[ ] is old law to be omitted.
LBD12571-06-1
S. 2809--D 2 A. 4009--D
services and inpatient hospital services, in relation to the effec-
tiveness thereof; to amend section 4 of chapter 505 of the laws of
1995, amending the public health law relating to the operation of
department of health facilities, in relation to the effectiveness
thereof; to amend section 3 of chapter 303 of the laws of 1999, amend-
ing the New York state medical care facilities finance agency act
relating to financing health facilities, in relation to the effective-
ness thereof; to repeal subdivision 2, and paragraphs (c), (d) and (g)
of subdivision 3 of section 242 of the elder law, relating to eligi-
bility for comprehensive coverage for elderly pharmaceutical insur-
ance; to repeal section 244 of the elder law, relating to the elderly
pharmaceutical insurance coverage panel; to repeal subdivisions 1, 2
and 4 of section 247 of the elder law, relating to cost-sharing
responsibilities of participants in the elderly pharmaceutical insur-
ance coverage program; and to repeal section 248 of the elder law,
relating to cost-sharing responsibilities of participants in the
elderly catastrophic insurance program (Part A); to amend the public
health law, in relation to rates of payment and medical assistance
(Part B); to amend the New York Health Care Reform Act of 1996, in
relation to extending certain provisions relating thereto; to amend
the New York Health Care Reform Act of 2000, in relation to extending
the effectiveness of provisions thereof; to amend the public health
law, in relation to the distribution of pool allocations and graduate
medical education; to amend chapter 62 of the laws of 2003 amending
the general business law and other laws relating to enacting major
components necessary to implement the state fiscal plan for the 2003-
04 state fiscal year, in relation to the deposit of certain funds; to
amend the public health law, in relation to health care initiative
pool distributions; to amend the public authorities law, in relation
to the transfer of certain funds; to amend the social services law, in
relation to extending payment provisions for general hospitals; to
amend chapter 600 of the laws of 1986 amending the public health law
relating to the development of pilot reimbursement programs for ambu-
latory care services, in relation to the effectiveness of such chap-
ter; to amend chapter 520 of the laws of 1978 relating to providing
for a comprehensive survey of health care financing, education and
illness prevention and creating councils for the conduct thereof, in
relation to extending the effectiveness of portions thereof; to amend
the public health law, in relation to extending access to community
health care services in rural areas; to amend the public health law,
in relation to continuing the priority restoration adjustment; to
amend chapter 266 of the laws of 1986 amending the civil practice law
and rules and other laws relating to malpractice and professional
medical conduct, in relation to extending the applicability of certain
provisions thereof; to amend the insurance law, in relation to liqui-
dation of domestic insurers; to amend chapter 63 of the laws of 2001
amending chapter 20 of the laws of 2001 amending the military law and
other laws relating to making appropriations for the support of
government, in relation to extending the applicability of certain
provisions thereof; to amend chapter 904 of the laws of 1984, amending
the public health law and the social services law relating to encour-
aging comprehensive health services, in relation to the effectiveness
thereof; to amend the social services law and the public health law,
in relation to rates of payment for personal care service providers,
residential health care facilities and diagnostic and treatment
centers; and to amend chapter 495 of the laws of 2004 amending the
S. 2809--D 3 A. 4009--D
insurance law and the public health law relating to the New York state
health insurance continuation assistance demonstration project, in
relation to the effectiveness of such provisions (Part C); to amend
the public health law, in relation to payments to residential health
care facilities; to amend chapter 474 of the laws of 1996, amending
the education law and other laws relating to rates for residential
healthcare facilities, in relation to reimbursements; to amend chapter
884 of the laws of 1990, amending the public health law relating to
authorizing bad debt and charity care allowances for certified home
health agencies, in relation to the effectiveness thereof; to amend
chapter 81 of the laws of 1995, amending the public health law and
other laws relating to medical reimbursement and welfare reform, in
relation to reimbursements and the effectiveness thereof; to amend the
public health law, in relation to capital related inpatient expenses;
to amend part C of chapter 58 of the laws of 2007, amending the social
services law and other laws relating to enacting the major components
of legislation necessary to implement the health and mental hygiene
budget for the 2007-2008 state fiscal year, in relation to rates of
payment by state governmental agencies; to amend chapter 451 of the
laws of 2007, amending the public health law, the social services law
and the insurance law, relating to providing enhanced consumer and
provider protections, in relation to extending the effectiveness of
certain provisions thereof; to amend the public health law, in
relation to rates of payment for long term home health care programs;
to amend chapter 2 of the laws of 1998, amending the public health law
and other laws relating to expanding the child health insurance plan,
in relation to the effectiveness of certain provisions thereof; to
amend chapter 649 of the laws of 1996, amending the public health law,
the mental hygiene law and the social services law relating to author-
izing the establishment of special needs plans, in relation to the
effectiveness thereof; to amend chapter 58 of the laws of 2008, amend-
ing the social services law and the public health law relating to
adjustments of rates, in relation to the effectiveness of certain
provisions thereof; to amend chapter 535 of the laws of 1983, amending
the social services law relating to eligibility of certain enrollees
for medical assistance, in relation to the effectiveness thereof; to
amend chapter 19 of the laws of 1998, amending the social services law
relating to limiting the method of payment for prescription drugs
under the medical assistance program, in relation to the effectiveness
thereof; to amend chapter 710 of the laws of 1988, amending the social
services law and the education law relating to medical assistance
eligibility of certain persons and providing for managed medical care
demonstration programs, in relation to the effectiveness thereof; to
amend chapter 165 of the laws of 1991, amending the public health law
and other laws relating to establishing payments for medical assist-
ance, in relation to the effectiveness thereof; to repeal certain
provisions of the public health law relating to capital related inpa-
tient expenses; and to repeal certain provisions of chapter 41 of the
laws of 1992, amending the public health law and other laws relating
to health care providers relating to the effectiveness of certain
provisions thereof (Part D); to amend the social services law, in
relation to suspension of eligibility for medical assistance (Part E);
to amend chapter 57 of the laws of 2006, relating to establishing a
cost of living adjustment for designated human services programs, in
relation to foregoing such adjustment during the 2011-2012 state
fiscal year (Part F); to amend the mental hygiene law, in relation to
S. 2809--D 4 A. 4009--D
the closure and the reduction in size of certain facilities serving
persons with mental illness; and providing for the repeal of certain
provisions upon expiration thereof (Part G); and to amend the public
health law, in relation to general hospital inpatient reimbursement
for annual rates; to amend the public health law, in relation to
establishing ceiling limitations for certain rates of payment; to
repeal certain provisions of the social services law relating to
prescription drug payments; to amend the social services law, in
relation to a study to determine costs incurred by public school
districts for certain medical care, services and supplies; to amend
the public health law, in relation to calculation of capital costs and
to repeal certain provisions of such law relating thereto; to amend
chapter 58 of the laws of 2010 amending the public health law and
other laws relating to Medicaid payments, in relation to the HIV
special needs plan; to amend the public health law, in relation to the
pharmacy and therapeutics committee and the preferred drug program;
and to repeal certain provisions of such law relating thereto; to
amend the social services law and the public health law, in relation
to covered part D drugs, limited coverage for formula therapy,
prescription footwear, speech therapy, physical therapy and occupa-
tional therapy, payment for home health care nursing services, and
coverage for smoking cessation counseling services, the furnishing of
medical assistance to applicants with responsible relatives, mail
order prescriptions, and the commissioner of health's authority to
negotiate agreements resolving multiple pending rate appeals; to
repeal subdivision 12 of section 272 of the public health law relating
to authorization under the preferred drug program for anti-psychotics,
anti-depressants, anti-rejection drugs for transplants and anti-retro-
virals used in the treatment of HIV and AIDS; to amend the public
health law, in relation to diagnostic care centers; to amend the
public health law, in relation to temporary operator certificates for
general hospitals or diagnostic and treatment centers; to amend the
social services law, in relation to health home services; to amend the
public health law, in relation to statewide planning and research
cooperative systems; to amend the public health law, in relation to
managed long term care plans and residential health care facilities;
to amend the social services law, in relation to insurance co-pay-
ments; to amend the public health law, in relation to providing palli-
ative care support for patients with advanced life limiting conditions
and illnesses; to amend the social services law, in relation to
provisions of home health care services, to establish a workgroup to
develop a plan and draft legislation for the purpose of operating and
managing public nursing homes; to amend the public health law, in
relation to encouraging cooperative, collaborative and integrative
arrangements between health care providers, payers, and others; to
amend the social services law, in relation to definition of estate; to
amend the public health law, in relation to the New York state medical
indemnity fund and the New York state hospital quality initiative; to
amend the mental hygiene law, in relation to compliance with opera-
tional standards by hospitals and providers of services in hospitals;
to amend the public health law, in relation to serious event report-
ing; to amend the public health law in relation to creating an
accountable care organization demonstration program; to amend the
social services law, in relation to limiting the reporting of death by
the operator of an adult home or residence, to define certain terms as
used in the social services law, and to require preclaim review for
S. 2809--D 5 A. 4009--D
participating providers of medical assistance program items and
services; to amend the public health law, and part B of chapter 58 of
the laws of 2010, amending chapter 474 of the laws of 1996 amending
the education law and other laws relating to rates for residential
healthcare facilities and other laws relating to Medicaid payments, in
relation to seeking federal approvals to establish payment methodol-
ogies with accountable care organizations, to amend the social
services law, in relation to medical assistance for needy persons and
to repeal certain provisions of such law relating thereto; to amend
the social services law, in relation to the character and adequacy of
assistance; to amend the public health law, in relation to operating
costs and rates of payment and repealing certain provisions of such
law relating thereto; to amend chapter 58 of the laws of 2009, amend-
ing the public health law and other laws relating to Medicaid
reimbursements to residential health care facilities, in relation to
such reimbursements; and to amend the public health law, in relation
to residential health care facility supplemental payments, non-capital
components of rates, temporary nursing home stability contributions,
authorizes commissioner of health to enter into contracts for purposes
of the Early Innovator federal grant award; to amend chapter 385 of
the laws of 2008 amending the insurance law relating to an exemption
to certain provisions of law relating to risk-based capital for
property/casualty insurance companies, in relation to the effective-
ness thereof; and to amend the insurance law, in relation to applica-
tions for orders of rehabilitation or liquidation; to amend chapter 19
of the laws of 1998, amending the social services law relating to
limiting the method of payment for prescription drugs under the
medical assistance program, in relation to extending the effectiveness
thereof and providing for the repeal of certain provisions upon expi-
ration thereof (Part H)
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 2011-2012
state fiscal year. Each component is wholly contained within a Part
identified as Parts A through H. The effective date for each particular
provision contained within such Part is set forth in the last section of
such Part. Any provision in any section contained within a Part, includ-
ing the effective date of the Part, which makes a reference to a section
"of this act", when used in connection with that particular component,
shall be deemed to mean and refer to the corresponding section of the
Part in which it is found. Section three of this act sets forth the
general effective date of this act.
PART A
Section 1. Paragraph (f) 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,
is 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-
S. 2809--D 6 A. 4009--D
able enrollment period and to maintain such enrollment. [This require-
ment shall be waived if such enrollment would result in significant
additional financial liability by the participant, including, but not
limited 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 partic-
ipant, the participant's spouse or other dependent. The elderly pharma-
ceutical 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] FOR UNMARRIED PARTICIPANTS WITH INDI-
VIDUAL ANNUAL INCOME LESS THAN OR EQUAL TO TWENTY-THREE THOUSAND DOLLARS
AND MARRIED PARTICIPANTS WITH JOINT ANNUAL INCOME LESS THAN OR EQUAL TO
TWENTY-NINE THOUSAND DOLLARS, 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.]
S 2. Subdivision 6 of section 241 of the elder law is amended and two
new subdivisions 8 and 9 are added to read as follows:
6. "Annual coverage period" shall mean the period of twelve consec-
utive calendar months for which an eligible program participant has met
the [application fee or deductible requirements, as the case may be, of
sections two hundred forty-seven and two hundred forty-eight] REQUIRE-
MENTS OF SECTION TWO HUNDRED FORTY-TWO of this title.
8. "COVERAGE GAP PERIOD" SHALL MEAN THE PERIOD BETWEEN THE END OF THE
MEDICARE PART D INITIAL COVERAGE PHASE AND THE START OF MEDICARE PART D
CATASTROPHIC COVERAGE.
9. "MEDICARE PART D EXCLUDED DRUG CLASSES" SHALL MEAN ANY DRUGS OR
CLASSES OF DRUGS, OR THEIR MEDICAL USES, WHICH ARE DESCRIBED IN SECTION
1927(D)(2) OR 1927(D)(3) OF THE FEDERAL SOCIAL SECURITY ACT, WITH THE
EXCEPTION OF SMOKING CESSATION AGENTS.
S 3. Subdivision 1 of section 242 of the elder law, paragraph (b) as
amended by section 14 of part B of chapter 57 of the laws of 2006, is
amended to read as follows:
1. Persons eligible for [comprehensive] coverage under [section two
hundred forty-seven of] this title shall include:
(a) any unmarried resident who is at least sixty-five years of age,
WHO IS ENROLLED IN MEDICARE PART D, and whose income for the calendar
S. 2809--D 7 A. 4009--D
year immediately preceding the effective date of the annual coverage
period beginning on or after January first, two thousand five, is less
than or equal to [twenty] THIRTY-FIVE thousand dollars. After the
initial determination of eligibility, each eligible individual must be
redetermined eligible at least every twenty-four months; and
(b) any married resident who is at least sixty-five years of age, WHO
IS ENROLLED IN MEDICARE PART D, and whose income for the calendar year
immediately preceding the effective date of the annual coverage period
when combined with the income in the same calendar year of such married
person's spouse beginning on or after January first, two thousand one,
is less than or equal to [twenty-six] FIFTY thousand dollars. After the
initial determination of eligibility, each eligible individual must be
redetermined eligible at least every twenty-four months.
S 3-a. Subdivision 2 of section 242 of the elder law is REPEALED.
S 3-b. Paragraph (c) of subdivision 3 of section 242 of the elder law
is REPEALED and a new paragraph (c) is added to read as follows:
(C) FOR PERSONS WHO MEET THE ELIGIBILITY REQUIREMENTS TO PARTICIPATE
IN THE ELDERLY PHARMACEUTICAL INSURANCE COVERAGE PROGRAM, THE PROGRAM
WILL PAY FOR A DRUG COVERED BY THE PERSON'S MEDICARE PART D PLAN OR A
DRUG IN A MEDICARE PART D EXCLUDED DRUG CLASS, AS DEFINED IN SUBDIVISION
NINE OF SECTION TWO HUNDRED FORTY-ONE OF THIS TITLE, DURING THE COVERAGE
GAP, AS DEFINED IN SUBDIVISION EIGHT OF SECTION TWO HUNDRED FORTY-ONE OF
THIS TITLE, PROVIDED THAT SUCH DRUG IS A COVERED DRUG, AS DEFINED IN
SUBDIVISION ONE OF SECTION TWO HUNDRED FORTY-ONE OF THIS TITLE, AND THAT
THE PARTICIPANT COMPLIES WITH THE POINT OF SALE CO-PAYMENT REQUIREMENTS
SET FORTH IN SECTION TWO HUNDRED FORTY-SEVEN OF THIS TITLE.
S 3-c. Paragraph (d) of subdivision 3 of section 242 of the elder law
is REPEALED.
S 3-d. Paragraphs (e) and (f) of subdivision 3 of section 242 of the
elder law, paragraph (e) as amended by section 112 of part C of chapter
58 of the laws of 2009, paragraph (f) as amended by section one of this
act, are amended to read as follows:
(e) As a condition of [continued] eligibility for benefits under this
title, if a program participant's income indicates that the participant
could be eligible for an income-related subsidy under section 1860D-14
of the federal social security act by either applying for such subsidy
or by enrolling in a medicare savings program as a qualified medicare
beneficiary (QMB), a specified low-income medicare beneficiary (SLMB),
or a qualifying individual (QI), a program participant is required to
provide, and to authorize the elderly pharmaceutical insurance coverage
program to obtain, any information or documentation required to estab-
lish the participant's eligibility for such subsidy, and to authorize
the elderly pharmaceutical insurance coverage program to apply on behalf
of the participant for the subsidy or the medicare savings program. The
elderly pharmaceutical insurance coverage program shall make a reason-
able effort to notify the program participant of his or her need to
provide any of the above required information. After a reasonable effort
has been made to contact the participant, a participant shall be noti-
fied in writing that he or she has sixty days to provide such required
information. If such information is not provided within the sixty day
period, the participant's coverage may be terminated.
(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] BE ENROLLED in Medicare part D [at
the first available enrollment period] and to maintain such enrollment.
S. 2809--D 8 A. 4009--D
[This requirement shall be waived if such enrollment would result in
significant additional financial liability by the participant, includ-
ing, but not limited 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.]
S 3-e. Paragraph (g) of subdivision 3 of section 242 of the elder law
is REPEALED.
S 3-f. Paragraph (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, is
amended to read as follows:
(h) [In order to maximize prescription drug coverage under Medicare
part D, the] THE elderly pharmaceutical insurance coverage program is
authorized to represent program participants under this title [in the
pursuit of such] WITH RESPECT TO THEIR MEDICARE PART D coverage. [Such
representation shall not result in any additional financial liability on
behalf of such program participants and shall include, but not be limit-
ed 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 3-g. Section 243 of the elder law is amended to read as follows:
S 243. Pharmaceutical insurance contract. 1. The [elderly pharmaceu-
tical insurance coverage panel, established pursuant to section two
hundred forty-four of this title] COMMISSIONER OF HEALTH shall, subject
to the approval of the director of the budget, enter into a contract
with one or more contractors to assist in carrying out the provisions of
this title. Such contractual arrangements shall be made subject to a
competitive process pursuant to the state finance law and shall ensure
that state payments for the contractor's necessary and legitimate
expenses for the administration of this program are limited to the
amount specified in advance, and that such payments shall not exceed the
amount appropriated therefor in any fiscal year. The [panel] COMMISSION-
ER shall[, at each of its regularly scheduled meetings,] review the
contract pricing provisions to assure that the level of contract
payments are in the best interest of the state, giving consideration to
the total level of participant enrollment achieved, the volume of claims
processed, and such other factors as may be relevant in order to contain
state expenditures. In the event that the [panel] COMMISSIONER deter-
mines that the contract payment provisions do not protect the interest
of the state, the [executive director] COMMISSIONER shall initiate
contract negotiations for the purpose of modifying contract payments
and/or scope requirements.
2. The responsibilities of the contractor or contractors shall
include, but need not be limited to:
(a) providing for a method of determining, on an annual basis and upon
their application therefor, the eligibility of persons pursuant to
section two hundred forty-two of this title within a reasonable period
of time, including alternative methods for such determination of eligi-
bility, such as through the mail or home visits, where reasonable and/or
S. 2809--D 9 A. 4009--D
necessary, and for notifying applicants of such eligibility determi-
nations;
(b) notifying each eligible program participant in writing upon the
commencement of the annual coverage period of such participant's cost-
sharing responsibilities pursuant to [sections] SECTION two hundred
forty-seven [and two hundred forty-eight] of this title. The contractor
shall also notify each eligible program participant of any adjustment of
the co-payment schedule by mail no less than thirty days prior to the
effective date of such adjustments and shall inform such eligible
program participants of the date such adjustments shall take effect;
(c) issuing an identification card to each ELIGIBLE program partic-
ipant [who is eligible to purchase prescribed covered drugs for an
amount specified pursuant to subdivision three of section two hundred
forty-seven or subdivision three of section two hundred forty-eight of
this title. The dates of the annual coverage period shall be imprinted
on the card. When an eligible program participant meets the annual
limits on point of sale co-payments set forth in subdivision four of
section two hundred forty-seven or subdivision four of section two
hundred forty-eight of this title, either new identification cards shall
be issued to such participant indicating waiver of such co-payment
requirements for the remainder of the annual coverage period or the
contractor shall develop and implement an alternative method to permit
the purchase of covered drugs without a co-payment requirement];
(d) [developing and implementing the system for those individuals
electing the deductible option to record their personal covered drug
expenditures in accordance with subdivision three of section two hundred
forty-eight of this title. Such recordkeeping system shall be provided
to each such participant at a nominal charge which shall be subject to
the approval of the panel. The contractor shall also reimburse partic-
ipants for personal covered drug expenditures made in excess of their
deductible requirements, less the co-payments required by subdivision
four of section two hundred forty-eight of this title, made prior to
their receipt of an identification card issued in accordance with para-
graph (c) of this subdivision;
(e)] processing of claims for reimbursement to participating provider
pharmacies pursuant to section two hundred fifty of this title;
[(f)] (E) performing or causing to be performed utilization reviews
for such purposes as may be required by the [elderly pharmaceutical
insurance coverage panel] COMMISSIONER OF HEALTH;
[(g)] (F) conducting audits and surveys of participating provider
pharmacies as specified pursuant to the terms and conditions of the
contract; and
[(h)] (G) coordinating coverage with insurance companies and other
public and private organizations offering such coverage for those eligi-
ble program participants having partial coverage for covered drugs
through third-party sources, and providing for recoupment of any dupli-
cate reimbursement paid by the state on behalf of such eligible program
participants.
3. The contractor or contractors shall be required to provide such
reports as may be deemed necessary by the [elderly pharmaceutical insur-
ance coverage panel] COMMISSIONER OF HEALTH and shall maintain files in
a manner and format approved by the [executive director] COMMISSIONER.
4. The contractor or contractors may contract with private not-for-
profit or proprietary corporations, or with entities of local government
within the state of New York, to perform such obligations of the
S. 2809--D 10 A. 4009--D
contractor or contractors as the [elderly pharmaceutical insurance
coverage panel] COMMISSIONER OF HEALTH shall permit.
S 3-h. Section 244 of the elder law is REPEALED and a new section 244
is added to read as follows:
S 244. POWERS OF THE COMMISSIONER OF HEALTH. THE POWERS OF THE
COMMISSIONER OF HEALTH IN ADMINISTERING THE ELDERLY PHARMACEUTICAL
INSURANCE COVERAGE PROGRAM SHALL INCLUDE BUT NOT BE LIMITED TO THE
FOLLOWING:
1. SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET, PROMULGATING
PROGRAM REGULATIONS PURSUANT TO SECTION TWO HUNDRED FORTY-SIX OF THIS
TITLE;
2. DETERMINING THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES OF
ELIGIBLE PROGRAM PARTICIPANTS PURSUANT TO SECTION TWO HUNDRED FORTY-SEV-
EN OF THIS TITLE;
3. ENTERING INTO CONTRACTS PURSUANT TO SECTION TWO HUNDRED FORTY-THREE
OF THIS TITLE;
4. IMPLEMENTING ALTERNATIVE PROGRAM IMPROVEMENTS FOR THE EFFICIENT AND
EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH THE PROVISIONS OF
THIS TITLE;
5. ESTABLISHING OR CONTRACTING FOR A THERAPEUTIC DRUG MONITORING
PROGRAM, FOR THE PURPOSE OF MONITORING THERAPEUTIC DRUG USE BY ELIGIBLE
PROGRAM PARTICIPANTS IN AN EFFORT TO PREVENT THE INCORRECT OR UNNECES-
SARY CONSUMPTION OF SUCH THERAPEUTIC DRUGS.
S 3-i. The section heading of section 247 of the elder law is amended
to read as follows:
Cost-sharing responsibilities of eligible program participants [for
comprehensive coverage].
S 3-j. Subdivision 1 of section 247 of the elder law is REPEALED and a
new subdivision 1 is added to read as follows:
1. AS A CONDITION OF ELIGIBILITY FOR BENEFITS UNDER THIS TITLE,
PARTICIPANTS MUST MAINTAIN MEDICARE PART D COVERAGE AND PAY MONTHLY
PREMIUMS TO THEIR MEDICARE PART D DRUG PLAN.
S 3-k. Subdivisions 2 and 4 of section 247 of the elder law are
REPEALED and subdivision 3 is renumbered subdivision 2 and paragraph (a)
is amended to read as follows:
(a) [Upon satisfaction of the registration fee pursuant to this
section an eligible] A program participant must pay a point of sale
co-payment as set forth in paragraph (b) of this subdivision at the time
of each purchase of a [covered] drug prescribed for such individual THAT
IS DESCRIBED IN PARAGRAPH (C) OF SUBDIVISION THREE OF SECTION TWO
HUNDRED FORTY-TWO OF THIS TITLE. [Such co-payment shall not be waived
or reduced in whole or in part, subject to the limits provided by subdi-
vision four of this section.]
S 3-l. Section 248 of the elder law is REPEALED.
S 3-m. Section 250 of the elder law, paragraph (a) of subdivision 1 as
amended by section 6-a and subparagraph l of paragraph (b) of subdivi-
sion 1 as amended by section 1 of part A of chapter 58 of the laws of
2008, paragraph (b) of subdivision 1 as amended by section 17 of part A
of chapter 58 of the laws of 2004, subparagraph 1 of paragraph (a) of
subdivision 3 and subdivision 5 as amended by section 19 of part B of
chapter 57 of the laws of 2006, subdivision 6 as amended by section 19-a
of part A of chapter 109 of the laws of 2010, is amended to read as
follows:
S 250. Reimbursement to participating provider pharmacies. 1. The
amount of reimbursement which shall be paid by the state to a partic-
ipating provider pharmacy [for any covered drug filled or refilled for
S. 2809--D 11 A. 4009--D
any eligible program participant] FILLING OR REFILLING A PRESCRIPTION
FOR A DRUG THAT IS DESCRIBED IN PARAGRAPH (C) OF SUBDIVISION THREE OF
SECTION TWO HUNDRED FORTY-TWO OF THIS TITLE shall be equal to the
allowed amount defined as follows, minus the point of sale co-payment as
required by [sections] SECTION two hundred forty-seven [and two hundred
forty-eight] of this title:
(a) Multiple source covered drugs. Except for brand name drugs that
are required by the prescriber to be dispensed as written, the allowed
amount for a multiple source covered drug shall equal the lower of:
(1) The pharmacy's usual and customary charge to the general public,
taking into consideration any quantity and promotional discounts to the
general public at the time of purchase, or
(2) The upper limit, if any, set by the centers for medicare and medi-
caid services for such multiple source drug, or
(3) Average wholesale price discounted by twenty-five percent, or
(4) The maximum allowable cost, if any, established by the commission-
er of health pursuant to paragraph (e) of subdivision nine of section
three hundred sixty-seven-a of the social services law.
Plus a dispensing fee for drugs reimbursed pursuant to subparagraphs
two, three, and four of this paragraph, as defined in paragraph (c) of
this subdivision.
(b) Other covered drugs. The allowed amount for brand name drugs
required by the prescriber to be dispensed as written and for covered
drugs other than multiple source drugs shall be determined by applying
the lower of:
(1) Average wholesale price discounted by sixteen and twenty-five one
hundredths percent, plus a dispensing fee as defined in paragraph (c) of
this subdivision, or
(2) The pharmacy's usual and customary charge to the general public,
taking into consideration any quantity and promotional discounts to the
general public at the time of purchase.
(c) As required by paragraphs (a) and (b) of this subdivision, a
dispensing fee of four dollars fifty cents will apply to generic drugs
and a dispensing fee of three dollars fifty cents will apply to brand
name drugs.
2. For purposes of determining the amount of reimbursement which shall
be paid to a participating provider pharmacy, the [panel] COMMISSIONER
OF HEALTH shall determine or cause to be determined, through a statis-
tically valid survey, the quantities of each covered drug that partic-
ipating provider pharmacies buy most frequently. Using the result of
this survey, the contractor shall update every thirty days the list of
average wholesale prices upon which such reimbursement is determined
using nationally recognized and most recently revised sources. Such
price revisions shall be made available to all participating provider
pharmacies. The pharmacist shall be reimbursed based on the price in
effect at the time the covered drug is dispensed.
3. [(a) Notwithstanding any inconsistent provision of law, the program
for elderly pharmaceutical insurance coverage shall reimburse for
covered drugs which are dispensed under the program by a provider phar-
macy only pursuant to the terms of a rebate agreement between the
program and the manufacturer (as defined under section 1927 of the
federal social security act) of such covered drugs; provided, however,
that:
(1) any agreement between the program and a manufacturer entered into
before August first, nineteen hundred ninety-one, shall be deemed to
have been entered into on April first, nineteen hundred ninety-one; and
S. 2809--D 12 A. 4009--D
provided further, that if a manufacturer has not entered into an agree-
ment with the department before August first, nineteen hundred ninety-
one, such agreement shall not be effective until April first, nineteen
hundred ninety-two, unless such agreement provides that rebates will be
retroactively calculated as if the agreement had been in effect on April
first, nineteen hundred ninety-one; and
(2) the program may reimburse for any covered drugs pursuant to subdi-
visions one and two of this section, for which a rebate agreement does
not exist and which are determined by the elderly pharmaceutical insur-
ance coverage panel to be essential to the health of persons participat-
ing in the program; and likely to provide effective therapy or diagnosis
for a disease not adequately treated or diagnosed by any other covered
drug; and which are recommended for reimbursement by the panel and
approved by the commissioner of health.
(b) The rebate agreement between such manufacturer and the program for
elderly pharmaceutical insurance coverage shall utilize for covered
drugs the identical formula used to determine the rebate for federal
financial participation for drugs, pursuant to section 1927(c) of the
federal social security act, to determine the amount of the rebate
pursuant to this subdivision.
(c) The amount of rebate pursuant to paragraph (b) of this subdivision
shall be calculated by multiplying the required rebate formulas by the
total number of units of each dosage form and strength dispensed. The
rebate agreement shall also provide for periodic payment of the rebate,
provision of information to the program, audits, verification of data,
damages to the program for any delay or non-production of necessary data
by the manufacturer and for the confidentiality of information.
(d) The program in providing utilization data to a manufacturer (as
provided for under section 1927 (b) of the federal social security act)
shall provide such data by zip code, if requested, for the top three
hundred most commonly used drugs by volume covered under a rebate agree-
ment.
(e) Any funds collected pursuant to any rebate agreements entered into
with a manufacturer pursuant to this subdivision, shall be deposited
into the elderly pharmaceutical insurance coverage program premium
account.
4.] Notwithstanding any other provision of law, entities which offer
insurance coverage for provision of and/or reimbursement for pharmaceu-
tical expenses, including but not limited to, entities
licensed/certified pursuant to article thirty-two, forty-two, forty-
three or forty-four of the insurance law (employees welfare funds) or
article forty-four of the public health law, shall participate in a
benefit recovery program with the elderly pharmaceutical insurance
coverage (EPIC) program which includes, but is not limited to, a semi-
annual match of EPIC's file of enrollees against the entity's file of
insured to identify individuals enrolled in both plans with claims paid
within the twenty-four months preceding the date the entity receives the
match request information from EPIC. Such entity shall indicate if phar-
maceutical coverage is available from the entity for the insured
persons, list the copayment or other payment obligations of the insured
persons applicable to the pharmaceutical coverage, and (after receiving
necessary claim information from EPIC) list the amounts which the entity
would have paid for the pharmaceutical claims for those identified indi-
viduals and the entity shall reimburse EPIC for pharmaceutical expenses
paid by EPIC that are covered under the contract between the entity and
its insured in only those instances where the entity has not already
S. 2809--D 13 A. 4009--D
made payment of the claim. Reimbursement of the net amount payable
(after rebates and discounts) that would have been paid under the cover-
age issued by the entity will be made by the entity to EPIC within sixty
days of receipt from EPIC of the standard data in electronic format
necessary for the entity to adjudicate the claim and if the standard
data is provided to the entity by EPIC in paper format payment by the
entity shall be made within one hundred eighty days. After completing
at least one match process with EPIC in electronic format, an entity
shall be entitled to elect a monthly or bi-monthly match process rather
than a semi-annual match process.
[5.] 4. Notwithstanding any other provision of law, the [panel]
COMMISSIONER OF HEALTH shall maximize the coordination of benefits for
persons enrolled under Title XVIII of the federal social security act
(medicare) and enrolled under this title in order to facilitate medicare
payment of claims. The [panel] COMMISSIONER OF HEALTH may select an
independent contractor, through a request-for-proposal process, to
implement a centralized coordination of benefits system under this
subdivision for individuals qualified in both the elderly pharmaceutical
insurance coverage (EPIC) program and medicare programs who receive
medications or other covered products from a pharmacy provider currently
enrolled in the elderly pharmaceutical insurance coverage (EPIC)
program.
[6. (a)] 5. The EPIC program shall be the payor of last resort for
individuals qualified in both the EPIC program and title XVIII of the
federal social security act (Medicare). [For such individuals, no
reimbursement shall be available under EPIC for covered drug expenses
except:
(i) where a prescription drug plan authorized by Part D of the federal
social security act (referred to in this subdivision as a Medicare Part
D plan) has approved coverage and EPIC has an obligation under this
title to pay a portion of the participant's cost-sharing responsibility
under Medicare Part D; or
(ii) where the provider pharmacy has certified that a Medicare Part D
plan has denied coverage.
(b) If the provider pharmacy certifies as set forth in subparagraph
(ii) of paragraph (a) of this subdivision, the EPIC program shall pay
for the drug as the primary payor upon a showing of compliance with the
notification and appeal provisions of subparagraph two of paragraph (c)
of subdivision three of section two hundred forty-two of this title.]
S 3-n. Section 254 of the elder law is amended to read as follows:
S 254. Cost of living adjustment. [1.] Within amounts appropriated,
the [panel] COMMISSIONER OF HEALTH shall adjust the program eligibility
standards set forth in subdivision [two] ONE of section two hundred
forty-two of this title to account for increases in the cost of living.
[2. The panel shall further adjust individual and joint income catego-
ries set forth in subdivisions two and four of section two hundred
forty-eight of this title to conform to the adjustments made pursuant to
subdivision one of this section.]
S 4. Notwithstanding any contrary provision of law, rates established
pursuant to section 69-4.30 of Title 10 of the New York Codes, Rules and
Regulations for approved services rendered on and after April 1, 2011
shall be reduced by five percent.
S 5. Intentionally omitted.
S 6. Intentionally omitted.
S 7. Intentionally omitted.
S 8. Intentionally omitted.
S. 2809--D 14 A. 4009--D
S 9. Intentionally omitted.
S 10. Intentionally omitted.
S 11. Intentionally omitted.
S 12. Subdivisions 4 and 5 of section 2545 of the public health law,
as added by section 2 of chapter 428 of the laws of 1992, are amended to
read as follows:
4. If the IFSP TEAM MEMBERS, INCLUDING THE early intervention official
and the parent agree on the IFSP, the IFSP shall be deemed final and the
service coordinator shall be authorized to implement the plan.
5. If the IFSP TEAM MEMBERS, INCLUDING THE early intervention official
and the parent do not agree on an IFSP, the service coordinator shall
implement the sections of the proposed IFSP that are not in dispute, and
the parent shall have the due process rights set forth in section twen-
ty-five hundred forty-nine of this title.
S 13. Subdivision 2 of section 605 of the public health law, as
amended by section 7 of part B of chapter 57 of the laws of 2006, is
amended to read as follows:
2. State aid reimbursement for public health services provided by a
municipality under this title, shall be made [as follows:
(a)] if the municipality is providing some or all of the basic public
health services identified in paragraph (b) of subdivision three of
section six hundred two of this title, pursuant to an approved plan, at
a rate of no less than thirty-six per centum of the difference between
the amount of moneys expended by the municipality for public health
services required by paragraph (b) of subdivision three of section six
hundred two of this title during the fiscal year and the base grant
provided pursuant to subdivision one of this section. No such reimburse-
ment shall be provided for services if they are not approved in a plan
or if no plan is submitted for such services.
[(b) if the municipality is providing other public health services
within limits to be prescribed by regulation by the commissioner in
addition to some or all of the public health services required in para-
graph (b) of subdivision three of section six hundred two of this title,
pursuant to an approved plan, at a rate of not less than thirty-six per
centum of the moneys expended by the municipality for such other
services. No such reimbursement shall be provided for services if they
are not approved in a plan or if no plan is submitted for such
services.]
S 14. Intentionally omitted.
S 15. Intentionally omitted.
S 16. Paragraph (fff) 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:
(fff) Funds shall be made available to the empire state stem cell fund
established by section ninety-nine-p of the state finance law [from the
public asset as defined in section four thousand three hundred one of
the insurance law and accumulated from the conversion of one or more
article forty-three corporations and its or their not-for-profit subsid-
iaries occurring on or after January first, two thousand seven. Such
funds shall be made available] within amounts appropriated up to fifty
million dollars annually and shall not exceed five hundred million
dollars in total.
S 17. Subdivision 2 of section 2407 of the public health law, as
amended by chapter 430 of the laws of 2005, is amended to read as
follows:
S. 2809--D 15 A. 4009--D
2. The advisory council shall be responsible for advising the commis-
sioner with respect to the implementation of this article and shall make
recommendations as to [the selection of approved organizations and] the
standards to be established by the commissioner pursuant to section
twenty-four hundred six of this title. [The commissioner shall consult
with the advisory council prior to developing standards for approved
organizations, selecting approved organizations, making grants to such
organizations and implementing the breast and cervical cancer detection
and education program.]
S 18. Subdivision 3 of section 571 of the public health law, as
amended by chapter 436 of the laws of 1993, is amended to read as
follows:
3. "Reference system" means a system of [periodic testing] ASSESSMENT
of methods, procedures and materials of clinical laboratories and blood
banks, including, but not limited to, ONGOING VALIDATION WHICH MAY
INCLUDE DIRECT TESTING AND EXPERIMENTATION BY THE DEPARTMENT OF SUCH
METHODS, PROCEDURES AND MATERIALS, the distribution of [manuals of
approved methods] STANDARDS AND GUIDELINES, inspection of facilities,
[cooperative research, and] periodic submission of test specimens for
examination, AND RESEARCH CONDUCTED BY THE DEPARTMENT THAT INVOLVES THE
STUDY OF NEW OR EXISTING METHODS, PROCEDURES AND MATERIALS RELATED TO
THE QUALITY OF CLINICAL LABORATORY MEDICINE.
S 19. Subdivisions 1, 2 and 6 of section 575 of the public health law,
as amended by chapter 436 of the laws of 1993, are amended to read as
follows:
1. Application for a permit shall be made by the owner and the direc-
tor of the clinical laboratory or blood bank [upon forms provided by the
department] IN A MANNER AND FORMAT PRESCRIBED BY THE DEPARTMENT. The
application shall contain the name of the owner, the name of the direc-
tor, the procedures or categories of procedures or services for which
the permit is sought, the location or locations and physical description
of the facility or location or locations at which tests are to be
performed or at which a blood bank is to be operated, and such other
information as the department may require.
2. A permit OR PERMIT CATEGORY shall not be issued unless a valid
certificate of qualification in the category of procedures for which the
permit is sought has been issued to the director pursuant to the
provisions of section five hundred seventy-three of this title, [and]
unless ALL FEES AND OUTSTANDING PENALTIES, IF ANY, HAVE BEEN PAID, AND
the department finds that the clinical laboratory or blood bank is
competently staffed and properly equipped, and will be operated in the
manner required by this title.
6. A permit shall become void by a change in the director, owner, or
location. A CATEGORY ON A PERMIT SHALL BECOME VOID BY A CHANGE IN THE
DIRECTOR FOR THAT CATEGORY. The department may, pursuant to regulations
adopted under this title, extend the date on which a permit OR CATEGORY
ON A PERMIT shall become void for a period not to exceed sixty days from
the date of a change of the director, owner or location. An application
for a NEW permit [may] MUST be made [at any time,] in the manner
provided by this section.
S 20. Subdivision 3 and paragraphs (a), (b), (c) and (e) of subdivi-
sion 4 of section 576 of the public health law, as amended by chapter
436 of the laws of 1993, are amended to read as follows:
3. The department shall operate a reference system and shall prescribe
standards for the PROPER OPERATION OF CLINICAL LABORATORIES AND BLOOD
BANKS AND FOR THE examination of specimens. As part of such reference
S. 2809--D 16 A. 4009--D
system, the department may REVIEW AND APPROVE TESTING METHODS DEVELOPED
OR MODIFIED BY CLINICAL LABORATORIES AND BLOOD BANKS PRIOR TO THE TEST-
ING METHODS BEING OFFERED IN THIS STATE, AND MAY require clinical labo-
ratories and blood banks to analyze test samples submitted by the
department and to report on the results of such analyses. The rules and
regulations of the department shall prescribe the REQUIREMENTS FOR THE
PROPER OPERATION OF A CLINICAL LABORATORY OR BLOOD BANK, FOR THE
APPROVAL OF METHODS AND THE manner in which proficiency testing or
analyses of samples shall be performed and reports submitted. Failure to
meet department standards FOR THE PROPER OPERATION OF A CLINICAL LABORA-
TORY OR BLOOD BANK, INCLUDING THE CRITERIA FOR APPROVAL OF METHODS, OR
FAILURE TO MAINTAIN SATISFACTORY PERFORMANCE in proficiency testing
shall result in termination of the permit in the category or categories
of testing established by the department in regulation until remediation
is achieved. Such standards shall be at least as stringent as federal
standards promulgated under the federal clinical laboratory improvement
[act] AMENDMENTS of nineteen hundred eighty-eight. Such failure and
termination shall be subject to review in accordance with regulations
adopted by the department.
(a) The department may adopt and amend rules and regulations to effec-
tuate the provisions and purposes of this title. Such rules and regu-
lations shall establish [inspection and reference] fees for clinical
laboratories and blood banks in amounts not exceeding the cost of the
[inspection and] reference [program] SYSTEM for clinical laboratories
and blood banks and shall be subject to the approval of the director of
the budget. FOR THE PURPOSES OF THIS SUBDIVISION, STANDARD FEDERALLY
ESTABLISHED GOVERNMENTAL COST ALLOCATION PRACTICES SHALL BE USED BY THE
COMMISSIONER TO DETERMINE THE COST OF THE REFERENCE SYSTEM. THE DEPART-
MENT SHALL MAKE AVAILABLE, ON THE DEPARTMENT'S WEBSITE, INFORMATION ON
THE COSTS INCLUDED IN DETERMINING THE PERMITTED LABORATORIES' FEES. THE
DEPARTMENT SHALL NOT DEEM AS COSTS OF THE REFERENCE SYSTEM, COSTS ASSO-
CIATED WITH FEDERAL GRANTS AND PATENTS WHICH ARE NOT RELATED TO THE
REFERENCE SYSTEM. THE FEE PAID BY THE DEPARTMENT TO MAINTAIN AN
EXEMPTION FOR CLINICAL LABORATORIES AND BLOOD BANKS FROM THE REQUIRE-
MENTS OF THE FEDERAL CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF NINE-
TEEN HUNDRED EIGHTY-EIGHT SHALL BE DEEMED A COST OF THE REFERENCE
SYSTEM.
(b) In determining the fee charges to be assessed, the department
shall, on or before May first of each year, compute the [total actual]
costs for the preceding state fiscal year which were expended to operate
and administer the duties of the department pursuant to this title. The
department shall, at such time or times and pursuant to such procedure
as it shall determine by regulation, bill and collect from each clinical
laboratory and blood bank an amount computed by multiplying such total
computed operating expenses of the department by a fraction the numera-
tor of which is the gross annual receipts of such clinical laboratory or
blood bank during such twelve month period preceding the date of compu-
tation as the department shall designate by regulation, and the denomi-
nator of which is the total gross annual receipts of all clinical labo-
ratories or blood banks operating in the state during such period.
(c) Each such clinical laboratory and blood bank shall submit to the
department, in such form and at such times as the department may
require, a report containing information regarding its gross annual
receipts [from the performance of tests or examination of specimens] FOR
ALL ACTIVITIES PERFORMED pursuant to a permit issued by the department
in accordance with the provisions of section five hundred seventy-five
S. 2809--D 17 A. 4009--D
of this title. The department may require additional information and
audit and review such information to verify its accuracy.
(e) On or before September fifteenth of each year, the department
shall [recompute the actual] RECONCILE ITS costs and expenses [of the
department] FOR THE REFERENCE SYSTEM for the preceding state fiscal year
and shall, on or before October fifteenth send to each clinical labora-
tory and blood bank, a statement setting forth the amount due and paya-
ble by, or the amount computed to the credit of, such clinical laborato-
ry or blood bank, computed on the basis of the above stated formula,
except that for the purposes of such computation the fraction shall be
multiplied against the total recomputed [actual] expenses of the depart-
ment for such fiscal year. Any amount due shall be payable not later
than thirty days following the date of such statement. Any credit shall
be applied against any succeeding payment due.
S 21. Subdivision 1 of section 577 of the public health law is amended
by adding a new paragraph (i) to read as follows:
(I) HAS BEEN FOUND UPON INSPECTION BY THE DEPARTMENT TO BE IN NONCOM-
PLIANCE WITH A PROVISION OR PROVISIONS OF THIS TITLE OR THE RULES AND
REGULATIONS PROMULGATED HEREUNDER, AND HAS FAILED TO ADDRESS SUCH FIND-
INGS AS REQUIRED BY THE DEPARTMENT.
S 22. Intentionally Omitted.
S 23. Intentionally Omitted.
S 24. Intentionally Omitted.
S 25. Intentionally Omitted.
S 25-a. Section 2818 of the public health law is amended by adding a
new subdivision 6 to read as follows:
6. NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION, SECTIONS
ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW,
OR ANY OTHER CONTRARY PROVISION OF LAW, SUBJECT TO AVAILABLE APPROPRI-
ATIONS, FUNDS AVAILABLE FOR EXPENDITURE PURSUANT TO THIS SECTION MAY BE
DISTRIBUTED BY THE COMMISSIONER WITHOUT A COMPETITIVE BID OR REQUEST FOR
PROPOSAL PROCESS FOR GRANTS TO GENERAL HOSPITALS AND RESIDENTIAL HEALTH
CARE FACILITIES FOR THE PURPOSE OF FACILITATING CLOSURES, MERGERS AND
RESTRUCTURING OF SUCH FACILITIES IN ORDER TO STRENGTHEN AND PROTECT
CONTINUED ACCESS TO ESSENTIAL HEALTH CARE RESOURCES. PRIOR TO AN
AWARDED BEING GRANTED TO AN ELIGIBLE APPLICANT WITHOUT A COMPETITIVE BID
OR REQUEST FOR PROPOSAL PROCESS, THE COMMISSIONER SHALL NOTIFY THE CHAIR
OF THE SENATE FINANCE COMMITTEE, THE CHAIR OF THE ASSEMBLY WAYS AND
MEANS COMMITTEE AND THE DIRECTOR OF THE DIVISION OF BUDGET OF THE INTENT
TO GRANT SUCH AN AWARD. SUCH NOTICE SHALL INCLUDE INFORMATION REGARDING
HOW THE ELIGIBLE APPLICANT MEETS CRITERIA ESTABLISHED PURSUANT TO THIS
SECTION.
S 26. Section 32 of part A of chapter 58 of the laws of 2008, amending
the elder law and other laws relating to reimbursement to particular
provider pharmacies and prescription drug coverage, as amended by
section 20 of part OO of chapter 57 of the laws of 2008, is amended to
read as follows:
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, 2008; provided
however, that sections one, six-a, nineteen, twenty, twenty-four, and
twenty-five of this act shall take effect July 1, 2008; provided however
that sections sixteen, seventeen and eighteen of this act shall expire
April 1, [2011] 2014; provided, however, that the amendments made by
section twenty-eight of this act shall take effect on the same date as
section 1 of chapter 281 of the laws of 2007 takes effect; provided
further, that sections twenty-nine, thirty, and thirty-one of this act
S. 2809--D 18 A. 4009--D
shall take effect October 1, 2008; provided further, that section twen-
ty-seven of this act shall take effect January 1, 2009; and provided
further, that section twenty-seven of this act shall expire and be
deemed repealed March 31, [2011] 2014; and provided, further, however,
that the amendments to subdivision 1 of section 241 of the education law
made by section twenty-nine of this act shall not affect the expiration
of such subdivision and shall be deemed to expire therewith and provided
that the amendments to section 272 of the public health law made by
section thirty of this act shall not affect the repeal of such section
and shall be deemed repealed therewith.
S 27. Section 4 of part X2 of chapter 62 of the laws of 2003, amending
the public health law relating to allowing for the use of funds of the
office of professional medical conduct for activities of the patient
health information and quality improvement act of 2000, as amended by
chapter 21 of the laws of 2010, is amended to read as follows:
S 4. This act shall take effect immediately; provided that the
provisions of section one of this act shall be deemed to have been in
full force and effect on and after April 1, 2003, and shall expire March
31, [2011] 2013 when upon such date the provisions of such section shall
be deemed repealed.
S 28. Paragraph (b) of subdivision 1 of section 76 of chapter 731 of
the laws of 1993, amending the public health law and other laws relating
to reimbursement, delivery and capital cost of ambulatory health care
services and inpatient hospital services, as amended by section 14 of
part A of chapter 58 of the laws of 2007, is amended to read as follows:
(b) sections fifteen through nineteen and subdivision 3 of section
2807-e of the public health law as added by section twenty of this act
shall expire on [July 1, 2011] JULY 1, 2014, and section seventy-four of
this act shall expire on July 1, 2007;
S 29. Section 4 of chapter 505 of the laws of 1995, amending the
public health law relating to the operation of department of health
facilities, as amended by chapter 609 of the laws of 2007, is amended to
read as follows:
S 4. This act shall take effect immediately; provided, however, that
the provisions of paragraph (b) of subdivision 4 of section 409-c of the
public health law, as added by section three of this act, shall take
effect January 1, 1996 and shall expire and be deemed repealed [sixteen]
TWENTY years from the effective date thereof.
S 30. Section 3 of chapter 303 of the laws of 1999, amending the New
York state medical care facilities finance agency act relating to
financing health facilities, as amended by chapter 607 of the laws of
2007, is amended to read as follows:
S 3. This act shall take effect immediately, provided, however, that
subdivision 15-a of section 5 of section 1 of chapter 392 of the laws of
1973, as added by section one of this act, shall expire and be deemed
repealed June 30, [2011] 2015; and provided further, however, that the
expiration and repeal of such subdivision 15-a shall not affect or
impair in any manner any health facilities bonds issued, or any lease or
purchase of a health facility executed, pursuant to such subdivision
15-a prior to its expiration and repeal and that, with respect to any
such bonds issued and outstanding as of June 30, [2011] 2015, the
provisions of such subdivision 15-a as they existed immediately prior to
such expiration and repeal shall continue to apply through the latest
maturity date of any such bonds, or their earlier retirement or redemp-
tion, for the sole purpose of authorizing the issuance of refunding
bonds to refund bonds previously issued pursuant thereto.
S. 2809--D 19 A. 4009--D
S 31. This act shall take effect April 1, 2011, provided, however
that:
(a) section one of this act shall take effect July 1, 2011;
(b) sections two through three-n of this act shall take effect January
1, 2012;
(c) section thirteen of this act shall take effect July 1, 2011; and
(d) related to sections eighteen, nineteen, twenty and twenty-one of
this act, the commissioner of health is authorized to promulgate, on an
emergency basis, any regulations necessary to implement any provision of
such sections upon their effective date.
PART B
Section 1. (a) Notwithstanding any inconsistent provision of law,
rule or regulation to the contrary, and subject to the availability of
federal financial participation, effective for the period April 1, 2011
through March 31, 2012, and each state fiscal year thereafter, the
department of health is authorized to make supplemental Medicaid
payments for professional services provided by physicians, nurse practi-
tioners and physician assistants who are participating in a plan for the
management of clinical practice at the State University of New York, in
accordance with title 11 of article 5 of the social services law for
patients eligible for federal financial participation under title XIX of
the federal social security act, in amounts that will increase fees for
such professional services to an amount equal to the average commercial
or Medicare rate that would otherwise be received for such services
rendered by such physicians, nurse practitioners and physician assist-
ants. The calculation of such supplemental fee payments shall be made in
accordance with applicable federal law and regulation and subject to the
approval of the division of the budget. Such supplemental Medicaid fee
payments may be added to the professional fees paid under the fee sched-
ule or made as aggregate lump sum payments to eligible clinical practice
plans authorized to receive professional fees.
(b) The affiliated State University of New York health science centers
shall be responsible for payment of one hundred percent of the non-fed-
eral share of such supplemental Medicaid payments for all services
provided by physicians, nurse practitioners and physician assistants who
are participating in a plan for the management of clinical practice, in
accordance with section 365-a of the social services law, regardless of
whether another social services district or the department of health may
otherwise be responsible for furnishing medical assistance to the eligi-
ble persons receiving such services.
S 2. Subdivision 21 of section 2807-c of the public health law is
amended by adding a new paragraph (e-1) to read as follows:
(E-1) FOR PERIODS ON AND AFTER JANUARY FIRST, TWO THOUSAND ELEVEN, FOR
PURPOSES OF CALCULATIONS PURSUANT TO PARAGRAPHS (B) AND (C) OF THIS
SUBDIVISION OF MAXIMUM DISPROPORTIONATE SHARE PAYMENT DISTRIBUTIONS FOR
A RATE YEAR OR PART THEREOF, COSTS INCURRED OF FURNISHING HOSPITAL
SERVICES NET OF MEDICAL ASSISTANCE PAYMENTS, OTHER THAN DISPROPORTIONATE
SHARE PAYMENTS, AND PAYMENTS BY UNINSURED PATIENTS SHALL FOR THE TWO
THOUSAND ELEVEN CALENDAR YEAR, SHALL BE DETERMINED INITIALLY BASED ON
EACH HOSPITAL'S SUBMISSION OF A FULLY COMPLETED TWO THOUSAND EIGHT
DISPROPORTIONATE SHARE HOSPITAL DATA COLLECTION TOOL, WHICH IS REQUIRED
TO BE SUBMITTED TO THE DEPARTMENT BY MARCH THIRTY-FIRST, TWO THOUSAND
ELEVEN, AND SHALL BE SUBSEQUENTLY REVISED TO REFLECT EACH HOSPITAL'S
SUBMISSION OF A FULLY COMPLETED TWO THOUSAND NINE DISPROPORTIONATE SHARE
S. 2809--D 20 A. 4009--D
HOSPITAL DATA COLLECTION TOOL, WHICH IS REQUIRED TO BE SUBMITTED TO THE
DEPARTMENT BY OCTOBER FIRST, TWO THOUSAND ELEVEN.
FOR CALENDAR YEARS ON AND AFTER TWO THOUSAND TWELVE, SUCH INITIAL
DETERMINATIONS SHALL REFLECT SUBMISSION OF DATA AS REQUIRED BY THE
COMMISSIONER ON A SPECIFIED DATE. ALL SUCH INITIAL DETERMINATIONS SHALL
SUBSEQUENTLY BE REVISED TO REFLECT ACTUAL RATE PERIOD DATA AND STATIS-
TICS. INDIGENT CARE PAYMENTS WILL BE WITHHELD IN INSTANCES WHEN A HOSPI-
TAL HAS NOT SUBMITTED REQUIRED INFORMATION BY THE DUE DATES PRESCRIBED
IN THIS PARAGRAPH, PROVIDED, HOWEVER, THAT SUCH PAYMENTS SHALL BE MADE
UPON SUBMISSION OF SUCH REQUIRED DATA. FOR PURPOSES OF CALCULATIONS
PURSUANT TO PARAGRAPH (D) OF THIS SUBDIVISION OF ELIGIBILITY TO RECEIVE
DISPROPORTIONATE SHARE PAYMENTS FOR A RATE YEAR OR PART THEREOF, THE
HOSPITAL INPATIENT UTILIZATION RATE SHALL BE DETERMINED BASED ON THE
BASE YEAR STATISTICS IN ACCORDANCE WITH THE METHODOLOGY ESTABLISHED BY
THE COMMISSIONER, AND COSTS INCURRED OF FURNISHING HOSPITAL SERVICES
SHALL BE DETERMINED IN ACCORDANCE WITH A METHODOLOGY ESTABLISHED BY THE
COMMISSIONER CONSISTENT WITH REQUIREMENTS OF THE SECRETARY OF THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR PURPOSES OF FEDERAL FINAN-
CIAL PARTICIPATION PURSUANT TO THE TITLE XIX OF THE FEDERAL SOCIAL SECU-
RITY ACT IN DISPROPORTIONATE SHARE PAYMENTS.
S 3. Intentionally omitted.
S 4. Intentionally omitted.
S4-a. Intentionally omitted.
S 5. Notwithstanding any contrary provision of law and subject to the
availability of federal financial participation, for periods on and
after July 1, 2011, Medicaid rates of payments for inpatient services
provided by residential health care facilities which, as of the effec-
tive date of this section, operate discrete units for treatment of resi-
dents with huntington's disease, shall be increased by a rate add-on
amount. The aggregate amount of such rate add-ons for the period July 1,
2011 through December 31, 2011 shall be eight hundred fifty thousand
dollars ($850,000), and shall be one million seven hundred thousand
dollars ($1,700,000) for the 2012 calendar year and each year thereafter
and such amounts shall be allocated to each eligible residential health
care facility proportionally, based on the number of beds in each facil-
ity's discrete unit for treatment of huntington's disease relative to
the total number of such beds in all such units. Such rate add-ons shall
be computed utilizing reported Medicaid days from certified cost reports
as submitted to the department of health for the calendar year period
two years prior to the applicable rate year and, further, such rate
add-ons shall not be subject to subsequent adjustment or reconciliation.
S 6. Notwithstanding section 448 of chapter 170 of the laws of 1994
and section 4 of chapter 81 of the laws of 1995, as amended, and any
other inconsistent provision of law or regulation and subject to the
availability of federal financial participation, for the period April 1,
2011 through June 30, 2011, medical assistance rates of payment to resi-
dential health care facilities and diagnostic treatment centers licensed
under article 28 of the public health law for adult day health care
services provided to registrants with acquired immunodeficiency syndrome
(AIDS) or other human immunodeficiency virus (HIV) related illnesses,
shall be increased by an aggregate amount of one million eight hundred
sixty-seven thousand dollars ($1,867,000). Such amount shall be allo-
cated proportionally among such providers based on the medical assist-
ance visits reported by each provider in the most recently available
cost report, as submitted to the department of health by January 1,
2011, and shall be included as adjustments to each provider's daily rate
S. 2809--D 21 A. 4009--D
of payment for such services. Such adjustments shall not be subject to
subsequent adjustment or reconciliation.
S 7. Notwithstanding any contrary provision of law or regulation and
subject to availability of federal financial participation, for the
period April 1, 2011 through June 30, 2011, rates of payment by govern-
mental agencies to residential health care facilities and diagnostic and
treatment centers licensed under article 28 of the public health law for
adult day health care services provided to registrants with acquired
immunodeficiency syndrome (AIDS) or other human immunodeficiency virus
(HIV) related illnesses, shall reflect an adjustment to such rates of
payments in an aggregate amount of two hundred thirty-six thousand
dollars ($236,000) and distributed proportionally as rate add-ons, based
on each eligible providers' Medicaid visits as reported in such provid-
er's most recently available cost report as submitted to the department
of health prior to January 1, 2011, and provided further, however, that
such adjustments shall not be subject to subsequent adjustment or recon-
ciliation.
S 8. Intentionally omitted.
S 9. Intentionally omitted.
S 10. 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 11. 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 12. 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-
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 13. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2011; provided,
however, that:
(a) 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;
(b) 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;
(c) 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;
(d) 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
S. 2809--D 22 A. 4009--D
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;
and
(e) 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 C
Section 1. Subdivision 5 of section 168 of chapter 639 of the laws of
1996, constituting the New York Health Care Reform Act of 1996, as
amended by section 1 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
5. sections 2807-c, 2807-j, 2807-s and 2807-t of the public health
law, as amended or as added by this act, shall expire on December 31,
[2011] 2014, and shall be thereafter effective only in respect to any
act done on or before such date or action or proceeding arising out of
such act including continued collections of funds from assessments and
allowances and surcharges established pursuant to sections 2807-c,
2807-j, 2807-s and 2807-t of the public health law, and administration
and distributions of funds from pools established pursuant to sections
2807-c, 2807-j, 2807-k, 2807-l, 2807-m, 2807-s and 2807-t of the public
health law related to patient services provided before December 31,
[2011] 2014, and continued expenditure of funds authorized for programs
and grants until the exhaustion of funds therefor;
S 2. Subdivision 1 of section 138 of chapter 1 of the laws of 1999,
constituting the New York Health Care Reform Act of 2000, as amended by
section 1-a of part B of chapter 58 of the laws of 2008, is amended to
read as follows:
1. sections 2807-c, 2807-j, 2807-s, and 2807-t of the public health
law, as amended by this act, shall expire on December 31, [2011] 2014,
and shall be thereafter effective only in respect to any act done before
such date or action or proceeding arising out of such act including
continued collections of funds from assessments and allowances and
surcharges established pursuant to sections 2807-c, 2807-j, 2807-s and
2807-t of the public health law, and administration and distributions of
funds from pools established pursuant to sections 2807-c, 2807-j,
2807-k, 2807-l, 2807-m, 2807-s, 2807-t, 2807-v and 2807-w of the public
health law, as amended or added by this act, related to patient services
provided before December 31, [2011] 2014, and continued expenditure of
funds authorized for programs and grants until the exhaustion of funds
therefor;
S 3. Paragraph (a) of subdivision 9 of section 2807-j of the public
health law, as amended by section 2 of part B of chapter 58 of the laws
of 2008, is amended to read as follows:
(a) funds shall be deposited and credited to a special revenue-other
fund to be established by the comptroller or to the health care reform
act (HCRA) resources fund established pursuant to section ninety-two-dd
of the state finance law, whichever is applicable. To the extent of
funds appropriated therefore, the commissioner shall make payments to
general hospitals related to bad debt and charity care pursuant to
section twenty-eight hundred seven-k of this article. Funds shall be
deposited in the following amounts:
S. 2809--D 23 A. 4009--D
(i) fifty-seven and thirty-three-hundredths percent of the funds accu-
mulated for the period January first, nineteen hundred ninety-seven
through December thirty-first, nineteen hundred ninety-seven,
(ii) fifty-seven and one-hundredths percent of the funds accumulated
for the period January first, nineteen hundred ninety-eight through
December thirty-first, nineteen hundred ninety-eight,
(iii) fifty-five and thirty-two-hundredths percent of the funds accu-
mulated for the period January first, nineteen hundred ninety-nine
through December thirty-first, nineteen hundred ninety-nine, and
(iv) seven hundred sixty-five million dollars annually of the funds
accumulated for the periods January first, two thousand through December
thirty-first, two thousand [ten] THIRTEEN, and
(v) one hundred ninety-one million two hundred fifty thousand dollars
of the funds accumulated for the period January first, two thousand
[eleven] FOURTEEN through March thirty-first, two thousand [eleven]
FOURTEEN.
S 4. Section 34 of part A3 of chapter 62 of the laws of 2003, amending
the general business law and other laws relating to enacting major
components necessary to implement the state fiscal plan for the 2003-04
state fiscal year, as amended by section 3 of part B of chapter 58 of
the laws of 2008, is amended to read as follows:
S 34. (1) Notwithstanding any inconsistent provision of law, rule or
regulation and effective April 1, 2008 through March 31, [2011] 2014,
the commissioner of health is authorized to transfer and the state comp-
troller is authorized and directed to receive for deposit to the credit
of the department of health's special revenue fund - other, health care
reform act (HCRA) resources fund - 061, provider collection monitoring
account, within amounts appropriated each year, those funds collected
and accumulated pursuant to section 2807-v of the public health law,
including income from invested funds, for the purpose of payment for
administrative costs of the department of health related to adminis-
tration of statutory duties for the collections and distributions
authorized by section 2807-v of the public health law.
(2) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the state comp-
troller is authorized and directed to receive for deposit to the credit
of the department of health's special revenue fund - other, health care
reform act (HCRA) resources fund - 061, provider collection monitoring
account, within amounts appropriated each year, those funds collected
and accumulated and interest earned through surcharges on payments for
health care services pursuant to section 2807-s of the public health law
and from assessments pursuant to section 2807-t of the public health law
for the purpose of payment for administrative costs of the department of
health related to administration of statutory duties for the collections
and distributions authorized by sections 2807-s, 2807-t, and 2807-m of
the public health law.
(3) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with the provisions of
paragraph (a) of subdivision 1 of section 2807-l of the public health
law for the purposes of payment for administrative costs of the depart-
ment of health related to the child health insurance plan program
authorized pursuant to title 1-A of article 25 of the public health law
S. 2809--D 24 A. 4009--D
into the special revenue funds - other, health care reform act (HCRA)
resources fund - 061, child health insurance account, established within
the department of health.
(4) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with the provisions of
paragraph (e) of subdivision 1 of section 2807-l of the public health
law for the purpose of payment for administrative costs of the depart-
ment of health related to the health occupation development and work-
place demonstration program established pursuant to section 2807-h and
the health workforce retraining program established pursuant to section
2807-g of the public health law into the special revenue funds - other,
health care reform act (HCRA) resources fund - 061, health occupation
development and workplace demonstration program account, established
within the department of health.
(5) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds allocated pursuant to paragraph (j) of subdivision 1 of section
2807-v of the public health law for the purpose of payment for adminis-
trative costs of the department of health related to administration of
the state's tobacco control programs and cancer services provided pursu-
ant to sections 2807-r and 1399-ii of the public health law into such
accounts established within the department of health for such purposes.
(6) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, the funds
authorized for distribution in accordance with the provisions of section
2807-l of the public health law for the purposes of payment for adminis-
trative costs of the department of health related to the programs funded
pursuant to section 2807-l of the public health law into the special
revenue funds - other, health care reform act (HCRA) resources fund -
061, pilot health insurance account, established within the department
of health.
(7) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with the provisions of
subparagraph (ii) of paragraph (f) of subdivision 19 of section 2807-c
of the public health law from monies accumulated and interest earned in
the bad debt and charity care and capital statewide pools through an
assessment charged to general hospitals pursuant to the provisions of
subdivision 18 of section 2807-c of the public health law and those
funds authorized for distribution in accordance with the provisions of
section 2807-l of the public health law for the purposes of payment for
administrative costs of the department of health related to programs
funded under section 2807-l of the public health law into the special
revenue funds - other, health care reform act (HCRA) resources fund -
061, primary care initiatives account, established within the department
of health.
S. 2809--D 25 A. 4009--D
(8) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with section 2807-l of
the public health law for the purposes of payment for administrative
costs of the department of health related to programs funded under
section 2807-l of the public health law into the special revenue funds -
other, health care reform act (HCRA) resources fund - 061, health care
delivery administration account, established within the department of
health.
(9) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2011] 2014, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized pursuant to sections 2807-d, 3614-a and 3614-b of the
public health law and section 367-i of the social services law and for
distribution in accordance with the provisions of subdivision 9 of
section 2807-j of the public health law for the purpose of payment for
administration of statutory duties for the collections and distributions
authorized by sections 2807-c, 2807-d, 2807-j, 2807-k, 2807-l, 3614-a
and 3614-b of the public health law and section 367-i of the social
services law into the special revenue funds - other, health care reform
act (HCRA) resources fund - 061, provider collection monitoring account,
established within the department of health.
S 5. Subparagraphs (xiv) and (xv) of paragraph (a) of subdivision 6 of
section 2807-s of the public health law, as amended by section 4 of part
I of chapter 2 of the laws of 2009, are amended to read as follows:
(xiv) A gross annual statewide amount for the period January first,
two thousand nine through December thirty-first, two thousand [ten]
THIRTEEN, shall be nine hundred [thirty-nine] FORTY-FOUR million
dollars.
(xv) A gross statewide amount for the period January first, two thou-
sand [eleven] FOURTEEN through March thirty-first, two thousand [eleven]
FOURTEEN, shall be two hundred [thirty-four] THIRTY-SIX million [seven
hundred fifty thousand] dollars.
S 5-a. Subparagraphs (iv) and (v) of paragraph (c) of subdivision 6 of
section 2807-s of the public health law, as amended by section 12 of
part B of chapter 58 of the laws of 2008, are amended to read as
follows:
(iv) A further gross annual statewide amount for two thousand, two
thousand one, two thousand two, two thousand three, two thousand four,
two thousand five, two thousand six, two thousand seven, two thousand
eight, two thousand nine [and], two thousand ten, TWO THOUSAND ELEVEN,
TWO THOUSAND TWELVE AND TWO THOUSAND THIRTEEN shall be eighty-nine
million dollars.
(v) A further gross statewide amount for the period January first, two
thousand [eleven] FOURTEEN through March thirty-first, two thousand
[eleven] FOURTEEN, shall be twenty-two million two hundred fifty thou-
sand dollars.
S 5-b. Subparagraphs (i) and (ii) of paragraph (e) of subdivision 6 of
section 2807-s of the public health law, as amended by section 13 of
part B of chapter 58 of the laws of 2008, are amended to read as
follows:
S. 2809--D 26 A. 4009--D
(i) A further gross annual statewide amount shall be twelve million
dollars for each period prior to January first, two thousand [eleven]
FOURTEEN.
(ii) A further gross statewide amount for the period January first,
two thousand [eleven] FOURTEEN through March thirty-first, two thousand
[eleven] FOURTEEN shall be three million dollars.
S 6. Intentionally omitted.
