDER IN CONNECTION WITH ONE OR MORE CONTINUING MEDICAL
EDUCATION PROGRAMS.
(O) "SUBSTANTIAL VALUE" MEANS THE VALUE OF AN ITEM OR SERVICE WHICH
REASONABLY APPEARS TO AN OBJECTIVE PERSON TO BE ONE HUNDRED DOLLARS OR
MORE.
3. (A) NO PHARMACEUTICAL COMPANY SHALL OFFER OR PROVIDE TO A HEALTH
CARE PROFESSIONAL, AND NO HEALTH CARE PROFESSIONAL SHALL ACCEPT:
(I) ANY FINANCIAL SUPPORT, INCLUDING BUT NOT LIMITED TO ANY GRANT,
SCHOLARSHIP, SUBSIDY, SUPPORT, CONSULTING CONTRACT, SPEAKER CONTRACT OR
EDUCATIONAL OR PRACTICE-RELATED ITEMS TO REWARD THE PROFESSIONAL FOR
HAVING PRESCRIBED PARTICULAR DRUGS, BIOLOGICS OR MEDICAL DEVICES IN THE
PAST, OR TO INDUCE THE PROFESSIONAL TO PRESCRIBE OR CONTINUE PRESCRIBING
PARTICULAR DRUGS, BIOLOGICS OR MEDICAL DEVICES IN THE FUTURE;
(II) ANY TANGIBLE OR INTANGIBLE GOOD OR SERVICE IN A MANNER OR ON
CONDITIONS THAT WOULD INTERFERE WITH THE INDEPENDENCE OF THE HEALTH CARE
PROFESSIONAL'S PRESCRIBING PRACTICES; OR
(III) ANY PAYMENT IN CASH OR CASH EQUIVALENTS, EITHER DIRECTLY OR
INDIRECTLY, EXCEPT AS COMPENSATION FOR BONA FIDE CONSULTING SERVICES OR
SPEAKER SERVICES PURSUANT TO SUBDIVISION NINE OR TEN OF THIS SECTION.
(B) NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT:
(I) THE PROVISION OF PRICE CONCESSIONS BY A PHARMACEUTICAL COMPANY TO
A HEALTH CARE PROFESSIONAL, SUCH AS REBATES OR DISCOUNTS, OF THE TYPE
THAT ARE COMMONLY OFFERED IN THE NORMAL COURSE OF BUSINESS, FOR LEGITI-
MATE BUSINESS REASONS AND TO THE EXTENT SUCH CONCESSIONS COMPLY WITH
APPLICABLE LAWS AND REGULATIONS;
(II) THE PROVISION OF PRESCRIPTION DRUGS BY A PHARMACEUTICAL COMPANY
TO A HEALTH CARE PROFESSIONAL WITHOUT CHARGE SOLELY AND EXCLUSIVELY FOR
THE PURPOSE OF PERMITTING THE PROFESSIONAL TO DISTRIBUTE SUCH DRUGS TO
HIS OR HER PATIENTS WITHOUT CHARGE, TO THE EXTENT SUCH PROVISION AND
DISTRIBUTION COMPLY WITH APPLICABLE LAWS AND REGULATIONS INCLUDING THE
PRESCRIPTION DRUG MARKETING ACT; OR
(III) THE INVESTMENT OF A PHARMACEUTICAL COMPANY IN A BUSINESS VENTURE
IN THE PHARMACEUTICAL OR BIOTECHNOLOGY FIELD IN WHICH A HEALTH CARE
PROFESSIONAL IS A PRINCIPAL, OR OTHER JOINT ARRANGEMENT BETWEEN A PHAR-
MACEUTICAL COMPANY OR HEALTH CARE PROFESSIONAL IN SUCH A VENTURE,
PROVIDED THAT THE RELATIONSHIP BETWEEN THE COMPANY AND THE PROFESSIONAL
CHIEFLY RELATES TO SUCH VENTURE AND IS NOT INTENDED TO INFLUENCE THE
PROFESSIONAL'S PRESCRIBING DECISIONS.
4. NO PHARMACEUTICAL COMPANY SHALL PROVIDE ANY PROMOTIONAL MATERIALS
TO A HEALTH CARE PROFESSIONAL UNLESS SUCH MATERIALS:
(A) ARE ACCURATE AND NOT MISLEADING;
(B) MAKE CLAIMS ABOUT A PRODUCT ONLY WHEN PROPERLY SUBSTANTIATED;
(C) ACCURATELY REFLECT THE BALANCE BETWEEN RISKS AND BENEFITS;
(D) ARE CONSISTENT WITH ALL OTHER REQUIREMENTS OF THE UNITED STATES
FOOD AND DRUG ADMINISTRATION GOVERNING SUCH COMMUNICATIONS; AND
(E) DO NOT VIOLATE THE PROVISIONS OF ARTICLE TWENTY-TWO-A OF THE
GENERAL BUSINESS LAW.
NOTHING IN THIS SECTION SHALL BE CONSTRUED TO LIMIT THE APPLICATION OF
ANY PROVISION OF ARTICLE TWENTY-TWO-A OF THE GENERAL BUSINESS LAW OR OF
SUBDIVISION TWELVE OF SECTION SIXTY-THREE OF THE EXECUTIVE LAW, OR ANY
OTHER APPLICABLE FEDERAL OR STATE LAW OR REGULATION.
S. 6608 47 A. 9708
5. (A) NO PHARMACEUTICAL COMPANY MAY OFFER OR PROVIDE MEALS TO HEALTH
CARE PROFESSIONALS, AND NO HEALTH CARE PROFESSIONAL MAY ACCEPT OR PERMIT
HIS OR HER STAFF MEMBERS TO ACCEPT SUCH MEALS FROM A PHARMACEUTICAL
COMPANY, UNLESS SUCH MEALS:
(I) ARE PROVIDED IN CONNECTION WITH STRUCTURED, ORAL INFORMATIONAL
PRESENTATIONS THAT PROVIDE SCIENTIFIC OR EDUCATIONAL VALUE AND MEET THE
CRITERIA SET FORTH IN SUBDIVISION FOUR OF THIS SECTION;
(II) ARE SERVED ONLY FOR CONSUMPTION DURING SUCH PRESENTATION AND ARE
NOT OFFERED OR SERVED FOR CONSUMPTION AT ANOTHER TIME OR PLACE OR
OUTSIDE THE PRESENCE OF THE PHARMACEUTICAL COMPANY;
(III) ARE, IF OFFERED OR PROVIDED BY A FIELD SALES REPRESENTATIVE OR
THEIR IMMEDIATE MANAGERS, PROVIDED ONLY IN THE PROFESSIONAL'S OFFICE OR
IN A HOSPITAL SETTING;
(IV) ARE OFFERED OR PROVIDED ONLY TO HEALTH CARE PROFESSIONALS AND
MEMBERS OF THEIR STAFF ATTENDING PRESENTATIONS, AND ARE NOT OFFERED OR
PROVIDED TO SPOUSES OR OTHER GUESTS OF A HEALTH CARE PROFESSIONAL;
(V) ARE MODEST AS JUDGED BY LOCAL STANDARDS;
(VI) ARE NOT PROVIDED AS PART OF AN ENTERTAINMENT OR RECREATIONAL
EVENT;
(VII) ARE PROVIDED IN A MANNER AND LOCATION CONDUCIVE TO INFORMATIONAL
COMMUNICATION; AND
(VIII) ARE PROVIDED TO A PARTICULAR HEALTH CARE PROFESSIONAL OR
MEMBERS OF SUCH PROFESSIONAL'S STAFF ON NO MORE THAN AN OCCASIONAL
BASIS.
(B) NOTWITHSTANDING THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
SION, MEALS MAY BE PROVIDED TO AND ACCEPTED BY HEALTH CARE PROFESSIONALS
WHO INTERACT WITH PERSONNEL EMPLOYED BY A PHARMACEUTICAL COMPANY, OTHER
THAN FIELD SALES REPRESENTATIVES OR THEIR IMMEDIATE MANAGERS, OR WHO ARE
ENGAGED IN BONA FIDE CONSULTING SERVICES OR SPEAKER SERVICES PURSUANT TO
SUBDIVISION NINE OR TEN OF THIS SECTION, OUTSIDE OF THE PROFESSIONAL'S
OFFICE OR A HOSPITAL SETTING, PROVIDED THAT SUCH MEALS:
(I) ARE INCIDENTAL TO A SUBSTANTIVE INTERACTION WITH THE HEALTH CARE
PROFESSIONAL;
(II) ARE NOT PROVIDED AS PART OF AN ENTERTAINMENT OR RECREATIONAL
EVENT;
(III) ARE HELD IN VENUES THAT ARE APPROPRIATE AND CONDUCIVE TO INFOR-
MATIONAL COMMUNICATION AND TRAINING ABOUT MEDICAL INFORMATION;
(IV) ARE MODEST AS JUDGED BY LOCAL STANDARDS; AND
(V) ARE PROVIDED ON NO MORE THAN AN OCCASIONAL BASIS.
6. (A) NO PHARMACEUTICAL COMPANY SHALL OFFER OR PROVIDE TO ANY HEALTH
CARE PROFESSIONAL, AND NO HEALTH CARE PROFESSIONAL SHALL ACCEPT FROM A
PHARMACEUTICAL COMPANY, ANY ENTERTAINMENT OR RECREATIONAL ITEMS OR BENE-
FITS, INCLUDING BUT NOT LIMITED TO TICKETS TO THE THEATER OR SPORTING
EVENTS, SPORTING EQUIPMENT, OR LEISURE OR VACATION TRIPS, REGARDLESS OF:
(I) THE VALUE OF THE ITEMS OR BENEFITS;
(II) WHETHER THE COMPANY ENGAGES THE HEALTH CARE PROFESSIONAL AS A
SPEAKER OR CONSULTANT; OR
(III) WHETHER THE ENTERTAINMENT OR RECREATION IS SECONDARY TO AN
EDUCATIONAL PURPOSE.
(B) NOTHING CONTAINED IN PARAGRAPH (A) OF THIS SUBDIVISION SHALL BE
CONSTRUED TO PROHIBIT A PHARMACEUTICAL COMPANY FROM PROVIDING TO A
HEALTH CARE PROFESSIONAL, OR TO PROHIBIT A HEALTH CARE PROFESSIONAL FROM
ACCEPTING, ENTERTAINMENT OR RECREATIONAL BENEFITS IF THE HEALTH CARE
PROFESSIONAL IS EMPLOYED BY THE PHARMACEUTICAL COMPANY ON A FULL-TIME,
SALARIED BASIS.
S. 6608 48 A. 9708
7. (A) NO PHARMACEUTICAL COMPANY SHALL BE A PROVIDER OF ANY CONTINUING
MEDICAL EDUCATION PROGRAM WITHIN THE STATE.
(B) NO PHARMACEUTICAL COMPANY SHALL BE A SPONSOR OF ANY CONTINUING
MEDICAL EDUCATION PROGRAM WITHIN THE STATE UNLESS THE COMPANY HAS
ADOPTED AND IS IN COMPLIANCE WITH POLICIES BY WHICH THE COMPANY:
(I) HAS SEPARATED ITS CONTINUING MEDICAL EDUCATION GRANT-MAKING FUNC-
TIONS FROM ITS SALES AND MARKETING DEPARTMENTS AND DOES NOT PERMIT ITS
SALES AND MARKETING DEPARTMENTS TO HAVE ANY INVOLVEMENT IN ITS CONTINU-
ING MEDICAL EDUCATION GRANT-MAKING ACTIVITIES;
(II) HAS DEVELOPED AND UTILIZES OBJECTIVE CRITERIA FOR MAKING CONTINU-
ING MEDICAL EDUCATION GRANT DECISIONS TO ENSURE THAT THE PROGRAM FUNDED
BY THE COMPANY IS A BONA FIDE EDUCATIONAL PROGRAM AND THAT THE FINANCIAL
SUPPORT IS NOT AN INDUCEMENT TO PRESCRIBE OR RECOMMEND A PARTICULAR
MEDICINE OR COURSE OF TREATMENT; AND
(III) AGREES TO RESPECT THE INDEPENDENT JUDGMENT OF THE CONTINUING
MEDICAL EDUCATION PROVIDER AND TO FOLLOW STANDARDS FOR COMMERCIAL
SUPPORT ESTABLISHED BY THE ACCREDITATION COUNCIL FOR CONTINUING MEDICAL
EDUCATION OR AN EQUIVALENT NATIONAL ENTITY THAT ACCREDITS CONTINUING
MEDICAL EDUCATION AND IS INDEPENDENT OF ANY SPONSOR OR ORGANIZATION OF
SPONSORS.
(C) NO PHARMACEUTICAL COMPANY SHALL, IN CONNECTION WITH ANY CONTINUING
MEDICAL EDUCATION PROGRAM WITHIN THE STATE:
(I) PROVIDE ANY ADVICE OR GUIDANCE TO THE CONTINUING MEDICAL EDUCATION
PROVIDER, EVEN IF ASKED BY THE PROVIDER, REGARDING THE CONTENT OR FACUL-
TY FOR A PARTICULAR CONTINUING MEDICAL EDUCATION PROGRAM FUNDED BY THE
COMPANY; OR
(II) PROVIDE ANY VERBAL OR WRITTEN INFORMATION TO A HEALTH CARE
PROFESSIONAL WHO IS EXPECTED TO SERVE AS A PRESENTER AT SUCH CONTINUING
MEDICAL EDUCATION PROGRAM REGARDING ANY DRUG, BIOLOGIC OR DEVICE MANU-
FACTURED, DISTRIBUTED OR MARKETED BY OR ON BEHALF OF THE COMPANY UNLESS
SUCH INFORMATION IS CONSISTENT WITH THE CRITERIA SET FORTH IN SUBDIVI-
SION FOUR OF THIS SECTION.
(D) NO PHARMACEUTICAL COMPANY MAY DIRECTLY OR INDIRECTLY OFFER OR
PROVIDE, AND NO HEALTH CARE PROFESSIONAL SHALL ACCEPT, ANY FINANCIAL
SUPPORT IN CONNECTION WITH THE PROFESSIONAL'S ATTENDANCE OR PRESENTATION
AT A CONTINUING MEDICAL EDUCATION PROGRAM, INCLUDING BUT NOT LIMITED TO
FINANCIAL SUPPORT INTENDED TO COMPENSATE THE PROFESSIONAL FOR HIS OR HER
TIME SPENT ATTENDING OR PRESENTING AT THE CONTINUING MEDICAL EDUCATION
PROGRAM OR TO REIMBURSE THE PROFESSIONAL FOR THE COSTS OF TRAVEL, LODG-
ING, OR OTHER PERSONAL EXPENSES INCURRED FOR ATTENDANCE OR PRESENTATION
AT THE CONTINUING MEDICAL EDUCATION PROGRAM.
(E) THE PROVIDER OF A CONTINUING MEDICAL EDUCATION PROGRAM AT ITS OWN
DISCRETION MAY APPLY FINANCIAL SUPPORT RECEIVED FROM A PHARMACEUTICAL
COMPANY FOR SUCH PROGRAM TO REDUCE THE OVERALL CONTINUING MEDICAL EDUCA-
TION REGISTRATION FEE FOR ALL ATTENDEES. IN SUCH CASE, NOTWITHSTANDING
PARAGRAPH (D) OF THIS SUBDIVISION, HEALTH CARE PROFESSIONALS MAY ACCEPT
THE BENEFIT OF THE REDUCED FEE.
(F) A PHARMACEUTICAL COMPANY SHALL NOT PROVIDE MEALS DIRECTLY AT
CONTINUING MEDICAL EDUCATION PROGRAMS, EXCEPT THAT A CONTINUING MEDICAL
EDUCATION PROVIDER AT ITS OWN DISCRETION MAY APPLY THE FINANCIAL SUPPORT
PROVIDED BY A COMPANY FOR A CONTINUING MEDICAL EDUCATION PROGRAM TO
PROVIDE MODEST MEALS FOR ALL PARTICIPANTS. IN SUCH CASE, NOTWITHSTAND-
ING PARAGRAPH (D) OF THIS SUBDIVISION, HEALTH CARE PROFESSIONALS MAY
ACCEPT SUCH MEALS.
(G) NOTWITHSTANDING PARAGRAPH (D) OF THIS SUBDIVISION, A PHARMACEU-
TICAL COMPANY MAY PROVIDE FINANCIAL SUPPORT FOR THE COSTS OF TRAVEL,
S. 6608 49 A. 9708
LODGING, OR OTHER PERSONAL EXPENSES TO A HEALTH CARE PROFESSIONAL
ATTENDING OR PRESENTING AT A CONTINUING MEDICAL EDUCATION PROGRAM WHO IS
A FULL-TIME SALARIED EMPLOYEE OF THE PHARMACEUTICAL COMPANY, OR WHO IS
ENGAGED BY THE COMPANY AS A SPEAKER OR CONSULTANT PURSUANT TO A BONA
FIDE AGREEMENT AND SUCH FINANCIAL SUPPORT IS PROVIDED PURSUANT TO SUCH
AGREEMENT.
(H) NO HEALTH CARE PROFESSIONAL PRACTICING IN THE STATE SHALL ATTEND
OR PRESENT AT ANY CONTINUING MEDICAL EDUCATION PROGRAM SPONSORED BY ANY
PHARMACEUTICAL COMPANY UNLESS ADVISED BY THE PROGRAM PROVIDER THAT SUCH
PHARMACEUTICAL COMPANY HAS PROVIDED ASSURANCE THAT IT HAS ADOPTED THE
POLICIES ARTICULATED IN PARAGRAPH (B) OF THIS SUBDIVISION AND IS IN
COMPLIANCE WITH SUCH POLICIES AND WITH THE REQUIREMENTS OF PARAGRAPH (C)
OF THIS SUBDIVISION.
(I) NO HEALTH CARE PROFESSIONAL WHO PRACTICES IN THE STATE AND SERVES
AS A PRESENTER AT A CONTINUING MEDICAL EDUCATION PROGRAM SHALL:
(I) PRESENT OR MAKE AVAILABLE ANY MATERIALS AT SUCH CONTINUING MEDICAL
EDUCATION PROGRAM UNLESS SUCH MATERIALS ARE, TO THE BEST OF THE PROFES-
SIONAL'S KNOWLEDGE BASED ON REASONABLE INQUIRY, CONSISTENT WITH THE
CRITERIA SET FORTH IN SUBDIVISION FOUR OF THIS SECTION;
(II) REPRESENT TO ATTENDEES OF SUCH CONTINUING MEDICAL EDUCATION
PROGRAM THAT HE OR SHE AUTHORED ANY MATERIALS DISCUSSED, DISTRIBUTED OR
OTHERWISE PRESENTED DURING HIS OR HER PRESENTATION AT SUCH CONTINUING
MEDICAL EDUCATION PROGRAM UNLESS HE OR SHE MADE SUBSTANTIAL CONTRIB-
UTIONS TO THE INTELLECTUAL CONTENT OF SUCH MATERIALS; OR
(III) FAIL TO DISCLOSE DURING HIS OR HER PRESENTATION THE EXISTENCE
AND NATURE OF ANY FINANCIAL SUPPORT HE OR SHE HAS RECEIVED FROM OR
EXPECTS TO RECEIVE FROM A SPONSOR OF SUCH CONTINUING MEDICAL EDUCATION
PROGRAM OR FROM A PHARMACEUTICAL COMPANY THAT MANUFACTURERS, DISTRIBUTES
OR MARKETS ANY DRUG, BIOLOGIC OR MEDICAL DEVICE DISCUSSED IN SUCH PRES-
ENTATION OR COMMONLY PRESCRIBED FOR A DISEASE, INJURY OR CONDITION
DISCUSSED IN SUCH PRESENTATION, EXCEPT THAT DISCLOSURE NEED NOT BE MADE
OF ANY FEE REDUCTION PURSUANT TO PARAGRAPH (G) OF THIS SUBDIVISION OR
THE ACCEPTANCE OF A MEAL PURSUANT TO PARAGRAPH (F) OF THIS SUBDIVISION.
8. (A) NO PHARMACEUTICAL COMPANY SHALL DIRECTLY OR INDIRECTLY OFFER OR
PROVIDE ANY FINANCIAL SUPPORT TO A HEALTH CARE PROFESSIONAL IN
CONNECTION WITH THE PROFESSIONAL'S ATTENDANCE AT OR PARTICIPATION IN A
CONFERENCE OR MEETING, INCLUDING BUT NOT LIMITED TO COMPENSATION FOR THE
PROFESSIONAL'S TIME SPENT ATTENDING OR PARTICIPATING IN THE CONFERENCE
OR MEETING OR REIMBURSEMENT OF THE COSTS INCURRED BY THE PROFESSIONAL
FOR TRAVEL, LODGING, OR OTHER PERSONAL EXPENSES IN CONNECTION WITH THE
ATTENDANCE AT OR PARTICIPATION IN THE CONFERENCE OR MEETING.
(B) NO PHARMACEUTICAL COMPANY SHALL PROVIDE FINANCIAL SUPPORT FOR A
CONFERENCE OR MEETING IF IT HAS ANY RESPONSIBILITY FOR AND CONTROL OVER
THE SELECTION OF CONTENT, FACULTY, EDUCATIONAL METHODS, MATERIALS, OR
VENUE OF THE CONFERENCE OR GUIDELINES, EXCEPT FOR CONFERENCES OR MEET-
INGS SPONSORED BY THE COMPANY.
(C) NOTWITHSTANDING PARAGRAPH (A) OR (B) OF THIS SUBDIVISION, A PHAR-
MACEUTICAL COMPANY MAY PROVIDE FINANCIAL SUPPORT TO THE SPONSOR OF A
CONFERENCE OR MEETING, WHICH MAY BE USED BY THE SPONSOR TO REDUCE THE
OVERALL CONFERENCE REGISTRATION FEE FOR ALL ATTENDEES.
(D) A PHARMACEUTICAL COMPANY MAY PROVIDE MODEST MEALS OR RECEPTIONS
DURING COMPANY-SPONSORED MEETINGS TO HEALTH CARE PROFESSIONALS WITH WHOM
THEY HAVE BONA FIDE CONSULTING OR SPEAKER ARRANGEMENTS, BUT MAY NOT
PROVIDE RECREATIONAL OR ENTERTAINMENT EVENTS IN CONJUNCTION WITH SUCH
MEETINGS.
S. 6608 50 A. 9708
9. NO PHARMACEUTICAL COMPANY SHALL PROVIDE FINANCIAL SUPPORT TO A
HEALTH CARE PROFESSIONAL PURSUANT TO A CONSULTING AGREEMENT, AND NO
HEALTH CARE PROFESSIONAL SHALL ACCEPT SUCH FINANCIAL SUPPORT, UNLESS:
(A) THE CONSULTING ARRANGEMENT IS A BONA FIDE CONSULTING AGREEMENT;
AND
(B) SUCH FINANCIAL SUPPORT CONSTITUTES REASONABLE COMPENSATION FOR THE
PROFESSIONAL'S CONSULTING SERVICES AND REASONABLE REIMBURSEMENT FOR
REASONABLE TRAVEL, LODGING, AND MEAL EXPENSES INCURRED AS PART OF
PROVIDING SUCH SERVICES, AND IS BASED ON FAIR MARKET VALUE.
10. (A) NO PHARMACEUTICAL COMPANY SHALL PROVIDE FINANCIAL SUPPORT TO A
HEALTH CARE PROFESSIONAL AS A SPEAKER PURSUANT TO A SPEAKER AGREEMENT,
AND NO HEALTH CARE PROFESSIONAL SHALL ACCEPT SUCH FINANCIAL SUPPORT,
UNLESS:
(I) THE SPEAKER ARRANGEMENT MEETS THE CRITERIA OF A BONA FIDE CONSULT-
ING AGREEMENT;
(II) SUCH FINANCIAL SUPPORT CONSTITUTES REASONABLE COMPENSATION FOR
THE PROFESSIONAL'S SPEAKER SERVICES AND REASONABLE REIMBURSEMENTS FOR
REASONABLE TRAVEL, LODGING AND MEAL EXPENSES INCURRED AS PART OF PROVID-
ING SUCH SERVICES, AND IS BASED ON FAIR MARKET VALUE; AND
(III) THE PROFESSIONAL POSSESSES THE GENERAL MEDICAL EXPERTISE AND
REPUTATION, KNOWLEDGE AND EXPERIENCE REGARDING A PARTICULAR THERAPEUTIC
AREA, AND COMMUNICATIONS SKILLS SUCH AS WOULD REASONABLY BE EXPECTED OF
A SPEAKER IN THE RELEVANT FIELD.
(B) NO PHARMACEUTICAL COMPANY SHALL RETAIN A HEALTH CARE PROFESSIONAL
AS A SPEAKER UNLESS THE COMPANY:
(I) CAPS THE TOTAL AMOUNT OF ANNUAL COMPENSATION IT WILL PAY TO AN
INDIVIDUAL HEALTH CARE PROFESSIONAL IN CONNECTION WITH ALL SPEAKING
ARRANGEMENTS AT A REASONABLE AMOUNT;
(II) PROVIDES FOR PERIODIC MONITORING OF SPEAKER PROGRAMS FOR COMPLI-
ANCE WITH UNITED STATES FOOD AND DRUG ADMINISTRATION REGULATORY REQUIRE-
MENTS FOR COMMUNICATIONS ON BEHALF OF THE COMPANY ABOUT ITS MEDICINES;
(III) ENSURES THAT EACH PROFESSIONAL RECEIVES EXTENSIVE TRAINING ON
THE COMPANY'S DRUG PRODUCTS OR OTHER SPECIFIC TOPIC TO BE PRESENTED AND
ON COMPLIANCE WITH UNITED STATES FOOD AND DRUG ADMINISTRATION REGULATORY
REQUIREMENTS FOR COMMUNICATIONS;
(IV) REASONABLY BELIEVES THAT THE TRAINING WILL RESULT IN THE PARTIC-
IPANTS PROVIDING A VALUABLE SERVICE TO THE COMPANY; AND
(V) SPEAKER TRAINING SESSIONS ARE HELD IN VENUES THAT ARE APPROPRIATE
AND CONDUCIVE TO INFORMATIONAL COMMUNICATION AND TRAINING ABOUT MEDICAL
INFORMATION.
(C) A PHARMACEUTICAL COMPANY SHALL NOT PROVIDE MEALS TO HEALTH CARE
PROFESSIONALS AT SPEAKER PROGRAMS UNLESS SUCH MEALS ARE MODEST, OFFERED
TO ALL ATTENDEES AND OCCUR IN A VENUE AND MANNER CONDUCIVE TO INFORMA-
TIONAL COMMUNICATION.
(D) A PHARMACEUTICAL COMPANY SHALL ENSURE THAT EACH SPEAKER AND HIS OR
HER MATERIALS CLEARLY IDENTIFY THE COMPANY THAT IS SPONSORING THE PRES-
ENTATION, THE FACT THAT THE SPEAKER IS PRESENTING ON BEHALF OF THE
COMPANY, AND THAT THE SPEAKER IS PRESENTING INFORMATION THAT IS CONSIST-
ENT WITH UNITED STATES FOOD AND DRUG ADMINISTRATION GUIDELINES.
11. (A) NO PHARMACEUTICAL COMPANY SHALL RETAIN AS A SPEAKER OR
CONSULTANT ANY HEALTH CARE PROFESSIONAL WHO IS A MEMBER OF A COMMITTEE
THAT SETS FORMULARIES OR DEVELOPS CLINICAL GUIDELINES UNLESS THE COMPANY
REQUIRES THAT THE PROFESSIONAL DISCLOSE TO SUCH COMMITTEE THE EXISTENCE
AND NATURE OF HIS OR HER RELATIONSHIP WITH THE COMPANY, FOR AS LONG AS
SUCH RELATIONSHIP LASTS AND FOR AT LEAST TWO YEARS AFTER SUCH RELATION-
SHIP IS TERMINATED.
S. 6608 51 A. 9708
(B) NO HEALTH CARE PROFESSIONAL SHALL SERVE BOTH AS A SPEAKER OR
CONSULTANT FOR A PHARMACEUTICAL COMPANY AND AS A MEMBER OF A COMMITTEE
THAT SETS FORMULARIES OR DEVELOPS CLINICAL GUIDELINES UNLESS HE OR SHE:
(I) DISCLOSES TO SUCH COMMITTEE THE EXISTENCE AND NATURE OF HIS OR HER
RELATIONSHIP WITH THE COMPANY, WHICH DISCLOSURE REQUIREMENT SHALL EXTEND
FOR A MINIMUM OF TWO YEARS BEYOND THE TERMINATION OF ANY SPEAKER OR
CONSULTANT ARRANGEMENT; AND
(II) FOLLOWS THE RELEVANT PROCEDURES SET FORTH BY THE COMMITTEE OF
WHICH THEY ARE A MEMBER, WHICH MAY INCLUDE RECUSING THEMSELVES FROM
DECISIONS RELATING TO THE PRESCRIPTION DRUG, DEVICE OR BIOLOGIC FOR
WHICH THEY HAVE PROVIDED SPEAKING OR CONSULTING SERVICES.
