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