S 7. Section 2807-l of the public health law, as amended by section 4
of part B of chapter 58 of the laws of 2008, clause (A) of subparagraph
(i) of paragraph (b) of subdivision 1 as amended by section 51 of part B
and paragraph (n) of subdivision 1 as amended by section 9 of part C of
chapter 58 of the laws of 2009, subparagraph (iv) of paragraph (c) of
subdivision 1 as amended by section 13 of part B of chapter 109 of the
laws of 2010, is amended to read as follows:
S 2807-l. Health care initiatives pool distributions. 1. Funds accumu-
lated in the health care initiatives pools pursuant to paragraph (b) of
subdivision nine of section twenty-eight hundred seven-j of this arti-
cle, or the health care reform act (HCRA) resources fund established
pursuant to section ninety-two-dd of the state finance law, whichever is
applicable, including income from invested funds, shall be distributed
or retained by the commissioner or by the state comptroller, as applica-
ble, in accordance with the following.
(a) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions to programs to provide health care coverage for unin-
sured or underinsured children pursuant to sections twenty-five hundred
ten and twenty-five hundred eleven of this chapter from the respective
health care initiatives pools established for the following periods in
the following amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
up to one hundred twenty million six hundred thousand dollars;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, up to one hundred sixty-four million five hundred thousand
dollars;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
up to one hundred eighty-one million dollars;
(iv) from the pool for the period January first, two thousand through
December thirty-first, two thousand, two hundred seven million dollars;
(v) from the pool for the period January first, two thousand one
through December thirty-first, two thousand one, two hundred thirty-five
million dollars;
(vi) from the pool for the period January first, two thousand two
through December thirty-first, two thousand two, three hundred twenty-
four million dollars;
(vii) from the pool for the period January first, two thousand three
through December thirty-first, two thousand three, up to four hundred
fifty million three hundred thousand dollars;
(viii) from the pool for the period January first, two thousand four
through December thirty-first, two thousand four, up to four hundred
sixty million nine hundred thousand dollars;
(ix) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period January first, two thou-
S. 2809--D 27 A. 4009--D
sand five through December thirty-first, two thousand five, up to one
hundred fifty-three million eight hundred thousand dollars;
(x) from the health care reform act (HCRA) resources fund for the
period January first, two thousand six through December thirty-first,
two thousand six, up to three hundred twenty-five million four hundred
thousand dollars;
(xi) from the health care reform act (HCRA) resources fund for the
period January first, two thousand seven through December thirty-first,
two thousand seven, up to four hundred twenty-eight million fifty-nine
thousand dollars;
(xii) from the health care reform act (HCRA) resources fund for the
period January first, two thousand eight through December thirty-first,
two thousand ten, up to four hundred fifty-three million six hundred
seventy-four thousand dollars annually; [and]
(xiii) from the health care reform act (HCRA) resources fund for the
period January first, two thousand eleven, through March thirty-first,
two thousand eleven, up to one hundred thirteen million four hundred
eighteen thousand dollars[.];
(XIV) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN, THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND TWELVE, UP TO THREE HUNDRED TWENTY-FOUR MILLION SEVEN HUNDRED
FORTY-FOUR THOUSAND DOLLARS;
(XV) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR THE
PERIOD APRIL FIRST, TWO THOUSAND TWELVE, THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND THIRTEEN, UP TO THREE HUNDRED FORTY-SIX MILLION FOUR HUNDRED
FORTY-FOUR THOUSAND DOLLARS; AND
(XVI) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR THE
PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN, THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND FOURTEEN, UP TO THREE HUNDRED SEVENTY MILLION SIX HUNDRED
NINETY-FIVE THOUSAND DOLLARS.
(b) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions for health insurance programs under the individual
subsidy programs established pursuant to the expanded health care cover-
age act of nineteen hundred eighty-eight as amended, and for evaluation
of such programs from the respective health care initiatives pools or
the health care reform act (HCRA) resources fund, whichever is applica-
ble, established for the following periods in the following amounts:
(i) (A) an amount not to exceed six million dollars on an annualized
basis for the periods January first, nineteen hundred ninety-seven
through December thirty-first, nineteen hundred ninety-nine; up to six
million dollars for the period January first, two thousand through
December thirty-first, two thousand; up to five million dollars for the
period January first, two thousand one through December thirty-first,
two thousand one; up to four million dollars for the period January
first, two thousand two through December thirty-first, two thousand two;
up to two million six hundred thousand dollars for the period January
first, two thousand three through December thirty-first, two thousand
three; up to one million three hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four; up to six hundred seventy thousand dollars for the period
January first, two thousand five through June thirtieth, two thousand
five; up to one million three hundred thousand dollars for the period
April first, two thousand six through March thirty-first, two thousand
seven; and up to one million three hundred thousand dollars annually for
the period April first, two thousand seven through March thirty-first,
S. 2809--D 28 A. 4009--D
two thousand nine, shall be allocated to individual subsidy programs;
and
(B) an amount not to exceed seven million dollars on an annualized
basis for the periods during the period January first, nineteen hundred
ninety-seven through December thirty-first, nineteen hundred ninety-nine
and four million dollars annually for the periods January first, two
thousand through December thirty-first, two thousand two, and three
million dollars for the period January first, two thousand three through
December thirty-first, two thousand three, and two million dollars for
the period January first, two thousand four through December thirty-
first, two thousand four, and two million dollars for the period January
first, two thousand five through June thirtieth, two thousand five shall
be allocated to the catastrophic health care expense program.
(ii) Notwithstanding any law to the contrary, the characterizations of
the New York state small business health insurance partnership program
as in effect prior to June thirtieth, two thousand three, voucher
program as in effect prior to December thirty-first, two thousand one,
individual subsidy program as in effect prior to June thirtieth, two
thousand five, and catastrophic health care expense program, as in
effect prior to June thirtieth, two thousand five, may, for the purposes
of identifying matching funds for the community health care conversion
demonstration project described in a waiver of the provisions of title
XIX of the federal social security act granted to the state of New York
and dated July fifteenth, nineteen hundred ninety-seven, may continue to
be used to characterize the insurance programs in sections four thousand
three hundred twenty-one-a, four thousand three hundred twenty-two-a,
four thousand three hundred twenty-six and four thousand three hundred
twenty-seven of the insurance law, which are successor programs to these
programs.
(c) Up to seventy-eight million dollars shall be reserved and accumu-
lated from year to year from the pool for the period January first,
nineteen hundred ninety-seven through December thirty-first, nineteen
hundred ninety-seven, for purposes of public health programs, up to
seventy-six million dollars shall be reserved and accumulated from year
to year from the pools for the periods January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight and January first, nineteen hundred ninety-nine through December
thirty-first, nineteen hundred ninety-nine, up to eighty-four million
dollars shall be reserved and accumulated from year to year from the
pools for the period January first, two thousand through December thir-
ty-first, two thousand, up to eighty-five million dollars shall be
reserved and accumulated from year to year from the pools for the period
January first, two thousand one through December thirty-first, two thou-
sand one, up to eighty-six million dollars shall be reserved and accumu-
lated from year to year from the pools for the period January first, two
thousand two through December thirty-first, two thousand two, up to
eighty-six million one hundred fifty thousand dollars shall be reserved
and accumulated from year to year from the pools for the period January
first, two thousand three through December thirty-first, two thousand
three, up to fifty-eight million seven hundred eighty thousand dollars
shall be reserved and accumulated from year to year from the pools for
the period January first, two thousand four through December thirty-
first, two thousand four, up to sixty-eight million seven hundred thirty
thousand dollars shall be reserved and accumulated from year to year
from the pools or the health care reform act (HCRA) resources fund,
whichever is applicable, for the period January first, two thousand five
S. 2809--D 29 A. 4009--D
through December thirty-first, two thousand five, up to ninety-four
million three hundred fifty thousand dollars shall be reserved and accu-
mulated from year to year from the health care reform act (HCRA)
resources fund for the period January first, two thousand six through
December thirty-first, two thousand six, up to seventy million nine
hundred thirty-nine thousand dollars shall be reserved and accumulated
from year to year from the health care reform act (HCRA) resources fund
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven, up to fifty-five million six hundred
eighty-nine thousand dollars annually shall be reserved and accumulated
from year to year from the health care reform act (HCRA) resources fund
for the period January first, two thousand eight through December thir-
ty-first, two thousand ten, [and] up to thirteen million nine hundred
twenty-two thousand dollars shall be reserved and accumulated from year
to year from the health care reform act (HCRA) resources fund for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven, AND FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOU-
SAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, UP TO
FUNDING AMOUNTS SPECIFIED BELOW and shall be available, including income
from invested funds, for:
(i) deposit by the commissioner, within amounts appropriated, and the
state comptroller is hereby authorized and directed to receive for
deposit to, to the credit of the department of health's special revenue
fund - other, hospital based grants program account or the health care
reform act (HCRA) resources fund, whichever is applicable, for purposes
of services and expenses related to general hospital based grant
programs, up to twenty-two million dollars annually from the nineteen
hundred ninety-seven pool, nineteen hundred ninety-eight pool, nineteen
hundred ninety-nine pool, two thousand pool, two thousand one pool and
two thousand two pool, respectively, up to twenty-two million dollars
from the two thousand three pool, up to ten million dollars for the
period January first, two thousand four through December thirty-first,
two thousand four, up to eleven million dollars for the period January
first, two thousand five through December thirty-first, two thousand
five, up to twenty-two million dollars for the period January first, two
thousand six through December thirty-first, two thousand six, up to
twenty-two million ninety-seven thousand dollars annually for the period
January first, two thousand seven through December thirty-first, two
thousand ten, [and] up to five million five hundred twenty-four thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, UP TO THIRTEEN MILLION FOUR HUNDRED
FORTY-FIVE THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND
ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, AND UP TO THIR-
TEEN MILLION THREE HUNDRED SEVENTY-FIVE THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN;
(ii) deposit by the commissioner, within amounts appropriated, and the
state comptroller is hereby authorized and directed to receive for
deposit to, to the credit of the emergency medical services training
account established in section ninety-seven-q of the state finance law
or the health care reform act (HCRA) resources fund, whichever is appli-
cable, up to sixteen million dollars on an annualized basis for the
periods January first, nineteen hundred ninety-seven through December
thirty-first, nineteen hundred ninety-nine, up to twenty million dollars
for the period January first, two thousand through December thirty-
first, two thousand, up to twenty-one million dollars for the period
S. 2809--D 30 A. 4009--D
January first, two thousand one through December thirty-first, two thou-
sand one, up to twenty-two million dollars for the period January first,
two thousand two through December thirty-first, two thousand two, up to
twenty-two million five hundred fifty thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three, up to nine million six hundred eighty thousand dollars
for the period January first, two thousand four through December thir-
ty-first, two thousand four, up to twelve million one hundred thirty
thousand dollars for the period January first, two thousand five through
December thirty-first, two thousand five, up to twenty-four million two
hundred fifty thousand dollars for the period January first, two thou-
sand six through December thirty-first, two thousand six, up to twenty
million four hundred ninety-two thousand dollars annually for the period
January first, two thousand seven through December thirty-first, two
thousand ten, [and] up to five million one hundred twenty-three thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, UP TO EIGHTEEN MILLION THREE HUNDRED
FIFTY THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, UP TO EIGHTEEN MILLION
NINE HUNDRED FIFTY THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO
THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND
UP TO NINETEEN MILLION FOUR HUNDRED NINETEEN THOUSAND DOLLARS FOR THE
PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND FOURTEEN;
(iii) priority distributions by the commissioner up to thirty-two
million dollars on an annualized basis for the period January first, two
thousand through December thirty-first, two thousand four, up to thir-
ty-eight million dollars on an annualized basis for the period January
first, two thousand five through December thirty-first, two thousand
six, up to eighteen million two hundred fifty thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven, up to three million dollars annually for the period
January first, two thousand eight through December thirty-first, two
thousand ten, [and] up to seven hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven, AND UP TO TWO MILLION NINE HUNDRED THOUSAND DOLLARS
EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN to be allocated (A)
for the purposes established pursuant to subparagraph (ii) of paragraph
(f) of subdivision nineteen of section twenty-eight hundred seven-c of
this article as in effect on December thirty-first, nineteen hundred
ninety-six and as may thereafter be amended, up to fifteen million
dollars annually for the periods January first, two thousand through
December thirty-first, two thousand four, up to twenty-one million
dollars annually for the period January first, two thousand five through
December thirty-first, two thousand six, and up to seven million five
hundred thousand dollars for the period January first, two thousand
seven through March thirty-first, two thousand seven;
(B) pursuant to a memorandum of understanding entered into by the
commissioner, the majority leader of the senate and the speaker of the
assembly, for the purposes outlined in such memorandum upon the recom-
mendation of the majority leader of the senate, up to eight million
five hundred thousand dollars annually for the period January first, two
thousand through December thirty-first, two thousand six, and up to four
million two hundred fifty thousand dollars for the period January first,
two thousand seven through June thirtieth, two thousand seven, and for
S. 2809--D 31 A. 4009--D
the purposes outlined in such memorandum upon the recommendation of the
speaker of the assembly, up to eight million five hundred thousand
dollars annually for the periods January first, two thousand through
December thirty-first, two thousand six, and up to four million two
hundred fifty thousand dollars for the period January first, two thou-
sand seven through June thirtieth, two thousand seven; and
(C) for services and expenses, including grants, related to emergency
assistance distributions as designated by the commissioner. Notwith-
standing section one hundred twelve or one hundred sixty-three of the
state finance law or any other contrary provision of law, such distrib-
utions shall be limited to providers or programs where, as determined by
the commissioner, emergency assistance is vital to protect the life or
safety of patients, to ensure the retention of facility caregivers or
other staff, or in instances where health facility operations are jeop-
ardized, or where the public health is jeopardized or other emergency
situations exist, up to three million dollars annually for the period
April first, two thousand seven through March thirty-first, two thousand
eleven, AND UP TO TWO MILLION NINE HUNDRED THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN. Upon any distribution of
such funds, the commissioner shall immediately notify the chair and
ranking minority member of the senate finance committee, the assembly
ways and means committee, the senate committee on health, and the assem-
bly committee on health;
(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 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 seven
hundred seventy-five thousand dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven, AND UP
TO TWO MILLION FIVE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR
THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND FOURTEEN; and
(v) deposit by the commissioner, within amounts appropriated, and the
state comptroller is hereby authorized and directed to receive for
deposit to, to the credit of the department of health's special revenue
fund - other, miscellaneous special revenue fund - 339 maternal and
child HIV services account or the health care reform act (HCRA)
resources fund, whichever is applicable, for purposes of a special
program for HIV services for [infants and pregnant] women AND CHILDREN,
INCLUDING ADOLESCENTS pursuant to section [seventy-one of chapter seven
hundred thirty-one of the laws of nineteen hundred ninety-three, amend-
S. 2809--D 32 A. 4009--D
ing] TWENTY-FIVE HUNDRED-F-ONE OF the public health law [and other laws
relating to reimbursement, delivery and capital costs of ambulatory
health care services and inpatient hospital services], up to five
million dollars annually for the periods January first, two thousand
through December thirty-first, two thousand two, up to five million
dollars for the period January first, two thousand three through Decem-
ber thirty-first, two thousand three, up to two million five hundred
thousand dollars for the period January first, two thousand four through
December thirty-first, two thousand four, up to two million five hundred
thousand dollars for the period January first, two thousand five through
December thirty-first, two thousand five, up to five million dollars for
the period January first, two thousand six through December thirty-
first, two thousand six, up to five million dollars annually for the
period January first, two thousand seven through December thirty-first,
two thousand ten, [and] up to one million two hundred fifty thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, AND UP TO FIVE MILLION DOLLARS EACH
STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN;
(d) (i) An amount of up to twenty million dollars annually for the
period January first, two thousand through December thirty-first, two
thousand six, up to ten million dollars for the period January first,
two thousand seven through June thirtieth, two thousand seven, up to
twenty million dollars annually for the period January first, two thou-
sand eight through December thirty-first, two thousand ten, [and] up to
five million dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, AND UP TO NINETEEN
MILLION SIX HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND FOURTEEN, shall be transferred to the health facility restruc-
turing pool established pursuant to section twenty-eight hundred fifteen
of this article;
(ii) provided, however, amounts transferred pursuant to subparagraph
(i) of this paragraph may be reduced in an amount to be approved by the
director of the budget to reflect the amount received from the federal
government under the state's 1115 waiver which is directed under its
terms and conditions to the health facility restructuring program.
(e) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions to organizations to support the health workforce
retraining program established pursuant to section twenty-eight hundred
seven-g of this article from the respective health care initiatives
pools established for the following periods in the following amounts
from the pools or the health care reform act (HCRA) resources fund,
whichever is applicable, during the period January first, nineteen
hundred ninety-seven through December thirty-first, nineteen hundred
ninety-nine, up to fifty million dollars on an annualized basis, up to
thirty million dollars for the period January first, two thousand
through December thirty-first, two thousand, up to forty million dollars
for the period January first, two thousand one through December thirty-
first, two thousand one, up to fifty million dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two, up to forty-one million one hundred fifty thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three, up to forty-one million one hundred fifty
thousand dollars for the period January first, two thousand four through
S. 2809--D 33 A. 4009--D
December thirty-first, two thousand four, up to fifty-eight million
three hundred sixty thousand dollars for the period January first, two
thousand five through December thirty-first, two thousand five, up to
fifty-two million three hundred sixty thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six, up to thirty-five million four hundred thousand dollars annu-
ally for the period January first, two thousand seven through December
thirty-first, two thousand ten [and], up to eight million eight hundred
fifty thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, AND UP TO TWENTY-EIGHT
MILLION FOUR HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND FOURTEEN, less the amount of funds available for allocations
for rate adjustments for workforce training programs for payments by
state governmental agencies for inpatient hospital services.
(f) Funds shall be accumulated and transferred from as follows:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
(A) thirty-four million six hundred thousand dollars shall be trans-
ferred to funds reserved and accumulated pursuant to paragraph (b) of
subdivision nineteen of section twenty-eight hundred seven-c of this
article, and (B) eighty-two million dollars shall be transferred and
deposited and credited to the credit of the state general fund medical
assistance local assistance account;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, eighty-two million dollars shall be transferred and deposited and
credited to the credit of the state general fund medical assistance
local assistance account;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
eighty-two million dollars shall be transferred and deposited and cred-
ited to the credit of the state general fund medical assistance local
assistance account;
(iv) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period January first, two thou-
sand through December thirty-first, two thousand four, eighty-two
million dollars annually, and for the period January first, two thousand
five through December thirty-first, two thousand five, eighty-two
million dollars, and for the period January first, two thousand six
through December thirty-first, two thousand six, eighty-two million
dollars, and for the period January first, two thousand seven through
December thirty-first, two thousand seven, eighty-two million dollars,
and for the period January first, two thousand eight through December
thirty-first, two thousand eight, ninety million seven hundred thousand
dollars shall be deposited by the commissioner, and the state comp-
troller is hereby authorized and directed to receive for deposit to the
credit of the state special revenue fund - other, HCRA transfer fund,
medical assistance account;
(v) from the health care reform act (HCRA) resources fund for the
period January first, two thousand nine through December thirty-first,
two thousand nine, one hundred eight million nine hundred seventy-five
thousand dollars, and for the period January first, two thousand ten
through December thirty-first, two thousand ten, one hundred twenty-six
million one hundred thousand dollars, [and] for the period January
first, two thousand eleven through March thirty-first, two thousand
S. 2809--D 34 A. 4009--D
eleven, twenty million five hundred thousand dollars, AND FOR EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, ONE HUNDRED FORTY-SIX MILLION
FOUR HUNDRED THOUSAND DOLLARS, shall be deposited by the commissioner,
and the state comptroller is hereby authorized and directed to receive
for deposit, to the credit of the state special revenue fund - other,
HCRA transfer fund, medical assistance account.
(g) Funds shall be transferred to primary health care services pools
created by the commissioner, and shall be available, including income
from invested funds, for distributions in accordance with former section
twenty-eight hundred seven-bb of this article from the respective health
care initiatives pools for the following periods in the following
percentage amounts of funds remaining after allocations in accordance
with paragraphs (a) through (f) of this subdivision:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
fifteen and eighty-seven-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, fifteen and eighty-seven-hundredths percent; and
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
sixteen and thirteen-hundredths percent.
(h) Funds shall be reserved and accumulated from year to year by the
commissioner and shall be available, including income from invested
funds, for purposes of primary care education and training pursuant to
article nine of this chapter from the respective health care initiatives
pools established for the following periods in the following percentage
amounts of funds remaining after allocations in accordance with para-
graphs (a) through (f) of this subdivision and shall be available for
distributions as follows:
(i) funds shall be reserved and accumulated:
(A) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
six and thirty-five-hundredths percent;
(B) from the pool for the period January first, nineteen hundred nine-
ty-eight through December thirty-first, nineteen hundred ninety-eight,
six and thirty-five-hundredths percent; and
(C) from the pool for the period January first, nineteen hundred nine-
ty-nine through December thirty-first, nineteen hundred ninety-nine, six
and forty-five-hundredths percent;
(ii) funds shall be available for distributions including income from
invested funds as follows:
(A) for purposes of the primary care physician loan repayment program
in accordance with section nine hundred three of this chapter, up to
five million dollars on an annualized basis;
(B) for purposes of the primary care practitioner scholarship program
in accordance with section nine hundred four of this chapter, up to two
million dollars on an annualized basis;
(C) for purposes of minority participation in medical education grants
in accordance with section nine hundred six of this chapter, up to one
million dollars on an annualized basis; and
(D) provided, however, that the commissioner may reallocate any funds
remaining or unallocated for distributions for the primary care practi-
tioner scholarship program in accordance with section nine hundred four
of this chapter.
S. 2809--D 35 A. 4009--D
(i) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for distrib-
utions in accordance with section twenty-nine hundred fifty-two and
section twenty-nine hundred fifty-eight of this chapter for rural health
care delivery development and rural health care access development,
respectively, from the respective health care initiatives pools or the
health care reform act (HCRA) resources fund, whichever is applicable,
for the following periods in the following percentage amounts of funds
remaining after allocations in accordance with paragraphs (a) through
(f) of this subdivision, and for periods on and after January first, two
thousand, in the following amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
thirteen and forty-nine-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, thirteen and forty-nine-hundredths percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
thirteen and seventy-one-hundredths percent;
(iv) from the pool for the periods January first, two thousand through
December thirty-first, two thousand two, seventeen million dollars annu-
ally, and for the period January first, two thousand three through
December thirty-first, two thousand three, up to fifteen million eight
hundred fifty thousand dollars;
(v) from the pool or the health care reform act (HCRA) resources fund,
whichever is applicable, for the period January first, two thousand four
through December thirty-first, two thousand four, up to fifteen million
eight hundred fifty thousand dollars, and for the period January first,
two thousand five through December thirty-first, two thousand five, up
to nineteen million two hundred thousand dollars, and for the period
January first, two thousand six through December thirty-first, two thou-
sand six, up to nineteen million two hundred thousand dollars, for the
period January first, two thousand seven through December thirty-first,
two thousand ten, up to eighteen million one hundred fifty thousand
dollars annually, [and] for the period January first, two thousand elev-
en through March thirty-first, two thousand eleven, up to four million
five hundred thirty-eight thousand dollars, AND FOR EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN, UP TO SIXTEEN MILLION TWO HUNDRED THOU-
SAND DOLLARS.
(j) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions related to health information and health care quality
improvement pursuant to former section twenty-eight hundred seven-n of
this article from the respective health care initiatives pools estab-
lished for the following periods in the following percentage amounts of
funds remaining after allocations in accordance with paragraphs (a)
through (f) of this subdivision:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
six and thirty-five-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, six and thirty-five-hundredths percent; and
S. 2809--D 36 A. 4009--D
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
six and forty-five-hundredths percent.
(k) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for allo-
cations and distributions in accordance with section twenty-eight
hundred seven-p of this article for diagnostic and treatment center
uncompensated care from the respective health care initiatives pools or
the health care reform act (HCRA) resources fund, whichever is applica-
ble, for the following periods in the following percentage amounts of
funds remaining after allocations in accordance with paragraphs (a)
through (f) of this subdivision, and for periods on and after January
first, two thousand, in the following amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
thirty-eight and one-tenth percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, thirty-eight and one-tenth percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
thirty-eight and seventy-one-hundredths percent;
(iv) from the pool for the periods January first, two thousand through
December thirty-first, two thousand two, forty-eight million dollars
annually, and for the period January first, two thousand three through
June thirtieth, two thousand three, twenty-four million dollars;
(v) (A) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period July first, two thousand
three through December thirty-first, two thousand three, up to six
million dollars, for the period January first, two thousand four through
December thirty-first, two thousand six, up to twelve million dollars
annually, for the period January first, two thousand seven through
December thirty-first, two thousand [ten] THIRTEEN, up to forty-eight
million dollars annually, and for the period January first, two thousand
[eleven] FOURTEEN through March thirty-first, two thousand [eleven]
FOURTEEN, up to twelve million dollars;
(B) from the health care reform act (HCRA) resources fund for the
period January first, two thousand six through December thirty-first,
two thousand six, an additional seven million five hundred thousand
dollars, for the period January first, two thousand seven through Decem-
ber thirty-first, two thousand [ten] THIRTEEN, an additional seven
million five hundred thousand dollars annually, and for the period Janu-
ary first, two thousand [eleven] FOURTEEN through March thirty-first,
two thousand [eleven] FOURTEEN, an additional one million eight hundred
seventy-five thousand dollars, for voluntary non-profit diagnostic and
treatment center uncompensated care in accordance with subdivision
four-c of section twenty-eight hundred seven-p of this article; and
(vi) funds reserved and accumulated pursuant to this paragraph for
periods on and after July first, two thousand three, shall be deposited
by the commissioner, within amounts appropriated, and the state comp-
troller is hereby authorized and directed to receive for deposit to the
credit of the state special revenue funds - other, HCRA transfer fund,
medical assistance account, for purposes of funding the state share of
rate adjustments made pursuant to section twenty-eight hundred seven-p
of this article, provided, however, that in the event federal financial
participation is not available for rate adjustments made pursuant to
S. 2809--D 37 A. 4009--D
paragraph (b) of subdivision one of section twenty-eight hundred seven-p
of this article, funds shall be distributed pursuant to paragraph (a) of
subdivision one of section twenty-eight hundred seven-p of this article
from the respective health care initiatives pools or the health care
reform act (HCRA) resources fund, whichever is applicable.
(l) Funds shall be reserved and accumulated from year to year by the
commissioner and shall be available, including income from invested
funds, for transfer to and allocation for services and expenses for the
payment of benefits to recipients of drugs under the AIDS drug assist-
ance program (ADAP) - HIV uninsured care program as administered by
Health Research Incorporated from the respective health care initi-
atives pools or the health care reform act (HCRA) resources fund, which-
ever is applicable, established for the following periods in the follow-
ing percentage amounts of funds remaining after allocations in
accordance with paragraphs (a) through (f) of this subdivision, and for
periods on and after January first, two thousand, in the following
amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
nine and fifty-two-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, nine and fifty-two-hundredths percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine and December thirty-first, nineteen hundred ninety-nine,
nine and sixty-eight-hundredths percent;
(iv) from the pool for the periods January first, two thousand through
December thirty-first, two thousand two, up to twelve million dollars
annually, and for the period January first, two thousand three through
December thirty-first, two thousand three, up to forty million dollars;
and
(v) from the pool or the health care reform act (HCRA) resources fund,
whichever is applicable, for the periods January first, two thousand
four through December thirty-first, two thousand four, up to fifty-six
million dollars, for the period January first, two thousand five through
December thirty-first, two thousand six, up to sixty million dollars
annually, for the period January first, two thousand seven through
December thirty-first, two thousand ten, up to sixty million dollars
annually, [and] for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, up to fifteen million
dollars, AND EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO
THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, UP TO
FORTY-TWO MILLION THREE HUNDRED THOUSAND DOLLARS.
(m) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions pursuant to section twenty-eight hundred seven-r of
this article for cancer related services from the respective health care
initiatives pools or the health care reform act (HCRA) resources fund,
whichever is applicable, established for the following periods in the
following percentage amounts of funds remaining after allocations in
accordance with paragraphs (a) through (f) of this subdivision, and for
periods on and after January first, two thousand, in the following
amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
seven and ninety-four-hundredths percent;
S. 2809--D 38 A. 4009--D
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, seven and ninety-four-hundredths percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine and December thirty-first, nineteen hundred ninety-nine, six
and forty-five-hundredths percent;
(iv) from the pool for the period January first, two thousand through
December thirty-first, two thousand two, up to ten million dollars on an
annual basis;
(v) from the pool for the period January first, two thousand three
through December thirty-first, two thousand four, up to eight million
nine hundred fifty thousand dollars on an annual basis;
(vi) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period January first, two thou-
sand five through December thirty-first, two thousand six, up to ten
million fifty thousand dollars on an annual basis, for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand ten, up to nineteen million dollars annually, and for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven, up to four million seven hundred fifty thousand dollars.
(n) Funds shall be accumulated and transferred from the health care
reform act (HCRA) resources fund as follows: for the period April first,
two thousand seven through March thirty-first, two thousand eight, and
on an annual basis for the periods April first, two thousand eight
through November thirtieth, two thousand nine, funds within amounts
appropriated shall be transferred and deposited and credited to the
credit of the state special revenue funds - other, HCRA transfer fund,
medical assistance account, for purposes of funding the state share of
rate adjustments made to public and voluntary hospitals in accordance
with paragraphs (i) and (j) of subdivision one of section twenty-eight
hundred seven-c of this article.
2. Notwithstanding any inconsistent provision of law, rule or regu-
lation, any funds accumulated in the health care initiatives pools
pursuant to paragraph (b) of subdivision nine of section twenty-eight
hundred seven-j of this article, as a result of surcharges, assessments
or other obligations during the periods January first, nineteen hundred
ninety-seven through December thirty-first, nineteen hundred ninety-
nine, which are unused or uncommitted for distributions pursuant to this
section shall be reserved and accumulated from year to year by the
commissioner and, within amounts appropriated, transferred and deposited
into the special revenue funds - other, miscellaneous special revenue
fund - 339, child health insurance account or any successor fund or
account, for purposes of distributions to implement the child health
insurance program established pursuant to sections twenty-five hundred
ten and twenty-five hundred eleven of this chapter for periods on and
after January first, two thousand one; provided, however, funds reserved
and accumulated for priority distributions pursuant to subparagraph
(iii) of paragraph (c) of subdivision one of this section shall not be
transferred and deposited into such account pursuant to this subdivi-
sion; and provided further, however, that any unused or uncommitted pool
funds accumulated and allocated pursuant to paragraph (j) of subdivision
one of this section shall be distributed for purposes of the health
information and quality improvement act of 2000.
3. Revenue from distributions pursuant to this section shall not be
included in gross revenue received for purposes of the assessments
pursuant to subdivision eighteen of section twenty-eight hundred seven-c
S. 2809--D 39 A. 4009--D
of this article, subject to the provisions of paragraph (e) of subdivi-
sion eighteen of section twenty-eight hundred seven-c of this article,
and shall not be included in gross revenue received for purposes of the
assessments pursuant to section twenty-eight hundred seven-d of this
article, subject to the provisions of subdivision twelve of section
twenty-eight hundred seven-d of this article.
S 8. 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, para-
graphs (g), (h), (i) and (i-1) as amended by section 5 of part I of
chapter 2 of the laws of 2009, subparagraphs (xi) and (xii) of paragraph
(j) as amended by section 12, paragraph (jj) as amended by section 10,
subparagraph (vii) of paragraph (qq) as amended by section 11 and
subparagraph (vii) of paragraph (uu) as amended by section 9 of part B
of chapter 109 of the laws of 2010, paragraph (s) as amended by section
8, paragraphs (x) and (y) as amended by section 6, paragraph (kk) as
amended by section 124, subparagraph (vi) of paragraph (uu) as amended
by section 120, paragraph (xx) as amended by section 10 and paragraphs
(ggg) and (hhh) as amended by section 7 of part C of chapter 58 of the
laws of 2009, is amended to read as follows:
1. Funds accumulated in the tobacco control and insurance initiatives
pool or in the health care reform act (HCRA) resources fund established
pursuant to section ninety-two-dd of the state finance law, whichever is
applicable, including income from invested funds, shall be distributed
or retained by the commissioner or by the state comptroller, as applica-
ble, in accordance with the following:
(a) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medicaid fraud hotline and
medicaid administration account, or any successor fund or account, for
purposes of services and expenses related to the toll-free medicaid
fraud hotline established pursuant to section one hundred eight of chap-
ter one of the laws of nineteen hundred ninety-nine from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts: four hundred thousand dollars annually
for the periods January first, two thousand through December thirty-
first, two thousand two, up to four hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three, up to four hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four, up to four hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five, up to four hundred thousand dollars for the period January first,
two thousand six through December thirty-first, two thousand six, up to
four hundred thousand dollars for the period January first, two thousand
seven through December thirty-first, two thousand seven, up to four
hundred thousand dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, up to four
hundred thousand dollars for the period January first, two thousand nine
through December thirty-first, two thousand nine, up to four hundred
thousand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten, [and] up to one hundred thou-
sand dollars for the period January first, two thousand eleven through
March thirty-first, two thousand eleven AND WITHIN AMOUNTS APPROPRIATED
ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN.
S. 2809--D 40 A. 4009--D
(b) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of payment of audits or audit contracts necessary to determine payor and
provider compliance with requirements set forth in sections twenty-eight
hundred seven-j, twenty-eight hundred seven-s and twenty-eight hundred
seven-t of this article [and hospital compliance with paragraph six of
subdivision (a) of section 405.4 of title 10 of the official compilation
of codes, rules and regulations of the state of New York in accordance
with subdivision nine of section twenty-eight hundred three of this
article] from the tobacco control and insurance initiatives pool estab-
lished for the following periods in the following amounts: five million
six hundred thousand dollars annually for the periods January first, two
thousand through December thirty-first, two thousand two, up to five
million dollars for the period January first, two thousand three through
December thirty-first, two thousand three, up to five million dollars
for the period January first, two thousand four through December thir-
ty-first, two thousand four, up to five million dollars for the period
January first, two thousand five through December thirty first, two
thousand five, up to five million dollars for the period January first,
two thousand six through December thirty-first, two thousand six, up to
seven million eight hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, and up to eight million three hundred twenty-five thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight, up to eight million five hundred
thousand dollars for the period January first, two thousand nine through
December thirty-first, two thousand nine, up to eight million five
hundred thousand dollars for the period January first, two thousand ten
through December thirty-first, two thousand ten, [and] up to two million
one hundred twenty-five thousand dollars for the period January first,
two thousand eleven through March thirty-first, two thousand eleven, AND
UP TO FOURTEEN MILLION SEVEN HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN.
(c) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, enhanced community services
account, or any successor fund or account, for mental health services
programs for case management services for adults and children; supported
housing; home and community based waiver services; family based treat-
ment; family support services; mobile mental health teams; transitional
housing; and community oversight, established pursuant to articles seven
and forty-one of the mental hygiene law and subdivision nine of section
three hundred sixty-six of the social services law; and for comprehen-
sive care centers for eating disorders pursuant to THE FORMER section
twenty-seven hundred ninety-nine-l of this chapter, provided however
that, for such centers, funds in the amount of five hundred thousand
dollars on an annualized basis shall be transferred from the enhanced
community services account, or any successor fund or account, and depos-
ited into the fund established by section ninety-five-e of the state
finance law; from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) forty-eight million dollars to be reserved, to be retained or for
distribution pursuant to a chapter of the laws of two thousand, for the
S. 2809--D 41 A. 4009--D
period January first, two thousand through December thirty-first, two
thousand;
(ii) eighty-seven million dollars to be reserved, to be retained or
for distribution pursuant to a chapter of the laws of two thousand one,
for the period January first, two thousand one through December thirty-
first, two thousand one;
(iii) eighty-seven million dollars to be reserved, to be retained or
for distribution pursuant to a chapter of the laws of two thousand two,
for the period January first, two thousand two through December thirty-
first, two thousand two;
(iv) eighty-eight million dollars to be reserved, to be retained or
for distribution pursuant to a chapter of the laws of two thousand
three, for the period January first, two thousand three through December
thirty-first, two thousand three;
(v) eighty-eight million dollars, plus five hundred thousand dollars,
to be reserved, to be retained or for distribution pursuant to a chapter
of the laws of two thousand four, and pursuant to THE FORMER section
twenty-seven hundred ninety-nine-l of this chapter, for the period Janu-
ary first, two thousand four through December thirty-first, two thousand
four;
(vi) eighty-eight million dollars, plus five hundred thousand dollars,
to be reserved, to be retained or for distribution pursuant to a chapter
of the laws of two thousand five, and pursuant to THE FORMER section
twenty-seven hundred ninety-nine-l of this chapter, for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(vii) eighty-eight million dollars, plus five hundred thousand
dollars, to be reserved, to be retained or for distribution pursuant to
a chapter of the laws of two thousand six, and pursuant to section twen-
ty-seven hundred ninety-nine-l of this chapter, for the period January
first, two thousand six through December thirty-first, two thousand six;
(viii) eighty-six million four hundred thousand dollars, plus five
hundred thousand dollars, to be reserved, to be retained or for distrib-
ution pursuant to a chapter of the laws of two thousand seven and pursu-
ant to THE FORMER section twenty-seven hundred ninety-nine-l of this
chapter, for the period January first, two thousand seven through Decem-
ber thirty-first, two thousand seven; and
(ix) twenty-two million nine hundred thirteen thousand dollars, plus
one hundred twenty-five thousand dollars, to be reserved, to be retained
or for distribution pursuant to a chapter of the laws of two thousand
eight and pursuant to THE FORMER section twenty-seven hundred ninety-
nine-l of this chapter, for the period January first, two thousand eight
through March thirty-first, two thousand eight.
(d) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of services and expenses related to the family health plus program
including up to two and one-half million dollars annually for the period
January first, two thousand through December thirty-first, two thousand
two, for administration and marketing costs associated with such program
established pursuant to clause (A) of subparagraph (v) of paragraph (a)
of subdivision two of section three hundred sixty-nine-ee of the social
services law from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
S. 2809--D 42 A. 4009--D
(i) three million five hundred thousand dollars for the period January
first, two thousand through December thirty-first, two thousand;
(ii) twenty-seven million dollars for the period January first, two
thousand one through December thirty-first, two thousand one; and
(iii) fifty-seven million dollars for the period January first, two
thousand two through December thirty-first, two thousand two.
(e) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of services and expenses related to the family health plus program
including up to two and one-half million dollars annually for the period
January first, two thousand through December thirty-first, two thousand
two for administration and marketing costs associated with such program
established pursuant to clause (B) of subparagraph (v) of paragraph (a)
of subdivision two of section three hundred sixty-nine-ee of the social
services law from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) two million five hundred thousand dollars for the period January
first, two thousand through December thirty-first, two thousand;
(ii) thirty million five hundred thousand dollars for the period Janu-
ary first, two thousand one through December thirty-first, two thousand
one; and
(iii) sixty-six million dollars for the period January first, two
thousand two through December thirty-first, two thousand two.
(f) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medicaid fraud hotline and
medicaid administration account, or any successor fund or account, for
purposes of payment of administrative expenses of the department related
to the family health plus program established pursuant to section three
hundred sixty-nine-ee of the social services law from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts: five hundred thousand dollars on an
annual basis for the periods January first, two thousand through Decem-
ber thirty-first, two thousand six, five hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven, and five hundred thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight, five hundred thousand dollars for the period January
first, two thousand nine through December thirty-first, two thousand
nine, five hundred thousand dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten, [and] one
hundred twenty-five thousand dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven AND
WITHIN AMOUNTS APPROPRIATED ON AND AFTER APRIL FIRST, TWO THOUSAND ELEV-
EN.
(g) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the health maintenance organization
direct pay market program established pursuant to sections forty-three
hundred twenty-one-a and forty-three hundred twenty-two-a of the insur-
ance law from the tobacco control and insurance initiatives pool estab-
lished for the following periods in the following amounts:
S. 2809--D 43 A. 4009--D
(i) up to thirty-five million dollars for the period January first,
two thousand through December thirty-first, two thousand of which fifty
percentum shall be allocated to the program pursuant to section four
thousand three hundred twenty-one-a of the insurance law and fifty
percentum to the program pursuant to section four thousand three hundred
twenty-two-a of the insurance law;
(ii) up to thirty-six million dollars for the period January first,
two thousand one through December thirty-first, two thousand one of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum to the program pursuant to section four thousand
three hundred twenty-two-a of the insurance law;
(iii) up to thirty-nine million dollars for the period January first,
two thousand two through December thirty-first, two thousand two of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum to the program pursuant to section four thousand
three hundred twenty-two-a of the insurance law;
(iv) up to forty million dollars for the period January first, two
thousand three through December thirty-first, two thousand three of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum to the program pursuant to section four thousand
three hundred twenty-two-a of the insurance law;
(v) up to forty million dollars for the period January first, two
thousand four through December thirty-first, two thousand four of which
fifty percentum shall be allocated to the program pursuant to section
four thousand three hundred twenty-one-a of the insurance law and fifty
percentum to the program pursuant to section four thousand three hundred
twenty-two-a of the insurance law;
(vi) up to forty million dollars for the period January first, two
thousand five through December thirty-first, two thousand five of which
fifty percentum shall be allocated to the program pursuant to section
four thousand three hundred twenty-one-a of the insurance law and fifty
percentum to the program pursuant to section four thousand three hundred
twenty-two-a of the insurance law;
(vii) up to forty million dollars for the period January first, two
thousand six through December thirty-first, two thousand six of which
fifty percentum shall be allocated to the program pursuant to section
four thousand three hundred twenty-one-a of the insurance law and fifty
percentum shall be allocated to the program pursuant to section four
thousand three hundred twenty-two-a of the insurance law;
(viii) up to forty million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-two-a of the insurance law;
and
(ix) up to forty million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight of
which fifty per centum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty per centum shall be allocated to the program pursuant to
section four thousand three hundred twenty-two-a of the insurance law.
S. 2809--D 44 A. 4009--D
(h) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the healthy New York individual
program established pursuant to sections four thousand three hundred
twenty-six and four thousand three hundred twenty-seven of the insurance
law from the tobacco control and insurance initiatives pool established
for the following periods in the following amounts:
(i) up to six million dollars for the period January first, two thou-
sand one through December thirty-first, two thousand one;
(ii) up to twenty-nine million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iii) up to five million one hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iv) up to twenty-four million six hundred thousand dollars for the
period January first, two thousand four through December thirty-first,
two thousand four;
(v) up to thirty-four million six hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand five;
(vi) up to fifty-four million eight hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six;
(vii) up to sixty-one million seven hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(viii) up to one hundred three million seven hundred fifty thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight.
(i) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the healthy New York group program
established pursuant to sections four thousand three hundred twenty-six
and four thousand three hundred twenty-seven of the insurance law from
the tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) up to thirty-four million dollars for the period January first,
two thousand one through December thirty-first, two thousand one;
(ii) up to seventy-seven million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iii) up to ten million five hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iv) up to twenty-four million six hundred thousand dollars for the
period January first, two thousand four through December thirty-first,
two thousand four;
(v) up to thirty-four million six hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand five;
(vi) up to fifty-four million eight hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six;
(vii) up to sixty-one million seven hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
S. 2809--D 45 A. 4009--D
(viii) up to one hundred three million seven hundred fifty thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight.
(i-1) Notwithstanding the provisions of paragraphs (h) and (i) of this
subdivision, the commissioner shall reserve and accumulate up to two
million five hundred thousand dollars annually for the periods January
first, two thousand four through December thirty-first, two thousand
six, one million four hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, two million dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, from funds
otherwise available for distribution under such paragraphs for the
services and expenses related to the pilot program for entertainment
industry employees included in subsection (b) of section one thousand
one hundred twenty-two of the insurance law, and an additional seven
hundred thousand dollars annually for the periods January first, two
thousand four through December thirty-first, two thousand six, an addi-
tional three hundred thousand dollars for the period January first, two
thousand seven through June thirtieth, two thousand seven for services
and expenses related to the pilot program for displaced workers included
in subsection (c) of section one thousand one hundred twenty-two of the
insurance law.
(j) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the tobacco use prevention and
control program established pursuant to sections thirteen hundred nine-
ty-nine-ii and thirteen hundred ninety-nine-jj of this chapter, from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) up to thirty million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to forty million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to forty million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
(iv) up to thirty-six million nine hundred fifty thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(v) up to thirty-six million nine hundred fifty thousand dollars for
the period January first, two thousand four through December thirty-
first, two thousand four;
(vi) up to forty million six hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(vii) up to eighty-one million nine hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six, provided, however, that within amounts appropriated, a
portion of such funds may be transferred to the Roswell Park Cancer
Institute Corporation to support costs associated with cancer research;
(viii) up to ninety-four million one hundred fifty thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven, provided, however, that within amounts
appropriated, a portion of such funds may be transferred to the Roswell
Park Cancer Institute Corporation to support costs associated with
cancer research;
S. 2809--D 46 A. 4009--D
(ix) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand eight through December thirty-
first, two thousand eight;
(x) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand nine through December thirty-
first, two thousand nine;
(xi) up to eighty-seven million seven hundred seventy-five thousand
dollars for the period January first, two thousand ten through December
thirty-first, two thousand ten; [and]
(xii) up to twenty-one million four hundred twelve thousand dollars
for the period January first, two thousand eleven through March thirty-
first, two thousand eleven[.]; AND
(XIII) UP TO FIFTY-TWO MILLION ONE HUNDRED THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(k) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, health care services account,
or any successor fund or account, for purposes of services and expenses
related to public health programs, including comprehensive care centers
for eating disorders pursuant to THE FORMER section twenty-seven hundred
ninety-nine-l of this chapter, provided however that, for such centers,
funds in the amount of five hundred thousand dollars on an annualized
basis shall be transferred from the health care services account, or any
successor fund or account, and deposited into the fund established by
section ninety-five-e of the state finance law FOR PERIODS PRIOR TO
MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, from the tobacco control and
insurance initiatives pool established for the following periods in the
following amounts:
(i) up to thirty-one million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to forty-one million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to eighty-one million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iv) one hundred twenty-two million five hundred thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(v) one hundred eight million five hundred seventy-five thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand four through December thirty-first, two
thousand four;
(vi) ninety-one million eight hundred thousand dollars, plus an addi-
tional five hundred thousand dollars, for the period January first, two
thousand five through December thirty-first, two thousand five;
(vii) one hundred fifty-six million six hundred thousand dollars, plus
an additional five hundred thousand dollars, for the period January
first, two thousand six through December thirty-first, two thousand six;
(viii) one hundred fifty-one million four hundred thousand dollars,
plus an additional five hundred thousand dollars, for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(ix) one hundred sixteen million nine hundred forty-nine thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
S. 2809--D 47 A. 4009--D
od January first, two thousand eight through December thirty-first, two
thousand eight;
(x) one hundred sixteen million nine hundred forty-nine thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand nine through December thirty-first, two
thousand nine;
(xi) one hundred sixteen million nine hundred forty-nine thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand ten through December thirty-first, two
thousand ten; [and]
(xii) twenty-nine million two hundred thirty-seven thousand two
hundred fifty dollars, plus an additional one hundred twenty-five thou-
sand dollars, for the period January first, two thousand eleven through
March thirty-first, two thousand eleven[.];
(XIII) ONE HUNDRED TWENTY MILLION THIRTY-EIGHT THOUSAND DOLLARS FOR
THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND TWELVE; AND
(XIV) ONE HUNDRED NINETEEN MILLION FOUR HUNDRED SEVEN THOUSAND DOLLARS
EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(l) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the personal care and certified home health agency rate or fee
increases established pursuant to subdivision three of section three
hundred sixty-seven-o of the social services law from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) twenty-three million two hundred thousand dollars for the period
January first, two thousand through December thirty-first, two thousand;
(ii) twenty-three million two hundred thousand dollars for the period
January first, two thousand one through December thirty-first, two thou-
sand one;
(iii) twenty-three million two hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(iv) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(v) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand four through December thirty-first,
two thousand four;
(vi) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand five;
(vii) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six;
(viii) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(ix) up to sixteen million three hundred thousand dollars for the
period January first, two thousand eight through March thirty-first, two
thousand eight.
S. 2809--D 48 A. 4009--D
(m) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of services and expenses related to home care workers insurance
pilot demonstration programs established pursuant to subdivision two of
section three hundred sixty-seven-o of the social services law from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) three million eight hundred thousand dollars for the period Janu-
ary first, two thousand through December thirty-first, two thousand;
(ii) three million eight hundred thousand dollars for the period Janu-
ary first, two thousand one through December thirty-first, two thousand
one;
(iii) three million eight hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(iv) up to three million eight hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(v) up to three million eight hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(vi) up to three million eight hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(vii) up to three million eight hundred thousand dollars for the peri-
od January first, two thousand six through December thirty-first, two
thousand six;
(viii) up to three million eight hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(ix) up to nine hundred fifty thousand dollars for the period January
first, two thousand eight through March thirty-first, two thousand
eight.
(n) Funds shall be transferred by the commissioner and shall be depos-
ited to the credit of the special revenue funds - other, miscellaneous
special revenue fund - 339, elderly pharmaceutical insurance coverage
program premium account authorized pursuant to the provisions of title
three of article two of the elder law, or any successor fund or account,
for funding state expenses relating to the program from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) one hundred seven million dollars for the period January first,
two thousand through December thirty-first, two thousand;
(ii) one hundred sixty-four million dollars for the period January
first, two thousand one through December thirty-first, two thousand one;
(iii) three hundred twenty-two million seven hundred thousand dollars
for the period January first, two thousand two through December thirty-
first, two thousand two;
(iv) four hundred thirty-three million three hundred thousand dollars
for the period January first, two thousand three through December thir-
ty-first, two thousand three;
S. 2809--D 49 A. 4009--D
(v) five hundred four million one hundred fifty thousand dollars for
the period January first, two thousand four through December thirty-
first, two thousand four;
(vi) five hundred sixty-six million eight hundred thousand dollars for
the period January first, two thousand five through December thirty-
first, two thousand five;
(vii) six hundred three million one hundred fifty thousand dollars for
the period January first, two thousand six through December thirty-
first, two thousand six;
(viii) six hundred sixty million eight hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven;
(ix) three hundred sixty-seven million four hundred sixty-three thou-
sand dollars for the period January first, two thousand eight through
December thirty-first, two thousand eight;
(x) three hundred thirty-four million eight hundred twenty-five thou-
sand dollars for the period January first, two thousand nine through
December thirty-first, two thousand nine;
(xi) three hundred forty-four million nine hundred thousand dollars
for the period January first, two thousand ten through December thirty-
first, two thousand ten; [and]
(xii) eighty-seven million seven hundred eighty-eight thousand dollars
for the period January first, two thousand eleven through March thirty-
first, two thousand eleven[.];
(XIII) ONE HUNDRED FORTY-THREE MILLION ONE HUNDRED FIFTY THOUSAND
DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWELVE;
(XIV) ONE HUNDRED TWENTY MILLION NINE HUNDRED FIFTY THOUSAND DOLLARS
FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN; AND
(XV) ONE HUNDRED TWENTY-EIGHT MILLION EIGHT HUNDRED FIFTY THOUSAND
DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(o) Funds shall be reserved and accumulated and shall be transferred
to the Roswell Park Cancer Institute Corporation, from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) up to ninety million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to sixty million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to eighty-five million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iv) eighty-five million two hundred fifty thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(v) seventy-eight million dollars for the period January first, two
thousand four through December thirty-first, two thousand four;
(vi) seventy-eight million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(vii) ninety-one million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(viii) seventy-eight million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(ix) seventy-eight million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
S. 2809--D 50 A. 4009--D
(x) seventy-eight million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(xi) seventy-eight million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; [and]
(xii) nineteen million five hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven[.]; AND
(XIII) SIXTY-NINE MILLION EIGHT HUNDRED FORTY THOUSAND DOLLARS EACH
STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(p) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, indigent care fund - 068, indigent care account,
or any successor fund or account, for purposes of providing a medicaid
disproportionate share payment from the high need indigent care adjust-
ment pool established pursuant to section twenty-eight hundred seven-w
of this article, from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) eighty-two million dollars annually for the periods January first,
two thousand through December thirty-first, two thousand two;
(ii) up to eighty-two million dollars for the period January first,
two thousand three through December thirty-first, two thousand three;
(iii) up to eighty-two million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(iv) up to eighty-two million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to eighty-two million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(vi) up to eighty-two million dollars for the period January first,
two thousand seven through December thirty-first, two thousand seven;
(vii) up to eighty-two million dollars for the period January first,
two thousand eight through December thirty-first, two thousand eight;
(viii) up to eighty-two million dollars for the period January first,
two thousand nine through December thirty-first, two thousand nine;
(ix) up to eighty-two million dollars for the period January first,
two thousand ten through December thirty-first, two thousand ten; [and]
(x) up to twenty million five hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven; AND
(XI) UP TO EIGHTY-TWO MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND FOURTEEN.
(q) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of providing distributions to eligible school based health centers
established pursuant to section eighty-eight of chapter one of the laws
of nineteen hundred ninety-nine, from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
(i) seven million dollars annually for the period January first, two
thousand through December thirty-first, two thousand two;
(ii) up to seven million dollars for the period January first, two
thousand three through December thirty-first, two thousand three;
(iii) up to seven million dollars for the period January first, two
thousand four through December thirty-first, two thousand four;
S. 2809--D 51 A. 4009--D
(iv) up to seven million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(v) up to seven million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(vi) up to seven million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(vii) up to seven million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(viii) up to seven million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(ix) up to seven million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; [and]
(x) up to one million seven hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven; AND
(XI) UP TO FIVE MILLION SIX HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN.
(r) Funds shall be deposited by the commissioner within amounts appro-
priated, and the state comptroller is hereby authorized and directed to
receive for deposit to the credit of the state special revenue funds -
other, HCRA transfer fund, medical assistance account, or any successor
fund or account, for purposes of providing distributions for supplemen-
tary medical insurance for Medicare part B premiums, physicians
services, outpatient services, medical equipment, supplies and other
health services, from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) forty-three million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) sixty-one million dollars for the period January first, two thou-
sand one through December thirty-first, two thousand one;
(iii) sixty-five million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
(iv) sixty-seven million five hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(v) sixty-eight million dollars for the period January first, two
thousand four through December thirty-first, two thousand four;
(vi) sixty-eight million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(vii) sixty-eight million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(viii) seventeen million five hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(ix) sixty-eight million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(x) sixty-eight million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(xi) sixty-eight million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; [and]
(xii) seventeen million dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven[.]; AND
(XIII) SIXTY-EIGHT MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND FOURTEEN.
S. 2809--D 52 A. 4009--D
(s) Funds shall be deposited by the commissioner within amounts appro-
priated, and the state comptroller is hereby authorized and directed to
receive for deposit to the credit of the state special revenue funds -
other, HCRA transfer fund, medical assistance account, or any successor
fund or account, for purposes of providing distributions pursuant to
paragraphs (s-5), (s-6), (s-7) and (s-8) of subdivision eleven of
section twenty-eight hundred seven-c of this article from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) eighteen million dollars for the period January first, two thou-
sand through December thirty-first, two thousand;
(ii) twenty-four million dollars annually for the periods January
first, two thousand one through December thirty-first, two thousand two;
(iii) up to twenty-four million dollars for the period January first,
two thousand three through December thirty-first, two thousand three;
(iv) up to twenty-four million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(v) up to twenty-four million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(vi) up to twenty-four million dollars for the period January first,
two thousand six through December thirty-first, two thousand six;
(vii) up to twenty-four million dollars for the period January first,
two thousand seven through December thirty-first, two thousand seven;
(viii) up to twenty-four million dollars for the period January first,
two thousand eight through December thirty-first, two thousand eight;
and
(ix) up to twenty-two million dollars for the period January first,
two thousand nine through November thirtieth, two thousand nine.
(t) Funds shall be reserved and accumulated from year to year by the
commissioner and shall be made available, including income from invested
funds:
(i) For the purpose of making grants to a state owned and operated
medical school which does not have a state owned and operated hospital
on site and available for teaching purposes. Notwithstanding sections
one hundred twelve and one hundred sixty-three of the state finance law,
such grants shall be made in the amount of up to five hundred thousand
dollars for the period January first, two thousand through December
thirty-first, two thousand;
(ii) For the purpose of making grants to medical schools pursuant to
section eighty-six-a of chapter one of the laws of nineteen hundred
ninety-nine in the sum of up to four million dollars for the period
January first, two thousand through December thirty-first, two thousand;
and
(iii) The funds disbursed pursuant to subparagraphs (i) and (ii) of
this paragraph from the tobacco control and insurance initiatives pool
are contingent upon meeting all funding amounts established pursuant to
paragraphs (a), (b), (c), (d), (e), (f), (l), (m), (n), (p), (q), (r)
and (s) of this subdivision, paragraph (a) of subdivision nine of
section twenty-eight hundred seven-j of this article, and paragraphs
(a), (i) and (k) of subdivision one of section twenty-eight hundred
seven-l of this article.
(u) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
S. 2809--D 53 A. 4009--D
share of services and expenses related to the nursing home quality
improvement demonstration program established pursuant to section twen-
ty-eight hundred eight-d of this article from the tobacco control and
insurance initiatives pool established for the following periods in the
following amounts:
(i) up to twenty-five million dollars for the period beginning April
first, two thousand two and ending December thirty-first, two thousand
two, and on an annualized basis, for each annual period thereafter
beginning January first, two thousand three and ending December thirty-
first, two thousand four;
(ii) up to eighteen million seven hundred fifty thousand dollars for
the period January first, two thousand five through December thirty-
first, two thousand five; and
(iii) up to fifty-six million five hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six.
(v) Funds shall be transferred by the commissioner and shall be depos-
ited to the credit of the hospital excess liability pool created pursu-
ant to section eighteen of chapter two hundred sixty-six of the laws of
nineteen hundred eighty-six, or any successor fund or account, for
purposes of expenses related to the purchase of excess medical malprac-
tice insurance and the cost of administrating the pool, including costs
associated with the risk management program established pursuant to
section forty-two of part A of chapter one of the laws of two thousand
two required by paragraph (a) of subdivision one of section eighteen of
chapter two hundred sixty-six of the laws of nineteen hundred eighty-six
as may be amended from time to time, from the tobacco control and insur-
ance initiatives pool established for the following periods in the
following amounts:
(i) up to fifty million dollars or so much as is needed for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(ii) up to seventy-six million seven hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(iii) up to sixty-five million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(iv) up to sixty-five million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to one hundred thirteen million eight hundred thousand dollars
for the period January first, two thousand six through December thirty-
first, two thousand six;
(vi) up to one hundred thirty million dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(vii) up to one hundred thirty million dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight;
(viii) up to one hundred thirty million dollars for the period January
first, two thousand nine through December thirty-first, two thousand
nine;
(ix) up to one hundred thirty million dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
[and]
S. 2809--D 54 A. 4009--D
(x) up to thirty-two million five hundred thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven[.]; AND
(XI) UP TO ONE HUNDRED TWENTY-SEVEN MILLION FOUR HUNDRED THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(w) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the treatment of breast and cervical cancer pursuant to para-
graph (v) of subdivision four of section three hundred sixty-six of the
social services law, from the tobacco control and insurance initiatives
pool established for the following periods in the following amounts:
(i) up to four hundred fifty thousand dollars for the period January
first, two thousand two through December thirty-first, two thousand two;
(ii) up to two million one hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) up to two million one hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) up to two million one hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) up to two million one hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) up to two million one hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) up to two million one hundred thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) up to two million one hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) up to two million one hundred thousand dollars for the period
January first, two thousand ten through December thirty-first, two thou-
sand ten; [and]
(x) up to five hundred twenty-five thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven[.]; AND
(XI) UP TO TWO MILLION ONE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN.
(x) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the non-public general hospital rates increases for recruitment
and retention of health care workers from the tobacco control and insur-
ance initiatives pool established for the following periods in the
following amounts:
S. 2809--D 55 A. 4009--D
(i) twenty-seven million one hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) fifty million eight hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) sixty-nine million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) sixty-nine million three hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) sixty-nine million three hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) sixty-five million three hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) sixty-one million one hundred fifty thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight; and
(viii) forty-eight million seven hundred twenty-one thousand dollars
for the period January first, two thousand nine through November thirti-
eth, two thousand nine.
(y) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to public general hospitals for recruitment and retention of
health care workers pursuant to paragraph (b) of subdivision thirty of
section twenty-eight hundred seven-c of this article from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) eighteen million five hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) thirty-seven million four hundred thousand dollars on an annual-
ized basis for the period January first, two thousand three through
December thirty-first, two thousand three;
(iii) fifty-two million two hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) fifty-two million two hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) fifty-two million two hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) forty-nine million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(vii) forty-nine million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight; and
(viii) twelve million two hundred fifty thousand dollars for the peri-
od January first, two thousand nine through March thirty-first, two
thousand nine.
Provided, however, amounts pursuant to this paragraph may be reduced
in an amount to be approved by the director of the budget to reflect
amounts received from the federal government under the state's 1115
S. 2809--D 56 A. 4009--D
waiver which are directed under its terms and conditions to the health
workforce recruitment and retention program.
(z) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the non-public residential health care facility rate increases
for recruitment and retention of health care workers pursuant to para-
graph (a) of subdivision eighteen of section twenty-eight hundred eight
of this article from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) twenty-one million five hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) thirty-three million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand three through
December thirty-first, two thousand three;
(iii) forty-six million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) forty-six million three hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) forty-six million three hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) thirty million nine hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(vii) twenty-four million seven hundred thousand dollars for the peri-
od January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) twelve million three hundred seventy-five thousand dollars for
the period January first, two thousand nine through December thirty-
first, two thousand nine;
(ix) nine million three hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten; and
(x) two million three hundred twenty-five thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven.
(aa) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to public residential health care facilities for recruitment
and retention of health care workers pursuant to paragraph (b) of subdi-
vision eighteen of section twenty-eight hundred eight of this article
from the tobacco control and insurance initiatives pool established for
the following periods in the following amounts:
(i) seven million five hundred thousand dollars on an annualized basis
for the period January first, two thousand two through December thirty-
first, two thousand two;
(ii) eleven million seven hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
S. 2809--D 57 A. 4009--D
(iii) sixteen million two hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) sixteen million two hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(v) sixteen million two hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six;
(vi) ten million eight hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(vii) six million seven hundred fifty thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight; and
(viii) one million three hundred fifty thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine.
(bb)(i) Funds shall be deposited by the commissioner, within amounts
appropriated, and subject to the availability of federal financial
participation, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for the purpose of supporting the
state share of adjustments to Medicaid rates of payment for personal
care services provided pursuant to paragraph (e) of subdivision two of
section three hundred sixty-five-a of the social services law, for local
social service districts which include a city with a population of over
one million persons and computed and distributed in accordance with
memorandums of understanding to be entered into between the state of New
York and such local social service districts for the purpose of support-
ing the recruitment and retention of personal care service workers or
any worker with direct patient care responsibility, from the tobacco
control and insurance initiatives pool established for the following
periods and the following amounts:
(A) forty-four million dollars, on an annualized basis, for the period
April first, two thousand two through December thirty-first, two thou-
sand two;
(B) seventy-four million dollars, on an annualized basis, for the
period January first, two thousand three through December thirty-first,
two thousand three;
(C) one hundred four million dollars, on an annualized basis, for the
period January first, two thousand four through December thirty-first,
two thousand four;
(D) one hundred thirty-six million dollars, on an annualized basis,
for the period January first, two thousand five through December thir-
ty-first, two thousand five;
(E) one hundred thirty-six million dollars, on an annualized basis,
for the period January first, two thousand six through December thirty-
first, two thousand six;
(F) one hundred thirty-six million dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(G) one hundred thirty-six million dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight;
S. 2809--D 58 A. 4009--D
(H) one hundred thirty-six million dollars for the period January
first, two thousand nine through December thirty-first, two thousand
nine;
(I) one hundred thirty-six million dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
[and]
(J) thirty-four million dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven[.]; AND
(K) ONE HUNDRED THIRTY-SIX MILLION DOLLARS EACH STATE FISCAL YEAR FOR
THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND FOURTEEN.
(ii) Adjustments to Medicaid rates made pursuant to this paragraph
shall not, in aggregate, exceed the following amounts for the following
periods:
(A) for the period April first, two thousand two through December
thirty-first, two thousand two, one hundred ten million dollars;
(B) for the period January first, two thousand three through December
thirty-first, two thousand three, one hundred eighty-five million
dollars;
(C) for the period January first, two thousand four through December
thirty-first, two thousand four, two hundred sixty million dollars;
(D) for the period January first, two thousand five through December
thirty-first, two thousand five, three hundred forty million dollars;
(E) for the period January first, two thousand six through December
thirty-first, two thousand six, three hundred forty million dollars;
(F) for the period January first, two thousand seven through December
thirty-first, two thousand seven, three hundred forty million dollars;
(G) for the period January first, two thousand eight through December
thirty-first, two thousand eight, three hundred forty million dollars;
(H) for the period January first, two thousand nine through December
thirty-first, two thousand nine, three hundred forty million dollars;
(I) for the period January first, two thousand ten through December
thirty-first, two thousand ten, three hundred forty million dollars;
[and]
(J) for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, eighty-five million dollars[.]; AND
(K) FOR EACH STATE FISCAL YEAR WITHIN THE PERIOD APRIL FIRST, TWO
THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, THREE
HUNDRED FORTY MILLION DOLLARS.
(iii) Personal care service providers which have their rates adjusted
pursuant to this paragraph shall use such funds for the purpose of
recruitment and retention of non-supervisory personal care services
workers or any worker with direct patient care responsibility only and
are prohibited from using such funds for any other purpose. Each such
personal care services provider shall submit, at a time and in a manner
to be determined by the commissioner, a written certification attesting
that such funds will be used solely for the purpose of recruitment and
retention of non-supervisory personal care services workers or any work-
er with direct patient care responsibility. The commissioner is author-
ized to audit each such provider to ensure compliance with the written
certification required by this subdivision and shall recoup any funds
determined to have been used for purposes other than recruitment and
retention of non-supervisory personal care services workers or any work-
er with direct patient care responsibility. Such recoupment shall be in
addition to any other penalties provided by law.
S. 2809--D 59 A. 4009--D
(cc) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for the purpose of supporting the
state share of adjustments to Medicaid rates of payment for personal
care services provided pursuant to paragraph (e) of subdivision two of
section three hundred sixty-five-a of the social services law, for local
social service districts which shall not include a city with a popu-
lation of over one million persons for the purpose of supporting the
personal care services worker recruitment and retention program as
established pursuant to section three hundred sixty-seven-q of the
social services law, from the tobacco control and insurance initiatives
pool established for the following periods and the following amounts:
(i) two million eight hundred thousand dollars for the period April
first, two thousand two through December thirty-first, two thousand two;
(ii) five million six hundred thousand dollars, on an annualized
basis, for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) eight million four hundred thousand dollars, on an annualized
basis, for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) ten million eight hundred thousand dollars, on an annualized
basis, for the period January first, two thousand five through December
thirty-first, two thousand five;
(v) ten million eight hundred thousand dollars, on an annualized
basis, for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) eleven million two hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(vii) eleven million two hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight;
(viii) eleven million two hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) eleven million two hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten; [and]
(x) two million eight hundred thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven[.]; AND
(XI) ELEVEN MILLION TWO HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN.
(dd) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for purposes of funding the state share
of Medicaid expenditures for physician services from the tobacco control
and insurance initiatives pool established for the following periods in
the following amounts:
(i) up to fifty-two million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
S. 2809--D 60 A. 4009--D
(ii) eighty-one million two hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) eighty-five million two hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) eighty-five million two hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) eighty-five million two hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) [eight-five] EIGHTY-FIVE million two hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven;
(vii) eighty-five million two hundred thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) eighty-five million two hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) eighty-five million two hundred thousand dollars for the period
January first, two thousand ten through December thirty-first, two thou-
sand ten; [and]
(x) twenty-one million three hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven[.]; AND
(XI) EIGHTY-FIVE MILLION TWO HUNDRED THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(ee) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for purposes of funding the state share
of the free-standing diagnostic and treatment center rate increases for
recruitment and retention of health care workers pursuant to subdivision
seventeen of section twenty-eight hundred seven of this article from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) three million two hundred fifty thousand dollars for the period
April first, two thousand two through December thirty-first, two thou-
sand two;
(ii) three million two hundred fifty thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) three million two hundred fifty thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) three million two hundred fifty thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) three million two hundred fifty thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
S. 2809--D 61 A. 4009--D
(vi) three million two hundred fifty thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) three million four hundred thirty-eight thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight;
(viii) two million four hundred fifty thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) one million five hundred thousand dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
and
(x) three hundred twenty-five thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven.
(ff) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for purposes of funding the state share
of Medicaid expenditures for disabled persons as authorized pursuant to
subparagraphs twelve and thirteen of paragraph (a) of subdivision one of
section three hundred sixty-six of the social services law from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) one million eight hundred thousand dollars for the period April
first, two thousand two through December thirty-first, two thousand two;
(ii) sixteen million four hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) eighteen million seven hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) thirty million six hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(v) thirty million six hundred thousand dollars for the period January
first, two thousand six through December thirty-first, two thousand six;
(vi) thirty million six hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(vii) fifteen million dollars for the period January first, two thou-
sand eight through December thirty-first, two thousand eight;
(viii) fifteen million dollars for the period January first, two thou-
sand nine through December thirty-first, two thousand nine;
(ix) fifteen million dollars for the period January first, two thou-
sand ten through December thirty-first, two thousand ten; [and]
(x) three million seven hundred fifty thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven[.]; AND
(XI) FIFTEEN MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FOURTEEN.