12. NO PHARMACEUTICAL COMPANY SHALL OFFER OR PROVIDE FINANCIAL ASSIST-
ANCE FOR SCHOLARSHIPS OR OTHER EDUCATIONAL FUNDS TO PERMIT MEDICAL
STUDENTS, RESIDENTS, FELLOWS, AND OTHER HEALTH CARE PROFESSIONALS IN
TRAINING TO ATTEND EDUCATIONAL CONFERENCES UNLESS:
(A) SUCH CONFERENCES ARE SPONSORED BY THE MAJOR EDUCATIONAL, SCIENTIF-
IC, OR POLICY-MAKING MEETINGS OF NATIONAL, REGIONAL, OR SPECIALTY
MEDICAL ASSOCIATIONS; AND
(B) THE SELECTION OF INDIVIDUALS WHO WILL RECEIVE THE ASSISTANCE IS
MADE BY THE ACADEMIC OR TRAINING INSTITUTION.
13. A PHARMACEUTICAL COMPANY THAT OBTAINS PRESCRIBER DATA FROM HEALTH
CARE PROFESSIONALS SHALL:
(A) MAINTAIN THE CONFIDENTIAL NATURE OF PRESCRIBER DATA AND COMPLY
WITH ALL APPLICABLE LAWS AND REGULATIONS THAT PROTECT THE CONFIDENTIALI-
TY OF PATIENT INFORMATION;
(B) DEVELOP WRITTEN POLICIES REGARDING THE USE OF THE DATA;
(C) EDUCATE ITS EMPLOYEES AND AGENTS ABOUT SUCH POLICIES;
(D) DESIGNATE AN INTERNAL CONTACT PERSON TO HANDLE INQUIRIES REGARDING
THE USE OF THE DATA;
(E) IDENTIFY APPROPRIATE DISCIPLINARY ACTIONS FOR MISUSE OF PRESCRIBER
DATA; AND
(F) ABIDE BY THE WISHES OF ANY HEALTH CARE PROFESSIONAL WHO REQUESTS
THAT HIS OR HER PRESCRIBER DATA NOT BE MADE AVAILABLE FOR ANY SALES OR
MARKETING PURPOSE.
14. NO PHARMACEUTICAL COMPANY SHALL OFFER OR PROVIDE TO HEALTH CARE
PROFESSIONALS OR MEMBERS OF THEIR STAFF:
(A) ANY ITEM OR SERVICE INTENDED FOR THE PERSONAL BENEFIT OF THE
PROFESSIONAL OR STAFF MEMBERS, SUCH AS FLORAL ARRANGEMENTS, ARTWORK,
COMPACT DISCS OR TICKETS TO A SPORTING EVENT;
(B) ANY TANGIBLE ITEM, EVEN IF THEY ARE PRACTICE-RELATED ITEMS OF
MINIMAL VALUE SUCH AS PENS, NOTE PADS, OR MUGS, OR ARE ACCOMPANIED BY
PATIENT OR PHYSICIAN EDUCATIONAL MATERIALS, EXCEPT FOR EDUCATIONAL ITEMS
DESCRIBED IN THIS SUBDIVISION; OR
(C) ANY CASH OR CASH EQUIVALENTS, SUCH AS GIFT CERTIFICATES, EITHER
DIRECTLY OR INDIRECTLY, EXCEPT AS COMPENSATION FOR BONA FIDE SERVICES
EXPRESSLY PERMITTED UNDER THIS SECTION.
15. A PHARMACEUTICAL COMPANY MAY OFFER OR PROVIDE TO HEALTH CARE
PROFESSIONALS ITEMS DESIGNED PRIMARILY FOR THE EDUCATION OF PATIENTS OR
HEALTH CARE PROFESSIONALS ONLY IF THE ITEMS:
(A) ARE NOT OF SUBSTANTIAL VALUE AND DO NOT HAVE VALUE TO THE HEALTH
CARE PROFESSIONAL OUTSIDE OF HIS OR HER PROFESSIONAL RESPONSIBILITIES,
SUCH AS AN ANATOMICAL MODEL FOR USE IN AN EXAMINATION ROOM; AND
(B) ARE NOT OFFERED TO A PARTICULAR HEALTH CARE PROFESSIONAL ON MORE
THAN AN OCCASIONAL BASIS, EVEN IF EACH INDIVIDUAL ITEM IS APPROPRIATE.
16. (A) NO PHARMACEUTICAL COMPANY SHALL SELL OR MARKET PRESCRIPTION
DRUGS, BIOLOGICS OR MEDICAL DEVICES TO HEALTH CARE PROFESSIONALS PRAC-
S. 6608 52 A. 9708
TICING IN THIS STATE UNLESS THE REPRESENTATIVES WHO ARE EMPLOYED BY OR
ACT ON BEHALF OF THE COMPANY AND WHO VISIT HEALTH CARE PROFESSIONALS
PRACTICING IN THIS STATE ARE:
(I) TRAINED IN THE APPLICABLE LAWS AND REGULATIONS THAT GOVERN THE
REPRESENTATIVES' INTERACTIONS WITH HEALTH CARE PROFESSIONALS, WHICH
TRAINING SHALL BE UPDATED AS NECESSARY;
(II) TRAINED IN OR OTHERWISE KNOWLEDGEABLE ABOUT GENERAL SCIENCE AND
PRODUCT-SPECIFIC INFORMATION SUFFICIENT TO ALLOW THE REPRESENTATIVES TO
PROVIDE ACCURATE, UP-TO-DATE INFORMATION, CONSISTENT WITH UNITED STATES
FOOD AND DRUG ADMINISTRATION REQUIREMENTS AND OTHER CRITERIA SET FORTH
IN SUBDIVISION FOUR OF THIS SECTION;
(III) PERIODICALLY ASSESSED TO ENSURE THAT THEY COMPLY WITH APPLICABLE
LAWS, REGULATIONS AND RELEVANT COMPANY POLICIES AND STANDARDS OF
CONDUCT; AND
(IV) SUBJECT TO APPROPRIATE ACTION WHEN THEY FAIL TO COMPLY WITH LAWS,
REGULATIONS AND RELEVANT COMPANY POLICIES AND STANDARDS OF CONDUCT.
17. THE COMMISSIONER MAY ASSESS A CIVIL PENALTY:
(A) AGAINST A PHARMACEUTICAL COMPANY THAT VIOLATES ANY PROVISION OF
THIS SECTION IN AN AMOUNT THAT IS NOT LESS THAN FIFTEEN THOUSAND DOLLARS
AND NOT MORE THAN TWO HUNDRED FIFTY THOUSAND DOLLARS PER VIOLATION; AND
(B) AGAINST A HEALTH CARE PROFESSIONAL THAT VIOLATES ANY PROVISION OF
THIS SECTION IN AN AMOUNT THAT IS NOT LESS THAN FIVE THOUSAND DOLLARS
AND NOT MORE THAN TEN THOUSAND DOLLARS PER VIOLATION.
S 38-a. Section 6509 of the education law is amended by adding a new
subdivision 15 to read as follows:
(15) A VIOLATION OF SECTION TWO HUNDRED SEVENTY-NINE OF THE PUBLIC
HEALTH LAW.
S 38-b. Section 6530 of the education law is amended by adding a new
subdivision 50 to read as follows:
50. A VIOLATION OF SECTION TWO HUNDRED SEVENTY-NINE OF THE PUBLIC
HEALTH LAW.
S 39. The opening paragraphs of paragraphs (d) and (e) of subdivision
5-a of section 2807-m of the public health law, as amended by section 98
of part C of chapter 58 of the laws of 2009, are amended to read as
follows:
One million nine hundred sixty thousand dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight, one million nine hundred sixty thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine, [one] TWO million [nine] SEVEN hundred [sixty] FIFTEEN
thousand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten, and [four] SEVEN hundred [nine-
ty] FORTY-ONE thousand dollars for the period January first, two thou-
sand 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 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 available funds going to the rest of the state and shall
be distributed in a manner to be determined by the commissioner as
follows:
Four million nine hundred thousand dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight, four million nine hundred thousand dollars [annually] for the
period January first, two thousand nine through December thirty-first,
S. 6608 53 A. 9708
two thousand [ten] NINE, SIX MILLION SEVEN HUNDRED THOUSAND DOLLARS FOR
THE PERIOD JANUARY FIRST, TWO THOUSAND TEN THROUGH DECEMBER
THIRTY-FIRST, TWO THOUSAND TEN, and one million [two] SIX hundred [twen-
ty-five] NINETY-SEVEN 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 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:
S 39-a. Paragraphs (a) and (c) of subdivision 10 of section 2807-m of
the public health law, as added by section 75-e of part C of chapter 58
of the laws of 2008, are amended to read as follows:
(a) Beginning January first, two thousand eight, the commissioner is
authorized, within amounts available pursuant to subdivision five-a of
this section, to make loan repayment awards to primary care physicians
or other physician specialties determined by the commissioner to be in
short supply, licensed to practice medicine in New York state, who agree
to practice for at least five years in an underserved area, as deter-
mined by the commissioner. Such physician shall be eligible for a loan
repayment award of up to one hundred fifty thousand dollars over a five
year period distributed as follows: fifteen percent of total loan debt
not to exceed twenty thousand dollars for the first year; fifteen
percent of total loan debt not to exceed twenty-five thousand dollars
for the second year; twenty percent of total loan debt not to exceed
thirty-five thousand dollars for the third year; and twenty-five percent
of total loan debt not to exceed thirty-five thousand dollars per year
for the fourth [and] YEAR; AND ANY UNPAID BALANCE OF THE TOTAL LOAN DEBT
NOT TO EXCEED THE MAXIMUM AWARD AMOUNT FOR THE fifth [years] YEAR of
practice in such area.
(c) In the event that a five-year commitment pursuant to the agreement
referenced in paragraph (a) of this subdivision is not fulfilled, the
recipient shall be responsible for repayment[, plus interest at a rate
determined by the commissioner but not less than the rate of interest
set by the commissioner of taxation and finance with respect to under-
payments of personal income tax pursuant to section six hundred eighty-
four of the tax law, based upon the following schedule: service of less
than two years requires repayment of one hundred percent of total funds
received; service of less than three years requires repayment of fifty
percent of total funds received; service of less than four years
requires repayment of twenty-five percent of total funds received, and
service of more than four years but less than five years requires repay-
ment of ten percent of total funds received] IN AMOUNTS WHICH SHALL BE
CALCULATED IN ACCORDANCE WITH THE FORMULA SET FORTH IN SUBDIVISION (B)
OF SECTION TWO HUNDRED FIFTY-FOUR-O OF TITLE FORTY-TWO OF THE UNITED
STATES CODE, AS AMENDED.
S 40. Subdivision 1 of section 2802-a of the public health law, as
added by section 87 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
1. Notwithstanding any other provision of law to the contrary, the
commissioner is authorized to approve up to [five] TEN general hospitals
within the state to operate transitional care units by and within such
general hospitals. For purposes of this section, "transitional care"
shall mean sub acute care services provided to patients of a general
S. 6608 54 A. 9708
hospital who no longer require acute care general hospital inpatient
services, but continue to need specialized medical, nursing and other
hospital ancillary services and are not yet appropriate for discharge.
S 41. Subdivision 2 of section 105 of part B of chapter 58 of the
laws of 2005, amending the public health law and other laws relating to
implementing the state fiscal plan for the 2005-2006 state fiscal year,
is amended to read as follows:
2. Section eighty-seven of this act shall expire and be deemed
repealed [five] TEN years from the date on which it shall have become a
law;
S 42. Subdivision 2 of section 12 of the public health law, as amended
by chapter 856 of the laws of 1974, is amended and a new subdivision 1-a
is added to read as follows:
1-A. (A) ANY PERSON WHO, WITH THE INTENT TO DEFRAUD, KNOWINGLY AND
WILLFULLY VIOLATES, DISOBEYS OR DISREGARDS ANY MATERIAL TERM OR
PROVISION OF THE MEDICAL ASSISTANCE PROGRAM ESTABLISHED UNDER SECTION
THREE HUNDRED SIXTY-THREE-A OF THE SOCIAL SERVICES LAW OR OF ANY LAWFUL
NOTICE, ORDER OR REGULATION PURSUANT THEREOF SHALL BE LIABLE TO THE
PEOPLE OF THE STATE FOR A CIVIL PENALTY OF TEN THOUSAND DOLLARS FOR
EVERY SUCH VIOLATION.
(B) THE PENALTY PROVIDED FOR IN PARAGRAPH (A) OF THIS SUBDIVISION
SHALL BE INCREASED TO TWENTY-FIVE THOUSAND DOLLARS FOR A SUBSEQUENT
VIOLATION COMMITTED WITHIN FIVE YEARS OF THE INITIAL VIOLATION FOR WHICH
A PENALTY WAS ASSESSED PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVISION.
(C) THE PENALTY PROVIDED FOR IN PARAGRAPH (B) OF THIS SUBDIVISION
SHALL BE INCREASED TO FIFTY THOUSAND DOLLARS FOR A SUBSEQUENT VIOLATION
COMMITTED WITHIN FIVE YEARS OF THE INITIAL VIOLATION FOR WHICH A PENALTY
WAS ASSESSED PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVISION.
2. The [penalty] PENALTIES provided for in [subdivision] SUBDIVISIONS
one AND ONE-A of this section may be recovered by an action brought by
the commissioner in any court of competent jurisdiction.
S 43. Subdivision 4 of section 6 of part C of chapter 58 of the laws
of 2005, amending the public health law and other laws relating to
authorizing reimbursements for expenditures made by social services
districts for medical assistance, is amended to read as follows:
4. If the commissioner of health finds that a district has either
substantially failed to demonstrate due diligence, including due dili-
gence with respect to the identification and reporting of fraud and
abuse, according to the prescribed requirements and guidelines or
continues to fail to comply with such requirements then such commission-
er may impose such sanctions and penalties as are permitted under the
public health law and the social services law. IN ADDITION, IF THE
FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES, OR A SUCCESSOR AGEN-
CY, DISALLOWS CLAIMS FOR FEDERAL FINANCIAL PARTICIPATION SUBMITTED TO IT
BY THE DEPARTMENT OF HEALTH, OR IF ANY FEDERAL AGENCY DETERMINES TO
RECOVER FEDERAL MEDICAID FUNDS PREVIOUSLY PAID TO THE DEPARTMENT OF
HEALTH, THE DEPARTMENT MAY RECOVER FROM A DISTRICT THE AMOUNT OF SUCH
DISALLOWANCE OR RECOVERY THAT THE COMMISSIONER DETERMINES WAS CAUSED BY
A DISTRICT'S FAILURE TO PROPERLY ADMINISTER, SUPERVISE OR OPERATE THE
MEDICAID PROGRAM. ANY SUCH RECOVERY FROM A DISTRICT SHALL BE MADE
NOTWITHSTANDING, AND IN ADDITION TO, ANY DISTRICT MEDICAID SHARE AMOUNTS
CALCULATED PURSUANT TO SECTION ONE OF THIS PART.
S 43-a. Paragraph (f) of section 1 of part C of chapter 58 of the laws
of 2005, amending the public health law and other laws relating to
authorizing reimbursements for expenditures made by social services
S. 6608 55 A. 9708
districts for medical assistance, as amended by section 62 of part C of
chapter 58 of the laws of 2007, is amended to read as follows:
(f) Subject to paragraph (g) of this section, the state fiscal year
social services district expenditure cap amount calculated for each
social services district pursuant to paragraph (d) of this section shall
be allotted to each district during that fiscal year and paid to the
department in equal weekly amounts in a manner to be determined by the
commissioner and communicated to such districts and, SUBJECT TO THE
PROVISIONS OF SUBDIVISION FOUR OF SECTION SIX OF THIS PART, shall repre-
sent each district's maximum responsibility for medical assistance
expenditures governed by this section.
S 43-b. Paragraph (b) of section 1 of part C of chapter 58 of the laws
of 2005, amending the public health law and other laws relating to
authorizing reimbursements for expenditures made by social services
districts for medical assistance, is amended to read as follows:
(b) Commencing with the period April 1, 2005 though March 31, 2006, a
social services district's yearly net share of medical assistance
expenditures shall be calculated in relation to a reimbursement base
year which, for purposes of this section, is defined as January 1, 2005
through December 31, 2005. The final base year expenditure calculation
for each social services district shall be made by the commissioner of
health, and approved by the director of the division of the budget, no
later than June 30, 2006. Such calculations shall be based on actual
expenditures made by or on behalf of social services districts, and
revenues received by social services districts, during the base year and
shall be made without regard to expenditures made, and revenues
received, outside the base year that are related to services provided
during, or prior to, the base year. Such base year calculations shall be
based on the social services district medical assistance shares
provisions in effect on January 1, 2005. SUBJECT TO THE PROVISIONS OF
SUBDIVISION FOUR OF SECTION SIX OF THIS PART, THE STATE/LOCAL SOCIAL
SERVICES DISTRICT RELATIVE PERCENTAGES OF THE NON-FEDERAL SHARE OF
MEDICAL ASSISTANCE EXPENDITURES INCURRED PRIOR TO JANUARY 1, 2006 SHALL
NOT BE SUBJECT TO ADJUSTMENT ON AND AFTER JULY 1, 2006.
S 44. Notwithstanding any contrary provision of law, surcharges and
assessments due and owing pursuant to sections 2807-j, 2807-s and 2807-t
of the public health law for any period prior to January 1, 2010, which
are paid and accompanied by all required reports and which were received
on or before December 31, 2010 shall not be subject to penalties as
otherwise provided in such sections, provided, however, that such
reports may be based on estimates by payors and designated providers of
services of the amounts owed, subject to subsequent audit by the commis-
sioner of health or such commissioner's designee, however, with regard
to all principal, interest and penalty amounts collected by the commis-
sioner of health prior to the effective date of this act, the interest
and penalty provisions of sections 2807-j, 2807-s and 2807-t of the
public health law shall remain in full force and effect and such amounts
collected shall not be subject to further adjustment pursuant to this
section. Furthermore, the provisions of this section shall not apply to
any surcharge or assessment payments made in response to a final audit
finding issued by such commissioner of health or such commissioner's
designee.
S 45. Paragraph (f) of subdivision 8-a of section 2807-j of the public
health law, as added by section 39 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
S. 6608 56 A. 9708
(f) The commissioner may enter into agreements with designated provid-
ers of services, and with third-party payors, in regard to which audit
findings have been made pursuant to this section or section twenty-eight
hundred seven-s of this article, extending and applying such audit find-
ings or a portion thereof in settlement and satisfaction of potential
audit liabilities for subsequent un-audited periods through the two
thousand [five] NINE calendar year. The commissioner may waive payment
of interest and penalties otherwise applicable to such subsequent unau-
dited periods when such amounts due as a result of such agreement, other
than waived penalties and interest, are paid in full to the commissioner
or the commissioner's designee within sixty days of execution of such
agreement by all parties to the agreement.
S 46. Section 2872 of the public health law is amended by adding a new
subdivision 3-b to read as follows:
3-B. "ELIGIBLE SECURED HOSPITAL BORROWER". A NOT-FOR-PROFIT HOSPITAL
CORPORATION ORGANIZED UNDER THE LAWS OF THIS STATE, WHICH HAS FINANCED
OR REFINANCED A PROJECT OR PROJECTS PURSUANT TO THE FORMER SECTION
SEVEN-A OF SECTION ONE OF CHAPTER THREE HUNDRED NINETY-TWO OF THE LAWS
OF NINETEEN HUNDRED SEVENTY-THREE AND FOR WHICH SPECIAL HOSPITAL PROJECT
BONDS (AS DEFINED IN FORMER PARAGRAPH (D) OF SUBDIVISION THREE OF
SECTION THREE OF SECTION ONE OF CHAPTER THREE HUNDRED NINETY-TWO OF THE
LAWS OF NINETEEN HUNDRED SEVENTY-THREE) REMAIN OUTSTANDING.
S 46-a. The public health law is amended by adding a new section
2874-b to read as follows:
S 2874-B. REFINANCING MORTGAGE LOANS TO ELIGIBLE SECURED HOSPITAL
BORROWERS. ELIGIBLE SECURED HOSPITAL BORROWERS, AS DEFINED IN SUBDIVI-
SION THREE-B OF SECTION TWENTY-EIGHT HUNDRED SEVENTY-TWO OF THIS ARTI-
CLE, SHALL BE AUTHORIZED TO REFINANCE ANY MORTGAGE LOAN FINANCED WITH
THE PROCEEDS OF SPECIAL HOSPITAL PROJECT BONDS, WHICH LOANS ARE
OUTSTANDING AS OF THE EFFECTIVE DATE OF THIS SECTION. A MORTGAGE LOAN TO
AN ELIGIBLE SECURED HOSPITAL BORROWER, AS DEFINED IN SUBDIVISION THREE-B
OF SECTION TWENTY-EIGHT HUNDRED SEVENTY-TWO OF THIS ARTICLE, MADE BY THE
MEDICAL CARE FACILITIES FINANCE AGENCY, AND ANY SUCCESSOR THERETO, MAY
BE REFINANCED FOR A TERM NOT LONGER THAN THE TERM SUFFICIENT TO ASSURE
THAT THE INTEREST ON BONDS ISSUED TO REFINANCE THE MORTGAGE LOAN WILL BE
EXCLUDABLE FROM GROSS INCOME OF THE HOLDERS THEREOF FOR FEDERAL TAX
PURPOSES, PROVIDED THAT IN NO EVENT SHALL THE TERM OF SUCH REFINANCING
LOAN EXCEED THIRTY YEARS FROM THE DATE OF THE ISSUANCE OF THE REFUNDING
BONDS AND SHALL INCLUDE ALL COSTS ASSOCIATED WITH THE REFINANCING OF
INDEBTEDNESS. ALL REFINANCING APPLICATIONS BY ELIGIBLE SECURED HOSPITAL
BORROWERS SHALL BE APPROVED BY THE ELIGIBLE SECURED HOSPITAL BORROWER'S
BOARD AND THE COMMISSIONER. SUCH REFINANCING APPLICATIONS SHALL INCLUDE
ANALYTICAL EVIDENCE SUFFICIENT TO DEMONSTRATE THAT THE PROPOSED REFI-
NANCING IS BEING UNDERTAKEN FOR SOUND BUSINESS PURPOSES AND IN FURTHER-
ANCE OF MAINTAINING OR IMPROVING THE FINANCIAL CONDITION OF THE HOSPI-
TAL. SUCH EVIDENCE MAY INCLUDE BUT IS NOT LIMITED TO: PRESENT VALUE
ANALYSIS OF DEBT SERVICE PAYMENTS, INCLUDING WHERE APPLICABLE, PRESENT
VALUE ANALYSIS THAT SEGREGATES DEBT SERVICE PAYMENTS BETWEEN PRINCIPAL
AND INTEREST COMPONENTS; FINANCIAL PRO FORMAS THAT PROJECT THE BORROW-
ER'S REVENUES, EXPENSES AND FINANCIAL POSITION FOR A PERIOD DETERMINED
BY THE COMMISSIONER; OR ANY OTHER ANALYSIS OR INFORMATION THE COMMIS-
SIONER DEEMS NECESSARY TO EVALUATE THE APPLICATION (INCLUDING BUT NOT
LIMITED TO ANALYSIS AND RECOMMENDATIONS OF CONSULTANTS). AS A CONDITION
OF SUCH PRIOR APPROVAL, THE COMMISSIONER SHALL APPROVE THE PRINCIPAL
AMOUNT OF THE REFINANCING, AND REQUIRE THE ELIGIBLE SECURED HOSPITAL
BORROWER TO GIVE THE DEPARTMENT A WRITTEN UNDERTAKING, ACCEPTABLE TO THE
S. 6608 57 A. 9708
COMMISSIONER, THAT IT WILL NOT CLAIM ADDITIONAL REIMBURSEMENT UNDER THE
MEDICAL ASSISTANCE PROGRAM AS ESTABLISHED UNDER TITLE ELEVEN OF ARTICLE
FIVE OF THE SOCIAL SERVICES LAW DUE TO INTEREST PAYMENTS ON REFINANCING
INDEBTEDNESS. ANY SUCH ADDITIONAL INTEREST PAYMENTS ON REFINANCED
INDEBTEDNESS COVERED BY SUCH WRITTEN UNDERTAKING SHALL NOT BE CONSIDERED
AS ALLOWABLE COSTS UNDER THE MEDICAL ASSISTANCE PROGRAM AND SHALL NOT BE
INCLUDED IN REIMBURSEMENT RATES OF PAYMENT UNDER ARTICLE TWENTY-EIGHT OF
THIS CHAPTER.
S 46-b. Subdivision 3 of section 3 of section 1 of chapter 392 of the
laws of 1973, constituting the New York state medical care facilities
finance agency act, is amended by adding a new paragraph (d-1) to read
as follows:
(D-1) "SPECIAL HOSPITAL PROJECT BONDS" SHALL MEAN BONDS ISSUED PURSU-
ANT TO SECTION SEVEN-C OF THIS ACT FOR THE PURPOSE OF REFINANCING
OUTSTANDING MORTGAGE LOANS OF ELIGIBLE SECURED HOSPITAL BORROWERS, AS
DEFINED IN SUBDIVISION SIX-C OF THIS SECTION, PURSUANT TO THIS ACT.
S 46-c. Section 3 of section 1 of chapter 392 of the laws of 1973,
constituting the New York state medical care facilities finance agency
act, is amended by adding a new subdivision 6-c to read as follows:
6-C. "ELIGIBLE SECURED HOSPITAL BORROWER" SHALL MEAN A NOT-FOR-PROFIT
HOSPITAL CORPORATION ORGANIZED UNDER THE LAWS OF THIS STATE, WHICH HAS
FINANCED OR REFINANCED A PROJECT OR PROJECTS PURSUANT TO FORMER SECTION
SEVEN-A OF THIS ACT, AND FOR WHICH SPECIAL HOSPITAL PROJECT BONDS, AS
DEFINED IN FORMER PARAGRAPH D OF SUBDIVISION THREE OF THIS SECTION,
REMAIN OUTSTANDING.
S 46-d. Subdivision 10 of section 3 of section 1 of chapter 392 of the
laws of 1973, constituting the New York state medical care facilities
finance agency act, as amended by chapter 803 of the laws of 1984, is
amended to read as follows:
10. "Hospital project" shall mean a specific work or improvement or
the refinancing of existing indebtedness which constitutes a lien or
encumbrance upon the real property or assets of the eligible borrower OR
THE REFINANCING OF EXISTING INDEBTEDNESS OF AN ELIGIBLE SECURED HOSPITAL
BORROWER, AS DEFINED IN SUBDIVISION SIX-C OF THIS SECTION, FOR WHICH
SPECIAL HOSPITAL PROJECT BONDS, AS DEFINED IN FORMER PARAGRAPH (D) OF
SUBDIVISION THREE OF THIS SECTION, REMAIN OUTSTANDING whether or not
such refinancing is related to the construction, acquisition or rehabil-
itation of a specified work or improvement undertaken by a non-profit
hospital corporation or a non-profit medical corporation, constituting
an eligible borrower in accordance with the provisions of article [twen-
ty-eight-B] 28-B of the public health law.
S 46-e. Subdivision 11 of section 3 of section 1 of chapter 392 of the
laws of 1973, constituting the New York state medical care facilities
finance agency act, is amended to read as follows:
11. "Hospital project cost" shall mean the sum total of all costs
incurred by a non-profit hospital corporation or a non-profit medical
corporation, constituting an eligible borrower undertaking a project as
approved by the commissioner in accordance with the provisions of arti-
cle [twenty-eight-B] 28-B of the public health law, OR, IN CASE OF AN
ELIGIBLE SECURED HOSPITAL BORROWER, ALL COSTS INCURRED IN CONNECTION
WITH THE REFINANCING OF EXISTING INDEBTEDNESS APPROVED BY THE COMMIS-
SIONER PURSUANT TO SECTION 2874-B OF THE PUBLIC HEALTH LAW.
S 46-f. Subdivision 12 of section 3 of section 1 of chapter 392 of the
laws of 1973, constituting the New York state medical care facilities
finance agency act, as amended by chapter 156 of the laws of 1974, is
amended to read as follows:
S. 6608 58 A. 9708
12. "Mortgage loan" shall mean a loan made by the agency to an eligi-
ble borrower in an amount not to exceed the total hospital project cost
and secured by a first mortgage lien on the real property of which the
hospital project consists and the personal property attached to or used
in connection with the construction, acquisition, reconstruction, reha-
bilitation, improvement or operation of the hospital project. Such loan
may be further secured by such a lien upon other real property owned by
the eligible borrower. Notwithstanding the foregoing provisions of this
subdivision or any other provisions of this act to the contrary, any
personal property may be excluded from the lien of the mortgage provided
(a) the commissioner [of health] finds that such property is not essen-
tial for the rendition of required hospital services as such term is
defined in article [twenty-eight] 28 of the public health law, and (b)
the agency consents to such exclusion.
The term "mortgage loan" shall also mean and include a loan made by
the agency to a limited-profit nursing home company in an amount not to
exceed ninety-five [percentum] PER CENTUM of the nursing home project
cost, or to a non-profit nursing home company in an amount not to exceed
the total nursing home project cost, and secured by a first mortgage
lien on the real property of which the nursing home project consists and
the personal property attached to or used in connection with the
construction, acquisition, reconstruction, rehabilitation, improvement
or operation of the nursing home project. Notwithstanding the foregoing
provisions of this subdivision or any other provision of this article to
the contrary, any personal property may be excluded from the lien of the
mortgage provided (a) the commissioner finds that such property is not
essential for the nursing home project as such term is defined in arti-
cle [twenty-eight-A] 28-A of the public health law, and (b) the agency
consents to such exclusion.
