S T A T E   O F   N E W   Y O R K
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                                  3740

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2009
                               ___________

Introduced  by  M.  of  A.  KOON, DelMONTE, ROBINSON, N. RIVERA, CAHILL,
  MAGNARELLI -- Multi-Sponsored by -- M.  of  A.  CLARK,  JOHN,  LAVINE,
  MAGEE,  MAYERSOHN,  PHEFFER,  REILLY  -- read once and referred to the
  Committee on Aging

AN ACT to amend the elder law, in relation to the cost-sharing responsi-
  bilities of EPIC program participants on a quarterly deductible basis

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

  Section  1.  Subdivision 2 of section 248 of the elder law, paragraphs
(c) and (d) as amended by section 18 of part B of chapter 57 of the laws
of 2006, is amended to read as follows:
  2. Deductible schedule. Eligible  individuals  electing  to  meet  the
requirements  of  this  subdivision  shall  incur  an amount of personal
covered drug expenditures during any [annual] QUARTERLY coverage  period
which  are  not  reimbursed  by  any other public or private third party
payment source or insurance plan, and shall be deemed to have met  their
deductible  requirements  for  the  remainder of such [annual] QUARTERLY
coverage period. The amount of personal covered drug expenditures to  be
incurred  by  eligible  program  participants  for catastrophic coverage
under this option shall be in accordance with the following schedule:
  (a) [Annual] QUARTERLY personal covered drug expenditures  for  unmar-
ried individual eligible program participants:
individual income of $20,001 to $21,000........... [$530] $132.50
individual income of $21,001 to $22,000........... [$550] $137.50
individual income of $22,001 to $23,000........... [$580] $145.00
individual income of $23,001 to $24,000........... [$720] $180.00
individual income of $24,001 to $25,000........... [$750] $187.50
individual income of $25,001 to $26,000........... [$780] $195.00
individual income of $26,001 to $27,000........... [$810] $202.50
individual income of $27,001 to $28,000........... [$840] $210.00
individual income of $28,001 to $29,000........... [$870] $217.50

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02450-01-9
              

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individual income of $29,001 to $30,000........... [$900] $225.00
individual income of $30,001 to $31,000........... [$930] $232.50
individual income of $31,001 to $32,000........... [$960] $240.00
individual income of $32,001 to $33,000......... [$1,160] $290.00
individual income of $33,001 to $34,000......... [$1,190] $297.50
individual income of $34,001 to $35,000......... [$1,230] $307.50
  (b)  [Annual]  QUARTERLY  personal  covered drug expenditures for each
married individual eligible program participant:
joint income of $26,001 to $27,000................ [$650] $162.50
joint income of $27,001 to $28,000................ [$675] $168.75
joint income of $28,001 to $29,000................ [$700] $175.00
joint income of $29,001 to $30,000................ [$725] $181.25
joint income of $30,001 to $31,000................ [$900] $225.00
joint income of $31,001 to $32,000................ [$930] $232.50
joint income of $32,001 to $33,000................ [$960] $240.00
joint income of $33,001 to $34,000................ [$990] $247.50
joint income of $34,001 to $35,000.............. [$1,020] $255.00
joint income of $35,001 to $36,000.............. [$1,050] $262.50
joint income of $36,001 to $37,000.............. [$1,080] $270.00
joint income of $37,001 to $38,000.............. [$1,110] $277.50
joint income of $38,001 to $39,000.............. [$1,140] $285.00
joint income of $39,001 to $40,000.............. [$1,170] $292.50
joint income of $40,001 to $41,000.............. [$1,200] $300.00
joint income of $41,001 to $42,000.............. [$1,230] $307.50
joint income of $42,001 to $43,000.............. [$1,260] $315.00
joint income of $43,001 to $44,000.............. [$1,290] $322.50
joint income of $44,001 to $45,000.............. [$1,320] $330.00
joint income of $45,001 to $46,000.............. [$1,575] $393.75
joint income of $46,001 to $47,000.............. [$1,610] $402.50
joint income of $47,001 to $48,000.............. [$1,645] $411.25
joint income of $48,001 to $49,000.............. [$1,680] $420.00
joint income of $49,001 to $50,000.............. [$1,715] $428.75
  (c) In the event that the state expenditures per participant  electing
to  meet  the  deductible requirements of this subdivision, exclusive of
expenditures for program administration, in the program year  commencing
October first, [nineteen hundred eighty-eight] TWO THOUSAND NINE, and in
each  program  year thereafter, exceed such expenditures in the previous
program year by  a  minimum  of  ten  percent,  the  [annual]  QUARTERLY
personal  covered  drug  expenditures set forth in this subdivision may,
unless otherwise provided by law, be increased, pro-rata, for the subse-
quent program year, provided that such increase shall not  exceed  eight
percent of the prior year personal covered drug expenditures as may have
been adjusted in accordance with this paragraph.
  (d)  In  the  event  that the state expenditures per such participant,
incurred pursuant to this subdivision,  exclusive  of  expenditures  for
program  administration,  in  the program year commencing October first,
[nineteen hundred eighty-eight] TWO THOUSAND NINE, and in  each  program
year thereafter, are less than such expenditures in the previous program
year  by  a  minimum  of  ten  percent,  the [annual] QUARTERLY personal
covered drug expenditures set forth  in  this  subdivision  may,  unless
otherwise  provided  by  law, be decreased, pro-rata, for the subsequent
program year, provided that such decrease shall not exceed eight percent
of the prior year personal covered drug expenditures as  may  have  been
adjusted in accordance with this paragraph.
  (e)  The  determination  to adjust [annual] QUARTERLY personal covered
drug expenditures set forth in this subdivision, shall follow  a  review

A. 3740                             3

of such factors as the relative financial capacity of the state and such
eligible program participants to support such adjustments and changes in
the  consumer  price  index. The frequency of such adjustments shall not
exceed  once  in  any twelve month period and such adjustments shall not
become effective for individual program participants prior to the  first
day of the next annual coverage period for each participant.
  S  2. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law.