(gg) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to non-public general hospitals pursuant to paragraph (c) of
S. 2809--D 62 A. 4009--D
subdivision thirty of section twenty-eight hundred seven-c of this arti-
cle from the tobacco control and insurance initiatives pool established
for the following periods in the following amounts:
(i) up to one million three hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) up to three million two hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) up to five million six hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) up to eight million six hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) up to eight million six hundred thousand dollars on an annualized
basis for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) up to two million six hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) up to two million six hundred thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) up to two million six hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) up to two million six hundred thousand dollars for the period
January first, two thousand ten through December thirty-first, two thou-
sand ten; and
(x) up to six hundred fifty thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven.
(hh) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the special revenue
fund - other, HCRA transfer fund, medical assistance account for
purposes of providing financial assistance to residential health care
facilities pursuant to subdivisions nineteen and twenty-one of section
twenty-eight hundred eight of this article, from the tobacco control and
insurance initiatives pool established for the following periods in the
following amounts:
(i) for the period April first, two thousand two through December
thirty-first, two thousand two, ten million dollars;
(ii) for the period January first, two thousand three through December
thirty-first, two thousand three, nine million four hundred fifty thou-
sand dollars;
(iii) for the period January first, two thousand four through December
thirty-first, two thousand four, nine million three hundred fifty thou-
sand dollars;
(iv) up to fifteen million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(v) up to fifteen million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(vi) up to fifteen million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
S. 2809--D 63 A. 4009--D
(vii) up to fifteen million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(viii) up to fifteen million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(ix) up to fifteen million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; [and]
(x) up to three million seven hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven[.]; AND
(XI) FIFTEEN MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FOURTEEN.
(ii) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for the purpose of supporting the
state share of Medicaid expenditures for disabled persons as authorized
by sections 1619 (a) and (b) of the federal social security act pursuant
to the tobacco control and insurance initiatives pool established for
the following periods in the following amounts:
(i) six million four hundred thousand dollars for the period April
first, two thousand two through December thirty-first, two thousand two;
(ii) eight million five hundred thousand dollars, for the period Janu-
ary first, two thousand three through December thirty-first, two thou-
sand three;
(iii) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand four through December thirty-first, two thousand
four;
(iv) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(v) eight million five hundred thousand dollars for the period January
first, two thousand six through December thirty-first, two thousand six;
(vi) eight million six hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(vii) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight;
(viii) eight million five hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten; [and]
(x) two million one hundred twenty-five thousand dollars for the peri-
od January first, two thousand eleven through March thirty-first, two
thousand eleven; AND
(XI) EIGHT MILLION FIVE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN.
(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-
S. 2809--D 64 A. 4009--D
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 two
million two hundred thousand dollars, AND FOR THE PERIOD APRIL FIRST,
TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE UP
TO ONE MILLION ONE HUNDRED THOUSAND DOLLARS.
(kk) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds -- other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of Medical Assistance Program expenditures from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) thirty-eight million eight hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(ii) up to two hundred ninety-five million dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) up to four hundred seventy-two million dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) up to nine hundred million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to eight hundred sixty-six million three hundred thousand
dollars for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) up to six hundred sixteen million seven hundred thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven;
(vii) up to five hundred seventy-eight million nine hundred twenty-
five thousand dollars for the period January first, two thousand eight
through December thirty-first, two thousand eight; and
(viii) within amounts appropriated on and after January first, two
thousand nine.
(ll) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds -- other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of Medicaid expenditures related to the city of New York from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) eighty-two million seven hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
S. 2809--D 65 A. 4009--D
(ii) one hundred twenty-four million six hundred thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(iii) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand four through December thir-
ty-first, two thousand four;
(iv) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand five through December thir-
ty-first, two thousand five;
(v) one hundred twenty-four million seven hundred thousand dollars for
the period January first, two thousand six through December thirty-
first, two thousand six;
(vi) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven;
(vii) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand eight through December thir-
ty-first, two thousand eight;
(viii) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand nine through December thir-
ty-first, two thousand nine;
(ix) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand ten through December thirty-
first, two thousand ten; [and]
(x) thirty-one million one hundred seventy-five thousand dollars for
the period January first, two thousand eleven through March thirty-
first, two thousand eleven[.]; AND
(XI) ONE HUNDRED TWENTY-FOUR MILLION SEVEN HUNDRED THOUSAND DOLLARS
EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
(mm) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding specified
percentages of the state share of services and expenses related to the
family health plus program in accordance with the following schedule:
(i) (A) for the period January first, two thousand three through
December thirty-first, two thousand four, one hundred percent of the
state share;
(B) for the period January first, two thousand five through December
thirty-first, two thousand five, seventy-five percent of the state
share; and,
(C) for periods beginning on and after January first, two thousand
six, fifty percent of the state share.
(ii) Funding for the family health plus program will include up to
five million dollars annually for the period January first, two thousand
three through December thirty-first, two thousand six, up to five
million dollars for the period January first, two thousand seven through
December thirty-first, two thousand seven, up to seven million two
hundred thousand dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, up to seven
million two hundred thousand dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine, up to
seven million two hundred thousand dollars for the period January first,
two thousand ten through December thirty-first, two thousand ten, [and]
S. 2809--D 66 A. 4009--D
up to one million eight hundred thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven, UP TO SIX MILLION FORTY-NINE THOUSAND DOLLARS FOR THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND TWELVE, UP TO SIX MILLION TWO HUNDRED EIGHTY-NINE THOUSAND DOLLARS
FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND UP TO SIX MILLION FOUR HUNDRED
SIXTY-ONE THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND
THIRTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, for adminis-
tration and marketing costs associated with such program established
pursuant to clauses (A) and (B) of subparagraph (v) of paragraph (a) of
subdivision two of section three hundred sixty-nine-ee of the social
services law from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(A) one hundred ninety million six hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(B) three hundred seventy-four million dollars for the period January
first, two thousand four through December thirty-first, two thousand
four;
(C) five hundred thirty-eight million four hundred thousand dollars
for the period January first, two thousand five through December thir-
ty-first, two thousand five;
(D) three hundred eighteen million seven hundred seventy-five thousand
dollars for the period January first, two thousand six through December
thirty-first, two thousand six;
(E) four hundred eighty-two million eight hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven;
(F) five hundred seventy million twenty-five thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight;
(G) six hundred ten million seven hundred twenty-five thousand dollars
for the period January first, two thousand nine through December thir-
ty-first, two thousand nine;
(H) six hundred twenty-seven million two hundred seventy-five thousand
dollars for the period January first, two thousand ten through December
thirty-first, two thousand ten; [and]
(I) one hundred fifty-seven million eight hundred seventy-five thou-
sand dollars for the period January first, two thousand eleven through
March thirty-first, two thousand eleven[.];
(J) SIX HUNDRED TWENTY-EIGHT MILLION FOUR HUNDRED THOUSAND DOLLARS FOR
THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND TWELVE;
(K) SIX HUNDRED FIFTY MILLION FOUR HUNDRED THOUSAND DOLLARS FOR THE
PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND THIRTEEN; AND
(L) SIX HUNDRED FIFTY MILLION FOUR HUNDRED THOUSAND DOLLARS FOR THE
PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND FOURTEEN.
(nn) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, health care services account,
or any successor fund or account, for purposes related to adult home
initiatives for medicaid eligible residents of residential facilities
S. 2809--D 67 A. 4009--D
licensed pursuant to section four hundred sixty-b of the social services
law from the tobacco control and insurance initiatives pool established
for the following periods in the following amounts:
(i) up to four million dollars for the period January first, two thou-
sand three through December thirty-first, two thousand three;
(ii) up to six million dollars for the period January first, two thou-
sand four through December thirty-first, two thousand four;
(iii) up to eight million dollars for the period January first, two
thousand five through December thirty-first, two thousand five,
provided, however, that up to five million two hundred fifty thousand
dollars of such funds shall be received by the comptroller and deposited
to the credit of the special revenue fund - other / aid to localities,
HCRA transfer fund - 061, enhanced community services account - 05, or
any successor fund or account, for the purposes set forth in this para-
graph;
(iv) up to eight million dollars for the period January first, two
thousand six through December thirty-first, two thousand six, provided,
however, that up to five million two hundred fifty thousand dollars of
such funds shall be received by the comptroller and deposited to the
credit of the special revenue fund - other / aid to localities, HCRA
transfer fund - 061, enhanced community services account - 05, or any
successor fund or account, for the purposes set forth in this paragraph;
(v) up to eight million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven,
provided, however, that up to five million two hundred fifty thousand
dollars of such funds shall be received by the comptroller and deposited
to the credit of the special revenue fund - other / aid to localities,
HCRA transfer fund - 061, enhanced community services account - 05, or
any successor fund or account, for the purposes set forth in this para-
graph;
(vi) up to two million seven hundred fifty thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight;
(vii) up to two million seven hundred fifty thousand dollars for the
period January first, two thousand nine through December thirty-first,
two thousand nine;
(viii) up to two million seven hundred fifty thousand dollars for the
period January first, two thousand ten through December thirty-first,
two thousand ten; and
(ix) up to six hundred eighty-eight thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven.
(oo) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to non-public general hospitals pursuant to paragraph (e) of
subdivision twenty-five of section twenty-eight hundred seven-c of this
article from the tobacco control and insurance initiatives pool estab-
lished for the following periods in the following amounts:
(i) up to five million dollars on an annualized basis for the period
January first, two thousand four through December thirty-first, two
thousand four;
(ii) up to five million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(iii) up to five million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
S. 2809--D 68 A. 4009--D
(iv) up to five million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven; and
(v) up to five million dollars for the period January first, two thou-
sand eight through December thirty-first, two thousand eight;
(vi) up to five million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(vii) up to five million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; 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.
(pp) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purpose of supporting the provision of tax credits for long term care
insurance pursuant to subdivision one of section one hundred ninety of
the tax law, paragraph (a) of subdivision twenty-five-a of section two
hundred ten of such law, subsection (aa) of section six hundred six of
such law, paragraph one of subsection (k) of section fourteen hundred
fifty-six of such law and paragraph one of subdivision (m) of section
fifteen hundred eleven of such law, in the following amounts:
(i) ten million dollars for the period January first, two thousand
four through December thirty-first, two thousand four;
(ii) ten million dollars for the period January first, two thousand
five through December thirty-first, two thousand five;
(iii) ten million dollars for the period January first, two thousand
six through December thirty-first, two thousand six; and
(iv) five million dollars for the period January first, two thousand
seven through June thirtieth, two thousand seven.
(qq) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purpose of supporting the long-term care insurance education and
outreach program established pursuant to section two hundred seventeen-a
of the elder law for the following periods in the following amounts:
(i) up to five million dollars for the period January first, two thou-
sand four through December thirty-first, two thousand four; of such
funds one million nine hundred fifty thousand 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 three million fifty thousand dollars shall be deposited by
the commissioner, within amounts appropriated, and the comptroller is
hereby authorized and directed to receive for deposit to the credit of
the special revenue funds - other, HCRA transfer fund, long term care
insurance resource center account of the state office for the aging or
any future account designated for the purpose of implementing the long
term care insurance education and outreach program and providing the
long term care insurance resource centers with the necessary resources
to carry out their operations;
(ii) up to five million dollars for the period January first, two
thousand five through December thirty-first, two thousand five; of such
funds one million nine hundred fifty thousand 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 three million fifty thousand dollars shall be deposited by
the commissioner, within amounts appropriated, and the comptroller is
hereby authorized and directed to receive for deposit to the credit of
the special revenue funds - other, HCRA transfer fund, long term care
S. 2809--D 69 A. 4009--D
insurance resource center account of the state office for the aging or
any future account designated for the purpose of implementing the long
term care insurance education and outreach program and providing the
long term care insurance resource centers with the necessary resources
to carry out their operations;
(iii) up to five million dollars for the period January first, two
thousand six through December thirty-first, two thousand six; of such
funds one million nine hundred fifty thousand 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 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;
(iv) up to five million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven; of
such funds one million nine hundred fifty thousand 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 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;
(v) up to five million dollars for the period January first, two thou-
sand eight through December thirty-first, two thousand eight; of such
funds one million nine hundred fifty thousand 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 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;
(vi) up to five million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine; of such
funds one million nine hundred fifty thousand 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 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;
(vii) up to four hundred eighty-eight thousand dollars for the period
January first, two thousand ten through March thirty-first, two thousand
ten; of such funds four hundred eighty-eight thousand dollars shall be
made available to the department for the purpose of developing, imple-
menting and administering the long-term care insurance education and
outreach program.
(rr) Funds shall be reserved and accumulated from the tobacco control
and insurance initiatives pool and shall be available, including income
from invested funds, for the purpose of supporting expenses related to
implementation of the provisions of title III of article twenty-nine-D
of this chapter, for the following periods and in the following amounts:
(i) up to ten million dollars for the period January first, two thou-
sand six through December thirty-first, two thousand six;
(ii) up to ten million dollars for the period January first, two thou-
sand seven through December thirty-first, two thousand seven;
S. 2809--D 70 A. 4009--D
(iii) up to ten million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(iv) up to ten million dollars for the period January first, two thou-
sand nine through December thirty-first, two thousand nine;
(v) up to ten million dollars for the period January first, two thou-
sand ten through December thirty-first, two thousand ten; and
(vi) up to two million five hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven.
(ss) Funds shall be reserved and accumulated from the tobacco control
and insurance initiatives pool and used for a health care stabilization
program established by the commissioner for the purposes of stabilizing
critical health care providers and health care programs whose ability to
continue to provide appropriate services are threatened by financial or
other challenges, in the amount of up to twenty-eight million dollars
for the period July first, two thousand four through June thirtieth, two
thousand five. Notwithstanding the provisions of section one hundred
twelve of the state finance law or any other inconsistent provision of
the state finance law or any other law, funds available for distribution
pursuant to this paragraph may be allocated and distributed by the
commissioner, or the state comptroller as applicable without a compet-
itive bid or request for proposal process. Considerations relied upon by
the commissioner in determining the allocation and distribution of these
funds shall include, but not be limited to, the following: (i) the
importance of the provider or program in meeting critical health care
needs in the community in which it operates; (ii) the provider or
program provision of care to under-served populations; (iii) the quality
of the care or services the provider or program delivers; (iv) the abil-
ity of the provider or program to continue to deliver an appropriate
level of care or services if additional funding is made available; (v)
the ability of the provider or program to access, in a timely manner,
alternative sources of funding, including other sources of government
funding; (vi) the ability of other providers or programs in the communi-
ty to meet the community health care needs; (vii) whether the provider
or program has an appropriate plan to improve its financial condition;
and (viii) whether additional funding would permit the provider or
program to consolidate, relocate, or close programs or services where
such actions would result in greater stability and efficiency in the
delivery of needed health care services or programs.
(tt) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of providing grants for two long term care demonstration projects
designed to test new models for the delivery of long term care services
established pursuant to section twenty-eight hundred seven-x of this
chapter, for the following periods and in the following amounts:
(i) up to five hundred thousand dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(ii) up to five hundred thousand dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(iii) up to five hundred thousand dollars for the period January
first, two thousand six through December thirty-first, two thousand six;
(iv) up to one million dollars for the period January first, two thou-
sand seven through December thirty-first, two thousand seven; and
(v) up to two hundred fifty thousand dollars for the period January
first, two thousand eight through March thirty-first, two thousand
eight.
S. 2809--D 71 A. 4009--D
(uu) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purpose of supporting disease management and telemedicine demonstration
programs authorized pursuant to [sections] SECTION twenty-one hundred
eleven [and thirty-six hundred twenty-one] of this chapter[, respective-
ly,] for the following periods in the following amounts:
(i) five million dollars for the period January first, two thousand
four through December thirty-first, two thousand four, of which three
million dollars shall be available for disease management demonstration
programs and two million dollars shall be available for telemedicine
demonstration programs;
(ii) five million dollars for the period January first, two thousand
five through December thirty-first, two thousand five, of which three
million dollars shall be available for disease management demonstration
programs and two million dollars shall be available for telemedicine
demonstration programs;
(iii) nine million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six, of which seven million five hundred thousand dollars shall be
available for disease management demonstration programs and two million
dollars shall be available for telemedicine demonstration programs;
(iv) nine million five hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, of which seven million five hundred thousand dollars shall be
available for disease management demonstration programs and one million
dollars shall be available for telemedicine demonstration programs;
(v) nine million five hundred thousand dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight, of which seven million five hundred thousand dollars shall be
available for disease management demonstration programs and two million
dollars shall be available for telemedicine demonstration programs;
(vi) seven million eight hundred thirty-three thousand three hundred
thirty-three dollars for the period January first, two thousand nine
through December thirty-first, two thousand nine, of which seven million
five hundred thousand dollars shall be available for disease management
demonstration programs and three hundred thirty-three thousand three
hundred thirty-three dollars shall be available for telemedicine demon-
stration programs for the period January first, two thousand nine
through March first, two thousand nine;
(vii) one million eight hundred seventy-five thousand dollars for the
period January first, two thousand ten through March thirty-first, two
thousand ten shall be available for disease management demonstration
programs.
(ww) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the general hospital rates increases for recruitment and
retention of health care workers pursuant to paragraph (e) of subdivi-
sion thirty of section twenty-eight hundred seven-c of this article from
the tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) sixty million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five; and
S. 2809--D 72 A. 4009--D
(ii) sixty million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six.
(xx) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the general hospital rates increases for rural hospitals pursu-
ant to subdivision thirty-two of section twenty-eight hundred seven-c of
this article from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) three million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five;
(ii) three million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six;
(iii) three million five hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(iv) three million five hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight; and
(v) three million two hundred eight thousand dollars for the period
January first, two thousand nine through November thirtieth, two thou-
sand nine.
(yy) Funds shall be reserved and accumulated from year to year and
shall be available, within amounts appropriated and notwithstanding
section one hundred twelve of the state finance law and any other
contrary provision of law, for the purpose of supporting grants not to
exceed five million dollars to be made by the commissioner without a
competitive bid or request for proposal process, in support of the
delivery of critically needed health care services, to health care
providers located in the counties of Erie and Niagara which executed a
memorandum of closing and conducted a merger closing in escrow on Novem-
ber twenty-fourth, nineteen hundred ninety-seven and which entered into
a settlement dated December thirtieth, two thousand four for a loss on
disposal of assets under the provisions of title XVIII of the federal
social security act applicable to mergers occurring prior to December
first, nineteen hundred ninety-seven.
(zz) Funds shall be reserved and accumulated from year to year and
shall be available, within amounts appropriated, for the purpose of
supporting expenditures authorized pursuant to section twenty-eight
hundred eighteen of this article from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
(i) six million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five;
(ii) one hundred eight million three hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six, provided, however, that within amounts appropriated in
the two thousand six through two thousand seven state fiscal year, a
portion of such funds may be transferred to the Roswell Park Cancer
Institute Corporation to fund capital costs;
S. 2809--D 73 A. 4009--D
(iii) one hundred seventy-one million dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, provided, however, that within amounts appropriated in the two
thousand six through two thousand seven state fiscal year, a portion of
such funds may be transferred to the Roswell Park Cancer Institute
Corporation to fund capital costs;
(iv) one hundred seventy-one million five hundred thousand dollars for
the period January first, two thousand eight through December thirty-
first, two thousand eight;
(v) one hundred twenty-eight million seven hundred fifty thousand
dollars for the period January first, two thousand nine through December
thirty-first, two thousand nine;
(vi) one hundred thirty-one million three hundred seventy-five thou-
sand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten; [and]
(vii) thirty-four million two hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven[.];
(VIII) FOUR HUNDRED THIRTY-THREE MILLION THREE HUNDRED SIXTY-SIX THOU-
SAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND TWELVE;
(IX) ONE HUNDRED FIFTY MILLION EIGHT HUNDRED SIX THOUSAND DOLLARS FOR
THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND THIRTEEN; AND
(X) SEVENTY-EIGHT MILLION SEVENTY-ONE THOUSAND DOLLARS FOR THE PERIOD
APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FOURTEEN.
(aaa) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for services
and expenses related to school based health centers, in an amount up to
three million five hundred thousand dollars for the period April first,
two thousand six through March thirty-first, two thousand seven, up to
three million five hundred thousand dollars for the period April first,
two thousand seven through March thirty-first, two thousand eight, up to
three million five hundred thousand dollars for the period April first,
two thousand eight through March thirty-first, two thousand nine, up to
three million five hundred thousand dollars for the period April first,
two thousand nine through March thirty-first, two thousand ten, [and] up
to three million five hundred thousand dollars for the period April
first, two thousand ten through March thirty-first, two thousand eleven,
AND UP TO TWO MILLION EIGHT HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FOURTEEN. The total amount of funds provided
herein shall be distributed as grants based on the ratio of each provid-
er's total enrollment for all sites to the total enrollment of all
providers. This formula shall be applied to the total amount provided
herein.
(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
S. 2809--D 74 A. 4009--D
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, 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.
(ccc) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of increases in the rates for certified home health agencies, long
term home health care programs, AIDS home care programs, hospice
programs and managed long term care plans and approved managed long term
care operating demonstrations as defined in section forty-four hundred
three-f of this chapter for recruitment and retention of health care
workers pursuant to subdivisions nine and ten of section thirty-six
hundred fourteen of this chapter from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
(i) twenty-five million dollars for the period June first, two thou-
sand six through December thirty-first, two thousand six;
(ii) fifty million dollars for the period January first, two thousand
seven through December thirty-first, two thousand seven;
(iii) fifty million dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight;
(iv) fifty million dollars for the period January first, two thousand
nine through December thirty-first, two thousand nine;
(v) fifty million dollars for the period January first, two thousand
ten through December thirty-first, two thousand ten; [and]
(vi) twelve million five hundred thousand dollars for the period Janu-
ary first, two thousand eleven through March thirty-first, two thousand
eleven[.]; AND
(VII) FIFTY MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FOURTEEN.
(ddd) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of increases in the medical assistance rates for providers for
purposes of enhancing the provision, quality and/or efficiency of home
care services pursuant to subdivision eleven of section thirty-six
hundred fourteen of this chapter from the tobacco control and insurance
initiatives pool established for the following period in the amount of
eight million dollars for the period April first, two thousand six
through December thirty-first, two thousand six.
(eee) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, to the Center
for Functional Genomics at the State University of New York at Albany,
S. 2809--D 75 A. 4009--D
for the purposes of the Adirondack network for cancer education and
research in rural communities grant program to improve access to health
care and shall be made available from the tobacco control and insurance
initiatives pool established for the following period in the amount of
up to five million dollars for the period January first, two thousand
six through December thirty-first, two thousand six.
(fff) Funds shall be made available to the empire state stem cell fund
established by section ninety-nine-p of the state finance law from the
public asset as defined in section four thousand three hundred one of
the insurance law and accumulated from the conversion of one or more
article forty-three corporations and its or their not-for-profit subsid-
iaries occurring on or after January first, two thousand seven. Such
funds shall be made available within amounts appropriated up to fifty
million dollars annually and shall not exceed five hundred million
dollars in total.
(ggg) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for the purpose of supporting the state
share of Medicaid expenditures for hospital translation services as
authorized pursuant to paragraph (k) of subdivision one of section twen-
ty-eight hundred seven-c of this article from the tobacco control and
initiatives pool established for the following periods in the following
amounts:
(i) sixteen million dollars for the period July first, two thousand
eight through December thirty-first, two thousand eight; and
(ii) fourteen million seven hundred thousand dollars for the period
January first, two thousand nine through November thirtieth, two thou-
sand nine.
(hhh) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for the purpose of supporting the state
share of Medicaid expenditures for adjustments to inpatient rates of
payment for general hospitals located in the counties of Nassau and
Suffolk as authorized pursuant to paragraph (l) of subdivision one of
section twenty-eight hundred seven-c of this article from the tobacco
control and initiatives pool established for the following periods in
the following amounts:
(i) two million five hundred thousand dollars for the period April
first, two thousand eight through December thirty-first, two thousand
eight; and
(ii) two million two hundred ninety-two thousand dollars for the peri-
od January first, two thousand nine through November thirtieth, two
thousand nine.
S 9. Subdivision 3 of section 1680-j of the public authorities law, as
amended by section 34 of part C of chapter 58 of the laws of 2009, is
amended to read as follows:
3. Notwithstanding any law to the contrary, and in accordance with
section four of the state finance law, the comptroller is hereby author-
ized and directed to transfer from the health care reform act (HCRA)
resources fund (061) to the general fund, upon the request of the direc-
tor of the budget, up to $6,500,000 on or before March 31, 2006, and the
comptroller is further hereby authorized and directed to transfer from
S. 2809--D 76 A. 4009--D
the healthcare reform act (HCRA); Resources fund (061) to the Capital
Projects Fund, upon the request of the director of budget, up to
$139,000,000 for the period April 1, 2006 through March 31, 2007, up to
$171,100,000 for the period April 1, 2007 through March 31, 2008, up to
$208,100,000 for the period April 1, 2008 through March 31, 2009, up to
$151,600,000 for the period April 1, 2009 through March 31, 2010, [and]
up to [$238,000,000] $215,743,000 for the period April 1, 2010 through
March 31, 2011, UP TO $433,366,000 FOR THE PERIOD APRIL 1, 2011 THROUGH
MARCH 31, 2012, UP TO $150,806,000 FOR THE PERIOD APRIL 1, 2012 THROUGH
MARCH 31, 2013, UP TO $78,071,000 FOR THE PERIOD APRIL 1, 2013 THROUGH
MARCH 31, 2014, AND UP TO $86,005,000 FOR THE PERIOD APRIL 1, 2014
THROUGH MARCH 31, 2015.
S 10. Paragraph (a) of subdivision 12 of section 367-b of the social
services law, as amended by section 8 of part B of chapter 58 of the
laws of 2008, is amended to read as follows:
(a) For the purpose of regulating cash flow for general hospitals, the
department shall develop and implement a payment methodology to provide
for timely payments for inpatient hospital services eligible for case
based payments per discharge based on diagnosis-related groups provided
during the period January first, nineteen hundred eighty-eight through
March thirty-first two thousand [eleven] FOURTEEN, by such hospitals
which elect to participate in the system.
S 11. Section 2 of chapter 600 of the laws of 1986, amending the
public health law relating to the development of pilot reimbursement
programs for ambulatory care services, as amended by section 9 of part B
of chapter 58 of the laws of 2008, is amended to read as follows:
S 2. This act shall take effect immediately, except that this act
shall expire and be of no further force and effect on and after April 1,
[2011] 2014; provided, however, that the commissioner of health shall
submit a report to the governor and the legislature detailing the objec-
tive, impact, design and computation of any pilot reimbursement program
established pursuant to this act, on or before March 31, 1994 and annu-
ally thereafter. Such report shall include an assessment of the finan-
cial impact of such payment system on providers, as well as the impact
of such system on access to care.
S 12. Paragraph (i) of subdivision (b) of section 1 of chapter 520 of
the laws of 1978, relating to providing for a comprehensive survey of
health care financing, education and illness prevention and creating
councils for the conduct thereof, as amended by section 11 of part B of
chapter 58 of the laws of 2008, is amended to read as follows:
(i) oversight and evaluation of the inpatient financing system in
place for 1988 through March 31, [2011] 2014, and the appropriateness
and effectiveness of the bad debt and charity care financing provisions;
S 13. The opening paragraph of section 2952 of the public health law,
as amended by section 21 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
To the extent of funds available therefor, the sum of seven million
dollars shall annually be available for periods prior to January first,
two thousand three, and up to six million five hundred thirty thousand
dollars annually for the period January first, two thousand three
through December thirty-first, two thousand four, up to seven million
sixty-two thousand dollars for the period January first, two thousand
five through December thirty-first, two thousand six annually, up to
seven million sixty-two thousand dollars annually for the period January
first, two thousand seven through December thirty-first, two thousand
ten, [and] up to one million seven hundred sixty-six thousand dollars
S. 2809--D 77 A. 4009--D
for the period January first, two thousand eleven through March thirty-
first, two thousand eleven, AND WITHIN AMOUNTS APPROPRIATED FOR EACH
STATE FISCAL YEAR ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN, shall
be available to the commissioner from funds made available pursuant to
section twenty-eight hundred seven-l of this chapter for grants pursuant
to this section.
S 14. Subdivision 1 of section 2958 of the public health law, as
amended by section 22 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
1. To the extent of funds available therefor, the sum of ten million
dollars shall annually be made available for periods prior to January
first, two thousand three, and up to nine million three hundred twenty
thousand dollars for the period January first, two thousand three
through December thirty-first, two thousand three, up to nine million
three hundred twenty thousand dollars for the period January first, two
thousand four through December thirty-first, two thousand four, up to
twelve million eighty-eight thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five, up to twelve million eighty-eight thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six, up to eleven million eighty-eight thousand dollars annually
for the period January first, two thousand seven through December thir-
ty-first, two thousand ten, [and] up to two million seven hundred seven-
ty-two thousand dollars for the period January first, two thousand elev-
en through March thirty-first, two thousand eleven, AND WITHIN AMOUNTS
APPROPRIATED FOR EACH STATE FISCAL YEAR ON AND AFTER APRIL FIRST, TWO
THOUSAND ELEVEN, shall be available to the commissioner from funds
pursuant to section twenty-eight hundred seven-l of this chapter to
provide assistance to general hospitals classified as a rural hospital
for purposes of determining payment for inpatient services provided to
beneficiaries of title XVIII of the federal social security act (Medi-
care) or under state regulations, in recognition of the unique costs
incurred by these facilities to provide hospital services in remote or
sparsely populated areas pursuant to subdivision two of this section.
S 15. Paragraph (a) of subdivision 1 of section 18 of chapter 266 of
the laws of 1986, amending the civil practice law and rules and other
laws relating to malpractice and professional medical conduct, as
amended by section 23 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
(a) The superintendent of insurance and the commissioner of health or
their designee shall, from funds available in the hospital excess
liability pool created pursuant to subdivision [(5)] 5 of this section,
purchase a policy or policies for excess insurance coverage, as author-
ized by paragraph [(1)] 1 of subsection (e) of section 5502 of the
insurance law; or from an insurer, other than an insurer described in
section 5502 of the insurance law, duly authorized to write such cover-
age and actually writing medical malpractice insurance in this state; or
shall purchase equivalent excess coverage in a form previously approved
by the superintendent of insurance for purposes of providing equivalent
excess coverage in accordance with section 19 of chapter 294 of the laws
of 1985, for medical or dental malpractice occurrences between July 1,
1986 and June 30, 1987, between July 1, 1987 and June 30, 1988, between
July 1, 1988 and June 30, 1989, between July 1, 1989 and June 30, 1990,
between July 1, 1990 and June 30, 1991, between July 1, 1991 and June
30, 1992, between July 1, 1992 and June 30, 1993, between July 1, 1993
and June 30, 1994, between July 1, 1994 and June 30, 1995, between July
S. 2809--D 78 A. 4009--D
1, 1995 and June 30, 1996, between July 1, 1996 and June 30, 1997,
between July 1, 1997 and June 30, 1998, between July 1, 1998 and June
30, 1999, between July 1, 1999 and June 30, 2000, between July 1, 2000
and June 30, 2001, between July 1, 2001 and June 30, 2002, between July
1, 2002 and June 30, 2003, between July 1, 2003 and June 30, 2004,
between July 1, 2004 and June 30, 2005, between July 1, 2005 and June
30, 2006, between July 1, 2006 and June 30, 2007, between July 1, 2007
and June 30, 2008, between July 1, 2008 and June 30, 2009, between July
1, 2009 and June 30, 2010, [and] between July 1, 2010 and June 30, 2011,
BETWEEN JULY 1, 2011 AND JUNE 30, 2012, BETWEEN JULY 1, 2012 AND JUNE
30, 2013 AND BETWEEN JULY 1, 2013 AND JUNE 30, 2014 or reimburse the
hospital where the hospital purchases equivalent excess coverage as
defined in subparagraph (i) of paragraph (a) of subdivision [(1-a)] 1-A
of this section for medical or dental malpractice occurrences between
July 1, 1987 and June 30, 1988, between July 1, 1988 and June 30, 1989,
between July 1, 1989 and June 30, 1990, between July 1, 1990 and June
30, 1991, between July 1, 1991 and June 30, 1992, between July 1, 1992
and June 30, 1993, between July 1, 1993 and June 30, 1994, between July
1, 1994 and June 30, 1995, between July 1, 1995 and June 30, 1996,
between July 1, 1996 and June 30, 1997, between July 1, 1997 and June
30, 1998, between July 1, 1998 and June 30, 1999, between July 1, 1999
and June 30, 2000, between July 1, 2000 and June 30, 2001, between July
1, 2001 and June 30, 2002, between July 1, 2002 and June 30, 2003,
between July 1, 2003 and June 30, 2004, between July 1, 2004 and June
30, 2005, between July 1, 2005 and June 30, 2006, between July 1, 2006
and June 30, 2007, between July 1, 2007 and June 30, 2008, between July
1, 2008 and June 30, 2009, between July 1, 2009 and June 30, 2010, [and]
between July 1, 2010 and June 30, 2011, BETWEEN JULY 1, 2011 AND JUNE
30, 2012, BETWEEN JULY 1, 2012 AND JUNE 30, 2013 AND BETWEEN JULY 1,
2013 AND JUNE 30, 2014 for physicians or dentists certified as eligible
for each such period or periods pursuant to subdivision [(2)] 2 of this
section by a general hospital licensed pursuant to article 28 of the
public health law; provided that no single insurer shall write more than
fifty percent of the total excess premium for a given policy year; and
provided, however, that such eligible physicians or dentists must have
in force an individual policy, from an insurer licensed in this state of
primary malpractice insurance coverage in amounts of no less than one
million three hundred thousand dollars for each claimant and three
million nine hundred thousand dollars for all claimants under that poli-
cy during the period of such excess coverage for such occurrences or be
endorsed as additional insureds under a hospital professional liability
policy which is offered through a voluntary attending physician ("chan-
neling") program previously permitted by the superintendent of insurance
during the period of such excess coverage for such occurrences. During
such period, such policy for excess coverage or such equivalent excess
coverage shall, when combined with the physician's or dentist's primary
malpractice insurance coverage or coverage provided through a voluntary
attending physician ("channeling") program, total an aggregate level of
two million three hundred thousand dollars for each claimant and six
million nine hundred thousand dollars for all claimants from all such
policies with respect to occurrences in each of such years provided,
however, if the cost of primary malpractice insurance coverage in excess
of one million dollars, but below the excess medical malpractice insur-
ance coverage provided pursuant to this act, exceeds the rate of nine
percent per annum, then the required level of primary malpractice insur-
ance coverage in excess of one million dollars for each claimant shall
S. 2809--D 79 A. 4009--D
be in an amount of not less than the dollar amount of such coverage
available at nine percent per annum; the required level of such coverage
for all claimants under that policy shall be in an amount not less than
three times the dollar amount of coverage for each claimant; and excess
coverage, when combined with such primary malpractice insurance cover-
age, shall increase the aggregate level for each claimant by one million
dollars and three million dollars for all claimants; and provided
further, that, with respect to policies of primary medical malpractice
coverage that include occurrences between April 1, 2002 and June 30,
2002, such requirement that coverage be in amounts no less than one
million three hundred thousand dollars for each claimant and three
million nine hundred thousand dollars for all claimants for such occur-
rences shall be effective April 1, 2002.
S 16. Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
amending the civil practice law and rules and other laws relating to
malpractice and professional medical conduct, as amended by section 24
of part B of chapter 58 of the laws of 2008, is amended to read as
follows:
(3)(a) The superintendent of insurance shall determine and certify to
each general hospital and to the commissioner of health the cost of
excess malpractice insurance for medical or dental malpractice occur-
rences between July 1, 1986 and June 30, 1987, between July 1, 1988 and
June 30, 1989, between July 1, 1989 and June 30, 1990, between July 1,
1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, between
July 1, 1992 and June 30, 1993, between July 1, 1993 and June 30, 1994,
between July 1, 1994 and June 30, 1995, between July 1, 1995 and June
30, 1996, between July 1, 1996 and June 30, 1997, between July 1, 1997
and June 30, 1998, between July 1, 1998 and June 30, 1999, between July
1, 1999 and June 30, 2000, between July 1, 2000 and June 30, 2001,
between July 1, 2001 and June 30, 2002, between July 1, 2002 and June
30, 2003, between July 1, 2003 and June 30, 2004, between July 1, 2004
and June 30, 2005, between July 1, 2005 and June 30, 2006, between July
1, 2006 and June 30, 2007, between July 1, 2007 and June 30, 2008,
between July 1, 2008 and June 30, 2009, between July 1, 2009 and June
30, 2010, [and] between July 1, 2010 and June 30, 2011, BETWEEN JULY 1,
2011 AND JUNE 30, 2012, BETWEEN JULY 1, 2012 AND JUNE 30, 2013, AND
BETWEEN JULY 1, 2013 AND JUNE 30, 2014 allocable to each general hospi-
tal for physicians or dentists certified as eligible for purchase of a
policy for excess insurance coverage by such general hospital in accord-
ance with subdivision [(2)] 2 of this section, and may amend such deter-
mination and certification as necessary.
(b) The superintendent of insurance shall determine and certify to
each general hospital and to the commissioner of health the cost of
excess malpractice insurance or equivalent excess coverage for medical
or dental malpractice occurrences between July 1, 1987 and June 30,
1988, between July 1, 1988 and June 30, 1989, between July 1, 1989 and
June 30, 1990, between July 1, 1990 and June 30, 1991, between July 1,
1991 and June 30, 1992, between July 1, 1992 and June 30, 1993, between
July 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995,
between July 1, 1995 and June 30, 1996, between July 1, 1996 and June
30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998
and June 30, 1999, between July 1, 1999 and June 30, 2000, between July
1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002,
between July 1, 2002 and June 30, 2003, between July 1, 2003 and June
30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005
and June 30, 2006, between July 1, 2006 and June 30, 2007, between July
S. 2809--D 80 A. 4009--D
1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009,
between July 1, 2009 and June 30, 2010, [and] between July 1, 2010 and
June 30, 2011, BETWEEN JULY 1, 2011 AND JUNE 30, 2012, BETWEEN JULY 1,
2012 AND JUNE 30, 2013, AND BETWEEN JULY 1, 2013 AND JUNE 30, 2014 allo-
cable to each general hospital for physicians or dentists certified as
eligible for purchase of a policy for excess insurance coverage or
equivalent excess coverage by such general hospital in accordance with
subdivision [(2)] 2 of this section, and may amend such determination
and certification as necessary. The superintendent of insurance shall
determine and certify to each general hospital and to the commissioner
of health the ratable share of such cost allocable to the period July 1,
1987 to December 31, 1987, to the period January 1, 1988 to June 30,
1988, to the period July 1, 1988 to December 31, 1988, to the period
January 1, 1989 to June 30, 1989, to the period July 1, 1989 to December
31, 1989, to the period January 1, 1990 to June 30, 1990, to the period
July 1, 1990 to December 31, 1990, to the period January 1, 1991 to June
30, 1991, to the period July 1, 1991 to December 31, 1991, to the period
January 1, 1992 to June 30, 1992, to the period July 1, 1992 to December
31, 1992, to the period January 1, 1993 to June 30, 1993, to the period
July 1, 1993 to December 31, 1993, to the period January 1, 1994 to June
30, 1994, to the period July 1, 1994 to December 31, 1994, to the period
January 1, 1995 to June 30, 1995, to the period July 1, 1995 to December
31, 1995, to the period January 1, 1996 to June 30, 1996, to the period
July 1, 1996 to December 31, 1996, to the period January 1, 1997 to June
30, 1997, to the period July 1, 1997 to December 31, 1997, to the period
January 1, 1998 to June 30, 1998, to the period July 1, 1998 to December
31, 1998, to the period January 1, 1999 to June 30, 1999, to the period
July 1, 1999 to December 31, 1999, to the period January 1, 2000 to June
30, 2000, to the period July 1, 2000 to December 31, 2000, to the period
January 1, 2001 to June 30, 2001, to the period July 1, 2001 to June 30,
2002, to the period July 1, 2002 to June 30, 2003, to the period July 1,
2003 to June 30, 2004, to the period July 1, 2004 to June 30, 2005, to
the period July 1, 2005 and June 30, 2006, to the period July 1, 2006
and June 30, 2007, to the period July 1, 2007 and June 30, 2008, to the
period July 1, 2008 and June 30, 2009, to the period July 1, 2009 and
June 30, 2010, [and] to the period July 1, 2010 and June 30, 2011, TO
THE PERIOD JULY 1, 2011 AND JUNE 30, 2012, TO THE PERIOD JULY 1, 2012
AND JUNE 30, 2013, AND TO THE PERIOD JULY 1, 2013 AND JUNE 30, 2014.
S 17. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of
section 18 of chapter 266 of the laws of 1986, amending the civil prac-
tice law and rules and other laws relating to malpractice and profes-
sional medical conduct, as amended by section 25 of part B of chapter 58
of the laws of 2008, are amended to read as follows:
(a) To the extent funds available to the hospital excess liability
pool pursuant to subdivision [(5)] 5 of this section as amended, and
pursuant to section 6 of part J of chapter 63 of the laws of 2001, as
may from time to time be amended, which amended this subdivision, are
insufficient to meet the costs of excess insurance coverage or equiv-
alent excess coverage for coverage periods during the period July 1,
1992 to June 30, 1993, during the period July 1, 1993 to June 30, 1994,
during the period July 1, 1994 to June 30, 1995, during the period July
1, 1995 to June 30, 1996, during the period July 1, 1996 to June 30,
1997, during the period July 1, 1997 to June 30, 1998, during the period
July 1, 1998 to June 30, 1999, during the period July 1, 1999 to June
30, 2000, during the period July 1, 2000 to June 30, 2001, during the
period July 1, 2001 to October 29, 2001, during the period April 1, 2002
S. 2809--D 81 A. 4009--D
to June 30, 2002, during the period July 1, 2002 to June 30, 2003,
during the period July 1, 2003 to June 30, 2004, during the period July
1, 2004 to June 30, 2005, during the period July 1, 2005 to June 30,
2006, during the period July 1, 2006 to June 30, 2007, during the period
July 1, 2007 to June 30, 2008, during the period July 1, 2008 to June
30, 2009, during the period July 1, 2009 to June 30, 2010 [and], during
the period July 1, 2010 to June 30, 2011, DURING THE PERIOD JULY 1, 2011
TO JUNE 30, 2012, DURING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, AND
DURING THE PERIOD JULY 1, 2013 TO JUNE 30, 2014 allocated or reallocated
in accordance with paragraph (a) of subdivision [(4-a)] 4-A of this
section to rates of payment applicable to state governmental agencies,
each physician or dentist for whom a policy for excess insurance cover-
age or equivalent excess coverage is purchased for such period shall be
responsible for payment to the provider of excess insurance coverage or
equivalent excess coverage of an allocable share of such insufficiency,
based on the ratio of the total cost of such coverage for such physician
to the sum of the total cost of such coverage for all physicians applied
to such insufficiency.
(b) Each provider of excess insurance coverage or equivalent excess
coverage covering the period July 1, 1992 to June 30, 1993, or covering
the period July 1, 1993 to June 30, 1994, or covering the period July 1,
1994 to June 30, 1995, or covering the period July 1, 1995 to June 30,
1996, or covering the period July 1, 1996 to June 30, 1997, or covering
the period July 1, 1997 to June 30, 1998, or covering the period July 1,
1998 to June 30, 1999, or covering the period July 1, 1999 to June 30,
2000, or covering the period July 1, 2000 to June 30, 2001, or covering
the period July 1, 2001 to October 29, 2001, or covering the period
April 1, 2002 to June 30, 2002, or covering the period July 1, 2002 to
June 30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
covering the period July 1, 2004 to June 30, 2005, or covering the peri-
od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
June 30, 2007, or covering the period July 1, 2007 to June 30, 2008, or
covering the period July 1, 2008 to June 30, 2009, or covering the peri-
od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
June 30, 2011, OR COVERING THE PERIOD JULY 1, 2011 TO JUNE 30, 2012, OR
COVERING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, OR COVERING THE PERI-
OD JULY 1, 2013 TO JUNE 30, 2014 shall notify a covered physician or
dentist by mail, mailed to the address shown on the last application for
excess insurance coverage or equivalent excess coverage, of the amount
due to such provider from such physician or dentist for such coverage
period determined in accordance with paragraph (a) of this subdivision.
Such amount shall be due from such physician or dentist to such provider
of excess insurance coverage or equivalent excess coverage in a time and
manner determined by the superintendent of insurance.
(c) If a physician or dentist liable for payment of a portion of the
costs of excess insurance coverage or equivalent excess coverage cover-
ing the period July 1, 1992 to June 30, 1993, or covering the period
July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to
June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or
covering the period July 1, 1996 to June 30, 1997, or covering the peri-
od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
covering the period July 1, 2000 to June 30, 2001, or covering the peri-
od July 1, 2001 to October 29, 2001, or covering the period April 1,
2002 to June 30, 2002, or covering the period July 1, 2002 to June 30,
2003, or covering the period July 1, 2003 to June 30, 2004, or covering
S. 2809--D 82 A. 4009--D
the period July 1, 2004 to June 30, 2005, or covering the period July 1,
2005 to June 30, 2006, or covering the period July 1, 2006 to June 30,
2007, or covering the period July 1, 2007 to June 30, 2008, or covering
the period July 1, 2008 to June 30, 2009, or covering the period July 1,
2009 to June 30, 2010, or covering the period July 1, 2010 to June 30,
2011, OR COVERING THE PERIOD JULY 1, 2011 TO JUNE 30, 2012, OR COVERING
THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, OR COVERING THE PERIOD JULY 1,
2013 TO JUNE 30, 2014 determined in accordance with paragraph (a) of
this subdivision fails, refuses or neglects to make payment to the
provider of excess insurance coverage or equivalent excess coverage in
such time and manner as determined by the superintendent of insurance
pursuant to paragraph (b) of this subdivision, excess insurance coverage
or equivalent excess coverage purchased for such physician or dentist in
accordance with this section for such coverage period shall be cancelled
and shall be null and void as of the first day on or after the commence-
ment of a policy period where the liability for payment pursuant to this
subdivision has not been met.
(d) Each provider of excess insurance coverage or equivalent excess
coverage shall notify the superintendent of insurance and the commis-
sioner of health or their designee of each physician and dentist eligi-
ble for purchase of a policy for excess insurance coverage or equivalent
excess coverage covering the period July 1, 1992 to June 30, 1993, or
covering the period July 1, 1993 to June 30, 1994, or covering the peri-
od July 1, 1994 to June 30, 1995, or covering the period July 1, 1995 to
June 30, 1996, or covering the period July 1, 1996 to June 30, 1997, or
covering the period July 1, 1997 to June 30, 1998, or covering the peri-
od July 1, 1998 to June 30, 1999, or covering the period July 1, 1999 to
June 30, 2000, or covering the period July 1, 2000 to June 30, 2001, or
covering the period July 1, 2001 to October 29, 2001, or covering the
period April 1, 2002 to June 30, 2002, or covering the period July 1,
2002 to June 30, 2003, or covering the period July 1, 2003 to June 30,
2004, or covering the period July 1, 2004 to June 30, 2005, or covering
the period July 1, 2005 to June 30, 2006, or covering the period July 1,
2006 to June 30, 2007, or covering the period July 1, 2007 to June 30,
2008, or covering the period July 1, 2008 to June 30, 2009, or covering
the period July 1, 2009 to June 30, 2010, or covering the period July 1,
2010 to June 30, 2011, OR COVERING THE PERIOD JULY 1, 2011 TO JUNE 30,
2012, OR COVERING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, OR COVERING
THE PERIOD JULY 1, 2013 TO JUNE 30, 2014 that has made payment to such
provider of excess insurance coverage or equivalent excess coverage in
accordance with paragraph (b) of this subdivision and of each physician
and dentist who has failed, refused or neglected to make such payment.
(e) A provider of excess insurance coverage or equivalent excess
coverage shall refund to the hospital excess liability pool any amount
allocable to the period July 1, 1992 to June 30, 1993, and to the period
July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June
30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the
period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to
the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
to June 30, 2001, and to the period July 1, 2001 to October 29, 2001,
and to the period April 1, 2002 to June 30, 2002, and to the period July
1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30,
2004, and to the period July 1, 2004 to June 30, 2005, and to the period
July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June
30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the
S. 2809--D 83 A. 4009--D
period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
June 30, 2010, and to the period July 1, 2010 to June 30, 2011, AND TO
THE PERIOD JULY 1, 2011 TO JUNE 30, 2012, AND TO THE PERIOD JULY 1, 2012
TO JUNE 30, 2013, AND TO THE PERIOD JULY 1, 2013 TO JUNE 30, 2014
received from the hospital excess liability pool for purchase of excess
insurance coverage or equivalent excess coverage covering the period
July 1, 1992 to June 30, 1993, and covering the period July 1, 1993 to
June 30, 1994, and covering the period July 1, 1994 to June 30, 1995,
and covering the period July 1, 1995 to June 30, 1996, and covering the
period July 1, 1996 to June 30, 1997, and covering the period July 1,
1997 to June 30, 1998, and covering the period July 1, 1998 to June 30,
1999, and covering the period July 1, 1999 to June 30, 2000, and cover-
ing the period July 1, 2000 to June 30, 2001, and covering the period
July 1, 2001 to October 29, 2001, and covering the period April 1, 2002
to June 30, 2002, and covering the period July 1, 2002 to June 30, 2003,
and covering the period July 1, 2003 to June 30, 2004, and covering the
period July 1, 2004 to June 30, 2005, and covering the period July 1,
2005 to June 30, 2006, and covering the period July 1, 2006 to June 30,
2007, and covering the period July 1, 2007 to June 30, 2008, and cover-
ing the period July 1, 2008 to June 30, 2009, and covering the period
July 1, 2009 to June 30, 2010, and covering the period July 1, 2010 to
June 30, 2011, AND COVERING THE PERIOD JULY 1, 2011 TO JUNE 30, 2012,
AND COVERING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, AND COVERING THE
PERIOD JULY 1, 2013 TO JUNE 30, 2014 for a physician or dentist where
such excess insurance coverage or equivalent excess coverage is
cancelled in accordance with paragraph (c) of this subdivision.
S 18. Section 40 of chapter 266 of the laws of 1986, amending the
civil practice law and rules and other laws relating to malpractice and
professional medical conduct, as amended by chapter 216 of the laws of
2009, is amended to read as follows:
S 40. The superintendent of insurance shall establish rates for poli-
cies providing coverage for physicians and surgeons medical malpractice
for the periods commencing July 1, 1985 and ending June 30, [2011] 2014;
provided, however, that notwithstanding any other provision of law, the
superintendent shall not establish or approve any increase in rates for
the period commencing July 1, 2009 and ending June 30, 2010. The super-
intendent shall direct insurers to establish segregated accounts for
premiums, payments, reserves and investment income attributable to such
premium periods and shall require periodic reports by the insurers
regarding claims and expenses attributable to such periods to monitor
whether such accounts will be sufficient to meet incurred claims and
expenses. On or after July 1, 1989, the superintendent shall impose a
surcharge on premiums to satisfy a projected deficiency that is attrib-
utable to the premium levels established pursuant to this section for
such periods; provided, however, that such annual surcharge shall not
exceed eight percent of the established rate until July 1, [2011] 2014,
at which time and thereafter such surcharge shall not exceed twenty-five
percent of the approved adequate rate, and that such annual surcharges
shall continue for such period of time as shall be sufficient to satisfy
such deficiency. The superintendent shall not impose such surcharge
during the period commencing July 1, 2009 and ending June 30, 2010. On
and after July 1, 1989, the surcharge prescribed by this section shall
be retained by insurers to the extent that they insured physicians and
surgeons during the July 1, 1985 through June 30, [2011] 2014 policy
periods; in the event and to the extent physicians and surgeons were
insured by another insurer during such periods, all or a pro rata share
S. 2809--D 84 A. 4009--D
of the surcharge, as the case may be, shall be remitted to such other
insurer in accordance with rules and regulations to be promulgated by
the superintendent. Surcharges collected from physicians and surgeons
who were not insured during such policy periods shall be apportioned
among all insurers in proportion to the premium written by each insurer
during such policy periods; if a physician or surgeon was insured by an
insurer subject to rates established by the superintendent during such
policy periods, and at any time thereafter a hospital, health mainte-
nance organization, employer or institution is responsible for respond-
ing in damages for liability arising out of such physician's or
surgeon's practice of medicine, such responsible entity shall also remit
to such prior insurer the equivalent amount that would then be collected
as a surcharge if the physician or surgeon had continued to remain
insured by such prior insurer. In the event any insurer that provided
coverage during such policy periods is in liquidation, the
property/casualty insurance security fund shall receive the portion of
surcharges to which the insurer in liquidation would have been entitled.
The surcharges authorized herein shall be deemed to be income earned for
the purposes of section 2303 of the insurance law. The superintendent,
in establishing adequate rates and in determining any projected defi-
ciency pursuant to the requirements of this section and the insurance
law, shall give substantial weight, determined in his discretion and
judgment, to the prospective anticipated effect of any regulations
promulgated and laws enacted and the public benefit of stabilizing
malpractice rates and minimizing rate level fluctuation during the peri-
od of time necessary for the development of more reliable statistical
experience as to the efficacy of such laws and regulations affecting
medical, dental or podiatric malpractice enacted or promulgated in 1985,
1986, by this act and at any other time. Notwithstanding any provision
of the insurance law, rates already established and to be established by
the superintendent pursuant to this section are deemed adequate if such
rates would be adequate when taken together with the maximum authorized
annual surcharges to be imposed for a reasonable period of time whether
or not any such annual surcharge has been actually imposed as of the
establishment of such rates.
S 19. Subsection (c) of section 2343 of the insurance law, as amended
by section 27 of part B of chapter 58 of the laws of 2008, is amended to
read as follows:
(c) Notwithstanding any other provision of this chapter, no applica-
tion for an order of rehabilitation or liquidation of a domestic insurer
whose primary liability arises from the business of medical malpractice
insurance, as that term is defined in subsection (b) of section five
thousand five hundred one of this chapter, shall be made on the grounds
specified in subsection (a) or (c) of section seven thousand four
hundred two of this chapter at any time prior to June thirtieth, two
thousand [eleven] FOURTEEN.
S 20. Section 5 and subdivisions (a) and (e) of section 6 of part J of
chapter 63 of the laws of 2001, amending chapter 20 of the laws of 2001
amending the military law and other laws relating to making appropri-
ations for the support of government, as amended by section 28 of part B
of chapter 58 of the laws of 2008, are amended to read as follows:
S 5. The superintendent of insurance and the commissioner of health
shall determine, no later than June 15, 2002, June 15, 2003, June 15,
2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008, June
15, 2009, June 15, 2010, [and] June 15, 2011, JUNE 15, 2012, JUNE 15,
2013, AND JUNE 15, 2014, the amount of funds available in the hospital
S. 2809--D 85 A. 4009--D
excess liability pool, created pursuant to section 18 of chapter 266 of
the laws of 1986, and whether such funds are sufficient for purposes of
purchasing excess insurance coverage for eligible participating physi-
cians and dentists during the period July 1, 2001 to June 30, 2002, or
July 1, 2002 to June 30, 2003, or July 1, 2003 to June 30, 2004, or July
1, 2004 to June 30, 2005, or July 1, 2005 to June 30, 2006, or July 1,
2006 to June 30, 2007, or July 1, 2007 to June 30, 2008, or July 1, 2008
to June 30, 2009, or July 1, 2009 to June 30, 2010, or July 1, 2010 to
June 30, 2011, OR JULY 1, 2011 TO JUNE 30, 2012, OR JULY 1, 2012 TO JUNE
30, 2013, OR JULY 1, 2013 TO JUNE 30, 2014, as applicable.
(a) This section shall be effective only upon a determination, pursu-
ant to section five of this act, by the superintendent of insurance and
the commissioner of health, and a certification of such determination to
the state director of the budget, the chair of the senate committee on
finance and the chair of the assembly committee on ways and means, that
the amount of funds in the hospital excess liability pool, created
pursuant to section 18 of chapter 266 of the laws of 1986, is insuffi-
cient for purposes of purchasing excess insurance coverage for eligible
participating physicians and dentists during the period July 1, 2001 to
June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003 to June
30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to June 30,
2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June 30,
2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
2010, or July 1, 2010 to June 30, 2011, OR JULY 1, 2011 TO JUNE 30,
2012, OR JULY 1, 2012 TO JUNE 30, 2013, OR JULY 1, 2013 TO JUNE 30,
2014, as applicable.
(e) The commissioner of health shall transfer for deposit to the
hospital excess liability pool created pursuant to section 18 of chapter
266 of the laws of 1986 such amounts as directed by the superintendent
of insurance for the purchase of excess liability insurance coverage for
eligible participating physicians and dentists for the policy year July
1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1,
2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005
to June 30, 2006, or July 1, 2006 to June 30, 2007, as applicable, and
the cost of administering the hospital excess liability pool for such
applicable policy year, pursuant to the program established in chapter
266 of the laws of 1986, as amended, no later than June 15, 2002, June
15, 2003, June 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007,
June 15, 2008, June 15, 2009, June 15, 2010, [and] June 15, 2011, JUNE
15, 2012, JUNE 15, 2013, AND JUNE 15, 2014, as applicable.
S 21. Section 18 of chapter 904 of the laws of 1984, amending the
public health law and the social services law relating to encouraging
comprehensive health services, as amended by section 64 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
S 18. This act shall take effect immediately, except that sections
six, nine, ten and eleven of this act shall take effect on the sixtieth
day after it shall have become a law, sections two, three, four and nine
of this act shall expire and be of no further force or effect on or
after March 31, [2012] 2014, section two of this act shall take effect
on April 1, 1985 or seventy-five days following the submission of the
report required by section one of this act, whichever is later, and
sections eleven and thirteen of this act shall expire and be of no
further force or effect on or after March 31, 1988.
S 22. Paragraphs (i) and (j) of subdivision 1 of section 367-q of the
social services law, as added by section 22-d of part B of chapter 58 of
S. 2809--D 86 A. 4009--D
the laws of 2008, are amended and three new paragraphs (k), (l) and (m)
are added to read as follows:
(i) for the period April first, two thousand nine through March thir-
ty-first, two thousand ten, twenty-eight million five hundred thousand
dollars; [and]
(j) for the period April first, two thousand ten through March thir-
ty-first, two thousand eleven, twenty-eight million five hundred thou-
sand dollars[.];
(K) FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWELVE, TWENTY-EIGHT MILLION FIVE HUNDRED
THOUSAND DOLLARS;
(L) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, TWENTY-EIGHT MILLION FIVE HUNDRED
THOUSAND DOLLARS; AND
(M) FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FOURTEEN, TWENTY-EIGHT MILLION FIVE HUNDRED
THOUSAND DOLLARS.
S 23. Paragraph (f) of subdivision 9 of section 3614 of the public
health law, as added by section 22-e of part B of chapter 58 of the laws
of 2008, is amended and three new paragraphs (g), (h) and (i) are added
to read as follows:
(f) for the period April first, two thousand ten through March thir-
ty-first, two thousand eleven, up to one hundred million dollars[.];
(G) FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWELVE, UP TO ONE HUNDRED MILLION DOLLARS;
(H) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, UP TO ONE HUNDRED MILLION DOLLARS;
(I) FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FOURTEEN, UP TO ONE HUNDRED MILLION DOLLARS.
S 24. Paragraph (a) of subdivision 10 of section 3614 of the public
health law, as amended by section 5 of part C of chapter 109 of the laws
of 2006, is amended to read as follows:
(a) Such adjustments to rates of payments shall be allocated propor-
tionally based on each certified home health agency's, long term home
health care program, AIDS home care and hospice program's home health
aide or other direct care services total annual hours of service
provided to medicaid patients, as reported in each such agency's most
[recent] RECENTLY AVAILABLE cost report as submitted to the department
[prior to November first, two thousand five] or for the purpose of the
managed long term care program a suitable proxy developed by the depart-
ment in consultation with the interested parties. Payments made pursuant
to this section shall not be subject to subsequent adjustment or recon-
ciliation.
S 25. Section 4 of chapter 495 of the laws of 2004, amending the
insurance law and the public health law relating to the New York state
health insurance continuation assistance demonstration project, as
amended by section 29 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
S 4. This act shall take effect on the sixtieth day after it shall
have become a law; provided, however, that this act shall remain in
effect until July 1, [2011] 2014 when upon such date the provisions of
this act shall expire and be deemed repealed; provided, further, that a
displaced worker shall be eligible for continuation assistance retroac-
tive to July 1, 2004.
S 26. The opening paragraph and clauses (C), (D) and (G) of subpara-
graph (i) of paragraph (b) and paragraphs (c), (d), (e), (f) and (g) of
S. 2809--D 87 A. 4009--D
subdivision 5-a of section 2807-m of the public health law, the opening
paragraph and clauses (C), (D) and (G) of subparagraph (i) of paragraph
(b) as amended by section 4 of part B of chapter 109 of the laws of
2010, paragraphs (c), (f) and (g) and the opening paragraphs of para-
graphs (d) and (e) as amended by section 98 of part C of chapter 58 of
the laws of 2009 and paragraphs (d) and (e) as added by section 75-c of
part C of chapter 58 of the laws of 2008, are amended to read as
follows:
Nine million one hundred twenty thousand dollars annually for the
period January first, two thousand nine through December thirty-first,
two thousand ten, and two million two hundred eighty thousand dollars
for the period January first, two thousand eleven, AND NINE MILLION ONE
HUNDRED TWENTY THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FOURTEEN, through March thirty-first, two thousand eleven, shall be
set aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section to be allocated
regionally with two-thirds of the available funding going to New York
city and one-third of the available funding going to the rest of the
state and shall be available for distribution as follows:
(C) If the dollar amount for the total number of clinical research
positions in the region calculated pursuant to clause (B) of this
subparagraph exceeds [thirty percent of the funding available pursuant
to] THE TOTAL AMOUNT APPROPRIATED FOR PURPOSES OF this paragraph, [or an
amount equal to the sum of one clinical research position per teaching
general hospital in the region, whichever is greater,] including clin-
ical research positions that continue from and were funded in prior
distribution periods, the commissioner shall eliminate one-half of the
clinical research positions submitted by each consortium or teaching
general hospital rounded down to the nearest one position. Such
reduction shall be repeated until the dollar amount for the total number
of clinical research positions in the region does not exceed [thirty
percent of the regional pool, or an amount equal to the sum of one clin-
ical research position per teaching general hospital in the region,
whichever is greater] THE TOTAL AMOUNT APPROPRIATED FOR PURPOSES OF THIS
PARAGRAPH. IF THE REPEATED REDUCTION OF THE TOTAL NUMBER OF CLINICAL
RESEARCH POSITIONS IN THE REGION BY ONE-HALF DOES NOT RENDER A TOTAL
FUNDING AMOUNT THAT IS EQUAL TO OR LESS THAN THE TOTAL AMOUNT RESERVED
FOR THAT REGION WITHIN THE APPROPRIATION, THE FUNDING FOR EACH CLINICAL
RESEARCH POSITION IN THAT REGION SHALL BE REDUCED PROPORTIONALLY IN ONE
THOUSAND DOLLAR INCREMENTS UNTIL THE TOTAL DOLLAR AMOUNT FOR THE TOTAL
NUMBER OF CLINICAL RESEARCH POSITIONS IN THAT REGION DOES NOT EXCEED THE
TOTAL AMOUNT RESERVED FOR THAT REGION WITHIN THE APPROPRIATION. ANY
REDUCTION IN FUNDING WILL BE EFFECTIVE FOR THE DURATION OF THE AWARD.
No clinical research positions that continue from and were funded in
prior distribution periods shall be eliminated OR REDUCED by such
[reduction] METHODOLOGY.
(D) Each consortium or teaching general hospital shall receive [fifty
percent of its annual distribution amount calculated pursuant to this
subparagraph once the requirements set forth in clause (G) of this
subparagraph have been met. The remaining distribution amount shall be
disbursed subsequent to the submission of information required pursuant
to clause (G) of this subparagraph] ITS ANNUAL DISTRIBUTION AMOUNT IN
ACCORDANCE WITH THE FOLLOWING:
(I) EACH CONSORTIUM OR TEACHING GENERAL HOSPITAL WITH A ONE-YEAR ECRIP
AWARD SHALL RECEIVE ITS ANNUAL DISTRIBUTION AMOUNT IN FULL UPON
S. 2809--D 88 A. 4009--D
COMPLETION OF THE REQUIREMENTS SET FORTH IN ITEMS (I) AND (II) OF CLAUSE
(G) OF THIS SUBPARAGRAPH. THE REQUIREMENTS SET FORTH IN ITEMS (IV) AND
(V) OF CLAUSE (G) OF THIS SUBPARAGRAPH MUST BE COMPLETED BY THE CONSOR-
TIUM OR TEACHING GENERAL HOSPITAL IN ORDER FOR THE CONSORTIUM OR TEACH-
ING GENERAL HOSPITAL TO BE ELIGIBLE TO APPLY FOR ECRIP FUNDING IN ANY
SUBSEQUENT FUNDING CYCLE.
(II) EACH CONSORTIUM OR TEACHING GENERAL HOSPITAL WITH A TWO-YEAR
ECRIP AWARD SHALL RECEIVE ITS FIRST ANNUAL DISTRIBUTION AMOUNT IN FULL
UPON COMPLETION OF THE REQUIREMENTS SET FORTH IN ITEMS (I) AND (II) OF
CLAUSE (G) OF THIS SUBPARAGRAPH. EACH CONSORTIUM OR TEACHING GENERAL
HOSPITAL WILL RECEIVE ITS SECOND ANNUAL DISTRIBUTION AMOUNT IN FULL UPON
COMPLETION OF THE REQUIREMENTS SET FORTH IN ITEM (III) OF CLAUSE (G) OF
THIS SUBPARAGRAPH. THE REQUIREMENTS SET FORTH IN ITEMS (IV) AND (V) OF
CLAUSE (G) OF THIS SUBPARAGRAPH MUST BE COMPLETED BY THE CONSORTIUM OR
TEACHING GENERAL HOSPITAL IN ORDER FOR THE CONSORTIUM OR TEACHING GENER-
AL HOSPITAL TO BE ELIGIBLE TO APPLY FOR ECRIP FUNDING IN ANY SUBSEQUENT
FUNDING CYCLE.
(G) In order to be eligible for distributions pursuant to this subpar-
agraph, each consortium and teaching general hospital shall provide to
the commissioner by July first of each distribution period, the follow-
ing data and information on a hospital-specific basis. Such data and
information shall be certified as to accuracy and completeness by the
chief executive officer, chief financial officer or chair of the consor-
tium governing body of each consortium or teaching general hospital and
shall be maintained by each consortium and teaching general hospital for
five years from the date of submission:
(I) For each clinical research position, information on the type,
scope, training objectives, institutional support, clinical research
experience of the sponsor-mentor, plans for submitting research outcomes
to peer reviewed journals and at scientific meetings, including a meet-
ing sponsored by the department, the name of a principal contact person
responsible for tracking the career development of researchers placed in
clinical research positions, as defined in paragraph (c) of subdivision
one of this section, and who is authorized to certify to the commission-
er that all the requirements of the clinical research training objec-
tives set forth in this subparagraph shall be met. Such certification
shall be provided by July first of each distribution period;
(II) For each clinical research position, information on the name,
citizenship status, medical education and training, and medical license
number of the researcher, if applicable, shall be provided by December
thirty-first of the calendar year following the distribution period;
(III) Information on the status of the clinical research plan, accom-
plishments, changes in research activities, progress, and performance of
the researcher shall be provided [six months after the clinical research
position has commenced and every six months thereafter for a full-time
position and for a half-time position, one year after the clinical
research position has commenced and every year thereafter] UPON
COMPLETION OF ONE-HALF OF THE AWARD TERM;
(IV) A final report detailing training experiences, accomplishments,
activities and performance of the clinical researcher, and data, meth-
ods, results and analyses of the clinical research plan shall be
provided three months after the clinical research position ends; and
(V) TRACKING INFORMATION CONCERNING PAST RESEARCHERS, INCLUDING BUT
NOT LIMITED TO (A) BACKGROUND INFORMATION, (B) EMPLOYMENT HISTORY, (C)
RESEARCH STATUS, (D) CURRENT RESEARCH ACTIVITIES, (E) PUBLICATIONS AND
S. 2809--D 89 A. 4009--D
PRESENTATIONS, (F) RESEARCH SUPPORT, AND (G) ANY OTHER INFORMATION
NECESSARY TO TRACK THE RESEARCHER; AND
(VI) Any other data or information required by the commissioner to
implement this subparagraph.