THE TERM "MORTGAGE LOAN" SHALL ALSO MEAN AND INCLUDE A LOAN MADE TO AN
ELIGIBLE SECURED HOSPITAL BORROWER, AS DEFINED IN SUBDIVISION SIX-C OF
THIS SECTION, TO REFINANCE OUTSTANDING INDEBTEDNESS PURSUANT TO THIS
ACT.
S 46-g. Subdivision 10 of section 5 of section 1 of chapter 392 of the
laws of 1973 constituting the New York state medical care facilities
finance agency act, as amended by chapter 387 of the laws of 2006, is
amended to read as follows:
10. Subject to the approval of the commissioner of health pursuant to
the provisions of article 28-B of the public health law, to make mort-
gage loans and project loans to non-profit hospital corporations and
non-profit medical corporations constituting eligible borrowers AND
ELIGIBLE SECURED HOSPITAL BORROWERS AS DEFINED IN SUBDIVISION SIX-C OF
SECTION THREE OF THIS ACT and to undertake commitments to make any such
mortgage loans and project loans;
S 46-h. Section 1 of chapter 392 of the laws of 1973, constituting
the New York state medical care facilities finance agency act, is
amended by adding a new section 7-c to read as follows:
S 7-C. SECURED HOSPITAL PROJECTS RESERVE FUNDS AND APPROPRIATIONS. 1.
SPECIAL HOSPITAL PROJECT BONDS, AS DEFINED IN PARAGRAPH (D-1) OF SUBDI-
VISION THREE OF SECTION THREE OF THIS ACT, ISSUED TO REFINANCE THE
PROJECTS OF ELIGIBLE SECURED HOSPITAL BORROWERS, AS DEFINED IN SUBDIVI-
SION SIX-C OF SECTION THREE OF THIS ACT, SHALL BE SECURED BY (A) A MORT-
GAGE LIEN, (B) FUNDS AND ACCOUNTS ESTABLISHED UNDER THE BOND RESOLUTION,
(C) THE SECURED HOSPITAL SPECIAL DEBT SERVICE RESERVE FUND OR FUNDS, (D)
THE SECURED HOSPITAL CAPITAL RESERVE FUND OR FUNDS, AND (E) SUCH SERVICE
S. 6608 59 A. 9708
CONTRACT OR CONTRACTS ENTERED INTO IN ACCORDANCE WITH THE PROVISIONS OF
SUBDIVISION FOUR OF THIS SECTION.
2. (A) THE AGENCY SHALL ESTABLISH A SECURED HOSPITAL SPECIAL DEBT
SERVICE RESERVE FUND OR FUNDS AND PAY INTO SUCH FUND OR FUNDS MONEYS
FROM THE SECURED HOSPITAL FUND UP TO AN AMOUNT NOT TO EXCEED AN AMOUNT
NECESSARY TO ENSURE THE REPAYMENT OF PRINCIPAL AND INTEREST DUE ON ANY
OUTSTANDING INDEBTEDNESS ON SPECIAL HOSPITAL PROJECTS BONDS, AS DEFINED
IN PARAGRAPH (D-1) OF SUBDIVISION THREE OF SECTION THREE OF THIS ACT.
FUNDS DEPOSITED IN SUCH SECURED HOSPITAL SPECIAL DEBT SERVICE RESERVE
FUND OR FUNDS SHALL BE USED IN THE EVENT THAT AN ELIGIBLE SECURED HOSPI-
TAL BORROWER, AS DEFINED IN SUBDIVISION SIX-C OF SECTION THREE OF THIS
ACT, FAILS TO MAKE PAYMENTS IN AN AMOUNT SUFFICIENT TO PAY THE REQUIRED
DEBT SERVICE PAYMENTS ON SPECIAL HOSPITAL PROJECT BONDS, AS DEFINED IN
PARAGRAPH (D-1) OF SUBDIVISION THREE OF SECTION THREE OF THIS ACT.
(B) THE AGENCY SHALL, FOR THE PURPOSES OF PARAGRAPH (A) OF THIS SUBDI-
VISION AND FOR THE SUPPORT OF ELIGIBLE SECURED HOSPITAL BORROWERS, PAY
INTO THE SECURED HOSPITAL FUND CURRENTLY ESTABLISHED AND MAINTAINED BY
THE AGENCY: (I) ALL FUNDS REQUIRED TO BE PAID IN ACCORDANCE WITH THE
PROVISIONS OF ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW AND REGU-
LATIONS PROMULGATED IN SUCH ARTICLE; (II) ANY MORTGAGE INSURANCE PREMIUM
ASSESSED IN AN AMOUNT FIXED AT THE DISCRETION OF THE AGENCY, UPON THE
ISSUANCE OF SPECIAL HOSPITAL PROJECT BONDS, AS DEFINED IN PARAGRAPH
(D-1) OF SUBDIVISION THREE OF SECTION THREE OF THIS ACT; (III) ANY
INCOME OR INTEREST EARNED ON OTHER RESERVE FUNDS WHICH THE AGENCY ELECTS
TO TRANSFER TO THE SECURED HOSPITAL FUND; AND (IV) ANY OTHER MONEYS
WHICH MAY BE MADE AVAILABLE TO THE AGENCY FROM ANY OTHER SOURCE OR
SOURCES. MONEYS PAID INTO THE SECURED HOSPITAL FUND SHALL, IN THE
DISCRETION OF THE AGENCY, BUT SUBJECT TO AGREEMENTS WITH BONDHOLDERS, BE
USED TO FUND THE SPECIAL DEBT SERVICE RESERVE FUND OR FUNDS AT A LEVEL
OR LEVELS WHICH MINIMIZE THE NEED FOR USE OF THE CAPITAL RESERVE FUND OR
FUNDS IN THE EVENT OF THE FAILURE OF AN ELIGIBLE SECURED HOSPITAL
BORROWER, AS DEFINED IN SUBDIVISION SIX-C OF SECTION THREE OF THIS ACT,
TO MAKE THE REQUIRED DEBT SERVICE PAYMENTS ON SPECIAL HOSPITAL PROJECT
BONDS, AS DEFINED IN PARAGRAPH (D-1) OF SUBDIVISION THREE OF SECTION
THREE OF THIS ACT.
(C) NOTWITHSTANDING THE PROVISIONS OF PARAGRAPHS (A) AND (B) OF THIS
SUBDIVISION, THE STATE HEREBY EXPRESSLY RESERVES THE RIGHT TO MODIFY OR
REPEAL THE PROVISIONS OF ARTICLE 28 OF THE PUBLIC HEALTH LAW.
3. THE AGENCY SHALL ESTABLISH A SECURED HOSPITAL CAPITAL RESERVE FUND
OR FUNDS WHICH SHALL BE FUNDED AT AN AMOUNT OR AMOUNTS EQUAL TO THE
LESSER OF EITHER: (A) THE MAXIMUM AMOUNT OF PRINCIPAL, SINKING FUND
PAYMENTS AND INTEREST DUE IN ANY SUCCEEDING YEAR ON OUTSTANDING SPECIAL
HOSPITAL PROJECT BONDS, AS DEFINED IN PARAGRAPH (D-1) OF SUBDIVISION
THREE OF SECTION THREE OF THIS ACT, OR (B) FOR TAX EXEMPT BONDS, THE
MAXIMUM AMOUNT TO ENSURE THAT SUCH BONDS WILL NOT BE CONSIDERED ARBI-
TRAGE BONDS UNDER THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. THE
CAPITAL RESERVE FUND SHALL BE FUNDED BY THE SALE OF SPECIAL HOSPITAL
PROJECT BONDS, AS DEFINED IN PARAGRAPH (D-1) OF SUBDIVISION THREE OF
SECTION THREE OF THIS ACT, OR FROM SUCH OTHER FUNDS AS MAY BE LEGALLY
AVAILABLE FOR SUCH PURPOSE, AS PROVIDED FOR IN THE BOND RESOLUTION OR
RESOLUTIONS AUTHORIZING THE ISSUANCE OF SUCH BONDS.
4. (A) NOTWITHSTANDING THE PROVISIONS OF ANY GENERAL OR SPECIAL LAW TO
THE CONTRARY, AND SUBJECT TO THE MAKING OF ANNUAL APPROPRIATIONS THERE-
FOR BY THE LEGISLATURE IN ORDER TO REFINANCE MORTGAGE LOANS TO ELIGIBLE
SECURED HOSPITAL BORROWERS, AS DEFINED IN SUBDIVISION SIX-C OF SECTION
THREE OF THIS ACT, THE DIRECTOR OF THE BUDGET IS AUTHORIZED IN ANY STATE
S. 6608 60 A. 9708
FISCAL YEAR TO ENTER INTO ONE OR MORE SERVICE CONTRACTS, WHICH SERVICE
CONTRACTS SHALL NOT EXCEED THE TERM OF THE SPECIAL HOSPITAL PROJECT
BONDS, ISSUED FOR THE BENEFIT OF THE ELIGIBLE SECURED HOSPITAL BORROWER,
UPON SUCH TERMS AS THE DIRECTOR OF THE BUDGET AND THE AGENCY AGREE, SO
AS TO PROVIDE ANNUALLY TO THE AGENCY IN THE AGGREGATE SUCH SUM, IF ANY,
AS NECESSARY TO MEET THE DEBT SERVICE PAYMENTS DUE ON OUTSTANDING
SPECIAL HOSPITAL PROJECT BONDS, AS DEFINED IN PARAGRAPH (D-1) OF SUBDI-
VISION THREE OF SECTION THREE OF THIS ACT, IN ANY YEAR IF THE FUNDS
PROVIDED FOR IN THIS SECTION ARE INADEQUATE.
(B) ANY SERVICE CONTRACT ENTERED INTO PURSUANT TO PARAGRAPH (A) OF
THIS SUBDIVISION SHALL PROVIDE (I) THAT THE OBLIGATION OF THE DIRECTOR
OF THE BUDGET OR OF THE STATE TO FUND OR TO PAY THE AMOUNTS THEREIN
PROVIDED FOR SHALL NOT CONSTITUTE A DEBT OF THE STATE WITHIN THE MEANING
OF ANY CONSTITUTIONAL OR STATUTORY PROVISION AND SHALL BE DEEMED EXECU-
TORY ONLY TO THE EXTENT OF MONEYS AVAILABLE AND THAT NO LIABILITY SHALL
BE INCURRED BY THE STATE BEYOND THE MONEYS AVAILABLE FOR SUCH PURPOSE,
AND THAT SUCH OBLIGATION IS SUBJECT TO ANNUAL APPROPRIATION BY THE
LEGISLATURE; AND (II) THAT THE AMOUNTS PAID TO THE AGENCY PURSUANT TO
ANY SUCH CONTRACT MAY BE USED BY IT SOLELY TO PAY OR TO ASSIST IN
FINANCING COSTS OF MORTGAGE LOANS TO ELIGIBLE SECURED HOSPITAL BORROW-
ERS, AS DEFINED IN SUBDIVISION SIX-C OF SECTION THREE OF THIS ACT.
5. THE AGENCY SHALL NOT ISSUE SPECIAL HOSPITAL PROJECT BONDS, AS
DEFINED IN PARAGRAPH (D-1) OF SUBDIVISION THREE OF SECTION THREE OF THIS
ACT, EXCEPT TO REFINANCE MORTGAGE LOANS FOR ELIGIBLE SECURED HOSPITAL
BORROWERS AS PROVIDED IN SECTION THREE OF THIS ACT.
S 46-i. Notwithstanding any other provision of this act: (i)
reimbursement for interest on any indebtedness hereunder to be paid by
the medical assistance program established under title 11 of article 5
of the social services law shall be subject to the availability of
federal financial participation; and (ii) the refinancing of a mortgage
loan pursuant to this act shall not alter, affect or change the compo-
nent of medical assistance reimbursement applicable to the depreciation
of any asset or assets.
S 47. Subdivision 2 of section 366-a of the social services law is
amended by adding a new paragraph (d) to read as follows:
(D) NOTWITHSTANDING THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
SION, AN APPLICANT OR RECIPIENT WHOSE ELIGIBILITY UNDER THIS TITLE IS
DETERMINED WITHOUT REGARD TO THE AMOUNT OF HIS OR HER ACCUMULATED
RESOURCES MAY ATTEST TO THE AMOUNT OF INTEREST INCOME GENERATED BY SUCH
RESOURCES IF THE AMOUNT OF SUCH INTEREST INCOME IS EXPECTED TO BE IMMA-
TERIAL TO MEDICAL ASSISTANCE ELIGIBILITY, AS DETERMINED BY THE COMMIS-
SIONER OF HEALTH. IN THE EVENT THERE IS AN INCONSISTENCY BETWEEN THE
INFORMATION REPORTED BY THE APPLICANT OR RECIPIENT AND ANY INFORMATION
OBTAINED BY THE COMMISSIONER OF HEALTH FROM OTHER SOURCES AND SUCH
INCONSISTENCY IS MATERIAL TO MEDICAL ASSISTANCE ELIGIBILITY, THE COMMIS-
SIONER OF HEALTH SHALL REQUEST THAT THE APPLICANT OR RECIPIENT PROVIDE
ADEQUATE DOCUMENTATION TO VERIFY HIS OR HER INTEREST INCOME.
S 47-a. Subdivision 2 of section 369-ee of the social services law is
amended by adding a new paragraph (b-1) to read as follows:
(B-1) NOTWITHSTANDING THE PROVISIONS OF PARAGRAPH (B) OF THIS SUBDIVI-
SION, AN INDIVIDUAL MAY ATTEST TO THE AMOUNT OF INTEREST INCOME GENER-
ATED BY HIS OR HER ACCUMULATED RESOURCES IF THE AMOUNT OF SUCH INTEREST
INCOME IS EXPECTED TO BE IMMATERIAL TO ELIGIBILITY UNDER THIS SECTION,
AS DETERMINED BY THE COMMISSIONER OF HEALTH. IN THE EVENT THERE IS AN
INCONSISTENCY BETWEEN THE INFORMATION REPORTED BY THE INDIVIDUAL AND ANY
INFORMATION OBTAINED BY THE COMMISSIONER OF HEALTH FROM OTHER SOURCES
S. 6608 61 A. 9708
AND SUCH INCONSISTENCY IS MATERIAL TO ELIGIBILITY UNDER THIS SECTION,
THE COMMISSIONER OF HEALTH SHALL REQUEST THAT THE INDIVIDUAL PROVIDE
ADEQUATE DOCUMENTATION TO VERIFY HIS OR HER INTEREST INCOME.
S 48. Paragraph (d) of subdivision 5 of section 366-a of the social
services law, as amended by section 1 of part R of chapter 58 of the
laws of 2009, 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 OF ELIGIBILITY for assistance under this title [for a recipient
of], PERSONS RECEIVING medicaid COMMUNITY COVERAGE WITH COMMUNITY-BASED
LONG TERM CARE, INCLUDING BUT NOT LIMITED TO waiver services provided or
authorized by the office of mental retardation and developmental disa-
bilities, 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 [deter-
mine] RECERTIFY such eligibility.
S 49. Paragraph (a) of subdivision 4 of section 366 of the social
services law, as amended by chapter 453 of the laws of 1990, subpara-
graph (i) as amended by section 59 of part B of chapter 436 of the laws
of 1997, is amended to read as follows:
(a) [(i)] Notwithstanding any other provision of law, each family
which was eligible for medical assistance pursuant to subparagraph eight
or nine of paragraph (a) of subdivision one of this section in at least
[three] ONE of the six months immediately preceding the month in which
such family became ineligible for such assistance because of hours of,
or income from, employment of the caretaker relative, or because of loss
of entitlement to the earnings disregard under subparagraph (iii) of
paragraph (a) of subdivision eight of section one hundred thirty-one-a
of this [chapter] ARTICLE shall, while such family includes a dependent
child, remain eligible for medical assistance for [six] TWELVE calendar
months immediately following the month in which such family would other-
wise be determined to be ineligible for medical assistance pursuant to
the provisions of this title and the regulations of the department
governing income and resource limitations relating to eligibility deter-
minations for families described in subparagraph eight of paragraph (a)
of subdivision one of this section.
[(ii) Each family which received medical assistance for the entire six
month period under subparagraph (i) of this paragraph and complied with
the department's reporting requirements for such initial six month peri-
od shall be offered the option of extending such eligibility for an
additional six calendar months if and for so long as such family
includes a dependent child and meets the income requirements in subpara-
graph (ii) of paragraph (b) of this subdivision.]
S. 6608 62 A. 9708
S 50. Paragraph (b) of subdivision 4 of section 366 of the social
services law, as added by chapter 453 of the laws of 1990, subparagraph
(i) as amended by section 60 of part B of chapter 436 of the laws of
1997, is amended to read as follows:
(b) (i) Upon giving notice of termination of medical assistance
provided pursuant to subparagraph eight or nine of paragraph (a) of
subdivision one of this section, the department shall notify each such
family of its rights to extended benefits under paragraph (a) of this
subdivision and describe [any reporting requirements and] the conditions
under which such extension may be terminated. [The department shall also
provide subsequent notices of the option to extend coverage pursuant to
paragraph (a) of this subdivision in the third and sixth months of the
initial six month extended coverage period and notices of the reporting
requirements under such paragraph in each of the third and sixth months
of the initial six month extended coverage period and in the third month
of the additional extended coverage period.]
(ii) The department shall promulgate regulations implementing the
requirements of this paragraph and paragraph (a) of this subdivision
relating to the conditions under which [initial] extended coverage [and
additional extended coverage] hereunder may be terminated, the scope of
coverage, [the reporting requirements] and the conditions under which
coverage may be extended pending a redetermination of eligibility. Such
regulations shall, at a minimum, provide for: (A) termination of such
coverage at the close of the first month in which the family ceases to
include a dependent child [and at the close of the first or fourth month
of the additional extended coverage period if the family fails to
report, as required by the regulations, or the caretaker relative had no
earnings in one or more of the previous three months unless such lack of
earnings was for good cause, or the family's average gross monthly earn-
ings, less necessary work related child care costs of the caretaker
relative, during the preceding three months was greater than one hundred
eighty-five percent of the federal income official poverty line applica-
ble to the family's size]; (B) notice of termination prior to the effec-
tive date of any terminations; (C) [quarterly reporting of income and
child care costs during the initial and additional extended coverage
periods; (D)] coverage under employee health plans and health mainte-
nance organizations; and [(E)] (D) disqualification of persons for
extended coverage benefits under this paragraph for fraud.
S 51. Notwithstanding any inconsistent provision of section 112 or 163
of the state finance law or any other contrary provision of the state
finance law or any other contrary provision of law, the commissioner of
health may, without a competitive bid or request for proposal process,
enter into contracts with one or more certified public accounting firms
for the purpose of conducting audits of disproportionate share hospital
payments made by the state of New York to general hospitals and for the
purpose of conducting audits of hospital cost reports as submitted to
the state of New York in accordance with article 28 of the public health
law.
S 52. Section 17 of part C of chapter 58 of the laws of 2005 amending
the public health law and other laws relating to implementing the state
fiscal plan for the 2005-2006 state fiscal year, as added by section 21
of part E of chapter 63 of the laws of 2005, is amended to read as
follows:
S 17. 1. Notwithstanding any inconsistent provision of law, rule or
regulation, for payments made by a state governmental agency to a gener-
al hospital for specialty inpatient AND OUTPATIENT hospital services
S. 6608 63 A. 9708
provided to patients eligible for payments pursuant to title 11 of arti-
cle 5 of the social services law discharged on or after April 1, 2005
through March 31, [2010] 2015, the commissioner of health, subject to
the approval of the director of the budget, may:
(a) after a hospital has agreed to participate in a program selected
pursuant to subdivision two of this section, establish rates of payment
or special payment rate methodologies for specialty [inpatient] hospital
services selected in accordance with subdivision two of this section
provided to patients eligible for payments pursuant to title 11 of arti-
cle 5 of the social services law through negotiations with hospitals in
any area of the state. Such negotiated rates, if any, shall be negoti-
ated with each individual selected hospital. Such negotiation shall
include a process for the commissioner of health and each selected
hospital to mutually identify services for which such negotiated rates
shall apply. Such rates shall be reasonable and adequate to reimburse
the costs of an economically and efficiently operated provider of
services. The commissioner of health may establish adjusted rates of
payment pursuant to an administrative rate appeal process to hospitals
that participate in such negotiations and agree to receive the negoti-
ated payment rates established under this paragraph for the patients
described in this paragraph in lieu of rates of payment otherwise appli-
cable pursuant to section 2807-c of the public health law without a
competitive bid or request for proposal process; and/or
(b) select among hospitals in any area of the state those eligible for
reimbursement for specialty [inpatient] hospital services selected in
accordance with subdivision two of this section and establish payments
for such services based on a competitive bidding process.
2. The commissioner of health shall select [a maximum of five
geographically defined inpatient] hospital sites for which reimbursement
may be negotiated for a maximum of [five] TEN specialty inpatient AND
OUTPATIENT services that are selected based on the following criteria:
(a) such services may be provided more efficiently and economically;
and
(b) there is a correlation between the volume of such services or
procedures performed by [an inpatient] A hospital and improved patient
outcomes that is accepted by medical experts in the field as evidenced
by inclusion in peer reviewed scientific literature published and/or
recognized by national organizations; and
(c) identification of such services and the implementation of this
section with respect to such services is consistent with other initi-
atives to enhance the quality and patient outcomes of [inpatient] HOSPI-
TAL services and procedures that are or are being planned to be under-
taken by the department of health, including but not limited to projects
that identify centers of excellence for particular services; and
(d) identification of such services for purposes of implementing this
section will not diminish access, including geographic access, which for
purposes of this section shall mean that a patient shall not be
prevented from accessing services in a timely fashion due to distance or
travel time; [and]
(e) [such services have low utilization or are provided in units with
low occupancy; and
(f)] any other criteria determined by the commissioner of health to
promote the cost effective delivery of specialty [inpatient] hospital
services; AND
(F) CRITERIA UTILIZED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID
SERVICES WITH REGARD TO PAYMENT METHODOLOGIES UTILIZED WITH REGARD TO
S. 6608 64 A. 9708
CENTERS OF EXCELLENCE PURSUANT TO TITLE XVIII OF THE FEDERAL SOCIAL
SECURITY ACT (MEDICARE).
3. Selection of hospitals by the commissioner of health pursuant to
subdivision two of this section shall be made based on the following
criteria:
(a) Consultation with hospitals, hospital associations or other
provider organizations, and consumers; and
(b) Assurances of patient access, including geographic access, to the
selected specialty services; and
(c) Historical volume of services provided by the hospital; and
(d) Consistency with other quality and outcomes improvement initi-
atives being or planned to be pursued by the department of health,
including but not limited to, projects that identify centers of excel-
lence; and
(e) The order and timeline under which services identified pursuant to
this section shall be provided; and
(f) Such other criteria that the commissioner of health may deem
appropriate.
4. [Inpatient hospital] HOSPITAL services not selected by the commis-
sioner of health pursuant to this section and not subject to negotiation
under paragraph (a) of subdivision one of this section provided to
patients eligible for payments pursuant to title 11 of article 5 of the
social services law shall be reimbursed pursuant to [section] SECTIONS
2807 OR 2807-c of the public health law, AS APPLICABLE.
5. Notwithstanding any inconsistent provisions of law, rule or regu-
lation, for purposes of this program, no payments within a geograph-
ically defined site shall be made for specialty [inpatient] hospital
services selected by the commissioner of health in accordance with
subdivision two of this section for which there is an adjusted rate of
payment with a hospital pursuant to paragraph (a) or (b) of subdivision
one of this section when such services are provided to patients eligible
for payments pursuant to title 11 of article 5 of the social services
law by a hospital which has not received adjusted rates of payment
pursuant to paragraph (a) or (b) of subdivision one of this section;
provided, however, payments may be made to such hospital in accordance
with section 2807-c of the public health law if the provision of such
services has been prior approved by the commissioner of health, or if
the inpatient admission is a result of an emergency admission.
6. Payment of rates established pursuant to this section for purposes
of this program shall be contingent upon federal approval of a waiver
application submitted by the commissioner of health in order to receive
federal financial participation for services provided under this
section; provided, however, the commissioner of health shall provide a
copy of such waiver application to the legislature prior to submission
for federal approval. The commissioner of health may take any steps
necessary to implement this section prior to receiving federal approval
of such waiver application.
7. The commissioner of health shall report to the governor and the
legislature concerning the implementation of this section, including
available data regarding the cost effective delivery of specialty inpa-
tient services selected in accordance with this section, within eighteen
months from the date of issuance of adjusted rates of payment entered
into pursuant to paragraphs (a) and (b) of subdivision one of this
section.
S. 6608 65 A. 9708
S 53. Paragraph (q) of subdivision 2 of section 365-a of the social
services law, as added by section 32 of part C of chapter 58 of the laws
of 2008, is amended to read as follows:
(q) diabetes self-management training services for persons diagnosed
with diabetes when such services are ordered by a physician, registered
[physician's] PHYSICIAN assistant, registered nurse practitioner, or
licensed midwife and provided by a licensed, registered, or certified
health care professional, as determined by the commissioner of health,
who is certified as a diabetes educator by the National Certification
Board for Diabetes Educators, or a successor national certification
board, OR PROVIDED BY SUCH A PROFESSIONAL WHO IS AFFILIATED WITH A
PROGRAM CERTIFIED BY THE AMERICAN DIABETES ASSOCIATION, THE AMERICAN
ASSOCIATION OF DIABETES EDUCATORS, THE INDIAN HEALTH SERVICES, OR ANY
OTHER NATIONAL ACCREDITATION ORGANIZATION APPROVED BY THE FEDERAL
CENTERS FOR MEDICARE AND MEDICAID SERVICES; provided, however, that the
provisions of this paragraph 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 health care services
provided pursuant to this paragraph. Nothing in this paragraph shall be
construed to modify any licensure, certification or scope of practice
provision under title eight of the education law.
S 54. The opening paragraph of paragraph (i) of subdivision 1 of
section 2807-c of the public health law, as amended by section 19 of
part B of chapter 58 of the laws of 2008, is amended to read as follows:
For the rate period July first, two thousand seven through March thir-
ty-first, two thousand eight and for rates applicable to the state
fiscal year commencing April first, two thousand eight, and each state
fiscal year thereafter through March thirty-first, two thousand [elev-
en,] NINE, AND FOR THE PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH
NOVEMBER THIRTIETH, TWO THOUSAND NINE, PROVIDED, HOWEVER, THAT FOR THE
PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH NOVEMBER THIRTIETH, TWO
THOUSAND NINE THE AGGREGATE RATE ADJUSTMENTS CALCULATED PURSUANT TO
SUBPARAGRAPH (II) OF THIS PARAGRAPH SHALL NOT EXCEED FOUR MILLION
DOLLARS, AND contingent upon the availability of federal financial
participation:
S 55. The opening paragraph of paragraph (j) of subdivision 1 of
section 2807-c of the public health law, as amended by section 19-a of
part B of chapter 58 of the laws of 2008, is amended to read as follows:
For the rate period July first, two thousand seven through March thir-
ty-first, two thousand eight and for rates applicable to the state
fiscal year commencing April first, two thousand eight, and each state
fiscal year thereafter through March thirty-first, two thousand [elev-
en,] NINE AND FOR THE PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH
NOVEMBER THIRTIETH, TWO THOUSAND NINE, PROVIDED, HOWEVER, THAT FOR THE
PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH NOVEMBER THIRTIETH, TWO
THOUSAND NINE THE AGGREGATE RATE ADJUSTMENTS CALCULATED PURSUANT TO
SUBPARAGRAPH (II) OF THIS PARAGRAPH SHALL NOT EXCEED TWENTY-EIGHT
MILLION DOLLARS, AND contingent upon the availability of federal finan-
cial participation:
S 56. The opening paragraph of paragraph (1) of subdivision 1 of
section 2807-c of the public health law, as added by section 65-f of
part A of chapter 58 of the laws of 2007, is amended to read as follows:
Effective for periods on and after July first, two thousand seven
THROUGH NOVEMBER THIRTIETH, TWO THOUSAND NINE:
S. 6608 66 A. 9708
S 57. Paragraph (a) of subdivision 32 of section 2807-c of the public
health law, as amended by section 1 of part U of chapter 57 of the laws
of 2007, is amended to read as follows:
(a) The commissioner shall adjust inpatient medical assistance rates
of payment established pursuant to this section for rural hospitals as
defined in paragraph (c) of subdivision one of section twenty-eight
hundred seven-w of this article in accordance with paragraph (b) of this
subdivision for purposes of supporting critically needed health care
services in rural areas in the following aggregate amounts for the
following periods:
seven million dollars for the period May first, two thousand five
through December thirty-first, two thousand five, seven million dollars
for the period January first, two thousand six through December thirty-
first, two thousand six, seven million dollars for the period April
first, two thousand seven through December thirty-first, two thousand
seven, [and] seven million dollars for [each] calendar year [thereafter]
TWO THOUSAND EIGHT, AND SIX MILLION FOUR HUNDRED SEVENTEEN THOUSAND
DOLLARS FOR THE PERIOD JANUARY FIRST, TWO THOUSAND NINE THROUGH NOVEMBER
THIRTIETH, TWO THOUSAND NINE.
S 58. Subparagraph (ii) of paragraph (k) of subdivision 1 of section
2807-c of the public health law, as amended by section 30-a of part B of
chapter 58 of the laws of 2008, is amended to read as follows:
(ii) for the period April first, two thousand eight through March
thirty-first, two thousand nine, and each state fiscal year thereafter
through [March thirty-first, two thousand eleven] NOVEMBER THIRTIETH,
TWO THOUSAND NINE, thirty-eight million dollars shall be allocated ON AN
ANNUALIZED BASIS for such purpose to such hospitals in accordance with
[regulations promulgated by the commissioner and which shall provide]
THE METHODOLOGY SET FORTH IN SUBPARAGRAPH (I) OF THIS PARAGRAPH,
PROVIDED, HOWEVER, that [up to] thirty percent of such funds shall be
allocated proportionally, based on the number of foreign languages
utilized by one or more percent of the residents in each hospital total
service area population, PROVIDED, HOWEVER, THAT FOR THE PERIOD APRIL
FIRST, TWO THOUSAND NINE THROUGH NOVEMBER THIRTIETH, TWO THOUSAND NINE,
SUCH ALLOCATION SHALL BE REDUCED TO TWENTY-FIVE MILLION THREE HUNDRED
THIRTY-THREE THOUSAND DOLLARS.
S 59. The opening paragraph and subparagraphs (i) and (ii) of para-
graph (e-1) of subdivision 4 of section 2807-c of the public health law,
as added by section 12 of part C of chapter 58 of the laws of 2009, are
amended to read as follows:
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] ASSOCIATED WITH ADMISSIONS occurring on
and after [December first, two thousand nine,] APRIL FIRST, TWO THOUSAND
TEN, be in accordance with the following:
(i) For rate periods on and after [December first, two thousand nine]
APRIL FIRST, TWO THOUSAND TEN, the commissioner, in consultation with
the commissioner of the office of mental health, shall promulgate regu-
lations, and may promulgate emergency regulations, establishing method-
ologies for determining the operating cost components of rates of
S. 6608 67 A. 9708
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 thousand eight] JULY FIRST, TWO
THOUSAND NINE 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)] (I)
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.
S 60. Paragraph (u) of subdivision 2 of section 365-a of the social
services law, as added by section 27 of part C of chapter 58 of the laws
of 2009, is amended to read as follows:
(u) screening, brief intervention, and referral to treatment in hospi-
tal OUTPATIENT AND emergency departments AND FREE-STANDING DIAGNOSTIC
AND TREATMENT CENTERS of individuals at risk for substance abuse includ-
ing referral to the appropriate level of intervention and treatment in a
community setting; provided, however, that the provisions of this para-
graph relating to screening, brief intervention, and referral to treat-
ment services shall not take effect unless all necessary approvals under
federal law and regulation have been obtained to receive federal finan-
cial participation in such costs.
S 61. Subparagraph (ii) of paragraph (f) of subdivision 2-a of section
2807 of the public health law, as amended by section 16-a of part C of
chapter 58 of the laws of 2009, 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] TWENTY-ONE and to
persons requiring 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]
S. 6608 68 A. 9708
(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;
(F) WHEELCHAIR EVALUATION SERVICES AND EYEGLASS DISPENSING SERVICES;
AND
(G) IMMUNIZATION SERVICES, EFFECTIVE FOR SERVICES RENDERED ON AND
AFTER JUNE TENTH, TWO THOUSAND NINE.
S 62. Clauses (A) and (B) of subparagraph (iii) of paragraph (g) of
subdivision 35 of section 2807-c of the public health law, as added by
section 2 of part C of chapter 58 of the laws of 2009, are amended to
read as follows:
(A) for the period December first, two thousand nine through March
thirty-first, two thousand ten, up to [seventy-five] THIRTY-THREE
million FIVE HUNDRED THOUSAND dollars;
(B) for the period April first, two thousand ten through March thir-
ty-first, two thousand eleven, up to [thirty-three] SEVENTY-FIVE million
[five hundred thousand] dollars, PROVIDED, HOWEVER, THAT, NOTWITHSTAND-
ING SUBPARAGRAPH (II) OF THIS PARAGRAPH, NO FACILITY SHALL RECEIVE AN
AMOUNT PURSUANT TO THIS CLAUSE THAT IS LESS THAN SUCH FACILITY RECEIVED
PURSUANT TO CLAUSE (A) OF THIS SUBPARAGRAPH;
S 63. Intentionally omitted.
S 64. Subparagraphs (i) and (ii) of paragraph (b) of subdivision 2-a
of section 2807 of the public health law, as amended by section 14 of
part C of chapter 58 of the laws of 2009, are amended to read as
follows:
(i) for the period [March] SEPTEMBER first, two thousand nine through
[December first] NOVEMBER THIRTIETH, two thousand nine, seventy-five
percent of such rates of payment for services provided by each diagnos-
tic and treatment center and each free-standing ambulatory surgery
center 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 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;
S 65. Paragraph (s) of subdivision 2 of section 365-a of the social
services law, as added by section 27 of part C of chapter 58 of the laws
of 2009, is amended 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
S. 6608 69 A. 9708
and adolescents ten to [nineteen] TWENTY 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.
S 66. Subdivision 2-a of section 2807 of the public health law is
amended by adding a new paragraph (f-1) to read as follows:
(F-1) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR
ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER MAY WITH THE
APPROVAL OF THE DIRECTOR OF THE BUDGET, FOR PERIODS PRIOR TO TWO THOU-
SAND TWELVE, ESTABLISH RATES OF PAYMENTS FOR SELECTED PATIENT SERVICE
CATEGORIES THAT ARE BASED ENTIRELY UPON THE AMBULATORY PATIENT GROUPS
METHODOLOGY AS AUTHORIZED PURSUANT TO PARAGRAPH (E) OF THIS SUBDIVISION.
S 67. Subdivision 7-a of section 101 of part A of chapter 57 of the
laws of 2006, amending the social services law relating to medically
fragile children, as amended by section 65 of part C of chapter 58 of
the laws of 2008, is amended to read as follows:
7-a. Sections fifty-eight, fifty-eight-a and fifty-eight-b shall take
effect January 1, 2007 [and shall expire and be deemed repealed January
1, 2011].
S 67-a. Paragraph (d) of subdivision 3 of section 367-a of the social
services law, as added by chapter 33 of the laws of 1998, subparagraphs
1 and 2 as amended by section 2 of part G of chapter 23 of the laws of
2002, is amended to read as follows:
(d) (1) Beginning April first, two thousand two and to the extent that
federal financial participation is available at a one hundred percent
federal Medical assistance percentage and subject to sections 1933 and
1902(a)(10)(E)(iv) of the federal social security act, medical assist-
ance shall be available for full payment of medicare part B premiums for
individuals (referred to as qualified individuals 1) who are entitled to
hospital insurance benefits under part A of title XVIII of the federal
social security act and whose income exceeds the income level estab-
lished by the state and is at least one hundred twenty percent, but less
than one hundred thirty-five percent, of the federal poverty level, for
a family of the size involved and who are not otherwise eligible for
medical assistance under the state plan;
(2) [Beginning April first, two thousand two and to the extent that
federal financial participation is available at a one hundred percent
federal Medical assistance percentage and subject to sections 1933 and
1902(a)(10)(E)(iv) of the federal social security act, medical assist-
ance shall be available for payment of that portion of the medicare part
B premium increase that is attributable to the operation of the amend-
ments made by section 4611(e)(3) of the balanced budget act of 1997, for
individuals (referred to as qualified individuals 2) who are entitled to
hospital insurance benefits under part A of title XVIII of the federal
social security act and whose income exceeds the income level estab-
lished by the state and is at least one hundred thirty-five percent, but
less than one hundred seventy-five percent, of the federal poverty
level, for a family of the size involved and who are not otherwise
eligible for medical assistance under the state plan;
(3)] Premium payments for the individuals described in [subparagraphs]
SUBPARAGRAPH one [and two] of this paragraph will be one hundred percent
S. 6608 70 A. 9708
federally funded up to the amount of the federal allotment. The depart-
ment shall discontinue enrollment into the program when the part B
premium payments made pursuant to [such paragraphs] SUBPARAGRAPH ONE OF
THIS PARAGRAPH meet the yearly federal allotment.
[(4)] (3) The commissioner of health shall develop a simplified appli-
cation form, consistent with federal law, for payments pursuant to this
section. The commissioner of health, in cooperation with the office for
the aging, shall publicize the availability of such payments to medicare
beneficiaries.
S 68. Section 2 of chapter 33 of the laws of 1998, amending the social
services law relating to authorizing payment of medicare part B premiums
to certain medicaid recipients, as amended by chapter 415 of the laws of
2008, is amended to read as follows:
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after January 1, 1998[,
provided, however that such provisions shall expire and be deemed
repealed December 31, 2010].
S 69. Intentionally omitted.
S 70. Notwithstanding any inconsistent provision of law, rule or regu-
lation, for purposes of implementing the provisions of the public health
law and the social services law, references to titles XIX and XXI of the
federal social security act in the public health law and the social
services law shall be deemed to include and also to mean any successor
titles thereto under the federal social security act.
S 71. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the effectiveness of the provisions of sections 2807 and 3614 of
the public health law, section 18 of chapter 2 of the laws of 1988, and
18 NYCRR 505.14(h), as they relate to time frames for notice, approval
or certification of rates of payment, are hereby suspended and without
force or effect for purposes of implementing the provisions of this act.
S 72. 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 judg-
ement 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 73. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2010, provided
that:
(a) section twelve of this act shall take effect June 1, 2010;
sections thirty-two and thirty-three of this act shall take effect July
1, 2010; and sections twenty-six, twenty-seven, twenty-eight, twenty-
nine, thirty and thirty-seven of this act shall take effect January 1,
2011;
(b) 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;
(c) this act shall not be construed to alter, change, affect, impair
or defeat any rights, obligations, duties or interests accrued, incurred
or conferred prior to the effective date of this act;
S. 6608 71 A. 9708
(d) 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;
(e) 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;
(f) 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;
(g) the amendments to subdivision 8 of section 272 of the public
health law made by section eleven of this act shall not affect the
repeal of such section and shall be deemed repealed therewith;
(h) the amendments to subparagraph (ii) of paragraph (b) of subdivi-
sion 9 of section 367-a of the social services law made by section thir-
teen of this act shall not affect the expiration of such subdivision and
shall be deemed to expire therewith;
(i) the amendments to section 2807-j of the public health law made by
sections sixteen and forty-five of this act shall not affect the expira-
tion of such section and shall be deemed to expire therewith;
(j) the amendments to section 2807-s of the public health law made by
section twenty of this act shall not affect the expiration of such
section and shall be deemed to expire therewith;
(k) the amendments to subdivision 7 of section 2510 of the public
health law made by section thirty-two of this act shall not affect the
expiration of such subdivision and shall be deemed to expire therewith;
(l) the amendments to article 2-A of the public health law made by
section thirty-eight of this act shall not affect the repeal of such
article and shall be deemed repealed therewith;
(m) the amendments to subdivision 1 of section 2802-a of the public
health law made by section forty-one of this act shall not affect the
repeal of such section and shall be deemed repealed therewith;
(n) sections forty-six through forty-six-i of this act shall expire
and be deemed repealed on and after March 31, 2011; and
(o) the amendments to paragraph (d) of subdivision 3 of section 367-a
of the social services law made by section sixty-seven-a of this act
shall not affect the repeal of such paragraph and shall be deemed
repealed therewith.
PART C
Section 1. Subdivision 17 of section 2808 of the public health law, as
added by chapter 433 of the laws of 1997, is amended to read as follows:
17. (A) Notwithstanding any inconsistent provision of law or regu-
lation to the contrary, for the period April first, nineteen hundred
ninety-seven through March thirty-first, nineteen hundred ninety-eight,
the commissioner shall not be required to revise a certified rate of
payment established pursuant to this article based on consideration of
rate appeals filed by a residential health care facility or based upon
adjustments to capital cost reimbursement as a result of approval by the
commissioner of an application for construction under section twenty-
eight hundred two of this article. For the period April first, nineteen
hundred ninety-eight, through March thirty-first, nineteen hundred nine-
S. 6608 72 A. 9708
ty-nine, the commissioner shall revise certified rates of payment in an
aggregate amount not to exceed twenty million dollars, state share
medical assistance. In cases where the commissioner determines that a
significant financial hardship exists, he or she may, subject to the
approval of the director of the budget, consider an exemption to this
subdivision. Beginning April first, nineteen hundred ninety-nine and
thereafter, the commissioner shall consider such rate appeals within a
reasonable period.
(B) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
THE CONTRARY, FOR STATE FISCAL YEAR PERIODS BEGINNING APRIL FIRST, TWO
THOUSAND TEN AND ENDING MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, THE
COMMISSIONER SHALL NOT BE REQUIRED TO REVISE CERTIFIED RATES OF PAYMENT
ESTABLISHED PURSUANT TO THIS ARTICLE FOR RATE PERIODS PRIOR TO APRIL
FIRST, TWO THOUSAND TWELVE, BASED ON CONSIDERATION OF RATE APPEALS FILED
BY RESIDENTIAL HEALTH CARE FACILITIES OR BASED UPON ADJUSTMENTS TO CAPI-
TAL COST REIMBURSEMENT AS A RESULT OF APPROVAL BY THE COMMISSIONER OF AN
APPLICATION FOR CONSTRUCTION UNDER SECTION TWENTY-EIGHT HUNDRED TWO OF
THIS ARTICLE, IN EXCESS OF AGGREGATE ANNUAL AMOUNTS OF EIGHTY MILLION
DOLLARS FOR EACH SUCH STATE FISCAL YEAR. IN REVISING SUCH RATES WITHIN
SUCH FISCAL LIMITS THE COMMISSIONER MAY PRIORITIZE RATE APPEALS FOR
FACILITIES WHICH THE COMMISSIONER DETERMINES ARE FACING SIGNIFICANT
FINANCIAL HARDSHIP AND, FURTHER, THE COMMISSIONER IS AUTHORIZED TO ENTER
INTO AGREEMENTS WITH SUCH FACILITIES TO RESOLVE MULTIPLE PENDING RATE
APPEALS BASED UPON A NEGOTIATED AGGREGATE AMOUNT AND MAY OFFSET SUCH
NEGOTIATED AGGREGATE AMOUNTS AGAINST ANY AMOUNTS OWED BY THE FACILITY TO
THE DEPARTMENT, INCLUDING, BUT NOT LIMITED TO, AMOUNTS OWED PURSUANT TO
SECTION TWENTY-EIGHT HUNDRED SEVEN-D OF THIS ARTICLE. RATE ADJUSTMENTS
MADE PURSUANT TO THIS PARAGRAPH REMAIN FULLY SUBJECT TO APPROVAL BY THE
DIRECTOR OF THE BUDGET IN ACCORDANCE WITH THE PROVISIONS OF SUBDIVISION
TWO OF SECTION TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE.
S 2. Section 2808 of the public health law is amended by adding a new
subdivision 25 to read as follows:
25. RESERVED BED DAYS. (A) FOR PURPOSES OF THIS SUBDIVISION, A
"RESERVED BED DAY" IS A DAY FOR WHICH A GOVERNMENTAL AGENCY PAYS A RESI-
DENTIAL HEALTH CARE FACILITY TO RESERVE A BED FOR A PERSON ELIGIBLE FOR
MEDICAL ASSISTANCE PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE
SOCIAL SERVICES LAW WHILE HE OR SHE IS TEMPORARILY HOSPITALIZED OR ON
LEAVE OF ABSENCE FROM THE FACILITY.
(B) NOTWITHSTANDING ANY OTHER PROVISIONS OF THIS SECTION OR ANY OTHER
LAW OR REGULATION TO THE CONTRARY, FOR RESERVED BED DAYS PROVIDED ON
BEHALF OF PERSONS TWENTY-ONE YEARS OF AGE OR OLDER:
(I) PAYMENTS FOR RESERVED BED DAYS SHALL BE MADE AT NINETY-FIVE
PERCENT OF THE MEDICAID RATE OTHERWISE PAYABLE TO THE FACILITY FOR
SERVICES PROVIDED ON BEHALF OF SUCH PERSON;
(II) PAYMENT TO A FACILITY FOR RESERVED BED DAYS PROVIDED ON BEHALF OF
SUCH PERSON FOR TEMPORARY HOSPITALIZATIONS MAY NOT EXCEED FOURTEEN DAYS
IN ANY TWELVE MONTH PERIOD;
(III) PAYMENT TO A FACILITY FOR RESERVED BED DAYS PROVIDED ON BEHALF
OF SUCH PERSON FOR NON-HOSPITALIZATION LEAVES OF ABSENCE MAY NOT EXCEED
TEN DAYS IN ANY TWELVE MONTH PERIOD.
S 3. Subparagraph (vi) of paragraph (b) of subdivision 2 of section
2807-d of the public health law, as amended by section 37 of part C of
chapter 58 of the laws of 2007, is amended to read as follows:
(vi) Notwithstanding any contrary provision of this paragraph or any
other provision of law or regulation to the contrary, for residential
health care facilities the assessment shall be six percent of each resi-
S. 6608 73 A. 9708
dential health care facility's gross receipts received from all patient
care services and other operating income on a cash basis for the period
April first, two thousand two through March thirty-first, two thousand
three for hospital or health-related services, including adult day
services; provided, however, that residential health care facilities'
gross receipts attributable to payments received pursuant to title XVIII
of the federal social security act (medicare) shall be excluded from the
assessment; provided, however, that for all such gross receipts received
on or after April first, two thousand three through March thirty-first,
two thousand five, such assessment shall be five percent, and further
provided that for all such gross receipts received on or after April
first, two thousand five through March thirty-first, two thousand nine,
and on or after April first, two thousand nine through March thirty-
first, two thousand [eleven] TEN, such assessment shall be six percent,
AND PROVIDED FURTHER, HOWEVER, THAT ON AND AFTER APRIL FIRST, TWO THOU-
SAND TEN, SUCH ASSESSMENT SHALL BE SEVEN PERCENT.
S 4. Paragraph (c) of subdivision 10 of section 2807-d of the public
health law, as amended by section 2 of part H of chapter 686 of the laws
of 2003, is amended to read as follows:
(c) provided, however, that for the purposes of determining rates of
payment pursuant to this article for residential health care facilities,
the assessment imposed pursuant to subparagraph (vi) of paragraph (b) of
subdivision two of this section shall be a reimbursable cost to be
reflected as timely as practicable, and subsequently reconciled to actu-
al cost, in rates of payment applicable within the assessment period,
PROVIDED, HOWEVER, THAT SUCH ASSESSMENTS IN EXCESS OF SIX PERCENT SHALL
NOT BE A REIMBURSABLE COST FOR THE PURPOSES OF DETERMINING MEDICAID
RATES OF PAYMENT.
S 5. Subparagraph (i) of paragraph (b) of subdivision 2-b of section
2808 of the public health law, as amended by section 3 of part D of
chapter 58 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] FEBRUARY TWENTY-EIGHTH,
TWO THOUSAND ELEVEN the operating cost component of rates of payment
shall reflect allowable operating costs as reported in each facility's
cost report for the two thousand two calendar year, as adjusted for
inflation on an annual basis in accordance with the methodology set
forth in paragraph (c) of subdivision ten of section twenty-eight
hundred seven-c of this article, provided, however, that for those
facilities which do not receive a per diem add-on adjustment pursuant to
subparagraph (ii) of paragraph (a) of this subdivision, rates shall be
further adjusted to include the proportionate benefit, as determined by
the commissioner, of the expiration of the opening paragraph and para-
graph (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 subdivision ten of
section twenty-eight hundred seven-c of this article and further
provided, however, that rates for facilities whose operating cost compo-
nent reflects base year costs subsequent to January first, two thousand
two shall have rates computed in accordance with this paragraph, utiliz-
S. 6608 74 A. 9708
ing allowable operating costs as reported in such subsequent base year
period, and trended forward to the rate year in accordance with applica-
ble inflation factors.
S 5-a. The opening paragraph and subparagraph (vi) of paragraph (a),
and subparagraph (i) of paragraph (d) of subdivision 2-c of section 2808
of the public health law, as added by section 5 of part D of chapter 58
of the laws of 2009, are amended to read as follows:
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]
MARCH FIRST, TWO THOUSAND ELEVEN shall be determined in accordance with
the following; PROVIDED, HOWEVER, THAT THE PROVISIONS OF PARAGRAPH (D)
OF THIS SUBDIVISION SHALL BE EFFECTIVE ON AND AFTER APRIL FIRST, TWO
THOUSAND TEN:
(vi) Notwithstanding subparagraph (i) of this paragraph, the operating
cost component of the rates, effective [April first, two thousand ten]
MARCH FIRST, TWO THOUSAND ELEVEN for the following categories of facili-
ties, as established pursuant to applicable regulations, shall reflect
the rates in effect for such facilities on [March thirty-first, two
thousand ten] FEBRUARY TWENTY-EIGHTH, TWO THOUSAND ELEVEN, as adjusted
for inflation in accordance with applicable statutes: (A) AIDS facili-
ties or discrete AIDS units within facilities, (B) discrete units for
residents receiving care in a long-term inpatient rehabilitation program
for traumatic 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 children. Such rate shall remain in effect until the department, in
consultation with representatives of the nursing home industry, as
selected by the commissioner, develops a regional pricing or alternative
methodology for determining such rates.
(i) Subject to the availability of federal financial participation,
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 IN AGGREGATE AMOUNTS OF UP TO FIFTY MILLION DOLLARS
FOR THE STATE FISCAL YEAR BEGINNING APRIL FIRST, TWO THOUSAND TEN AND
WITHIN AMOUNTS APPROPRIATED FOR EACH STATE FISCAL YEAR THEREAFTER.
Within amounts available, payments will be determined by the commission-
er 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.
S 5-b. Section 2 of part D of chapter 58 of the laws of 2009, amending
the public health law and other laws relating to Medicaid reimbursements
to residential health care facilities, is amended to read as follows:
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-
S. 6608 75 A. 9708
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,
however, that the operating component of such rates for the period April
1, 2009 through March 31, 2010 shall not be subject to case mix adjust-
ments pursuant to subparagraph (ii) of paragraph (b) of subdivision 2-b
of section 2808 of the public health law, as otherwise scheduled pursu-
ant to such subparagraph for January of 2010,] and provided further,
however, 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, INCLUDING PAYMENTS
MADE PURSUANT TO SUBPARAGRAPH (I) OF PARAGRAPH (D) OF SUBDIVISION 2-C OF
SECTION 2808 OF THE PUBLIC HEALTH LAW, make such proportional adjust-
ments to such rates as are necessary to reduce such total aggregate rate
adjustments such that the aggregate total reflects no such increase OR
DECREASE, AND PROVIDED FURTHER, HOWEVER, THE CASE MIX ADJUSTMENTS AS
OTHERWISE AUTHORIZED BY SUBPARAGRAPH (II) OF PARAGRAPH (B) OF SUBDIVI-
SION 2-B OF SECTION 2808 OF THE PUBLIC HEALTH LAW AND AS SCHEDULED FOR
JANUARY OF 2011 SHALL NOT BE MADE. Adjustments made pursuant to this
section shall not be subject to subsequent correction or reconciliation.
S 5-c. Section 48 of part C of chapter 109 of the laws of 2006, amend-
ing the social services law and other laws relating to the Medicaid
reimbursement rate settings, as amended by section 6 of part D of chap-
ter 58 of the laws of 2009, 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
pertaining to Medicaid reimbursement rate-setting for residential health
care facilities for future periods, including, but not limited to, the
following areas:
(a) operating costs that should be considered allowable in the devel-
opment of regional prices;
(b) 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 appropriate 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)] 2-C of
section 2808 of the public health law or other mechanisms;
(c) 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;
S. 6608 76 A. 9708
(e) appropriate regions to be utilized;
(f) the reasons underlying the existing proportion of Medicaid
patients to non-Medicaid patients in New York facilities;
(g) issues related to Medicare;
(h) impact of planned rightsizing of the acute care system;
(i) impact of planned rightsizing of nursing home system;
(j) impact of using Medicaid only case mix; and
(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, by May thirty-first, two thousand nine, advocates
for residential health care facility residents and representatives of
regional associations 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 and designate such employees of the department 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 commis-
sioner of health's recommendations to the governor, the temporary presi-
dent of the senate, the speaker of the assembly, and the minority lead-
ers of the senate and the assembly by [December fifteenth, two thousand
nine] JULY 1, 2010, and a subsequent report shall be submitted to these
individuals no later than [February fifteenth, two thousand ten] NOVEM-
BER 1, 2010. The workgroup shall continue until December thirty-first,
two thousand ten to evaluate the implementation of the new system.
S 6. Section 2808 of the public health law is amended by adding a new
subdivision 26 to read as follows:
26. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, FOR RATE PERI-
ODS ON AND AFTER APRIL FIRST, TWO THOUSAND TEN, RESIDENTIAL HEALTH CARE
FACILITY MEDICAID RATES OF PAYMENT SHALL NOT INCLUDE REIMBURSEMENT FOR
THE COST OF PRESCRIPTION DRUGS. SUCH REIMBURSEMENT SHALL BE IN ACCORD-
ANCE WITH OTHERWISE APPLICABLE PROVISIONS OF SECTION THREE HUNDRED
SIXTY-SEVEN-A OF THE SOCIAL SERVICES LAW.
S 7. Paragraph (c) of subdivision 2 of section 3614-a of the public
health law, as added by section 1 of part B of chapter 58 of the laws of
2009, is amended 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, PROVIDED, HOWEVER, THAT FOR PERI-
ODS ON AND AFTER APRIL FIRST, TWO THOUSAND TEN, SUCH ASSESSMENT FOR SUCH
SERVICES SHALL BE SEVEN TENTHS OF ONE PERCENT OF EACH AGENCY'S OR
PROVIDER'S GROSS RECEIPTS.
S 8. Subdivision 6 of section 3614-a of the public health law is
amended by adding a new paragraph (g) to read as follows:
(G) DELINQUENT AMOUNTS WHICH HAVE BEEN REFERRED FOR RECOUPMENT OR
OFFSET PURSUANT TO PARAGRAPH (C) OF THIS SUBDIVISION, OR WHICH HAVE BEEN
REFERRED TO THE OFFICE OF THE ATTORNEY GENERAL FOR COLLECTION, SHALL BE
DEEMED FINAL AND NOT SUBJECT TO FURTHER REVISION OR RECONCILIATION BY
THE COMMISSIONER BASED ON ANY ADDITIONAL REPORTS OR OTHER INFORMATION
SUBMITTED BY THE AGENCY OR PROVIDER, PROVIDED, HOWEVER, THAT SUCH DELIN-
S. 6608 77 A. 9708
QUENCIES SHALL NOT BE REFERRED FOR SUCH RECOUPMENT OR FOR SUCH
COLLECTION BASED ON ESTIMATED AMOUNTS UNLESS THE AGENCY OR THE PROVIDER
HAS RECEIVED WRITTEN NOTIFICATION OF SUCH DELINQUENCIES AND HAS BEEN
GIVEN NO LESS THAN THIRTY DAYS IN WHICH TO SUBMIT DELINQUENT REPORTS.
S 9. Paragraph (b) of subdivision 2 of section 3614-b of the public
health law, as added by section 3 of part B of chapter 58 of the laws of
2009, is amended to read as follows:
(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, PROVIDED, HOWEVER, THAT FOR PERI-
ODS ON AND AFTER APRIL FIRST, TWO THOUSAND TEN, SUCH ASSESSMENT FOR SUCH
SERVICES SHALL BE SEVEN TENTHS OF ONE PERCENT OF EACH SUCH LICENSED HOME
CARE SERVICES AGENCY'S GROSS RECEIPTS.
S 10. Subdivision 6 of section 3614-b of the public health law is
amended by adding a new paragraph (g) to read as follows:
(G) DELINQUENT AMOUNTS WHICH HAVE BEEN REFERRED FOR RECOUPMENT OR
OFFSET PURSUANT TO PARAGRAPH (C) OF THIS SUBDIVISION, OR WHICH HAVE BEEN
REFERRED TO THE OFFICE OF THE ATTORNEY GENERAL FOR COLLECTION, SHALL BE
DEEMED FINAL AND NOT SUBJECT TO FURTHER REVISION OR RECONCILIATION BY
THE COMMISSIONER BASED ON ANY ADDITIONAL REPORTS OR OTHER INFORMATION
SUBMITTED BY THE AGENCY, PROVIDED, HOWEVER, THAT SUCH DELINQUENCIES
SHALL NOT BE REFERRED FOR SUCH RECOUPMENT OR FOR SUCH COLLECTION BASED
ON ESTIMATED AMOUNTS UNLESS THE AGENCY HAS RECEIVED WRITTEN NOTIFICATION
OF SUCH DELINQUENCIES AND HAS BEEN GIVEN NO LESS THAN THIRTY DAYS IN
WHICH TO SUBMIT DELINQUENT REPORTS.
S 11. Paragraph (b) of subdivision 2 of section 367-i of the social
services law, as added by section 4 of part B of chapter 58 of the laws
of 2009, is amended to read as follows:
(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,
PROVIDED, HOWEVER, THAT FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOU-
SAND TEN, SUCH ASSESSMENT FOR SUCH SERVICES SHALL BE SEVEN TENTHS OF ONE
PERCENT OF EACH SUCH PROVIDER'S GROSS RECEIPTS.