(c) Ambulatory care training. Four million nine hundred thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight, four million nine hundred thousand
dollars for the period January first, two thousand nine through December
thirty-first, two thousand nine, four million nine hundred thousand
dollars for the period January first, two thousand ten through December
thirty-first, two thousand ten, [and] one million two hundred twenty-
five thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, AND FOUR MILLION THREE
HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL
FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
FOURTEEN, shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
and shall be available for distributions to sponsoring institutions to
be directed to support clinical training of medical students and resi-
dents in free-standing ambulatory care settings, including community
health centers and private practices. Such funding shall be allocated
regionally with two-thirds of the available funding going to New York
city and one-third of the available funding going to the rest of the
state and shall be distributed to sponsoring institutions in each region
pursuant to a request for application or request for proposal process
with preference being given to sponsoring institutions which provide
training in sites located in underserved rural or inner-city areas and
those that include medical students in such training.
(d) Physician loan repayment program. 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 thou-
sand nine through December thirty-first, two thousand nine, one million
nine hundred sixty thousand dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten, [and] four
hundred ninety thousand dollars for the period January first, two thou-
sand eleven through March thirty-first, two thousand eleven, AND ONE
MILLION SEVEN HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND FOURTEEN, 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:
(i) Funding shall first be awarded to repay loans of up to twenty-five
physicians who train in primary care or specialty tracks in teaching
general hospitals, and who enter and remain in primary care or specialty
practices in underserved communities, as determined by the commissioner.
(ii) After distributions in accordance with subparagraph (i) of this
paragraph, all remaining funds shall be awarded to repay loans of physi-
cians who enter and remain in primary care or specialty practices in
underserved communities, as determined by the commissioner, including
S. 2809--D 90 A. 4009--D
but not limited to physicians working in general hospitals, or other
health care facilities.
(iii) In no case shall less than fifty percent of the funds available
pursuant to this paragraph be distributed in accordance with subpara-
graphs (i) and (ii) of this paragraph to physicians identified by gener-
al hospitals.
(e) Physician practice support. Four million nine hundred thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight, four million nine hundred thousand
dollars annually for the period January first, two thousand nine through
December thirty-first, two thousand ten, [and] one million two hundred
twenty-five thousand dollars for the period January first, two thousand
eleven through March thirty-first, two thousand eleven, AND FOUR MILLION
THREE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FOURTEEN, 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:
(i) Preference in funding shall first be accorded to teaching general
hospitals for up to twenty-five awards, to support costs incurred by
physicians trained in primary or specialty tracks who thereafter estab-
lish or join practices in underserved communities, as determined by the
commissioner.
(ii) After distributions in accordance with subparagraph (i) of this
paragraph, all remaining funds shall be awarded to physicians to support
the cost of establishing or joining practices in underserved communi-
ties, as determined by the commissioner, and to hospitals and other
health care providers to recruit new physicians to provide services in
underserved communities, as determined by the commissioner.
(iii) In no case shall less than fifty percent of the funds available
pursuant to this paragraph be distributed to general hospitals in
accordance with subparagraphs (i) and (ii) of this paragraph.
(f) Study on physician workforce. Five hundred ninety thousand dollars
annually for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand ten, [and] one hundred forty-eight thou-
sand dollars for the period January first, two thousand eleven through
March thirty-first, two thousand eleven, AND FIVE HUNDRED SIXTEEN THOU-
SAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO
THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, 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 to fund a study of physician workforce needs and solutions
including, but not limited to, an analysis of residency programs and
projected physician workforce and community needs. The commissioner
shall enter into agreements with one or more organizations to conduct
such study based on a request for proposal process.
(g) Diversity in medicine/post-baccalaureate program. Notwithstanding
any inconsistent provision of section one hundred twelve or one hundred
sixty-three of the state finance law or any other law, one million nine
hundred sixty thousand dollars annually for the period January first,
two thousand eight through December thirty-first, two thousand ten,
[and] four hundred ninety thousand dollars for the period January first,
S. 2809--D 91 A. 4009--D
two thousand eleven through March thirty-first, two thousand eleven, AND
ONE MILLION SEVEN HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR
THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND FOURTEEN, shall be set aside and reserved by the commis-
sioner from the regional pools established pursuant to subdivision two
of this section and shall be available for distributions to the Associ-
ated Medical Schools of New York to fund its diversity program including
existing and new post-baccalaureate programs for minority and econom-
ically disadvantaged students and encourage participation from all
medical schools in New York. The associated medical schools of New York
shall report to the commissioner on an annual basis regarding the use of
funds for such purpose in such form and manner as specified by the
commissioner.
S 26-a. Subdivision 7 of section 2807-m of the public health law, as
amended by section 99 of part C of chapter 58 of the laws of 2009, is
amended to read as follows:
7. Notwithstanding any inconsistent provision of section one hundred
twelve or one hundred sixty-three of the state finance law or any other
law, up to one million dollars for the period January first, two thou-
sand through December thirty-first, two thousand, one million six
hundred thousand dollars annually for the periods January first, two
thousand one through December thirty-first, two thousand eight, one
million five hundred thousand dollars annually for the periods January
first, two thousand nine through December thirty-first, two thousand
ten, [and] three hundred seventy-five thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven, AND ONE MILLION THREE HUNDRED TWENTY THOUSAND DOLLARS EACH
STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, shall be set aside
and reserved by the commissioner from the regional pools established
pursuant to subdivision two of this section and shall be available for
distributions to the New York state area health education center program
for the purpose of expanding community-based training of medical
students. In addition, one million dollars annually for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand ten, [and] two hundred fifty thousand dollars for the period Janu-
ary first, two thousand eleven through March thirty-first, two thousand
eleven, AND EIGHT HUNDRED EIGHTY THOUSAND DOLLARS EACH STATE FISCAL YEAR
FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FOURTEEN, shall be set aside and reserved by
the commissioner from the regional pools established pursuant to subdi-
vision two of this section and shall be available for distributions to
the New York state area health education center program for the purpose
of post-secondary training of health care professionals who will achieve
specific program outcomes within the New York state area health educa-
tion center program. The New York state area health education center
program shall report to the commissioner on an annual basis regarding
the use of funds for each purpose in such form and manner as specified
by the commissioner.
S 27. Subdivision 4-c of section 2807-p of the public health law, as
amended by section 13-c of Part C of chapter 58 of the laws of 2009, is
amended to read as follows:
4-c. Notwithstanding any provision of law to the contrary, the commis-
sioner shall make additional payments for uncompensated care to volun-
tary non-profit diagnostic and treatment centers that are eligible for
distributions under subdivision four of this section in the following
S. 2809--D 92 A. 4009--D
amounts: for the period June first, two thousand six through December
thirty-first, two thousand six, in the amount of seven million five
hundred thousand dollars, for the period January first, two thousand
seven through December thirty-first, two thousand seven, seven million
five hundred thousand dollars, for the period January first, two thou-
sand eight through December thirty-first, two thousand eight, seven
million five hundred thousand dollars, for the period January first, two
thousand nine through December thirty-first, two thousand nine, fifteen
million five hundred thousand dollars, for the period January first, two
thousand ten through December thirty-first, two thousand ten, seven
million five hundred thousand dollars, FOR THE PERIOD JANUARY FIRST, TWO
THOUSAND ELEVEN THOUGH DECEMBER THIRTY-FIRST, TWO THOUSAND ELEVEN, SEVEN
MILLION FIVE HUNDRED THOUSAND DOLLARS, FOR THE PERIOD JANUARY FIRST, TWO
THOUSAND TWELVE THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE,
SEVEN MILLION FIVE HUNDRED THOUSAND DOLLARS, FOR THE PERIOD JANUARY
FIRST, TWO THOUSAND THIRTEEN THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND
THIRTEEN, SEVEN MILLION FIVE HUNDRED THOUSAND DOLLARS, and for the peri-
od January first, two thousand [eleven] FOURTEEN through March thirty-
first, two thousand [eleven] FOURTEEN, in the amount of one million
eight hundred seventy-five thousand dollars, provided, however, that for
periods on and after January first, two thousand eight, such additional
payments shall be distributed to voluntary, non-profit diagnostic and
treatment centers and to public diagnostic and treatment centers in
accordance with paragraph (g) of subdivision four of this section. In
the event that federal financial participation is available for rate
adjustments pursuant to this section, the commissioner shall make such
payments as additional adjustments to rates of payment for voluntary
non-profit diagnostic and treatment centers that are eligible for
distributions under subdivision four-a of this section in the following
amounts: for the period June first, two thousand six through December
thirty-first, two thousand six, fifteen million dollars in the aggre-
gate, and for the period January first, two thousand seven through June
thirtieth, two thousand seven, seven million five hundred thousand
dollars in the aggregate. The amounts allocated pursuant to this para-
graph shall be aggregated with and distributed pursuant to the same
methodology applicable to the amounts allocated to such diagnostic and
treatment centers for such periods pursuant to subdivision four of this
section if federal financial participation is not available, or pursuant
to subdivision four-a of this section if federal financial participation
is available. Notwithstanding section three hundred sixty-eight-a of
the social services law, there shall be no local share in a medical
assistance payment adjustment under this subdivision.
S 28. Subdivision 3 and paragraph (a) of subdivision 4 of section
2807-k of the public health law, as amended by section 15 of part C of
chapter 58 of the laws of 2010, are amended to read as follows:
3. Each major public general hospital shall be allocated for distrib-
ution from the pools established pursuant to this section for each year
through December thirty-first, two thousand [eleven] FOURTEEN, an amount
equal to the amount allocated to such major public general hospital from
the regional pool established pursuant to subdivision seventeen of
section twenty-eight hundred seven-c of this article for the period
January first, nineteen hundred ninety-six through December thirty-
first, nineteen hundred ninety-six, provided, however, that payments on
and after January first, two thousand nine shall be subject to the
provisions of subdivision five-a of this section.
S. 2809--D 93 A. 4009--D
(a) From funds in the pool for each year, thirty-six million dollars
shall be reserved on an annual basis through December thirty-first, two
thousand [eleven] FOURTEEN, for distribution as high need adjustments in
accordance with subdivision six of this section, provided, however, that
payments on and after January first, two thousand nine shall be subject
to the provisions of subdivision five-a of this section.
S 29. The opening paragraph, paragraph (a) of subdivision 1 and subdi-
vision 2 of section 2807-w of the public health law, as amended by
section 14 of part C of chapter 58 of the laws of 2010, are amended to
read as follows:
Funds allocated pursuant to paragraph (p) of subdivision one of
section twenty-eight hundred seven-v of this article, shall be deposited
as authorized and used for the purpose of making medicaid dispropor-
tionate share payments of up to eighty-two million dollars on an annual-
ized basis pursuant to subdivision twenty-one of section twenty-eight
hundred seven-c of this article, for the period January first, two thou-
sand through March thirty-first, two thousand [eleven] FOURTEEN, in
accordance with the following:
(a) Each eligible rural hospital shall receive one hundred forty thou-
sand dollars on an annualized basis for the periods January first, two
thousand through December thirty-first, two thousand [eleven] FOURTEEN,
provided as a disproportionate share payment; provided, however, that if
such payment pursuant to this paragraph exceeds a hospital's applicable
disproportionate share limit, then the total amount in excess of such
limit shall be provided as a nondisproportionate share payment in the
form of a grant directly from this pool without allocation to the
special revenue funds - other, indigent care fund - 068, or any succes-
sor fund or account, and provided further that payments for periods on
and after January first, two thousand nine shall be subject to the
provisions of subdivision five-a of section twenty-eight hundred seven-k
of this article;
2. From the funds in the pool each year, thirty-six million dollars on
an annualized basis for the periods January first, two thousand through
December thirty-first, two thousand [eleven] FOURTEEN, of the funds not
distributed in accordance with subdivision one of this section, shall be
distributed in accordance with the formula set forth in subdivision six
of section twenty-eight hundred seven-k of this article, provided,
however, that payments for periods on and after January first, two thou-
sand nine shall be subject to the provisions of subdivision five-a of
section twenty-eight hundred seven-k of this article.
S 30. Subparagraph (v) of paragraph (a) of subdivision 3 of section
2807-j of the public health law, as added by chapter 639 of the laws of
1996, is amended to read as follows:
(v) revenue received from physician practice or faculty practice plan
discrete billings for [private practicing] physician services;
S 31. Clause (D) of subparagraph (ii) of paragraph (b) of subdivision
3 of section 2807-j of the public health law, as added by chapter 639 of
the laws of 1996, is amended to read as follows:
(D) revenue received from physician practice or faculty practice plan
discrete billings for [private practicing] physician services;
S 32. 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. 2809--D 94 A. 4009--D
S 33. 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 34. 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 judgement 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 judge-
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 35. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2011, provided
that:
(a) 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;
(b) 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;
(c) 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;
(d) 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;
(e) 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;
(f) the amendments to sections 2807-j and 2807-s of the public health
law made by sections three, five, five-a, five-b, six, thirty and thir-
ty-one, respectively, of this act shall not affect the expiration of
such sections and shall expire therewith; and
(g) the amendments to paragraph (i-l) of subdivision 1 of section
2807-v of the public health law made by section eight of this act shall
not affect the repeal of such paragraph and shall be deemed repealed
therewith.
PART D
Section 1. Paragraph (e-1) of subdivision 12 of section 2808 of the
public health law, as separately amended by section 11 of part B and
section 21 of part D of chapter 58 of the laws of 2009, is amended to
read as follows:
(e-1) Notwithstanding any inconsistent provision of law or regulation,
the commissioner shall provide, in addition to payments established
pursuant to this article prior to application of this section, addi-
S. 2809--D 95 A. 4009--D
tional payments under the medical assistance program pursuant to title
eleven of article five of the social services law for non-state operated
public residential health care facilities, including public residential
health care facilities located in the county of Nassau, the county of
Westchester and the county of Erie, but excluding public residential
health care facilities operated by a town or city within a county, in
aggregate annual amounts of up to one hundred fifty million dollars in
additional payments for the state fiscal year beginning April first, two
thousand six and for the state fiscal year beginning April first, two
thousand seven and for the state fiscal year beginning April first, two
thousand eight and of up to three hundred million dollars in such aggre-
gate annual additional payments for the state fiscal year beginning
April first, two thousand nine, and for the state fiscal year beginning
April first, two thousand ten and for the state fiscal year beginning
April first, two thousand eleven, AND FOR THE STATE FISCAL YEARS BEGIN-
NING APRIL FIRST, TWO THOUSAND TWELVE AND APRIL FIRST, TWO THOUSAND
THIRTEEN. The amount allocated to each eligible public residential
health care facility for this period shall be computed in accordance
with the provisions of paragraph (f) of this subdivision, provided,
however, that patient days shall be utilized for such computation
reflecting actual reported data for two thousand three and each repre-
sentative succeeding year as applicable.
S 2. 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 healthcare facilities, as amended by section 2 of
part B of chapter 58 of the laws of 2010, 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] 2013,
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
S. 2809--D 96 A. 4009--D
data as further reconciled to actual reported 1996 reconciled data, and
for 1997 based initially on reported 1995 reconciled data as further
reconciled to actual reported 1997 reconciled data, for 1998 based
initially on reported 1995 reconciled data as further reconciled to
actual reported 1998 reconciled data, for 1999 based initially on
reported 1995 reconciled data as further reconciled to actual reported
1999 reconciled data, for 2000 based initially on reported 1995 recon-
ciled data as further reconciled to actual reported 2000 data, for 2001
based initially on reported 1995 reconciled data as further reconciled
to actual reported 2001 data, for 2002 based initially on reported 2000
reconciled data as further reconciled to actual reported 2002 data, and
for state fiscal years beginning on April 1, 2005, based initially on
reported 2000 reconciled data as further reconciled to actual reported
data for 2005, and for state fiscal years beginning on April 1, 2006,
based initially on reported 2000 reconciled data as further reconciled
to actual reported data for 2006, 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 3. Section 11 of chapter 884 of the laws of 1990, amending the
public health law relating to authorizing bad debt and charity care
allowances for certified home health agencies, as amended by section 14
of part B of chapter 58 of the laws of 2009, is amended to read as
follows:
S 11. This act shall take effect immediately and:
(a) sections one and three shall expire on December 31, 1996,
(b) sections four through ten shall expire on June 30, [2011] 2013,
and
(c) provided that the amendment to section 2807-b of the public health
law by section two of this act shall not affect the expiration of such
section 2807-b as otherwise provided by law and shall be deemed to
expire therewith.
S 4. Subdivision 2 of section 246 of chapter 81 of the laws of 1995,
amending the public health law and other laws relating to medical
reimbursement and welfare reform, as amended by section 15 of part B of
chapter 58 of the laws of 2009, is amended to read as follows:
2. Sections five, seven through nine, twelve through fourteen, and
eighteen of this act shall be deemed to have been in full force and
effect on and after April 1, 1995 through March 31, 1999 and on and
after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
through March 31, 2003 and on and after April 1, 2003 through March 31,
2006 and on and after April 1, 2006 through March 31, 2007 and on and
after April 1, 2007 through March 31, 2009 and on and after April 1,
2009 through March 31, 2011 AND SECTIONS TWELVE, THIRTEEN AND FOURTEEN
S. 2809--D 97 A. 4009--D
OF THIS ACT SHALL BE DEEMED TO BE IN FULL FORCE AND EFFECT ON AND AFTER
APRIL 1, 2011 THROUGH MARCH 31, 2013;
S 5. Intentionally omitted.
S 6. Intentionally omitted.
S 7. Paragraphs (a) and (e) of subdivision 8 of section 2807-c of the
public health law, paragraph (a) as amended by chapter 731 of the laws
of 1993 and paragraph (e) as added by chapter 81 of the laws of 1995,
are amended to read as follows:
(a) Capital related inpatient expenses including but not limited to
straight line depreciation on buildings and non-movable equipment,
accelerated depreciation on major movable equipment if requested by the
hospital, rentals and interest on capital debt (or for hospitals
financed pursuant to article twenty-eight-B of this chapter, such
expenses, including amortization in lieu of depreciation, as determined
pursuant to the reimbursement regulations promulgated pursuant to such
article and article twenty-eight of this chapter), [and excluding costs
related to services provided to beneficiaries of title XVIII of the
federal social security act (medicare),] shall be included in rates of
payment determined pursuant to this section based on a budget for capi-
tal related inpatient expenses and subsequently reconciled to actual
expenses and statistics through appropriate audit procedures. General
hospitals shall submit to the commissioner, at least one hundred twenty
days prior to the commencement of each year, a schedule of capital
related inpatient expenses for the forthcoming year. Any capital expend-
iture which requires or required approval pursuant to this article must
have received such approval for any capital related expense generated by
such capital expenditure to be included in rates of payment. The basis
for determining capital related inpatient expenses shall be the lesser
of actual cost or the final amount specifically approved for the
construction of the capital asset. The submitted budget may include the
capital related inpatient expenses for all existing capital assets as
well as estimates of capital related inpatient expenses for capital
assets to be acquired or placed in use prior to the commencement of the
rate year or during the rate year provided all required approvals have
been obtained.
The council shall adopt, with the approval of the commissioner, regu-
lations to:
(i) identify by type the eligible capital related inpatient expenses;
(ii) safeguard the future financial viability of voluntary, non-profit
general hospitals by requiring funding of inpatient depreciation on
building and fixed and movable equipment;
(iii) provide authorization to adjust inpatient rates by advancing
payment of depreciation as needed, in instances of capital debt related
financial distress of voluntary, non-profit general hospitals; and
(iv) provide a methodology for the reimbursement treatment of sales.
(e) Notwithstanding any inconsistent provision of this subdivision,
commencing April first, nineteen hundred ninety-five, when a factor for
reconciliation of budgeted capital related inpatient expenses to actual
capital related inpatient expenses [excluding costs related to services
provided to beneficiaries of title XVIII of the federal social security
act (medicare)] for a prior year is included in the capital related
inpatient expenses component of rates of payment, such capital related
inpatient expenses component of rates of payment shall be reduced by the
commissioner by the difference between the reconciled capital related
inpatient expenses included in rates of payment determined in accordance
with paragraphs (a), (b) and (c) of this subdivision for such prior year
S. 2809--D 98 A. 4009--D
and capital related inpatient expenses for such prior year calculated
[based on a determination of costs related to services provided to bene-
ficiaries of title XVIII of the federal social security act (medicare)]
based on the hospital's average capital related inpatient expenses
computed on a per diem basis.
S 8. Paragraph (d) of subdivision 8 of section 2807-c of the public
health law is REPEALED.
S 9. Section 194 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 24 of part B of chapter 58 of the
laws of 2009, is amended to read as follows:
S 194. 1. Notwithstanding any inconsistent provision of law or regu-
lation, the trend factors used to project reimbursable operating costs
to the rate period for purposes of determining rates of payment pursuant
to article 28 of the public health law for residential health care
facilities for reimbursement of inpatient services provided to patients
eligible for payments made by state governmental agencies on and after
April 1, 1996 through March 31, 1999 and for payments made on and after
July 1, 1999 through March 31, 2000 and on and after April 1, 2000
through March 31, 2003 and on and after April 1, 2003 through March 31,
2007 and on and after April 1, 2007 through March 31, 2009 and on and
after April 1, 2009 through March 31, 2011 AND ON AND AFTER APRIL 1,
2011 THROUGH MARCH 31, 2013 shall reflect no trend factor projections or
adjustments for the period April 1, 1996, through March 31, 1997.
2. The commissioner of health shall adjust such rates of payment to
reflect the exclusion pursuant to this section of such specified trend
factor projections or adjustments.
S 10. Subdivision 1 of section 89-a of part C of chapter 58 of the
laws of 2007, amending the social services law and other laws relating
to enacting the major components of legislation necessary to implement
the health and mental hygiene budget for the 2007-2008 state fiscal
year, as amended by section 25 of part B of chapter 58 of the laws of
2009, is amended to read as follows:
1. Notwithstanding paragraph (c) of subdivision 10 of section 2807-c
of the public health law and section 21 of chapter 1 of the laws of
1999, as amended, and any other inconsistent provision of law or regu-
lation to the contrary, in determining rates of payments by state
governmental agencies effective for services provided beginning April 1,
2006, through March 31, 2009, and on and after April 1, 2009 through
March 31, 2011, AND ON AND AFTER APRIL 1, 2011 THROUGH MARCH 31, 2013
for inpatient and outpatient services provided by general hospitals and
for inpatient services and outpatient adult day health care services
provided by residential health care facilities pursuant to article 28 of
the public health law, the commissioner of health shall apply a trend
factor projection of two and twenty-five hundredths percent attributable
to the period January 1, 2006 through December 31, 2006, and on and
after January 1, 2007, provided, however, that on reconciliation of such
trend factor for the period January 1, 2006 through December 31, 2006
pursuant to paragraph (c) of subdivision 10 of section 2807-c of the
public health law, such trend factor shall be the final US Consumer
Price Index (CPI) for all urban consumers, as published by the US
Department of Labor, Bureau of Labor Statistics less twenty-five
hundredths of a percentage point.
S 11. Paragraph (f) of subdivision 1 of section 64 of chapter 81 of
the laws of 1995, amending the public health law and other laws relating
S. 2809--D 99 A. 4009--D
to medical reimbursement and welfare reform, as amended by section 26 of
part B of chapter 58 of the laws of 2009, is amended to read as follows:
(f) Prior to February 1, 2001, February 1, 2002, February 1, 2003,
February 1, 2004, February 1, 2005, February 1, 2006, February 1, 2007,
February 1, 2008, February 1, 2009, February 1, 2010, [and] February 1,
2011, FEBRUARY 1, 2012, AND FEBRUARY 1, 2013 the commissioner of health
shall calculate the result of the statewide total of residential health
care facility days of care provided to beneficiaries of title XVIII of
the federal social security act (medicare), divided by the sum of such
days of care plus days of care provided to residents eligible for
payments pursuant to title 11 of article 5 of the social services law
minus the number of days provided to residents receiving hospice care,
expressed as a percentage, for the period commencing January 1, through
November 30, of the prior year respectively, based on such data for such
period. This value shall be called the 2000, 2001, 2002, 2003, 2004,
2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
target percentage respectively.
S 12. Subparagraph (ii) of paragraph (b) of subdivision 3 of section
64 of chapter 81 of the laws of 1995, amending the public health law and
other laws relating to medical reimbursement and welfare reform, as
amended by section 27 of part B of chapter 58 of the laws of 2009, is
amended to read as follows:
(ii) If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide target
percentages are not for each year at least three percentage points high-
er than the statewide base percentage, the commissioner of health shall
determine the percentage by which the statewide target percentage for
each year is not at least three percentage points higher than the state-
wide base percentage. The percentage calculated pursuant to this para-
graph shall be called the 1997, 1998, 2000, 2001, 2002, 2003, 2004,
2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
reduction percentage respectively. If the 1997, 1998, 2000, 2001, 2002,
2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND
2013 statewide target percentage for the respective year is at least
three percentage points higher than the statewide base percentage, the
statewide reduction percentage for the respective year shall be zero.
S 13. Subparagraph (iii) of paragraph (b) of subdivision 4 of section
64 of chapter 81 of the laws of 1995, amending the public health law and
other laws relating to medical reimbursement and welfare reform, as
amended by section 28 of part B of chapter 58 of the laws of 2009, is
amended to read as follows:
(iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,
2009, 2010 [and], 2011, 2012, AND 2013 statewide reduction percentage
shall be multiplied by one hundred two million dollars respectively to
determine the 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide aggregate
reduction amount. If the 1998 and the 2000, 2001, 2002, 2003, 2004,
2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
reduction percentage shall be zero respectively, there shall be no 1998,
2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and],
2011, 2012, AND 2013 reduction amount.
S 14. Paragraph (b) of subdivision 5 of section 64 of chapter 81 of
the laws of 1995, amending the public health law and other laws relating
to medical reimbursement and welfare reform, as amended by section 29 of
part B of chapter 58 of the laws of 2009, is amended to read as follows:
S. 2809--D 100 A. 4009--D
(b) The 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
aggregate reduction amounts shall for each year be allocated by the
commissioner of health among residential health care facilities that are
eligible to provide services to beneficiaries of title XVIII of the
federal social security act (medicare) and residents eligible for
payments pursuant to title 11 of article 5 of the social services law on
the basis of the extent of each facility's failure to achieve a two
percentage points increase in the 1996 target percentage, a three
percentage point increase in the 1997, 1998, 2000, 2001, 2002, 2003,
2004, 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013
target percentage and a two and one-quarter percentage point increase in
the 1999 target percentage for each year, compared to the base percent-
age, calculated on a facility specific basis for this purpose, compared
to the statewide total of the extent of each facility's failure to
achieve a two percentage points increase in the 1996 and a three
percentage point increase in the 1997 and a three percentage point
increase in the 1998 and a two and one-quarter percentage point increase
in the 1999 target percentage and a three percentage point increase in
the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010
[and], 2011, 2012, AND 2013 target percentage compared to the base
percentage. These amounts shall be called the 1996, 1997, 1998, 1999,
2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and],
2011, 2012, AND 2013 facility specific reduction amounts respectively.
S 14-a. Section 228 of chapter 474 of the laws of 1996, amending the
education law and other laws relating to rates for residential health
care facilities, as amended by section 30 of part B of chapter 58 of the
laws of 2009, is amended to read as follows:
S 228. 1. Definitions. (a) Regions, for purposes of this section,
shall mean a downstate region to consist of Kings, New York, Richmond,
Queens, Bronx, Nassau and Suffolk counties and an upstate region to
consist of all other New York state counties. A certified home health
agency or long term home health care program shall be located in the
same county utilized by the commissioner of health for the establishment
of rates pursuant to article 36 of the public health law.
(b) Certified home health agency (CHHA) shall mean such term as
defined in section 3602 of the public health law.
(c) Long term home health care program (LTHHCP) shall mean such term
as defined in subdivision 8 of section 3602 of the public health law.
(d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
ly, located within a region.
(e) Medicaid revenue percentage, for purposes of this section, shall
mean CHHA and LTHHCP revenues attributable to services provided to
persons eligible for payments pursuant to title 11 of article 5 of the
social services law divided by such revenues plus CHHA and LTHHCP reven-
ues attributable to services provided to beneficiaries of Title XVIII of
the federal social security act (medicare).
(f) Base period, for purposes of this section, shall mean calendar
year 1995.
(g) Target period. For purposes of this section, the 1996 target peri-
od shall mean August 1, 1996 through March 31, 1997, the 1997 target
period shall mean January 1, 1997 through November 30, 1997, the 1998
target period shall mean January 1, 1998 through November 30, 1998, the
1999 target period shall mean January 1, 1999 through November 30, 1999,
the 2000 target period shall mean January 1, 2000 through November 30,
2000, the 2001 target period shall mean January 1, 2001 through November
S. 2809--D 101 A. 4009--D
30, 2001, the 2002 target period shall mean January 1, 2002 through
November 30, 2002, the 2003 target period shall mean January 1, 2003
through November 30, 2003, the 2004 target period shall mean January 1,
2004 through November 30, 2004, and the 2005 target period shall mean
January 1, 2005 through November 30, 2005, the 2006 target period shall
mean January 1, 2006 through November 30, 2006, and the 2007 target
period shall mean January 1, 2007 through November 30, 2007 and the 2008
target period shall mean January 1, 2008 through November 30, 2008, and
the 2009 target period shall mean January 1, 2009 through November 30,
2009 and the 2010 target period shall mean January 1, 2010 through
November 30, 2010 and the 2011 target period shall mean January 1, 2011
through November 30, 2011 AND THE 2012 TARGET PERIOD SHALL MEAN JANUARY
1, 2012 THROUGH NOVEMBER 30, 2012 AND THE 2013 TARGET PERIOD SHALL MEAN
JANUARY 1, 2013 THROUGH NOVEMBER 30, 2013.
2. (a) Prior to February 1, 1997, for each regional group the commis-
sioner of health shall calculate the 1996 medicaid revenue percentages
for the period commencing August 1, 1996 to the last date for which such
data is available and reasonably accurate.
(b) Prior to February 1, 1998, prior to February 1, 1999, prior to
February 1, 2000, prior to February 1, 2001, prior to February 1, 2002,
prior to February 1, 2003, prior to February 1, 2004, prior to February
1, 2005, prior to February 1, 2006, prior to February 1, 2007, prior to
February 1, 2008, prior to February 1, 2009, prior to February 1, 2010
[and], prior to February 1, 2011, PRIOR TO FEBRUARY 1, 2012 AND PRIOR TO
FEBRUARY 1, 2013 for each regional group the commissioner of health
shall calculate the prior year's medicaid revenue percentages for the
period commencing January 1 through November 30 of such prior year.
3. By September 15, 1996, for each regional group the commissioner of
health shall calculate the base period medicaid revenue percentage.
4. (a) For each regional group, the 1996 target medicaid revenue
percentage shall be calculated by subtracting the 1996 medicaid revenue
reduction percentages from the base period medicaid revenue percentages.
The 1996 medicaid revenue reduction percentage, taking into account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
(i) one and one-tenth percentage points for CHHAs located within the
downstate region;
(ii) six-tenths of one percentage point for CHHAs located within the
upstate region;
(iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
(iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
(b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional group,
the target medicaid revenue percentage for the respective year shall be
calculated by subtracting the respective year's medicaid revenue
reduction percentage from the base period medicaid revenue percentage.
The medicaid revenue reduction percentages for 1997, 1998, 2000, 2001,
2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012,
AND 2013 taking into account regional and program differences in utili-
zation of medicaid and medicare services, for the following regional
groups shall be equal to for each such year:
(i) one and one-tenth percentage points for CHHAs located within the
downstate region;
S. 2809--D 102 A. 4009--D
(ii) six-tenths of one percentage point for CHHAs located within the
upstate region;
(iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
(iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
(c) For each regional group, the 1999 target medicaid revenue percent-
age shall be calculated by subtracting the 1999 medicaid revenue
reduction percentage from the base period medicaid revenue percentage.
The 1999 medicaid revenue reduction percentages, taking into account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
(i) eight hundred twenty-five thousandths (.825) of one percentage
point for CHHAs located within the downstate region;
(ii) forty-five hundredths (.45) of one percentage point for CHHAs
located within the upstate region;
(iii) one and thirty-five hundredths percentage points (1.35) for
LTHHCPs located within the downstate region; and
(iv) one and two hundred seventy-five thousandths percentage points
(1.275) for LTHHCPs located within the upstate region.
5. (a) For each regional group, if the 1996 medicaid revenue percent-
age is not equal to or less than the 1996 target medicaid revenue
percentage, the commissioner of health shall compare the 1996 medicaid
revenue percentage to the 1996 target medicaid revenue percentage to
determine the amount of the shortfall which, when divided by the 1996
medicaid revenue reduction percentage, shall be called the 1996
reduction factor. These amounts, expressed as a percentage, shall not
exceed one hundred percent. If the 1996 medicaid revenue percentage is
equal to or less than the 1996 target medicaid revenue percentage, the
1996 reduction factor shall be zero.
(b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional
group, if the medicaid revenue percentage for the respective year is not
equal to or less than the target medicaid revenue percentage for such
respective year, the commissioner of health shall compare such respec-
tive year's medicaid revenue percentage to such respective year's target
medicaid revenue percentage to determine the amount of the shortfall
which, when divided by the respective year's medicaid revenue reduction
percentage, shall be called the reduction factor for such respective
year. These amounts, expressed as a percentage, shall not exceed one
hundred percent. If the medicaid revenue percentage for a particular
year is equal to or less than the target medicaid revenue percentage for
that year, the reduction factor for that year shall be zero.
6. (a) For each regional group, the 1996 reduction factor shall be
multiplied by the following amounts to determine each regional group's
applicable 1996 state share reduction amount:
(i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;
(ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
(iii) one million two hundred seventy thousand dollars ($1,270,000)
for LTHHCPs located within the downstate region; and
(iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
located within the upstate region.
For each regional group reduction, if the 1996 reduction factor shall
be zero, there shall be no 1996 state share reduction amount.
S. 2809--D 103 A. 4009--D
(b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional group,
the reduction factor for the respective year shall be multiplied by the
following amounts to determine each regional group's applicable state
share reduction amount for such respective year:
(i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;
(ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
(iii) one million two hundred seventy thousand dollars ($1,270,000)
for LTHHCPs located within the downstate region; and
(iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
located within the upstate region.
For each regional group reduction, if the reduction factor for a
particular year shall be zero, there shall be no state share reduction
amount for such year.
(c) For each regional group, the 1999 reduction factor shall be multi-
plied by the following amounts to determine each regional group's appli-
cable 1999 state share reduction amount:
(i) one million seven hundred ninety-two thousand five hundred dollars
($1,792,500) for CHHAs located within the downstate region;
(ii) five hundred sixty-two thousand five hundred dollars ($562,500)
for CHHAs located within the upstate region;
(iii) nine hundred fifty-two thousand five hundred dollars ($952,500)
for LTHHCPs located within the downstate region; and
(iv) four hundred forty-two thousand five hundred dollars ($442,500)
for LTHHCPs located within the upstate region.
For each regional group reduction, if the 1999 reduction factor shall
be zero, there shall be no 1999 state share reduction amount.
7. (a) For each regional group, the 1996 state share reduction amount
shall be allocated by the commissioner of health among CHHAs and LTHHCPs
on the basis of the extent of each CHHA's and LTHHCP's failure to
achieve the 1996 target medicaid revenue percentage, calculated on a
provider specific basis utilizing revenues for this purpose, expressed
as a proportion of the total of each CHHA's and LTHHCP's failure to
achieve the 1996 target medicaid revenue percentage within the applica-
ble regional group. This proportion shall be multiplied by the applica-
ble 1996 state share reduction amount calculation pursuant to paragraph
(a) of subdivision 6 of this section. This amount shall be called the
1996 provider specific state share reduction amount.
(b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional
group, the state share reduction amount for the respective year shall be
allocated by the commissioner of health among CHHAs and LTHHCPs on the
basis of the extent of each CHHA's and LTHHCP's failure to achieve the
target medicaid revenue percentage for the applicable year, calculated
on a provider specific basis utilizing revenues for this purpose,
expressed as a proportion of the total of each CHHA's and LTHHCP's fail-
ure to achieve the target medicaid revenue percentage for the applicable
year within the applicable regional group. This proportion shall be
multiplied by the applicable year's state share reduction amount calcu-
lation pursuant to paragraph (b) or (c) of subdivision 6 of this
section. This amount shall be called the provider specific state share
reduction amount for the applicable year.
8. (a) The 1996 provider specific state share reduction amount shall
be due to the state from each CHHA and LTHHCP and may be recouped by the
S. 2809--D 104 A. 4009--D
state by March 31, 1997 in a lump sum amount or amounts from payments
due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
social services law.
(b) The provider specific state share reduction amount for 1997, 1998,
1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010
[and], 2011, 2012, AND 2013 respectively, shall be due to the state from
each CHHA and LTHHCP and each year the amount due for such year may be
recouped by the state by March 31 of the following year in a lump sum
amount or amounts from payments due to the CHHA and LTHHCP pursuant to
title 11 of article 5 of the social services law.
9. CHHAs and LTHHCPs shall submit such data and information at such
times as the commissioner of health may require for purposes of this
section. The commissioner of health may use data available from third-
party payors.
10. On or about June 1, 1997, for each regional group the commissioner
of health shall calculate for the period August 1, 1996 through March
31, 1997 a medicaid revenue percentage, a reduction factor, a state
share reduction amount, and a provider specific state share reduction
amount in accordance with the methodology provided in paragraph (a) of
subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
sion 6 and paragraph (a) of subdivision 7 of this section. The provider
specific state share reduction amount calculated in accordance with this
subdivision shall be compared to the 1996 provider specific state share
reduction amount calculated in accordance with paragraph (a) of subdivi-
sion 7 of this section. Any amount in excess of the amount determined in
accordance with paragraph (a) of subdivision 7 of this section shall be
due to the state from each CHHA and LTHHCP and may be recouped in
accordance with paragraph (a) of subdivision 8 of this section. If the
amount is less than the amount determined in accordance with paragraph
(a) of subdivision 7 of this section, the difference shall be refunded
to the CHHA and LTHHCP by the state no later than July 15, 1997. CHHAs
and LTHHCPs shall submit data for the period August 1, 1996 through
March 31, 1997 to the commissioner of health by April 15, 1997.
11. If a CHHA or LTHHCP fails to submit data and information as
required for purposes of this section:
(a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
caid revenue percentage between the applicable base period and the
applicable target period for purposes of the calculations pursuant to
this section; and
(b) the commissioner of health shall reduce the current rate paid to
such CHHA and such LTHHCP by state governmental agencies pursuant to
article 36 of the public health law by one percent for a period begin-
ning on the first day of the calendar month following the applicable due
date as established by the commissioner of health and continuing until
the last day of the calendar month in which the required data and infor-
mation are submitted.
12. The commissioner of health shall inform in writing the director of
the budget and the chair of the senate finance committee and the chair
of the assembly ways and means committee of the results of the calcu-
lations pursuant to this section.
S 15. Subdivision 5-a of section 246 of chapter 81 of the laws of
1995, amending the public health law and other laws relating to medical
reimbursement and welfare reform, as amended by section 32 of part B of
chapter 58 of the laws of 2009, is amended to read as follows:
5-a. Section sixty-four-a of this act shall be deemed to have been in
full force and effect on and after April 1, 1995 through March 31, 1999
S. 2809--D 105 A. 4009--D
and on and after July 1, 1999 through March 31, 2000 and on and after
April 1, 2000 through March 31, 2003 and on and after April 1, 2003
through March 31, 2007, and on and after April 1, 2007 through March 31,
2009, and on and after April 1, 2009 through March 31, 2011, AND ON AND
AFTER APRIL 1, 2011 THROUGH MARCH 31, 2013;
S 16. Section 64-b of chapter 81 of the laws of 1995, amending the
public health law and other laws relating to medical reimbursement and
welfare reform, as amended by section 33 of part B of chapter 58 of the
laws of 2009, is amended to read as follows:
S 64-b. Notwithstanding any inconsistent provision of law, the
provisions of subdivision 7 of section 3614 of the public health law, as
amended, shall remain and be in full force and effect on April 1, 1995
through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
and after April 1, 2000 through March 31, 2003 and on and after April 1,
2003 through March 31, 2007, and on and after April 1, 2007 through
March 31, 2009, and on and after April 1, 2009 through March 31, 2011,
AND ON AND AFTER APRIL 1, 2011 THROUGH MARCH 31, 2013.
S 17. Subdivision 1 of section 20 of chapter 451 of the laws of 2007,
amending the public health law, the social services law and the insur-
ance law, relating to providing enhanced consumer and provider
protections, as amended by section 38 of part B of chapter 58 of the
laws of 2009, is amended to read as follows:
1. sections four, eleven and thirteen of this act shall take effect
immediately and shall expire and be deemed repealed June 30, [2011]
2013;
S 18. The opening paragraph of subdivision 7-a of section 3614 of the
public health law, as amended by section 46 of part B of chapter 58 of
the laws of 2009, is amended to read as follows:
Notwithstanding any inconsistent provision of law or regulation, for
the purposes of establishing rates of payment by governmental agencies
for long term home health care programs for the period April first, two
thousand five, through December thirty-first, two thousand five, and for
the period January first, two thousand six through March thirty-first,
two thousand seven, and on and after April first, two thousand seven
through March thirty-first, two thousand nine, and on and after April
first, two thousand nine through March thirty-first, two thousand elev-
en, AND ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, the reimbursable base year adminis-
trative and general costs of a provider of services shall not exceed the
statewide average of total reimbursable base year administrative and
general costs of such providers of services.
S 19. Subdivisions 3, 4 and 5 of section 47 of chapter 2 of the laws
of 1998, amending the public health law and other laws relating to
expanding the child health insurance plan, as amended by section 24 of
part A of chapter 58 of the laws of 2007, are amended to read as
follows:
3. section six of this act shall take effect January 1, 1999;
provided, however, that subparagraph (iii) of paragraph (c) of subdivi-
sion 9 of section 2510 of the public health law, as added by this act,
shall expire on July 1, [2011] 2014;
4. sections two, three, four, seven, eight, nine, fourteen, fifteen,
sixteen, eighteen, eighteen-a, twenty-three, twenty-four, and twenty-
nine of this act shall take effect January 1, 1999 and shall expire on
July 1, [2011] 2014; section twenty-five of this act shall take effect
on January 1, 1999 and shall expire on April 1, 2005;
S. 2809--D 106 A. 4009--D
5. section twelve of this act shall take effect January 1, 1999;
provided, however, paragraphs (g) and (h) of subdivision 2 of section
2511 of the public health law, as added by such section, shall expire on
July 1, [2011] 2014;
S 20. Section 10 of chapter 649 of the laws of 1996, amending the
public health law, the mental hygiene law and the social services law
relating to authorizing the establishment of special needs plans, as
amended by section 63 of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
S 10. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after July 1, 1996; provided,
however, that sections one, two and three of this act shall expire and
be deemed repealed on March 31, [2012] 2016 provided, however that the
amendments to section 364-j of the social services law made by section
four of this act shall not affect the expiration of such section and
shall be deemed to expire therewith and provided, further, that the
provisions of subdivisions 8, 9 and 10 of section 4401 of the public
health law, as added by section one of this act; section 4403-d of the
public health law as added by section two of this act and the provisions
of section seven of this act, except for the provisions relating to the
establishment of no more than twelve comprehensive HIV special needs
plans, shall expire and be deemed repealed on July 1, 2000.
S 21. Subdivision (i-1) of section 79 of part C of chapter 58 of the
laws of 2008, amending the social services law and the public health law
relating to adjustments of rates, is amended to read as follows:
(i-1) section thirty-one-a of this act shall be deemed repealed July
1, [2011] 2014;
S 22. Section 2 of chapter 535 of the laws of 1983, amending the
social services law relating to eligibility of certain enrollees for
medical assistance, as amended by section 69 of part C of chapter 58 of
the laws of 2008, is amended to read as follows:
S 2. This act shall take effect immediately and shall remain in full
force and effect through March 31, [2012] 2016.
S 23. Subdivision 12 of section 246 of chapter 81 of the laws of 1995,
amending the public health law and other laws relating to medical
reimbursement and welfare reform, as amended by section 56 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
12. Sections one hundred five-b through one hundred five-f of this act
shall expire March 31, [2011] 2013.
S 24. Intentionally omitted.
S 25. Section 11 of chapter 710 of the laws of 1988, amending the
social services law and the education law relating to medical assistance
eligibility of certain persons and providing for managed medical care
demonstration programs, as amended by section 66 of part C of chapter 58
of the laws of 2008, is amended to read as follows:
S 11. This act shall take effect immediately; except that the
provisions of sections one, two, three, four, eight and ten of this act
shall take effect on the ninetieth day after it shall have become a law;
and except that the provisions of sections five, six and seven of this
act shall take effect January 1, 1989; and except that effective imme-
diately, the addition, amendment and/or repeal of any rule or regulation
necessary for the implementation of this act on its effective date are
authorized and directed to be made and completed on or before such
effective date; provided, however, that the provisions of section 364-j
of the social services law, as added by section one of this act shall
expire and be deemed repealed on and after March 31, [2012] 2016, the
S. 2809--D 107 A. 4009--D
provisions of section 364-k of the social services law, as added by
section two of this act, except subdivision 10 of such section, shall
expire and be deemed repealed on and after January 1, 1994, and the
provisions of subdivision 10 of section 364-k of the social services
law, as added by section two of this act, shall expire and be deemed
repealed on January 1, 1995.
S 26. Subdivision (c) of section 62 of chapter 165 of the laws of
1991, amending the public health law and other laws relating to estab-
lishing payments for medical assistance, as amended by section 67 of
part C of chapter 58 of the laws of 2008, is amended to read as follows:
(c) section 364-j of the social services law, as amended by section
eight of this act and subdivision 6 of section 367-a of the social
services law as added by section twelve of this act shall expire and be
deemed repealed on March 31, [2012] 2015 and provided further, that the
amendments to the provisions of section 364-j of the social services law
MADE BY SECTION EIGHT OF THIS ACT shall only apply to managed care
programs approved on or after the effective date of this act;
S 26-a. Subdivision (x) of section 165 of chapter 41 of the laws of
1992, amending the public health law and other laws relating to health
care providers, is REPEALED.
S 27. 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 28. 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 29. 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 judge-
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 30. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2011; provided,
however, that the amendments to paragraph (e) of subdivision 8 of
section 2807-c of the public health law made by section seven of this
act shall not affect the expiration of such paragraph and shall be
deemed to expire therewith.
PART E
Section 1. Section 366 of the social services law is amended by adding
a new subdivision 1-b to read as follows:
1-B. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IN THE EVENT THAT A
PERSON WHO IS AN INPATIENT IN AN INSTITUTION FOR MENTAL DISEASES, AS
DEFINED BY FEDERAL LAW AND REGULATIONS, AND WHO WAS IN RECEIPT OF
MEDICAL ASSISTANCE PURSUANT TO THIS TITLE IMMEDIATELY PRIOR TO BEING
S. 2809--D 108 A. 4009--D
ADMITTED TO SUCH FACILITY, OR WHO WAS DIRECTLY ADMITTED TO SUCH FACILITY
AFTER BEING AN INPATIENT IN ANOTHER INSTITUTION FOR MENTAL DISEASES AND
WHO WAS IN RECEIPT OF MEDICAL ASSISTANCE PRIOR TO ADMISSION TO SUCH
TRANSFERRING INSTITUTION, SUCH PERSON SHALL REMAIN ELIGIBLE FOR MEDICAL
ASSISTANCE WHILE AN INPATIENT IN SUCH FACILITY; PROVIDED, HOWEVER, THAT
NO MEDICAL ASSISTANCE SHALL BE FURNISHED PURSUANT TO THIS TITLE FOR ANY
CARE, SERVICES, OR SUPPLIES PROVIDED DURING THE TIME THAT SUCH PERSON IS
AN INPATIENT, EXCEPT TO THE EXTENT THAT FEDERAL FINANCIAL PARTICIPATION
IS AVAILABLE FOR THE COSTS OF SUCH CARE, SERVICES, OR SUPPLIES. UPON
RELEASE FROM SUCH FACILITY, SUCH PERSON SHALL CONTINUE TO BE ELIGIBLE
FOR RECEIPT OF MEDICAL ASSISTANCE FURNISHED PURSUANT TO THIS TITLE UNTIL
SUCH TIME AS THE PERSON IS DETERMINED TO NO LONGER BE ELIGIBLE FOR
RECEIPT OF SUCH ASSISTANCE. TO THE EXTENT PERMITTED BY FEDERAL LAW, THE
TIME DURING WHICH SUCH PERSON IS AN INPATIENT IN AN INSTITUTION FOR
MENTAL DISEASES SHALL NOT BE INCLUDED IN ANY CALCULATION OF WHEN THE
PERSON MUST RECERTIFY HIS OR HER ELIGIBILITY FOR MEDICAL ASSISTANCE IN
ACCORDANCE WITH THIS ARTICLE.
S 2. Paragraph (c) of subdivision 1 of section 366 of the social
services law, as amended by chapter 355 of the laws of 2007, is amended
to read as follows:
(c) except as provided in subparagraph six of paragraph (a) of this
subdivision or subdivision one-a OR SUBDIVISION ONE-B of this section,
is not an inmate or patient in an institution or facility wherein
medical assistance for needy persons may not be provided in accordance
with applicable federal or state requirements; and
S 3. This act shall take effect April 1, 2011; provided that all
actions necessary for the timely implementation of this act, including
revisions to information, eligibility and benefit computer systems
utilized by social services districts and administered by the department
of health of the state of New York, shall be taken prior to such effec-
tive date so that the provisions of this act may be implemented on such
date.
PART F
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, as amended by section
1 of part F of chapter 111 of the laws of 2010, are amended to read as
follows:
3-b. Notwithstanding any inconsistent provision of law, beginning
April 1, 2009 and ending March 31, [2011] 2012, 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, [2011] 2012 and ending March 31, [2014] 2015, 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 2 of part F of chapter 111 of
the laws of 2010, is amended to read as follows:
S. 2809--D 109 A. 4009--D
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,
[2014] 2015; 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, 2011; provided,
however, that the amendments to section 1 of part C of chapter 57 of the
laws of 2006 made by section one of this act shall not affect the repeal
of such section and shall be deemed repealed therewith.
PART G
Section 1. Subdivision (b) of section 7.17 of the mental hygiene law,
as amended by section 1 of part J of chapter 58 of the laws of 2005, is
amended to read as follows:
(b) There shall be in the office the hospitals named below for the
care, treatment and rehabilitation of [the mentally disabled] PERSONS
WITH MENTAL ILLNESS and for research and teaching in the science and
skills required for the care, treatment and rehabilitation of such
[mentally disabled] PERSONS WITH MENTAL ILLNESS.
Greater Binghamton Health Center
Bronx Psychiatric Center
Buffalo Psychiatric Center
Capital District Psychiatric Center
Central New York Psychiatric Center
Creedmoor Psychiatric Center
Elmira Psychiatric Center
Hudson River Psychiatric Center
Kingsboro Psychiatric Center
Kirby Forensic Psychiatric Center
Manhattan Psychiatric Center
Mid-Hudson Forensic Psychiatric Center
Mohawk Valley Psychiatric Center
Nathan S. Kline Institute for Psychiatric Research
New York State Psychiatric Institute
Pilgrim Psychiatric Center
Richard H. Hutchings Psychiatric Center
Rochester Psychiatric Center
Rockland Psychiatric Center
St. Lawrence Psychiatric Center
South Beach Psychiatric Center
Bronx Children's Psychiatric Center
Brooklyn Children's [Psychiatric] Center
Queens Children's Psychiatric Center
Rockland Children's Psychiatric Center
Sagamore Children's Psychiatric Center
Western New York Children's Psychiatric Center
The New York State Psychiatric Institute and The Nathan S. Kline
Institute for Psychiatric Research are designated as institutes for the
conduct of medical research and other scientific investigation directed
towards furthering knowledge of the etiology, diagnosis, treatment and
prevention of mental illness. THE BROOKLYN CHILDREN'S CENTER IS A FACIL-
ITY OPERATED BY THE OFFICE TO PROVIDE COMMUNITY-BASED MENTAL HEALTH
SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCES.
S. 2809--D 110 A. 4009--D
S 2. Notwithstanding the provisions of subdivisions (b) and (e) of
section 7.17 of the mental hygiene law, 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 2011-12 to close, consolidate,
reduce, transfer or otherwise redesign services of hospitals, other
facilities and programs operated by the office of mental health, and to
implement significant service reductions and reconfigurations according
to this section as shall be determined by the commissioner of mental
health to be necessary for the cost-effective and efficient operation of
such hospitals, other facilities and programs.
(a) In addition to the closure, consolidation or merger of one or more
facilities, the commissioner of mental health is authorized to perform
any significant service reductions that would reduce inpatient bed
capacity by up to 600 beds, which shall include but not be limited to
closures of wards at a state-operated psychiatric center or the conver-
sion of beds to transitional placement programs, provided that the
commissioner provide at least 30 days notice of such reductions to the
temporary president of the senate and the speaker of the assembly and
simultaneously post such notice upon its public website. In assessing
which significant service reductions to undertake, the commissioner
shall consider data related to inpatient census, indicating nonutiliza-
tion or under utilization of beds, and the efficient operation of facil-
ities.
(b) At least sixty days prior to the anticipated closure, consol-
idation or merger of any hospitals named in subdivision (b) of section
7.17 of the mental hygiene law, the commissioner of mental health shall
provide notice of such closure, consolidation or merger to the temporary
president of the senate and speaker of the assembly, the chief executive
officer of the county in which the facility is located, and shall post
such notice upon its public website. The commissioner shall be author-
ized to conduct any and all preparatory actions which may be required to
effectuate such closures during such sixty day period. In assessing
which of such hospitals to close, the commissioner shall consider the
following factors: (1) the size, scope and type of services provided by
the hospital; (2) the current and anticipated long-term need for the
types of services provided by the facility within its catchment area,
which may include, but not be limited to, services for adults or chil-
dren, or other specialized services, such as forensic services; (3) the
availability of staff sufficient to address the current and anticipated
long term service needs; (4) the long term capital investment required
to ensure that the facility meets relevant state and federal regulatory
and capital construction requirements, and national accreditation stand-
ards; (5) the proximity of the facility to other facilities with space
that could accommodate anticipated need, the relative cost of any neces-
sary renovations of such space, the relative potential operating effi-
ciency of such facilities, and the size, scope and types of services
provided by the other facilities; (6) anticipated savings based upon
economies of scale or other factors; (7) community mental health
services available in the facility catchment area and the ability of
such community mental health services to meet the behavioral health
needs of the impacted consumers; and (8) the anticipated impact of the
closure on access to mental health services.
(c) Any transfers of inpatient capacity or any resulting transfer of
functions shall be authorized to be made by the commissioner of mental
health and any transfer of personnel upon such transfer of capacity or
S. 2809--D 111 A. 4009--D
transfer of functions shall be accomplished in accordance with the
provisions of section 70 of the civil service law.
S 3. 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 4. This act shall take effect April 1, 2011; provided that section
two of this act shall expire and be deemed repealed March 31, 2012.
PART H
Section 1. Notwithstanding paragraph (c) of subdivision 10 of section
2807-c of the public health law, section 21 of chapter 1 of the laws of
1999, or any other contrary provision of law, in determining rates of
payments by state governmental agencies effective for services provided
on and after April 1, 2011, 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 or units of such facilities that
provide services primarily to children under twenty-one years of age,
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 no greater than zero trend
factors attributable to the 2011 and 2012 calendar years in accordance
with paragraph (c) of subdivision 10 of section 2807-c of the public
health law, provided, however, that such no greater than zero trend
factors for such 2011 and 2012 calendar years shall also be applied to
rates of payment for personal care services provided in those local
social service districts, including New York City, whose rates of
payment for such services are established by such local social service
districts pursuant to a rate-setting exemption issued by the commission-
er of health to such local social services districts in accordance with
applicable regulations, and provided further, however, that for rates of
payment for assisted living program services provided on and after April
1, 2011, trend factors attributable to the 2011 and 2012 calendar years
shall be established at no greater than zero percent.
S 2. Notwithstanding paragraph (c) of subdivision 10 of section 2807-c
of the public health law, section 21 of chapter 1 of the laws of 1999,
or any other contrary provision of law, in determining rates of payments
by state governmental agencies effective for services provided on and
after January 1, 2013 through March 31, 2013, for inpatient and outpa-
tient 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 or units of such facilities that
provide services primarily to children under twenty-one years of age,
for home health care services provided pursuant to article 36 of the
public health law, by certified home health agencies, long term home
S. 2809--D 112 A. 4009--D
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 no greater than zero trend
factors attributable to the 2013 calendar year in accordance with para-
graph (c) of subdivision 10 of section 2807-c of the public health law,
provided, however, that such no greater than zero trend factors for such
2013 calendar year shall also be applied to rates of payment for
personal care services provided in those local social service districts,
including New York city, whose rates of payment for such services are
established by such local social service districts pursuant to a rate-
setting exemption issued by the commissioner of health to such local
social service districts in accordance with applicable regulations, and
provided further, however, that for rates of payment for assisted living
program services provided on and after January 1, 2013 through March 31,
2013, trend factors attributable to the 2013 calendar year shall be
established at no greater than zero percent.
S 2-a. Intentionally omitted.
S 3. 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 ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, RATES OF PAYMENT BY GOVERNMENT
AGENCIES FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, EXCEPT
FOR SUCH SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND
OTHER DISCRETE GROUPS AS MAY BE DETERMINED BY THE COMMISSIONER PURSUANT
TO REGULATIONS, SHALL REFLECT CEILING LIMITATIONS DETERMINED IN ACCORD-
ANCE WITH THIS SUBDIVISION, PROVIDED, HOWEVER, THAT AT THE DISCRETION OF
THE COMMISSIONER SUCH CEILINGS MAY, AS AN ALTERNATIVE, BE APPLIED TO
PAYMENTS FOR SERVICES PROVIDED ON AND AFTER APRIL FIRST, TWO THOUSAND
ELEVEN, EXCEPT FOR SUCH SERVICES PROVIDED TO CHILDREN AND OTHER DISCRETE
GROUPS AS MAY BE DETERMINED BY THE COMMISSIONER PURSUANT TO REGULATIONS.
IN DETERMINING SUCH PAYMENTS OR RATES OF PAYMENT, AGENCY CEILINGS SHALL
BE ESTABLISHED. SUCH CEILINGS SHALL BE APPLIED TO PAYMENTS OR RATES OF
PAYMENT FOR CERTIFIED HOME HEALTH AGENCY SERVICES AS ESTABLISHED PURSU-
ANT TO THIS SECTION AND APPLICABLE REGULATIONS. CEILINGS SHALL BE BASED
ON A BLEND OF: (I) AN AGENCY'S TWO THOUSAND NINE AVERAGE PER PATIENT
MEDICAID CLAIMS, WEIGHTED AT A PERCENTAGE AS DETERMINED BY THE COMMIS-
SIONER; AND (II) THE TWO THOUSAND NINE STATEWIDE AVERAGE PER PATIENT
MEDICAID CLAIMS ADJUSTED BY A REGIONAL WAGE INDEX FACTOR AND AN AGENCY
PATIENT CASE MIX INDEX, WEIGHTED AT A PERCENTAGE AS DETERMINED BY THE
COMMISSIONER. SUCH CEILINGS WILL BE EFFECTIVE APRIL FIRST, TWO THOUSAND
ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE. AN INTERIM
PAYMENT OR RATE OF PAYMENT ADJUSTMENT EFFECTIVE APRIL FIRST, TWO THOU-
SAND ELEVEN, SHALL BE APPLIED TO AGENCIES WITH PROJECTED AVERAGE PER
PATIENT MEDICAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, TO BE OVER
THEIR CEILINGS. SUCH AGENCIES SHALL HAVE THEIR PAYMENTS OR RATES OF
PAYMENT REDUCED TO REFLECT THE AMOUNT BY WHICH SUCH CLAIMS EXCEED THEIR
CEILINGS.
(B) CEILING LIMITATIONS DETERMINED PURSUANT TO PARAGRAPH (A) OF THIS
SUBDIVISION SHALL BE SUBJECT TO RECONCILIATION. IN DETERMINING PAYMENT
OR RATE OF PAYMENT ADJUSTMENTS BASED ON SUCH RECONCILIATION, ADJUSTED
AGENCY CEILINGS SHALL BE ESTABLISHED. SUCH ADJUSTED CEILINGS SHALL BE
BASED ON A BLEND OF: (I) AN AGENCY'S TWO THOUSAND NINE AVERAGE PER
PATIENT MEDICAID CLAIMS ADJUSTED BY THE PERCENTAGE OF INCREASE OR
DECREASE IN SUCH AGENCY'S PATIENT CASE MIX FROM THE TWO THOUSAND NINE
S. 2809--D 113 A. 4009--D
CALENDAR YEAR TO THE ANNUAL PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, WEIGHTED AT A PERCENT-
AGE AS DETERMINED BY THE COMMISSIONER; AND (II) THE TWO THOUSAND NINE
STATEWIDE AVERAGE PER PATIENT MEDICAID CLAIMS ADJUSTED BY A REGIONAL
WAGE INDEX FACTOR AND THE AGENCY'S PATIENT CASE MIX INDEX FOR THE ANNUAL
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND TWELVE, WEIGHTED AT A PERCENTAGE AS DETERMINED BY THE COMMIS-
SIONER. SUCH ADJUSTED AGENCY CEILING SHALL BE COMPARED TO ACTUAL MEDI-
CAID PAID CLAIMS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND TWELVE. IN THOSE INSTANCES WHEN AN
AGENCY'S ACTUAL PER PATIENT MEDICAID CLAIMS ARE DETERMINED TO EXCEED THE
AGENCY'S ADJUSTED CEILING, THE AMOUNT OF SUCH EXCESS SHALL BE DUE FROM
EACH SUCH AGENCY TO THE STATE AND MAY BE RECOUPED BY THE DEPARTMENT IN A
LUMP SUM AMOUNT OR THROUGH REDUCTIONS IN THE MEDICAID PAYMENTS DUE TO
THE AGENCY. IN THOSE INSTANCES WHERE AN INTERIM PAYMENT OR RATE OF
PAYMENT ADJUSTMENT WAS APPLIED TO AN AGENCY IN ACCORDANCE WITH PARAGRAPH
(A) OF THIS SUBDIVISION, AND SUCH AGENCY'S ACTUAL PER PATIENT MEDICAID
CLAIMS ARE DETERMINED TO BE LESS THAN THE AGENCY'S ADJUSTED CEILING, THE
AMOUNT BY WHICH SUCH MEDICAID CLAIMS ARE LESS THAN THE AGENCY'S ADJUSTED
CEILING SHALL BE REMITTED TO EACH SUCH AGENCY BY THE DEPARTMENT IN A
LUMP SUM AMOUNT OR THROUGH AN INCREASE IN THE MEDICAID PAYMENTS DUE TO
THE AGENCY.
(C) INTERIM PAYMENT OR RATE OF PAYMENT ADJUSTMENTS PURSUANT TO THIS
SUBDIVISION SHALL BE BASED ON MEDICAID PAID CLAIMS, AS DETERMINED BY THE
COMMISSIONER, FOR SERVICES PROVIDED BY AGENCIES IN THE BASE YEAR TWO
THOUSAND NINE. AMOUNTS DUE FROM RECONCILING RATE ADJUSTMENTS SHALL BE
BASED ON MEDICAID PAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, FOR
SERVICES PROVIDED BY AGENCIES IN THE BASE YEAR TWO THOUSAND NINE AND
MEDICAID PAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, FOR SERVICES
PROVIDED BY AGENCIES IN THE RECONCILIATION PERIOD APRIL FIRST, TWO THOU-
SAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE. IN DETER-
MINING CASE MIX, EACH PATIENT SHALL BE CLASSIFIED USING A SYSTEM BASED
ON MEASURES WHICH MAY INCLUDE, BUT NOT BE LIMITED TO, CLINICAL AND FUNC-
TIONAL MEASURES, AS REPORTED ON THE FEDERAL OUTCOME AND ASSESSMENT
INFORMATION SET (OASIS), AS MAY BE AMENDED.
(D) THE COMMISSIONER MAY REQUIRE AGENCIES TO COLLECT AND SUBMIT ANY
DATA REQUIRED TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION. THE
COMMISSIONER MAY PROMULGATE REGULATIONS TO IMPLEMENT THE PROVISIONS OF
THIS SUBDIVISION.
(E) PAYMENTS OR RATE OF PAYMENT ADJUSTMENTS DETERMINED PURSUANT TO
THIS SUBDIVISION SHALL, FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, BE RETROACTIVELY RECON-
CILED UTILIZING THE METHODOLOGY IN PARAGRAPH (B) OF THIS SUBDIVISION AND
UTILIZING ACTUAL PAID CLAIMS FROM SUCH PERIOD.
(F) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION,
PAYMENTS OR RATE OF PAYMENT ADJUSTMENTS MADE PURSUANT TO THIS SUBDIVI-
SION SHALL NOT RESULT IN AN AGGREGATE ANNUAL DECREASE IN MEDICAID
PAYMENTS TO PROVIDERS SUBJECT TO THIS SUBDIVISION THAT IS IN EXCESS OF
TWO HUNDRED MILLION DOLLARS, AS DETERMINED BY THE COMMISSIONER AND NOT
SUBJECT TO SUBSEQUENT ADJUSTMENT, AND THE COMMISSIONER SHALL MAKE SUCH
ADJUSTMENTS TO SUCH PAYMENTS OR RATES OF PAYMENT AS ARE NECESSARY TO
ENSURE THAT SUCH AGGREGATE LIMITS ON PAYMENT DECREASES ARE NOT EXCEEDED.
S 4. Section 3614 of the public health law is amended by adding a new
subdivision 13 to read as follows:
13. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGU-
LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
S. 2809--D 114 A. 4009--D
IPATION, EFFECTIVE APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND FIFTEEN, PAYMENTS BY GOVERNMENT AGENCIES FOR
SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, EXCEPT FOR SUCH
SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND OTHER
DISCREET GROUPS AS MAY BE DETERMINED BY THE COMMISSIONER PURSUANT TO
REGULATIONS, SHALL BE BASED ON EPISODIC PAYMENTS. IN ESTABLISHING SUCH
PAYMENTS, A STATEWIDE BASE PRICE SHALL BE ESTABLISHED FOR EACH SIXTY DAY
EPISODE OF CARE AND ADJUSTED BY A REGIONAL WAGE INDEX FACTOR AND AN
INDIVIDUAL PATIENT CASE MIX INDEX. SUCH EPISODIC PAYMENTS MAY BE FURTHER
ADJUSTED FOR LOW UTILIZATION CASES AND TO REFLECT A PERCENTAGE LIMITA-
TION OF THE COST FOR HIGH-UTILIZATION CASES THAT EXCEED OUTLIER THRESH-
OLDS OF SUCH PAYMENTS.
(B) INITIAL BASE YEAR EPISODIC PAYMENTS SHALL BE BASED ON MEDICAID
PAID CLAIMS, AS DETERMINED AND ADJUSTED BY THE COMMISSIONER TO ACHIEVE
SAVINGS COMPARABLE TO THE PRIOR STATE FISCAL YEAR, FOR SERVICES PROVIDED
BY ALL CERTIFIED HOME HEALTH AGENCIES IN THE BASE YEAR TWO THOUSAND
NINE. SUBSEQUENT BASE YEAR EPISODIC PAYMENTS MAY BE BASED ON MEDICAID
PAID CLAIMS FOR SERVICES PROVIDED BY ALL CERTIFIED HOME HEALTH AGENCIES
IN A BASE YEAR SUBSEQUENT TO TWO THOUSAND NINE, AS DETERMINED BY THE
COMMISSIONER, PROVIDED, HOWEVER, THAT SUCH BASE YEAR ADJUSTMENT SHALL BE
MADE NOT LESS FREQUENTLY THAN EVERY THREE YEARS. IN DETERMINING CASE
MIX, EACH PATIENT SHALL BE CLASSIFIED USING A SYSTEM BASED ON MEASURES
WHICH MAY INCLUDE, BUT NOT LIMITED TO, CLINICAL AND FUNCTIONAL MEASURES,
AS REPORTED ON THE FEDERAL OUTCOME AND ASSESSMENT INFORMATION SET
(OASIS), AS MAY BE AMENDED.
(C) 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.
S 5. Sections 365-i and 369-dd of the social services law are
REPEALED.
S 5-a. Subparagraph (v) of paragraph (e) of subdivision 1 and subdivi-
sion 2-b of section 369-ee of the social services law, subparagraph (v)
of paragraph (e) of subdivision 1 as amended by section 1 of part C and
subdivision 2-b as added by section 2 of part C of chapter 58 of the
laws of 2008, are amended to read as follows:
(v) prescription drugs [as defined in section two hundred seventy of
the public health law, which shall be provided pursuant to subdivision
two-b of this section,] and non-prescription smoking cessation products
or devices;
2-b. Prescription drug payments. [(a) Subject to paragraph (b) of this
subdivision, payment for drugs, except for such drugs provided by
medical practitioners, and for which payment is authorized pursuant to
paragraph (e) of subdivision one of this section, shall be made pursuant
to subdivision nine of section three hundred sixty-seven-a of this arti-
cle and article two-A of the public health law and subdivision four of
section three hundred sixty-five-a of this article. Payment for such
drugs provided by medical practitioners shall be included in the capita-
tion payment for services or supplies provided to persons eligible for
health care services under this title.
(b)] Payment for drugs for which payment is authorized pursuant to
paragraph (e) of subdivision one of this section[, and that are provided
by an employer partnership for family health plus plan authorized by
section three hundred sixty-nine-ff of this title,] shall be included in
the capitation payment for services or supplies provided to persons
eligible for health care services under [such] A FAMILY HEALTH INSURANCE
plan.
S. 2809--D 115 A. 4009--D
S 6. Section 368-d of the social services law is amended by adding
three new subdivisions 4, 5 and 6 to read as follows:
4. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO CONTRACT WITH ONE OR
MORE ENTITIES TO CONDUCT A STUDY TO DETERMINE ACTUAL DIRECT AND INDIRECT
COSTS INCURRED BY PUBLIC SCHOOL DISTRICTS AND STATE OPERATED/STATE
SUPPORTED SCHOOLS WHICH OPERATE PURSUANT TO ARTICLE EIGHTY-FIVE, EIGHT-
Y-SEVEN OR EIGHTY-EIGHT OF THE EDUCATION LAW FOR MEDICAL CARE, SERVICES
AND SUPPLIES, INCLUDING RELATED SPECIAL EDUCATION SERVICES AND SPECIAL
TRANSPORTATION, FURNISHED TO CHILDREN WITH HANDICAPPING CONDITIONS.
5. 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 COMMISSIONER OF HEALTH IS AUTHORIZED TO ENTER INTO A CONTRACT OR
CONTRACTS UNDER SUBDIVISION FOUR OF THIS SECTION WITHOUT A COMPETITIVE
BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
(A) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
OF NO LESS THAN THIRTY DAYS:
(I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
(IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER OF HEALTH; AND
(C) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
PURPOSES OF THIS SECTION.
(D) UPON SELECTION OF A CONTRACTOR OR CONTRACTORS, THE DEPARTMENT OF
HEALTH SHALL PROVIDE WRITTEN NOTIFICATION OF SUCH SELECTION AND A SUMMA-
RY OF THE CRITERIA EMPLOYED IN SUCH SELECTION TO THE CHAIR OF THE SENATE
FINANCE COMMITTEE AND THE CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMIT-
TEE.
6. THE COMMISSIONER SHALL EVALUATE THE RESULTS OF THE STUDY CONDUCTED
PURSUANT TO SUBDIVISION FOUR OF THIS SECTION TO DETERMINE, AFTER IDEN-
TIFICATION OF ACTUAL DIRECT AND INDIRECT COSTS INCURRED BY PUBLIC SCHOOL
DISTRICTS AND STATE OPERATED/STATE SUPPORTED SCHOOLS, WHETHER IT IS
ADVISABLE TO CLAIM FEDERAL REIMBURSEMENT FOR EXPENDITURES UNDER THIS
SECTION AS CERTIFIED PUBLIC EXPENDITURES. IN THE EVENT SUCH CLAIMS ARE
SUBMITTED, IF FEDERAL REIMBURSEMENT RECEIVED FOR CERTIFIED PUBLIC
EXPENDITURES ON BEHALF OF MEDICAL ASSISTANCE RECIPIENTS WHOSE ASSISTANCE
AND CARE ARE THE RESPONSIBILITY OF A SOCIAL SERVICES DISTRICT IN A CITY
WITH A POPULATION OF OVER TWO MILLION, RESULTS IN A DECREASE IN THE
STATE SHARE OF ANNUAL EXPENDITURES PURSUANT TO THIS SECTION FOR SUCH
RECIPIENTS, THEN TO THE EXTENT THAT THE AMOUNT OF ANY SUCH DECREASE WHEN
COMBINED WITH ANY DECREASE IN THE STATE SHARE OF ANNUAL EXPENDITURES
DESCRIBED IN SUBDIVISION FIVE OF SECTION THREE HUNDRED SIXTY-EIGHT-E OF
THIS TITLE EXCEEDS FIFTY MILLION DOLLARS, THE EXCESS AMOUNT SHALL BE
TRANSFERRED TO SUCH CITY. ANY SUCH EXCESS AMOUNT TRANSFERRED SHALL NOT
BE CONSIDERED A REVENUE RECEIVED BY SUCH SOCIAL SERVICES DISTRICT IN
DETERMINING THE DISTRICT'S ACTUAL MEDICAL ASSISTANCE EXPENDITURES FOR
PURPOSES OF PARAGRAPH (B) OF SECTION ONE OF PART C OF CHAPTER
FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND FIVE.
S. 2809--D 116 A. 4009--D
S 7. Section 368-e of the social services law is amended by adding
three new subdivisions 3, 4 and 5 to read as follows:
3. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO CONTRACT WITH ONE OR
MORE ENTITIES TO CONDUCT A STUDY TO DETERMINE ACTUAL DIRECT AND INDIRECT
COSTS INCURRED BY COUNTIES FOR MEDICAL CARE, SERVICES AND SUPPLIES,
INCLUDING RELATED SPECIAL EDUCATION SERVICES AND SPECIAL TRANSPORTATION,
FURNISHED TO PRE-SCHOOL CHILDREN WITH HANDICAPPING CONDITIONS.
4. 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 COMMISSIONER OF HEALTH IS AUTHORIZED TO ENTER INTO A CONTRACT OR
CONTRACTS UNDER SUBDIVISION THREE OF THIS SECTION WITHOUT A COMPETITIVE
BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
(A) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
OF NO LESS THAN THIRTY DAYS:
(I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
(IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER OF HEALTH; AND
(C) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
PURPOSES OF THIS SECTION.
(D) UPON SELECTION OF A CONTRACTOR OR CONTRACTORS, THE DEPARTMENT OF
HEALTH SHALL PROVIDE WRITTEN NOTIFICATION OF SUCH SELECTION AND A SUMMA-
RY OF THE CRITERIA EMPLOYED IN SUCH SELECTION TO THE CHAIR OF THE SENATE
FINANCE COMMITTEE AND THE CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMIT-
TEE.
5. THE COMMISSIONER SHALL EVALUATE THE RESULTS OF THE STUDY CONDUCTED
PURSUANT TO SUBDIVISION THREE OF THIS SECTION TO DETERMINE, AFTER IDEN-
TIFICATION OF ACTUAL DIRECT AND INDIRECT COSTS INCURRED BY COUNTIES FOR
MEDICAL CARE, SERVICES, AND SUPPLIES FURNISHED TO PRE-SCHOOL CHILDREN
WITH HANDICAPPING CONDITIONS, WHETHER IT IS ADVISABLE TO CLAIM FEDERAL
REIMBURSEMENT FOR EXPENDITURES UNDER THIS SECTION AS CERTIFIED PUBLIC
EXPENDITURES. IN THE EVENT SUCH CLAIMS ARE SUBMITTED, IF FEDERAL
REIMBURSEMENT RECEIVED FOR CERTIFIED PUBLIC EXPENDITURES ON BEHALF OF
MEDICAL ASSISTANCE RECIPIENTS WHOSE ASSISTANCE AND CARE ARE THE RESPON-
SIBILITY OF A SOCIAL SERVICES DISTRICT IN A CITY WITH A POPULATION OF
OVER TWO MILLION, RESULTS IN A DECREASE IN THE STATE SHARE OF ANNUAL
EXPENDITURES PURSUANT TO THIS SECTION FOR SUCH RECIPIENTS, THEN TO THE
EXTENT THAT THE AMOUNT OF ANY SUCH DECREASE WHEN COMBINED WITH ANY
DECREASE IN THE STATE SHARE OF ANNUAL EXPENDITURES DESCRIBED IN SUBDIVI-
SION SIX OF SECTION THREE HUNDRED SIXTY-EIGHT-D OF THIS TITLE EXCEEDS
FIFTY MILLION DOLLARS, THE EXCESS AMOUNT SHALL BE TRANSFERRED TO SUCH
CITY. ANY SUCH EXCESS AMOUNT TRANSFERRED SHALL NOT BE CONSIDERED A
REVENUE RECEIVED BY SUCH SOCIAL SERVICES DISTRICT IN DETERMINING THE
DISTRICT'S ACTUAL MEDICAL ASSISTANCE EXPENDITURES FOR PURPOSES OF PARA-
GRAPH (B) OF SECTION ONE OF PART C OF CHAPTER FIFTY-EIGHT OF THE LAWS OF
TWO THOUSAND FIVE.
S. 2809--D 117 A. 4009--D
S 8. Paragraph d of subdivision 20 of section 2808 of the public
health law is REPEALED and a new paragraph d is added to read as
follows:
D. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW, RULE OR REGULATION,
FOR RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN, THE
COMMISSIONER MAY REDUCE OR ELIMINATE THE PAYMENT FACTOR FOR RETURN ON OR
RETURN OF EQUITY IN THE CAPITAL COST COMPONENT OF MEDICAID RATES OF
PAYMENT FOR SERVICES PROVIDED BY RESIDENTIAL HEALTH CARE FACILITIES.
S 9. Paragraph (b) of subdivision 11 of section 272 of the public
health law, as added by section 36 of part C of chapter 58 of the laws
of 2009, is amended to read as follows:
(b) The commissioner may designate a pharmaceutical manufacturer as
one with whom the commissioner is negotiating or has negotiated a
manufacturer agreement, and all of the drugs it manufactures or markets
shall be included in the preferred drug program. The commissioner may
negotiate directly with a pharmaceutical manufacturer for rebates relat-
ing to any or all of the drugs it manufactures or markets. A manufactur-
er agreement shall designate any or all of the drugs manufactured or
marketed by the pharmaceutical manufacturer as being preferred or non
preferred drugs. When a pharmaceutical manufacturer has been designated
by the commissioner under this paragraph but THE COMMISSIONER has not
reached a manufacturer agreement with the pharmaceutical manufacturer,
then THE COMMISSIONER MAY DESIGNATE SOME OR all of the drugs manufac-
tured or marketed by the pharmaceutical manufacturer [shall be] AS non
preferred drugs. However, notwithstanding this paragraph, any drug that
is selected to be on the preferred drug list under paragraph (b) of
subdivision ten of this section on grounds that it is significantly more
clinically effective and safer than other drugs in its therapeutic class
shall be a preferred drug.
S 10. Subparagraphs (i) and (ii) of paragraph (b) of subdivision 9 of
section 367-a of the social services law, subparagraph (i) as amended by
section 10 and subparagraph (ii) as amended by section 4 of part C of
chapter 58 of the laws of 2008, are amended to read as follows:
(i) if the drug dispensed is a multiple source prescription drug for
which an upper limit has been set by the federal centers for medicare
and medicaid services, the lower of: (A) an amount equal to the specific
upper limit set by such federal agency for the multiple source
prescription drug; (B) the estimated acquisition cost of such drug to
pharmacies which, for purposes of this subparagraph, shall mean 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; (C) the maxi-
mum acquisition cost, if any, established pursuant to paragraph (e) of
this subdivision; [or] (D) the dispensing pharmacy's usual and customary
price charged to the general public[,]; OR (E) THE AVERAGE ACQUISITION
COST IF AVAILABLE; and
(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, THE AVERAGE ACQUISITION COST IF AVAILABLE 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] SEVENTEEN percent thereof OR THE WHOLE-
S. 2809--D 118 A. 4009--D
SALE ACQUISITION COST OF A PRESCRIPTION DRUG BASED UPON PACKAGE SIZE
DISPENSED FROM, AS REPORTED BY THE PRESCRIPTION DRUG PRICING SERVICE
USED BY THE DEPARTMENT, MINUS ZERO AND FORTY-ONE HUNDREDTHS PERCENT
THEREOF, and updated monthly by the department[; or, for a specialized
HIV pharmacy, as defined in paragraph (f) of this subdivision, acquisi-
tion 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 twelve percent there-
of, and updated monthly by the department]. For multiple source generic
drugs, estimated acquisition cost means the lower of THE AVERAGE ACQUI-
SITION COST, 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 there-
of, or the maximum acquisition cost, if any, established pursuant to
paragraph (e) of this subdivision[; or, for a specialized HIV pharmacy,
as defined in paragraph (f) of this subdivision, 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 twelve percent thereof, or
the maximum acquisition cost, if any, established pursuant to paragraph
(e) of this subdivision].
S 10-a. Subparagraph (i) of paragraph (d) of subdivision 9 of section
367-a of the social services law, as amended by chapter 19 of the laws
of 1998, is amended to read as follows:
(i) for prescription drugs categorized as generic by the prescription
drug pricing service used by the department, [four] THREE dollars and
fifty cents per prescription; and
S 10-b. Paragraph (f) of subdivision 9 of section 367-a of the social
services law is REPEALED and a new paragraph (f) is added to read as
follows:
(F) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
THE CONTRARY, THE COMMISSIONER SHALL HAVE THE AUTHORITY TO ESTABLISH THE
AMOUNT OF PAYMENTS AND DISPENSING FEES UNDER THIS TITLE FOR THOSE DRUGS
WHICH MAY NOT BE DISPENSED WITHOUT A PRESCRIPTION AS REQUIRED BY SECTION
SIXTY-EIGHT HUNDRED TEN OF THE EDUCATION LAW AND FOR WHICH PAYMENT IS
AUTHORIZED PURSUANT TO PARAGRAPH (G) OF SUBDIVISION TWO OF SECTION THREE
HUNDRED SIXTY-FIVE-A OF THIS TITLE. THE COMMISSIONER SHALL NOT CHANGE
THE AMOUNTS OF OR METHOD FOR SUCH PAYMENTS OR DISPENSING FEES ON OR
AFTER APRIL FIRST, TWO THOUSAND ELEVEN UNLESS NOTICE IS GIVEN SIXTY DAYS
IN ADVANCE OF SUCH CHANGE TO THE CHAIRS OF THE COMMITTEES ON SENATE
FINANCE, ASSEMBLY WAYS AND MEANS, SENATE HEALTH, AND ASSEMBLY HEALTH.
S 11. Subdivision 1 of section 3-d of part B of chapter 58 of the laws
of 2010 amending the public health law and other laws relating to Medi-
caid payments, is amended to read as follows;
1. Notwithstanding any provision of law, rule or regulation to the
contrary, and subject to the availability of federal financial partic-
ipation, for periods on and after April 1, 2010, payments made to
managed care providers sponsored by a public benefit corporation located
in a city of more than one million persons which provide coverage prima-
rily to Medicaid patients in accordance with sections 364-j and 369-ee
of the social services law may, at the election of the social services
district, be increased up to an annual aggregate amount of two hundred
million dollars; provided, however that, notwithstanding the social
services district Medicaid cap provisions of part C of chapter 58 of the
laws of 2005, such social services district shall be responsible for
payment of one hundred percent of the non-federal share of such
S. 2809--D 119 A. 4009--D
increase, and provided further, however, that such payment increases
shall not be applied to payments related to the Medicaid advantage
program [or the HIV special needs plan]. Social services district fund-
ing of the non-federal share of any such payments shall be deemed to be
voluntary for purposes of the increased federal medical assistance
percentage provisions of the American Recovery and Reinvestment Act of
2009; provided however that, in the event the federal Centers for Medi-
care and Medicaid Services determines that such non-federal share
payments are not voluntary payments for purposes of such Act, the
provisions of this section shall be null and void.
S 12. Intentionally omitted.
S 13. Subdivision 1 of section 271 of the public health law, as added
by section 10 of part C of chapter 58 of the laws of 2005, is amended to
read as follows:
1. There is hereby established in the department a pharmacy and thera-
peutics committee. The committee shall consist of [seventeen] EIGHTEEN
members, who shall be appointed by the commissioner and who shall serve
three year terms; except that for the initial appointments to the
committee, five members shall serve one year terms, seven shall serve
two year terms, and five shall serve three year terms. Committee members
may be reappointed upon the completion of their terms. [No] WITH THE
EXCEPTION OF THE CHAIRPERSON, NO member of the committee shall be an
employee of the state or any subdivision of the state, other than for
his or her membership on the committee, except for employees of health
care facilities or universities operated by the state, a public benefit
corporation, the State University of New York or municipalities.
S 14. Paragraphs (d) and (e) of subdivision 2 of section 271 of the
public health law, as added by section 10 of part C of chapter 58 of the
laws of 2005, are amended, and a new paragraph (f) is added to read as
follows:
(d) one person with expertise in drug utilization review who is either
a health care professional licensed under title eight of the education
law, is a pharmacologist or has a doctorate in pharmacology; [and]
(e) three persons who shall be consumers or representatives of organ-
izations with a regional or statewide constituency and who have been
involved in activities related to health care consumer advocacy, includ-
ing issues affecting Medicaid or EPIC recipients[.]; AND
(F) A CHAIRPERSON DESIGNATED PURSUANT TO SUBDIVISION FOUR OF THIS
SECTION.
S 15. Subdivision 4 of section 271 of the public health law is
REPEALED and a new subdivision 4 is added to read as follows:
4. THE COMMISSIONER SHALL DESIGNATE A MEMBER OF THE DEPARTMENT TO
SERVE AS CHAIRPERSON OF THE COMMITTEE.
S 16. Intentionally omitted.
S 17. Subdivision 10 of section 272 of the public health law is
amended by adding a new paragraph (d) to read as follows:
(D) NOTWITHSTANDING ANY PROVISION OF THIS SECTION TO THE CONTRARY, THE
COMMISSIONER MAY DESIGNATE THERAPEUTIC CLASSES OF DRUGS, INCLUDING
CLASSES WITH ONLY ONE DRUG, AS ALL PREFERRED PRIOR TO ANY REVIEW THAT
MAY BE CONDUCTED BY THE COMMITTEE PURSUANT TO THIS SECTION.
S 18. Intentionally omitted.
S 19. Subdivision 4 of section 364-j of the social services law is
amended by adding a new paragraph (u) to read as follows:
(U) A MANAGED CARE PROVIDER THAT PROVIDES COVERAGE FOR PRESCRIPTION
DRUGS SHALL PERMIT EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED
PRESCRIPTION, AT HIS OR HER OPTION, AT ANY MAIL ORDER PHARMACY OR
S. 2809--D 120 A. 4009--D
NON-MAIL-ORDER RETAIL PHARMACY IN THE MANAGED CARE PROVIDER NETWORK, IF
THE NON-MAIL-ORDER RETAIL PHARMACY OFFERS TO ACCEPT A PRICE THAT IS
COMPARABLE TO THAT OF THE MAIL ORDER PHARMACY.
S 20. 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-
retrovirals used in the treatment of HIV/AIDS, or anti-rejection drugs
used for the treatment of organ and tissue transplants].
S 21. Subdivision 12 of section 272 of the public health law is
REPEALED.
S 22. Paragraph (c) of subdivision 8 of section 2807 of the public
health law, as added by section 28 of part B of chapter 1 of the laws of
2002, is amended to read as follows:
(c) Rates of payments to facilities which first qualify as federally
qualified health centers or rural health centers on or after October
first, two thousand shall be computed in accordance with the provisions
of paragraph (b) of subdivision two of this section, provided, however,
that the operating cost component of such rates shall reflect an average
of the operating cost component of rates of payments issued to other
facilities subject to this subdivision during the same rate period,
located in the same geographic region and with a similar case load, and
further provided that the capital cost component of such rates shall
reflect the most recently available capital cost data as reported to the
department. For each twelve month period following the rate period in
which such facilities commence operation, the operating cost component
of rates of payment for such facilities shall be computed in accordance
with paragraph (b) of this subdivision. IN CALCULATING THE OPERATING
COST COMPONENT OF SUCH RATES FOR FACILITIES WHICH FIRST QUALIFY AS
FEDERALLY QUALIFIED HEALTH CARE CENTERS ON OR AFTER OCTOBER FIRST, TWO
THOUSAND, THE COUNTIES COMPRISING THE GEOGRAPHIC REGION KNOWN AS DOWN-
STATE SHALL BE THE SAME AS THE COUNTIES COMPRISING THE DOWNSTATE REGION
FOR PURPOSES OF REIMBURSING DIAGNOSTIC AND TREATMENT CENTERS UNDER AMBU-
LATORY PATIENT GROUPS, WHICH COUNTIES ARE SPECIFIED IN THE REGULATIONS
ADOPTED BY THE COMMISSIONER IMPLEMENTING SECTION 18 OF PART C OF CHAPTER
FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND EIGHT.
S 23. Paragraph (g) of subdivision 2 of section 365-a of the social
services law, as amended by section 1 of part F of chapter 497 of the
laws of 2008, is amended to read as follows:
(g) sickroom supplies, eyeglasses, prosthetic appliances and dental
prosthetic appliances furnished in accordance with the regulations of
the department[,]; provided FURTHER that: (I) the commissioner of health
is authorized to implement a preferred diabetic supply program wherein
the department of health will receive enhanced rebates from preferred
manufacturers of glucometers and test strips, and may subject non-pre-
ferred manufacturers' glucometers and test strips to prior authorization
under section two hundred seventy-three of the public health law; (II)
ENTERAL FORMULA THERAPY AND NUTRITIONAL SUPPLEMENTS ARE LIMITED TO
COVERAGE ONLY FOR NASOGASTRIC, JEJUNOSTOMY, OR GASTROSTOMY TUBE FEEDING
OR FOR TREATMENT OF AN INBORN METABOLIC DISORDER, OR TO ADDRESS GROWTH
AND DEVELOPMENT PROBLEMS IN CHILDREN; (III) PRESCRIPTION FOOTWEAR AND
INSERTS ARE LIMITED TO COVERAGE ONLY WHEN USED AS AN INTEGRAL PART OF A
S. 2809--D 121 A. 4009--D
LOWER LIMB ORTHOTIC APPLIANCE, AS PART OF A DIABETIC TREATMENT PLAN, OR
TO ADDRESS GROWTH AND DEVELOPMENT PROBLEMS IN CHILDREN; AND (IV)
COMPRESSION AND SUPPORT STOCKINGS ARE LIMITED TO COVERAGE ONLY FOR PREG-
NANCY OR TREATMENT OF VENOUS STASIS ULCERS;
(G-1) drugs provided on an in-patient basis, those drugs contained on
the list established by regulation of the commissioner of health pursu-
ant to subdivision four of this section, and those drugs which may not
be dispensed without a prescription as required by section sixty-eight
hundred ten of the education law and which the commissioner of health
shall determine to be reimbursable based upon such factors as the avail-
ability of such drugs or alternatives at low cost if purchased by a
medicaid recipient, or the essential nature of such drugs as described
by such commissioner in regulations, provided, however, that such drugs,
exclusive of long-term maintenance drugs, shall be dispensed in quanti-
ties no greater than a thirty day supply or one hundred doses, whichever
is greater; provided further that the commissioner of health is author-
ized to require prior authorization for any refill of a prescription
when less than seventy-five percent of the previously dispensed amount
per fill should have been used were the product used as normally indi-
cated; PROVIDED FURTHER THAT THE COMMISSIONER OF HEALTH IS AUTHORIZED TO
REQUIRE PRIOR AUTHORIZATION OF PRESCRIPTIONS OF OPIOID ANALGESICS IN
EXCESS OF FOUR PRESCRIPTIONS IN A THIRTY-DAY PERIOD IN ACCORDANCE WITH
SECTION TWO HUNDRED SEVENTY-THREE OF THE PUBLIC HEALTH LAW; medical
assistance shall not include any drug provided on other than an in-pa-
tient basis for which a recipient is charged or a claim is made in the
case of a prescription drug, in excess of the maximum reimbursable
amounts to be established by department regulations in accordance with
standards established by the secretary of the United States department
of health and human services, or, in the case of a drug not requiring a
prescription, in excess of the maximum reimbursable amount established
by the commissioner of health pursuant to paragraph (a) of subdivision
four of this section;
S 24. Intentionally omitted.
S 25. Section 367-w of the social services law is REPEALED.
S 26. Notwithstanding any provision of law to the contrary and subject
to the availability of federal financial participation, for periods on
and after April 1, 2011, clinics certified pursuant to articles 16, 31
or 32 of the mental hygiene law shall be subject to targeted Medicaid
reimbursement rate reductions in accordance with the provisions of this
section. Such reductions shall be based on utilization thresholds which
may be established either as provider-specific or patient-specific
thresholds. Provider-specific thresholds shall be based on average
patient utilization for a given provider in comparison to a peer based
standard to be determined for each service. The commissioners of the
office of mental health, the office for persons with developmental disa-
bilities, and the office of alcoholism and substance abuse services, in
consultation with the commissioner of health, are authorized to waive
utilization thresholds for patients of clinics certified pursuant to
article 16, 31, or 32 of the mental hygiene law who are enrolled in
specific treatment programs or otherwise meet criteria as may be speci-
fied by such commissioners. When applying a provider-specific thresh-
old, rates will be reduced on a prospective basis based on the amount
any provider is over the determined threshold level. Patient-specific
thresholds will be based on annual thresholds determined for each
service over which the per visit payment for each visit in excess of the
standard during a twelve month period shall be reduced by a pre-deter-
S. 2809--D 122 A. 4009--D
mined amount. The thresholds, peer based standards and the payment
reductions shall be determined by the department of health, with the
approval of the division of the budget, and in consultation with the
office of mental health, the office for people with developmental disa-
bilities and the office of alcoholism and substance abuse services, and
any such resulting rates shall be subject to certification by the appro-
priate commissioners pursuant to subdivision (a) of section 43.02 of the
mental hygiene law. The base period used to establish the thresholds
shall be the 2009 calendar year. The total annualized reduction in
payments shall be not more than $10,900,000 for Article 31 clinics, not
more than $2,400,000 for Article 16 clinics, and not more than
$13,250,000 for Article 32 clinics. The commissioner of health may
promulgate regulations to implement the provisions of this section.
S 27. Paragraph (h) of subdivision 2 of section 365-a of the social
services law, as amended by chapter 444 of the laws of 1979 and as
relettered by chapter 478 of the laws of 1980, is amended to read as
follows:
(h) SPEECH THERAPY, AND WHEN PROVIDED AT THE DIRECTION OF A PHYSICIAN
OR NURSE PRACTITIONER, physical therapy [and relative] INCLUDING RELATED
rehabilitative services [when provided at the direction of a physician]
AND OCCUPATIONAL THERAPY; PROVIDED, HOWEVER, THAT SPEECH THERAPY, PHYS-
ICAL THERAPY AND OCCUPATIONAL THERAPY EACH SHALL BE LIMITED TO COVERAGE
OF TWENTY VISITS PER YEAR; SUCH LIMITATION SHALL NOT APPLY TO PERSONS
WITH DEVELOPMENTAL DISABILITIES;
S 28. Section 3614 of the public health law is amended by adding a new
subdivision 2-a to read as follows:
2-A. NOTWITHSTANDING ANY CONTRARY LAW, RULE OR REGULATION, FOR RATE
PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN, MEDICAID RATES OF
PAYMENTS FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, BY
LONG TERM HOME HEALTH CARE PROGRAMS OR BY AN AIDS HOME CARE PROGRAM
SHALL NOT REFLECT A SEPARATE PAYMENT FOR HOME CARE NURSING SERVICES
PROVIDED TO PATIENTS DIAGNOSED WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME
(AIDS).
S 29. Intentionally omitted.
S 30. Subparagraphs (x), (xi), (xii), (xiii) and (xiv) of paragraph
(a) of subdivision 7 of section 2807-s of the public health law, as
amended by section 100 of part C of chapter 58 of the laws of 2009, are
amended to read as follows:
(x) forty-seven million two hundred ten thousand dollars on an annual
basis for the periods January first, two thousand nine through December
thirty-first, two thousand ten; [and]
(xi) eleven million eight hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven;
(xii) TWENTY-THREE MILLION EIGHT HUNDRED THIRTY-SIX THOUSAND DOLLARS
FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWELVE;
(XIII) TWENTY-THREE MILLION EIGHT HUNDRED THIRTY-SIX THOUSAND DOLLARS
EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN;
(XIV) provided, however, for periods prior to January first, two thou-
sand nine, amounts set forth in this paragraph may be reduced by the
commissioner in an amount to be approved by the director of the budget
to reflect the amount received from the federal government under the
state's 1115 waiver which is directed under its terms and conditions to
S. 2809--D 123 A. 4009--D
the graduate medical education program established pursuant to section
twenty-eight hundred seven-m of this article;
[(xiii)] (XV) provided further, however, for periods prior to July
first, two thousand nine, amounts set forth in this paragraph shall be
reduced by an amount equal to the total actual distribution reductions
for all facilities pursuant to paragraph (e) of subdivision three of
section twenty-eight hundred seven-m of this article; and
[(xiv)] (XVI) provided further, however, for periods prior to July
first, two thousand nine, amounts set forth in this paragraph shall be
reduced by an amount equal to the actual distribution reductions for all
facilities pursuant to paragraph (s) of subdivision one of section twen-
ty-eight hundred seven-m of this article.
S 31. Paragraph (s) of subdivision 2 of section 365-a of the social
services law, as amended by section 46 of part B of chapter 58 of the
laws of 2010, 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
and adolescents ten to 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 assistant, 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 32. Subparagraph (i) of paragraph (b-1) of subdivision 1 of section
2807-c of the public health law, as amended by section 10 of part C of
chapter 58 of the laws of 2010, is amended to read as follows:
(i) For patients discharged on and after January first, nineteen
hundred ninety-seven and prior to January first, two thousand and on and
after January first, two thousand, payments to general hospitals for
reimbursement of inpatient hospital services provided to patients eligi-
ble for payments pursuant to the workers' compensation law, the volun-
teer firefighters' benefit law, the volunteer ambulance workers' benefit
law, and the comprehensive motor vehicle insurance reparations act shall
be at the rates of payment determined pursuant to this section for state
governmental agencies, excluding adjustments pursuant to subdivision
fourteen-f of this section and subdivision thirty-three of this section
[and], excluding such further reductions to such payments as are enacted
as part of the state budget for the state fiscal year commencing April
first, two thousand ten AND EXCLUDING SUCH FURTHER REDUCTIONS TO SUCH
PAYMENTS AS ARE ENACTED AS PART OF THE STATE BUDGET FOR STATE FISCAL
YEARS COMMENCING ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN.
S 33. The public health law is amended by adding a new section 3614-c
to read as follows:
S 3614-C. HOME CARE WORKER WAGE PARITY. 1. AS USED IN THIS SECTION,
THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANING:
(A) "LIVING WAGE LAW" MEANS ANY LAW ENACTED BY NASSAU, SUFFOLK OR
WESTCHESTER COUNTY OR A CITY WITH A POPULATION OF ONE MILLION OR MORE
WHICH ESTABLISHES A MINIMUM WAGE FOR SOME OR ALL EMPLOYEES WHO PERFORM
WORK ON CONTRACTS WITH SUCH COUNTY OR CITY.
(B) "TOTAL COMPENSATION" MEANS ALL WAGES AND OTHER DIRECT COMPENSATION
PAID TO OR PROVIDED ON BEHALF OF THE EMPLOYEE INCLUDING, BUT NOT LIMITED
TO, WAGES, HEALTH, EDUCATION OR PENSION BENEFITS, SUPPLEMENTS IN LIEU OF
S. 2809--D 124 A. 4009--D
BENEFITS AND COMPENSATED TIME OFF, EXCEPT THAT IT DOES NOT INCLUDE
EMPLOYER TAXES OR EMPLOYER PORTION OF PAYMENTS FOR STATUTORY BENEFITS,
INCLUDING BUT NOT LIMITED TO FICA, DISABILITY INSURANCE, UNEMPLOYMENT
INSURANCE AND WORKERS' COMPENSATION.
(C) "PREVAILING RATE OF TOTAL COMPENSATION" MEANS THE AVERAGE HOURLY
AMOUNT OF TOTAL COMPENSATION PAID TO ALL HOME CARE AIDES COVERED BY
WHATEVER COLLECTIVELY BARGAINED AGREEMENT COVERS THE GREATEST NUMBER OF
HOME CARE AIDES IN A CITY WITH A POPULATION OF ONE MILLION OR MORE. FOR
PURPOSES OF THIS DEFINITION, ANY SET OF COLLECTIVELY BARGAINED AGREE-
MENTS IN SUCH CITY WITH SUBSTANTIALLY THE SAME TERMS AND CONDITIONS
RELATING TO TOTAL COMPENSATION SHALL BE CONSIDERED AS A SINGLE COLLEC-
TIVELY BARGAINED AGREEMENT.
(D) "HOME CARE AIDE" MEANS A HOME HEALTH AIDE, PERSONAL CARE AIDE,
HOME ATTENDANT OR OTHER LICENSED OR UNLICENSED PERSON WHOSE PRIMARY
RESPONSIBILITY INCLUDES THE PROVISION OF IN-HOME ASSISTANCE WITH ACTIV-
ITIES OF DAILY LIVING, INSTRUMENTAL ACTIVITIES OF DAILY LIVING OR
HEALTH-RELATED TASKS; PROVIDED, HOWEVER, THAT HOME CARE AIDE DOES NOT
INCLUDE ANY INDIVIDUAL (I) WORKING ON A CASUAL BASIS, OR (II) WHO IS A
RELATIVE THROUGH BLOOD, MARRIAGE OR ADOPTION OF: (1) THE EMPLOYER; OR
(2) THE PERSON FOR WHOM THE WORKER IS DELIVERING SERVICES, UNDER A
PROGRAM FUNDED OR ADMINISTERED BY FEDERAL, STATE OR LOCAL GOVERNMENT.
(E) "MANAGED CARE PLAN" MEANS ANY MANAGED CARE PROGRAM, ORGANIZATION
OR DEMONSTRATION COVERING PERSONAL CARE OR HOME HEALTH AIDE SERVICES,
AND WHICH RECEIVES PREMIUMS FUNDED, IN WHOLE OR IN PART, BY THE NEW YORK
STATE MEDICAL ASSISTANCE PROGRAM, INCLUDING BUT NOT LIMITED TO ALL MEDI-
CAID MANAGED CARE, MEDICAID MANAGED LONG TERM CARE, MEDICAID ADVANTAGE,
AND MEDICAID ADVANTAGE PLUS PLANS AND ALL PROGRAMS OF ALL-INCLUSIVE CARE
FOR THE ELDERLY.
(F) "EPISODE OF CARE" MEANS ANY SERVICE UNIT REIMBURSED, IN WHOLE OR
IN PART, BY THE NEW YORK STATE MEDICAL ASSISTANCE PROGRAM, WHETHER
THROUGH DIRECT REIMBURSEMENT OR COVERED BY A PREMIUM PAYMENT, AND WHICH
COVERS, IN WHOLE OR IN PART, ANY SERVICE PROVIDED BY A HOME CARE AIDE,
INCLUDING BUT NOT LIMITED TO ALL SERVICE UNITS DEFINED AS VISITS, HOURS,
DAYS, MONTHS OR EPISODES.
2. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR REGU-
LATION, NO PAYMENTS BY GOVERNMENT AGENCIES SHALL BE MADE TO CERTIFIED
HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS OR MANAGED
CARE PLANS FOR ANY EPISODE OF CARE FURNISHED, IN WHOLE OR IN PART, BY
ANY HOME CARE AIDE WHO IS COMPENSATED AT AMOUNTS LESS THAN THE APPLICA-
BLE MINIMUM RATE OF HOME CARE AIDE TOTAL COMPENSATION ESTABLISHED PURSU-
ANT TO THIS SECTION.
3. (A) THE MINIMUM RATE OF HOME CARE AIDE TOTAL COMPENSATION IN A CITY
WITH A POPULATION OF ONE MILLION OR MORE SHALL BE:
(I) FOR THE PERIOD MARCH FIRST, TWO THOUSAND TWELVE THROUGH FEBRUARY
TWENTY-EIGHTH, TWO THOUSAND THIRTEEN, NINETY PERCENT OF THE TOTAL
COMPENSATION MANDATED BY THE LIVING WAGE LAW OF SUCH CITY;
(II) FOR THE PERIOD MARCH FIRST, TWO THOUSAND THIRTEEN THROUGH FEBRU-
ARY TWENTY-EIGHTH, TWO THOUSAND FOURTEEN, NINETY-FIVE PERCENT OF THE
TOTAL COMPENSATION MANDATED BY THE LIVING WAGE LAW OF SUCH CITY;
(III) FOR ALL PERIODS ON AND AFTER MARCH FIRST, TWO THOUSAND FOURTEEN,
NO LESS THAN THE PREVAILING RATE OF TOTAL COMPENSATION AS OF JANUARY
FIRST, TWO THOUSAND ELEVEN, OR THE TOTAL COMPENSATION MANDATED BY THE
LIVING WAGE LAW OF SUCH CITY, WHICHEVER IS GREATER.
(B) THE MINIMUM RATE OF HOME CARE AIDE TOTAL COMPENSATION IN THE COUN-
TIES OF NASSAU, SUFFOLK AND WESTCHESTER SHALL BE:
S. 2809--D 125 A. 4009--D
(I) FOR THE PERIOD MARCH FIRST, TWO THOUSAND THIRTEEN THROUGH FEBRUARY
TWENTY-EIGHTH, TWO THOUSAND FOURTEEN, NINETY PERCENT OF THE TOTAL
COMPENSATION MANDATED BY THE LIVING WAGE LAW AS SET ON MARCH FIRST, TWO
THOUSAND THIRTEEN OF A CITY WITH A POPULATION OF A MILLION OR MORE;
(II) FOR THE PERIOD MARCH FIRST, TWO THOUSAND FOURTEEN THROUGH FEBRU-
ARY TWENTY-EIGHTH, TWO THOUSAND FIFTEEN, NINETY-FIVE PERCENT OF THE
TOTAL COMPENSATION MANDATED BY THE LIVING WAGE LAW AS SET ON MARCH
FIRST, TWO THOUSAND FOURTEEN OF A CITY WITH A POPULATION OF A MILLION OR
MORE;
(III) FOR THE PERIOD MARCH FIRST, TWO THOUSAND FIFTEEN, THROUGH FEBRU-
ARY TWENTY-EIGHTH, TWO THOUSAND SIXTEEN, ONE HUNDRED PERCENT OF THE
TOTAL COMPENSATION MANDATED BY THE LIVING WAGE LAW AS SET ON MARCH
FIRST, TWO THOUSAND FIFTEEN OF A CITY WITH A POPULATION OF A MILLION OR
MORE;
(IV) FOR ALL PERIODS ON OR AFTER MARCH FIRST, TWO THOUSAND SIXTEEN,
THE LESSER OF (I) ONE HUNDRED AND FIFTEEN PERCENT OF THE TOTAL COMPEN-
SATION MANDATED BY THE LIVING WAGE LAW AS SET ON MARCH FIRST OF EACH
SUCCEEDING YEAR OF A CITY WITH A POPULATION OF ONE MILLION OR MORE OR;
(II) THE TOTAL COMPENSATION MANDATED BY THE LIVING WAGE LAW OF NASSAU,
SUFFOLK OR WESTCHESTER COUNTY, BASED ON THE LOCATION OF THE EPISODE OF
CARE
4. ANY PORTION OF THE MINIMUM RATE OF HOME CARE AIDE TOTAL COMPEN-
SATION ATTRIBUTABLE TO HEALTH BENEFIT COSTS OR PAYMENTS IN LIEU OF
HEALTH BENEFITS, AND PAID TIME OFF, AS ESTABLISHED PURSUANT TO SUBDIVI-
SION THREE OF THIS SECTION SHALL BE SUPERSEDED BY THE TERMS OF ANY
EMPLOYER BONA FIDE COLLECTIVE BARGAINING AGREEMENT IN EFFECT AS OF JANU-
ARY FIRST, TWO THOUSAND ELEVEN, OR A SUCCESSOR TO SUCH AGREEMENT, WHICH
PROVIDES FOR HOME CARE AIDES' HEALTH BENEFITS THROUGH PAYMENTS TO JOINT-
LY ADMINISTERED LABOR-MANAGEMENT FUNDS.
5. THE TERMS OF THIS SECTION SHALL APPLY EQUALLY TO SERVICES PROVIDED
BY HOME CARE AIDES WHO WORK ON EPISODES OF CARE AS DIRECT EMPLOYEES OF
CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, OR
MANAGED CARE PLANS, OR AS EMPLOYEES OF LICENSED HOME CARE SERVICES AGEN-
CIES, LIMITED LICENSED HOME CARE SERVICES AGENCIES, OR UNDER ANY OTHER
ARRANGEMENT.
6. NO PAYMENTS BY GOVERNMENT AGENCIES SHALL BE MADE TO CERTIFIED HOME
HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, OR MANAGED CARE
PLANS FOR ANY EPISODE OF CARE WITHOUT THE CERTIFIED HOME HEALTH AGENCY,
LONG TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN HAVING DELIV-
ERED PRIOR WRITTEN CERTIFICATION TO THE COMMISSIONER, ON FORMS PREPARED
BY THE DEPARTMENT IN CONSULTATION WITH THE DEPARTMENT OF LABOR, THAT ALL
SERVICES PROVIDED UNDER EACH EPISODE OF CARE ARE IN FULL COMPLIANCE WITH
THE TERMS OF THIS SECTION AND ANY REGULATIONS PROMULGATED PURSUANT TO
THIS SECTION.
7. IF A CERTIFIED HOME HEALTH AGENCY OR LONG TERM HOME HEALTH CARE
PROGRAM ELECTS TO PROVIDE HOME CARE AIDE SERVICES THROUGH CONTRACTS WITH
LICENSED HOME CARE SERVICES AGENCIES OR THROUGH OTHER THIRD PARTIES,
PROVIDED THAT THE EPISODE OF CARE ON WHICH THE HOME CARE AIDE WORKS IS
COVERED UNDER THE TERMS OF THIS SECTION, THE CERTIFIED HOME HEALTH AGEN-
CY, LONG TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN MUST OBTAIN
A WRITTEN CERTIFICATION FROM THE LICENSED HOME CARE SERVICES AGENCY OR
OTHER THIRD PARTY, ON FORMS PREPARED BY THE DEPARTMENT IN CONSULTATION
WITH THE DEPARTMENT OF LABOR, WHICH ATTESTS TO THE LICENSED HOME CARE
SERVICES AGENCY'S OR OTHER THIRD PARTY'S COMPLIANCE WITH THE TERMS OF
THIS SECTION. SUCH CERTIFICATIONS SHALL ALSO OBLIGATE THE CERTIFIED HOME
HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN
S. 2809--D 126 A. 4009--D
TO OBTAIN, ON NO LESS THAN A QUARTERLY BASIS, ALL INFORMATION FROM THE
LICENSED HOME CARE SERVICES AGENCY OR OTHER THIRD PARTIES NECESSARY TO
VERIFY COMPLIANCE WITH THE TERMS OF THIS SECTION. SUCH CERTIFICATIONS
AND THE INFORMATION EXCHANGED PURSUANT TO THEM SHALL BE RETAINED BY ALL
CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, OR
MANAGED CARE PLANS, AND ALL LICENSED HOME CARE SERVICES AGENCIES, OR
OTHER THIRD PARTIES FOR A PERIOD OF NO LESS THAN TEN YEARS, AND MADE
AVAILABLE TO THE DEPARTMENT UPON REQUEST.
8. THE COMMISSIONER SHALL DISTRIBUTE TO ALL CERTIFIED HOME HEALTH
AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, AND MANAGED CARE PLANS
OFFICIAL NOTICE OF THE MINIMUM RATES OF HOME CARE AIDE COMPENSATION AT
LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE EFFECTIVE DATE OF EACH MINI-
MUM RATE FOR EACH SOCIAL SERVICES DISTRICT COVERED BY THE TERMS OF THIS
SECTION.
9. THE COMMISSIONER IS AUTHORIZED TO PROMULGATE REGULATIONS, AND MAY
PROMULGATE EMERGENCY REGULATIONS, TO IMPLEMENT THE PROVISIONS OF THIS
SECTION.
10. NOTHING IN THIS SECTION SHOULD BE CONSTRUED AS APPLICABLE TO ANY
SERVICE PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME
HEALTH CARE PROGRAMS, OR MANAGED CARE PLANS EXCEPT FOR ALL EPISODES OF
CARE REIMBURSED IN WHOLE OR IN PART BY THE NEW YORK MEDICAID PROGRAM.
11. NO CERTIFIED HOME HEALTH AGENCY, MANAGED CARE PLAN OR LONG TERM
HOME HEALTH CARE PROGRAM SHALL BE LIABLE FOR RECOUPMENT OF PAYMENTS FOR
SERVICES PROVIDED THROUGH A LICENSED HOME CARE SERVICES AGENCY OR OTHER
THIRD PARTY WITH WHICH THE CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME
HEALTH CARE PROGRAM, OR MANAGED CARE PLAN HAS A CONTRACT BECAUSE THE
LICENSED AGENCY OR OTHER THIRD PARTY FAILED TO COMPLY WITH THE
PROVISIONS OF THIS SECTION IF THE CERTIFIED HOME HEALTH AGENCY, LONG
TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN HAS REASONABLY AND
IN GOOD FAITH COLLECTED CERTIFICATIONS AND ALL INFORMATION REQUIRED
PURSUANT TO SUBDIVISIONS SIX AND SEVEN OF THIS SECTION.
S 33-a. Intentionally omitted.
S 34. Subdivision 22-a of section 2808 of the public health law is
amended by adding a new paragraph (d) to read as follows:
(D) (I) NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF SUBDIVISIONS
TWO-B OR TWO-C OF THIS SECTION OR ANY OTHER CONTRARY PROVISION OF LAW,
AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR
INPATIENT SERVICES PROVIDED BY RESIDENTIAL HEALTH CARE FACILITIES ON AND
AFTER APRIL FIRST, TWO THOUSAND ELEVEN, THE COMMISSIONER MAY, SUBJECT TO
THE APPROVAL OF THE DIRECTOR OF THE BUDGET, GRANT APPROVAL OF A TEMPO-
RARY ADJUSTMENT TO MEDICAID RATES FOR ELIGIBLE FACILITIES, AS DETERMINED
IN ACCORDANCE WITH THIS PARAGRAPH.
(II) ELIGIBLE FACILITIES SHALL BE THOSE RESIDENTIAL HEALTH CARE FACIL-
ITIES WHICH, AS DETERMINED BY THE COMMISSIONER, REQUIRE SHORT-TERM
ASSISTANCE TO ACCOMMODATE ADDITIONAL PATIENT SERVICES REQUIREMENTS STEM-
MING FROM THE CLOSURE OF OTHER FACILITIES IN THE AREA, INCLUDING, BUT
NOT LIMITED TO, ADDITIONAL STAFF, SERVICE RECONFIGURATION AND ENHANCED
INFORMATION TECHNOLOGY CAPABILITY.
(III) ELIGIBLE FACILITIES SHALL SUBMIT WRITTEN PROPOSALS DEMONSTRATING
THE NEED FOR ADDITIONAL SHORT-TERM RESOURCES AND HOW SUCH ADDITIONAL
RESOURCES WILL RESULT IN IMPROVEMENTS TO:
(A) THE COST EFFECTIVENESS OF SERVICE DELIVERY;
(B) QUALITY OF CARE; AND
(C) OTHER FACTORS DEEMED APPROPRIATE BY THE COMMISSIONER.
(IV) SUCH WRITTEN PROPOSALS SHALL BE SUBMITTED TO THE DEPARTMENT AT
LEAST SIXTY DAYS PRIOR TO THE REQUESTED EFFECTIVE DATE OF THE TEMPORARY
S. 2809--D 127 A. 4009--D
RATE ADJUSTMENT. THE TEMPORARY RATE ADJUSTMENT SHALL BE IN EFFECT FOR A
SPECIFIED PERIOD OF TIME AS DETERMINED BY THE COMMISSIONER. AT THE END
OF THE SPECIFIED TIMEFRAME, THE FACILITY WILL BE REIMBURSED IN ACCORD-
ANCE WITH OTHERWISE APPLICABLE RATE-SETTING METHODOLOGIES. THE COMMIS-
SIONER MAY ESTABLISH, AS A CONDITION OF RECEIVING SUCH A TEMPORARY RATE
ADJUSTMENT, BENCHMARKS AND GOALS TO BE ACHIEVED IN ACCORDANCE WITH THE
FACILITY'S APPROVED PROPOSALS AND MAY ALSO REQUIRE THAT THE FACILITY
SUBMIT SUCH PERIODIC REPORTS CONCERNING THE ACHIEVEMENT OF SUCH BENCH-
MARKS AND GOALS AS THE COMMISSIONER DEEMS NECESSARY. FAILURE TO ACHIEVE
SATISFACTORY PROGRESS, AS DETERMINED BY THE COMMISSIONER, IN ACCOMPLISH-
ING SUCH BENCHMARKS AND GOALS SHALL BE A BASIS FOR ENDING THE FACILITY'S
TEMPORARY RATE ADJUSTMENT PRIOR TO THE END OF THE SPECIFIED TIMEFRAME.
S 35. The public health law is amended by adding a new article 29-AA
to read as follows:
ARTICLE 29-AA
PATIENT CENTERED MEDICAL HOMES
SECTION 2959-A. MULTIPAYOR PATIENT CENTERED MEDICAL HOME PROGRAM.
S 2959-A. MULTIPAYOR PATIENT CENTERED MEDICAL HOME PROGRAM. 1. (A)
THE COMMISSIONER IS AUTHORIZED TO ESTABLISH MEDICAL HOME MULTIPAYOR
PROGRAMS (REFERRED TO IN THIS SECTION AS A "PROGRAM") WHEREBY ENHANCED
PAYMENTS ARE MADE TO PRIMARY CARE CLINICIANS AND CLINICS STATEWIDE THAT
ARE CERTIFIED AS MEDICAL HOMES FOR THE PURPOSE OF IMPROVING HEALTH CARE
OUTCOMES AND EFFICIENCY THROUGH IMPROVED ACCESS, PATIENT CARE CONTINUITY
AND COORDINATION OF HEALTH SERVICES.
(B) AS USED IN THIS SECTION:
(I) "CLINIC" MEANS A GENERAL HOSPITAL PROVIDING OUTPATIENT CARE OR
DIAGNOSTIC AND TREATMENT CENTER, LICENSED UNDER ARTICLE TWENTY-EIGHT OF
THIS CHAPTER; AND
(II) "PRIMARY CARE CLINICIAN" MEANS A PHYSICIAN, NURSE PRACTITIONER,
OR MIDWIFE ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE UNDER TITLE
EIGHT OF THE EDUCATION LAW AND WHO IS PRACTICING IN A PRIMARY CARE
SPECIALTY.
(III) "PRIMARY CARE MEDICAL HOME COLLABORATIVE" MEANS AN ENTITY
APPROVED BY THE COMMISSIONER WHICH SHALL INCLUDE BUT NOT BE LIMITED TO
HEALTH CARE PROVIDERS, WHICH MAY INCLUDE BUT NOT BE LIMITED TO HOSPI-
TALS, DIAGNOSTIC AND TREATMENT CENTERS, PRIVATE PRACTICES AND INDEPEND-
ENT PRACTICE ASSOCIATIONS, AND PAYORS OF HEALTH CARE SERVICES, WHICH MAY
INCLUDE BUT NOT BE LIMITED TO EMPLOYERS, HEALTH PLANS AND INSURERS.
2. (A) IN ORDER TO PROMOTE IMPROVED QUALITY OF, AND ACCESS TO, HEALTH
CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES, IT IS THE POLICY
OF THE STATE TO ENCOURAGE COOPERATIVE, COLLABORATIVE AND INTEGRATIVE
ARRANGEMENTS AMONG PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE
SERVICES PROVIDERS WHO MIGHT OTHERWISE BE COMPETITORS, UNDER THE ACTIVE
SUPERVISION OF THE COMMISSIONER. IT IS THE INTENT OF THE STATE TO
SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS AND REGULATION ONLY TO THE
EXTENT NECESSARY TO ACCOMPLISH THE PURPOSES OF THIS ARTICLE, AND TO
PROVIDE STATE ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS
TO PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE SERVICES PROVIDERS
WITH RESPECT TO THE PLANNING, IMPLEMENTATION AND OPERATION OF THE MULTI-
PAYOR PATIENT CENTERED MEDICAL HOME PROGRAM.
(B) THE COMMISSIONER OR HIS OR HER DULY AUTHORIZED REPRESENTATIVE MAY
ENGAGE IN APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS, AND MAY
INSPECT OR REQUEST ADDITIONAL DOCUMENTATION FROM PAYORS OF HEALTH CARE
SERVICES AND HEALTH CARE SERVICES PROVIDERS TO VERIFY THAT MEDICAL HOMES
S. 2809--D 128 A. 4009--D
CERTIFIED PURSUANT TO THIS SECTION OPERATE IN ACCORDANCE WITH ITS INTENT
AND PURPOSE.
3. THE COMMISSIONER IS AUTHORIZED TO PARTICIPATE IN, ACTIVELY SUPER-
VISE, FACILITATE AND APPROVE A PRIMARY CARE MEDICAL HOME COLLABORATIVE
FOR EACH PROGRAM AROUND THE STATE TO ESTABLISH: (A) THE BOUNDARIES OF
EACH PROGRAM AND THE PROVIDERS ELIGIBLE TO PARTICIPATE, PROVIDED THAT
THE BOUNDARIES OF PROGRAMS MAY OVERLAP; (B) PRACTICE STANDARDS FOR EACH
MEDICAL HOME PROGRAM ADOPTED WITH CONSIDERATION OF EXISTING STANDARDS
DEVELOPED BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE ("NCQA"), THE
JOINT COMMISSION OF ACCREDITATION OF HEALTHCARE ORGANIZATIONS ("JCAHCO"
OR THE "JOINT COMMISSION"), AMERICAN ACCREDITATION HEALTHCARE COMMISSION
("URAC"), AMERICAN COLLEGE OF PHYSICIANS, THE AMERICAN ACADEMY OF FAMILY
PHYSICIANS, THE AMERICAN ACADEMY OF PEDIATRICS, AND THE AMERICAN OSTEO-
PATHIC ASSOCIATION; THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, AND THE
AMERICAN COLLEGE OF NURSE PRACTITIONERS; (C) STANDARDS FOR IMPLEMENTA-
TION AND USE OF HEALTH INFORMATION TECHNOLOGY, INCLUDING PARTICIPATION
IN HEALTH INFORMATION EXCHANGES THROUGH THE STATEWIDE HEALTH INFORMATION
NETWORK; (D) METHODOLOGIES BY WHICH PAYORS WILL PROVIDE ENHANCED RATES
OF PAYMENT TO CERTIFIED MEDICAL HOMES; (E) REQUIREMENTS FOR COLLECTING
DATA RELATING TO THE PROVIDING AND PAYING FOR HEALTH CARE SERVICES UNDER
THE PROGRAM AND PROVIDING OF DATA TO THE COMMISSIONER, PAYORS AND HEALTH
CARE PROVIDERS UNDER THE PROGRAM, TO PROMOTE THE EFFECTIVE OPERATION AND
EVALUATION OF THE PROGRAM, CONSISTENT WITH PROTECTION OF THE CONFIDEN-
TIALITY OF INDIVIDUAL PATIENT INFORMATION; AND (F) PROVISIONS UNDER
WHICH THE COMMISSIONER MAY TERMINATE THE PROGRAM.
3-A. THE COMMISSIONER MAY DEVELOP OR APPROVE (A) METHODOLOGIES TO PAY
ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT MEET SPECIFIC PROCESS OR
OUTCOME STANDARDS ESTABLISHED BY EACH MULTIPAYOR PATIENT CENTERED
MEDICAL HOME COLLABORATIVE; (B) ALTERNATIVE METHODOLOGIES FOR PAYORS OF
HEALTH CARE SERVICES TO HEALTH CARE PROVIDERS UNDER THE PROGRAM; (C)
PROVISIONS FOR PAYMENTS TO PROVIDERS THAT MAY VARY BY SIZE OR FORM OF
ORGANIZATION OF THE PROVIDER, OR PATIENT CASE MIX, TO ACCOMMODATE
DIFFERENT LEVELS OF RESOURCES AND DIFFICULTY TO MEET THE STANDARDS OF
THE PROGRAM; (D) PROVISIONS FOR PAYMENTS TO ENTITIES THAT PROVIDE
SERVICES TO HEALTH CARE PROVIDERS TO ASSIST THEM IN MEETING MEDICAL HOME
STANDARDS UNDER THE PROGRAM SUCH AS THE SERVICES OF COMMUNITY HEALTH
WORKERS.
4. THE COMMISSIONER IS AUTHORIZED TO ESTABLISH AN ADVISORY GROUP OF
STATE AGENCIES AND STAKEHOLDERS, SUCH AS PROFESSIONAL ORGANIZATIONS AND
ASSOCIATIONS, AND CONSUMERS, TO IDENTIFY LEGAL AND/OR ADMINISTRATIVE
BARRIERS TO THE SHARING OF CARE MANAGEMENT AND CARE COORDINATION
SERVICES AMONG PARTICIPATING HEALTH CARE SERVICES PROVIDERS AND TO MAKE
RECOMMENDATIONS FOR STATUTORY AND/OR REGULATORY CHANGES TO ADDRESS SUCH
BARRIERS.
5. PATIENT, PAYOR AND HEALTH CARE SERVICES PROVIDER PARTICIPATION IN
THE MULTIPAYOR PATIENT CENTERED MEDICAL HOME PROGRAM SHALL BE ON A
VOLUNTARY BASIS.
6. CLINICS AND PRIMARY CARE CLINICIANS PARTICIPATING IN A PROGRAM ARE
NOT ELIGIBLE FOR ADDITIONAL ENHANCEMENTS OR BONUSES UNDER THE STATEWIDE
PATIENT CENTERED MEDICAL HOME PROGRAM ESTABLISHED PURSUANT TO SECTION
THREE HUNDRED SIXTY-FOUR-M OF THE SOCIAL SERVICES LAW. THE COMMISSIONER
SHALL DEVELOP OR APPROVE A METHOD FOR DETERMINING PAYMENT UNDER A
PROGRAM WHERE A PROVIDER PARTICIPATES, OR A PATIENT IS SERVED, IN AN
AREA WHERE PROGRAM BOUNDARIES OVERLAP.
7. SUBJECT TO THE AVAILABILITY OF FUNDING AND FEDERAL FINANCIAL
PARTICIPATION, THE COMMISSIONER IS AUTHORIZED:
S. 2809--D 129 A. 4009--D
(A) TO PAY ENHANCED RATES OF PAYMENT UNDER MEDICAID FEE-FOR-SERVICE,
MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS TO CLIN-
ICS AND CLINICIANS THAT ARE CERTIFIED AS PATIENT CENTERED MEDICAL HOMES
UNDER THIS TITLE;
(B) TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT MEET SPECIFIC
PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER IN CONSULTA-
TION WITH EACH MULTIPAYOR PATIENT CENTERED MEDICAL HOME COLLABORATIVE;
(C) TO AUTHORIZE ALTERNATIVE PAYMENT METHODOLOGIES UNDER MEDICAID
FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD
HEALTH PLUS FOR HEALTH CARE PROVIDERS AND TO SERVE THE PURPOSES OF THE
PROGRAM, INCLUDING PAYMENTS TO ENTITIES UNDER PARAGRAPH (G) OF SUBDIVI-
SION THREE OF THIS SECTION; AND
(D) TO TEST NEW MODELS OF PAYMENT TO HIGH VOLUME MEDICAID PRIMARY CARE
MEDICAL HOME PRACTICES THAT INCORPORATE RISK ADJUSTED GLOBAL PAYMENTS
COMBINED WITH CARE MANAGEMENT AND PAY FOR PERFORMANCE ADJUSTMENTS.
8. (A) THE COMMISSIONER IS AUTHORIZED TO CONTRACT WITH ONE OR MORE
ENTITIES TO ASSIST THE STATE IN IMPLEMENTING THE PROVISIONS OF THIS
SECTION. SUCH ENTITY OR ENTITIES SHALL BE THE SAME ENTITY OR ENTITIES
CHOSEN TO ASSIST IN THE IMPLEMENTATION OF THE HEALTH HOME PROVISIONS OF
SECTION THREE HUNDRED SIXTY-FIVE-L OF THE SOCIAL SERVICES LAW. RESPON-
SIBILITIES OF THE CONTRACTOR SHALL INCLUDE BUT NOT BE LIMITED TO: DEVEL-
OPING RECOMMENDATIONS WITH RESPECT TO PROGRAM POLICY, REIMBURSEMENT,
SYSTEM REQUIREMENTS, REPORTING REQUIREMENTS, EVALUATION PROTOCOLS, AND
PROVIDER AND PATIENT ENROLLMENT; PROVIDING TECHNICAL ASSISTANCE TO
POTENTIAL MEDICAL HOME AND HEALTH HOME PROVIDERS; DATA COLLECTION; DATA
SHARING; PROGRAM EVALUATION, AND PREPARATION OF REPORTS.
(B) 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 COMMISSIONER IS AUTHORIZED TO ENTER INTO A CONTRACT OR CONTRACTS
UNDER PARAGRAPH (A) OF THIS SUBDIVISION WITHOUT A REQUEST FOR PROPOSAL
PROCESS, PROVIDED, HOWEVER, THAT:
(I) THE DEPARTMENT SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO LESS
THAN THIRTY DAYS:
(1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
TION IS FIRST POSTED ON THE WEBSITE; AND
(4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER; AND
(III) THE COMMISSIONER SHALL SELECT SUCH CONTRACTOR OR CONTRACTORS
THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE PURPOSES OF
THIS SECTION.
9. THE COMMISSIONER MAY DIRECTLY, OR BY CONTRACT, PROVIDE:
(A) TECHNICAL ASSISTANCE TO A PRIMARY CARE MEDICAL HOME COLLABORATIVE
IN RELATION TO ESTABLISHING AND OPERATING A PROGRAM;
(B) CONSUMER ASSISTANCE TO PATIENTS PARTICIPATING IN A PROGRAM AS TO
MATTERS RELATING TO THE PROGRAM;
(C) TECHNICAL AND OTHER ASSISTANCE TO HEALTH CARE PROVIDERS PARTIC-
IPATING IN A PROGRAM AS TO MATTERS RELATING TO THE PROGRAM, INCLUDING
ACHIEVING MEDICAL HOME STANDARDS;
S. 2809--D 130 A. 4009--D
(D) CARE COORDINATION PROVIDER TECHNICAL AND OTHER ASSISTANCE TO INDI-
VIDUALS AND ENTITIES PROVIDING CARE COORDINATION SERVICES TO HEALTH CARE
PROVIDERS UNDER A PROGRAM; AND
(E) INFORMATION SHARING AND OTHER ASSISTANCE AMONG PROGRAMS TO IMPROVE
THE OPERATION OF PROGRAMS, CONSISTENT WITH APPLICABLE LAWS RELATING TO
PATIENT CONFIDENTIALITY.
10. THE COMMISSIONER SHALL, TO THE EXTENT NECESSARY FOR THE PURPOSE OF
THIS SECTION, SUBMIT THE APPROPRIATE WAIVERS AND OTHER APPLICATIONS,
INCLUDING, BUT NOT LIMITED TO, THOSE AUTHORIZED PURSUANT TO SECTIONS
ELEVEN HUNDRED FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL
SOCIAL SECURITY ACT, OR SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS OR
APPLICATIONS NECESSARY TO ACHIEVE THE PURPOSES OF HIGH QUALITY, INTE-
GRATED, AND COST EFFECTIVE CARE AND INTEGRATED FINANCIAL ELIGIBILITY
POLICIES UNDER MEDICAID, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS OR
MEDICARE. COPIES OF SUCH ORIGINAL WAIVER AND OTHER APPLICATIONS SHALL BE
PROVIDED TO THE CHAIRMAN OF THE SENATE FINANCE COMMITTEE AND THE CHAIR-
MAN OF THE ASSEMBLY WAYS AND MEANS COMMITTEE SIMULTANEOUSLY WITH THEIR
SUBMISSION TO THE FEDERAL GOVERNMENT.
11. THE ADIRONDACK MEDICAL HOME MULTIPAYOR DEMONSTRATION PROGRAM
(INCLUDING THE ADIRONDACK MEDICAL HOME COLLABORATIVE) PREVIOUSLY ESTAB-
LISHED UNDER SECTION TWENTY-NINE HUNDRED FIFTY-NINE OF THIS CHAPTER IS
CONTINUED AND SHALL BE DEEMED TO BE A PROGRAM UNDER THIS SECTION.
12. THE COMMISSIONER SHALL ANNUALLY REPORT TO THE GOVERNOR AND THE
LEGISLATURE ON THE OPERATION OF THE PROGRAMS AND THEIR EFFECTIVENESS IN
ACHIEVING THE PURPOSES OF THIS SECTION, WITH PARTICULAR REFERENCE TO THE
QUALITY, COST, AND OUTCOMES FOR ENROLLEES IN MEDICAID FEE-FOR-SERVICE,
MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS.
S 35-a. Subparagraph (v) of paragraph (b) of subdivision 35 of section
2807-c of the public health law, as amended by section 2 of part B of
chapter 109 of the laws of 2010, is amended to read as follows:
(v) [Such] SUCH regulations shall incorporate quality related measures
[pertaining to], INCLUDING, BUT NOT LIMITED TO, potentially preventable
[complications and] re-admissions (PPRs) and provide for rate adjust-
ments or payment disallowances related to PPRs AND OTHER POTENTIALLY
PREVENTABLE NEGATIVE OUTCOMES (PPNOS), which shall be calculated in
accordance with methodologies as determined by the commissioner,
provided, however, that such methodologies shall be based on a [risk
adjusted] comparison of the actual and [the] RISK ADJUSTED expected
number of PPRs AND OTHER PPNOS in a given hospital and with benchmarks
established by the commissioner and provided further that such rate
adjustments or payment disallowances shall result in an aggregate
reduction in Medicaid payments of no less than thirty-five million
dollars for the period July first, two thousand ten through March thir-
ty-first, two thousand eleven and no less than [forty-seven] FIFTY-ONE
million dollars for the period April first, two thousand eleven through
March thirty-first, two thousand twelve, PROVIDED FURTHER THAT SUCH
AGGREGATE REDUCTIONS SHALL BE OFFSET BY MEDICAID PAYMENT REDUCTIONS
OCCURRING AS A RESULT OF DECREASED PPRS DURING THE PERIOD JULY FIRST,
TWO THOUSAND TEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN AND THE
PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
THOUSAND TWELVE AND AS A RESULT OF DECREASED PPNOS DURING THE PERIOD
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND TWELVE; and provided further that [the regulations promulgated
pursuant to this subparagraph shall be effective on and after July
first, two thousand ten, and provided further, however, that] for the
period July first, two thousand ten through March thirty-first, two
S. 2809--D 131 A. 4009--D
thousand twelve, such rate adjustments or payment disallowances shall
not apply to behavioral health PPRs; or to readmissions that occur on or
after fifteen days following an initial admission. By no later than
[April] JULY first, two thousand eleven the commissioner shall enter
into consultations with representatives of the health care facilities
subject to this section regarding potential prospective revisions to
applicable methodologies and benchmarks set forth in regulations issued
pursuant to this subparagraph;
S 36. 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 and two new subparagraphs
(xii) and (xiii) are added 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. In addition, such regulations shall
specify the reports and information required by the commissioner to
assess the cost, quality and health system needs for medical education
provided[.];
(XII) SUCH REGULATIONS MAY INCORPORATE QUALITY RELATED MEASURES
PERTAINING TO THE INAPPROPRIATE USE OF CERTAIN MEDICAL PROCEDURES,
INCLUDING, BUT NOT LIMITED TO, CESAREAN DELIVERIES, CORONARY ARTERY
BYPASS GRAFTS AND PERCUTANEOUS CORONARY INTERVENTIONS;
(XIII) SUCH REGULATIONS MAY IMPOSE A FEE ON GENERAL HOSPITAL SUFFI-
CIENT TO COVER THE COSTS OF AUDITING THE INSTITUTIONAL COST REPORTS
SUBMITTED BY GENERAL HOSPITALS, WHICH SHALL BE DEPOSITED IN THE HEALTH
CARE REFORM ACT (HCRA) RESOURCES ACCOUNT.
S 37. The social services law is amended by adding a new section 365-l
to read as follows:
S 365-L. HEALTH HOMES. 1. NOTWITHSTANDING ANY LAW, RULE OR REGULATION
TO THE CONTRARY, THE COMMISSIONER OF HEALTH IS AUTHORIZED, IN CONSULTA-
TION WITH THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH, OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, AND OFFICE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES, TO (A) ESTABLISH, IN ACCORDANCE WITH APPLI-
CABLE FEDERAL LAW AND REGULATIONS, STANDARDS FOR THE PROVISION OF HEALTH
HOME SERVICES TO MEDICAID ENROLLEES WITH CHRONIC CONDITIONS, (B) ESTAB-
LISH PAYMENT METHODOLOGIES FOR HEALTH HOME SERVICES BASED ON FACTORS
INCLUDING BUT NOT LIMITED TO THE COMPLEXITY OF THE CONDITIONS PROVIDERS
WILL BE MANAGING, THE ANTICIPATED AMOUNT OF PATIENT CONTACT NEEDED TO
MANAGE SUCH CONDITIONS, AND THE HEALTH CARE COST SAVINGS REALIZED BY
PROVISION OF HEALTH HOME SERVICES, (C) ESTABLISH THE CRITERIA UNDER
WHICH A MEDICAID ENROLLEE WILL BE DESIGNATED AS BEING AN ELIGIBLE INDI-
VIDUAL WITH CHRONIC CONDITIONS FOR PURPOSES OF THIS PROGRAM, (D) ASSIGN
ANY MEDICAID ENROLLEE DESIGNATED AS AN ELIGIBLE INDIVIDUAL WITH CHRONIC
CONDITIONS TO A PROVIDER OF HEALTH HOME SERVICES.