S 12. Subdivision 6 of section 367-i of the social services law is
amended by adding a new paragraph (f) to read as follows:
(F) DELINQUENT AMOUNTS WHICH HAVE BEEN REFERRED FOR RECOUPMENT OR
OFFSET PURSUANT TO PARAGRAPH (C) OF SUBDIVISION FIVE OF THIS SECTION, OR
WHICH HAVE BEEN REFERRED TO THE OFFICE OF THE ATTORNEY GENERAL FOR
COLLECTION, SHALL BE DEEMED FINAL AND NOT SUBJECT TO FURTHER REVISION OR
RECONCILIATION BY THE COMMISSIONER OF HEALTH BASED ON ANY ADDITIONAL
REPORTS OR OTHER INFORMATION SUBMITTED BY THE PROVIDER, PROVIDED, HOWEV-
ER, THAT SUCH DELINQUENCIES SHALL NOT BE REFERRED FOR SUCH RECOUPMENT OR
FOR SUCH COLLECTION BASED ON ESTIMATED AMOUNTS UNLESS THE PROVIDER HAS
RECEIVED WRITTEN NOTIFICATION OF SUCH DELINQUENCIES AND HAS BEEN GIVEN
NO LESS THAN THIRTY DAYS IN WHICH TO SUBMIT DELINQUENT REPORTS.
S 13. Paragraph (e) of subdivision 2 of section 365-a of the social
services law, as amended by chapter 170 of the laws of 1994, is amended
to read as follows:
(e) (I) personal care services, including personal emergency response
services, shared aide and an individual aide, WHICH, FOR INDIVIDUALS WHO
S. 6608 78 A. 9708
HAVE ATTAINED THE AGE OF TWENTY-ONE, AND SUBJECT TO THE PROVISIONS OF
SUBPARAGRAPH (II) OF THIS PARAGRAPH, SHALL NOT EXCEED AN AVERAGE OF
TWELVE HOURS PER DAY IN ANY AUTHORIZATION PERIOD, furnished to an indi-
vidual who is not an inpatient or resident of a hospital, nursing facil-
ity, intermediate care facility for the mentally retarded, or institu-
tion for mental disease, as determined to meet the recipient's needs for
assistance [when cost effective and appropriate in accordance with
section three hundred sixty-seven-k and section three hundred sixty-sev-
en-o of this title], and when prescribed by a physician, in accordance
with the recipient's plan of treatment and provided by individuals who
are qualified to provide such services, who are supervised by a regis-
tered nurse and who are not members of the recipient's family, and
furnished in the recipient's home or other location;
(II) MEDICALLY NECESSARY PERSONAL CARE SERVICES THAT EXCEED AN AVERAGE
OF TWELVE HOURS PER DAY IN ANY AUTHORIZATION PERIOD MAY BE PROVIDED TO
AN INDIVIDUAL WHO IS RECEIVING SERVICES FROM A CERTIFIED HOME HEALTH
AGENCY, OR IS ENROLLED IN THE LONG TERM HOME HEALTH CARE PROGRAM, A
MANAGED LONG TERM CARE PLAN, THE AIDS HOME CARE PROGRAM, OR THE NURSING
HOME TRANSITION AND DIVERSION WAIVER, IN ACCORDANCE WITH THE TERMS OF
THOSE PROGRAMS.
S 13-a. Section 365-f of the social services law is amended by adding
a new subdivision 2-a to read as follows:
2-A. PERSONAL CARE SERVICES PROVIDED UNDER THIS SECTION TO AN INDIVID-
UAL WHO HAS ATTAINED THE AGE OF TWENTY-ONE, AND WHO IS NOT RECEIVING
SUCH SERVICES FROM A CERTIFIED HOME HEALTH AGENCY, A LONG TERM HOME
HEALTH CARE PROGRAM, OR AN AIDS HOME CARE PROGRAM, SHALL NOT EXCEED AN
AVERAGE OF TWELVE HOURS PER DAY IN ANY AUTHORIZATION PERIOD.
S 13-b. Subdivision 6-a of section 366 of the social services law is
amended by adding a new paragraph i to read as follows:
I. NOTWITHSTANDING THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION
AND THE AGGREGATE COST PROVISION OF PARAGRAPH A OF THIS SUBDIVISION, A
PERSON MAY PARTICIPATE IN THE NURSING HOME TRANSITION AND DIVERSION
PROGRAM SPECIFIED IN THIS SUBDIVISION IF THE PERSON: HAS A MEDICAL NEED
FOR SERVICES THAT ARE DESCRIBED IN PARAGRAPH (E) OF SUBDIVISION TWO OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE OR IN SECTION THREE
HUNDRED SIXTY-FIVE-F OF THIS TITLE BUT THAT EXCEED A LIMIT IMPOSED BY
SUCH PROVISIONS; AND IS OTHERWISE INELIGIBLE FOR, OR IS UNABLE TO
ACCESS, LONG-TERM COMMUNITY-BASED SERVICES AVAILABLE UNDER THIS TITLE;
AND OTHERWISE MEETS THE CRITERIA FOR PARTICIPATION SET FORTH IN THIS
SUBDIVISION.
S 14. Section 3614 of the public health law is amended by adding a new
subdivision 12 to read as follows:
12. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGU-
LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
IPATION, EFFECTIVE JANUARY FIRST, TWO THOUSAND TWELVE, PAYMENTS BY
GOVERNMENT AGENCIES FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGEN-
CIES, EXCEPT FOR SUCH SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS
OF AGE AND OTHER DISCRETE GROUPS AS MAY BE DETERMINED BY THE COMMISSION-
ER PURSUANT TO REGULATIONS, SHALL BE BASED ON EPISODIC PAYMENTS. IN
ESTABLISHING SUCH PAYMENTS, THE COMMISSIONER SHALL TAKE INTO CONSIDER-
ATION THE FINDINGS OF THE HOME HEALTH CARE REIMBURSEMENT WORKGROUP
ESTABLISHED PURSUANT TO SECTION ONE HUNDRED TWENTY-FIVE-D OF PART C OF
CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND NINE; PROVIDED FURTHER
THAT A BASE PRICE SHALL BE ESTABLISHED FOR EACH EPISODE OF CARE AND
ADJUSTED BY A WAGE INDEX FACTOR AND AN INDIVIDUAL PATIENT CASE MIX
INDEX. SUCH EPISODIC PAYMENTS MAY BE FURTHER ADJUSTED FOR LOW AND HIGH-
S. 6608 79 A. 9708
UTILIZATION CASES THAT EXCEED OUTLIER THRESHOLDS OF SUCH PAYMENTS. BASE
YEAR EPISODIC PAYMENTS SHALL BE FURTHER ADJUSTED TO THE APPLICABLE RATE
YEAR IN ACCORDANCE WITH APPLICABLE TREND FACTOR ADJUSTMENTS. THE
COMMISSIONER MAY REQUIRE AGENCIES TO COLLECT AND SUBMIT ANY DATA
REQUIRED TO IMPLEMENT THIS SUBDIVISION. THE COMMISSIONER MAY PROMULGATE
REGULATIONS TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
(B) WITHIN AMOUNTS APPROPRIATED AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, THE COMMISSIONER SHALL ESTABLISH AN
INCENTIVE POOL FOR RATE ADJUSTMENTS TO ELIGIBLE AGENCIES THAT MEET QUAL-
ITY MEASURES, AS ESTABLISHED BY THE COMMISSIONER. SUCH PAYMENTS SHALL BE
MADE IN THE FORM OF ADJUSTMENTS TO MEDICAID RATES OF PAYMENT FOR
SERVICES PROVIDED BY AGENCIES MEETING SUCH QUALITY MEASURES.
S 15. Subdivision 2 of section 3616 of the public health law, as
amended by chapter 622 of the laws of 1988, is amended to read as
follows:
2. Continued provision of a long term home health care program, AIDS
home care program or certified home health agency services paid for by
government funds shall be based upon a comprehensive assessment of the
medical, social and environmental needs of the recipient of the
services. Such assessment shall be performed at least every one hundred
[twenty] EIGHTY days by the provider of a long term home health care
program, AIDS home care program or the certified home health agency
providing services for the patient and the local department of social
services, and shall be reviewed by a physician charged with the respon-
sibility by the commissioner. The commissioner shall prescribe the forms
on which the assessment will be made.
S 16. Notwithstanding any provision of law or regulation to the
contrary, and subject to the availability of federal financial partic-
ipation, the commissioner of health shall establish procedures to permit
long-term home health care programs and providers of other services
covered pursuant to federal waivers, or which provide case management
services, to collaborate to jointly serve individuals when the services
of both entities are necessary to meet such an individual's needs;
provided, however, that such entities shall maintain distinct yet coor-
dinated service and case management responsibilities and shall not
duplicate benefits.
S 17. Intentionally omitted.
S 18. Subdivision 3 of section 3612 of the public health law, as
amended by chapter 606 of the laws of 2003, is amended to read as
follows:
3. Any organization which provides or makes available any home care
services to the public in this state, in any organized program developed
or rendered under its auspices or provided under contract with any such
organization, shall submit annually to the commissioner a complete
description of its operation, including name, address, location or prin-
cipal place of business, ownership, identification of administrative
personnel responsible for home care services programs, the nature and
extent of such programs, and such other information as the commissioner
shall require. For certified home health agencies and licensed home care
services agencies such annual report shall include reports on the type,
frequency and reimbursement for services provided, including reimburse-
ment from federal and state governmental agencies. The commissioner
shall determine the form and content of the information compiled and the
annual date for submission of such information. The commissioner shall
require certified home health agencies to provide all information neces-
sary to a licensed home care services agency sub-contracting with such
S. 6608 80 A. 9708
certified home health agency, to allow such licensed home care services
agency to file its annual report. The commissioner shall make such
information available to the appropriate governmental agencies of the
state, the counties and the city of New York so as to make known the
availability of home care services to provide data for planning for
health needs of the people of the state. This information shall be
available to the public and to the health systems agencies. ANY ORGAN-
IZATION SUBJECT TO THE REPORTING REQUIREMENTS OF THIS SUBDIVISION SHALL
BE SUBJECT TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARS FOR
EACH VIOLATION OF SUCH REQUIREMENTS. SUCH PENALTY MAY BE RECOVERED BY AN
ACTION BROUGHT BY THE COMMISSIONER IN ANY COURT OF COMPETENT JURISDIC-
TION.
S 19. Federal-state Medicare shared savings partnership program.
Notwithstanding any provision of law to the contrary, the commissioner
of health shall seek federal approval for the establishment of a feder-
al-state Medicare shared savings partnership program. Such program may
include, among others, the following features: (a) an incentive through
shared savings to the state for achieving federal cost-savings and effi-
ciencies to Medicare, such as from reduced expenditures for hospital,
long-term care and other medical care provided to beneficiaries eligible
for both Medicare and Medicaid, which result from state initiatives in
the care and management of such beneficiaries; such incentive shall
provide for a reinvestment of a portion of such federal savings into the
state's health care system; (b) acceptance of risk by the state for the
delivery and financing of Medicare-covered services; and (c) an incen-
tive to permit providers of medical services to share in demonstrated
Medicare savings.
S 20. The social services law is amended by adding a new section 366-i
to read as follows:
S 366-I. LONG-TERM CARE FINANCING DEMONSTRATION PROGRAM. 1. NOTWITH-
STANDING ANY INCONSISTENT PROVISION OF SECTIONS THREE HUNDRED SIXTY-SIX
OR THREE HUNDRED SIXTY-SIX-C OF THIS TITLE, OR ANY OTHER PROVISION OF
LAW, THE COMMISSIONER OF HEALTH IS AUTHORIZED TO DEVELOP THE LONG-TERM
CARE FINANCING DEMONSTRATION PROGRAM, AN ALTERNATIVE PROGRAM FOR THE
ESTABLISHMENT OF ELIGIBILITY UNDER THE MEDICAL ASSISTANCE PROGRAM FOR UP
TO FIVE THOUSAND PERSONS.
2. THE PROVISIONS OF THIS SECTION 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 HEALTH CARE
SERVICES PROVIDED TO PERSONS DETERMINED TO BE ELIGIBLE FOR MEDICAL
ASSISTANCE PURSUANT TO THIS SECTION.
3. DEFINED PRIVATE CONTRIBUTION. UPON BEING DETERMINED ELIGIBLE FOR
THE DEMONSTRATION, A PERSON SHALL DISCLOSE HIS OR HER HOUSEHOLD'S
RESOURCES AND INCOME TO THE LOCAL SOCIAL SERVICES DISTRICT, OR AN ENTITY
ACTING ON BEHALF OF SUCH DISTRICT PURSUANT TO SUBDIVISION FIVE OF THIS
SECTION, AND SHALL ENTER INTO AN AGREEMENT WITH SUCH DISTRICT OR ENTITY.
THE AGREEMENT SHALL REQUIRE THE PERSON TO APPLY A DEFINED PRIVATE
CONTRIBUTION TOWARD THE COST OF INSTITUTIONAL OR NON-INSTITUTIONAL
LONG-TERM CARE, AS DEFINED BY THE COMMISSIONER IN REGULATIONS. SUCH
REGULATIONS SHALL PROVIDE FOR TWO LEVELS OF CONTRIBUTION: (A) A LEVEL
THAT WOULD PERMIT A FULL MEDICAL ASSISTANCE RESOURCE EXEMPTION PURSUANT
TO PARAGRAPH (A) OF SUBDIVISION FOUR OF THIS SECTION; AND (B) A LEVEL OR
LEVELS THAT WOULD PERMIT A MEDICAL ASSISTANCE RESOURCE EXEMPTION THAT IS
EQUIVALENT TO THE VALUE OF THE CONTRIBUTION PURSUANT TO PARAGRAPH (B) OF
SUBDIVISION FOUR OF THIS SECTION.
S. 6608 81 A. 9708
4. MEDICAL ASSISTANCE ELIGIBILITY. UPON COMPLETION OF THE DEFINED
PRIVATE CONTRIBUTION REQUIRED BY SUCH AGREEMENT, THE PERSON MAY APPLY
FOR MEDICAL ASSISTANCE UNDER THIS TITLE AND, IF OTHERWISE ELIGIBLE,
SHALL BE ELIGIBLE FOR SUCH ASSISTANCE EITHER: (A) IN THE CASE OF AN
INDIVIDUAL WHO OPTS FOR A CONTRIBUTION LEVEL UNDER PARAGRAPH (A) OF
SUBDIVISION THREE OF THIS SECTION, WITHOUT REGARD TO OTHERWISE APPLICA-
BLE RESOURCE REQUIREMENTS OF THIS TITLE; OR (B) IN THE CASE OF AN INDI-
VIDUAL WHO OPTS FOR A CONTRIBUTION LEVEL UNDER PARAGRAPH (B) OF SUBDIVI-
SION THREE OF THIS SECTION, WITHOUT REGARD TO AN AMOUNT OF RESOURCES
THAT IS EQUIVALENT TO THE VALUE OF THE CONTRIBUTION. IN EITHER CASE,
ELIGIBILITY FOR MEDICAL ASSISTANCE UNDER THIS TITLE SHALL, WITH RESPECT
TO THE AMOUNT OF RESOURCES THAT ARE EXEMPT FROM CONSIDERATION UNDER THIS
SUBDIVISION, BE WITHOUT REGARD TO THE LIEN AND ESTATE RECOVERY
PROVISIONS OF SECTION THREE HUNDRED SIXTY-NINE OF THIS TITLE; PROVIDED,
HOWEVER, THAT NOTHING HEREIN SHALL PREVENT THE IMPOSITION OF A LIEN OR
RECOVERY AGAINST PROPERTY OF AN INDIVIDUAL ON ACCOUNT OF MEDICAL ASSIST-
ANCE INCORRECTLY PAID.
5. THE COMMISSIONER IS AUTHORIZED TO ENTER INTO A CONTRACT WITH A
PRIVATE ENTITY TO ASSIST IN THE ADMINISTRATION OF THE DEMONSTRATION
PROGRAM ESTABLISHED BY THIS SECTION. SUCH A CONTRACT MAY INCLUDE, WITH-
OUT LIMITATION, ASSISTANCE IN THE DEVELOPMENT OF THE CRITERIA FOR THE
DEFINED PRIVATE CONTRIBUTION, DRAFTING OF THE DEFINED CONTRIBUTION
AGREEMENT, ACCEPTING AND PROCESSING APPLICATIONS FOR DEMONSTRATION
PARTICIPATION UNDER THIS SECTION, AND ACCEPTING AND PROCESSING APPLICA-
TIONS FOR MEDICAL ASSISTANCE FOR DEMONSTRATION PARTICIPANTS. NOTWITH-
STANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED TWELVE AND
ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION ONE HUNDRED
FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW, THE COMMIS-
SIONER IS AUTHORIZED TO ENTER INTO A CONTRACT UNDER THIS SUBDIVISION
WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS.
6. THE COMMISSIONER SHALL SUBMIT A REPORT TO THE GOVERNOR, PRESIDENT
PRO TEM OF THE SENATE AND SPEAKER OF THE ASSEMBLY BY THE FIRST DAY OF
NOVEMBER, TWO THOUSAND FIFTEEN, ON THE IMPLEMENTATION OF THIS SECTION.
SUCH REPORT SHALL INCLUDE A STATEMENT AS TO THE EXTENT TO WHICH INDIVID-
UALS HAVE OPTED TO PARTICIPATE IN THE DEMONSTRATION, AN ANALYSIS OF THE
IMPACT OF THE DEMONSTRATION ON MEDICAL ASSISTANCE PROGRAM LONG-TERM CARE
COSTS, ANY RECOMMENDATIONS FOR LEGISLATIVE ACTION, AND SUCH OTHER
MATTERS AS MAY BE PERTINENT.
S 21. The social services law is amended by adding a new section 367-v
to read as follows:
S 367-V. COUNTY LONG-TERM CARE FINANCING DEMONSTRATION PROGRAM. 1.
NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, THE COMMISSIONER IS
AUTHORIZED TO ESTABLISH A LONG-TERM CARE FINANCING DEMONSTRATION
PROGRAM, TO OPERATE IN UP TO FIVE COUNTIES, FOR THE PURPOSE OF CREATING
INCENTIVES AND FUNDING FOR THE TRANSFORMATION OF COUNTY NURSING HOME
BEDS INTO OTHER LONG-TERM CARE SETTINGS.
2. (A) THE DEMONSTRATION PROGRAM ESTABLISHED PURSUANT TO THIS SECTION
SHALL PERMIT A PARTICIPATING COUNTY TO REDUCE ITS COUNTY NURSING HOME
BED CAPACITY, OR TO CLOSE A COUNTY NURSING HOME, AND TO INVEST ANY
RESULTING DEMONSTRATED SAVINGS IN PROGRAMS OR SERVICES THAT WILL, TO THE
EXTENT FEASIBLE, ENCOURAGE THE USE OF COMMUNITY-BASED LONG-TERM CARE
ALTERNATIVES TO INSTITUTIONAL CARE.
(B) SUCH PROGRAMS OR SERVICES MAY INCLUDE, BUT ARE NOT LIMITED TO:
(I) EXPANSION OF COMMUNITY-BASED SERVICES SUCH AS THE PROGRAM FOR
ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE), THE LONG TERM HOME HEALTH
S. 6608 82 A. 9708
CARE PROGRAM, THE MANAGED LONG TERM CARE PROGRAM, ADULT DAY CARE
SERVICES, AND CAREGIVER SUPPORT SERVICES;
(II) EXPANSION OF SENIOR HOUSING;
(III) ASSISTED LIVING PROGRAM;
(IV) PAYMENT OF SUBSIDIES TO ENCOURAGE ASSISTED LIVING PROGRAMS, ADULT
CARE FACILITIES, AND NON-PUBLIC NURSING HOMES TO ACCEPT HARD-TO-SERVE
RESIDENTS; AND
(V) CONTRACTS WITH NON-PUBLIC NURSING HOMES TO GUARANTEE BEDS FOR
THOSE HARD-TO-SERVE PERSONS WHO CHOOSE NURSING HOME CARE OR FOR WHOM
OTHER COMMUNITY-BASED OPTIONS ARE NOT FEASIBLE OR ARE UNAVAILABLE.
3. A COUNTY WISHING TO PARTICIPATE IN THE DEMONSTRATION PROGRAM ESTAB-
LISHED PURSUANT TO THIS SECTION SHALL DEVELOP A PLAN AND SUBMIT AN
APPLICATION FOR PARTICIPATION TO THE COMMISSIONER OF HEALTH DETAILING
SUCH PLAN AT A TIME AND IN A MANNER TO BE DETERMINED BY SUCH COMMISSION-
ER. THE COMMISSIONER IS AUTHORIZED TO APPROVE OR DISAPPROVE ANY SUCH
APPLICATION AND TO CERTIFY THE AMOUNT OF DEMONSTRATED SAVINGS.
4. NOTWITHSTANDING THE CAP ON SOCIAL SERVICES DISTRICT SHARES OF
MEDICAL ASSISTANCE EXPENDITURES ESTABLISHED PURSUANT TO SECTION ONE OF
PART C OF CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND FIVE, THE
DIRECTOR OF THE DIVISION OF THE BUDGET IS AUTHORIZED, IN HIS OR HER SOLE
DISCRETION, TO ADJUST A DISTRICT'S CAP AMOUNT TO ACCOUNT FOR CHANGES IN
THE NON-FEDERAL SHARE OF MEDICAL ASSISTANCE RESULTING FROM ANY APPROVED
DEMONSTRATION PLAN.
5. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO SUBMIT ANY AMENDMENTS
TO THE STATE PLAN FOR MEDICAL ASSISTANCE AND ANY WAIVERS OF THE FEDERAL
SOCIAL SECURITY ACT THAT SUCH COMMISSIONER DETERMINES TO BE NECESSARY TO
OBTAIN FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF SERVICES PROVIDED
PURSUANT TO THIS SECTION.
6. THE COMMISSIONER OF HEALTH SHALL SUBMIT A REPORT TO THE GOVERNOR,
PRESIDENT PRO TEM OF THE SENATE AND SPEAKER OF THE ASSEMBLY BY THE FIRST
DAY OF NOVEMBER, TWO THOUSAND FIFTEEN, ON THE IMPLEMENTATION OF THIS
SECTION. SUCH REPORT SHALL INCLUDE IDENTIFICATION OF THE COUNTIES
APPROVED TO PARTICIPATE IN THE DEMONSTRATION, A DESCRIPTION OF SUCH
COUNTIES' APPROVED DEMONSTRATION PLANS, AN ANALYSIS OF THE IMPACT OF THE
DEMONSTRATION ON LONG-TERM CARE COSTS AND SERVICE DELIVERY, ANY RECOM-
MENDATIONS FOR LEGISLATIVE ACTION, AND SUCH OTHER MATTERS AS MAY BE
PERTINENT.
S 22. Subdivision 6 of section 3614 of the public health law, as
amended by chapter 645 of the laws of 2003, is amended by adding a new
paragraph (c) to read as follows:
(C) THE DEPARTMENT SHALL CONDUCT A STUDY OF THE USE OF RESIDENT DATA
COLLECTED FROM A UNIFORM ASSESSMENT TOOL IDENTIFIED BY THE COMMISSIONER
WITH RESPECT TO ITS EFFECTIVENESS IN EVALUATION AND ADJUSTING RATES OF
PAYMENT FOR ASSISTED LIVING PROGRAMS. ON OR BEFORE JULY THIRTY-FIRST,
TWO THOUSAND ELEVEN, THE COMMISSIONER SHALL PROVIDE THE GOVERNOR, THE
SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE
CHAIRPERSONS OF THE ASSEMBLY AND SENATE HEALTH COMMITTEES WITH A REPORT
SETTING FORTH THE CONCLUSIONS OF SUCH STUDY.
S 23. Subdivision 2 of section 2801-e of the public health law, as
added by chapter 750 of the laws of 2004, is amended to read as follows:
2. Notwithstanding any inconsistent provision of law or regulation to
the contrary, a residential health care facility, as defined in section
twenty-eight hundred one of this article, may apply to temporarily
decertify or permanently convert a portion of its existing certified
beds to another type of program or service under the voluntary residen-
tial health care facility rightsizing demonstration program. The commis-
S. 6608 83 A. 9708
sioner may approve temporary decertifications and permanent conversions
of beds totaling no more than [two thousand five hundred] FIVE THOUSAND
residential health care facility beds on a statewide basis under this
program. Such approvals shall reflect, to the extent practicable,
participation by a variety of residential health care facilities based
on geography, size and other pertinent factors.
S 24. Subdivision 4 of section 4403-f of the public health law is
REPEALED and two new subdivisions 4 and 4-a are added to read as
follows:
4. SOLVENCY. (A) THE COMMISSIONER SHALL BE RESPONSIBLE FOR EVALUATING,
APPROVING AND REGULATING ALL MATTERS RELATING TO FISCAL SOLVENCY,
INCLUDING RESERVES, SURPLUS AND PROVIDER CONTRACTS. THE COMMISSIONER MAY
PROMULGATE REGULATIONS TO IMPLEMENT THIS SECTION. THE COMMISSIONER, IN
THE ADMINISTRATION OF THIS SUBDIVISION:
(I) SHALL BE GUIDED BY THE STANDARDS WHICH GOVERN THE FISCAL SOLVENCY
OF A HEALTH MAINTENANCE ORGANIZATION, PROVIDED, HOWEVER, THAT THE
COMMISSIONER SHALL RECOGNIZE THE SPECIFIC DELIVERY COMPONENTS, OPERA-
TIONAL CAPACITY AND FINANCIAL CAPABILITY OF THE ELIGIBLE APPLICANT FOR A
CERTIFICATE OF AUTHORITY;
(II) SHALL NOT APPLY FINANCIAL SOLVENCY STANDARDS THAT EXCEED THOSE
REQUIRED FOR A HEALTH MAINTENANCE ORGANIZATION; AND
(III) SHALL ESTABLISH REASONABLE CAPITALIZATION AND CONTINGENT RESERVE
REQUIREMENTS.
(B) STANDARDS ESTABLISHED PURSUANT TO THIS SUBDIVISION SHALL BE
ADEQUATE TO PROTECT THE INTERESTS OF ENROLLEES IN MANAGED LONG TERM CARE
PLANS. THE COMMISSIONER SHALL BE SATISFIED THAT THE ELIGIBLE APPLICANT
IS FINANCIALLY SOUND, AND HAS MADE ADEQUATE PROVISIONS TO PAY FOR
SERVICES.
4-A. ROLE OF THE SUPERINTENDENT OF INSURANCE. (A) THE SUPERINTENDENT
OF INSURANCE SHALL DETERMINE AND APPROVE PREMIUMS IN ACCORDANCE WITH THE
INSURANCE LAW WHENEVER ANY POPULATION OF ENROLLEES NOT ELIGIBLE UNDER
TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT IS TO BE COVERED. THE
DETERMINATION AND APPROVAL OF THE SUPERINTENDENT OF INSURANCE SHALL
RELATE TO PREMIUMS CHARGED TO SUCH ENROLLEES NOT ELIGIBLE UNDER TITLE
XIX OF THE FEDERAL SOCIAL SECURITY ACT.
(B) THE SUPERINTENDENT OF INSURANCE SHALL EVALUATE AND APPROVE ANY
ENROLLEE CONTRACTS WHENEVER SUCH ENROLLEE CONTRACTS ARE TO COVER ANY
POPULATION OF ENROLLEES NOT ELIGIBLE UNDER TITLE XIX OF THE FEDERAL
SOCIAL SECURITY ACT.
S 25. Paragraphs (a), (b) and (c) of subdivision 6 of section 4403-f
of the public health law, paragraph (a) as added by section 16 of part C
of chapter 58 of the laws of 2007 and paragraphs (b) and (c) as added by
chapter 659 of the laws of 1997, are amended to read as follows:
(a) An applicant shall be issued a certificate of authority as a
managed long term care plan upon a determination by the commissioner[,
subject to any applicable evaluations, approvals, and regulations of the
superintendent of insurance as stated in this section,] that the appli-
cant complies with the operating requirements for a managed long term
care plan under this section. The commissioner shall issue no more than
fifty certificates of authority to managed long term care plans pursuant
to this section. For purposes of issuance of no more than fifty certif-
icates of authority, such certificates shall include those certificates
issued pursuant to paragraphs (b) and (c) of this subdivision.
(b) An operating demonstration shall be issued a certificate of
authority as a managed long term care plan upon a determination by the
commissioner[, subject to the necessary evaluations, approvals and regu-
S. 6608 84 A. 9708
lations of the superintendent of insurance as stated in this section,]
that such demonstration complies with the operating requirements for a
managed long term care plan under this section. Except as otherwise
expressly provided in paragraphs (d) and (e) of subdivision seven of
this section, nothing in this section shall be construed to affect the
continued legal authority of an operating demonstration to operate its
previously approved program.
(c) An approved managed long term care demonstration shall be issued a
certificate of authority as a managed long term care plan upon a deter-
mination by the commissioner[, subject to the necessary evaluations,
approvals and regulations of the superintendent of insurance set forth
in this section,] that such demonstration complies with the operating
requirements for a managed long term care plan under this section.
Notwithstanding any inconsistent provision of law to the contrary, all
authority for the operation of approved managed long term care demon-
strations which have not been issued a certificate of authority as a
managed long term care plan, shall expire one year after the adoption of
regulations implementing managed long term care plans.
S 26. Paragraph (f) of subdivision 7 of section 4403-f of the public
health law, as added by chapter 659 of the laws of 1997 and as relet-
tered by section 20 of part C of chapter 58 of the laws of 2007, is
amended to read as follows:
(f) Continuation of a certificate of authority issued under this
section[, subject to the necessary evaluations, approvals and regu-
lations of the superintendent of insurance,] shall be contingent upon
satisfactory performance by the managed long term care plan in the
delivery, continuity, accessibility, cost effectiveness and quality of
the services to enrolled members; compliance with applicable provisions
of this section and rules and regulations promulgated thereunder; the
continuing fiscal solvency of the organization; and, federal financial
participation in payments on behalf [on] OF enrollees who are eligible
to receive services under title XIX of the federal social security act.
S 27. Subdivision 9 of section 4403-f of the public health law, as
added by chapter 659 of the laws of 1997, is amended to read as follows:
9. Reports. The department shall provide an interim report to the
governor, temporary president of the senate and the speaker of the
assembly on or before April first, two thousand three and a final report
on or before April first, two thousand six on the results of the managed
long term care plans under this section. Such results shall be based on
data provided by the managed long term care plans and shall include but
not be limited to the quality, accessibility and appropriateness of
services; consumer satisfaction; the mean and distribution of impairment
measures of the enrollees by payor for each plan; the current method of
calculating premiums and the cost of comparable health and long term
care services provided on a fee-for-service basis for enrollees eligible
for services under title XIX of the federal social security act; and the
results of periodic reviews of enrollment levels and practices. [Such
reports shall contain a section prepared by the superintendent of insur-
ance as to the results of the plans approved in accordance with this
section concerning the matters regulated by the superintendent of insur-
ance.] Such reports shall [also] provide data on the demographic and
clinical characteristics of enrollees, voluntary and involuntary disen-
rollments from plans, AND utilization of services and shall examine the
feasibility of increasing the number of plans that may be approved. Data
collected pursuant to this section shall be available to the public in
an aggregated format to protect individual confidentiality, however
S. 6608 85 A. 9708
under no circumstance will data be released on items with cells with
smaller than statistically acceptable standards.
S 28. Paragraphs (b) and (c) of subdivision 5 of section 2808 of the
public health law, paragraph (b) as added by section 12 of part OO of
chapter 57 of the laws of 2008, and paragraph (c) as added by section 11
of part D of chapter 58 of the laws of 2009, are amended to read as
follows:
(b) On and after April first, two thousand [eight] TEN, no NON-PUBLIC
residential health care facility may withdraw equity or transfer assets
which in the aggregate exceed three percent of such facility's total
[Medicaid] REPORTED ANNUAL revenue [in any calendar year] FOR PATIENT
CARE SERVICES, BASED ON THE FACILITY'S MOST RECENTLY AVAILABLE REPORTED
DATA, without prior written notification to the commissioner. Notifica-
tion shall be made in a form acceptable to the department by certified
or registered mail.
(c) Notwithstanding any inconsistent provision of this subdivision, on
and after April first, two thousand [nine] TEN, no non-public residen-
tial 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 [Medi-
caid] REPORTED ANNUAL revenue [in the prior calendar year] FOR PATIENT
CARE SERVICES, BASED ON THE FACILITY'S MOST RECENTLY AVAILABLE REPORTED
DATA, 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 written request from the
facility. Requests shall be made in a form acceptable to the department
by certified or registered mail. In reviewing such requests the commis-
sioner shall consider the facility's overall financial 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 quality of care, and such other
factors as the commissioner deems appropriate. 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 29. Notwithstanding any inconsistent provision of law, rule or regu-
lation, for purposes of implementing the provisions of the public health
law and the social services law, references to titles XIX and XXI of the
federal social security act in the public health law and the social
services law shall be deemed to include and also to mean any successor
titles thereto under the federal social security act.
S 30. Notwithstanding any inconsistent provision of law, rule or regu-
lation, the effectiveness of the provisions of sections 2807 and 3614 of
the public health law, section 18 of chapter 2 of the laws of 1988, and
18 NYCRR 505.14(h), as they relate to time frames for notice, approval
or certification of rates of payment, are hereby suspended and without
force or effect for purposes of implementing the provisions of this act.
S 31. 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
S. 6608 86 A. 9708
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 32. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2010, provided,
however, that:
1. sections thirteen, thirteen-a and thirteen-b of this act shall take
effect July 1, 2010;
2. the amendments to subdivisions six, seven and nine of section
4403-f of the public health law made by sections twenty-five, twenty-six
and twenty-seven of this act shall not affect the repeal of such subdi-
visions and shall be deemed repealed therewith;
3. 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;
4. 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;
5. 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;
6. 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;
7. 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.
PART D
Section 1. Subsection (e) of 3231 of the insurance law, as added by
chapter 501 of the laws of 1992, subparagraph (B) of paragraph 2 as
amended by chapter 237 of the laws of 2009, is amended to read as
follows:
(e) (1) (A) An insurer desiring to increase or decrease premiums
[after April first, nineteen hundred ninety-three] for any policy form
subject to this section shall submit a rate filing or application to the
superintendent.
AN INSURER SHALL SEND WRITTEN NOTICE OF THE PROPOSED RATE ADJUSTMENT,
INCLUDING THE SPECIFIC CHANGE REQUESTED, TO EACH POLICY HOLDER AND
CERTIFICATE HOLDER AFFECTED BY THE ADJUSTMENT BETWEEN NINETY AND ONE
HUNDRED FIVE DAYS PRIOR TO THE PROPOSED EFFECTIVE DATE. THE NOTICE
SHALL PROMINENTLY INCLUDE MAILING AND WEBSITE ADDRESSES FOR BOTH THE
INSURANCE DEPARTMENT AND THE INSURER THROUGH WHICH A PERSON MAY CONTACT
THE INSURANCE DEPARTMENT OR INSURER TO RECEIVE ADDITIONAL INFORMATION OR
TO SUBMIT WRITTEN COMMENTS TO THE INSURANCE DEPARTMENT ON THE RATE
FILING OR APPLICATION. The superintendent shall determine whether the
filing or application shall become effective as filed, shall become
effective as modified, or shall be disapproved. THE SUPERINTENDENT MAY
MODIFY OR DISAPPROVE THE RATE FILING OR APPLICATION IF THE SUPERINTEN-
DENT FINDS THAT THE PREMIUMS ARE UNREASONABLE, EXCESSIVE, INADEQUATE, OR
S. 6608 87 A. 9708
UNFAIRLY DISCRIMINATORY, AND MAY CONSIDER THE FINANCIAL CONDITION OF THE
INSURER WHEN APPROVING, MODIFYING OR DISAPPROVING ANY PREMIUM ADJUST-
MENT. AN INSURER SHALL NOT IMPLEMENT A RATE ADJUSTMENT UNLESS THE INSUR-
ER PROVIDES AT LEAST FORTY-FIVE DAYS ADVANCE WRITTEN NOTICE OF THE
PREMIUM RATE ADJUSTMENT APPROVED BY THE SUPERINTENDENT TO EACH POLICY
HOLDER AND CERTIFICATE HOLDER AFFECTED BY THE RATE ADJUSTMENT.
(B) UPON RECEIPT OF A RATE FILING OR APPLICATION BY OR ON BEHALF OF AN
INSURER THAT, TOGETHER WITH ANY OTHER RATE ADJUSTMENTS IMPOSED DURING A
CONTINUOUS TWELVE-MONTH PERIOD, WOULD CAUSE AN AGGREGATE INCREASE IN
PREMIUMS FOR THAT POLICY FORM OF MORE THAN TEN PERCENT, THE SUPERINTEN-
DENT SHALL ORDER THAT A PUBLIC HEARING BE HELD AT THE INSURER'S EXPENSE.
THE WRITTEN NOTICE REQUIRED BY SUBPARAGRAPH (A) OF THIS PARAGRAPH SHALL
INCLUDE NOTICE OF THE PUBLIC HEARING. THE INSURER SHALL ALSO PUBLISH
NOTICE OF SUCH HEARING ON THREE SUCCESSIVE DAYS IN AT LEAST ONE NEWSPA-
PER HAVING GENERAL CIRCULATION IN EACH COUNTY WHERE PERSONS AFFECTED BY
THE PROPOSED CHANGE RESIDE. THE NOTICE OF HEARING SHALL BE SUBJECT TO
THE SUPERINTENDENT'S PRIOR APPROVAL, AND SHALL STATE THE DATE, TIME AND
PLACE OF THE HEARING (AS SCHEDULED BY THE SUPERINTENDENT), THE PURPOSE
THEREOF, THE CHANGES PROPOSED, THE POLICY FORMS AFFECTED, AND THE
PROPOSED EFFECTIVE DATE OF THE CHANGES. THE NOTICE OF HEARING SHALL ALSO
PROMINENTLY INCLUDE TOLL-FREE TELEPHONE NUMBERS AND MAILING AND WEBSITE
ADDRESSES FOR BOTH THE INSURANCE DEPARTMENT AND THE INSURER THROUGH
WHICH A PERSON MAY CONTACT THE INSURANCE DEPARTMENT OR INSURER TO
RECEIVE ADDITIONAL INFORMATION OR TO SUBMIT WRITTEN COMMENTS TO THE
INSURANCE DEPARTMENT ON THE RATE FILING OR APPLICATION. THE DATE SPECI-
FIED FOR THE HEARING SHALL NOT BE LESS THAN TEN NOR MORE THAN THIRTY
DAYS FROM THE DATE OF THE LAST PUBLICATION OF THE NOTICE OF THE HEARING.
UPON CONCLUSION OF THE PUBLIC HEARING, THE SUPERINTENDENT SHALL RENDER A
WRITTEN DETERMINATION AS TO WHETHER THE RATE FILING OR APPLICATION SHALL
BECOME EFFECTIVE AS FILED, SHALL BECOME EFFECTIVE AS MODIFIED, OR SHALL
BE DISAPPROVED.
(C) THE EXPECTED MINIMUM LOSS RATIO FOR A POLICY FORM SUBJECT TO THIS
SECTION, FOR WHICH A RATE FILING OR APPLICATION IS MADE PURSUANT TO THIS
PARAGRAPH, OTHER THAN A MEDICARE SUPPLEMENTAL INSURANCE POLICY, OR, WITH
THE APPROVAL OF THE SUPERINTENDENT, AN AGGREGATION OF POLICY FORMS THAT
ARE COMBINED INTO ONE COMMUNITY RATING EXPERIENCE POOL AND RATED
CONSISTENT WITH COMMUNITY RATING REQUIREMENTS, SHALL NOT BE LESS THAN
EIGHTY-FIVE PERCENT. IN REVIEWING A RATE FILING OR APPLICATION, THE
SUPERINTENDENT MAY MODIFY THE EIGHTY-FIVE PERCENT EXPECTED MINIMUM LOSS
RATIO REQUIREMENT IF THE SUPERINTENDENT DETERMINES THE MODIFICATION TO
BE IN THE INTERESTS OF THE PEOPLE OF THIS STATE. NO LATER THAN JUNE
THIRTIETH OF EACH YEAR, EVERY INSURER SUBJECT TO THIS SUBPARAGRAPH SHALL
ANNUALLY REPORT THE ACTUAL LOSS RATIO FOR THE PREVIOUS CALENDAR YEAR IN
A FORMAT ACCEPTABLE TO THE SUPERINTENDENT. IF AN EXPECTED LOSS RATIO IS
NOT MET, THE SUPERINTENDENT MAY DIRECT THE INSURER TO TAKE CORRECTIVE
ACTION, WHICH MAY INCLUDE THE SUBMISSION OF A RATE FILING TO REDUCE
FUTURE PREMIUMS, OR TO ISSUE DIVIDENDS, PREMIUM REFUNDS OR CREDITS, OR
ANY COMBINATION OF THESE.
(2) (A) [Beginning October first, nineteen hundred ninety-four] UNTIL
SEPTEMBER THIRTIETH, TWO THOUSAND TEN, as an alternate procedure to the
requirements of paragraph one of this subsection, an insurer desiring to
increase or decrease premiums for any policy form subject to this
section may instead submit a rate filing or application to the super-
intendent and such application or filing shall be deemed approved,
provided that: (i) the anticipated minimum loss ratio for a policy form
shall not be less than [seventy-five] EIGHTY-FIVE percent of the premi-
S. 6608 88 A. 9708
um[,]; and (ii) the insurer submits, as part of such filing, a certif-
ication by a member of the American Academy of Actuaries or other indi-
vidual acceptable to the superintendent that the insurer is in
compliance with the provisions of this paragraph, based upon that
person's examination, including a review of the appropriate records and
of the actuarial assumptions and methods used by the insurer in estab-
lishing premium rates for policy forms subject to this section. AN
INSURER SHALL NOT UTILIZE THE ALTERNATE PROCEDURE PURSUANT TO THIS PARA-
GRAPH TO IMPLEMENT A CHANGE IN RATES TO BE EFFECTIVE ON OR AFTER OCTOBER
FIRST, TWO THOUSAND TEN.
(B) Each calendar year, an insurer shall return, in the form of aggre-
gate benefits for each policy form filed pursuant to the alternate
procedure set forth in this paragraph at least [seventy-five]
EIGHTY-FIVE percent of the aggregate premiums collected for the policy
form during that calendar year. Insurers shall annually report, no later
than [May first] JUNE THIRTIETH of each year, the loss ratio calculated
pursuant to this paragraph for each such policy form for the previous
calendar year. In each case where the loss ratio for a policy form fails
to comply with the [seventy-five] EIGHTY-FIVE percent loss ratio
requirement, the insurer shall issue a dividend or credit against future
premiums for all policy holders with that policy form in an amount
sufficient to assure that the aggregate benefits paid in the previous
calendar year plus the amount of the dividends and credits shall equal
[seventy-five] EIGHTY-FIVE percent of the aggregate premiums collected
for the policy form in the previous calendar year. The dividend or cred-
it shall be issued to each policy holder who had a policy which was in
effect at any time during the applicable year. The dividend or credit
shall be prorated based on the direct premiums earned for the applicable
year among all policy holders eligible to receive such dividend or cred-
it. An insurer shall make a reasonable effort to identify the current
address of, and issue dividends or credits to, former policy holders
entitled to the dividend or credit. An insurer shall, with respect to
dividends or credits to which former policy holders that the insurer is
unable to identify after a reasonable effort would otherwise be enti-
tled, have the option, as deemed acceptable by the superintendent, of
prospectively adjusting premium rates by the amount of such dividends or
credits, issuing the amount of such dividends or credits to existing
policy holders, depositing the amount of such dividends or credits in
the fund established pursuant to section four thousand three hundred
twenty-two-a of this chapter, or utilizing any other method which
offsets the amount of such dividends or credits. All dividends and
credits must be distributed by September thirtieth of the year following
the calendar year in which the loss ratio requirements were not satis-
fied. The annual report required by this paragraph shall include an
insurer's calculation of the dividends and credits, as well as an expla-
nation of the insurer's plan to issue dividends or credits. The
instructions and format for calculating and reporting loss ratios and
issuing dividends or credits shall be specified by the superintendent by
regulation. Such regulations shall include provisions for the distrib-
ution of a dividend or credit in the event of cancellation or termi-
nation by a policy holder.
(3) ALL POLICY FORMS SUBJECT TO THIS SUBSECTION, OTHER THAN MEDICARE
SUPPLEMENTAL INSURANCE POLICY FORMS, ISSUED OR IN EFFECT DURING CALENDAR
YEAR TWO THOUSAND TEN SHALL BE SUBJECT TO A MINIMUM LOSS RATIO REQUIRE-
MENT OF EIGHTY-FIVE PERCENT. INSURERS MAY USE THE ALTERNATE FILING
PROCEDURE SET FORTH IN PARAGRAPH TWO OF THIS SUBSECTION TO ADJUST PREMI-
S. 6608 89 A. 9708
UM RATES IN ORDER TO MEET THE REQUIRED MINIMUM LOSS RATIO FOR CALENDAR
YEAR TWO THOUSAND TEN. THE RATE FILING OR APPLICATION SHALL BE SUBMIT-
TED NO LATER THAN SEPTEMBER THIRTIETH, TWO THOUSAND TEN.
S 2. Section 4308 of the insurance law, subsection (b) as amended and
subsections (d), (e) and (f) as added by chapter 501 of the laws of
1992, paragraph 3 of subsection (c) as amended by chapter 520 of the
laws of 1999, subsections (g), (h), (i) and (j) as added by chapter 504
of the laws of 1995 and paragraph 2 of subsection (h) as amended by
chapter 237 of the laws of 2009, is amended to read as follows:
S 4308. Supervision of superintendent; public hearings. (a) No corpo-
ration subject to the provisions of this article shall enter into any
contract unless and until it shall have filed with the superintendent a
copy of the contract or certificate and of all applications, riders and
endorsements for use in connection with the issuance or renewal thereof,
to be formally approved by him as conforming to the applicable
provisions of this article and not inconsistent with any other provision
of law applicable thereto. The superintendent shall, within a reasonable
time after the filing of any such form, notify the corporation filing
the same either of his approval or of his disapproval of such form.
(b) No corporation subject to the provisions of this article shall
enter into any contract unless and until it shall have filed with the
superintendent a schedule of the premiums or, if appropriate, rating
formula from which premiums are determined, to be paid under the
contracts and shall have obtained the superintendent's approval thereof.
The superintendent may refuse such approval if he finds that such premi-
ums, or the premiums derived from the rating formula, are excessive,
inadequate or unfairly discriminatory, provided, however, the super-
intendent may also consider the financial condition of such corporation
in approving or disapproving any premium or rating formula. ANY ADJUST-
MENTS TO AN APPROVED SCHEDULE OF PREMIUMS OR TO THE APPROVED RATING
FORMULA FOR NON-COMMUNITY RATED CONTRACTS SHALL ALSO BE SUBJECT TO THE
APPROVAL OF THE SUPERINTENDENT PROVIDED, HOWEVER, SUCH ADJUSTMENTS SHALL
NOT BE SUBJECT TO THE REQUIREMENTS OF SUBSECTION (C) OF THIS SECTION.
Any premium or formula approved by the superintendent shall make
provision for such increase as may be necessary to meet the requirements
of a plan approved by the superintendent in the manner prescribed in
section four thousand three hundred ten of this article for restoration
of the statutory reserve fund required by such section. Notwithstanding
any other provision of law, the superintendent, as part of the rate
increase approval process, may defer, reduce or reject a rate increase
if, in the judgment of the superintendent, the salary increases for
senior level management executives employed at corporations subject to
the provisions of this article are excessive or unwarranted given the
financial condition or overall performance of such corporation. The
superintendent is authorized to promulgate rules and regulations which
the superintendent deems necessary to carry out such deferral, reduction
or rejection.
(c) (1) [Except for an application pursuant to subsection (f) of
section four thousand three hundred four of this article, no] AN
increase or decrease in premiums with respect to [individual] COMMUNITY
RATED contracts [issued pursuant to the provisions of such section]
shall NOT be approved by the superintendent unless it is in compliance
with the provisions of this subsection as well as other applicable
provisions of law.
(2) [Prior to any such filing or application by or on behalf of a
corporation for an increase or decrease in premiums for such contracts,
S. 6608 90 A. 9708
such corporation, when directed by the superintendent, shall conduct a
public hearing with respect to the terms of such filing or application.
Notice of such hearing shall be published on three successive days in at
least two newspapers having general circulation within the territory or
district wherein such corporation seeking approval of the filing is
authorized to do business. The date specified for the hearing shall be
not less than ten nor more than thirty days from the date of the first
publication of the hearing. The notice of hearing shall state the
purpose thereof, the time when and the place where the public hearing
will be held. The public hearing shall be held at a time and location
deemed by the superintendent to be most convenient to the greatest
number of persons affected by such filing. At such hearing any person
may be heard in favor of, or against, the terms of the filing or appli-
cation.
(3) Following the public hearing held pursuant to paragraph two of
this subsection, a transcript of the testimony therein shall be submit-
ted together with a rate filing or application, to the superintendent.
Upon receipt of such filing or application by or on behalf of a corpo-
ration, the superintendent shall order that a public hearing be held
with respect to the terms of such filing or application. Notice of such
hearing shall be published on three successive days in at least two
newspapers having general circulation within the territory or district
wherein such corporation seeking approval of the filing or application
is authorized to do business. For a corporation writing more than three
billion dollars in premiums as of December thirty-first, nineteen
hundred ninety-six and whose service territory is greater than ten coun-
ties, such notice is to be published in at least one newspaper having
general circulation in each county where persons in the service territo-
ry are affected by the proposed change. The date specified for the hear-
ing shall be not less than ten nor more than thirty days from the date
of the last publication of the hearing. The notice of hearing shall also
state the purpose thereof, the time when and the place where the public
hearing will be held. For those corporations writing more than three
billion dollars in premiums as of December thirty-first, nineteen
hundred ninety-six, and whose territory is greater than ten counties,
the notice of hearing shall also state the changes proposed, the
contracts to be affected and the time when such changes would take
effect. The notice of hearing shall state, in prominent display, a toll-
free telephone number of the insurance department that may be contacted
to receive additional information on the subject rate application. The
public hearing shall be held at a time and location deemed by the super-
intendent to be most convenient to the greatest number of persons
affected by such filing or application. A copy of such notice of hearing
shall be forwarded by the superintendent by registered or certified mail
to the principal address of the corporation seeking approval of such
filing or application. The hearing may be continued or adjourned from
day to day within the discretion of the superintendent. At such hearing
any person may be heard in favor of, or against, the terms of the filing
or application. After conclusion of the public hearing the superinten-
dent shall render a written decision determining whether the filing or
application shall become effective as filed, shall become effective as
modified, or shall be disapproved. If, subsequent to the hearing, but
prior to the issuing of the superintendent's written decision on a rate
increase request, the corporation increases its requested rate for any
contract by two percent or more, a re-hearing shall be held. The time,
S. 6608 91 A. 9708
location, and notice requirements for such re-hearing shall be deter-
mined by the superintendent.
(4)] (A) A CORPORATION DESIRING TO INCREASE OR DECREASE PREMIUMS FOR
ANY CONTRACT SUBJECT TO THIS SUBSECTION SHALL SUBMIT A RATE FILING OR
APPLICATION TO THE SUPERINTENDENT. A CORPORATION SHALL SEND WRITTEN
NOTICE OF THE PROPOSED RATE ADJUSTMENT, INCLUDING THE SPECIFIC CHANGE
REQUESTED, TO EACH CONTRACT HOLDER AND SUBSCRIBER AFFECTED BY THE
ADJUSTMENT BETWEEN NINETY AND ONE HUNDRED FIVE DAYS PRIOR TO THE
PROPOSED EFFECTIVE DATE OF SUCH ADJUSTMENT. THE NOTICE SHALL PROMINENT-
LY INCLUDE MAILING AND WEBSITE ADDRESSES FOR BOTH THE INSURANCE DEPART-
MENT AND THE CORPORATION THROUGH WHICH A PERSON MAY CONTACT THE INSUR-
ANCE DEPARTMENT OR CORPORATION TO RECEIVE ADDITIONAL INFORMATION OR TO
SUBMIT WRITTEN COMMENTS TO THE INSURANCE DEPARTMENT ON THE RATE FILING
OR APPLICATION. THE SUPERINTENDENT SHALL DETERMINE WHETHER THE FILING
OR APPLICATION SHALL BECOME EFFECTIVE AS FILED, SHALL BECOME EFFECTIVE
AS MODIFIED, OR SHALL BE DISAPPROVED. THE SUPERINTENDENT MAY MODIFY OR
DISAPPROVE THE RATE FILING OR APPLICATION IF THE SUPERINTENDENT FINDS
THAT THE PREMIUMS ARE UNREASONABLE, EXCESSIVE, INADEQUATE, OR UNFAIRLY
DISCRIMINATORY, AND MAY CONSIDER THE FINANCIAL CONDITION OF THE CORPO-
RATION IN APPROVING, MODIFYING OR DISAPPROVING ANY PREMIUM ADJUSTMENT.
A CORPORATION SHALL NOT IMPLEMENT A RATE ADJUSTMENT UNLESS THE CORPO-
RATION PROVIDES AT LEAST FORTY-FIVE DAYS ADVANCE WRITTEN NOTICE OF THE
PREMIUM RATE ADJUSTMENT APPROVED BY THE SUPERINTENDENT TO EACH CONTRACT
HOLDER AND SUBSCRIBER AFFECTED BY THE RATE ADJUSTMENT.
(B) UPON RECEIPT OF A RATE FILING OR APPLICATION BY OR ON BEHALF OF A
CORPORATION THAT, TOGETHER WITH ANY OTHER RATE ADJUSTMENTS IMPOSED
DURING A CONTINUOUS TWELVE-MONTH PERIOD, WOULD CAUSE AN AGGREGATE
INCREASE IN PREMIUMS FOR THAT CONTRACT FORM OF MORE THAN TEN PERCENT,
THE SUPERINTENDENT SHALL ORDER THAT A PUBLIC HEARING BE HELD AT THE
CORPORATION'S EXPENSE. THE WRITTEN NOTICE REQUIRED BY SUBPARAGRAPH (A)
OF THIS PARAGRAPH SHALL INCLUDE NOTICE OF THE PUBLIC HEARING. THE
CORPORATION SHALL ALSO PUBLISH NOTICE OF SUCH HEARING ON THREE SUCCES-
SIVE DAYS IN AT LEAST ONE NEWSPAPER HAVING GENERAL CIRCULATION IN EACH
COUNTY WHERE PERSONS AFFECTED BY THE PROPOSED CHANGE RESIDE. THE NOTICE
OF HEARING SHALL BE SUBJECT TO THE SUPERINTENDENT'S PRIOR APPROVAL, AND
SHALL STATE THE DATE, TIME AND PLACE OF THE HEARING (AS SCHEDULED BY THE
SUPERINTENDENT), THE PURPOSE THEREOF, THE CHANGES PROPOSED, THE
CONTRACTS AFFECTED, AND THE PROPOSED EFFECTIVE DATE OF THE CHANGES. THE
NOTICE OF HEARING SHALL ALSO PROMINENTLY INCLUDE TOLL-FREE TELEPHONE
NUMBERS AND MAILING AND WEBSITE ADDRESSES FOR BOTH THE INSURANCE DEPART-
MENT AND THE CORPORATION THROUGH WHICH A PERSON MAY CONTACT THE INSUR-
ANCE DEPARTMENT OR CORPORATION TO RECEIVE ADDITIONAL INFORMATION OR TO
SUBMIT WRITTEN COMMENTS TO THE INSURANCE DEPARTMENT ON THE RATE FILING
OR APPLICATION. THE DATE SPECIFIED FOR THE HEARING SHALL NOT BE LESS
THAN TEN NOR MORE THAN THIRTY DAYS FROM THE DATE OF THE LAST PUBLICATION
OF THE NOTICE OF THE HEARING. UPON CONCLUSION OF THE PUBLIC HEARING, THE
SUPERINTENDENT SHALL RENDER A WRITTEN DETERMINATION AS TO WHETHER THE
RATE FILING OR APPLICATION SHALL BECOME EFFECTIVE AS FILED, SHALL BECOME
EFFECTIVE AS MODIFIED, OR SHALL BE DISAPPROVED.
(3)(A) THE EXPECTED MINIMUM LOSS RATIO FOR A CONTRACT FORM SUBJECT TO
THIS SUBSECTION FOR WHICH A RATE FILING OR APPLICATION IS MADE PURSUANT
TO THIS PARAGRAPH, OTHER THAN A MEDICARE SUPPLEMENTAL INSURANCE
CONTRACT, OR, WITH THE APPROVAL OF THE SUPERINTENDENT, AN AGGREGATION OF
CONTRACT FORMS THAT ARE COMBINED INTO ONE COMMUNITY RATING EXPERIENCE
POOL AND RATED CONSISTENT WITH COMMUNITY RATING REQUIREMENTS, SHALL NOT
BE LESS THAN EIGHTY-FIVE PERCENT. IN REVIEWING A RATE FILING OR APPLICA-
S. 6608 92 A. 9708
TION, THE SUPERINTENDENT MAY MODIFY THE EIGHTY-FIVE PERCENT EXPECTED
MINIMUM LOSS RATIO REQUIREMENT IF THE SUPERINTENDENT DETERMINES THE
MODIFICATION TO BE IN THE INTERESTS OF THE PEOPLE OF THIS STATE. NO
LATER THAN JUNE THIRTIETH OF EACH YEAR, EVERY CORPORATION SUBJECT TO
THIS SUBPARAGRAPH SHALL ANNUALLY REPORT THE ACTUAL LOSS RATIO FOR THE
PREVIOUS CALENDAR YEAR IN A FORMAT ACCEPTABLE TO THE SUPERINTENDENT. IF
AN EXPECTED LOSS RATIO IS NOT MET, THE SUPERINTENDENT MAY DIRECT THE
CORPORATION TO TAKE CORRECTIVE ACTION, WHICH MAY INCLUDE THE SUBMISSION
OF A RATE FILING TO REDUCE FUTURE PREMIUMS, OR TO ISSUE DIVIDENDS,
PREMIUM REFUNDS OR CREDITS, OR ANY COMBINATION OF THESE.
(B) THE EXPECTED MINIMUM LOSS RATIO FOR A MEDICARE SUPPLEMENTAL INSUR-
ANCE CONTRACT FORM SHALL NOT BE LESS THAN EIGHTY PERCENT. NO LATER THAN
MAY FIRST OF EACH YEAR, EVERY CORPORATION SUBJECT TO THIS SUBPARAGRAPH
SHALL ANNUALLY REPORT THE ACTUAL LOSS RATIO FOR EACH CONTRACT FORM
SUBJECT TO THIS SECTION FOR THE PREVIOUS CALENDAR YEAR IN A FORMAT
ACCEPTABLE TO THE SUPERINTENDENT. IN EACH CASE WHERE THE LOSS RATIO FOR
THE CONTRACT FORM FAILS TO COMPLY WITH THE EIGHTY PERCENT LOSS RATIO
REQUIREMENT, THE CORPORATION SHALL SUBMIT A CORRECTIVE ACTION PLAN TO
THE SUPERINTENDENT FOR ASSURING COMPLIANCE WITH THE APPLICABLE MINIMUM
LOSS RATIO STANDARD. THE CORRECTIVE ACTION PLAN SHALL BE SUBMITTED TO
THE SUPERINTENDENT WITHIN SIXTY DAYS OF THE CORPORATION'S SUBMISSION OF
THE ANNUAL REPORT REQUIRED BY THIS SUBPARAGRAPH. THE CORPORATION'S PLAN
MAY UTILIZE PREMIUM REFUNDS OR CREDITS, SUBJECT TO THE APPROVAL OF THE
SUPERINTENDENT.