2. IN ADDITION TO PAYMENTS MADE FOR HEALTH HOME SERVICES PURSUANT TO
SUBDIVISION ONE OF THIS SECTION, THE COMMISSIONER IS AUTHORIZED TO PAY
ADDITIONAL AMOUNTS TO PROVIDERS OF HEALTH HOME SERVICES THAT MEET PROC-
ESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER.
3. UNTIL SUCH TIME AS THE COMMISSIONER OBTAINS NECESSARY WAIVERS
AND/OR APPROVALS OF THE FEDERAL SOCIAL SECURITY ACT, MEDICAID ENROLLEES
ASSIGNED TO PROVIDERS OF HEALTH HOME SERVICES WILL BE ALLOWED TO OPT OUT
OF SUCH SERVICES. IN ADDITION, UPON ENROLLMENT, AN ENROLLEE SHALL BE
OFFERED AN OPTION OF AT LEAST TWO PROVIDERS OF HEALTH HOME SERVICES, TO
THE EXTENT PRACTICABLE.
4. PAYMENTS AUTHORIZED PURSUANT TO THIS SECTION WILL BE MADE WITH
STATE FUNDS ONLY, TO THE EXTENT THAT SUCH FUNDS ARE APPROPRIATED THERE-
S. 2809--D 132 A. 4009--D
FORE, UNTIL SUCH TIME AS FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF
SUCH SERVICES IS AVAILABLE.
5. THE COMMISSIONER IS AUTHORIZED TO SUBMIT AMENDMENTS TO THE STATE
PLAN FOR MEDICAL ASSISTANCE AND/OR SUBMIT ONE OR MORE APPLICATIONS FOR
WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT, TO OBTAIN FEDERAL FINANCIAL
PARTICIPATION IN THE COSTS OF HEALTH HOME SERVICES PROVIDED PURSUANT TO
THIS SECTION, AND AS PROVIDED IN SUBDIVISION THREE OF THIS SECTION.
6. NOTWITHSTANDING ANY LIMITATIONS IMPOSED BY SECTION THREE HUNDRED
SIXTY-FOUR-L OF THIS TITLE ON ENTITIES PARTICIPATING IN DEMONSTRATION
PROJECTS ESTABLISHED PURSUANT TO SUCH SECTION, THE COMMISSIONER IS
AUTHORIZED TO ALLOW SUCH ENTITIES WHICH MEET THE REQUIREMENTS OF THIS
SECTION TO PROVIDE HEALTH HOME SERVICES.
7. NOTWITHSTANDING ANY LAW, RULE, OR REGULATION TO THE CONTRARY, THE
COMMISSIONERS OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH,
THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ARE AUTHORIZED TO JOINTLY ESTAB-
LISH A SINGLE SET OF OPERATING AND REPORTING REQUIREMENTS AND A SINGLE
SET OF CONSTRUCTION AND SURVEY REQUIREMENTS FOR ENTITIES THAT:
(A) CAN DEMONSTRATE EXPERIENCE IN THE DELIVERY OF HEALTH, AND MENTAL
HEALTH AND/OR ALCOHOL AND SUBSTANCE ABUSE SERVICES AND/OR SERVICES TO
PERSONS WITH DEVELOPMENTAL DISABILITIES, AND THE CAPACITY TO OFFER INTE-
GRATED DELIVERY OF SUCH SERVICES IN EACH LOCATION APPROVED BY THE
COMMISSIONER; AND
(B) MEET THE STANDARDS ESTABLISHED PURSUANT TO SUBDIVISION ONE OF THIS
SECTION FOR PROVIDING AND RECEIVING PAYMENT FOR HEALTH HOME SERVICES;
PROVIDED, HOWEVER, THAT AN ENTITY MEETING THE STANDARDS ESTABLISHED
PURSUANT TO SUBDIVISION ONE OF THIS SECTION SHALL NOT BE REQUIRED TO BE
AN INTEGRATED SERVICE PROVIDER PURSUANT TO THIS SUBDIVISION.
IN ESTABLISHING A SINGLE SET OF OPERATING AND REPORTING REQUIREMENTS
AND A SINGLE SET OF CONSTRUCTION AND SURVEY REQUIREMENTS FOR ENTITIES
DESCRIBED IN THIS SUBDIVISION, THE COMMISSIONERS OF THE DEPARTMENT OF
HEALTH, THE OFFICE OF MENTAL HEALTH, THE OFFICE FOR PEOPLE WITH DEVELOP-
MENTAL DISABILITIES, AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES ARE AUTHORIZED TO WAIVE ANY REGULATORY REQUIREMENTS AS ARE
NECESSARY TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE INTE-
GRATED DELIVERY OF SERVICES IN A RATIONAL AND EFFICIENT MANNER.
8. (A) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO CONTRACT WITH ONE
OR MORE ENTITIES TO ASSIST THE STATE IN IMPLEMENTING THE PROVISIONS OF
THIS SECTION. SUCH ENTITY OR ENTITIES SHALL BE THE SAME ENTITY OR ENTI-
TIES CHOSEN TO ASSIST IN THE IMPLEMENTATION OF THE MULTIPAYOR PATIENT
CENTERED MEDICAL HOME PROGRAM PURSUANT TO SECTION TWENTY-NINE HUNDRED
FIFTY-NINE-A OF THE PUBLIC HEALTH LAW. RESPONSIBILITIES OF THE CONTRAC-
TOR SHALL INCLUDE BUT NOT BE LIMITED TO: DEVELOPING RECOMMENDATIONS WITH
RESPECT TO PROGRAM POLICY, REIMBURSEMENT, SYSTEM REQUIREMENTS, REPORTING
REQUIREMENTS, EVALUATION PROTOCOLS, AND PROVIDER AND PATIENT ENROLLMENT;
PROVIDING TECHNICAL ASSISTANCE TO POTENTIAL MEDICAL HOME AND HEALTH HOME
PROVIDERS; DATA COLLECTION; DATA SHARING; PROGRAM EVALUATION, AND PREPA-
RATION OF REPORTS.
(B) 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 COMMISSIONER OF HEALTH IS AUTHORIZED TO ENTER INTO A CONTRACT OR
CONTRACTS UNDER PARAGRAPH (A) OF THIS SUBDIVISION WITHOUT A COMPETITIVE
BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
(I) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
OF NO LESS THAN THIRTY DAYS:
S. 2809--D 133 A. 4009--D
(1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
TION IS FIRST POSTED ON THE WEBSITE; AND
(4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER OF HEALTH; AND
(III) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
PURPOSES OF THIS SECTION.
S 38. Section 2816 of the public health law, as added by chapter 225
of the laws of 2001, paragraph (a) of subdivision 2 as amended by
section 19 of part D of chapter 57 of the laws of 2006, is amended to
read as follows:
S 2816. Statewide planning and research cooperative system. 1. (A)
The statewide planning and research cooperative system in the department
is continued, as provided in AND SUBJECT TO this section, WITHIN AMOUNTS
APPROPRIATED FOR THAT PURPOSE. The [statewide planning and research
cooperative] system shall be developed and operated by the commissioner
in consultation with the council, [and shall be comprised of such data
elements] as may be specified by regulation OF THE COMMISSIONER. ANY
COMPONENT OR COMPONENTS OF THE SYSTEM MAY BE OPERATED UNDER A DIFFERENT
NAME OR NAMES, AND MAY BE STRUCTURED AS SEPARATE SYSTEMS. IN MAKING
REGULATIONS UNDER THIS SECTION, SUBSEQUENT TO APRIL FIRST, TWO THOUSAND
ELEVEN, THE COMMISSIONER SHALL CONSULT WITH THE SUPERINTENDENT OF INSUR-
ANCE OR THE HEAD OF ANY AGENCY THAT SUCCEEDS THE INSURANCE DEPARTMENT,
HEALTH CARE PROVIDERS, THIRD-PARTY HEALTH CARE PAYERS, AND ADVOCATES
REPRESENTING PATIENTS; PROTECT THE CONFIDENTIALITY OF PATIENT-IDENTIFIA-
BLE INFORMATION; PROMOTE THE ACCURACY AND COMPLETENESS OF REPORTING; AND
MINIMIZE THE BURDEN ON INSTITUTIONAL AND NON-INSTITUTIONAL HEALTH CARE
PROVIDERS AND THIRD-PARTY HEALTH CARE PAYERS.
(B) AS USED IN THIS SECTION, UNLESS THE CONTEXT CLEARLY REQUIRES
OTHERWISE:
(I) "HEALTH CARE" MEANS ANY SERVICES, SUPPLIES, EQUIPMENT, OR
PRESCRIPTION DRUGS REFERRED TO IN SUBDIVISION TWO OF THIS SECTION.
(II) "HEALTH CARE PROVIDER" INCLUDES, IN ADDITION TO ITS COMMON MEAN-
INGS, A CLINICAL LABORATORY, A PHARMACY, AN ENTITY THAT IS AN INTEGRATED
ORGANIZATION OF HEALTH CARE PROVIDERS, AND AN ACCOUNTABLE CARE ORGANIZA-
TION OF HEALTH CARE PROVIDERS.
(III) "SYSTEM" MEANS THE STATEWIDE PLANNING AND RESEARCH COOPERATIVE
SYSTEM UNDER THIS SECTION, AND ANY SEPARATE SYSTEM UNDER THIS SUBDIVI-
SION.
(IV) "THIRD-PARTY HEALTH CARE PAYER" INCLUDES, BUT IS NOT LIMITED TO,
AN INSURER, ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED PURSUANT
TO ARTICLE THIRTY-TWO, FORTY-THREE OR FORTY-SEVEN OF THE INSURANCE LAW,
OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW; OR AN ENTITY SUCH AS A
PHARMACY BENEFITS MANAGER, FISCAL ADMINISTRATOR, OR ADMINISTRATIVE
SERVICES PROVIDER THAT PARTICIPATES IN THE ADMINISTRATION OF A
THIRD-PARTY HEALTH CARE PAYER SYSTEM.
(V) "COVERED PERSON" IS A PERSON COVERED UNDER A THIRD-PARTY HEALTH
CARE PAYER CONTRACT, AGREEMENT, OR ARRANGEMENT.
S. 2809--D 134 A. 4009--D
2. [Regulations] NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY,
REGULATIONS governing the [statewide planning and research cooperative]
system shall include, but not be limited to, the following:
(a) Specification of patient, COVERED PERSON, CLAIMS, and other data
elements and format [to] WHICH SHALL be reported including data related
to:
(i) inpatient hospitalization data from general hospitals;
(ii) ambulatory surgery data from hospital-based ambulatory surgery
services and all other ambulatory surgery facilities licensed under this
article;
(iii) emergency department data from general hospitals;
(iv) outpatient [clinic], CLINICAL LABORATORY, AND PRESCRIPTION DATA,
INCLUDING BUT NOT LIMITED TO data from OR RELATING TO SERVICES,
SUPPLIES, EQUIPMENT, AND PRESCRIPTION DRUGS PROVIDED OR ORDERED BY
general hospitals and diagnostic and treatment centers licensed under
this article, [provided, however, that notwithstanding subdivision one
of this section the commissioner, in consultation with the health care
industry, is authorized to promulgate or adopt any rules or regulations
necessary to implement the collection of data pursuant to this subpara-
graph] PHARMACIES, CLINICAL LABORATORIES, AND OTHER HEALTH CARE PROVID-
ERS;
(v) COVERED PERSON AND CLAIMS DATA; and
(VI) the data specified in this paragraph shall include the identifi-
cation of patients transferred, admitted or treated subsequent to a
medical, surgical or diagnostic procedure by a licensed health care
professional OR at a HEALTH CARE site or facility [other than those
specified in subparagraph (i), (ii), (iii) or (iv) of this paragraph].
(b) Standards to assure the protection of patient privacy in data
collected [and], PUBLISHED, released [under this section], USED AND
ACCESSED UNDER THIS SECTION, INCLUDING COMPLIANCE WITH APPLICABLE FEDER-
AL LAW.
(c) Standards for the publication [and], release, AND USE of AND
ACCESS TO data reported in accordance with this section, INCLUDING FEES
TO BE CHARGED.
(D) PROVISIONS REQUIRING SPECIFIED HEALTH CARE PROVIDERS AND
THIRD-PARTY HEALTH CARE PAYERS TO REPORT DATA TO THE SYSTEM, WITH SPEC-
IFICATIONS OF THE DATA, CIRCUMSTANCES, FORMAT, TIME AND METHOD OF
REPORTING.
(E) PROVISIONS TO ACQUIRE DATA RELATING TO HEALTH CARE PROVIDED (I) TO
PATIENTS FOR WHOM THERE IS NO THIRD-PARTY HEALTH CARE PAYER AND (II)
UNDER ARRANGEMENTS THAT DO NOT INVOLVE FEE-FOR-SERVICE PAYMENT.
(F) PHASED-IN IMPLEMENTATION OF THE SYSTEM.
3. THE COMMISSIONER MAY PROVIDE THAT THE SYSTEM MAY PARTICIPATE IN OR
COOPERATE WITH A SIMILAR SYSTEM OPERATED BY, OR RECEIVE INFORMATION FROM
OR PROVIDE INFORMATION TO, A REGIONAL OR NATIONAL ENTITY OR ANOTHER
JURISDICTION, INCLUDING MAKING APPROPRIATE AGREEMENTS AND APPLYING FOR
APPROVALS, PROVIDED THAT THE PROTECTIONS FOR HEALTH CARE PROVIDERS,
PATIENTS, AND THIRD-PARTY HEALTH CARE PAYERS IN THIS SECTION ARE
PRESERVED AND COMPARABLE PROVISIONS ARE INCLUDED IN THE OTHER SYSTEM.
4. THE COMMISSIONER MAY PROVIDE FOR ACCESS TO DATA IN THE SYSTEM BY A
HEALTH CARE PROVIDER RELATING TO A PATIENT BEING TREATED BY THE HEALTH
CARE PROVIDER, SUBJECT TO THIS SECTION AND APPLICABLE STATE AND FEDERAL
LAW.
5. IN OPERATING THE SYSTEM, THE COMMISSIONER SHALL CONSIDER NATIONAL
STANDARDS, INCLUDING BUT NOT LIMITED TO THOSE APPROVED BY THE NATIONAL
UNIFORM BILLING COMMITTEE (NUBC) OR REQUIRED UNDER NATIONAL ELECTRONIC
S. 2809--D 135 A. 4009--D
DATA INTERCHANGE (EDI) STANDARDS FOR HEALTH CARE TRANSACTIONS. THE
COMMISSIONER SHALL ALSO CONSIDER THE USE OF THE STATEWIDE HEALTH INFOR-
MATION NETWORK FOR NEW YORK IN RELATION TO THE SYSTEM.
6. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW TO THE CONTRARY,
INCLUDING BUT NOT LIMITED TO SECTION ONE HUNDRED TWO OF THE EXECUTIVE
LAW, SUCH RULES AND REGULATIONS MAY DESCRIBE DATA ELEMENTS BY REFERENCE
TO INFORMATION REASONABLY AVAILABLE TO REGULATED PARTIES, AS SUCH MATE-
RIAL MAY BE AMENDED IN THE FUTURE, EVEN THOUGH SUCH MATERIAL CANNOT BE
PRECISELY IDENTIFIED TO THE EXTENT THAT IT IS AMENDED IN THE FUTURE;
PROVIDED, HOWEVER, THAT THE COMMISSIONER SHALL PRECISELY IDENTIFY AND
PUBLISH SUCH DATA ELEMENTS.
7. THE COMMISSIONER MAY CONTRACT WITH ONE OR MORE ENTITIES TO OPERATE
ANY PART OF THE SYSTEM SUBJECT TO THIS SECTION.
8. THE COMMISSIONER MAY ACCEPT GRANTS AND ENTER INTO CONTRACTS AS MAY
BE NECESSARY TO PROVIDE FUNDING FOR THE SYSTEM.
9. THE COMMISSIONER SHALL PUBLISH AN ANNUAL REPORT RELATING TO HEALTH
CARE UTILIZATION, COST, QUALITY, AND SAFETY, INCLUDING DATA ON HEALTH
DISPARITIES.
S 38-a. Paragraph (b) of subdivision 18-a of section 206 of the public
health law, as added by section 11 of part A of chapter 58 of the laws
of 2010, is amended to read as follows:
(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, HEALTH CARE CLAIMS AND OTHER ADMINISTRATIVE DATA, and
public health information systems, while protecting privacy and securi-
ty. 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 39. The social services law is amended by adding a new section 363-e
to read as follows:
S 363-E. MEDICAID PLAN, APPLICATIONS FOR WAIVERS AND PLAN AMENDMENTS;
PUBLIC DISCLOSURE. 1. THE COMMISSIONER OF HEALTH SHALL POST ON THE
DEPARTMENT OF HEALTH INTERNET WEBSITE IN AS TIMELY A MANNER AS PRACTICAL
THE ENTIRETY OF THE STATE'S PLAN FOR MEDICAL ASSISTANCE AS REQUIRED BY
TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT, OR ITS SUCCESSOR, AND
EVERY APPROVED AMENDMENT AND CHANGE TO THE PLAN.
2. THE COMMISSIONER OF HEALTH SHALL POST ON THE DEPARTMENT OF HEALTH
INTERNET WEBSITE IN AS TIMELY A MANNER AS PRACTICAL: EVERY APPLICATION
FOR A FEDERAL WAIVER AND EVERY PROPOSED STATE PLAN AMENDMENT, RELATING
TO THE STATE'S PLAN FOR MEDICAL ASSISTANCE, SUBMITTED TO THE FEDERAL
DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR ANY SUCCESSOR AGENCY OR PART
THEREOF.
S 40. Paragraph (u) of subdivision 2 of section 365-a of the social
services law, as amended by section 42 of part B of chapter 58 of the
laws of 2010, is amended to read as follows:
(u) screening, brief intervention, and referral to treatment [in
hospital outpatient and emergency departments and free-standing diagnos-
tic and treatment centers] of individuals at risk for substance abuse
including referral to the appropriate level of intervention and treat-
ment in a community setting; provided, however, that the provisions of
this paragraph relating to screening, brief intervention, and referral
to treatment services shall not take effect unless all necessary
S. 2809--D 136 A. 4009--D
approvals under federal law and regulation have been obtained to receive
federal financial participation in such costs.
S 41. Paragraphs (d) and (e) of subdivision 1 and paragraphs (c) and
(d) of subdivision 2 of section 4403-f of the public health law, para-
graph (d) of subdivision 1 as amended by section 6 of part C of chapter
58 of the laws of 2007, paragraph (e) of subdivision 1 as amended by
section 65-d of part A of chapter 57 of the laws of 2006, paragraph (c)
of subdivision 2 as added by chapter 659 of the laws of 1997 and para-
graph (d) of subdivision 2 as amended by section 9 of part C of chapter
58 of the laws of 2007, and paragraphs (d) and (e) of subdivision 1 as
relettered by section 7 of part C of chapter 58 of the laws of 2007, are
amended to read as follows:
(d) ["Approved managed long term care demonstration" means the sites
approved by the commissioner to participate in the "Evaluated Medicaid
Long Term Care Capitation Program".
(e)] "Health and long term care services" means services including,
but not limited to [primary care, acute care,] home and community-based
and institution-based long term care and ancillary services (that shall
include medical supplies and nutritional supplements) that are necessary
to meet the needs of persons whom the plan is authorized to enroll. THE
MANAGED LONG TERM CARE PLAN MAY ALSO COVER PRIMARY CARE AND ACUTE CARE
IF SO AUTHORIZED.
(c) [a description that demonstrates the cost-effectiveness of the
program as compared to the cost of services clients would otherwise have
received;
(d)] adequate documentation of the appropriate licenses, certif-
ications or approvals to provide care as planned, including contracts
with such providers as may be necessary to provide the full complement
of services required to be provided under this section.
S 41-a. Subdivision 3 of section 4403-f of the public health law, as
amended by chapter 627 of the laws of 2008, is amended to read as
follows:
3. Certificate of authority; approval. The commissioner shall not
approve an application for a certificate of authority unless the appli-
cant demonstrates to the commissioner's satisfaction:
(a) [the relative cost effectiveness to the medical assistance program
when compared to other managed long term care plans proposing to serve,
or serving, comparable populations;
(b)] that it will have in place acceptable quality-assurance mech-
anisms, grievance procedures, mechanisms to protect the rights of enrol-
lees and case management services to ensure continuity, quality, appro-
priateness and coordination of care;
[(c)] (B) that it will include an enrollment process which shall
ensure that enrollment in the plan is informed [and voluntary by enrol-
lees or their representatives and a voluntary disenrollment process].
The application shall [include the specific grounds that would warrant
involuntary disenrollment provided, however,] DESCRIBE THE DISENROLLMENT
PROCESS, WHICH SHALL PROVIDE THAT an otherwise eligible enrollee shall
not be involuntarily disenrolled on the basis of health status;
[(d)] (C) satisfactory evidence of the character and competence of the
proposed operators and reasonable assurance that the applicant will
provide high quality services to an enrolled population;
[(e)] (D) sufficient management systems capacity to meet the require-
ments of this section and the ability to efficiently process payment for
covered services;
S. 2809--D 137 A. 4009--D
[(f)] (E) readiness and capability to [achieve full capitation for
services reimbursed pursuant to title XVIII of the federal social secu-
rity act or, for an applicant designated as an eligible applicant prior
to April first, two thousand seven pursuant to paragraph (d) of subdivi-
sion six of this section that has its principal place of business in
Bronx county and is unable to achieve such full capitation, readiness
and capability to achieve full capitation on a scheduled basis for]
MAXIMIZE REIMBURSEMENT OF AND COORDINATE services reimbursed pursuant to
title XVIII of the federal social security act [or capability and proto-
cols for benefit coordination for services reimbursed pursuant to such
title] and all other applicable benefits, with such benefit coordination
including, but not limited to, measures to support sound clinical deci-
sions, reduce administrative complexity, coordinate access to services,
maximize benefits available pursuant to such title and ensure that
necessary care is provided;
[(g)] (F) readiness and capability to [achieve full capitation for]
ARRANGE AND MANAGE COVERED SERVICES AND COORDINATE NON-COVERED SERVICES
WHICH COULD INCLUDE PRIMARY, SPECIALTY, AND ACUTE CARE services reim-
bursed pursuant to title XIX of the federal social security act;
[(h)] (G) willingness and capability of taking, or cooperating in, all
steps necessary to secure and integrate any potential sources of funding
for services provided by the managed long term care plan, including, but
not limited to, funding available under titles XVI, XVIII, XIX and XX of
the federal social security act, the federal older Americans act of
nineteen hundred sixty-five, as amended, or any successor provisions
subject to approval of the director of the state office for aging, and
through financing options such as those authorized pursuant to section
three hundred sixty-seven-f of the social services law;
[(i)] (H) that the CONTRACTUAL arrangements for PROVIDERS OF health
and long term care services IN THE BENEFIT PACKAGE ARE SUFFICIENT TO
ensure the availability and accessibility of such services to the
proposed enrolled population CONSISTENT WITH GUIDELINES ESTABLISHED BY
THE COMMISSIONER; WITH RESPECT TO INDIVIDUALS IN RECEIPT OF SUCH
SERVICES PRIOR TO ENROLLMENT, SUCH GUIDELINES SHALL REQUIRE THE MANAGED
LONG TERM CARE PLAN TO CONTRACT WITH AGENCIES CURRENTLY PROVIDING SUCH
SERVICES, IN ORDER TO PROMOTE CONTINUITY OF CARE. IN ADDITION, SUCH
GUIDELINES SHALL REQUIRE MANAGED LONG TERM CARE PLANS TO OFFER AND COVER
CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES FOR ELIGIBLE INDIVIDUALS
WHO ELECT SUCH SERVICES PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F
OF THE SOCIAL SERVICES LAW; and
[(j)] (I) that the applicant is financially responsible and may be
expected to meet its obligations to its enrolled members.
S 41-b. Subdivisions 5, 6, 7 and 10 of section 4403-f of the public
health law, subdivision 5 as amended by section 15 of part C of chapter
58 of the laws of 2007, subdivisions 6 and 7 as added by chapter 659 of
the laws of 1997, paragraphs (a), (b) and (c) of subdivision 6 as
amended by section 6 of part C of chapter 58 of the laws of 2010, para-
graph (d) of subdivision 6 as amended by section 17 of part C of chapter
58 of the laws of 2007, paragraphs (c) and (d) of subdivision 7 as
amended by section 18 of part C of chapter 58 of the laws of 2007, para-
graphs (e) and (g) of subdivision 7 as relettered by section 20 of part
C of chapter 58 of the laws of 2007, paragraph (h) of subdivision 7 as
added by section 65-c of part A of chapter 57 of the laws of 2006, para-
graph (i) as added by section 65-f of part A of chapter 57 of the laws
of 2006, and such paragraphs (h) and (i) as relettered by section 20 of
part C of chapter 58 of the laws of 2007, paragraph (f) of subdivision 7
S. 2809--D 138 A. 4009--D
as amended by section 7 of part C of chapter 58 of the laws of 2010,
subparagraph (iii) of paragraph (h) of subdivision 7 as amended by
section 19 of part C of chapter 58 of the laws of 2007, subdivision 10
as amended by chapter 192 of the laws of 2006 and renumbered by section
22 of part C of chapter 58 of the laws of 2007, are amended to read as
follows:
5. Applicability of other laws. A managed long term care plan [or
approved managed long term care demonstration] shall be subject to the
provisions of the insurance law and regulations applicable to health
maintenance organizations, this article and regulations promulgated
pursuant thereto. To the extent that the provisions of this section are
inconsistent with the provisions of this chapter or the provisions of
the insurance law, the provisions of this section shall prevail.
6. Approval authority. (a) An applicant shall be issued a certificate
of authority as a managed long term care plan upon a determination by
the commissioner that the applicant complies with the operating require-
ments for a managed long term care plan under this section. The commis-
sioner shall issue no more than [fifty] SEVENTY-FIVE certificates of
authority to managed long term care plans pursuant to this section. [For
purposes of issuance of no more than fifty certificates 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 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] NOTHING in this section
shall be construed to affect the continued legal authority of an operat-
ing 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
determination by the commissioner 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 demonstrations which have not been issued a certificate of authori-
ty as a managed long term care plan, shall expire one year after the
adoption of regulations implementing managed long term care plans.
(d) The majority leader of the senate and the speaker of the assembly
may each designate in writing up to fifteen eligible applicants to apply
to be approved managed long term care demonstrations or plans. The
commissioner may designate in writing up to eleven eligible applicants
to apply to be approved managed long term care demonstrations or plans.]
FOR THE PERIOD BEGINNING APRIL FIRST, TWO THOUSAND TWELVE AND ENDING
MARCH THIRTY-FIRST, TWO THOUSAND FIFTEEN, THE MAJORITY LEADER OF THE
SENATE AND THE SPEAKER OF THE ASSEMBLY MAY EACH RECOMMEND TO THE COMMIS-
SIONER, IN WRITING, UP TO FOUR ELIGIBLE APPLICANTS TO CONVERT TO BE
APPROVED MANAGED LONG TERM CARE PLANS. AN APPLICANT SHALL ONLY BE
APPROVED AND ISSUED A CERTIFICATE OF AUTHORITY IF THE COMMISSIONER
DETERMINES THAT THE APPLICANT MEETS THE REQUIREMENTS OF SUBDIVISION
THREE OF THIS SECTION. THE MAJORITY LEADER OF THE SENATE OR THE SPEAKER
OF THE ASSEMBLY MAY ASSIGN THEIR AUTHORITY TO RECOMMEND ONE OR MORE
APPLICANTS UNDER THIS SECTION TO THE COMMISSIONER.
7. Program oversight and administration. (a)(i) The commissioner shall
promulgate regulations to implement this section and to ensure the qual-
S. 2809--D 139 A. 4009--D
ity, appropriateness and cost-effectiveness of the services provided by
managed long term care plans. The commissioner may waive rules and regu-
lations of the department, including but not limited to, those pertain-
ing to duplicative requirements concerning record keeping, boards of
directors, staffing and reporting, when such waiver will promote the
efficient delivery of appropriate, quality, cost-effective services and
when the health, safety and general welfare of enrollees will not be
impaired as a result of such waiver. In order to achieve managed long
term care plan system efficiencies and coordination and to promote the
objectives of high quality, integrated and cost effective care, the
commissioner may establish a single coordinated surveillance process,
allow for a comprehensive quality improvement and review process to meet
component quality requirements, and require a uniform cost report. The
commissioner shall require managed long term care plans to utilize qual-
ity improvement measures, based on health outcomes data, for internal
quality assessment processes and may utilize such measures as part of
the single coordinated surveillance process.
(ii) Notwithstanding any inconsistent provision of the social services
law to the contrary, the commissioner shall, pursuant to regulation,
determine whether and the extent to which the applicable provisions of
the social services law or regulations relating to approvals and author-
izations of, and utilization limitations on, health and long term care
services reimbursed pursuant to title XIX of the federal social security
act, including, but not limited to, fiscal assessment requirements, are
inconsistent with the flexibility necessary for the efficient adminis-
tration of managed long term care plans and such regulations shall
provide that such provisions shall not be applicable to enrollees or
managed long term care plans, provided that such determinations are
consistent with applicable federal law and regulation.
(b) (I) The commissioner shall, to the extent necessary, submit the
appropriate waivers, including, but not limited to, those authorized
pursuant to sections eleven hundred fifteen and nineteen hundred fifteen
of the federal social security act, or successor provisions, and any
other waivers necessary to achieve the purposes of high quality, inte-
grated, and cost effective care and integrated financial eligibility
policies under the medical assistance program or pursuant to title XVIII
of the federal social security act. IN ADDITION, THE COMMISSIONER IS
AUTHORIZED TO SUBMIT THE APPROPRIATE WAIVERS, INCLUDING BUT NOT LIMITED
TO THOSE AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED FIFTEEN AND
NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT OR SUCCESSOR
PROVISIONS, AND ANY OTHER WAIVERS NECESSARY TO REQUIRE ON OR AFTER APRIL
FIRST, TWO THOUSAND TWELVE, MEDICAL ASSISTANCE RECIPIENTS WHO ARE TWEN-
TY-ONE YEARS OF AGE OR OLDER AND WHO REQUIRE COMMUNITY-BASED LONG TERM
CARE SERVICES, AS SPECIFIED BY THE COMMISSIONER, FOR MORE THAN ONE
HUNDRED AND TWENTY DAYS, TO RECEIVE SUCH SERVICES THROUGH AN AVAILABLE
PLAN CERTIFIED PURSUANT TO THIS SECTION OR OTHER PROGRAM MODEL THAT
MEETS GUIDELINES SPECIFIED BY THE COMMISSIONER THAT SUPPORT COORDINATION
AND INTEGRATION OF SERVICES. SUCH GUIDELINES SHALL ADDRESS THE REQUIRE-
MENTS OF PARAGRAPHS (A), (B), (C), (D), (E), (F), (G), (H), AND (I) OF
SUBDIVISION THREE OF THIS SECTION AS WELL AS PAYMENT METHODS THAT ENSURE
PROVIDER ACCOUNTABILITY FOR COST EFFECTIVE QUALITY OUTCOMES. SUCH OTHER
PROGRAM MODELS MAY INCLUDE LONG TERM HOME HEALTH CARE PROGRAMS THAT
COMPLY WITH SUCH GUIDELINES. Copies of such original waiver applications
AND AMENDMENTS THERETO shall be provided to the [chairman] CHAIRS of the
senate finance committee [and the chairman of], the assembly ways and
S. 2809--D 140 A. 4009--D
means committee AND THE SENATE AND ASSEMBLY HEALTH COMMITTEES simultane-
ously with their submission to the federal government.
(II) THE COMMISSIONER, SHALL SEEK INPUT FROM REPRESENTATIVES OF HOME
AND COMMUNITY-BASED LONG TERM CARE SERVICES PROVIDERS, RECIPIENTS, AND
THE MEDICAID MANAGED CARE ADVISORY REVIEW PANEL, AMONG OTHERS, TO
FURTHER EVALUATE AND PROMOTE THE TRANSITION OF PERSONS IN RECEIPT OF
HOME AND COMMUNITY-BASED LONG TERM CARE SERVICES INTO MANAGED LONG TERM
CARE PLANS AND OTHER CARE COORDINATION MODELS AND TO DEVELOP GUIDELINES
FOR SUCH CARE COORDINATION MODELS. THE GUIDELINES SHALL BE FINALIZED AND
POSTED ON THE DEPARTMENT'S WEBSITE NO LATER THAN NOVEMBER FIFTEEN, TWO
THOUSAND ELEVEN.
(III) MEDICAL ASSISTANCE RECIPIENTS WHO ARE NATIVE AMERICANS SHALL NOT
BE REQUIRED TO ENROLL IN A MANAGED LONG TERM CARE PLAN OR OTHER CARE
COORDINATION MODEL PURSUANT TO THIS PARAGRAPH.
(IV) THE FOLLOWING MEDICAL ASSISTANCE RECIPIENTS SHALL NOT BE ELIGIBLE
TO PARTICIPATE IN A MANAGED LONG TERM CARE PROGRAM OR OTHER CARE COORDI-
NATION MODEL ESTABLISHED PURSUANT TO THIS PARAGRAPH:
(1) A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE FOR
LESS THAN SIX MONTHS, FOR A REASON OTHER THAN THAT THE PERSON IS ELIGI-
BLE FOR MEDICAL ASSISTANCE ONLY THROUGH THE APPLICATION OF EXCESS INCOME
TOWARD THE COST OF MEDICAL CARE AND SERVICES;
(2) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS ONLY WITH
RESPECT TO TUBERCULOSIS-RELATED SERVICES;
(3) A PERSON RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;
(4) A PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAILABLE
FROM OR UNDER A THIRD-PARTY PAYOR WHICH MAY BE MAINTAINED BY PAYMENT, OR
PART PAYMENT, OF THE PREMIUM OR COST SHARING AMOUNTS, WHEN PAYMENT OF
SUCH PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE, AS DETER-
MINED BY THE SOCIAL SERVICES DISTRICT;
(5) A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
GRAPH ELEVEN OF PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION THREE
HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES LAW;
(6) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO PARA-
GRAPH (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX OF THE
SOCIAL SERVICES LAW.
(V) THE FOLLOWING MEDICAL ASSISTANCE RECIPIENTS SHALL NOT BE ELIGIBLE
TO PARTICIPATE IN A MANAGED LONG TERM CARE PROGRAM OR OTHER CARE COORDI-
NATION MODEL ESTABLISHED PURSUANT TO THIS PARAGRAPH UNTIL PROGRAM
FEATURES AND REIMBURSEMENT RATES ARE APPROVED BY THE COMMISSIONER AND,
AS APPLICABLE, THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES:
(1) A PERSON ENROLLED IN A MANAGED CARE PLAN PURSUANT TO SECTION THREE
HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW;
(2) A PARTICIPANT IN THE TRAUMATIC BRAIN INJURY WAIVER PROGRAM;
(3) A PARTICIPANT IN THE NURSING HOME TRANSITION AND DIVERSION WAIVER
PROGRAM;
(4) A PERSON ENROLLED IN THE ASSISTED LIVING PROGRAM;
(5) A PERSON ENROLLED IN HOME AND COMMUNITY BASED WAIVER PROGRAMS
ADMINISTERED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES.
(VI) PERSONS REQUIRED TO ENROLL IN THE MANAGED LONG TERM CARE PROGRAM
OR OTHER CARE COORDINATION MODEL ESTABLISHED PURSUANT TO THIS PARAGRAPH
SHALL HAVE NO LESS THAN THIRTY DAYS TO SELECT A MANAGED LONG TERM CARE
PROVIDER, AND SHALL BE PROVIDED WITH INFORMATION TO MAKE AN INFORMED
CHOICE. WHERE A PARTICIPANT HAS NOT SELECTED SUCH A PROVIDER, THE
COMMISSIONER SHALL ASSIGN SUCH PARTICIPANT TO A MANAGED LONG TERM CARE
PROVIDER, TAKING INTO ACCOUNT QUALITY, CAPACITY AND GEOGRAPHIC ACCESSI-
BILITY.
S. 2809--D 141 A. 4009--D
(VII) MANAGED LONG TERM CARE PROVIDED AND PLANS CERTIFIED OR OTHER
CARE COORDINATION MODEL ESTABLISHED PURSUANT TO THIS PARAGRAPH SHALL
COMPLY WITH THE PROVISIONS OF PARAGRAPHS (D), (I), AND (T) AND SUBPARA-
GRAPH (III) OF PARAGRAPH (A) AND SUBPARAGRAPH (IV) OF PARAGRAPH (E) OF
SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL
SERVICES LAW.
(c)(i) A managed long term care plan shall not use deceptive or coer-
cive marketing methods to encourage participants to enroll. A managed
long term care plan shall not distribute marketing materials to poten-
tial enrollees before such materials have been approved by the commis-
sioner.
(ii) The commissioner shall ensure, through periodic reviews of
managed long term care plans, that enrollment was [a voluntary and] AN
informed choice; such plan has only enrolled persons whom it is author-
ized to enroll, and plan services are promptly available to enrollees
when appropriate. Such periodic reviews shall be made according to stan-
dards as determined by the commissioner in regulations.
(d) Notwithstanding any provision of law, rule or regulation to the
contrary, the commissioner may issue a request for proposals to carry
out reviews of enrollment and assessment activities in managed long term
care plans and operating demonstrations with respect to enrollees eligi-
ble to receive services under title XIX of the federal social security
act to determine if enrollment meets the requirements of subparagraph
(ii) of paragraph (c) of this subdivision; and that assessments of such
enrollees' health, functional and other status, for the purpose of
adjusting premiums, were accurate. [Evaluations shall address each
bidder's ability to ensure that enrollments in such plans are promptly
reviewed and that medical assistance required to be furnished pursuant
to title eleven of article five of the social services law will be
appropriately furnished to the recipients for whom the local commission-
ers are responsible pursuant to section three hundred sixty-five of such
title and that plan implementation will be consistent with the proper
and efficient administration of the medical assistance program and
managed long term care plans.]
(e) The commissioner may, in his or her discretion for the purpose of
protection of enrollees, impose measures including, but not limited to,
bans on further enrollments and requirements for use of enrollment
brokers until any identified problems are resolved to the satisfaction
of the commissioner.
(f) Continuation of a certificate of authority issued under this
section 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; compli-
ance with applicable provisions of this section and rules and regu-
lations promulgated thereunder; the continuing fiscal solvency of the
organization; and, federal financial participation in payments on behalf
of enrollees who are eligible to receive services under title XIX of the
federal social security act.
(g) [The commissioner shall ensure that (i) a process exists for the
resolution of disputes concerning the accuracy of assessments performed
pursuant to paragraphs (d) and (e) of this subdivision; and (ii) the
tasks described in paragraphs (d) and (e) of this subdivision are
consistently administered.
(h)] (i) Managed long term care plans and demonstrations may enroll
eligible persons in the plan or demonstration upon the completion of a
comprehensive assessment that shall include, but not be limited to, an
S. 2809--D 142 A. 4009--D
evaluation of the medical, social and environmental needs of each
prospective enrollee in such program. This assessment shall also serve
as the basis for the development and provision of an appropriate plan of
care for the [prospective] enrollee. UPON APPROVAL OF FEDERAL WAIVERS
PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVISION WHICH REQUIRE MEDICAL
ASSISTANCE RECIPIENTS WHO REQUIRE COMMUNITY-BASED LONG TERM CARE
SERVICES TO ENROLL IN A PLAN, AND UPON APPROVAL OF THE COMMISSIONER, A
PLAN MAY ENROLL AN APPLICANT WHO IS CURRENTLY RECEIVING HOME AND COMMU-
NITY-BASED SERVICES AND COMPLETE THE COMPREHENSIVE ASSESSMENT WITHIN
THIRTY DAYS OF ENROLLMENT PROVIDED THAT THE PLAN CONTINUES TO COVER
TRANSITIONAL CARE UNTIL SUCH TIME AS THE ASSESSMENT IS COMPLETED.
(ii) The assessment shall be completed by a representative of the
managed long term care plan or demonstration, in consultation with the
prospective enrollee's health care practitioner AS NECESSARY. The
commissioner shall prescribe the forms on which the assessment shall be
made.
(iii) The [completed assessment and documentation of the] enrollment
APPLICATION shall be submitted by the managed long term care plan or
demonstration to the [local department of social services, or to a
contractor selected pursuant to paragraph (d) of this subdivision,]
ENTITY DESIGNATED BY THE DEPARTMENT prior to the commencement of
services under the managed long term care plan or demonstration. For
purposes of reimbursement of the managed long term care plan or demon-
stration, if the [completed assessment and documentation are] ENROLLMENT
APPLICATION IS submitted on or before the twentieth day of the month,
the enrollment shall commence on the first day of the month following
the completion and submission and if the [completed assessment and
documentation are] ENROLLMENT APPLICATION IS submitted after the twenti-
eth day of the month, the enrollment shall commence on the first day of
the second month following submission. Enrollments conducted by a plan
or demonstration shall be subject to review and audit by the department
[and by the local social services district] or a contractor selected
pursuant to paragraph (d) of this subdivision.
(iv) Continued enrollment in a managed long term care plan or demon-
stration paid for by government funds shall be based upon a comprehen-
sive assessment of the medical, social and environmental needs of the
recipient of the services. Such assessment shall be performed at least
[annually] EVERY SIX MONTHS by the managed long term care plan serving
the enrollee. The commissioner shall prescribe the forms on which the
assessment will be made.
[(i)] (H) The commissioner shall, upon request by a managed long term
care plan[, approved managed long term care demonstration,] or operating
demonstration, and consistent with federal regulations promulgated
pursuant to the Health Insurance Portability and Accountability Act,
share with such plan or demonstration the following data if it is avail-
able:
(i) information concerning utilization of services and providers by
each of its enrollees prior to and during enrollment, including but not
limited to utilization of emergency department services, prescription
drugs, and hospital and nursing facility admissions.
(ii) aggregate data concerning utilization and costs for enrollees and
for comparable cohorts served through the Medicaid fee-for-service
program.
10. [The] NOTWITHSTANDING ANY INCONSISTENT PROVISION TO THE CONTRARY,
THE ENROLLMENT AND DISENROLLMENT PROCESS AND services provided or
arranged by all operating demonstrations or any program that receives
S. 2809--D 143 A. 4009--D
designation as a Program of All-Inclusive Care for the Elderly (PACE) as
authorized by federal public law 105-33, subtitle I of title IV of the
Balanced Budget Act of 1997, MUST MEET ALL APPLICABLE FEDERAL REQUIRE-
MENTS. SERVICES may include, but need not be limited to, housing, inpa-
tient and outpatient hospital services, nursing home care, home health
care, adult day care, assisted living services provided in accordance
with article forty-six-B of this chapter, adult care facility services,
enriched housing program services, hospice care, respite care, personal
care, homemaker services, diagnostic laboratory services, therapeutic
and diagnostic radiologic services, emergency services, emergency alarm
systems, home delivered meals, physical adaptations to the client's
home, physician care (including consultant and referral services),
ancillary services, case management services, transportation, and
related medical services.
S 42. Section 4401 of the public health law is amended by adding a
new subdivision 8 to read as follows:
8. "SPECIAL NEEDS MANAGED CARE PLAN" OR "SPECIALIZED MANAGED CARE
PLAN" SHALL MEAN A COMBINATION OF PERSONS NATURAL OR CORPORATE, OR ANY
GROUPS OF SUCH PERSONS, OR A COUNTY OR COUNTIES, WHO ENTER INTO AN
ARRANGEMENT, AGREEMENT OR PLAN, OR COMBINATION OF ARRANGEMENTS, AGREE-
MENTS OR PLANS, TO PROVIDE HEALTH AND BEHAVIORAL HEALTH SERVICES TO
ENROLLEES WITH SIGNIFICANT BEHAVIORAL HEALTH NEEDS.
S 42-a. The public health law is amended by adding a new section
4403-d to read as follows:
S 4403-D. SPECIAL NEEDS MANAGED CARE PLANS AND SPECIALIZED MANAGED
CARE PLANS. NO PERSON, GROUP OF PERSONS, COUNTY OR COUNTIES MAY OPERATE
A SPECIAL NEEDS MANAGED CARE PLAN OR SPECIALIZED MANAGED CARE PLAN WITH-
OUT FIRST OBTAINING A CERTIFICATE OF AUTHORITY FROM THE COMMISSIONER,
ISSUED JOINTLY WITH THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND
THE COMMISSIONER OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES.
S 42-b. Paragraph (m) of subdivision 1 of section 364-j of the social
services law, as amended by chapter 649 of the laws of 1996, is amended
to read as follows:
(m) "[Mental health special] SPECIAL needs MANAGED CARE plan" AND
"SPECIALIZED MANAGED CARE PLAN" shall have the same meaning as in
section forty-four hundred [three-d] ONE of the public health law.
S 42-c. Subdivision 2 of section 364-j of the social services law is
amended by adding a new paragraph (c) to read as follows:
(C) THE COMMISSIONER OF HEALTH, JOINTLY WITH THE COMMISSIONER OF
MENTAL HEALTH AND THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES SHALL BE AUTHORIZED TO ESTABLISH SPECIAL NEEDS MANAGED CARE AND
SPECIALIZED MANAGED CARE PLANS, UNDER THE MEDICAL ASSISTANCE PROGRAM, IN
ACCORDANCE WITH APPLICABLE FEDERAL LAW AND REGULATIONS. THE COMMISSIONER
OF HEALTH, IN COOPERATION WITH SUCH COMMISSIONERS, IS AUTHORIZED,
SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE DIVISION OF THE BUDGET,
TO APPLY FOR FEDERAL WAIVERS WHEN SUCH ACTION WOULD BE NECESSARY TO
ASSIST IN PROMOTING THE OBJECTIVES OF THIS SECTION.
S 42-d. The social services law is amended by adding a new section
365-m to read as follows:
S 365-M. ADMINISTRATION AND MANAGEMENT OF BEHAVIORAL HEALTH SERVICES.
1. THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTATION WITH THE
COMMISSIONER OF HEALTH, THE IMPACTED LOCAL GOVERNMENTAL UNITS AND WITH
THE APPROVAL OF THE DIVISION OF THE BUDGET, SHALL HAVE RESPONSIBILITY
FOR JOINTLY DESIGNATING REGIONAL ENTITIES TO PROVIDE ADMINISTRATIVE AND
S. 2809--D 144 A. 4009--D
MANAGEMENT SERVICES FOR THE PURPOSES OF PRIOR APPROVING AND COORDINATING
THE PROVISION OF BEHAVIORAL HEALTH SERVICES, FACILITATING THE CONTINUITY
OF POST-HOSPITALIZATION BEHAVIORAL HEALTH AND THE INTEGRATION OF BEHAV-
IORAL HEALTH SERVICES WITH OTHER SERVICES AVAILABLE UNDER THIS TITLE,
FOR RECIPIENTS OF MEDICAL ASSISTANCE WHO ARE NOT ENROLLED IN MANAGED
CARE, AND FOR SUCH APPROVAL, COORDINATION, FACILITATING CONTINUITY AND
INTEGRATION OF BEHAVIORAL HEALTH SERVICES THAT ARE NOT PROVIDED THROUGH
MANAGED CARE PROGRAMS UNDER THIS TITLE FOR INDIVIDUALS REGARDLESS OF
WHETHER OR NOT SUCH INDIVIDUALS ARE ENROLLED IN MANAGED CARE PROGRAMS.
SUCH REGIONAL ENTITIES SHALL ALSO BE RESPONSIBLE FOR PROMOTING APPROPRI-
ATE CARE AND SERVICE UTILIZATION WHILE SAFEGUARDING AGAINST UNNECESSARY
UTILIZATION OF SUCH CARE AND SERVICES AND ASSURING THAT PAYMENTS ARE
CONSISTENT WITH THE EFFICIENT AND ECONOMICAL DELIVERY OF QUALITY CARE.
2. IN EXERCISING THIS RESPONSIBILITY, THE COMMISSIONERS OF THE OFFICE
OF MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES ARE AUTHORIZED TO CONTRACT, AFTER CONSULTATION WITH THE COMMIS-
SIONER OF HEALTH AND THE IMPACTED LOCAL GOVERNMENTAL UNITS, WITH
REGIONAL BEHAVIORAL HEALTH ORGANIZATIONS OR OTHER ENTITIES. SUCH
CONTRACTS MAY INCLUDE RESPONSIBILITY FOR RECEIPT, REVIEW, AND DETERMI-
NATION OF PRIOR AUTHORIZATION REQUESTS FOR BEHAVIORAL HEALTH CARE AND
SERVICES UNDER SUBDIVISION ONE OF THIS SECTION, CONSISTENT WITH CRITERIA
ESTABLISHED OR APPROVED BY THE COMMISSIONERS OF MENTAL HEALTH AND ALCO-
HOLISM AND SUBSTANCE ABUSE SERVICES, AND AUTHORIZATION OF APPROPRIATE
CARE AND SERVICES BASED ON DOCUMENTED PATIENT MEDICAL NEED.
3. 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
TO THE CONTRARY, THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND
THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ARE AUTHORIZED TO
ENTER INTO A CONTRACT OR CONTRACTS UNDER SUBDIVISIONS ONE AND TWO OF
THIS SECTION WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS,
PROVIDED, HOWEVER, THAT:
(A) THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND
SUBSTANCE ABUSE SERVICES SHALL POST ON THEIR WEBSITES, FOR A PERIOD OF
NO LESS THAN THIRTY DAYS:
(I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACTOR CONTRACTS;
(II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
(IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONERS; AND
(C) THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTATION WITH THE
COMMISSIONER OF HEALTH AND THE IMPACTED LOCAL GOVERNMENTAL UNITS, SHALL
SELECT SUCH CONTRACTOR OR CONTRACTORS THAT, IN THEIR DISCRETION, HAVE
DEMONSTRATED THE ABILITY TO EFFECTIVELY, EFFICIENTLY, AND ECONOMICALLY
INTEGRATE BEHAVIORAL HEALTH AND HEALTH SERVICES; HAVE THE REQUISITE
EXPERTISE AND FINANCIAL RESOURCES; HAVE DEMONSTRATED THAT THEIR DIREC-
TORS, SPONSORS, MEMBERS, MANAGERS, PARTNERS OR OPERATORS HAVE THE REQUI-
SITE CHARACTER, COMPETENCE AND STANDING IN THE COMMUNITY, AND ARE BEST
SUITED TO SERVE THE PURPOSES OF THIS SECTION.
S. 2809--D 145 A. 4009--D
4. THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH, THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES AND THE DEPARTMENT OF HEALTH,
SHALL HAVE THE RESPONSIBILITY FOR JOINTLY DESIGNATING ON A REGIONAL
BASIS, AFTER CONSULTATION WITH THE LOCAL SOCIAL SERVICES DISTRICT AND
LOCAL GOVERNMENTAL UNIT, AS SUCH TERM IS DEFINED IN THE MENTAL HYGIENE
LAW, OF A CITY WITH A POPULATION OF OVER ONE MILLION PERSONS, AND AFTER
CONSULTATION OF OTHER AFFECTED COUNTIES, A LIMITED NUMBER OF SPECIALIZED
MANAGED CARE PLANS UNDER SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS
TITLE, SPECIAL NEED MANAGED CARE PLANS UNDER SECTION THREE HUNDRED
SIXTY-FOUR-J OF THIS TITLE, AND/OR INTEGRATED PHYSICAL AND BEHAVIORAL
HEALTH PROVIDER SYSTEMS CERTIFIED UNDER ARTICLE TWENTY-NINE-E OF THE
PUBLIC HEALTH LAW CAPABLE OF MANAGING THE BEHAVIORAL AND PHYSICAL HEALTH
NEEDS OF MEDICAL ASSISTANCE ENROLLEES WITH SIGNIFICANT BEHAVIORAL HEALTH
NEEDS. INITIAL DESIGNATIONS OF SUCH PLANS OR PROVIDER SYSTEMS SHOULD BE
MADE NO LATER THAN APRIL FIRST, TWO THOUSAND THIRTEEN, PROVIDED, HOWEV-
ER, SUCH DESIGNATIONS SHALL BE CONTINGENT UPON A DETERMINATION BY SUCH
STATE COMMISSIONERS THAT THE ENTITIES TO BE DESIGNATED HAVE THE CAPACITY
AND FINANCIAL ABILITY TO PROVIDE SERVICES IN SUCH PLANS OR PROVIDER
SYSTEMS, AND THAT THE REGION HAS A SUFFICIENT POPULATION AND SERVICE
BASE TO SUPPORT SUCH PLANS AND SYSTEMS. ONCE DESIGNATED, THE COMMISSION-
ER OF HEALTH SHALL MAKE ARRANGEMENTS TO ENROLL SUCH ENROLLEES IN SUCH
PLANS OR INTEGRATED PROVIDER SYSTEMS AND TO PAY SUCH PLANS OR PROVIDER
SYSTEMS ON A CAPITATED OR OTHER BASIS TO MANAGE, COORDINATE, AND PAY FOR
BEHAVIORAL AND PHYSICAL HEALTH MEDICAL ASSISTANCE SERVICES FOR SUCH
ENROLLEES. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTION ONE
HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, AND
SECTION ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY
OTHER LAW TO THE CONTRARY, THE DESIGNATIONS OF SUCH PLANS AND PROVIDER
SYSTEMS, AND ANY RESULTING CONTRACTS WITH SUCH PLANS, PROVIDERS OR
PROVIDER SYSTEMS ARE AUTHORIZED TO BE ENTERED INTO BY SUCH STATE COMMIS-
SIONERS WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS,
PROVIDED HOWEVER THAT:
(A) THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH AND THE
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES SHALL POST ON THEIR
WEBSITES, FOR A PERIOD OF NOT LESS THAN THIRTY DAYS:
(I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED BY THE PLANS
OR SYSTEMS;
(II) THE CRITERIA FOR SELECTION OF A PLAN OR SYSTEM;
(III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE PLAN OR SYSTEM MAY
SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
(IV) THE MANNER BY WHICH A PROSPECTIVE PLAN OR SYSTEM MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE PLANS OR SYSTEMS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONERS; AND
(C) THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTATION WITH THE
COMMISSIONER OF HEALTH, SHALL SELECT SUCH PLANS OR SYSTEMS THAT, IN
THEIR DISCRETION, HAVE DEMONSTRATED THE ABILITY TO EFFECTIVELY, EFFI-
CIENTLY, AND ECONOMICALLY MANAGE THE BEHAVIORAL AND PHYSICAL HEALTH
NEEDS OF MEDICAL ASSISTANCE ENROLLEES WITH SIGNIFICANT BEHAVIORAL HEALTH
NEEDS; HAVE THE REQUISITE EXPERTISE AND FINANCIAL RESOURCES; HAVE DEMON-
STRATED THAT THEIR DIRECTORS, SPONSORS, MEMBERS, MANAGERS, PARTNERS OR
OPERATORS HAVE THE REQUISITE CHARACTER, COMPETENCE AND STANDING IN THE
COMMUNITY, AND ARE BEST SUITED TO SERVE THE PURPOSES OF THIS SECTION.
S. 2809--D 146 A. 4009--D
OVERSIGHT OF SUCH CONTRACTS WITH SUCH PLANS, PROVIDERS OR PROVIDER
SYSTEMS SHALL BE THE JOINT RESPONSIBILITY OF SUCH STATE COMMISSIONERS,
AND FOR CONTRACTS AFFECTING A CITY WITH A POPULATION OF OVER ONE MILLION
PERSONS, ALSO WITH THE CITY'S LOCAL SOCIAL SERVICES DISTRICT AND LOCAL
GOVERNMENTAL UNIT, AS SUCH TERM IS DEFINED IN THE MENTAL HYGIENE LAW.
S 43. Intentionally omitted.
S 44. Intentionally omitted.
S 45. Intentionally omitted.
S 46. Intentionally omitted.
S 47. Intentionally omitted.
S 47-a. Subdivision 8 of section 2511 of the public health law is
amended by adding two new paragraphs (f) and (g) to read as follows:
(F) THE COMMISSIONER SHALL ADJUST SUBSIDY PAYMENTS MADE TO APPROVED
ORGANIZATIONS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, SO THAT THE AMOUNT OF EACH SUCH
PAYMENT IS REDUCED BY ONE AND SEVEN-TENTHS PERCENT.
(G) THE COMMISSIONER MAY INCREASE SUBSIDY PAYMENTS MADE TO APPROVED
ORGANIZATIONS THAT VOLUNTARILY PARTICIPATE IN THE MULTI-PAYOR PATIENT
CENTERED MEDICAL HOME PROGRAM TO REFLECT ADDITIONAL COSTS ASSOCIATED
WITH ENHANCED PAYMENTS MADE TO CERTIFIED MEDICAL HOMES BY APPROVED
ORGANIZATIONS AS REQUIRED BY ARTICLE TWENTY-NINE-AA OF THIS CHAPTER.
S 48. The public health law is amended by adding a new section 2997-d
to read as follows:
S 2997-D. HOSPITAL, NURSING HOME, HOME CARE, SPECIAL NEEDS ASSISTED
LIVING RESIDENCES AND ENHANCED ASSISTED LIVING RESIDENCES PALLIATIVE
CARE SUPPORT. 1. (A) "PALLIATIVE CARE" MEANS HEALTH CARE TREATMENT,
INCLUDING INTERDISCIPLINARY END-OF-LIFE CARE, AND CONSULTATION WITH
PATIENTS AND FAMILY MEMBERS, TO PREVENT OR RELIEVE PAIN AND SUFFERING
AND TO ENHANCE THE PATIENT'S QUALITY OF LIFE, INCLUDING HOSPICE CARE
UNDER ARTICLE FORTY OF THIS CHAPTER.
(B) "APPROPRIATE" HAS THE SAME MEANING AS PARAGRAPH (A) OF SUBDIVISION
ONE OF SECTION TWENTY-NINE HUNDRED NINETY-SEVEN-C OF THIS TITLE.
2. GENERAL HOSPITALS, NURSING HOMES, ORGANIZATIONS LICENSED OR CERTI-
FIED PURSUANT TO ARTICLE THIRTY-SIX OF THIS CHAPTER, AND ORGANIZATIONS
LICENSED AS SPECIAL NEEDS ASSISTED LIVING RESIDENCES OR ENHANCED
ASSISTED LIVING RESIDENCES PURSUANT TO ARTICLE FORTY-SIX-B OF THIS CHAP-
TER SHALL ESTABLISH POLICIES AND PROCEDURES TO PROVIDE PATIENTS WITH
ADVANCED LIFE LIMITING CONDITIONS AND ILLNESSES WHO MIGHT BENEFIT FROM
PALLIATIVE CARE, INCLUDING ASSOCIATED PAIN MANAGEMENT, SERVICES WITH
ACCESS TO INFORMATION AND COUNSELING REGARDING SUCH OPTIONS APPROPRIATE
TO THE PATIENT. POLICIES MUST INCLUDE PROVISION FOR PATIENTS WHO LACK
CAPACITY TO MAKE MEDICAL DECISIONS, SO THAT ACCESS TO SUCH INFORMATION
AND COUNSELING SHALL BE PROVIDED TO THE PERSONS WHO ARE LEGALLY AUTHOR-
IZED TO MAKE MEDICAL DECISIONS ON BEHALF OF SUCH PATIENTS.
3. GENERAL HOSPITALS, NURSING HOMES, ORGANIZATIONS LICENSED OR CERTI-
FIED PURSUANT TO ARTICLE THIRTY-SIX OF THIS CHAPTER, AND ORGANIZATIONS
LICENSED AS SPECIAL NEEDS ASSISTED LIVING RESIDENCES OR ENHANCED
ASSISTED LIVING RESIDENCES PURSUANT TO ARTICLE FORTY-SIX-B OF THIS CHAP-
TER SHALL FACILITATE ACCESS TO APPROPRIATE PALLIATIVE CARE CONSULTATIONS
AND SERVICES, INCLUDING ASSOCIATED PAIN MANAGEMENT CONSULTATIONS AND
SERVICES, INCLUDING BUT NOT LIMITED TO REFERRALS CONSISTENT WITH PATIENT
NEEDS AND PREFERENCES. THE DEPARTMENT SHALL TAKE INTO ACCOUNT ACCESS
AND PROXIMITY OF PALLIATIVE CARE SERVICES, INCLUDING THE AVAILABILITY OF
HOSPICE AND PALLIATIVE CARE BOARD CERTIFIED PRACTITIONERS AND OTHER
RELATED WORKFORCE STAFF, GEOGRAPHIC FACTORS, AND FACILITY SIZE THAT MAY
IMPACT DEVELOPMENT OF PALLIATIVE CARE SERVICES.
S. 2809--D 147 A. 4009--D
S 49. Intentionally omitted.
S 50. Legislative findings. The legislature finds that integration and
coordination of health care services is essential to the improvement of
health care quality, efficiency, access and outcomes. The federal
Patient Protection and Affordable Care Act creates several health system
demonstration and pilot programs, intended to promote and assess deliv-
ery system and payment reforms, that require integration of services,
coordination among providers, or a combination of the two. In addition,
collaborative arrangements among, or consolidation, mergers or acquisi-
tion, of providers may be necessary to preserve access to essential
services in some communities, and improve the quality of the services
they provide and the efficiency of their operations, as well as minimize
unnecessary increases in the cost of care.
Federal and state antitrust laws may prohibit or discourage such
collaboration or consolidation beneficial to residents of New York
state, given their potential for, or actual, reduction in competition.
The legislature finds that such agreements where they meet the standards
of this section, should be permitted and encouraged. Under these circum-
stances, competition as currently mandated by federal and state anti-
trust laws should be supplanted by a regulatory program to permit and
encourage mergers, acquisitions, and cooperative, collaborative and
integrative agreements among health care providers, and others, that are
beneficial to New York residents when the benefits of such agreements
outweigh any disadvantages caused by their potential or actual adverse
effects on competition. Regulatory oversight of such arrangements should
be provided to ensure that the benefits of such agreements outweigh any
disadvantages attributable to any reduction in competition that may
result from the agreements. Accordingly, the legislature intends to
authorize a regulatory program to permit and oversee merger, acquisi-
tion, integration, consolidation, collaboration, and coordination among
providers, where necessary to assure access to essential health care
services, to improve health care quality and outcomes, to enhance effi-
ciency, or to minimize the cost of health care.
S 51. The public health law is amended by adding a new article 29-F to
read as follows:
ARTICLE 29-F
IMPROVED INTEGRATION OF HEALTH CARE AND FINANCING
SECTION 2999-AA. ANTITRUST PROVISIONS, STATE OVERSIGHT.
2999-BB. DEPARTMENT AUTHORITY.
S 2999-AA. ANTITRUST PROVISIONS, STATE OVERSIGHT. 1. IN ORDER TO
PROMOTE IMPROVED QUALITY AND EFFICIENCY OF, AND ACCESS TO, HEALTH CARE
SERVICES AND TO PROMOTE IMPROVED CLINICAL OUTCOMES TO THE RESIDENTS OF
NEW YORK, IT SHALL BE THE POLICY OF THE STATE TO ENCOURAGE, WHERE APPRO-
PRIATE, COOPERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS INCLUD-
ING BUT NOT LIMITED TO, MERGERS AND ACQUISITIONS AMONG HEALTH CARE
PROVIDERS OR AMONG OTHERS WHO MIGHT OTHERWISE BE COMPETITORS, UNDER THE
ACTIVE SUPERVISION OF THE COMMISSIONER. TO THE EXTENT SUCH ARRANGEMENTS,
OR THE PLANNING AND NEGOTIATIONS THAT PRECEDE THEM, MIGHT BE ANTI-COM-
PETITIVE WITHIN THE MEANING AND INTENT OF THE STATE AND FEDERAL ANTI-
TRUST LAWS, THE INTENT OF THE STATE IS TO SUPPLANT COMPETITION WITH SUCH
ARRANGEMENTS UNDER THE ACTIVE SUPERVISION AND RELATED ADMINISTRATIVE
ACTIONS OF THE COMMISSIONER AS NECESSARY TO ACCOMPLISH THE PURPOSES OF
THIS ARTICLE, AND TO PROVIDE STATE ACTION IMMUNITY UNDER THE STATE AND
FEDERAL ANTITRUST LAWS WITH RESPECT TO ACTIVITIES UNDERTAKEN BY HEALTH
CARE PROVIDERS AND OTHERS PURSUANT TO THIS ARTICLE, WHERE THE BENEFITS
OF SUCH ACTIVE SUPERVISION, ARRANGEMENTS AND ACTIONS OF THE COMMISSIONER
S. 2809--D 148 A. 4009--D
OUTWEIGH ANY DISADVANTAGES LIKELY TO RESULT FROM A REDUCTION OF COMPETI-
TION. THE COMMISSIONER SHALL NOT APPROVE AN ARRANGEMENT FOR WHICH STATE
ACTION IMMUNITY IS SOUGHT UNDER THIS ARTICLE WITHOUT FIRST CONSULTING
WITH, AND RECEIVING A RECOMMENDATION FROM, THE PUBLIC HEALTH AND HEALTH
PLANNING COUNCIL. NO ARRANGEMENT UNDER THIS ARTICLE SHALL BE APPROVED
AFTER DECEMBER THIRTY-FIRST, TWO THOUSAND SIXTEEN.
2. THE COMMISSIONER OR HIS OR HER DULY AUTHORIZED REPRESENTATIVE MAY
ENGAGE IN APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS.
S 2999-BB. DEPARTMENT AUTHORITY. THE DEPARTMENT SHALL PROMULGATE
REGULATIONS TO IMPLEMENT THIS ARTICLE. SUCH REGULATIONS SHALL PROVIDE
STANDARDS FOR DETERMINING WHICH PROPOSED COLLABORATIONS, INTEGRATIONS,
MERGERS OR ACQUISITIONS SHALL BE COVERED BY THIS ARTICLE AND THE MANNER
BY WHICH THE INTERESTS SET FORTH IN THE LEGISLATIVE FINDINGS SHALL BE
ADVANCED THROUGH REGULATORY OVERSIGHT. THE DEPARTMENT SHALL FURTHER BE
AUTHORIZED TO IMPOSE FEES AS APPROPRIATE TO FACILITATE THE IMPLEMENTA-
TION OF THIS ARTICLE. THIS ARTICLE IS NOT INTENDED TO LIMIT THE AUTHORI-
TY OF THE ATTORNEY GENERAL OF THE STATE OF NEW YORK.
S 52. Article 29-D of the public health law is amended by adding a new
title 4 to read as follows:
TITLE 4
NEW YORK STATE MEDICAL INDEMNITY FUND
SECTION 2999-G. PURPOSE OF THIS TITLE.
2999-H. DEFINITIONS.
2999-I. CUSTODY AND ADMINISTRATION OF THE FUND.
2999-J. PAYMENTS FROM THE FUND.
S 2999-G. PURPOSE OF THIS TITLE. CREATION OF THE NEW YORK STATE
MEDICAL INDEMNITY FUND. THERE IS HEREBY CREATED THE NEW YORK STATE
MEDICAL INDEMNITY FUND (THE "FUND"). THE PURPOSE OF THE FUND IS TO
PROVIDE A FUNDING SOURCE FOR FUTURE HEALTH CARE COSTS ASSOCIATED WITH
BIRTH RELATED NEUROLOGICAL INJURIES, IN ORDER TO REDUCE PREMIUM COSTS
FOR MEDICAL MALPRACTICE INSURANCE COVERAGE.
S 2999-H. DEFINITIONS. AS USED IN THIS TITLE, UNLESS THE CONTEXT OR
SUBJECT MATTER REQUIRES OTHERWISE:
1. "BIRTH-RELATED NEUROLOGICAL INJURY" MEANS AN INJURY TO THE BRAIN OR
SPINAL CORD OF A LIVE INFANT CAUSED BY THE DEPRIVATION OF OXYGEN OR
MECHANICAL INJURY OCCURRING IN THE COURSE OF LABOR, DELIVERY OR RESUSCI-
TATION OR BY OTHER MEDICAL SERVICES PROVIDED OR NOT PROVIDED DURING
DELIVERY ADMISSION THAT RENDERED THE INFANT WITH A PERMANENT AND
SUBSTANTIAL MOTOR IMPAIRMENT OR WITH A DEVELOPMENTAL DISABILITY AS THAT
TERM IS DEFINED BY SECTION 1.03 OF THE MENTAL HYGIENE LAW, OR BOTH. THIS
DEFINITION SHALL APPLY TO LIVE BIRTHS ONLY.
2. "FUND" MEANS THE NEW YORK STATE MEDICAL INDEMNITY FUND.
3. "QUALIFYING HEALTH CARE COSTS" MEANS THE FUTURE MEDICAL, HOSPITAL,
SURGICAL, NURSING, DENTAL, REHABILITATION, CUSTODIAL, DURABLE MEDICAL
EQUIPMENT, HOME MODIFICATIONS, ASSISTIVE TECHNOLOGY, VEHICLE MODIFICA-
TIONS, PRESCRIPTION AND NON-PRESCRIPTION MEDICATIONS, AND OTHER HEALTH
CARE COSTS ACTUALLY INCURRED FOR SERVICES RENDERED TO AND SUPPLIES
UTILIZED BY QUALIFIED PLAINTIFFS, WHICH ARE NECESSARY TO MEET THEIR
HEALTH CARE NEEDS AS DETERMINED BY THEIR TREATING PHYSICIANS, PHYSICIAN
ASSISTANTS, OR NURSE PRACTITIONERS AND AS OTHERWISE DEFINED BY THE
COMMISSIONER IN REGULATION.