(4) In case of conflict between this subsection and any other
provision of law, this subsection shall prevail.
(d) The superintendent shall order an independent management and
financial audit of corporations subject to the provisions of this arti-
cle with a combined premium volume exceeding two billion dollars annual-
ly in order to develop a detailed understanding of such corporation's
financial status and to determine the viability of such corporation's
products. Such audit shall be performed by an organization upon
submission of a program plan in response to a request for proposal
approved by the superintendent in consultation with the commissioner of
health and the state comptroller. Such audit shall not be performed by
any organization that has in any way performed or furnished services of
any kind to the corporation within the past five years, unless it is
adequately demonstrated that such services would not compromise that
organization's performance and objectivity. The audit shall be completed
and a report submitted by May first, nineteen hundred ninety-three to
the superintendent, the commissioner of health, and the chairs of the
senate and assembly committees on health and insurance. The scope of the
audit shall include, but not be limited to, financial and competitive
position, corporate structure and governance, organization and manage-
ment, strategic direction, rate adequacy, and the regulatory and compet-
itive environment in the state of New York. Specifically, the audit
shall include, but not be limited to:
(i) determining the corporation's financial and market position,
including its reserves, trends in membership, market share, and profit-
ability by market segment;
(ii) evaluating the corporation's product offerings with respect to
market requirements and trends, the corporation's responses to the New
York health care market, and its management of medical claims costs;
(iii) assessing the effectiveness of the organizational and management
structure and performance, including, but not limited to, possible
improvement in the size, structure, composition and operation of the
S. 6608 93 A. 9708
board of directors, productivity improvement, information systems,
management development, personnel practices, mix and level of skills,
personnel turnover, investment practices and rate of return upon invest-
ment activities;
(iv) analyzing the corporation's strategic directions, its adequacy to
meet competitive, market, and existing regulatory trends, including an
evaluation of the use of brokers in marketing products, and the impact
of those strategies on the corporation's future financial performance
and on the health care system of New York;
(v) evaluating the adequacy of rates for existing products, partic-
ularly (but not limited to) small group, medicare supplemental, and
direct payment to identify areas that may need immediate remedial atten-
tion;
(vi) identifying any changes to the regulatory and legislative envi-
ronment that may need to be made to ensure that the corporation can
continue to be financially viable and competitive;
(vii) identifying and assessing specific transactions such as the
procurement of reinsurance, sale of real property and the sale of future
investment income to improve the financial condition of the corporation;
and
(viii) evaluating and identifying possible improvements in the corpo-
ration's managed care strategies, operations and claims handling.
(e) Notwithstanding any other provision of law, the superintendent
shall have the power to require independent management and financial
audits of corporations subject to the provisions of this article whenev-
er in the judgment of the superintendent, losses sustained by a corpo-
ration jeopardize its ability to provide meaningful coverage at afforda-
ble rates or when such audit would be necessary to protect the interests
of subscribers. The audit shall include, but not be limited to, an
investigation of the corporation's provision of benefits to senior citi-
zens, individual and family, and small group and small business
subscribers in relation to the needs of those subscribers. The audit
shall also include an evaluation of the efficiency of the corporation's
management, particularly with respect to lines of business which are
experiencing losses. In every case in which the superintendent chooses
to require an audit provided for in this subsection, the superintendent
shall have the authority to select the auditor. Any costs incurred as a
result of the operation of this subsection shall be assessed on all
domestic insurers in the same manner as provided for in section three
hundred thirty-two of this chapter.
(f) The results of any audit conducted pursuant to subsections (d) and
(e) of this section shall be provided to the corporation and each member
of its board of directors. The superintendent shall have the authority
to direct the corporation in writing to implement any recommendations
resulting from the audit that the superintendent finds to be necessary
and reasonable; provided, however, that the superintendent shall first
consider any written response submitted by the corporation or the board
of directors prior to making such finding. Upon any application for a
rate adjustment by the corporation, the superintendent shall review the
corporation's compliance with the directions and recommendations made
previously by the superintendent, as a result of the most recently
completed management or financial audit and shall include such findings
in any written decision concerning such application.
(g)(1) [Beginning January first, nineteen hundred ninety-six] UNTIL
SEPTEMBER THIRTIETH, TWO THOUSAND TEN, as an alternate procedure to the
requirements of subsection (c) of this section, a corporation subject to
S. 6608 94 A. 9708
the provisions of this article desiring to increase or decrease premiums
for any contract subject to this section may instead submit a rate
filing or application to the superintendent and such application or
filing shall be deemed approved, provided that (A) the anticipated
incurred loss ratio for a contract form shall not be less than eighty-
five percent for individual direct payment contracts or [seventy-five]
EIGHTY-FIVE percent for small group and small group remittance
contracts, nor, except in the case of individual direct payment
contracts with a loss ratio of greater than one hundred five percent
during nineteen hundred ninety-four, shall the loss ratio for any direct
payment, group or group remittance contract be more than one hundred
five percent of the anticipated earned premium, and (B) the corporation
submits, as part of such filing, a certification by a member of the
American Academy of Actuaries or other individual acceptable to the
superintendent that that corporation is in compliance with the
provisions of this subsection, based upon that person's examination,
including a review of the appropriate records and of the actuarial
assumptions and methods used by the corporation in establishing premium
rates for contracts subject to this section. A CORPORATION SHALL NOT
UTILIZE THE ALTERNATE PROCEDURE PURSUANT TO THIS SUBSECTION TO IMPLEMENT
A CHANGE IN RATES TO BE EFFECTIVE ON OR AFTER OCTOBER FIRST, TWO THOU-
SAND TEN. For purposes of this section, a small group is any group whose
contract is subject to the requirements of section forty-three hundred
seventeen of this article.
(2) Prior to January first, two thousand, no rate increase or decrease
may be deemed approved under this subsection if that increase or
decrease, together with any other rate increases or decreases imposed on
the same contract form, would cause the aggregate rate increase or
decrease for that contract form to exceed ten percent during any contin-
uous twelve month period. No rate increase may be imposed PURSUANT TO
THIS SUBSECTION unless at least thirty days advance written notice of
such increase has been provided to each contract holder and subscriber.
(h)(1) Each calendar year, a corporation subject to the provisions of
this article shall return, in the form of aggregate benefits incurred
for each contract form filed pursuant to the alternate procedure set
forth in subsection (g) of this section, at least eighty-five percent
for individual direct payment contracts or [seventy-five] EIGHTY-FIVE
percent for small group and small group remittance contracts, but,
except in the case of individual direct payment contracts with a loss
ratio of greater than one hundred five percent in nineteen hundred nine-
ty-four, for any direct payment, group or group remittance contract, not
in excess of one hundred five percent of the aggregate premiums earned
for the contract form during that calendar year. Corporations subject to
the provisions of this article shall annually report, no later than [May
first] JUNE THIRTIETH of each year, the loss ratio calculated pursuant
to this subsection for each such contract form for the previous calendar
year.
(2) In each case where the loss ratio for a contract form fails to
comply with the eighty-five percent minimum loss ratio requirement for
individual direct payment contracts, or the [seventy-five] EIGHTY-FIVE
percent minimum loss ratio requirement for small group and small group
remittance contracts, as set forth in paragraph one of this subsection,
the corporation shall issue a dividend or credit against future premiums
for all contract holders with that contract form in an amount sufficient
to assure that the aggregate benefits incurred in the previous calendar
year plus the amount of the dividends and credits shall equal no less
S. 6608 95 A. 9708
than eighty-five percent for individual direct payment contracts, or
[seventy-five] EIGHTY-FIVE percent for small group and small group
remittance contracts, of the aggregate premiums earned for the contract
form in the previous calendar year. The dividend or credit shall be
issued to each contract holder or subscriber who had a contract that was
in effect at any time during the applicable year. The dividend or credit
shall be prorated based on the direct premiums earned for the applicable
year among all contract holders or subscribers eligible to receive such
dividend or credit. A corporation shall make a reasonable effort to
identify the current address of, and issue dividends or credits to,
former contract holders or subscribers entitled to the dividend or cred-
it. A corporation shall, with respect to dividends or credits to which
former contract holders that the corporation is unable to identify after
a reasonable effort would otherwise be entitled, have the option, as
deemed acceptable by the superintendent, of prospectively adjusting
premium rates by the amount of such dividends or credits, issuing the
amount of such dividends or credits to existing contract holders, depos-
iting the amount of such dividends or credits in the fund established
pursuant to section four thousand three hundred twenty-two-a of this
article, or utilizing any other method which offsets the amount of such
dividends or credits. All dividends and credits must be distributed by
September thirtieth of the year following the calendar year in which the
loss ratio requirements were not satisfied. The annual report required
by paragraph one of this subsection shall include a corporation's calcu-
lation of the dividends and credits, as well as an explanation of the
corporation's plan to issue dividends or credits. The instructions and
format for calculating and reporting loss ratios and issuing dividends
or credits shall be specified by the superintendent by regulation. Such
regulations shall include provisions for the distribution of a dividend
or credit in the event of cancellation or termination by a contract
holder or subscriber.
(3) In each case where the loss ratio for a contract form fails to
comply with the one hundred five percent maximum loss ratio requirement
of paragraph one of this subsection, the corporation shall institute a
premium rate increase in an amount sufficient to assure that the aggre-
gate benefits incurred in the previous calendar year shall equal no more
than one hundred five percent of the sum of the aggregate premiums
earned for the contract form in the previous calendar year and the
aggregate premium rate increase. The rate increase shall be applied to
each contract that was in effect as of December thirty-first of the
applicable year and remains in effect as of the date the rate increase
is imposed. All rate increases must be imposed by September thirtieth of
the year following the calendar year in which the loss ratio require-
ments were not satisfied. The annual report required by paragraph one of
this subsection shall include a corporation's calculation of the premium
rate increase, as well as an explanation of the corporation's plan to
implement the rate increase. The instructions and format for calculating
and reporting loss ratios and implementing rate increases shall be spec-
ified by the superintendent by regulation.
(i) The alternate procedure described in subsections (g) and (h) of
this section shall apply to individual direct payment contracts issued
pursuant to sections four thousand three hundred twenty-one and four
thousand three hundred twenty-two of this article on and after January
first, nineteen hundred ninety-seven. SUCH ALTERNATE PROCEDURE SHALL NOT
BE UTILIZED TO IMPLEMENT A CHANGE IN RATES TO BE EFFECTIVE ON OR AFTER
OCTOBER FIRST, TWO THOUSAND TEN.
S. 6608 96 A. 9708
[(j) The eighty-five percent minimum loss ratio for individual direct
payment contracts described in subsections (g) and (h) of this section
shall be reduced to eighty-two and one-half percent as of January first,
nineteen hundred ninety-seven and shall be further reduced to eighty
percent as of January first, nineteen hundred ninety-eight and thereaft-
er. The refund or credit requirements for failure to meet minimum loss
ratios will continue, but at these reduced percentages.]
(J) ALL COMMUNITY RATED CONTRACTS, OTHER THAN MEDICARE SUPPLEMENTAL
INSURANCE CONTRACTS, ISSUED OR IN EFFECT DURING CALENDAR YEAR TWO THOU-
SAND TEN SHALL BE SUBJECT TO A MINIMUM LOSS RATIO REQUIREMENT OF EIGHT-
Y-FIVE PERCENT. CORPORATIONS MAY USE THE ALTERNATE PROCEDURE SET FORTH
IN SUBSECTION (G) OF THIS SECTION TO ADJUST PREMIUM RATES IN ORDER TO
MEET THE REQUIRED MINIMUM LOSS RATIO FOR CALENDAR YEAR TWO THOUSAND TEN.
THE RATE FILING OR APPLICATION SHALL BE SUBMITTED NO LATER THAN SEPTEM-
BER THIRTIETH, TWO THOUSAND TEN.
S 3. If any clause, sentence, paragraph, section or part of this act
shall be adjudged by any court of competent jurisdiction to be invalid,
the judgment shall not affect, impair or invalidate the remainder there-
of, but shall be confined in its operation to the clause, sentence,
paragraph, section or part thereof directly involved in the controversy
in which such judgment shall have been rendered.
S 4. This act shall take effect immediately.
PART E
Section 1. The first undesignated paragraph of section 29.23 of the
mental hygiene law is amended to read as follows:
The commissioner may authorize the directors of department facilities,
to receive or obtain funds or other personal property, excepting jewel-
ry, due or belonging to a patient who has no [committee] GUARDIAN
AUTHORIZED TO RECEIVE SUCH FUNDS OR PROPERTY, up to an amount or value
not exceeding five thousand dollars EXCEPTING FEDERAL OR STATE BENEFITS
PAID TO THE DIRECTOR AS REPRESENTATIVE PAYEE; and also from [a commit-
tee] SUCH GUARDIAN upon his discharge when the final order so provides
where the balance remaining in the hands of such [committee] GUARDIAN
does not exceed such amount. Such personal property, excepting jewelry,
other than moneys shall be retained by the director for the benefit of
the patient for whom received until sold as hereinafter provided. FEDER-
AL BENEFITS, INCLUDING BENEFITS FOR WHICH THERE IS A STATE SHARE, PAID
TO THE DIRECTOR AS REPRESENTATIVE PAYEE SHALL BE USED IN ACCORDANCE WITH
APPLICABLE FEDERAL LAW AND REGULATIONS. Such funds and the proceeds of
the sale of other personal property so received shall be placed to the
credit of the patient for whom received and disbursed on the order of
the director, to provide, in the first instance, for luxuries, comforts,
and necessities for such patient, including burial expenses, and, if
funds are thereafter available, for the support of such patient. The
commissioner may authorize directors, on behalf of any such patient, to
give receipts, execute releases and other documents required by law or
court order, to endorse checks and drafts, and to convert personal prop-
erty excepting jewelry into money by sale for an adequate consideration,
and to execute bills of sale or to permit such patient to do so, in
order that the proceeds may be deposited to the credit of such patient
in accordance with the provisions of this section.
S 2. Subdivision (e) of section 33.07 of the mental hygiene law, as
added by chapter 709 of the laws of 1986, is amended to read as follows:
S. 6608 97 A. 9708
(e) A mental hygiene facility which is a representative payee for a
patient pursuant to designation by the social security administration or
OTHER FEDERAL AGENCY AND which assumes management responsibility over
the funds of a patient, INCLUDING BENEFITS FOR WHICH THERE IS A STATE
SHARE, shall maintain such funds in [a fiduciary capacity to the
patient] ACCORDANCE WITH APPLICABLE FEDERAL LAW AND REGULATIONS. The
commissioners of mental health and mental retardation and developmental
disabilities [shall] ARE AUTHORIZED TO develop standards regarding the
management of patient funds.
S 3. This act shall take effect immediately.
PART F
Section 1. Chapter 119 of the laws of 2007, directing the commissioner
of mental health to study, evaluate and report on the unmet mental
health service needs of traditionally underserved populations, is
REPEALED.
S 2. This act shall take effect immediately.
PART G
Section 1. Section 10.08 of the mental hygiene law is amended by
adding a new subdivision (i) to read as follows:
(I) AT ANY PROCEEDING CONDUCTED PURSUANT TO THIS ARTICLE OTHER THAN A
TRIAL CONDUCTED PURSUANT TO SECTION 10.07 OF THIS ARTICLE, THE RESPOND-
ENT OR ANY WITNESS SHALL BE PERMITTED, UPON GOOD CAUSE SHOWN, TO MAKE AN
ELECTRONIC APPEARANCE IN THE COURT BY MEANS OF AN INDEPENDENT AUDIO-VI-
SUAL SYSTEM, AS THAT TERM IS DEFINED IN SUBDIVISION ONE OF SECTION
182.10 OF THE CRIMINAL PROCEDURE LAW, FOR PURPOSES OF A COURT APPEARANCE
OR FOR GIVING TESTIMONY. IT SHALL CONSTITUTE GOOD CAUSE THAT A WITNESS
IS CURRENTLY EMPLOYED BY THE STATE AT A SECURE TREATMENT FACILITY OR
ANOTHER WORK LOCATION, UNLESS THERE ARE COMPELLING CIRCUMSTANCES REQUIR-
ING THE WITNESS'S PERSONAL PRESENCE AT THE COURT PROCEEDING. FOR
PURPOSES OF THIS SUBDIVISION, AN "ELECTRONIC APPEARANCE" MEANS AN
APPEARANCE AT WHICH A PARTICIPANT IS NOT PRESENT IN THE COURT, BUT IN
WHICH (A) ALL OF THE PARTICIPANTS ARE ABLE TO SEE AND HEAR THE SIMUL-
TANEOUS REPRODUCTIONS OF THE VOICES AND IMAGES OF THE JUDGE, COUNSEL,
RESPONDENT OR ANY OTHER APPROPRIATE PARTICIPANT, AND (B) COUNSEL IS
PRESENT WITH THE RESPONDENT OR THE RESPONDENT AND COUNSEL ARE ABLE TO
SEE AND HEAR EACH OTHER AND ENGAGE IN PRIVATE CONVERSATION. WHEN A
RESPONDENT OR A WITNESS MAKES AN ELECTRONIC APPEARANCE, THE COURT
STENOGRAPHER SHALL RECORD ANY STATEMENTS IN THE SAME MANNER AS IF THE
RESPONDENT OR WITNESS HAD MADE A PERSONAL APPEARANCE. NOTHING IN THIS
SUBDIVISION SHALL BE CONSTRUED TO PROHIBIT THE RESPONDENT OR ANY WITNESS
FROM MAKING AN ELECTRONIC APPEARANCE IN THE COURT AT A TRIAL CONDUCTED
PURSUANT TO SECTION 10.07 OF THIS ARTICLE BY MEANS OF AN INDEPENDENT
AUDIO-VISUAL SYSTEM, UPON GOOD CAUSE SHOWN AND CONSENT OF THE PARTIES.
S 2. This act shall take effect immediately.
PART H
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 2010-11 to reduce inpatient capacity in the aggregate by no
more than 250 beds through closure of wards not to exceed 175 beds, or
S. 6608 98 A. 9708
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 250 beds in state fiscal year 2010-11, 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. Determi-
nations concerning the closure of such wards in fiscal year 2010-11
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 conversion of such wards to transitional placement
programs in fiscal year 2010-11 shall be made by the office of mental
health based upon the identification of patients who have received inpa-
tient 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 be limited to, a super-
vised residential program that provides outpatient services, treatment
and training, and which supports the transition of patients to more
integrated community settings.
S 2. Section 7 of part R2 of chapter 62 of the laws of 2003, amending
the mental hygiene law and the state finance law relating to the commu-
nity mental health support and workforce reinvestment program, the
membership of subcommittees for mental health of community services
boards and the duties of such subcommittees and creating the community
mental health and workforce reinvestment account, as amended by section
1 of part E of chapter 58 of the laws of 2004, is amended to read as
follows:
S 7. This act shall take effect immediately and shall expire March 31,
[2010] 2011 when upon such date the provisions of this act shall be
deemed repealed.
S 3. Subdivision (e) of section 41.55 of the mental hygiene law, as
amended by section 1 of part N1 of chapter 63 of the laws of 2003, is
amended to read as follows:
(e) The amount of community mental health support and workforce rein-
vestment funds for the office of mental health shall be determined in
the annual budget and shall include the amount of actual state oper-
ations general fund appropriation reductions, including personal service
savings and other than personal service savings directly attributed to
each child and adult non-geriatric inpatient bed closure. For the
purposes of this section a bed shall be considered to be closed upon the
elimination of funding for such beds in the executive budget. The
appropriation reductions as a result of inpatient bed closures shall be
no less than seventy thousand dollars per bed on a full annual basis, as
annually recommended by the commissioner, subject to the approval of the
director of the budget, in the executive budget request prior to the
fiscal year for which the executive budget is being submitted. [The
commissioner shall report to the governor, the temporary president of
the senate and the speaker of the assembly no later than October first,
two thousand three, and annually thereafter, with an explanation of the
methodologies used to calculate the per bed closure savings.] The meth-
odologies USED TO CALCULATE THE PER BED CLOSURE SAVINGS shall be devel-
oped by the commissioner and the director of the budget. In no event
S. 6608 99 A. 9708
shall the full annual value of community mental health support and work-
force reinvestment programs attributable to beds closed as a result of
net inpatient census decline exceed the twelve month value of the office
of mental health state operations general fund reductions resulting from
such census decline. Such reinvestment amount shall be made available in
the same proportion by which the office of mental health's state oper-
ations general fund appropriations are reduced each year as a result of
child and adult non-geriatric inpatient bed closures due to census
decline.
S 4. Subdivisions (h) and (l) of section 41.55 of the mental hygiene
law are REPEALED and subdivisions (i), (j), (k), and (m) are relettered
subdivisions (h), (i), (j) and (k).
S 5. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2010, provided
that the amendments to section 41.55 of the mental hygiene law made by
sections three and four of this act shall not affect the repeal of such
section and shall be deemed repealed therewith.
PART I
Section 1. The office of mental health is authorized to recover fund-
ing from community residences and family-based treatment providers
licensed by the office of mental health, consistent with contractual
obligations of such providers, and notwithstanding any other inconsist-
ent provision of law to the contrary, in an amount equal to 50 percent
of the income received by such providers which exceeds the fixed amount
of annual Medicaid revenue limitations, as established by the commis-
sioner of mental health. Recovery of such excess income shall be for the
following fiscal periods: for programs in counties located outside of
the city of New York, the applicable fiscal periods shall be January 1,
2003 through December 31, 2009; and for programs located within the city
of New York, the applicable fiscal periods shall be July 1, 2003 through
June 30, 2010.
S 2. This act shall take effect immediately.
PART J
Section 1. The opening paragraph of subdivision (e) of section 16.23
of the mental hygiene law, as added by chapter 786 of the laws of 1983,
is amended to read as follows:
The commissioner shall establish a procedure, subject to the approval
of the state comptroller, whereby payments may be made to operators of
family care homes for one or more of the following needs of clients
residing in such facilities, limited to [two hundred ninety dollars]
SUCH AMOUNTS per client per year AS SHALL BE SET BY THE COMMISSIONER AND
APPROVED BY THE DIRECTOR OF THE BUDGET and paid [semi-annually] in the
manner specified by such procedures:
S 2. The opening paragraph of paragraph 8 of subdivision (h) of
section 31.03 of the mental hygiene law, as added by chapter 809 of the
laws of 1980, is amended to read as follows:
The commissioner shall establish a procedure, subject to the approval
of the state comptroller, whereby payments may be made to operators of
family care homes for one or more of the following needs of clients
residing in such facilities, limited to [two hundred ninety dollars]
SUCH AMOUNTS per client per year AS SHALL BE SET BY THE COMMISSIONER AND
S. 6608 100 A. 9708
APPROVED BY THE DIRECTOR OF THE BUDGET and paid [semi-annually] in the
manner specified by such procedures:
S 3. Subdivision (d) of section 16.23 of the mental hygiene law, as
added by chapter 786 of the laws of 1983, is amended to read as follows:
(d) The office shall provide substitute caretakers to each family care
home for a maximum of [ten] FOURTEEN days per year, either directly or
as a purchase of service.
S 4. Paragraph 7 of subdivision (h) of section 31.03 of the mental
hygiene law, as amended by chapter 613 of the laws of 1981, is amended
to read as follows:
(7) The department shall provide substitute caretakers to each family
care home for a maximum of [ten] FOURTEEN days per year, either directly
or as a purchase of service.
S 5. The opening paragraph of subdivision (n) of section 41.36 of the
mental hygiene law, as amended by chapter 525 of the laws of 1985, is
amended to read as follows:
The commissioner shall establish a procedure, subject to the approval
of the state comptroller, whereby payments in addition to the client's
personal allowance may be made to providers of services for one or more
of the following needs of clients residing in such facilities, limited
to [two hundred fifty dollars] SUCH AMOUNTS per client per year AS SHALL
BE SET BY THE COMMISSIONER AND APPROVED BY THE DIRECTOR OF THE BUDGET
and paid [semi-annually] in the manner specified by such procedures:
S 6. This act shall take effect immediately.
PART K
Section 1. Paragraph 2 of subdivision (a) of section 32.05 of the
mental hygiene law, as added by chapter 558 of the laws of 1999, is
amended to read as follows:
2. operation of a discrete unit of a hospital or other facility
possessing an operating certificate pursuant to article twenty-eight of
the public health law for the purpose of providing residential or non-
residential chemical dependence services, OR THE PROVISION OF CHEMICAL
DEPENDENCE CRISIS SERVICES FOR THE LESSER OF TWO THOUSAND PATIENT DAYS
PER YEAR, OR TEN PERCENT OF TOTAL PATIENT DAYS PER YEAR, AS DETERMINED
BY THE COMMISSIONER, IN A HOSPITAL OR OTHER FACILITY POSSESSING AN OPER-
ATING CERTIFICATE PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH
LAW; or
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2010.
PART L
Section 1. Section 19.07 of the mental hygiene law is amended by
adding a new subdivision (i) to read as follows:
(I) THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES SHALL DEVEL-
OP AN ALCOHOL AND DRUG REHABILITATION PROGRAM, CONSISTENT WITH THE
PROVISIONS OF SECTION ELEVEN HUNDRED NINETY-SIX OF THE VEHICLE AND TRAF-
FIC LAW FOR THE PROVISION OF CHEMICAL DEPENDENCY PREVENTION, EDUCATION,
EVALUATION AND TREATMENT TO PERSONS REFERRED AS A RESULT OF A VIOLATION
OF SECTIONS ELEVEN HUNDRED NINETY-TWO AND ELEVEN HUNDRED NINETY-TWO-A OF
THE VEHICLE AND TRAFFIC LAW. THE COMMISSIONER OF THE OFFICE OF ALCOHOL-
ISM AND SUBSTANCE ABUSE SERVICES SHALL ADOPT STANDARDS, RULES AND REGU-
LATIONS, AND ESTABLISH FEES NECESSARY TO IMPLEMENT THE PROVISIONS OF
THIS SUBDIVISION.
S. 6608 101 A. 9708
S 2. Subdivisions 1, 2, 3, 4, and 6 of section 1196 of the vehicle and
traffic law, subdivisions 1, 2, 3 and 6 as added by chapter 47 of the
laws of 1988 and subdivision 4 as amended by chapter 196 of the laws of
1996, are amended to read as follows:
1. Program establishment. There is hereby established an alcohol and
drug rehabilitation program within the [department of motor vehicles]
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. The commissioner OF
THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES shall establish,
by regulation OR CONTRACT, the instructional and rehabilitative aspects
of the program. Such program shall [consist of at least fifteen hours
and] include, but need not be limited to, classroom instruction in areas
deemed suitable by the commissioner OF THE OFFICE OF ALCOHOLISM AND
SUBSTANCE ABUSE SERVICES. [No person shall be required to attend or
participate in such program or any aspect thereof for a period exceeding
eight months except upon the recommendation of the department of mental
hygiene or appropriate health officials administering the program on
behalf of a municipality.]
2. Curriculum. The form, content and method of presentation of the
various aspects of such program shall be established by the commissioner
OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. In the devel-
opment of the form, curriculum and content of such program, the commis-
sioner OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES may
consult with the commissioner of mental health, [the director of the
division of alcoholism and alcohol abuse, the director of the division
of substance abuse services] THE COMMISSIONER OF MOTOR VEHICLES and any
other state department or agency and request and receive assistance from
them. The commissioner OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES is also authorized to develop more than one curriculum and
course content for such program in order to meet the varying rehabilita-
tive needs of the participants.
3. Where available. A course in such program shall be available in at
least every county in the state, except where the commissioner OF THE
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES determines that there
is not a sufficient number of alcohol or drug-related traffic offenses
in a county to mandate the establishment of said course, and that
provisions be made for the residents of said county to attend a course
in another county where a course exists.
4. Eligibility. Participation in the program shall be limited to those
persons convicted of alcohol or drug-related traffic offenses or persons
who have been adjudicated youthful offenders for alcohol or drug-related
traffic offenses, or persons found to have been operating a motor vehi-
cle after having consumed alcohol in violation of section eleven hundred
ninety-two-a of this article, who choose to participate and who satisfy
the criteria and meet the requirements for participation as established
by this section and the regulations promulgated thereunder; provided,
however, in the exercise of discretion, the judge imposing sentence may
prohibit the defendant from enrolling in such program. The commissioner
OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES or [deputy] HIS
OR HER DESIGNEE may exercise discretion, to reject any person from
participation referred to such program and nothing herein contained
shall be construed as creating a right to be included in any course or
program established under this section. In addition, no person shall be
permitted to take part in such program if, during the five years imme-
diately preceding commission of an alcohol or drug-related traffic
offense or a finding of a violation of section eleven hundred ninety-
two-a of this article, such person has participated in a program estab-
S. 6608 102 A. 9708
lished pursuant to this article or been convicted of a violation of any
subdivision of section eleven hundred ninety-two of this article other
than a violation committed prior to November first, nineteen hundred
eighty-eight, for which such person did not participate in such program.