4. "QUALIFIED PLAINTIFF" MEANS EVERY PLAINTIFF OR CLAIMANT WHO (I) HAS
BEEN FOUND BY A JURY OR COURT TO HAVE SUSTAINED A BIRTH-RELATED NEURO-
LOGICAL INJURY AS THE RESULT OF MEDICAL MALPRACTICE, OR (II) HAS
SUSTAINED A BIRTH-RELATED NEUROLOGICAL INJURY AS THE RESULT OF ALLEGED
S. 2809--D 149 A. 4009--D
MEDICAL MALPRACTICE, AND HAS SETTLED HIS OR HER LAWSUIT OR CLAIM THERE-
FOR.
5. ANY REFERENCE TO THE "DEPARTMENT OF FINANCIAL SERVICES" AND THE
"SUPERINTENDENT OF FINANCIAL SERVICES" IN THIS TITLE SHALL MEAN, PRIOR
TO OCTOBER THIRD, TWO THOUSAND ELEVEN, RESPECTIVELY, THE "DEPARTMENT OF
INSURANCE" AND "SUPERINTENDENT OF INSURANCE."
S 2999-I. CUSTODY AND ADMINISTRATION OF THE FUND. 1. THE COMMISSIONER
OF TAXATION AND FINANCE SHALL BE THE CUSTODIAN OF THE FUND AND THE
SPECIAL ACCOUNT ESTABLISHED PURSUANT TO SECTION NINETY-NINE-T OF THE
STATE FINANCE LAW. ALL PAYMENTS FROM THE FUND SHALL BE MADE BY THE
COMMISSIONER OF TAXATION AND FINANCE UPON CERTIFICATES SIGNED BY THE
SUPERINTENDENT OF FINANCIAL SERVICES, OR HIS OR HER DESIGNEE, AS HEREIN-
AFTER PROVIDED. THE FUND SHALL BE SEPARATE AND APART FROM ANY OTHER FUND
AND FROM ALL OTHER STATE MONIES. NO MONIES FROM THE FUND SHALL BE TRANS-
FERRED TO ANY OTHER FUND, NOR SHALL ANY SUCH MONIES BE APPLIED TO THE
MAKING OF ANY PAYMENT FOR ANY PURPOSE OTHER THAN THE PURPOSE SET FORTH
IN THIS TITLE.
2. (A) THE FUND SHALL BE ADMINISTERED BY THE SUPERINTENDENT OF FINAN-
CIAL SERVICES OR HIS OR HER DESIGNEE IN ACCORDANCE WITH THE PROVISIONS
OF THIS ARTICLE.
(B) THE SUPERINTENDENT OF FINANCIAL SERVICES SHALL HAVE ALL POWERS
NECESSARY AND PROPER TO CARRY OUT THE PURPOSES OF THE FUND.
(C) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION, SECTIONS
ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW
OR ANY OTHER CONTRARY PROVISION OF LAW, THE SUPERINTENDENT OF FINANCIAL
SERVICES IS AUTHORIZED TO ENTER INTO A CONTRACT OR CONTRACTS WITHOUT A
COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS FOR PURPOSES OF ADMINIS-
TERING THE FUND FOR THE FIRST YEAR OF ITS OPERATION AND IN PREPARATION
THEREFOR.
(D) THE DEPARTMENT OF FINANCIAL SERVICES AND THE DEPARTMENT SHALL POST
ON THEIR WEBSITES INFORMATION ABOUT THE FUND, ELIGIBILITY FOR ENROLLMENT
IN THE FUND, AND THE PROCESS FOR ENROLLMENT IN THE FUND.
3. THE EXPENSE OF ADMINISTERING THE FUND, INCLUDING THE EXPENSES
INCURRED BY THE DEPARTMENT, SHALL BE PAID FROM THE FUND.
4. MONIES FOR THE FUND WILL BE PROVIDED PURSUANT TO THIS CHAPTER.
5. FOR THE STATE FISCAL YEAR BEGINNING APRIL FIRST, TWO THOUSAND ELEV-
EN AND ENDING MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, THE STATE FISCAL
YEAR BEGINNING APRIL FIRST, TWO THOUSAND TWELVE AND ENDING MARCH THIR-
TY-FIRST, TWO THOUSAND THIRTEEN, AND THE STATE FISCAL YEAR BEGINNING
APRIL FIRST, TWO THOUSAND THIRTEEN AND ENDING MARCH THIRTY-FIRST, TWO
THOUSAND FOURTEEN, THE SUPERINTENDENT OF FINANCIAL SERVICES SHALL CAUSE
TO BE DEPOSITED INTO THE FUND FOR EACH SUCH FISCAL YEAR THE AMOUNT
APPROPRIATED FOR SUCH PURPOSE. BEGINNING APRIL FIRST, TWO THOUSAND
FOURTEEN AND ANNUALLY THEREAFTER, THE SUPERINTENDENT OF FINANCIAL
SERVICES SHALL CAUSE TO BE DEPOSITED INTO THE FUND, SUBJECT TO AVAILABLE
APPROPRIATIONS, AN AMOUNT EQUAL TO THE DIFFERENCE BETWEEN THE AMOUNT
APPROPRIATED TO THE FUND IN THE PRECEDING FISCAL YEAR, AS INCREASED BY
THE ADJUSTMENT FACTOR DEFINED IN SUBDIVISION SEVEN OF THIS SECTION, AND
THE ASSETS OF THE FUND AT THE CONCLUSION OF THAT FISCAL YEAR.
6. (A) FOLLOWING THE DEPOSIT REFERENCED IN SUBDIVISION FIVE OF THIS
SECTION, THE SUPERINTENDENT OF FINANCIAL SERVICES SHALL CONDUCT AN ACTU-
ARIAL CALCULATION OF THE ESTIMATED LIABILITIES OF THE FUND FOR THE
COMING YEAR RESULTING FROM THE QUALIFIED PLAINTIFFS ENROLLED IN THE
FUND. THE ADMINISTRATOR SHALL FROM TIME TO TIME ADJUST SUCH CALCULATION.
IF THE TOTAL OF ALL ESTIMATES OF CURRENT LIABILITIES EQUALS OR EXCEEDS
EIGHTY PERCENT OF THE FUND'S ASSETS, THEN THE FUND SHALL NOT ACCEPT ANY
S. 2809--D 150 A. 4009--D
NEW ENROLLMENTS UNTIL A NEW DEPOSIT HAS BEEN MADE PURSUANT TO SUBDIVI-
SION FIVE OF THIS SECTION. WHEN, AS A RESULT OF SUCH NEW DEPOSIT, THE
FUND'S LIABILITIES NO LONGER EXCEED EIGHTY PERCENT OF THE FUND'S ASSETS,
THE FUND ADMINISTRATOR SHALL ENROLL NEW QUALIFIED PLAINTIFFS IN THE
ORDER THAT AN APPLICATION FOR ENROLLMENT HAS BEEN SUBMITTED IN ACCORD-
ANCE WITH SUBDIVISION SEVEN OF SECTION TWENTY-NINE HUNDRED NINETY-NINE-J
OF THIS TITLE.
(B) WHENEVER ENROLLMENT IS SUSPENDED PURSUANT TO PARAGRAPH (A) OF THIS
SUBDIVISION AND UNTIL SUCH TIME AS ENROLLMENT RESUMES PURSUANT TO SUCH
PARAGRAPH: (I) NOTICE OF SUCH SUSPENSION SHALL BE PROMPTLY POSTED ON
THE DEPARTMENT'S WEBSITE AND ON THE WEBSITE OF THE DEPARTMENT OF FINAN-
CIAL SERVICES; (II) THE FUND ADMINISTRATOR SHALL DENY EACH APPLICATION
FOR ENROLLMENT THAT HAD BEEN RECEIVED BUT NOT ACCEPTED PRIOR TO THE DATE
OF SUSPENSION AND EACH APPLICATION FOR ENROLLMENT RECEIVED AFTER THE
DATE OF SUCH SUSPENSION; AND (III) NOTIFICATION OF EACH SUCH DENIAL
SHALL BE MADE TO THE PLAINTIFF OR CLAIMANT OR PERSONS AUTHORIZED TO ACT
ON BEHALF OF SUCH PLAINTIFF OR CLAIMANT AND ALL DEFENDANTS IN REGARD TO
SUCH PLAINTIFF OR CLAIMANT, TO THE EXTENT THEY ARE KNOWN TO THE FUND
ADMINISTRATOR. JUDGMENTS AND SETTLEMENTS FOR PLAINTIFFS OR CLAIMANTS FOR
WHOM APPLICATIONS ARE DENIED UNDER THIS PARAGRAPH OR WHO ARE NOT ELIGI-
BLE FOR ENROLLMENT DUE TO SUSPENSION PURSUANT TO PARAGRAPH (A) OF THIS
SUBDIVISION SHALL BE SATISFIED AS IF THIS TITLE HAD NOT BEEN ENACTED.
(C) FOLLOWING A SUSPENSION, WHENEVER ENROLLMENT RESUMES PURSUANT TO
PARAGRAPH (A) OF THIS SUBDIVISION, NOTICE THAT ENROLLMENT HAS RESUMED
SHALL BE PROMPTLY POSTED ON THE DEPARTMENT'S WEBSITE AND ON THE WEBSITE
OF THE DEPARTMENT OF FINANCIAL SERVICES.
(D) THE SUSPENSION OF ENROLLMENT PURSUANT TO PARAGRAPH (A) OF THIS
SUBDIVISION SHALL NOT IMPACT PAYMENT UNDER THE FUND FOR ANY QUALIFIED
PLAINTIFFS ALREADY ENROLLED IN THE FUND.
7. FOR PURPOSES OF THIS SECTION, THE ADJUSTMENT FACTOR REFERENCED IN
THIS SECTION SHALL BE THE TEN YEAR ROLLING AVERAGE MEDICAL COMPONENT OF
THE CONSUMER PRICE INDEX AS PUBLISHED BY THE UNITED STATES DEPARTMENT OF
LABOR, BUREAU OF LABOR STATISTICS, FOR THE PRECEDING TEN YEARS.
S 2999-J. PAYMENTS FROM THE FUND. 1. THE FUND SHALL BE USED TO PAY
THE QUALIFYING HEALTH CARE COSTS OF QUALIFIED PLAINTIFFS.
2. THE PROVISION OF QUALIFYING HEALTH CARE COSTS TO QUALIFIED PLAIN-
TIFFS SHALL NOT BE SUBJECT TO PRIOR AUTHORIZATION, EXCEPT AS DESCRIBED
BY THE COMMISSIONER IN REGULATION; PROVIDED, HOWEVER, THAT SUCH REGU-
LATION SHALL NOT PREVENT QUALIFIED PLAINTIFFS FROM RECEIVING CARE OR
ASSISTANCE THAT WOULD, AT A MINIMUM, BE AUTHORIZED UNDER THE MEDICAID
PROGRAM; AND PROVIDED, FURTHER, THAT IF ANY PRIOR AUTHORIZATION IS
REQUIRED BY SUCH REGULATION, THE REGULATION SHALL REQUIRE THAT REQUESTS
FOR PRIOR AUTHORIZATION BE PROCESSED WITHIN A REASONABLY PROMPT PERIOD
OF TIME AND SHALL IDENTIFY A PROCESS FOR PROMPT ADMINISTRATIVE REVIEW OF
ANY DENIAL OF A REQUEST FOR PRIOR AUTHORIZATION.
3. IN DETERMINING THE AMOUNT OF QUALIFYING HEALTH CARE COSTS TO BE
PAID FROM THE FUND, ANY SUCH COST OR EXPENSE THAT WAS OR WILL, WITH
REASONABLE CERTAINTY, BE PAID, REPLACED OR INDEMNIFIED FROM ANY COLLAT-
ERAL SOURCE AS PROVIDED BY SUBDIVISION (A) OF SECTION FORTY-FIVE HUNDRED
FORTY-FIVE OF THE CIVIL PRACTICE LAW AND RULES SHALL NOT CONSTITUTE A
QUALIFYING HEALTH CARE COST AND SHALL NOT BE PAID FROM THE FUND. FOR
PURPOSES OF THIS TITLE, "COLLATERAL SOURCE" SHALL NOT INCLUDE MEDICARE
OR MEDICAID.
4. THE AMOUNT OF QUALIFYING HEALTH CARE COSTS TO BE PAID FROM THE FUND
SHALL BE CALCULATED: (A) WITH RESPECT TO SERVICES PROVIDED IN PRIVATE
PHYSICIAN PRACTICES ON THE BASIS OF ONE HUNDRED PERCENT OF THE USUAL AND
S. 2809--D 151 A. 4009--D
CUSTOMARY RATES, AS DEFINED BY THE COMMISSIONER IN REGULATION; OR (B)
WITH RESPECT TO ALL OTHER SERVICES, ON THE BASIS OF MEDICAID RATES OF
REIMBURSEMENT OR, WHERE NO SUCH RATES ARE AVAILABLE, AS DEFINED BY THE
COMMISSIONER IN REGULATION.
5. CLAIMS FOR THE PAYMENT OR REIMBURSEMENT FROM THE FUND OF QUALIFYING
HEALTH CARE COSTS SHALL BE MADE UPON FORMS PRESCRIBED AND FURNISHED BY
THE FUND ADMINISTRATOR IN CONSULTATION WITH THE COMMISSIONER AND IN
CONJUNCTION WITH REGULATIONS ESTABLISHING A MECHANISM FOR SUBMISSION OF
CLAIMS BY HEALTH CARE PROVIDERS DIRECTLY TO THE FUND, WHERE PRACTICABLE.
6. (A) EVERY SETTLEMENT AGREEMENT FOR CLAIMS ARISING OUT OF A
PLAINTIFF'S OR CLAIMANT'S BIRTH RELATED NEUROLOGICAL INJURY SUBJECT TO
THIS TITLE, AND THAT PROVIDES FOR THE PAYMENT OF FUTURE MEDICAL EXPENSES
FOR THE PLAINTIFF OR CLAIMANT, SHALL PROVIDE THAT IN THE EVENT THE
ADMINISTRATOR OF THE FUND DETERMINES THAT THE PLAINTIFF OR CLAIMANT IS A
QUALIFIED PLAINTIFF, ALL PAYMENTS FOR FUTURE MEDICAL EXPENSES SHALL BE
PAID IN ACCORDANCE WITH THIS TITLE, IN LIEU OF THAT PORTION OF THE
SETTLEMENT AGREEMENT THAT PROVIDES FOR PAYMENT OF SUCH EXPENSES. THE
PLAINTIFF'S OR CLAIMANT'S FUTURE MEDICAL EXPENSES SHALL BE PAID IN
ACCORDANCE WITH THIS TITLE. WHEN SUCH A SETTLEMENT AGREEMENT DOES NOT SO
PROVIDE, THE COURT SHALL DIRECT THE MODIFICATION OF THE AGREEMENT TO
INCLUDE SUCH TERM AS A CONDITION OF COURT APPROVAL.
(B) IN ANY CASE WHERE THE JURY OR COURT HAS MADE AN AWARD FOR FUTURE
MEDICAL EXPENSES ARISING OUT OF A BIRTH RELATED NEUROLOGICAL INJURY, ANY
PARTY TO SUCH ACTION OR PERSON AUTHORIZED TO ACT ON BEHALF OF SUCH PARTY
MAY MAKE APPLICATION TO THE COURT THAT THE JUDGMENT REFLECT THAT, IN
LIEU OF THAT PORTION OF THE AWARD THAT PROVIDES FOR PAYMENT OF SUCH
EXPENSES, AND UPON A DETERMINATION BY THE FUND ADMINISTRATOR THAT THE
PLAINTIFF IS A QUALIFIED PLAINTIFF, THE FUTURE MEDICAL EXPENSES OF THE
PLAINTIFF SHALL BE PAID OUT OF THE FUND IN ACCORDANCE WITH THIS TITLE.
UPON A FINDING BY THE COURT THAT THE APPLICANT HAS MADE A PRIMA FACIE
SHOWING THAT THE PLAINTIFF IS A QUALIFIED PLAINTIFF, THE COURT SHALL
ENSURE THAT THE JUDGMENT SO PROVIDES.
7. A QUALIFIED PLAINTIFF SHALL BE ENROLLED WHEN (A) SUCH PLAINTIFF OR
PERSON AUTHORIZED TO ACT ON BEHALF OF SUCH PERSON, UPON NOTICE TO ALL
DEFENDANTS, OR ANY OF THE DEFENDANTS IN REGARD TO THE PLAINTIFF'S CLAIM,
UPON NOTICE TO SUCH PLAINTIFF, MAKES AN APPLICATION FOR ENROLLMENT BY
PROVIDING THE FUND ADMINISTRATOR WITH A CERTIFIED COPY OF THE JUDGMENT
OR OF THE COURT APPROVED SETTLEMENT AGREEMENT; AND (B) THE FUND ADMINIS-
TRATOR DETERMINES UPON THE BASIS OF SUCH JUDGMENT OR SETTLEMENT AGREE-
MENT AND ANY ADDITIONAL INFORMATION THE FUND ADMINISTRATOR SHALL REQUEST
THAT THE RELEVANT PROVISIONS OF SUBDIVISION SIX OF THIS SECTION HAVE
BEEN MET AND THAT THE PLAINTIFF IS A QUALIFIED PLAINTIFF; PROVIDED THAT
NO ENROLLMENT SHALL OCCUR WHEN THE FUND IS CLOSED TO ENROLLMENT PURSUANT
TO SUBDIVISION SIX OF SECTION TWENTY-NINE HUNDRED NINETY-NINE-I OF THIS
TITLE.
8. AS TO ALL CLAIMS, THE FUND ADMINISTRATOR SHALL:
(A) DETERMINE WHICH OF SUCH COSTS ARE QUALIFYING HEALTH CARE COSTS TO
BE PAID FROM THE FUND; AND
(B) THEREUPON CERTIFY TO THE COMMISSIONER OF TAXATION AND FINANCE
THOSE COSTS THAT HAVE BEEN DETERMINED TO BE QUALIFYING HEALTH CARE COSTS
TO BE PAID FROM THE FUND.
9. PAYMENTS FROM THE FUND SHALL BE MADE BY THE COMMISSIONER OF TAXA-
TION AND FINANCE ON THE SAID CERTIFICATE OF THE SUPERINTENDENT OF FINAN-
CIAL SERVICES. NO PAYMENT SHALL BE MADE BY THE COMMISSIONER OF TAXATION
AND FINANCE IN EXCESS OF THE AMOUNT CERTIFIED. PROMPTLY UPON RECEIPT OF
THE SAID CERTIFICATE OF THE SUPERINTENDENT OF FINANCIAL SERVICES, THE
S. 2809--D 152 A. 4009--D
COMMISSIONER OF TAXATION AND FINANCE SHALL PAY THE QUALIFIED PLAINTIFF'S
HEALTH CARE PROVIDER OR REIMBURSE THE QUALIFIED PLAINTIFF THE AMOUNT SO
CERTIFIED FOR PAYMENT.
10. PAYMENT FROM THE FUND SHALL NOT GIVE THE FUND ANY RIGHT OF RECOV-
ERY AGAINST ANY QUALIFIED PLAINTIFF OR SUCH QUALIFIED PLAINTIFF'S ATTOR-
NEY EXCEPT IN THE CASE OF FRAUD OR MISTAKE.
11. ALL HEALTH CARE PROVIDERS SHALL ACCEPT FROM QUALIFIED PLAINTIFF'S
OR PERSONS AUTHORIZED TO ACT ON BEHALF OF SUCH PLAINTIFF'S ASSIGNMENTS
OF THE RIGHT TO RECEIVE PAYMENTS FROM THE FUND FOR QUALIFYING HEALTH
CARE COSTS.
12. HEALTH INSURERS (OTHER THAN MEDICARE AND MEDICAID) SHALL BE THE
PRIMARY PAYERS OF QUALIFYING HEALTH CARE COSTS OF QUALIFIED PLAINTIFFS.
SUCH COSTS SHALL BE PAID FROM THE FUND ONLY TO THE EXTENT THAT HEALTH
INSURERS OR OTHER COLLATERAL SOURCES OR OTHER PERSONS ARE NOT OTHERWISE
OBLIGATED TO MAKE PAYMENTS THEREFOR. HEALTH INSURERS THAT MAKE PAYMENTS
FOR QUALIFYING HEALTH CARE COSTS TO OR ON BEHALF OF QUALIFIED PLAINTIFFS
SHALL HAVE NO RIGHT OF RECOVERY AGAINST AND SHALL HAVE NO LIEN UPON THE
FUND OR ANY PERSON OR ENTITY NOR SHALL THE FUND CONSTITUTE AN ADDITIONAL
PAYMENT SOURCE TO OFFSET THE PAYMENTS OTHERWISE CONTRACTUALLY REQUIRED
TO BE MADE BY SUCH HEALTH INSURERS. THE SUPERINTENDENT OF FINANCIAL
SERVICES SHALL HAVE THE AUTHORITY TO ENFORCE THE PROVISIONS OF THIS
SUBDIVISION.
13. EXCEPT AS PROVIDED FOR BY THIS TITLE, WITH RESPECT TO A QUALIFIED
PLAINTIFF, NO PAYMENT SHALL BE REQUIRED TO BE MADE BY ANY DEFENDANT OR
SUCH DEFENDANT'S INSURER FOR QUALIFYING HEALTH CARE COSTS AND NO JUDG-
MENT SHALL BE MADE OR ENTERED REQUIRING THAT ANY SUCH PAYMENT BE MADE BY
ANY DEFENDANT OR SUCH DEFENDANT'S INSURER FOR SUCH HEALTH CARE COSTS.
14. THE DETERMINATION OF THE QUALIFIED PLAINTIFF'S ATTORNEY'S FEE
SHALL BE BASED UPON THE ENTIRE SUM AWARDED BY THE JURY OR THE COURT OR
THE FULL SUM OF THE SETTLEMENT, AS THE CASE MAY BE. THE QUALIFIED
PLAINTIFF'S ATTORNEY'S FEE SHALL BE PAID IN A LUMP SUM BY THE DEFENDANTS
AND THEIR INSURERS PURSUANT TO SECTION FOUR HUNDRED SEVENTY-FOUR-A OF
THE JUDICIARY LAW; PROVIDED HOWEVER THAT THE PORTION OF THE ATTORNEY FEE
THAT IS ALLOCATED TO THE NON-FUND ELEMENTS OF DAMAGES SHALL BE DEDUCTED
FROM THE NON-FUND PORTION OF THE AWARD IN A PROPORTIONAL MANNER.
15. THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF
FINANCIAL SERVICES, SHALL PROMULGATE, AMEND AND ENFORCE ALL RULES AND
REGULATIONS NECESSARY FOR THE PROPER ADMINISTRATION OF THE FUND IN
ACCORDANCE WITH THE PROVISIONS OF THIS SECTION, INCLUDING, BUT NOT
LIMITED TO, THOSE CONCERNING THE PAYMENT OF CLAIMS AND CONCERNING THE
ACTUARIAL CALCULATIONS NECESSARY TO DETERMINE, ANNUALLY, THE TOTAL
AMOUNT TO BE PAID INTO THE FUND AS PROVIDED HEREIN, AND AS OTHERWISE
NEEDED TO IMPLEMENT THIS TITLE.
16. THE COMMISSIONER SHALL CONVENE A CONSUMER ADVISORY COMMITTEE FOR
THE PURPOSE OF PROVIDING INFORMATION, AS REQUESTED BY THE COMMISSIONER,
IN THE DEVELOPMENT OF THE REGULATIONS AUTHORIZED BY SUBDIVISION FIFTEEN
OF THIS SECTION.
S 52-a. Article 29-D of the public health law is amended by adding a
new title 5 to read as follows:
TITLE 5
NEW YORK STATE HOSPITAL QUALITY INITIATIVE
SECTION 2999-M. NEW YORK STATE HOSPITAL QUALITY INITIATIVE.
S 2999-M. NEW YORK STATE HOSPITAL QUALITY INITIATIVE. THE NEW YORK
STATE HOSPITAL QUALITY INITIATIVE, INCLUDING THE NEW YORK STATE OBSTET-
RICAL PATIENT SAFETY WORKGROUP, WILL BE CREATED IN THE DEPARTMENT OF
S. 2809--D 153 A. 4009--D
HEALTH TO BE COMPRISED OF MEDICAL, HOSPITAL AND ACADEMIC EXPERTS AND
OTHER STAKEHOLDERS CHOSEN BY THE COMMISSIONER.
THE NEW YORK STATE QUALITY INITIATIVE WILL OVERSEE THE GENERAL DISSEM-
INATION OF INITIATIVES, GUIDANCE, AND BEST PRACTICES TO GENERAL HOSPI-
TALS. ACTIVITIES WILL INCLUDE BUT NOT BE LIMITED TO: BUILDING CULTURES
OF PATIENT SAFETY AND IMPLEMENTING EVIDENCE BASED CARE IN TARGET AREAS.
THE WORKGROUP WILL UNDERTAKE COLLABORATIVE WORK TO IMPROVE OBSTETRICAL
CARE OUTCOMES AND QUALITY OF CARE, BASED ON IDENTIFYING AND IMPLEMENTING
EVIDENCE BASED PRACTICES, AND CLINICAL PROTOCOLS THAT CAN BE STANDARD-
IZED AND ADOPTED BY HOSPITALS INCLUDING BUT NOT LIMITED TO:
(A) SURVEYING, REVIEWING AND ANALYZING CURRENT "BEST" PRACTICES
EMPLOYED IN OBSTETRICAL CASES, INCLUDING EXPLORING THE USE OF "VIRTUAL
GRAND ROUNDS";
(B) UNDERTAKING A REVIEW OF CLAIMS IN AN EFFORT TO DEVELOP A SET OF
"STANDARD BEST PRACTICES" FOR DELIVERIES IN NEW YORK STATE;
(C) FORMULATING AND RECOMMENDING TO THE COMMISSIONER BEST PRACTICE
STANDARDS AND DESIGNING NEW PROGRAMS FOR IMPLEMENTATION AND IMPROVED
OUTCOMES, INCLUDING BUT NOT LIMITED TO, CLINICAL BUNDLES FOR HIGH PRIOR-
ITY CONDITIONS, ELECTRONIC FETAL MONITORING TRAINING AND CERTIFICATION,
AND TEAM TRAINING; AND
(D) ENGAGING THE EXISTING REGIONAL PERINATAL CENTER NETWORK IN
DIALOGUES REGARDING THE ABOVE TOPICS AND MAKING RECOMMENDATIONS TO
IMPROVE AND/OR UPGRADE ASSISTANCE AND COMMUNICATION TO SMALLER HOSPI-
TALS.
S 52-b. 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 SET ASIDE AND ACCUMULATED FROM YEAR
TO YEAR AND SHALL BE MADE AVAILABLE, INCLUDING INCOME FROM INVESTMENT
FUNDS, FOR THE PURPOSE OF SUPPORTING THE NEW YORK STATE MEDICAL INDEM-
NITY FUND AS AUTHORIZED PURSUANT TO TITLE FOUR OF ARTICLE TWENTY-NINE-D
OF THIS CHAPTER, FOR THE FOLLOWING PERIODS AND IN THE FOLLOWING AMOUNTS,
PROVIDED, HOWEVER, THAT THE COMMISSIONER IS AUTHORIZED TO SEEK WAIVER
AUTHORITY FROM THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID FOR THE
PURPOSE OF SECURING MEDICAID FEDERAL FINANCIAL PARTICIPATION FOR SUCH
PROGRAM, IN WHICH CASE THE FUNDING AUTHORIZED PURSUANT TO THIS PARAGRAPH
SHALL BE UTILIZED AS THE NON-FEDERAL SHARE FOR SUCH PAYMENTS:
THIRTY MILLION DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE.
S 52-c. The public health law is amended by adding a new section
2807-d-1 to read as follows:
S 2807-D-1. HOSPITAL QUALITY CONTRIBUTIONS. 1. NOTWITHSTANDING ANY
CONTRARY PROVISION OF LAW AND SUBJECT TO THE RECEIPT OF ALL NECESSARY
FEDERAL APPROVALS OR WAIVERS, FOR PERIODS ON AND AFTER JULY FIRST, TWO
THOUSAND ELEVEN, A QUALITY CONTRIBUTION SHALL BE IMPOSED ON THE INPA-
TIENT REVENUE OF EACH GENERAL HOSPITAL THAT IS RECEIVED FOR THE
PROVISION OF INPATIENT OBSTETRICAL PATIENT CARE SERVICES IN AN AMOUNT
EQUAL TO ONE AND SIX-TENTHS PERCENT OF SUCH REVENUE, AS DEFINED IN
ACCORDANCE WITH PARAGRAPH (A) OF SUBDIVISION THREE OF SECTION
TWENTY-EIGHT HUNDRED SEVEN-D OF THIS ARTICLE, PROVIDED, HOWEVER, THAT IN
THE EVENT THE COMMISSIONER, IN CONSULTATION WITH THE DIRECTOR OF THE
BUDGET, DETERMINES THAT SUCH QUALITY CONTRIBUTION SHALL RAISE LESS THAN
OR MORE THAN THE TOTAL QUALITY COLLECTION AMOUNT SET FORTH IN SUBDIVI-
SION TWO OF THIS SECTION, THE COMMISSIONER, IN CONSULTATION WITH THE
DIRECTOR OF THE BUDGET, MAY PROMULGATE REGULATIONS, AND MAY PROMULGATE
EMERGENCY REGULATIONS, INCREASING OR DECREASING SUCH QUALITY CONTRIB-
S. 2809--D 154 A. 4009--D
UTIONS BY AMOUNTS SUFFICIENT TO ENSURE THE COLLECTION OF SUCH ANNUAL
QUALITY CONTRIBUTION AMOUNT.
2. THE ANNUAL QUALITY CONTRIBUTION AMOUNT REFERENCED IN SUBDIVISION
ONE OF THIS SECTION SHALL BE THIRTY MILLION DOLLARS FOR THE STATE FISCAL
YEAR BEGINNING APRIL FIRST, TWO THOUSAND ELEVEN, AND FOR EACH SUBSEQUENT
STATE FISCAL YEAR THEREAFTER IT SHALL BE THE AMOUNT OF THE PRECEDING
YEAR AS INCREASED BY THE TEN YEAR ROLLING AVERAGE OF THE MEDICAL COMPO-
NENT OF THE CONSUMER PRICE INDEX AS PUBLISHED BY THE UNITED STATES
DEPARTMENT OF LABOR, BUREAU OF LABOR STATISTICS, FOR THE PRECEDING TEN
YEARS.
3. THE QUALITY CONTRIBUTIONS DESCRIBED IN THIS SECTION SHALL BE ADMIN-
ISTERED IN ACCORDANCE WITH AND SUBJECT TO THE PROVISIONS OF SUBDIVISIONS
FOUR, FIVE, SIX, SEVEN, EIGHT AND TWELVE OF SECTION TWENTY-EIGHT HUNDRED
SEVEN-D OF THIS ARTICLE, PROVIDED, HOWEVER, THAT SUCH QUALITY CONTRIB-
UTIONS SHALL BE DEPOSITED IN THE HCRA RESOURCES FUND AS ESTABLISHED
PURSUANT TO SECTION NINETY-TWO-DD OF THE STATE FINANCE LAW; AND PROVIDED
FURTHER, HOWEVER, THAT SUCH CONTRIBUTIONS SHALL NOT BE AN ALLOWABLE COST
IN THE DETERMINATION OF REIMBURSEMENT RATES OF PAYMENT COMPUTED PURSUANT
TO THIS ARTICLE.
S 52-d. The civil practice law and rules is amended by adding a new
rule 3409 to read as follows:
RULE 3409. SETTLEMENT CONFERENCE IN DENTAL, PODIATRIC AND MEDICAL
MALPRACTICE ACTIONS. IN EVERY DENTAL, PODIATRIC OR MEDICAL MALPRACTICE
ACTION, THE COURT SHALL HOLD A MANDATORY SETTLEMENT CONFERENCE WITHIN
FORTY-FIVE DAYS AFTER THE FILING OF THE NOTE OF ISSUE AND CERTIFICATE OF
READINESS OR, IF A PARTY MOVES TO VACATE THE NOTE OF ISSUE AND CERTIF-
ICATE OF READINESS, WITHIN FORTY-FIVE DAYS AFTER THE DENIAL OF SUCH
MOTION. WHERE PARTIES ARE REPRESENTED BY COUNSEL, ONLY ATTORNEYS FULLY
FAMILIAR WITH THE ACTION AND AUTHORIZED TO DISPOSE OF THE CASE, OR
ACCOMPANIED BY A PERSON EMPOWERED TO ACT ON BEHALF OF THE PARTY REPRES-
ENTED, WILL BE PERMITTED TO APPEAR AT THE CONFERENCE. WHERE APPROPRIATE,
THE COURT MAY ORDER PARTIES, REPRESENTATIVES OF PARTIES, REPRESENTATIVES
OF INSURANCE CARRIERS OR PERSONS HAVING AN INTEREST IN ANY SETTLEMENT TO
ALSO ATTEND IN PERSON OR TELEPHONICALLY AT THE SETTLEMENT CONFERENCE.
THE CHIEF ADMINISTRATIVE JUDGE SHALL BY RULE ADOPT PROCEDURES TO IMPLE-
MENT SUCH SETTLEMENT CONFERENCE.
S 52-e. The state finance law is amended by adding a new section 99-t
to read as follows:
S 99-T. NEW YORK STATE MEDICAL INDEMNITY FUND ACCOUNT. 1. THERE IS
HEREBY ESTABLISHED IN THE CUSTODY OF THE COMMISSIONER OF TAXATION AND
FINANCE A SPECIAL ACCOUNT TO BE KNOWN AS THE "NEW YORK STATE MEDICAL
INDEMNITY FUND ACCOUNT".
2. ALL MONEYS RECEIVED BY THE NEW YORK STATE MEDICAL INDEMNITY FUND
PURSUANT TO TITLE FOUR OF ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW
FROM WHATEVER SOURCE DERIVED SHALL BE DEPOSITED TO THE EXCLUSIVE CREDIT
OF SUCH FUND ACCOUNT. SAID MONEYS SHALL BE KEPT SEPARATE AND SHALL NOT
BE COMMINGLED WITH ANY OTHER MONEYS IN THE CUSTODY OF THE COMMISSIONER
OF TAXATION AND FINANCE.
3. THE MONEYS IN SAID ACCOUNT SHALL BE RETAINED BY THE FUND AND SHALL
BE RELEASED BY THE COMMISSIONER OF TAXATION AND FINANCE ONLY UPON
CERTIFICATES SIGNED BY THE SUPERINTENDENT OF FINANCIAL SERVICES OR THE
HEAD OF ANY SUCCESSOR AGENCY TO THE DEPARTMENT OF INSURANCE OR HIS OR
HER DESIGNEE AND ONLY FOR THE PURPOSES SET FORTH IN TITLE FOUR OF ARTI-
CLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
S 52-f. Part C of chapter 58 of the laws of 2005, amending the public
health law and other laws relating to authorizing reimbursements for
S. 2809--D 155 A. 4009--D
expenditures made by social services districts for medical assistance,
is amended by adding a new section 5-a to read as follows:
S 5-A. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, THE
COMMISSIONER OF HEALTH IS AUTHORIZED TO APPROVE SOCIAL SERVICES DISTRICT
DEMONSTRATION PROGRAMS FOR THE PURPOSE OF MAXIMIZING MEDICAID RECOV-
ERIES. THE COMMISSIONER SHALL EVALUATE THE RESULTS OF ANY SUCH PROGRAMS,
INCLUDING ANY SAVINGS RESULTING THEREFROM. TEN PERCENT OF ANY SUCH
SAVINGS, AFTER CERTIFICATION BY THE DIRECTOR OF THE DIVISION OF THE
BUDGET, SHALL BE SHARED WITH THE APPLICABLE SOCIAL SERVICES DISTRICT IN
A MANNER TO BE DETERMINED JOINTLY BY THE COMMISSIONER OF HEALTH AND THE
DIRECTOR OF THE DIVISION OF THE BUDGET.
S 52-g. Subdivision 1 of section 104-b of the social services law, as
amended by chapter 271 of the laws of 1965, is amended to read as
follows:
1. If a recipient of public assistance and care shall have a right of
action, suit, claim, counterclaim or demand against another on account
of any personal injuries suffered by such recipient, then the public
welfare official for the public welfare district providing such assist-
ance and care shall have a lien for such amount as may be fixed by the
public welfare official not exceeding, however, the total amount of such
assistance and care furnished by such public welfare official on and
after the date when such injuries were incurred. IN ALL SUCH CASES,
NOTICE OF THE COMMENCEMENT OF SUCH AN ACTION SHALL BE SERVED UPON THE
PUBLIC WELFARE DISTRICT THAT HAS PROVIDED OR IS PROVIDING SUCH ASSIST-
ANCE AND CARE, OR UPON THE DEPARTMENT OF HEALTH.
The [welfare] commissioner shall endeavor to ascertain whether such
person, firm or corporation alleged to be responsible for such injuries
is insured with a liability insurance company, as the case may be, and
the name thereof.
S 52-h. The civil practice law and rules is amended by adding a new
section 306-c to read as follows:
S 306-C. NOTICE OF COMMENCEMENT OF ACTION FOR PERSONAL INJURIES BY
RECIPIENT OF MEDICAL ASSISTANCE. IN THE CASE OF AN INDIVIDUAL WHO HAS
SUFFERED PERSONAL INJURIES AND HAS RECEIVED MEDICAL ASSISTANCE PURSUANT
TO TITLES ELEVEN AND ELEVEN-D OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW
ON OR AFTER THE DATE OF SUCH INJURY, NOTICE OF THE COMMENCEMENT OF AN
ACTION BY OR ON BEHALF OF SUCH INDIVIDUAL FOR SUCH PERSONAL INJURIES
SHALL BE SENT TO THE SOCIAL SERVICES DISTRICT IN THE COUNTY IN WHICH
SUCH RECIPIENT RESIDES, OR TO THE DEPARTMENT OF HEALTH, BY CERTIFIED
MAIL, RETURN RECEIPT REQUESTED, OR ELECTRONICALLY IN ACCORD WITH REGU-
LATIONS PROMULGATED BY THE COMMISSIONER OF THE DEPARTMENT OF HEALTH,
WITHIN SIXTY DAYS OF THE COMPLETION OF SERVICE UPON ALL PARTIES TO SUCH
ACTION. PROOF OF SENDING SUCH NOTICE SHALL BE FILED WITH THE COURT IN
ACCORDANCE WITH RULE THREE HUNDRED SIX OF THIS ARTICLE. SENDING SUCH
NOTICE SHALL NOT BE A JURISDICTIONAL REQUIREMENT TO COMMENCING AN
ACTION.
S 52-i. Intentionally omitted.
S 52-j. Intentionally omitted.
S 52-k. Intentionally omitted.
S 52-l. Intentionally omitted.
S 52-m. Intentionally omitted.
S 53. 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] AN INDIVIDUAL'S "estate"
[means] INCLUDES all OF THE INDIVIDUAL'S real and personal property and
other assets [included within the individual's estate and] passing under
S. 2809--D 156 A. 4009--D
the terms of a valid will or by intestacy. PURSUANT TO REGULATIONS
ADOPTED BY THE COMMISSIONER, WHICH MAY BE PROMULGATED ON AN EMERGENCY
BASIS, AN INDIVIDUAL'S ESTATE ALSO INCLUDES ANY OTHER PROPERTY IN WHICH
THE INDIVIDUAL HAS 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; PROVIDED, HOWEVER, THAT A CLAIM
AGAINST A RECIPIENT OF SUCH PROPERTY BY DISTRIBUTION OR SURVIVAL SHALL
BE LIMITED TO THE VALUE OF THE PROPERTY RECEIVED OR THE AMOUNT OF
MEDICAL ASSISTANCE BENEFITS OTHERWISE RECOVERABLE PURSUANT TO THIS
SECTION, WHICHEVER IS LESS. NOTHING IN THIS SUBDIVISION SHALL BE
CONSTRUED AS AUTHORIZING THE DEPARTMENT OR A SOCIAL SERVICES DISTRICT TO
IMPOSE LIENS OR MAKE RECOVERIES THAT ARE PROHIBITED BY FEDERAL LAWS
GOVERNING THE MEDICAL ASSISTANCE PROGRAM.
S 54. Subparagraph 12 of paragraph (a) of subdivision 1 of section 366
of the social services law, as amended by section 42-a of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
(12) is a disabled person at least sixteen years of age, but under the
age of sixty-five, who: would be eligible for benefits under the supple-
mental security income program but for earnings in excess of the allow-
able limit; has net available income that does not exceed two hundred
fifty percent of the applicable federal income official poverty line, as
defined and updated by the United States department of health and human
services, for a one-person or two-person household, as defined by the
commissioner in regulation; has household resources, as defined in para-
graph (e) of subdivision two of section three hundred sixty-six-c of
this title, OTHER THAN RETIREMENT ACCOUNTS, that do not exceed [the
amount described in subparagraph four of paragraph (a) of subdivision
two of this section] TWENTY THOUSAND DOLLARS for a one-person HOUSEHOLD
or THIRTY THOUSAND DOLLARS FOR A two-person household, as defined by the
commissioner in regulation; and contributes to the cost of medical
assistance provided pursuant to this subparagraph in accordance with
subdivision twelve of section three hundred sixty-seven-a of this title;
for purposes of this subparagraph, disabled means having a medically
determinable impairment of sufficient severity and duration to qualify
for benefits under section 1902(a)(10)(A)(ii)(xv) of the social security
act; or
S 55. The mental hygiene law is amended by adding a new section 31.08
to read as follows:
S 31.08 COMPLIANCE WITH OPERATIONAL STANDARDS BY HOSPITALS.
(A) NOTWITHSTANDING THE PROVISIONS OF SECTION 31.07 OF THIS ARTICLE,
WITH RESPECT TO A HOSPITAL AS DEFINED IN SECTION 1.03 OF THIS CHAPTER,
WHICH IS A WARD, WING, UNIT, OR OTHER PART OF A HOSPITAL, AS DEFINED IN
ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, WHICH PROVIDES SERVICES
FOR PERSONS WITH MENTAL ILLNESS PURSUANT TO AN OPERATING CERTIFICATE
ISSUED BY THE COMMISSIONER, THE REQUIREMENTS OF SECTION 31.07 OF THIS
ARTICLE MAY BE DEEMED TO BE MET IF SUCH HOSPITAL HAS BEEN ACCREDITED BY
THE JOINT COMMISSION, OR ANY OTHER HOSPITAL ACCREDITING ORGANIZATION TO
WHICH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES HAS GRANTED DEEMING
STATUS, AND WHICH THE COMMISSIONER SHALL HAVE DETERMINED HAS ACCREDITING
STANDARDS SUFFICIENT TO ASSURE THE COMMISSIONER THAT HOSPITALS SO
ACCREDITED ARE IN COMPLIANCE WITH THE PROVISIONS OF THIS CHAPTER AND
APPLICABLE LAWS, RULES AND REGULATIONS IN REGARD TO SERVICES PROVIDED AT
SUCH WING, WARD, UNIT OR OTHER PART OF A HOSPITAL. SUCH ACCREDITATION
SHALL HAVE THE SAME LEGAL EFFECT AS A DETERMINATION BY THE COMMISSIONER
UNDER SECTION 31.07 OF THIS ARTICLE THAT THE HOSPITAL IS IN COMPLIANCE
WITH SUCH PROVISIONS. THE COMMISSIONER MAY EXEMPT ANY SUCH HOSPITAL
S. 2809--D 157 A. 4009--D
FROM THE ANNUAL INSPECTION AND VISITATION REQUIREMENTS ESTABLISHED IN
SECTION 31.07 OF THIS ARTICLE, PROVIDED THAT:
1. SUCH HOSPITAL HAS A HISTORY OF COMPLIANCE WITH SUCH PROVISIONS OF
LAW, RULES AND REGULATIONS AND A RECORD OF PROVIDING GOOD QUALITY CARE,
AS DETERMINED BY THE COMMISSIONER;
2. A COPY OF THE SURVEY REPORT AND THE CERTIFICATE OF ACCREDITATION OF
THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING ORGANIZATION IS
SUBMITTED BY THE ACCREDITING BODY OR THE HOSPITAL TO THE COMMISSIONER,
WITHIN SEVEN DAYS OF ISSUANCE TO THE HOSPITAL;
3. THE JOINT COMMISSION OR OTHER ACCREDITING ORGANIZATION HAS AGREED
TO AND DOES EVALUATE, AS PART OF ITS ACCREDITATION SURVEY, ANY MINIMAL
OPERATIONAL STANDARDS ESTABLISHED BY THE COMMISSIONER WHICH ARE IN ADDI-
TION TO THE MINIMAL OPERATIONAL STANDARDS OF ACCREDITATION OF THE JOINT
COMMISSION OR OTHER ACCREDITING ORGANIZATION; AND
4. THERE ARE NO CONSTRAINTS PLACED UPON ACCESS BY THE COMMISSIONER TO
THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING ORGANIZATION SURVEY
REPORTS, PLANS OF CORRECTION, INTERIM SELF-EVALUATION REPORTS, NOTICES
OF NONCOMPLIANCE, PROGRESS REPORTS ON CORRECTION OF AREAS OF NONCOMPLI-
ANCE, OR ANY OTHER RELATED REPORTS, INFORMATION, COMMUNICATIONS OR MATE-
RIALS REGARDING SUCH HOSPITAL.
(B) ANY HOSPITAL GOVERNED BY THE PROVISIONS OF SUBDIVISION (A) OF THIS
SECTION SHALL AT ALL TIMES BE SUBJECT TO INSPECTION OR VISITATION BY THE
COMMISSIONER TO DETERMINE COMPLIANCE WITH APPLICABLE LAW, REGULATIONS,
STANDARDS OR CONDITIONS AS DEEMED NECESSARY BY THE COMMISSIONER. ANY
SUCH HOSPITAL SHALL BE SUBJECT TO THE FULL RANGE OF LICENSING ENFORCE-
MENT AUTHORITY OF THE COMMISSIONER.
(C) ANY HOSPITAL GOVERNED BY THE PROVISIONS OF SUBDIVISION (A) OF THIS
SECTION SHALL NOTIFY THE COMMISSIONER IMMEDIATELY UPON RECEIPT OF NOTICE
BY THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING ORGANIZATION, OR
ANY COMMUNICATION THE HOSPITAL MAY RECEIVE THAT SUCH ORGANIZATION WILL
BE RECOMMENDING THAT SUCH HOSPITAL NOT BE ACCREDITED, NOT HAVE ITS
ACCREDITATION RENEWED, OR HAVE ITS ACCREDITATION TERMINATED, OR UPON
RECEIPT OF NOTICE OR OTHER COMMUNICATION FROM THE CENTERS FOR MEDICARE
AND MEDICAID SERVICES REGARDING A DETERMINATION THAT THE HOSPITAL WILL
BE TERMINATED FROM PARTICIPATION IN THE MEDICARE PROGRAM BECAUSE IT IS
NOT IN COMPLIANCE WITH ONE OR MORE CONDITIONS OF PARTICIPATION IN SUCH
PROGRAM, OR HAS DEFICIENCIES THAT EITHER INDIVIDUALLY OR IN COMBINATION
JEOPARDIZE THE HEALTH AND SAFETY OF PATIENTS OR ARE OF SUCH CHARACTER AS
TO SERIOUSLY LIMIT THE PROVIDER'S CAPACITY TO RENDER ADEQUATE CARE.
S 56. The mental hygiene law is amended by adding a new section 32.14
to read as follows:
S 32.14 COMPLIANCE WITH OPERATIONAL STANDARDS BY PROVIDERS OF SERVICES
IN HOSPITALS.
(A) NOTWITHSTANDING THE PROVISIONS OF SECTION 32.13 OF THIS ARTICLE,
WITH RESPECT TO A PROVIDER OF SERVICES AS DEFINED IN SECTION 1.03 OF
THIS CHAPTER THAT OCCUPIES A WARD, WING, UNIT, OR OTHER PART OF A HOSPI-
TAL, AS DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, WHICH
PROVIDES SERVICES FOR PERSONS WITH MENTAL DISABILITIES PURSUANT TO AN
OPERATING CERTIFICATE ISSUED BY THE COMMISSIONER, THE REQUIREMENTS OF
SECTION 32.13 OF THIS ARTICLE MAY BE DEEMED TO BE MET IF SUCH HOSPITAL
HAS BEEN ACCREDITED BY THE JOINT COMMISSION, OR ANY OTHER ACCREDITING
ORGANIZATION TO WHICH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES HAS
GRANTED DEEMING STATUS, AND WHICH THE COMMISSIONER SHALL HAVE DETERMINED
HAS ACCREDITING STANDARDS SUFFICIENT TO ASSURE THE COMMISSIONER THAT
PROVIDERS OF SERVICES OCCUPYING A WARD, WING, UNIT OR OTHER PART OF SUCH
HOSPITAL SO ACCREDITED ARE IN COMPLIANCE WITH THE PROVISIONS OF THIS
S. 2809--D 158 A. 4009--D
CHAPTER AND APPLICABLE LAWS, RULES AND REGULATIONS IN REGARD TO SERVICES
PROVIDED AT SUCH WARD, WING, UNIT OR OTHER PART OF A HOSPITAL. SUCH
ACCREDITATION SHALL HAVE THE SAME LEGAL EFFECT AS A DETERMINATION BY THE
COMMISSIONER UNDER SECTION 32.13 OF THIS ARTICLE THAT THE PROVIDER OF
SERVICES IS IN COMPLIANCE WITH SUCH PROVISIONS. THE COMMISSIONER MAY
EXEMPT ANY SUCH PROVIDER OF SERVICES, IN REGARD TO SERVICES PROVIDED AT
SUCH WARD, WING, UNIT OR OTHER PART OF A HOSPITAL, FROM THE ANNUAL
INSPECTION AND VISITATION REQUIREMENTS ESTABLISHED IN SECTION 32.13 OF
THIS ARTICLE, PROVIDED THAT:
1. SUCH PROVIDER OF SERVICES HAS A HISTORY OF COMPLIANCE WITH SUCH
PROVISIONS OF LAW, RULES AND REGULATIONS AND A RECORD OF PROVIDING GOOD
QUALITY CARE, AS DETERMINED BY THE COMMISSIONER;
2. A COPY OF THE SURVEY REPORT AND THE CERTIFICATE OF ACCREDITATION OF
THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING ORGANIZATION IS
SUBMITTED BY THE ACCREDITING BODY OR THE PROVIDER OF SERVICES TO THE
COMMISSIONER, WITHIN SEVEN DAYS OF ISSUANCE TO SUCH PROVIDER OF
SERVICES;
3. THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING ORGANIZATION HAS
AGREED TO AND DOES EVALUATE, AS PART OF ITS ACCREDITATION SURVEY, ANY
MINIMAL OPERATIONAL STANDARDS ESTABLISHED BY THE COMMISSIONER WHICH ARE
IN ADDITION TO THE MINIMAL OPERATIONAL STANDARDS OF ACCREDITATION OF THE
JOINT COMMISSION OR OTHER ACCREDITING ORGANIZATION; AND
4. THERE ARE NO CONSTRAINTS PLACED UPON ACCESS BY THE COMMISSIONER TO
THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING ORGANIZATION SURVEY
REPORTS, PLANS OF CORRECTION, INTERIM SELF-EVALUATION REPORTS, NOTICES
OF NONCOMPLIANCE, PROGRESS REPORTS ON CORRECTION OF AREAS OF NONCOMPLI-
ANCE, OR ANY OTHER RELATED REPORTS, INFORMATION, COMMUNICATIONS OR MATE-
RIALS REGARDING SUCH PROVIDER OF SERVICES.
(B) ANY PROVIDER OF SERVICES GOVERNED BY THE PROVISIONS OF SUBDIVISION
(A) OF THIS SECTION SHALL AT ALL TIMES BE SUBJECT TO INSPECTION OR VISI-
TATION BY THE COMMISSIONER TO DETERMINE COMPLIANCE WITH APPLICABLE LAW,
REGULATIONS, STANDARDS OR CONDITIONS AS DEEMED NECESSARY BY THE COMMIS-
SIONER. ANY SUCH PROVIDER OF SERVICES SHALL BE SUBJECT TO THE FULL RANGE
OF CERTIFICATION ENFORCEMENT AUTHORITY OF THE COMMISSIONER.
(C) ANY PROVIDER OF SERVICES GOVERNED BY THE PROVISIONS OF SUBDIVISION
(A) OF THIS SECTION SHALL NOTIFY THE COMMISSIONER IMMEDIATELY UPON
RECEIPT OF NOTICE BY THE JOINT COMMISSION OR OTHER APPROVED ACCREDITING
ORGANIZATION, OR ANY COMMUNICATION THE PROVIDER OF SERVICES MAY RECEIVE
THAT SUCH ORGANIZATION WILL BE RECOMMENDING THAT SUCH PROVIDER OF
SERVICES NOT BE ACCREDITED, NOT HAVE ITS ACCREDITATION RENEWED, OR HAVE
ITS ACCREDITATION TERMINATED, OR UPON RECEIPT OF NOTICE OR OTHER COMMU-
NICATION FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES REGARDING A
DETERMINATION THAT THE PROVIDER OF SERVICES WILL BE TERMINATED FROM
PARTICIPATION IN THE MEDICARE OR MEDICAID PROGRAM BECAUSE IT IS NOT IN
COMPLIANCE WITH ONE OR MORE CONDITIONS OF PARTICIPATION IN SUCH PROGRAM,
OR HAS DEFICIENCIES THAT EITHER INDIVIDUALLY OR IN COMBINATION JEOPARD-
IZE THE HEALTH AND SAFETY OF PATIENTS OR ARE OF SUCH CHARACTER AS TO
SERIOUSLY LIMIT THE PROVIDER'S CAPACITY TO RENDER ADEQUATE CARE.
S 57. Intentionally omitted.
S 58. Section 2805-l of the public health law, as added by chapter 266
of the laws of 1986, subdivision 3 as amended by chapter 542 of the laws
of 2000, subdivision 4 as added and subdivision 5 as renumbered by chap-
ter 632 of the laws of 2006, is amended to read as follows:
S 2805-l. [Incident] ADVERSE EVENT reporting. 1. (A) All hospitals[,
as defined in subdivision ten of section twenty-eight hundred one of
this article,] shall be required to report [incidents] EVENTS described
S. 2809--D 159 A. 4009--D
by subdivision two of this section to the department in a manner and
within time periods as may be specified by regulation of the department.
(B) FOR PURPOSES OF THIS SECTION, "HOSPITAL" MEANS ANY GENERAL HOSPI-
TAL OR DIAGNOSTIC AND TREATMENT CENTER.
2. The following [incidents] ADVERSE EVENTS shall be reported to the
department:
(a) patients' deaths or impairments of bodily functions in circum-
stances other than those related to the natural course of illness,
disease or proper treatment in accordance with generally accepted
medical standards;
(b) fires in the hospital which disrupt the provision of patient care
services or cause harm to patients or staff;
(c) equipment malfunction during treatment or diagnosis of a patient
which did or could have adversely affected a patient or hospital person-
nel;
(d) poisoning occurring within the hospital;
(e) strikes by hospital staff;
(f) disasters or other emergency situations external to the hospital
environment which affect hospital operations; and
(g) termination of any services vital to the continued safe operation
of the hospital or to the health and safety of its patients and person-
nel, including but not limited to the anticipated or actual termination
of telephone, electric, gas, fuel, water, heat, air conditioning, rodent
or pest control, laundry services, food or contract services.
3. NOTWITHSTANDING ANY PROVISION OF THIS SECTION TO THE CONTRARY, THE
COMMISSIONER IS AUTHORIZED, AS APPROPRIATE IN THE INTEREST OF PROMOTING
PATIENT SAFETY, AND AFTER CONSULTING WITH CLINICIANS, HOSPITAL ADMINIS-
TRATORS, RESEARCHERS, AND CONSUMERS WITH EXPERTISE IN THE AREA OF
PATIENT SAFETY AND QUALITY IMPROVEMENT, TO ADD, MODIFY OR ELIMINATE ONE
OR MORE ADVERSE EVENTS SET FORTH IN SUBDIVISION TWO OF THIS SECTION, BY
REGULATION, CONSISTENT WITH NATIONAL CONSENSUS STANDARDS ENDORSED BY THE
CONSENSUS-BASED ENTITY SELECTED FOR THE PURPOSE OF PURSUING CERTAIN
ACTIVITIES RELATING TO HEALTHCARE PERFORMANCE MEASUREMENT BY THE U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES PURSUANT TO THE MEDICARE
IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT (PUB. L. 110-275).
4. The hospital shall conduct an investigation of [incidents] EVENTS
described in paragraphs (a) through (d) of subdivision two of this
section within thirty days of obtaining knowledge of any information
which reasonably appears to show that such an [incident] EVENT has
occurred, provided that, if the hospital reasonably expects such inves-
tigation to extend beyond such thirty day period, the hospital shall
notify the department of such expectation and the reason therefor, and
shall inform the department of the expected completion date of the
investigation. The hospital shall provide to the department a copy of
the investigation report within twenty-four hours of completion. Nothing
herein shall limit the authority of the department to conduct an inves-
tigation of [incidents] EVENTS occurring in [general] hospitals.
5. THE DEPARTMENT SHALL:
(A) ANALYZE EVENT REPORTS, FINDINGS OF THE INVESTIGATIONS, THEIR ROOT
CAUSE ANALYSES, AND CORRECTIVE ACTION PLANS TO DETERMINE PATTERNS OF
SYSTEMIC FAILURE IN THE HEALTH CARE SYSTEM AND IDENTIFY SUCCESSFUL METH-
ODS TO CORRECT THESE FAILURES; AND
(B) COMMUNICATE TO FACILITIES THE DEPARTMENT'S CONCLUSIONS, IF ANY,
REGARDING EVENT REPORTS, PATTERNS OF SYSTEMIC FAILURE, AND RECOMMENDA-
TIONS FOR CORRECTIVE ACTION RESULTING FROM THE ANALYSIS OF SUBMISSIONS
FROM FACILITIES; AND MAY RELEASE, IN A FORMAT THAT DOES NOT IDENTIFY
S. 2809--D 160 A. 4009--D
SPECIFIC PATIENTS AND DOES NOT PROVIDE REASONABLE BASIS TO BELIEVE THAT
THE INFORMATION CAN BE USED TO IDENTIFY A PATIENT; (I) ANALYSES AND
FINDINGS DERIVED FROM THE ADVERSE EVENT DATA TO HOSPITALS OR THE PUBLIC
AND (II) ADVERSE EVENT DATA TO RESEARCHERS FOR PATIENT SAFETY RESEARCH
PROJECTS APPROVED BY THE COMMISSIONER, SUBJECT TO ANY TERMS AND CONDI-
TIONS IMPOSED BY THE COMMISSIONER CONCERNING THE SECURITY AND CONFIDEN-
TIALITY OF THE DATA AND THEIR USE; AND PROVIDED THAT NO SUCH DATA,
RECORD, DOCUMENTATION OR ACTION SUBJECT TO SUBDIVISION TWO OF SECTION
TWENTY-EIGHT HUNDRED FIVE-M OF THIS ARTICLE, SHALL BE SUBJECT TO DISCLO-
SURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW NOR ARTICLE THIRTY-ONE
OF THE CIVIL PRACTICE LAW AND RULES.
[4] 6. The commissioner shall establish protocols for hospital
personnel where a patient under the age of eighteen years dies during
transportation to the hospital or while at the hospital, under circum-
stances other than those related to the natural course of illness,
disease or proper treatment in accordance with generally accepted
medical standards. Such protocols shall address matters including, but
not limited to, the following:
(a) medical and social history, and examination of the patient;
(b) preservation of evidence and chain of custody;
(c) questioning of the patient's family, guardian or person in
parental authority;
(d) circumstances surrounding the injury resulting in death;
(e) determination of the cause of death;
(f) notification of law enforcement personnel; and
(g) reporting requirements under title six of article six of the
social services law.
In developing such protocols, the commissioner shall consult with the
office of children and family services, local departments of social
services, coordinators of child fatality review teams established pursu-
ant to section four hundred twenty-two-b of the social services law, law
enforcement agencies, pediatricians preferably with expertise in the
area of child abuse and maltreatment or forensic pediatrics, and such
other persons as the commissioner deems necessary.
[5] 7. The commissioner shall make, adopt, promulgate and enforce
such rules and regulations as he may deem appropriate to effectuate the
purposes of this section.
S 59. Intentionally omitted.
S 60. Intentionally omitted.
S 61. Intentionally omitted.
S 62. Intentionally omitted.
S 63. Subdivision 38 of section 2 of the social services law is
amended by adding four new paragraphs (f), (g), (h) and (i) to read as
follows:
(F) "VERIFICATION ORGANIZATION" MEANS AN ENTITY, OPERATING IN A MANNER
CONSISTENT WITH APPLICABLE FEDERAL AND STATE CONFIDENTIALITY AND PRIVACY
LAWS AND REGULATIONS, WHICH USES ELECTRONIC MEANS INCLUDING BUT NOT
LIMITED TO CONTEMPORANEOUS TELEPHONE VERIFICATION OR CONTEMPORANEOUS
VERIFIED ELECTRONIC DATA TO VERIFY WHETHER A SERVICE OR ITEM WAS
PROVIDED TO AN ELIGIBLE MEDICAID RECIPIENT. FOR EACH SERVICE OR ITEM THE
VERIFICATION ORGANIZATION SHALL CAPTURE:
(I) THE IDENTITY OF THE INDIVIDUAL PROVIDING SERVICES OR ITEMS TO THE
MEDICAID RECIPIENT;
(II) THE IDENTITY OF THE MEDICAID RECIPIENT; AND
(III) THE DATE, TIME, DURATION, LOCATION AND TYPE OF SERVICE OR ITEM.
S. 2809--D 161 A. 4009--D
A LIST OF VERIFICATION ORGANIZATIONS SHALL BE JOINTLY DEVELOPED BY THE
DEPARTMENT OF HEALTH AND THE OFFICE OF THE MEDICAID INSPECTOR GENERAL.
(G) "EXCEPTION REPORT" MEANS AN ELECTRONIC REPORT CONTAINING ALL THE
DATA FIELDS IN PARAGRAPH (F) OF THIS SUBDIVISION FOR CONFLICTS BETWEEN
SERVICES OR ITEMS ON THE BASIS OF THE IDENTITY OF THE PERSON PROVIDING
THE SERVICE OR ITEM TO THE MEDICAID RECIPIENT, THE IDENTITY OF THE MEDI-
CAID RECIPIENT, AND/OR TIME, DATE, DURATION OR LOCATION OF SERVICE;
(H) "CONFLICT REPORT" MEANS AN ELECTRONIC REPORT CONTAINING ALL OF THE
DATA FIELDS IN PARAGRAPH (F) OF THIS SUBDIVISION DETAILING INCONGRUITIES
IN SERVICES OR ITEMS BETWEEN SCHEDULING AND/OR LOCATION OF SERVICE WHEN
COMPARED TO A DUTY ROSTER.
(I) "PARTICIPATING PROVIDER" MEANS A CERTIFIED HOME HEALTH AGENCY,
LONG TERM HOME HEALTH AGENCY OR PERSONAL CARE PROVIDER WITH TOTAL MEDI-
CAID REIMBURSEMENTS EXCEEDING FIFTEEN MILLION DOLLARS PER CALENDAR YEAR.
S 64. The social services law is amended by adding a new section 363-e
to read as follows:
S 363-E. PRECLAIM REVIEW FOR PARTICIPATING PROVIDERS OF MEDICAL
ASSISTANCE PROGRAM SERVICES AND ITEMS. EVERY SERVICE OR ITEM WITHIN A
CLAIM SUBMITTED BY A PARTICIPATING PROVIDER SHALL BE REVIEWED AND VERI-
FIED BY A VERIFICATION ORGANIZATION PRIOR TO SUBMISSION OF A CLAIM TO
THE DEPARTMENT OF HEALTH. THE VERIFICATION ORGANIZATION SHALL DECLARE
EACH SERVICE OR ITEM TO BE VERIFIED OR UNVERIFIED. EACH PARTICIPATING
PROVIDER SHALL RECEIVE AND MAINTAIN REPORTS FROM THE VERIFICATION ORGAN-
IZATION WHICH SHALL CONTAIN DATA ON:
1. VERIFIED SERVICES OR ITEMS, INCLUDING WHETHER A SERVICE APPEARED ON
A CONFLICT OR EXCEPTION REPORT BEFORE VERIFICATION AND HOW THAT CONFLICT
OR EXCEPTION WAS RESOLVED; AND
2. SERVICES OR ITEMS THAT WERE NOT VERIFIED, INCLUDING CONFLICT AND
EXCEPTION REPORT DATA FOR THESE SERVICES.
S 65. Subparagraph (iii) of paragraph (d) of subdivision 1 of section
367-a of the social services law, as amended by section 53 of part C of
chapter 58 of the laws of 2008, is amended to read as follows:
(iii) When payment under part B of title XVIII of the federal social
security act for items and services provided to eligible persons who are
also beneficiaries under part B of title XVIII of the federal social
security act and for items and services provided to qualified medicare
beneficiaries under part B of title XVIII of the federal social security
act would exceed the amount that otherwise would be made under this
title if provided to an eligible person other than a person who is also
a beneficiary under part B or is a qualified medicare beneficiary, the
amount payable FOR SERVICES COVERED under this title shall be twenty
percent of the amount of any co-insurance liability of such eligible
persons pursuant to federal law were they not eligible for medical
assistance or were they not qualified medicare beneficiaries with
respect to such benefits under such part B; provided, however, amounts
payable under this title for items and services provided to eligible
persons who are also beneficiaries under part B or to qualified medicare
beneficiaries by an ambulance service under the authority of an operat-
ing certificate issued pursuant to article thirty of the public health
law, a psychologist licensed under article one hundred fifty-three of
the education law, or a facility under the authority of an operating
certificate issued pursuant to article sixteen, thirty-one or thirty-two
of the mental hygiene law and with respect to outpatient hospital and
clinic items and services provided by a facility under the authority of
an operating certificate issued pursuant to article twenty-eight of the
public health law, shall not be less than the amount of any co-insurance
S. 2809--D 162 A. 4009--D
liability of such eligible persons or such qualified medicare benefici-
aries, or for which such eligible persons or such qualified medicare
beneficiaries would be liable under federal law were they not eligible
for medical assistance or were they not qualified medicare beneficiaries
with respect to such benefits under part B.
S 65-a. Subdivision 1 of section 367-a of the social services law is
amended by adding a new paragraph (g) to read as follows:
(G) NOTWITHSTANDING ANY PROVISION OF THIS SECTION TO THE CONTRARY,
AMOUNTS PAYABLE UNDER THIS TITLE FOR MEDICAL ASSISTANCE IN THE FORM OF
HOSPITAL OUTPATIENT SERVICES OR DIAGNOSTIC AND TREATMENT CENTER SERVICES
PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW PROVIDED TO
ELIGIBLE PERSONS WHO ARE ALSO BENEFICIARIES UNDER PART B OF TITLE XVIII
OF THE FEDERAL SOCIAL SECURITY ACT SHALL NOT EXCEED THE APPROVED MEDICAL
ASSISTANCE PAYMENT LEVEL LESS THE AMOUNT PAYABLE UNDER PART B.
S 66. The public health law is amended by adding a new article 29-E to
read as follows:
ARTICLE 29-E
ACCOUNTABLE CARE ORGANIZATIONS DEMONSTRATION PROGRAM
SECTION 2999-N. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE.
2999-O. DEFINITIONS.
2999-P. ESTABLISHMENT OF ACO DEMONSTRATION PROGRAM.
2999-Q. ACCOUNTABLE CARE ORGANIZATIONS; REQUIREMENTS.
2999-R. OTHER LAWS.
S 2999-N. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE. THE
LEGISLATURE INTENDS TO TEST THE ABILITY OF ACCOUNTABLE CARE ORGANIZA-
TIONS TO ASSUME A ROLE IN DELIVERING AN ARRAY OF HEALTH CARE SERVICES,
FROM PRIMARY AND PREVENTIVE CARE THROUGH ACUTE INPATIENT HOSPITAL AND
POST-HOSPITAL CARE. THE LEGISLATURE FINDS THAT THE FORMATION AND OPERA-
TION OF ACCOUNTABLE CARE ORGANIZATIONS UNDER THIS ARTICLE, AND SUBJECT
TO APPROPRIATE REGULATION, CAN BE CONSISTENT WITH THE PURPOSES OF FEDER-
AL AND STATE ANTI-TRUST, ANTI-REFERRAL, AND OTHER STATUTES, INCLUDING
REDUCING OVER-UTILIZATION AND EXPENDITURES. THE LEGISLATURE FINDS THAT
THE DEVELOPMENT OF ACCOUNTABLE CARE ORGANIZATIONS UNDER THIS ARTICLE
WILL REDUCE HEALTH CARE COSTS, PROMOTE EFFECTIVE ALLOCATION OF HEALTH
CARE RESOURCES, AND ENHANCE THE QUALITY AND ACCESSIBILITY OF HEALTH
CARE. THE LEGISLATURE FINDS THAT THIS ARTICLE IS NECESSARY TO PROMOTE
THE FORMATION OF ACCOUNTABLE CARE ORGANIZATIONS AND PROTECT THE PUBLIC
INTEREST AND THE INTERESTS OF PATIENTS AND HEALTH CARE PROVIDERS.