In the exercise of discretion, the commissioner OF THE OFFICE OF ALCO-
HOLISM AND SUBSTANCE ABUSE SERVICES or [a deputy] HIS OR HER DESIGNEE
shall have the right to expel any participant from the program who fails
to satisfy the requirements for participation in such program or who
fails to satisfactorily participate in or attend any aspect of such
program. Notwithstanding any contrary provisions of this chapter, satis-
factory participation in and completion of a course in such program
shall result in the termination of any sentence of imprisonment that may
have been imposed by reason of a conviction therefor; provided, however,
that nothing contained in this section shall delay the commencement of
such sentence.
6. Fees. The commissioner OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE
ABUSE SERVICES shall establish a schedule of fees to be paid by or on
behalf of each participant in the program, and may, from time to time,
modify same. Such fees shall defray the ongoing expenses of the program.
Provided, however, that pursuant to an agreement with the [department]
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, a municipality,
department thereof, or other agency may conduct a course in such program
with all or part of the expense of such course and program being borne
by such municipality, department or agency. In no event shall such fee
be refundable, either for reasons of the participant's withdrawal or
expulsion from such program or otherwise.
S 3. Paragraph (d) of subdivision 7 of section 1196 of the vehicle and
traffic law, as amended by chapter 309 of the laws of 1996, is amended
to read as follows:
(d) The commissioner OF MOTOR VEHICLES shall require applicants for a
conditional license to pay a fee of seventy-five dollars for processing
costs. Such fees assessed under this subdivision shall be paid to the
commissioner OF MOTOR VEHICLES for deposit to the general fund and shall
be in addition to any fees established by the commissioner OF ALCOHOLISM
AND SUBSTANCE ABUSE SERVICES pursuant to subdivision six of this section
to defray the costs of the alcohol and drug rehabilitation program.
S 4. This act shall take effect January 1, 2011.
PART M
Section 1. Paragraph 1 of subdivision (a) of section 9.60 of the
mental hygiene law, as amended by chapter 158 of the laws of 2005, is
amended to read as follows:
(1) "assisted outpatient treatment" shall mean categories of outpa-
tient services which have been ordered by the court pursuant to this
section. Such treatment shall include case management services or
assertive community treatment team services to provide care coordi-
nation, and may also include any of the following categories of
services: medication; periodic blood tests or urinalysis to determine
compliance with prescribed medications; individual or group therapy; day
or partial day programming activities; educational and vocational train-
ing or activities; alcohol or substance abuse treatment and counseling
and periodic tests for the presence of alcohol or illegal drugs for
persons with a history of alcohol or substance abuse; supervision of
living arrangements; and any other services within a local [or unified]
services plan developed pursuant to article forty-one of this chapter,
S. 6608 103 A. 9708
prescribed to treat the person's mental illness and to assist the person
in living and functioning in the community, or to attempt to prevent a
relapse or deterioration that may reasonably be predicted to result in
suicide or the need for hospitalization.
S 2. Paragraph 2 of subdivision (b) of section 31.27 of the mental
hygiene law, as added by chapter 723 of the laws of 1989, is amended to
read as follows:
(2) The commissioner of mental health shall require that each compre-
hensive psychiatric emergency program submit a plan. The plan must be
approved by the commissioner prior to the issuance of an operating
certificate pursuant to this article. Each plan shall include: (i) a
description of the program's catchment area; (ii) a description of the
program's psychiatric emergency services, including crisis intervention
services, crisis outreach services, crisis residence services, extended
observation beds, and triage and referral services, whether or not
provided directly or through agreement with other providers of services;
(iii) agreements or affiliations with hospitals, as defined in section
1.03 of this chapter, to receive and admit persons who require inpatient
psychiatric services; (iv) agreements or affiliations with general
hospitals to receive and admit persons who have been referred by the
comprehensive psychiatric emergency program and who require medical or
surgical care which cannot be provided by the comprehensive psychiatric
emergency program; (v) a description of local resources available to the
program to prevent unnecessary hospitalizations of persons, which shall
include agreements with local mental health, health, substance abuse,
alcoholism or alcohol abuse, mental retardation and developmental disa-
bilities, or social services agencies to provide appropriate services;
(vi) a description of the program's linkages with local police agencies,
emergency medical services, ambulance services, and other transportation
agencies; (vii) a description of local resources available to the
program to provide appropriate community mental health services upon
release or discharge, which shall include case management services and
agreements with state or local mental health and other human service
providers; (viii) written criteria and guidelines for the development of
appropriate discharge planning for persons in need of post emergency
treatment or services[,]; (ix) a statement indicating that the program
has been included in an approved local [or unified] services plan devel-
oped pursuant to article forty-one of this chapter for each local
government located within the program's catchment area; and (x) any
other information or agreements required by the commissioner.
S 3. Subdivision (d) of section 33.13 of the mental hygiene law, as
amended by chapter 408 of the laws of 1999, is amended to read as
follows:
(d) Nothing in this section shall prevent the electronic or other
exchange of information concerning patients or clients, including iden-
tification, between and among (i) facilities or others providing
services for such patients or clients pursuant to an approved local [or
unified] services plan, as defined in article forty-one of this chapter,
or pursuant to agreement with the department, and (ii) the department or
any of its licensed or operated facilities. Furthermore, subject to the
prior approval of the commissioner of mental health, hospital emergency
services licensed pursuant to article twenty-eight of the public health
law shall be authorized to exchange information concerning patients or
clients electronically or otherwise with other hospital emergency
services licensed pursuant to article twenty-eight of the public health
law and/or hospitals licensed or operated by the office of mental
S. 6608 104 A. 9708
health; provided that such exchange of information is consistent with
standards, developed by the commissioner of mental health, which are
designed to ensure confidentiality of such information. Additionally,
information so exchanged shall be kept confidential and any limitations
on the release of such information imposed on the party giving the
information shall apply to the party receiving the information.
S 4. Subdivision (d) of section 33.13 of the mental hygiene law, as
amended by chapter 912 of the laws of 1984, is amended to read as
follows:
(d) Nothing in this section shall prevent the exchange of information
concerning patients or clients, including identification, between (i)
facilities or others providing services for such patients or clients
pursuant to an approved local [or unified] services plan, as defined in
article forty-one, or pursuant to agreement with the department and (ii)
the department or any of its facilities. Information so exchanged shall
be kept confidential and any limitations on the release of such informa-
tion imposed on the party giving the information shall apply to the
party receiving the information.
S 5. The article heading of article 41 of the mental hygiene law, as
added by chapter 978 of the laws of 1977, is amended to read as follows:
LOCAL [AND UNIFIED] SERVICES
S 6. The second undesignated paragraph and closing paragraph of
section 41.01 of the mental hygiene law, as amended by chapter 978 of
the laws of 1977, are amended to read as follows:
[In order to further the development, for each community in this
state, of a unified system for the delivery of such services, this arti-
cle gives to a local governmental unit the opportunity to participate in
the state-local development of such services by means of a unified
services plan. Such a plan is designed to be a mechanism whereby the
department, department facilities, and local government can jointly plan
for and deliver unified services to meet the needs of the consumers of
such services. The unified services system will strengthen state and
local partnership in the determination of the need for and the allo-
cation of services and more easily provide for the most effective and
economical utilization of new and existing state, local governmental,
and private resources to provide services. A uniform ratio of state and
local government responsibility for financing services under a unified
services plan is established by this article to eliminate having the
types of services provided in a community be determined by the local
government's share of the cost of a particular program rather than the
needs of the community.
It] EFFECTIVE IMPLEMENTATION OF THIS ARTICLE requires the direction
and administration, by each local governmental unit, of a local compre-
hensive planning process for its geographic area in which all providers
of services shall participate and cooperate in the provision of all
necessary information. It also initiates a planning effort involving the
state, local governments and other providers of service for the purpose
of promoting continuity of care through the development of integrated
systems of care and treatment for the mentally ill, mentally retarded
and developmentally disabled, and for those suffering from the diseases
of alcoholism and substance abuse.
S 7. Subdivisions 4 and 14 of section 41.03 of the mental hygiene law
are REPEALED, and subdivisions 5, 6, 7, 8, 9, 10, 11, 12, 13 and 15 of
S. 6608 105 A. 9708
such section, such section as renumbered by chapter 978 of the laws of
1977, are renumbered subdivisions 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13.
S 8. Subdivision 5 of section 41.03 of the mental hygiene law, as
amended by chapter 588 of the laws of 1973 and as renumbered by section
seven of this act, is amended to read as follows:
5. "local governmental unit" means the unit of local government given
authority in accordance with this chapter by local government to provide
local [or unified] services.
S 9. Subdivision (b) of section 41.04 of the mental hygiene law, as
added by chapter 978 of the laws of 1977, is amended to read as follows:
(b) Guidelines for the operation of local [and unified] services plans
and financing shall be adopted only by rule or regulation. Such rules
and regulations shall be submitted at least twenty-one days prior to the
effective date thereof to the New York state conference of local mental
hygiene directors for comment thereon; provided, however, if a commis-
sioner finds that the public health, welfare or safety requires the
prompt adoption of rules and regulations, he may dispense with such
submission prior to the effective date thereof but, in such case, such
commissioner shall submit such rules and regulations to the conference
as soon as possible for their review within sixty days after the effec-
tive date thereof.
S 10. Subdivisions (a) and (c) of section 41.07 of the mental hygiene
law, as amended by chapter 588 of the laws of 1973 and such section as
renumbered by chapter 978 of the laws of 1977, are amended to read as
follows:
(a) Local governmental units may provide local [or unified] services
and facilities directly or may contract for the provision of those
services by other units of local or state government, by voluntary agen-
cies, or by professionally qualified individuals.
(c) Local governments may provide joint local [or unified] services
and facilities through agreements, made pursuant to law, which may
provide either that one local government provide and supervise these
services for other local governments or that a joint board or a joint
local department be established to administer these services for the
populations of all contracting local governments.
S 11. Subdivision (f) of section 41.10 of the mental hygiene law, as
added by chapter 978 of the laws of 1977, is amended to read as follows:
(f) The conference shall have the following powers:
1. To review and comment upon rules or regulations proposed by any of
the offices of the department for the operation of local [and unified]
service plans and programs. Comments on rules or regulations approved by
the conference shall be given to the appropriate commissioner or commis-
sioners for review and consideration; and
2. To propose rules or regulations governing the operation of the
local [and unified] services programs, and to forward such proposed
rules or regulations to the appropriate commissioner or commissioners
for review and consideration.
S 12. Subdivisions (a) and (b) of section 41.11 of the mental hygiene
law, as amended by section 5 of part R2 of chapter 62 of the laws of
2003, are amended to read as follows:
(a) In all local governments with a population less than one hundred
thousand, community services boards, at the option of the local govern-
ment, shall have either nine or fifteen members appointed by the local
government. In all other local governments, a community services board
shall have fifteen members appointed by the local government.
S. 6608 106 A. 9708
Whenever practicable at least one member shall be a licensed physician
and one member shall be a certified psychologist and otherwise at least
two members shall be licensed physicians, such members to have demon-
strated an interest in the field of services for the mentally disabled.
The other members shall represent the community interest in all the
problems of the mentally disabled and shall include representatives from
community agencies for the mentally ill, the mentally retarded and
developmentally disabled, and those suffering from alcoholism and
substance abuse. The community services board shall have separate
subcommittees for mental health, mental retardation and developmental
disabilities, and alcoholism or, at the discretion of the local govern-
ment, alcoholism and substance abuse. Each separate subcommittee shall
have no more than nine members appointed by the local government, except
that each subcommittee for mental health shall have no more than eleven
members appointed by the local government. Three of each such subcommit-
tee shall be members of the board. Each separate subcommittee shall be
composed of persons who have demonstrated an interest in the field of
services for the particular class of mentally disabled and shall include
former patients, parents or relatives of such mentally disabled persons
and community agencies serving the particular class of mentally disa-
bled, except that each subcommittee for mental health shall include at
least two members who are or were consumers of mental health services,
and at least two members who are parents or relatives of persons with
mental illness. Each separate subcommittee shall advise the community
services board and the director of community services regarding the
exercise of all policy-making functions vested in such board or direc-
tor, as such functions pertain to the field of services for the partic-
ular class of mentally disabled individuals represented by such subcom-
mittee. In addition, each subcommittee for mental health shall be
authorized to annually evaluate the local services plan [or the unified
services plan, as appropriate], and shall be authorized to report on the
consistency of such [plans] PLAN with the needs of persons with serious
mental illness, including children and adolescents with serious
emotional disturbances. Any such report shall be forwarded annually to
the community services board and the director of community services and
a copy shall also be sent to the commissioner prior to the submission of
the local services plan [or unified services plan. Provided], PROVIDED,
however, that the provisions of this paragraph shall not apply to cities
of over a million in population.
(b) In cities of over a million a community services board shall
consist of fifteen members to be appointed by the mayor. There shall be
at least two residents of each county within such cities on the board.
At least one shall be a licensed physician and at least one shall be a
certified psychologist. The other members shall represent the community
interest in all of the problems of the mentally disabled and shall
include representatives from community agencies for the mentally ill,
the mentally retarded and developmentally disabled, and those suffering
from alcoholism and substance abuse. The community services board shall
have separate subcommittees for mental health, mental retardation and
developmental disabilities, and alcoholism or, at the discretion of the
local government, alcoholism and substance abuse. Each separate subcom-
mittee shall have no more than nine members appointed by the local
government, except that each subcommittee for mental health shall have
no more than eleven members appointed by the local government. Three
members of each such subcommittee shall be members of the board. Each
separate subcommittee shall be composed of persons who have demonstrated
S. 6608 107 A. 9708
an interest in the field of services for the particular class of mental-
ly disabled and shall include former patients, parents or relatives of
such mentally disabled persons and community agencies serving the
particular class of mentally disabled, except that each subcommittee for
mental health shall include at least two members who are or were consum-
ers of mental health services, and two members who are parents or rela-
tives of persons with mental illness. Each separate subcommittee shall
advise the community services board and the director of community
services regarding the exercise of all policy-making functions vested in
such board or director, as such functions pertain to the field of
services for the particular class of mentally disabled individuals
represented by such subcommittee. In addition, each subcommittee for
mental health shall be authorized to annually evaluate the local
services plan [or the unified services plan, as appropriate], and shall
be authorized to report on the consistency of such [plans] PLAN with the
needs of persons with serious mental illness, including children and
adolescents with serious emotional disturbances. Any such report shall
be forwarded annually to the community services board and the director
of community services, and a copy shall also be sent to the commissioner
prior to the submission of the local services plan [or unified services
plan].
S 13. Paragraphs 5, 6, 7 and 12 of subdivision (a) of section 41.13 of
the mental hygiene law, paragraphs 5 and 7 as amended by chapter 588 of
the laws of 1973, paragraph 6 as amended by chapter 746 of the laws of
1986, paragraph 12 as amended by chapter 24 of the laws of 1985 and such
section as renumbered by chapter 978 of the laws of 1977, are amended to
read as follows:
5. submit annually to the department for its approval and subsequent
state aid, a report of long range goals and specific intermediate range
plans as modified since the preceding report, along with a local
services plan [or unified services plan] for the next local fiscal year.
6. have the power, with the approval of local government, to enter
into contracts for the provision of services, including the provision of
community support services, and the construction of facilities [includ-
ing contracts executed pursuant to subdivision (e) of section 41.19 of
this article and have the power, when necessary, to approve construction
projects].
7. establish procedures for execution of the local services plan [or
the unified services plan] as approved by the local government and the
commissioner, including regulations to guide the provision of services
by all organizations and individuals within its program.
12. seek the cooperation and cooperate with other aging, public health
and social services agencies, public and private, in advancing the
program of local [or unified] services.
S 14. Section 41.14 of the mental hygiene law is REPEALED.
S 15. Subdivisions (a), (b), (c) and (e) of section 41.15 of the
mental hygiene law, subdivisions (a), (c) and (e) as amended by chapter
978 of the laws of 1977 and subdivision (b) as amended by chapter 707 of
the laws of 1988, are amended to read as follows:
(a) Net operating costs of programs incurred pursuant to [either] an
approved local services plan [or an approved unified services plan] in
accordance with the regulations of the commissioner or commissioners of
the office or offices of the department having jurisdiction of the
services and approved by the commissioner or commissioners of the office
or offices of the department having jurisdiction of the services shall
be eligible for state aid.
S. 6608 108 A. 9708
(b) Long range goals, intermediate range plans, and annual plans shall
meet requirements for comprehensive services set for each local govern-
ment by the commissioners of the offices of the department after taking
into consideration local needs and available resources. These services
shall be concerned with diagnosis, care, treatment, social and voca-
tional rehabilitation, community residential services licensed by the
department of mental hygiene, research, consultation and public educa-
tion, education and training of personnel, control and prevention of
mental disabilities, and the general furtherance of mental capability
and health. As part of the local services [or unified services plans]
PLAN required to establish eligibility for state aid in accordance with
the provisions herein, each local governmental unit shall submit a five-
year plan and annual implementation plans and budgets which shall
reflect local needs and resources, including the needs and resources
available for the provision of community support services, and the role
of facilities in the department in the provision of required services.
[If the local government has developed community services assessments
and plans pursuant to subdivision four of section four hundred nine-d
and paragraph (b) of subdivision three of section four hundred twenty-
three of the social services law covering the same time period covered
by the five year plan and annual implementation plans and budgets
required by this subdivision, then the five year plan and annual imple-
mentation plans and budget shall include those portions of the community
services assessments and plans relating to the provision of mental
health, alcoholism and substance abuse services and an estimate of funds
to be made available by the social services district for the provision
or purchase of these services.]
(c) Subject to regulations for special circumstances as established by
the commissioner or commissioners of the office or offices of the
department having jurisdiction of the services, no annual plan or inter-
mediate range plan of the local governmental unit shall be approved
unless it indicates that reasonable efforts are being made to extend or
improve local [or unified] services in each succeeding local fiscal year
in accordance with the statewide long range goals and objectives of the
department for the development and integration of state, regional, and
local services for the mentally disabled.
(e) Capital costs incurred by a local government or by a voluntary
agency, pursuant to [either] an approved local services plan [or an
approved unified services plan] and in accordance with the regulations
of the commissioner or commissioners of the office or offices of the
department having jurisdiction of the services and with the approval of
the commissioner or commissioners having jurisdiction of the services,
shall be eligible for state aid pursuant to the provisions of this arti-
cle. Capital costs incurred by a voluntary agency shall be eligible for
state aid only if incurred pursuant to an agreement between the volun-
tary agency and the local governmental unit where the construction is
located. Such agreement shall contain the approval by the local govern-
mental unit of such construction and an agreement by such unit to
include the program of the voluntary agency in its plans and proposals.
S 16. Subdivisions (b), (c), (d) and paragraph 2 of subdivision (e) of
section 41.16 of the mental hygiene law, as added by chapter 978 of the
laws of 1977, paragraph 1 of subdivision (b) as amended by chapter 55 of
the laws of 1992 and subdivision (c) as amended by chapter 99 of the
laws of 1999, are amended to read as follows:
(b) In accordance with regulations established by the commissioner or
commissioners of the offices of the department having jurisdiction of
S. 6608 109 A. 9708
the services, which shall provide for prompt action on proposed local
services [and unified services] plans, each local governmental unit
shall:
1. establish long range goals and objectives consistent with statewide
goals and objectives developed pursuant to section 5.07 of this chapter
and develop or annually update the local services [or unified services]
plan of the local governmental unit or units listing providers, esti-
mated costs and proposed utilization of state resources, including
facilities and manpower, which shall be used in part to formulate state-
wide comprehensive plans for services.
2. submit one local services plan [or a unified services plan] to the
single agent of the department jointly designated by the commissioners
of the offices of the department annually for approval by the commis-
sioner or commissioners of the office or offices of the department
having jurisdiction of the services.
(c) A local services plan [or unified services plan] shall be devel-
oped, in accordance with the regulations of the commissioner or commis-
sioners of the office or offices of the department having jurisdiction
of the services by the local governmental unit or units which shall
direct and administer a local comprehensive planning process for its
geographic area, consistent with statewide goals and objectives estab-
lished pursuant to section 5.07 of this chapter. The planning process
shall involve the directors of any department facilities, directors of
hospital based mental health services, directors of community mental
health centers, consumers, consumer groups, voluntary agencies, other
providers of services, and local correctional facilities and other local
criminal justice agencies. The local governmental unit, or units, shall
determine the proposed local services plan [or unified services plan] to
be submitted for approval. If any provider of services including facili-
ties in the department, or any representative of the consumer or commu-
nity interests within the local planning process, disputes any element
of the proposed plan for the area which it serves, the objection shall
be presented in writing to the director of the local governmental unit.
If such dispute cannot be resolved to the satisfaction of all parties,
the director shall determine the plan to be submitted. If requested and
supplied by the objecting party, a written objection to the plan shall
be appended thereto and transmitted to the single agent of the depart-
ment jointly designated by the commissioners.
(d) Each commissioner of an office in the department shall review the
portion of the local services plan [or unified services plan] submitted
over which his office has jurisdiction and approve or disapprove such
plan in accordance with the procedures of subdivision (e) [hereof] OF
THIS SECTION.
2. A commissioner of an office of the department shall not disapprove
any portion of the local services plan [or unified services plan] with-
out providing the local governmental unit an opportunity to be heard
regarding the proposed disapproval and to propose any modification of
the plan. Pending the resolution of any dispute over approval of a
portion of the plan, by final determination of the commissioner having
jurisdiction over the services, new programs proposed shall not be
implemented and programs previously implemented shall continue to be
funded at existing levels. If a portion of the plan is disapproved, the
commissioner of the office having jurisdiction over such portion shall
notify the local governmental unit in writing stating reasons for such
action.
S. 6608 110 A. 9708
S 17. Sections 41.19, 41.21 and 41.23 of the mental hygiene law are
REPEALED.
S 18. Subdivision (d) of section 41.36 of the mental hygiene law, as
amended by chapter 262 of the laws of 1992, is amended to read as
follows:
(d) Each local governmental unit shall include in its annual local [or
unified services] plan a review of existing community residential facil-
ities providing reimbursable services and a recommendation of antic-
ipated needs for the development of such facilities, consistent with the
needs of the mentally retarded and developmentally disabled within the
jurisdiction of the local governmental unit.
S 19. Subdivision (b) of section 41.39 of the mental hygiene law, as
amended by chapter 515 of the laws of 1992, is amended to read as
follows:
(b) Notwithstanding any other provisions of this article, income real-
ized by a voluntary not-for-profit agency from industrial contracts
entered into pursuant to its operation of a sheltered workshop shall be
matched dollar for dollar by an office of the department of mental
hygiene through direct contract with the agency provided that no part of
the expenses of such sheltered workshop are claimed through a contract
with the local governmental unit which is receiving funding for
reimbursement of such expenses from the same office of the department
provided that such sheltered workshop is operating in accordance with an
approved local [or unified] services plan. In no event shall any combi-
nation of income including state aid exceed the total cost of operation
of such sheltered workshop.
S 20. Paragraph 2 of subdivision (e), paragraph 6 of subdivision (f),
and subdivisions (g), (h) and (i) of section 41.47 of the mental hygiene
law, as added by chapter 746 of the laws of 1986, are amended to read as
follows:
(2) The commissioner shall establish revenue goals for services,
provided, however, the commissioner may approve local [or unified]
services plans or may enter into direct contracts with providers of
services which substitute alternative revenue goals for individual
providers of services based upon appropriate documentation and justi-
fication, as required by the commissioner.
(6) the extent to which the community support services authorized by
the contract are consistent and integrated with the applicable local [or
unified] services plan of the area to be served; and
(g) The commissioner may enter into a direct contract for the
provision of community support services when the commissioner deter-
mines, after the approval of the local [or unified] services plan and
the allocation of state aid therefore, that such direct contract is
necessary to assure that additional community support services are
available to persons who are functionally disabled as a result of mental
illness and are eligible for community support services. Before entering
into a direct contract with a provider located within the geographic
area of a local governmental unit which receives state aid for community
support services pursuant to this section, the commissioner shall notify
the local governmental unit and give the director of the local govern-
mental unit an opportunity to appeal the need for such direct contract.
Such appeals shall be informal in nature and the rules of evidence shall
not apply.
(h) In order to qualify for one hundred percent state aid pursuant to
this section in any local fiscal year local governmental units shall
assure that the local tax levy share of expenditures for net operating
S. 6608 111 A. 9708
costs pursuant to an approved local services plan for services provided
to mentally ill persons pursuant to section 41.18 of this article[, when
applicable,] shall be equal to or greater than the local tax levy share
of such expenditures under an approved local services plan in the last
complete local fiscal year preceding the effective date of this section,
[and when applicable, such local tax levy share of net operating costs
for local governmental units submitting unified services plans pursuant
to section 41.23 of this article, as adjusted to reflect changes in the
rate of state reimbursement for approved expenditures, shall be equal to
or greater than the local tax levy share of the net operating costs for
expenditures under the approved unified services plan in the last
complete local fiscal year preceding the effective date of this
section,] provided, however, any such required maintenance of expendi-
tures under this subdivision for local governmental units may be reduced
to reflect the local governmental share of revenue applicable to
increased payments made by governmental agencies pursuant to title elev-
en of article five of the social services law, which are a result of
increased efficiencies in the collection of such revenue and which
represent an increased proportion of the total local [or unified]
services operating costs from the prior local fiscal year. The commis-
sioner shall be authorized to reduce payments made to local governmental
units pursuant to this article, in the following local fiscal year, for
failure to maintain expenditures in accordance with this subdivision.
(i) The provisions of subdivision (h) of this section shall not apply
to a local governmental unit in any local fiscal year in which the total
amount of state aid granted to the local governmental unit for net oper-
ating costs under section 41.18 [or section 41.23] of the article is
less than such amount of state aid granted in the local fiscal year
preceding the effective date of this section, or in any local fiscal
year in which the total amount of state aid granted to the local govern-
mental unit under this section, plus the total amount of direct
contracts entered into between the commissioner and providers of
services for the provision of community support services to eligible
residents of such local governmental unit, shall be less than the total
amount of such aid and direct contracts in the first local fiscal year
following the effective date of this section.
S 21. Subdivision 4 of section 41.49 of the mental hygiene law, as
added by chapter 499 of the laws of 1988, is amended to read as follows:
4. Notwithstanding any other provision of this article, in order to
qualify for one hundred percent state aid pursuant to this section,
local governmental units shall assure that local contributions for
expenditures in any local fiscal year for local [or unified] services
provided to mentally ill persons made pursuant to this article, as
applicable, shall be equal to or greater than the amount expended by
such local governmental unit in the last complete local fiscal year
preceding the effective date of this section. The commissioner shall be
authorized to reduce payments made to local governmental units which
have received grants pursuant to this section, in the following local
fiscal year, for failure to maintain expenditures in accordance with
this subdivision.
S 22. Subdivision (d) of section 41.53 of the mental hygiene law, as
amended by chapter 223 of the laws of 1992, is amended to read as
follows:
(d) No such grant will be awarded unless the community residence is
consistent with the local services plan [or the unified services plan,
as appropriate], pursuant to this article.
S. 6608 112 A. 9708
S 23. This act shall take effect July 1, 2010; provided, however, that
the amendments made to sections 9.60 and 31.27 of the mental hygiene law
by sections one and two of this act shall not affect the repeal of such
sections and shall be deemed repealed therewith; the amendments to
subdivision (d) of section 33.13 of the mental hygiene law made by
section three of this act shall be subject to the expiration and rever-
sion of such subdivision pursuant to section 18 of chapter 408 of the
laws of 1999, as amended when upon such date the provisions of section
four of this act shall take effect; and the amendments to subdivisions
(a) and (b) of section 41.11 of the mental hygiene law made by section
twelve of this act shall not affect the expiration of such subdivisions
and shall be deemed to expire therewith.
PART N
Section 1. Subdivisions 3-b and 3-c of section 1 of part C of chapter
57 of the laws of 2006, relating to establishing a cost of living
adjustment for designated human services programs, subdivision 3-b as
added and subdivision 3-c as amended by section 1 of part L of chapter
58 of the laws of 2009, are amended to read as follows:
3-b. Notwithstanding any inconsistent provision of law, beginning
April 1, 2009 and ending March 31, [2010] 2011, the commissioners shall
not include a COLA for the purpose of establishing rates of payments,
contracts or any other form of reimbursement.
3-c. Notwithstanding any inconsistent provision of law, beginning
April 1, [2010] 2011 and ending March 31, [2013] 2014, the commissioners
shall develop the COLA under this section using the actual U.S. consumer
price index for all urban consumers (CPI-U) published by the United
States department of labor, bureau of labor statistics for the twelve
month period ending in July of the budget year prior to such state
fiscal year, for the purpose of establishing rates of payments,
contracts or any other form of reimbursement.
S 2. Section 4 of part C of chapter 57 of the laws of 2006, relating
to establishing a cost of living adjustment for designated human
services programs, as amended by section 7 of part F of chapter 497 of
the laws of 2008, is amended to read as follows:
S 4. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2006; provided
section one of this act shall expire and be deemed repealed April 1,
[2012] 2014; provided, further, that sections two and three of this act
shall expire and be deemed repealed December 31, 2009.
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, 2010; 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.
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. 6608 113 A. 9708
S 3. This act shall take effect immediately provided, however, that
the applicable effective date of Parts A through N of this act shall be
as specifically set forth in the last section of such Parts.