S 2999-O. DEFINITIONS. AS USED IN THIS ARTICLE, THE FOLLOWING TERMS
SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES
OTHERWISE:
1. "ACCOUNTABLE CARE ORGANIZATION" OR "ACO" MEANS AN ORGANIZATION OF
CLINICALLY INTEGRATED HEALTH CARE PROVIDERS CERTIFIED BY THE COMMISSION-
ER UNDER THIS ARTICLE.
2. "CERTIFICATE OF AUTHORITY" OR "CERTIFICATE" MEANS A CERTIFICATE OF
AUTHORITY ISSUED BY THE COMMISSIONER UNDER THIS ARTICLE.
3. "HEALTH CARE PROVIDER" INCLUDES BUT IS NOT LIMITED TO AN ENTITY
LICENSED OR CERTIFIED UNDER ARTICLE TWENTY-EIGHT OR THIRTY-SIX OF THIS
CHAPTER; AN ENTITY LICENSED OR CERTIFIED UNDER ARTICLE SIXTEEN, THIRTY-
ONE OR THIRTY-TWO OF THE MENTAL HYGIENE LAW; OR A HEALTH CARE PRACTI-
TIONER LICENSED OR CERTIFIED UNDER TITLE EIGHT OF THE EDUCATION LAW OR A
LAWFUL COMBINATION OF SUCH HEALTH CARE PRACTITIONERS; AND MAY ALSO
INCLUDE, TO THE EXTENT PROVIDED BY REGULATION OF THE COMMISSIONER, OTHER
ENTITIES THAT PROVIDE TECHNICAL ASSISTANCE, INFORMATION SYSTEMS AND
SERVICES, CARE COORDINATION AND OTHER SERVICES TO HEALTH CARE PROVIDERS
AND PATIENTS PARTICIPATING IN AN ACO.
S. 2809--D 163 A. 4009--D
4. "PRIMARY CARE" MEANS THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
RICS, OR PRIMARY CARE GYNECOLOGY, WITHOUT REGARD TO BOARD CERTIFICATION,
PROVIDED BY A HEALTH CARE PROVIDER ACTING WITHIN HIS, HER, OR ITS LAWFUL
SCOPE OF PRACTICE.
5. "THIRD-PARTY HEALTH CARE PAYER" HAS ITS ORDINARY MEANINGS AND MAY
INCLUDE ANY ENTITIES PROVIDED FOR BY REGULATION OF THE COMMISSIONER,
WHICH MAY INCLUDE AN ENTITY SUCH AS A PHARMACY BENEFITS MANAGER, FISCAL
ADMINISTRATOR, OR ADMINISTRATIVE SERVICES PROVIDER THAT PARTICIPATES IN
THE ADMINISTRATION OF A THIRD-PARTY HEALTH CARE PAYER SYSTEM.
6. ANY REFERENCES TO THE "DEPARTMENT OF FINANCIAL SERVICES" AND THE
"SUPERINTENDENT OF FINANCIAL SERVICES" IN THIS ARTICLE SHALL MEAN, PRIOR
TO OCTOBER THIRD, TWO THOUSAND ELEVEN, RESPECTIVELY, THE "DEPARTMENT OF
INSURANCE" AND THE "SUPERINTENDENT OF INSURANCE."
S 2999-P. ESTABLISHMENT OF ACO DEMONSTRATION PROGRAM. 1. AN ACCOUNT-
ABLE CARE ORGANIZATION: (A) IS AN ORGANIZATION OF CLINICALLY INTEGRATED
HEALTH CARE PROVIDERS THAT WORK TOGETHER TO PROVIDE, MANAGE, AND COORDI-
NATE HEALTH CARE (INCLUDING PRIMARY CARE) FOR A DEFINED POPULATION; WITH
A MECHANISM FOR SHARED GOVERNANCE; THE ABILITY TO NEGOTIATE, RECEIVE,
AND DISTRIBUTE PAYMENTS; AND ACCOUNTABILITY FOR THE QUALITY, COST, AND
DELIVERY OF HEALTH CARE TO THE ACO'S PATIENTS; IN ACCORDANCE WITH THIS
ARTICLE; AND (B) HAS BEEN ISSUED A CERTIFICATE OF AUTHORITY BY THE
COMMISSIONER UNDER THIS ARTICLE.
2. THE COMMISSIONER SHALL ESTABLISH A DEMONSTRATION PROGRAM WITHIN THE
DEPARTMENT TO TEST THE ABILITY OF ACOS TO DELIVER AN ARRAY OF HEALTH
CARE SERVICES FOR THE PURPOSE OF IMPROVING THE QUALITY, COORDINATION AND
ACCOUNTABILITY OF SERVICES PROVIDED TO PATIENTS IN NEW YORK.
3. THE COMMISSIONER MAY ISSUE A CERTIFICATE OF AUTHORITY TO AN ENTITY
THAT MEETS CONDITIONS FOR ACO CERTIFICATION AS SET FORTH IN REGULATIONS
PROMULGATED BY THE COMMISSIONER PURSUANT TO SECTION TWENTY-NINE HUNDRED
NINETY-NINE-Q OF THIS ARTICLE. THE COMMISSIONER SHALL NOT ISSUE MORE
THAN SEVEN CERTIFICATES UNDER THIS ARTICLE, AND SHALL NOT ISSUE ANY NEW
CERTIFICATE UNDER THIS ARTICLE AFTER DECEMBER THIRTY-FIRST, TWO THOUSAND
FIFTEEN.
4. THE COMMISSIONER MAY LIMIT, SUSPEND, OR TERMINATE A CERTIFICATE OF
AUTHORITY IF AN ACO IS NOT OPERATING IN ACCORDANCE WITH THIS ARTICLE.
5. THE COMMISSIONER IS AUTHORIZED TO SEEK FEDERAL APPROVALS AND WAIV-
ERS TO IMPLEMENT THIS ARTICLE, INCLUDING BUT NOT LIMITED TO THOSE
APPROVALS OR WAIVERS NECESSARY TO OBTAIN FEDERAL FINANCIAL PARTIC-
IPATION.
S 2999-Q. ACCOUNTABLE CARE ORGANIZATIONS; REQUIREMENTS. 1. THE COMMIS-
SIONER SHALL PROMULGATE REGULATIONS ESTABLISHING CRITERIA FOR CERTIF-
ICATES OF AUTHORITY, QUALITY STANDARDS FOR ACOS, REPORTING REQUIREMENTS
AND OTHER MATTERS DEEMED TO BE APPROPRIATE AND NECESSARY IN THE OPERA-
TION AND EVALUATION OF THE DEMONSTRATION PROGRAM. IN PROMULGATING SUCH
REGULATIONS, THE COMMISSIONER SHALL CONSULT WITH THE SUPERINTENDENT OF
FINANCIAL SERVICES, HEALTH CARE PROVIDERS, THIRD-PARTY HEALTH CARE
PAYERS, ADVOCATES REPRESENTING PATIENTS, AND OTHER APPROPRIATE PARTIES.
2. SUCH REGULATIONS MAY, AND SHALL AS NECESSARY FOR PURPOSES OF THIS
ARTICLE, ADDRESS MATTERS INCLUDING BUT NOT LIMITED TO:
(A) THE GOVERNANCE, LEADERSHIP AND MANAGEMENT STRUCTURE OF THE ACO,
INCLUDING THE MANNER IN WHICH CLINICAL AND ADMINISTRATIVE SYSTEMS AND
CLINICAL PARTICIPATION WILL BE MANAGED;
(B) DEFINITION OF THE POPULATION PROPOSED TO BE SERVED BY THE ACO,
WHICH MAY INCLUDE REFERENCE TO A GEOGRAPHICAL AREA AND PATIENT CHARAC-
TERISTICS;
S. 2809--D 164 A. 4009--D
(C) THE CHARACTER, COMPETENCE AND FISCAL RESPONSIBILITY AND SOUNDNESS
OF AN ACO AND ITS PRINCIPALS, IF AND TO THE EXTENT DEEMED APPROPRIATE BY
THE COMMISSIONER;
(D) THE ADEQUACY OF AN ACO'S NETWORK OF PARTICIPATING HEALTH CARE
PROVIDERS, INCLUDING PRIMARY CARE HEALTH CARE PROVIDERS;
(E) MECHANISMS BY WHICH AN ACO WILL PROVIDE, MANAGE, AND COORDINATE
QUALITY HEALTH CARE FOR ITS PATIENTS AND PROVIDE ACCESS TO HEALTH CARE
PROVIDERS THAT ARE NOT PARTICIPANTS IN THE ACO;
(F) MECHANISMS BY WHICH THE ACO SHALL RECEIVE AND DISTRIBUTE PAYMENTS
TO ITS PARTICIPATING HEALTH CARE PROVIDERS, WHICH MAY INCLUDE INCENTIVE
PAYMENTS OR MECHANISMS FOR POOLING PAYMENTS RECEIVED BY PARTICIPATING
HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS AND PATIENTS;
(G) MECHANISMS AND CRITERIA FOR ACCEPTING HEALTH CARE PROVIDERS TO
PARTICIPATE IN THE ACO THAT ARE RELATED TO THE NEEDS OF THE PATIENT
POPULATION TO BE SERVED AND NEEDS AND PURPOSES OF THE ACO, AND PREVENT-
ING UNREASONABLE DISCRIMINATION;
(H) MECHANISMS FOR QUALITY ASSURANCE AND GRIEVANCE PROCEDURES FOR
PATIENTS OR HEALTH CARE PROVIDERS WHERE APPROPRIATE;
(I) MECHANISMS THAT PROMOTE EVIDENCE-BASED HEALTH CARE, PATIENT
ENGAGEMENT, COORDINATION OF CARE, ELECTRONIC HEALTH RECORDS, INCLUDING
PARTICIPATION IN HEALTH INFORMATION EXCHANGES, AND OTHER ENABLING TECH-
NOLOGIES;
(J) PERFORMANCE STANDARDS FOR, AND MEASURES TO ASSESS, THE QUALITY AND
UTILIZATION OF CARE PROVIDED BY AN ACO;
(K) APPROPRIATE REQUIREMENTS FOR ACOS TO PROMOTE COMPLIANCE WITH THE
PURPOSES OF THIS ARTICLE;
(L) POSTING ON THE DEPARTMENT'S WEBSITE INFORMATION ABOUT ACOS THAT
WOULD BE USEFUL TO HEALTH CARE PROVIDERS AND PATIENTS;
(M) REQUIREMENTS FOR THE SUBMISSION OF INFORMATION AND DATA BY ACOS
AND THEIR PARTICIPATING AND AFFILIATED HEALTH CARE PROVIDERS AS NECES-
SARY FOR THE EVALUATION OF THE SUCCESS OF THE DEMONSTRATION PROGRAM;
(N) PROTECTION OF PATIENT RIGHTS AS APPROPRIATE;
(O) THE IMPACT OF THE ESTABLISHMENT AND OPERATION OF AN ACO ON ACCESS
TO ANY HEALTH CARE SERVICE IN THE AREA SERVED; AND
(P) ESTABLISHMENT OF STANDARDS, AS APPROPRIATE, TO PROMOTE THE ABILITY
OF AN ACO TO PARTICIPATE IN APPLICABLE FEDERAL PROGRAMS FOR ACOS.
3. (A) SUBJECT TO REGULATIONS OF THE COMMISSIONER: (I) AN ACO MAY
ENTER INTO ARRANGEMENTS WITH ONE OR MORE THIRD-PARTY HEALTH CARE PAYERS
TO ESTABLISH PAYMENT METHODOLOGIES FOR HEALTH CARE SERVICES FOR THE
THIRD-PARTY HEALTH CARE PAYER'S ENROLLEES PROVIDED BY THE ACO OR FOR
WHICH THE ACO IS RESPONSIBLE, SUCH AS FULL OR PARTIAL CAPITATION OR
OTHER ARRANGEMENTS; (II) SUCH ARRANGEMENTS MAY INCLUDE PROVISION FOR THE
ACO TO RECEIVE AND DISTRIBUTE PAYMENTS TO THE ACO'S PARTICIPATING HEALTH
CARE PROVIDERS, INCLUDING INCENTIVE PAYMENTS AND PAYMENTS FOR HEALTH
CARE SERVICES FROM THIRD-PARTY HEALTH CARE PAYERS AND PATIENTS; AND
(III) AN ACO MAY INCLUDE MECHANISMS FOR POOLING PAYMENTS RECEIVED BY
PARTICIPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS AND
PATIENTS.
(B) SUBJECT TO REGULATIONS OF THE COMMISSIONER, THE COMMISSIONER, IN
CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL SERVICES, MAY AUTHOR-
IZE A THIRD-PARTY HEALTH CARE PAYER TO PARTICIPATE IN PAYMENT METHODOL-
OGIES WITH AN ACO UNDER THIS SUBDIVISION, NOTWITHSTANDING ANY CONTRARY
PROVISION OF THIS CHAPTER, THE INSURANCE LAW, THE SOCIAL SERVICES LAW,
OR THE ELDER LAW, ON FINDING THAT THE PAYMENT METHODOLOGY IS CONSISTENT
WITH THE PURPOSES OF THIS ARTICLE.
S. 2809--D 165 A. 4009--D
4. THE PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY AN
ACO THROUGH HEALTH CARE PROVIDERS SHALL NOT BE CONSIDERED THE PRACTICE
OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCATION LAW BY THE ACO.
S 2999-R. OTHER LAWS. 1. (A) IT IS THE POLICY OF THE STATE TO PERMIT
AND ENCOURAGE COOPERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS
AMONG THIRD-PARTY HEALTH CARE PAYERS AND HEALTH CARE PROVIDERS WHO MIGHT
OTHERWISE BE COMPETITORS UNDER THE ACTIVE SUPERVISION OF THE COMMISSION-
ER. TO THE EXTENT THAT IT IS NECESSARY TO ACCOMPLISH THE PURPOSES OF
THIS ARTICLE, COMPETITION MAY BE SUPPLANTED AND THE STATE MAY PROVIDE
STATE ACTION IMMUNITY UNDER STATE AND FEDERAL ANTITRUST LAWS TO PAYORS
AND HEALTH CARE PROVIDERS.
(B) THE COMMISSIONER MAY ENGAGE IN STATE SUPERVISION TO PROMOTE STATE
ACTION IMMUNITY UNDER STATE AND FEDERAL ANTITRUST LAWS AND MAY INSPECT,
REQUIRE, OR REQUEST ADDITIONAL DOCUMENTATION AND TAKE OTHER ACTIONS
UNDER THIS ARTICLE TO VERIFY AND MAKE SURE THAT THIS ARTICLE IS IMPLE-
MENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
2. WITH RESPECT TO THE PLANNING, IMPLEMENTATION, AND OPERATION OF
ACOS, THE COMMISSIONER, BY REGULATION, MAY SPECIFICALLY DELINEATE SAFE
HARBORS THAT EXEMPT ACOS FROM THE APPLICATION OF THE FOLLOWING STATUTES:
(A) ARTICLE TWENTY-TWO OF THE GENERAL BUSINESS LAW RELATING TO
ARRANGEMENTS AND AGREEMENTS IN RESTRAINT OF TRADE;
(B) ARTICLE ONE HUNDRED THIRTY-ONE-A OF THE EDUCATION LAW RELATING TO
FEE-SPLITTING ARRANGEMENTS; AND
(C) TITLE TWO-D OF ARTICLE TWO OF THIS CHAPTER RELATING TO HEALTH CARE
PRACTITIONER REFERRALS.
3. FOR THE PURPOSES OF THIS ARTICLE, AN ACO SHALL BE DEEMED TO BE A
HOSPITAL FOR PURPOSES OF SECTIONS TWENTY-EIGHT HUNDRED FIVE-J,
TWENTY-EIGHT HUNDRED FIVE-K, TWENTY-EIGHT HUNDRED FIVE-L AND
TWENTY-EIGHT HUNDRED FIVE-M OF THIS CHAPTER AND SUBDIVISIONS THREE AND
FIVE OF SECTION SIXTY-FIVE HUNDRED TWENTY-SEVEN OF THE EDUCATION LAW.
S 67. Section 18 of part B of chapter 58 of the laws of 2010, amending
chapter 474 of the laws of 1996, amending the education law and other
laws relating to rates for residential healthcare facilities and other
laws relating to Medicaid payments, is amended to read as follows:
S 18. 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] 2011,
which are paid and accompanied by all required reports and which are
received on or before December 31, [2010] 2011 shall not be subject to
interest or 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 subse-
quent audit by the commissioner of health or the commissioner's desig-
nee, and provided further, however, with regard to all principal, inter-
est and penalty amounts collected by the commissioner of health prior to
the effective date of this act, the 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, and provided further,
however, that payments of principal amounts of surcharges and assess-
ments which were paid late and received prior to the effective date of
this provision, and in regard to which interest and penalty amounts have
not been collected, shall not be subject to such interest and penalties,
and provided, further, however, that the provisions of this section
shall not apply to delinquent amounts which have been referred by the
commissioner of health for recoupment or collection proceeding.
S. 2809--D 166 A. 4009--D
Furthermore, the provisions of this section shall not apply to any
surcharge or assessment payments made in response to a final audit find-
ing issued by the commissioner of health or the commissioner's designee.
S 68. Intentionally omitted.
S 69. Subparagraph (iii) of paragraph (b) of subdivision 25 of section
2808 of the public health law, as added by section 31 of part B of chap-
ter 109 of the laws of 2010, is amended and a new subparagraph (iv) is
added to read as follows:
(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[.]; AND
(IV) PAYMENTS FOR RESERVED BED DAYS FOR TEMPORARY HOSPITALIZATIONS
SHALL ONLY BE MADE TO A RESIDENTIAL HEALTH CARE FACILITY IF AT LEAST
FIFTY PERCENT OF THE FACILITY'S RESIDENTS ELIGIBLE TO PARTICIPATE IN A
MEDICARE MANAGED CARE PLAN ARE ENROLLED IN SUCH A PLAN.
S 70. Intentionally omitted.
S 71. Intentionally omitted.
S 72. Intentionally omitted.
S 73. Intentionally omitted.
S 74. Section 366 of the social services law is amended by adding a
new subdivision 14 to read as follows:
14. THE COMMISSIONER OF HEALTH MAY MAKE ANY AVAILABLE AMENDMENTS TO
THE STATE PLAN FOR MEDICAL ASSISTANCE SUBMITTED PURSUANT TO SECTION
THREE HUNDRED SIXTY-THREE-A OF THIS TITLE, OR, IF AN AMENDMENT IS NOT
POSSIBLE, DEVELOP AND SUBMIT AN APPLICATION FOR ANY WAIVER OR APPROVAL
UNDER THE FEDERAL SOCIAL SECURITY ACT THAT MAY BE NECESSARY TO DISREGARD
OR EXEMPT AN AMOUNT OF INCOME, FOR THE PURPOSE OF ASSISTING WITH HOUSING
COSTS, FOR INDIVIDUALS RECEIVING COVERAGE OF NURSING FACILITY SERVICES
UNDER THIS TITLE WHO ARE: (I) DISCHARGED FROM THE NURSING FACILITY TO
THE COMMUNITY; (II) ENROLLED IN A PLAN CERTIFIED PURSUANT TO SECTION
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW; AND (III) WHILE SO
ENROLLED, NOT CONSIDERED AN "INSTITUTIONALIZED SPOUSE" FOR PURPOSES OF
SECTION THREE HUNDRED SIXTY-SIX-C OF THIS TITLE.
S 75. Intentionally Omitted.
S 76. Subdivision 6 of section 364-i of the social services law is
amended by adding a new paragraph (a-2) to read as follows:
(A-2) AT THE TIME OF APPLICATION FOR PRESUMPTIVE ELIGIBILITY PURSUANT
TO THIS SUBDIVISION, A PREGNANT WOMAN WHO RESIDES IN A SOCIAL SERVICES
DISTRICT THAT HAS IMPLEMENTED THE STATE'S MANAGED CARE PROGRAM PURSUANT
TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE MUST CHOOSE A
MANAGED CARE PROVIDER. IF A MANAGED CARE PROVIDER IS NOT CHOSEN AT THE
TIME OF APPLICATION, THE PREGNANT WOMAN WILL BE ASSIGNED TO A MANAGED
CARE PROVIDER IN ACCORDANCE WITH SUBPARAGRAPHS (II), (III), (IV) AND (V)
OF PARAGRAPH (F) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED
SIXTY-FOUR-J OF THIS TITLE.
S 77. Paragraphs (b), (c), (d) and (f) of subdivision 3 of section
364-j of the social services law are REPEALED, paragraph (e) is relet-
tered paragraph (d), and two new paragraphs (b) and (c) are added to
read as follows:
(B) THE FOLLOWING MEDICAL ASSISTANCE RECIPIENTS SHALL NOT BE REQUIRED
TO PARTICIPATE IN A MANAGED CARE PROGRAM ESTABLISHED PURSUANT TO THIS
SECTION:
(I) INDIVIDUALS WITH A CHRONIC MEDICAL CONDITION WHO ARE BEING TREATED
BY A SPECIALIST PHYSICIAN THAT IS NOT ASSOCIATED WITH A MANAGED CARE
PROVIDER IN THE INDIVIDUAL'S SOCIAL SERVICES DISTRICT MAY DEFER PARTIC-
S. 2809--D 167 A. 4009--D
IPATION IN THE MANAGED CARE PROGRAM FOR SIX MONTHS OR UNTIL THE COURSE
OF TREATMENT IS COMPLETE, WHICHEVER OCCURS FIRST; AND
(II) NATIVE AMERICANS.
(C) THE FOLLOWING MEDICAL ASSISTANCE RECIPIENTS SHALL NOT BE ELIGIBLE
TO PARTICIPATE IN A MANAGED CARE PROGRAM ESTABLISHED PURSUANT TO THIS
SECTION:
(I) A PERSON ELIGIBLE FOR MEDICARE PARTICIPATING IN A CAPITATED DEMON-
STRATION PROGRAM FOR LONG TERM CARE;
(II) AN INFANT LIVING WITH AN INCARCERATED MOTHER IN A STATE OR LOCAL
CORRECTIONAL FACILITY AS DEFINED IN SECTION TWO OF THE CORRECTION LAW;
(III) A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE
FOR LESS THAN SIX MONTHS;
(IV) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS ONLY
WITH RESPECT TO TUBERCULOSIS-RELATED SERVICES;
(V) INDIVIDUALS RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;
(VI) A PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAIL-
ABLE FROM OR UNDER A THIRD-PARTY PAYOR WHICH MAY BE MAINTAINED BY
PAYMENT, OR PART PAYMENT, OF THE PREMIUM OR COST SHARING AMOUNTS, WHEN
PAYMENT OF SUCH PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE,
AS DETERMINED BY THE LOCAL SOCIAL SERVICES DISTRICT;
(VII) A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
GRAPH ELEVEN OF PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION THREE
HUNDRED SIXTY-SIX OF THIS TITLE;
(VIII) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
PARAGRAPH (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX OF
THIS TITLE; AND
(IX) A PERSON WHO IS MEDICARE/MEDICAID DUALLY ELIGIBLE AND WHO IS NOT
ENROLLED IN A MEDICARE MANAGED CARE PLAN.
S 77-a. Paragraph (g) of subdivision 3 of section 364-j of the social
services law, as amended by chapter 649 of the laws of 1996, and subpar-
agraph (i) as amended by section 30 of part C of chapter 58 of the laws
of 2008, is amended to read as follows:
[(g)] (E) The following categories of individuals [will not] MAY be
required to enroll with a managed care program [until] WHEN program
features and reimbursement rates are approved by the commissioner of
health and, as appropriate, the [commissioner] COMMISSIONERS of THE
DEPARTMENT OF mental health, THE OFFICE FOR PERSONS WITH DEVELOPMENTAL
DISABILITIES, THE OFFICE OF CHILDREN AND FAMILY SERVICES, AND THE OFFICE
OF ALCOHOL AND SUBSTANCE ABUSE SERVICES:
(i) an individual dually eligible for medical assistance and benefits
under the federal Medicare program and enrolled in a Medicare managed
care plan offered by an entity that is also a managed care provider;
provided that (notwithstanding paragraph (g) of subdivision four of this
section):
(a) if the individual changes his or her Medicare managed care plan as
authorized by title XVIII of the federal social security act, and
enrolls in another Medicare managed care plan that is also a managed
care provider, the individual shall be (if required by the commissioner
under this paragraph) enrolled in that managed care provider;
(b) if the individual changes his or her Medicare managed care plan as
authorized by title XVIII of the federal social security act, but
enrolls in another Medicare managed care plan that is not also a managed
care provider, the individual shall be disenrolled from the managed care
provider in which he or she was enrolled and withdraw from the managed
care program;
S. 2809--D 168 A. 4009--D
(c) if the individual disenrolls from his or her Medicare managed care
plan as authorized by title XVIII of the federal social security act,
and does not enroll in another Medicare managed care plan, the individ-
ual shall be disenrolled from the managed care provider in which he or
she was enrolled and withdraw from the managed care program;
(d) nothing herein shall require an individual enrolled in a managed
long term care plan, pursuant to section forty-four hundred three-f of
the public health law, to disenroll from such program.
(ii) an individual eligible for supplemental security income;
(iii) HIV positive individuals; [and]
(iv) persons with serious mental illness and children and adolescents
with serious emotional disturbances, as defined in section forty-four
hundred one of the public health law[.];
(V) A PERSON RECEIVING SERVICES PROVIDED BY A RESIDENTIAL ALCOHOL OR
SUBSTANCE ABUSE PROGRAM OR FACILITY FOR THE MENTALLY RETARDED;
(VI) A PERSON RECEIVING SERVICES PROVIDED BY AN INTERMEDIATE CARE
FACILITY FOR THE MENTALLY RETARDED OR WHO HAS CHARACTERISTICS AND NEEDS
SIMILAR TO SUCH PERSONS;
(VII) A PERSON WITH A DEVELOPMENTAL OR PHYSICAL DISABILITY WHO
RECEIVES HOME AND COMMUNITY-BASED SERVICES OR CARE-AT-HOME SERVICES
THROUGH EXISTING WAIVERS UNDER SECTION NINETEEN HUNDRED FIFTEEN (C) OF
THE FEDERAL SOCIAL SECURITY ACT OR WHO HAS CHARACTERISTICS AND NEEDS
SIMILAR TO SUCH PERSONS;
(VIII) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
SUBPARAGRAPH TWELVE OR SUBPARAGRAPH THIRTEEN OF PARAGRAPH (A) OF SUBDI-
VISION ONE OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
(IX) A PERSON RECEIVING SERVICES PROVIDED BY A LONG TERM HOME HEALTH
CARE PROGRAM, OR A PERSON RECEIVING INPATIENT SERVICES IN A STATE-OPER-
ATED PSYCHIATRIC FACILITY OR A RESIDENTIAL TREATMENT FACILITY FOR CHIL-
DREN AND YOUTH;
(X) CERTIFIED BLIND OR DISABLED CHILDREN LIVING OR EXPECTED TO BE
LIVING SEPARATE AND APART FROM THE PARENT FOR THIRTY DAYS OR MORE;
(XI) RESIDENTS OF NURSING FACILITIES;
(XII) A FOSTER CHILD IN THE PLACEMENT OF A VOLUNTARY AGENCY OR IN THE
DIRECT CARE OF THE LOCAL SOCIAL SERVICES DISTRICT;
(XIII) A PERSON OR FAMILY THAT IS HOMELESS; AND
(XIV) INDIVIDUALS FOR WHOM A MANAGED CARE PROVIDER IS NOT GEOGRAPH-
ICALLY ACCESSIBLE SO AS TO REASONABLY PROVIDE SERVICES TO THE PERSON. A
MANAGED CARE PROVIDER IS NOT GEOGRAPHICALLY ACCESSIBLE IF THE PERSON
CANNOT ACCESS THE PROVIDER'S SERVICES IN A TIMELY FASHION DUE TO
DISTANCE OR TRAVEL TIME.
S 78. Subparagraph (v) of paragraph (e) of subdivision 4 of section
364-j of the social services law, as amended by section 14 of part C of
chapter 58 of the laws of 2004, is amended to read as follows:
(v) Upon delivery of the pre-enrollment information, the local
district or the enrollment organization shall certify the participant's
receipt of such information. Upon verification that the participant has
received the pre-enrollment education information, a managed care
provider, a local district or the enrollment organization may enroll a
participant into a managed care provider. Managed care providers must
submit enrollment forms to the local department of social services. Upon
enrollment, participants will sign an attestation that they have been
informed that: participants have a choice of managed care providers;
participants have a choice of primary care practitioners; and, except as
otherwise provided in this section, including but not limited to the
exceptions listed in subparagraph (iii) of paragraph (a) of this subdi-
S. 2809--D 169 A. 4009--D
vision, participants must exclusively use their primary care practition-
ers and plan providers. The commissioner of health [or with respect to a
managed care plan serving participants in a city with a population of
over two million, the local department of social services in such city,]
may suspend or curtail enrollment or impose sanctions for failure to
appropriately notify clients as required in this subparagraph.
S 79. Subparagraph (i) of paragraph (f) of subdivision 4 of section
364-j of the social services law, as amended by section 14 of part C of
chapter 58 of the laws of 2004, is amended to read as follows:
(i) Participants SHALL CHOOSE A MANAGED CARE PROVIDER AT THE TIME OF
APPLICATION FOR MEDICAL ASSISTANCE; IF THE PARTICIPANT DOES NOT CHOOSE
SUCH A PROVIDER THE COMMISSIONER SHALL ASSIGN SUCH PARTICIPANT TO A
MANAGED CARE PROVIDER IN ACCORDANCE WITH SUBPARAGRAPHS (II), (III), (IV)
AND (V) OF THIS PARAGRAPH. PARTICIPANTS ALREADY IN RECEIPT OF MEDICAL
ASSISTANCE shall have no less than [sixty] THIRTY days from the date
selected by the district to enroll in the managed care program to select
a managed care provider, and as appropriate, a mental health special
needs plan, and shall be provided with information to make an informed
choice. Where a participant has not selected such a provider or mental
health special needs plan, the commissioner of health shall assign such
participant to a managed care provider, and as appropriate, to a mental
health special needs plan, taking into account capacity and geographic
accessibility. The commissioner may after the period of time established
in subparagraph (ii) of this paragraph assign participants to a managed
care provider taking into account quality performance criteria and cost.
Provided however, cost criteria shall not be of greater value than qual-
ity criteria in assigning participants.
S 80. Paragraphs (d), (e), and (f) of subdivision 5 of section 364-j
of the social services law, as added by section 15 of part C of chapter
58 of the laws of 2004, are amended to read as follows:
(d) Notwithstanding any inconsistent provision of this title and
section one hundred sixty-three of the state finance law, the commis-
sioner of health [or the local department of social services in a city
with a population of over two million] may contract with managed care
providers approved under paragraph (b) of this subdivision, without a
competitive bid or request for proposal process, to provide coverage for
participants pursuant to this title.
(e) Notwithstanding any inconsistent provision of this title and
section one hundred forty-three of the economic development law, no
notice in the procurement opportunities newsletter shall be required for
contracts awarded by the commissioner of health [or the local department
of social services in a city with a population of over two million], to
qualified managed care providers pursuant to this section.
(f) The care and services described in subdivision four of this
section will be furnished by a managed care provider pursuant to the
provisions of this section when such services are furnished in accord-
ance with an agreement with the department of health [or the local
department of social services in a city with a population of over two
million], and meet applicable federal law and regulations.
S 81. Paragraph (k) of subdivision 2 of section 365-a of the social
services law, as amended by chapter 659 of the laws of 1997, is amended
to read as follows:
(k) care and services furnished by an entity offering a comprehensive
health services plan, including an entity that has received a certif-
icate of authority pursuant to sections forty-four hundred three,
forty-four hundred three-a or forty-four hundred eight-a of the public
S. 2809--D 170 A. 4009--D
health law (as added by chapter six hundred thirty-nine of the laws of
nineteen hundred ninety-six) or a health maintenance organization
authorized under article forty-three of the insurance law, to eligible
individuals residing in the geographic area served by such entity, when
such services are furnished in accordance with an agreement approved by
the department which meets the requirements of federal law and regu-
lations [provided, that no such agreement shall allow for medical
assistance payments on a capitated basis for nursing facility, home care
or other long term care services of a duration and scope defined in
regulations of the department of health promulgated pursuant to section
forty-four hundred three-f of the public health law, unless such entity
has received a certificate of authority as a managed long term care plan
or is an operating demonstration or is an approved managed long term
care demonstration, pursuant to such section].
S 82. Paragraph (a) of subdivision 1 of section 367-f of the social
services law, as amended by section 37 of part D of chapter 58 of the
laws of 2009, is amended to read as follows:
(a) "Medicaid extended coverage" shall mean eligibility for medical
assistance (i) without regard to the resource requirements of section
three hundred sixty-six of this title, or in the case of an individual
covered under an insurance policy or certificate described in subdivi-
sion two of this section that provided a residential health care facili-
ty benefit less than [three] TWO years in duration, without consider-
ation of an amount of resources equivalent to the value of benefits
received by the individual under such policy or certificate, as deter-
mined under the rules of the partnership for long-term care program;
(ii) without regard to the recovery of medical assistance from the
estates of individuals and the imposition of liens on the homes of
persons pursuant to section three hundred sixty-nine of this title, with
respect to resources exempt from consideration pursuant to subparagraph
(i) of this paragraph; provided, however, that nothing in this section
shall prevent the imposition of a lien or recovery against property of
an individual on account of medical assistance incorrectly paid; and
(iii) based on an income eligibility standard for married couples equal
to the amount of the minimum monthly maintenance needs allowance defined
in paragraph (h) of subdivision two of section three hundred sixty-six-c
of this title, and for single individuals equal to one-half of such
amount; provided, however, that the commissioner of health shall not be
required to implement the provisions of this subparagraph if the use of
such income eligibility standards will result in a loss of federal
financial participation in the costs of Medicaid extended coverage
furnished in accordance with subparagraphs (i) and (ii) of this para-
graph.
S 83. Intentionally omitted.
S 84. Intentionally omitted.
S 85. Intentionally omitted.
S 86. Intentionally omitted.
S 87. Intentionally omitted.
S 88. Subparagraph 11 of paragraph (a) of subdivision 1 of section 366
of the social services law, as amended by section 1-h of part C of chap-
ter 58 of the laws of 2007, is amended to read as follows:
(11) for purposes of receiving family planning services eligible for
reimbursement by the federal government at a rate of ninety percent, is
not otherwise eligible for medical assistance and whose income is two
hundred percent or less of the comparable federal income official pover-
ty line (as defined and annually revised by the United States department
S. 2809--D 171 A. 4009--D
of health and human services); provided, however, that such ninety
percent limitation shall not apply to those services identified by the
commissioner of health as services, including treatment for sexually
transmitted diseases, generally performed as part of or as a follow-up
to a service eligible for such ninety percent reimbursement; PROVIDED
FURTHER THAT THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ESTABLISH
CRITERIA FOR PRESUMPTIVE ELIGIBILITY FOR SERVICES PROVIDED PURSUANT TO
THIS SUBPARAGRAPH IN ACCORDANCE WITH ALL APPLICABLE REQUIREMENTS OF
FEDERAL LAW OR REGULATION PERTAINING TO SUCH ELIGIBILITY. The commis-
sioner of health shall submit whatever waiver applications as may be
necessary to receive federal financial participation for services
provided under this subparagraph and the provisions of this subparagraph
shall be effective if and so long as such federal financial partic-
ipation shall be available; or
S 89. 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, SUBJECT TO THE PROVISIONS
OF SUBPARAGRAPHS (II), (III), AND (IV) OF THIS PARAGRAPH, furnished to
an individual who is not an inpatient or resident of a hospital, nursing
facility, intermediate care facility for the mentally retarded, or
institution 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-seven-o of this title], and when prescribed by a physician, in
accordance with the recipient's plan of treatment and provided by indi-
viduals who are qualified to provide such services, who are supervised
by a registered nurse and who are not members of the recipient's family,
and furnished in the recipient's home or other location;
(II) THE COMMISSIONER IS AUTHORIZED TO ADOPT STANDARDS, PURSUANT TO
EMERGENCY REGULATION, FOR THE PROVISION AND MANAGEMENT OF SERVICES
AVAILABLE UNDER THIS PARAGRAPH FOR INDIVIDUALS WHOSE NEED FOR SUCH
SERVICES EXCEEDS A SPECIFIED LEVEL TO BE DETERMINED BY THE COMMISSIONER;
(III) THE COMMISSIONER IS AUTHORIZED TO PROVIDE ASSISTANCE TO PERSONS
RECEIVING SERVICES UNDER THIS PARAGRAPH WHO ARE TRANSITIONING TO RECEIV-
ING CARE FROM A MANAGED LONG TERM CARE PLAN CERTIFIED PURSUANT TO
SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW;
(IV) PERSONAL CARE SERVICES AVAILABLE PURSUANT TO THIS PARAGRAPH SHALL
NOT EXCEED EIGHT HOURS PER WEEK FOR INDIVIDUALS WHOSE NEEDS ARE LIMITED
TO NUTRITIONAL AND ENVIRONMENTAL SUPPORT FUNCTIONS;
S 90. (a) Notwithstanding any other provision of law to the contrary,
for the state fiscal years beginning April 1, 2011 and ending on March
31, 2013, all Medicaid payments made for services provided on and after
April 1, 2011, shall, except as hereinafter provided, be subject to a
uniform two percent reduction and such reduction shall be applied, to
the extent practicable, in equal amounts during the fiscal year,
provided, however, that an alternative method may be considered at the
discretion of the commissioner of health and the director of the budget
based upon consultation with the health care industry including but not
limited to, a uniform reduction in Medicaid rates of payments or other
reductions provided that any method selected achieves up to $345,000,000
in Medicaid state share savings in state fiscal year 2011-12 and up to
$357,000,000 in state fiscal year 2012-13, except as hereinafter
provided, for services provided on and after April 1, 2011 through March
31, 2013. Any alternative methods to achieve the reduction must be
S. 2809--D 172 A. 4009--D
provided in writing and shall be filed with the senate finance committee
and the assembly ways and means committee not less than thirty days
before the date on which implementation is expected to begin. Nothing in
this section shall be deemed to prevent all or part of such alternative
reduction plan from taking effect retroactively, to the extent permitted
by the federal centers for medicare and medicaid services.
(b) The following types of appropriations shall be exempt from
reductions pursuant to this section:
(i) any reductions that would violate federal law including, but not
limited to, payments required pursuant to the federal Medicare program;
(ii) any reductions related to payments pursuant to article 32, arti-
cle 31 and article 16 of the mental hygiene law;
(iii) payments the state is obligated to make pursuant to court orders
or judgments;
(iv) payments for which the non-federal share does not reflect any
state funding; and
(v) at the discretion of the commissioner of health and the director
of the budget, payments with regard to which it is determined by the
commissioner of health and the director of the budget that application
of reductions pursuant to this section would result, by operation of
federal law, in a lower federal medical assistance percentage applicable
to such payments.
(c) Reductions to Medicaid payments or Medicaid rates of payments made
pursuant to this section shall be subject to the receipt of all neces-
sary federal approvals.
(d) Not less than 30 days prior to the conclusion of each state fiscal
year in which the provisions of this section apply, the department of
health shall prepare and transmit a report to the legislature that
details the actions taken to implement the Medicaid state share
reductions established pursuant to this section. Such report shall be
provided to the chairman of the senate finance committee and the assem-
bly ways and means committee.
S 91. Notwithstanding any inconsistent provision of state law, rule
or regulation to the contrary, subject to federal approval, the year to
year rate of growth of department of health state funds Medicaid spend-
ing shall not exceed the ten year rolling average of the medical compo-
nent of the consumer price index as published by the United States
department of labor, bureau of labor statistics, for the preceding ten
years.
S 92. 1. For state fiscal years 2011-12 and 2012-13, the director of
the budget, in consultation with the commissioner of health referenced
as "commissioner" for purposes of this section, shall assess on a month-
ly basis, as reflected in monthly reports pursuant to subdivision five
of this section known and projected department of health state funds
medicaid expenditures by category of service and by geographic regions,
as defined by the commissioner, and if the director of the budget deter-
mines that such expenditures are expected to cause medicaid disburse-
ments for such period to exceed the projected department of health medi-
caid state funds disbursements in the enacted budget financial plan
pursuant to subdivision 3 of section 23 of the state finance law, the
commissioner of health, in consultation with the director of the budget,
shall develop a medicaid savings allocation plan to limit such spending
to the aggregate limit level specified in the enacted budget financial
plan, provided, however, such projections may be adjusted by the direc-
tor of the budget to account for any changes in the New York state
federal medical assistance percentage amount established pursuant to the
S. 2809--D 173 A. 4009--D
federal social security act, changes in provider revenues, and beginning
April 1, 2012 the operational costs of the New York state medical indem-
nity fund.
2. Such medicaid savings allocation plan shall be designed, to reduce
the disbursements authorized by the appropriations herein in compliance
with the following guidelines: (1) reductions shall be made in compli-
ance with applicable federal law, including the provisions of the
Patient Protection and Affordable Care Act, Public Law No. 111-148, and
the Health Care and Education Reconciliation Act of 2010, Public Law No.
111-152 (collectively "Affordable Care Act") and any subsequent amend-
ments thereto or regulations promulgated thereunder; (2) reductions
shall be made in a manner that complies with the state Medicaid plan
approved by the federal centers for medicare and medicaid services,
provided, however, that the commissioner of health is authorized to
submit any state plan amendment or seek other federal approval, includ-
ing waiver authority, to implement the provisions of the medicaid
savings allocation plan that meets the other criteria set forth herein;
(3) reductions shall be made in a manner that maximizes federal finan-
cial participation, to the extent practicable, including any federal
financial participation that is available or is reasonably expected to
become available, in the discretion of the commissioner of health, under
the Affordable Care Act; (4) reductions shall be made uniformly among
categories of services and geographic regions of the state, to the
extent practicable, and shall be made uniformly within a category of
service, to the extent practicable, except where the commissioner of
health determines that there are sufficient grounds for non-uniformity,
including but not limited to: the extent to which specific categories of
services contributed to department of health medicaid state funds spend-
ing in excess of the limits specified herein; the need to maintain safe-
ty net services in underserved communities; or the potential benefits of
pursuing innovative payment models contemplated by the Affordable Care
Act, in which case such grounds shall be set forth in the medicaid
savings allocation plan; and (5) reductions shall be made in a manner
that does not unnecessarily create administrative burdens to Medicaid
applicants and recipients or providers.
3. (a) The commissioner of health shall seek the input of the legisla-
ture, as well as organizations representing health care providers,
consumers, businesses, workers, health insurers, and others with rele-
vant expertise, in developing such medicaid savings allocation plan, to
the extent that all or part of such plan, in the discretion of the
commissioner, is likely to have a material impact on the overall medi-
caid program, particular categories of service or particular geographic
regions of the states.
(b)(i) The commissioner of health shall post the medicaid savings
allocation plan on the department of health's website and shall provide
written copies of such plan to the chairs of the senate finance and the
assembly ways and means committees at least 30 days before the date on
which implementation is expected to begin.
(ii) The commissioner of health may revise the medicaid savings allo-
cation plan subsequent to the provision of notice and prior to implemen-
tation but need provide a new notice pursuant to subparagraph (i) of
this paragraph only if the commissioner determines, in his or her
discretion, that such revisions materially alter the plan.
(c) Notwithstanding the provisions of paragraphs (a) and (b) of this
subdivision, the commissioner of health need not seek the input
described in paragraph (a) of this subdivision or provide notice pursu-
S. 2809--D 174 A. 4009--D
ant to paragraph (b) of this paragraph if, in the discretion of the
commissioner, expedited development and implementation of a medicaid
savings allocation plan is necessary due to a public health emergency.
For purposes of this section, a public health emergency is defined as:
(i) a disaster, natural or otherwise, that significantly increases the
immediate need for health care personnel in an area of the state; (ii)
an event or condition that creates a widespread risk of exposure to a
serious communicable disease, or the potential for such widespread risk
of exposure; or (iii) any other event or condition determined by the
commissioner to constitute an imminent threat to public health.
(d) Nothing in this paragraph shall be deemed to prevent all or part
of such medical savings allocation plan from taking effect retroactively
to the extent permitted by the federal centers for medicare and medicaid
services.
4. In accordance with the medicaid savings allocation plan, the
commissioner of the department of health shall reduce department of
health state funds medicaid disbursements by the amount of the projected
overspending through, actions including, but not limited to modifying or
suspending reimbursement methods, including but not limited to all fees,
premium levels and rates of payment, notwithstanding any provision of
law that sets a specific amount or methodology for any such payments or
rates of payment; modifying Medicaid program benefits; seeking all
necessary Federal approvals, including, but not limited to waivers,
waiver amendments; and suspending time frames for notice, approval or
certification of rate requirements, notwithstanding any provision of
law, rule or regulation to the contrary, including but not limited to
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).
5. The department of health shall prepare a monthly report that sets
forth: (a) known and projected department of health medicaid expendi-
tures as described in subdivision one of this section; and (b) the
actions taken to implement any medicaid savings allocation plan imple-
mented pursuant to subdivision four of this section, including informa-
tion concerning the impact of such actions on each category of service
and each geographic region of the state. Each such monthly report shall
be provided to the chairs of the senate finance and the assembly ways
and means committees and shall be posted on the department of health's
website in a timely manner.
S 93. 1. Notwithstanding any inconsistent provision of law, rule or
regulation to the contrary, and subject to the availability of federal
financial participation, effective for the period April 1, 2011 through
March 31, 2012, and each state fiscal year thereafter, the department of
health is authorized to make supplemental Medicaid payments for profes-
sional services provided by physicians, nurse practitioners and physi-
cian assistants who are employed by a public benefit corporation or a
non-state operated public general hospital operated by a public benefit
corporation or who are providing professional services at a facility of
such public benefit corporation as either a member of a practice plan or
an employee of a professional corporation or limited liability corpo-
ration under contract to provide services to patients of such a public
benefit corporation, in accordance with 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 amounts
that will increase fees for such professional services to an amount
equal to either the Medicare rate or the average commercial rate that
would otherwise be received for such services rendered by such physi-
S. 2809--D 175 A. 4009--D
cians, nurse practitioners and physician assistants, provided, however,
that such supplemental fee payments shall not be available with regard
to services provided at facilities participating in the Medicare Teach-
ing Election Amendment. The calculation of such supplemental fee
payments shall be made in accordance with applicable federal law and
regulation and subject to the approval of the division of the budget.
Such supplemental Medicaid fee payments may be added to the professional
fees paid under the fee schedule or made as aggregate lump sum payments
to entities authorized to receive professional fees.
2. The supplemental Medicaid payments for professional services
authorized by subdivision one of this section may be made only at the
election of the public benefit corporation or the local social services
district in which the non-state operated public general hospital is
located. The electing public benefit corporation or local social
services district shall, notwithstanding the social services district
Medicaid cap provisions of Part C of chapter 58 of the laws of 2005, be
responsible for payment of one hundred percent of the non-federal share
of such supplemental Medicaid payments, in accordance with section 365-a
of the social services law, regardless of whether another social
services district or the department of health may otherwise be responsi-
ble for furnishing medical assistance to the eligible persons receiving
such services. Social services district or public benefit corporation
funding of the non-federal share of any such payments shall be deemed to
be voluntary for purposes of the increased federal medical assistance
percentage provisions of the American Recovery and Reinvestment Act of
2009, provided, however, that in the event the federal Centers for Medi-
care and Medicaid Services determines that such non-federal share
payments are not voluntary payments for purposes of such act, the
provisions of this section shall be null and void.
S 94. Subparagraph (i) of paragraph (b) of subdivision 2-b of section
2808 of the public health law, as amended by section 1 of part D of
chapter 58 of the laws of 2010, 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 June thirtieth, two thousand eleven] the operating cost compo-
nent of rates of payment shall reflect allowable operating costs as
reported in each facility's cost report for the two thousand two calen-
dar year, as adjusted for inflation on an annual basis in accordance
with the methodology set forth in paragraph (c) of subdivision ten of
section twenty-eight hundred seven-c of this article, provided, however,
that for those facilities which do not receive a per diem add-on adjust-
ment pursuant to subparagraph (ii) of paragraph (a) of this subdivision,
rates shall be further adjusted to include the proportionate benefit, as
determined by the commissioner, of the expiration of the opening para-
graph and paragraph (a) of subdivision sixteen of this section and of
paragraph (a) of subdivision fourteen of this section, and provided
further that the operating cost component of rates of payment for those
facilities which did not receive a per diem adjustment in accordance
with subparagraph (ii) of paragraph (a) of this subdivision shall not be
less than the operating component such facilities received in the two
thousand eight rate period, as adjusted for inflation on an annual basis
in accordance with the methodology set forth in paragraph (c) of subdi-
vision ten of section twenty-eight hundred seven-c of this article and
further provided, however, that rates for facilities whose operating
cost component reflects base year costs subsequent to January first, two
thousand two shall have rates computed in accordance with this para-
S. 2809--D 176 A. 4009--D
graph, utilizing allowable operating costs as reported in such subse-
quent base year period, and trended forward to the rate year in accord-
ance with applicable inflation factors.
S 95. Subdivision 2-c of section 2808 of the public health law is
REPEALED and a new subdivision 2-c is added to read as follows:
2-C. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR
ANY OTHER CONTRARY PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, THE NON-CAPITAL COMPONENT OF RATES OF
PAYMENT BY GOVERNMENTAL AGENCIES FOR INPATIENT SERVICES PROVIDED BY
RESIDENTIAL HEALTH CARE FACILITIES ON OR AFTER OCTOBER FIRST, TWO THOU-
SAND ELEVEN, BUT NO LATER THAN JANUARY FIRST, TWO THOUSAND TWELVE, SHALL
REFLECT A DIRECT STATEWIDE PRICE COMPONENT, AND INDIRECT STATEWIDE PRICE
COMPONENT, AND A FACILITY SPECIFIC NON-COMPARABLE COMPONENT, UTILIZING
ALLOWABLE OPERATING COSTS FOR A BASE YEAR AS DETERMINED BY THE COMMIS-
SIONER BY REGULATION. SUCH RATE COMPONENTS SHALL BE PERIODICALLY UPDATED
TO REFLECT CHANGES IN OPERATING COSTS.
(B) THE DIRECT AND INDIRECT STATEWIDE PRICE COMPONENTS SHALL BE
ADJUSTED BY A WAGE EQUALIZATION FACTOR AND SUCH OTHER FACTORS AS DETER-
MINED TO BE APPROPRIATE TO RECOGNIZE LEGITIMATE COST DIFFERENTIALS AND
THE DIRECT STATEWIDE PRICE COMPONENT SHALL BE SUBJECT TO A CASE MIX
ADJUSTMENT UTILIZING THE PATIENTS THAT ARE ELIGIBLE FOR MEDICAL ASSIST-
ANCE PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
LAW. SUCH WAGE EQUALIZATION FACTOR SHALL BE PERIODICALLY UPDATED TO
REFLECT CURRENT LABOR MARKET CONDITIONS.
(C) THE NON-CAPITAL COMPONENT OF THE RATES FOR: (I) AIDS FACILITIES OR
DISCRETE AIDS UNITS WITHIN FACILITIES; (II) DISCRETE UNITS FOR RESIDENTS
RECEIVING CARE IN A LONG-TERM INPATIENT REHABILITATION PROGRAM FOR TRAU-
MATIC BRAIN INJURED PERSONS; (III) DISCRETE UNITS PROVIDING SPECIALIZED
PROGRAMS FOR RESIDENTS REQUIRING BEHAVIORAL INTERVENTIONS; (IV) DISCRETE
UNITS FOR LONG-TERM VENTILATOR DEPENDENT RESIDENTS; AND (V) FACILITIES
OR DISCRETE UNITS WITHIN FACILITIES THAT PROVIDE EXTENSIVE NURSING,
MEDICAL, PSYCHOLOGICAL AND COUNSELING SUPPORT SERVICES SOLELY TO CHIL-
DREN SHALL REFLECT THE RATES IN EFFECT FOR SUCH FACILITIES ON JANUARY
FIRST, TWO THOUSAND NINE, AS ADJUSTED FOR INFLATION AND RATE APPEALS IN
ACCORDANCE WITH APPLICABLE STATUTES, PROVIDED, HOWEVER, THAT SUCH RATES
FOR FACILITIES DESCRIBED IN SUBPARAGRAPH (I) OF THIS PARAGRAPH SHALL
REFLECT THE APPLICATION OF THE PROVISIONS OF SECTION TWELVE OF PART D OF
CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND NINE, AND PROVIDED
FURTHER, HOWEVER, THAT INSOFAR AS SUCH RATES REFLECT TREND ADJUSTMENTS
FOR TREND FACTORS ATTRIBUTABLE TO THE TWO THOUSAND EIGHT AND TWO THOU-
SAND NINE CALENDAR YEARS THE AGGREGATE AMOUNT OF SUCH TREND FACTOR
ADJUSTMENTS SHALL BE SUBJECT TO THE PROVISIONS OF SECTION TWO OF PART D
OF CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND NINE, AS AMENDED.
(D) THE COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE
EMERGENCY REGULATIONS, TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
SUCH REGULATIONS SHALL BE DEVELOPED IN CONSULTATION WITH THE NURSING
HOME INDUSTRY AND ADVOCATES FOR RESIDENTIAL HEALTH CARE FACILITY RESI-
DENTS AND, FURTHER, THE COMMISSIONER SHALL PROVIDE NOTIFICATION CONCERN-
ING SUCH REGULATIONS TO THE CHAIRS OF THE SENATE AND ASSEMBLY HEALTH
COMMITTEES, THE CHAIR OF THE SENATE FINANCE COMMITTEE AND THE CHAIR OF
THE ASSEMBLY WAYS AND MEANS COMMITTEE. SUCH REGULATIONS SHALL INCLUDE
PROVISIONS FOR RATE ADJUSTMENTS OR PAYMENT ENHANCEMENTS TO FACILITATE A
MINIMUM FOUR-YEAR TRANSITION OF FACILITIES TO THE RATE-SETTING METHODOL-
OGY ESTABLISHED BY THIS SUBDIVISION AND MAY ALSO INCLUDE, BUT NOT BE
LIMITED TO, PROVISIONS FOR FACILITATING QUALITY IMPROVEMENTS IN RESIDEN-
TIAL HEALTH CARE FACILITIES.
S. 2809--D 177 A. 4009--D
S 96. 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, as amended by section 3 of part D
of chapter 58 of the laws of 2010, 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-
nation that such adjustments, including the application of adjustments
authorized by the provisions of paragraph (g) of subdivision 2-b of
section 2808 of the public health law, shall result in an aggregate
increase in total Medicaid rates of payment for such services for such
period that is less than or more than two hundred ten million dollars
($210,000,000), make such proportional adjustments to such rates as are
necessary to result in an increase of such aggregate expenditures of two
hundred ten million dollars ($210,000,000), and provided further, howev-
er, that notwithstanding 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 section 2808 of the public health law
for inpatient services provided by residential health care facilities
for the period April 1, 2010 through [June 30, 2011] MARCH 31, 2012, 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 adjustments 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 author-
ized by subparagraph (ii) of paragraph (b) of subdivision 2-b of section
2808 of the public health law and as scheduled for January AND JULY of
2011 shall not be made. Adjustments made pursuant to this section shall
not be subject to subsequent correction or reconciliation.
S 97. Section 2808 of the public health law is amended by adding a new
subdivision 2-d to read as follows:
2-D. RESIDENTIAL HEALTH CARE FACILITY SUPPLEMENTAL PAYMENTS. NOTWITH-
STANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR REGULATION AND
SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR THE
PERIOD MAY FIRST, TWO THOUSAND ELEVEN THROUGH MAY THIRTY-FIRST, TWO
THOUSAND ELEVEN, THE COMMISSIONER SHALL ADJUST INPATIENT MEDICAID RATES
OF PAYMENT ESTABLISHED PURSUANT TO THIS ARTICLE FOR ELIGIBLE RESIDENTIAL
HEALTH CARE FACILITIES IN ACCORDANCE WITH THE FOLLOWING:
(A) RATE ADJUSTMENTS MADE PURSUANT TO THIS SUBDIVISION SHALL BE IN THE
FORM OF RATE ADD-ONS AND SHALL NOT EXCEED AN AGGREGATE AMOUNT OF TWO
HUNDRED TWENTY-ONE MILLION THREE HUNDRED THOUSAND DOLLARS.
(B) ELIGIBLE FACILITIES ARE THOSE FACILITIES WHICH THE COMMISSIONER
DETERMINES HAVE EXPERIENCED A NET REDUCTION IN THEIR INPATIENT MEDICAID
REIMBURSEMENT FOR THE PERIOD APRIL FIRST, TWO THOUSAND NINE THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN AS A RESULT OF THE FOLLOWING:
(I) INPATIENT RATE ADJUSTMENTS MADE PURSUANT TO PARAGRAPH (B) OF
SUBDIVISION TWO-B OF THIS SECTION;
S. 2809--D 178 A. 4009--D
(II) USE OF THE CASE MIX METHODOLOGY DESCRIBED IN PARAGRAPH (G) OF
SUBDIVISION TWO-B OF THIS SECTION;
(III) INPATIENT RATE ADJUSTMENTS MADE PURSUANT TO SECTION TWO OF PART
D OF CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND NINE, AS AMENDED.
(C) THE FOLLOWING ELIGIBLE FACILITIES SHALL RECEIVE RATE ADJUSTMENTS
PURSUANT TO THIS SUBDIVISION EQUAL TO ONE HUNDRED PERCENT OF THEIR NET
REIMBURSEMENT REDUCTION AS COMPUTED BY THE COMMISSIONER IN ACCORDANCE
WITH PARAGRAPH (B) OF THIS SUBDIVISION:
(I) FACILITIES THAT HAVE BEEN DETERMINED BY THE COMMISSIONER AS BEING
ELIGIBLE FOR DISTRIBUTIONS OF AMOUNTS AVAILABLE FOR THE TWO THOUSAND
NINE PERIOD AS PROVIDED IN SUBDIVISION TWENTY-ONE OF THIS SECTION;
(II) NON-PUBLIC FACILITIES WHOSE TOTAL OPERATING LOSSES EQUAL OR
EXCEED FIVE PERCENT OF TOTAL OPERATING REVENUE AND WHOSE MEDICAID UTILI-
ZATION EQUALS OR EXCEEDS SEVENTY PERCENT, BASED ON EITHER THEIR TWO
THOUSAND NINE COST REPORT OR BASED ON THE OTHERWISE MOST RECENTLY AVAIL-
ABLE COST REPORT, AS DETERMINED BY THE COMMISSIONER;
(III) FACILITIES OR DISTINCT UNITS OF FACILITIES PROVIDING INPATIENT
SERVICES PRIMARILY TO CHILDREN UNDER THE AGE OF TWENTY-ONE.
(D) ELIGIBLE FACILITIES, OTHER THAN ELIGIBLE FACILITIES DESCRIBED IN
PARAGRAPH (C) OF THIS SUBDIVISION, SHALL RECEIVE RATE ADJUSTMENTS PURSU-
ANT TO THIS SUBDIVISION EQUAL TO FIFTY PERCENT OF THEIR NET REIMBURSE-
MENT REDUCTION AS COMPUTED BY THE COMMISSIONER IN ACCORDANCE WITH PARA-
GRAPH (B) OF THIS SUBDIVISION.
(E) ELIGIBLE FACILITIES AS DESCRIBED IN PARAGRAPH (D) OF THIS SUBDIVI-
SION WHICH, AS DETERMINED BY THE COMMISSIONER, AFTER APPLICATION OF THE
RATE ADJUSTMENTS AUTHORIZED BY PARAGRAPH (D) OF THIS SUBDIVISION, REMAIN
SUBJECT TO A NET REDUCTION IN THEIR INPATIENT MEDICAID REVENUE THAT IS
IN EXCESS OF TWO PERCENT, AS MEASURED WITH REGARD TO THE NON-CAPITAL
COMPONENTS OF FACILITY INPATIENT RATES IN EFFECT ON MARCH THIRTY-FIRST,
TWO THOUSAND NINE AS COMPUTED PRIOR TO THE APPLICATION OF TREND FACTOR
ADJUSTMENTS ATTRIBUTABLE TO THE TWO THOUSAND EIGHT AND TWO THOUSAND NINE
CALENDAR YEARS, SHALL HAVE THEIR RATES FURTHER ADJUSTED SUCH THAT SUCH
NET REDUCTION DOES NOT EXCEED SUCH TWO PERCENT.
(F) ELIGIBLE FACILITIES AS DESCRIBED IN PARAGRAPH (D) OF THIS SUBDIVI-
SION WHICH, AS DETERMINED BY THE COMMISSIONER, HAVE EXPERIENCED A NET
REDUCTION IN THEIR INPATIENT RATES OF MORE THAN SIX MILLION DOLLARS AS A
RESULT OF THE APPLICATION OF THE FACTOR DESCRIBED IN SUBPARAGRAPH (III)
OF PARAGRAPH (B) OF THIS SUBDIVISION SHALL AFTER APPLICATION OF THE
PROVISIONS OF PARAGRAPH (E) OF THIS SUBDIVISION, HAVE THEIR RATES
FURTHER ADJUSTED SUCH THAT ANY SUCH NET REDUCTION REMAINING AFTER THE
APPLICATION OF THE OTHER PROVISIONS OF THIS SUBDIVISION IS REDUCED TO
ZERO.
(G) IN COMPUTING NET REDUCTIONS OF MEDICAID REIMBURSEMENT PURSUANT TO
PARAGRAPH (B) OF THIS SUBDIVISION THE COMMISSIONER SHALL:
(I) DISREGARD THE IMPACT OF CASE MIX ADJUSTMENTS AS OTHERWISE SCHED-
ULED FOR JULY FIRST, TWO THOUSAND TEN; AND,
(II) DISREGARD THE IMPACT OF ANY RATE ADJUSTMENTS ISSUED ON OR AFTER
JANUARY FIRST, TWO THOUSAND ELEVEN, INCLUDING ADJUSTMENTS TO RATE PERI-
ODS PRIOR TO JANUARY FIRST, TWO THOUSAND ELEVEN.
(H) PAYMENTS MADE PURSUANT TO THIS SUBDIVISION SHALL NOT BE SUBJECT TO
SUBSEQUENT ADJUSTMENT OR RECONCILIATION AND, FURTHER, THE COMPUTATION
AND APPLICATION OF LIMITATIONS ON MEDICAID RATES OF PAYMENT AS DESCRIBED
IN SECTION TWO OF PART D OF CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOU-
SAND NINE, AS AMENDED, AND AS APPLICABLE TO THE RATE PERIODS DESCRIBED
IN PARAGRAPH (A) OF THIS SUBDIVISION, SHALL DISREGARD PAYMENTS MADE
PURSUANT TO THIS SUBDIVISION.
S. 2809--D 179 A. 4009--D
(I) ADDITIONAL RATE ADJUSTMENTS SHALL BE MADE PURSUANT TO THIS SUBDI-
VISION TO ELIGIBLE FACILITIES IN THE FORM OF RATE ADD-ONS FOR THE PERIOD
MAY FIRST, TWO THOUSAND ELEVEN THROUGH MAY THIRTY-FIRST, TWO THOUSAND
ELEVEN WHICH SHALL IN AGGREGATE BE EQUAL TO TWENTY-FIVE PERCENT OF THE
AGGREGATE AMOUNT DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION AND
WHICH SHALL BE DISTRIBUTED TO EACH ELIGIBLE FACILITY IN THE SAME PROPOR-
TION AS THE TOTAL DISTRIBUTIONS OTHERWISE RECEIVED BY EACH FACILITY
PURSUANT TO THIS SUBDIVISION.
(J) THE COMMISSIONER MAY, WITH THE APPROVAL OF THE DIRECTOR OF THE
BUDGET, AND SUBJECT TO THE IDENTIFICATION OF SUFFICIENT NURSING HOME
RELATED MEDICAID SAVINGS TO OFFSET THE EXPENDITURES AUTHORIZED BY THIS
PARAGRAPH, MAKE ADDITIONAL RATE ADJUSTMENTS PURSUANT TO THIS SUBDIVISION
TO ELIGIBLE FACILITIES IN THE FORM OF RATE ADD-ONS FOR THE PERIOD DECEM-
BER FIRST, TWO THOUSAND ELEVEN THROUGH DECEMBER THIRTY-FIRST, TWO THOU-
SAND ELEVEN WHICH SHALL IN AGGREGATE BE EQUAL TO TWELVE AND FIVE-TENTHS
PERCENT OF THE AGGREGATE AMOUNT DESCRIBED IN PARAGRAPH (A) OF THIS
SUBDIVISION AND WHICH SHALL BE DISTRIBUTED TO EACH ELIGIBLE FACILITY IN
THE SAME PROPORTION AS THE TOTAL DISTRIBUTIONS OTHERWISE RECEIVED BY
EACH FACILITY PURSUANT TO THIS SUBDIVISION.
S 98. Paragraph (b) of subdivision 17 of section 2808 of the public
health law, as added by section 30 of part B of chapter 109 of the laws
of 2010, is amended and a new paragraph (c) is added to read as follows:
(b) Notwithstanding any inconsistent provision of law or regulation to
the contrary, for the state fiscal year beginning April first, two thou-
sand ten and ending March thirty-first, two thousand [eleven] FIFTEEN,
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 [eleven] FIFTEEN, based on consideration of
rate appeals filed by residential health care facilities 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, in excess of an aggregate annual
amount of eighty million dollars for EACH such state fiscal year
PROVIDED, HOWEVER, THAT FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE SUCH AGGREGATE ANNUAL
AMOUNT SHALL BE FIFTY MILLION DOLLARS. In revising such rates within
such fiscal limit, the commissioner shall, in prioritizing such rate
appeals, include consideration of which facilities the commissioner
determines are facing significant financial hardship as well as such
other considerations as the commissioner deems appropriate and, further,
the commissioner is authorized to enter into agreements with such facil-
ities or any other facility 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; PROVIDED, HOWEVER,
THAT THE COMMISSIONER'S AUTHORITY TO NEGOTIATE SUCH AGREEMENTS RESOLVING
MULTIPLE PENDING RATE APPEALS AS HEREINBEFORE DESCRIBED SHALL CONTINUE
ON AND AFTER APRIL FIRST, TWO THOUSAND FIFTEEN. 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.
(C) NOTWITHSTANDING ANY OTHER CONTRARY PROVISION OF LAW, RULE OR REGU-
LATION, FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THE
COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE EMERGENCY
REGULATIONS, ESTABLISHING PRIORITIES AND TIME FRAMES FOR PROCESSING RATE
S. 2809--D 180 A. 4009--D
APPEALS, INCLUDING RATE APPEALS FILED PRIOR TO APRIL FIRST, TWO THOUSAND
ELEVEN, WITHIN AVAILABLE ADMINISTRATIVE RESOURCES; PROVIDED, HOWEVER,
THAT SUCH REGULATIONS SHALL NOT BE INCONSISTENT WITH THE PROVISIONS OF
PARAGRAPH (B) OF THIS SUBDIVISION.
S 99. Subdivision 2-b of section 2808 of the public health law is
amended by adding a new paragraph (h) to read as follows:
(H) NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR THE PERIOD APRIL
FIRST, TWO THOUSAND ELEVEN THROUGH JUNE THIRTIETH, TWO THOUSAND ELEVEN,
THE NON-CAPITAL COMPONENTS OF RATES SHALL BE SUBJECT TO A UNIFORM
PERCENTAGE REDUCTION SUFFICIENT TO REDUCE SUCH RATES BY AN AGGREGATE
AMOUNT OF TWENTY-SEVEN MILLION ONE HUNDRED THOUSAND DOLLARS, AND
PROVIDED FURTHER, HOWEVER, THAT SUCH REDUCTIONS SHALL BE DISREGARDED IN
COMPUTATIONS MADE PURSUANT TO SECTION TWO OF PART D OF CHAPTER
FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND NINE, AS AMENDED.
S 100. Paragraph (a) of subdivision 21 of section 2808 of the public
health law, as amended by section 8 of part D 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, for the purposes specified in subdivision nineteen of this
section, the commissioner shall adjust medical assistance rates of
payment established pursuant to this article for services provided on
and after October first, two thousand four through December thirty-
first, two thousand four and annually thereafter for services provided
on and after January first, two thousand five THROUGH APRIL THIRTIETH,
TWO THOUSAND ELEVEN AND ON AND AFTER MAY FIRST, TWO THOUSAND TWELVE, to
include a rate adjustment to assist qualifying facilities pursuant to
this subdivision, provided, however, that public residential health care
facilities shall not be eligible for rate adjustments pursuant to this
subdivision for rate periods on and after April first, two thousand
nine[.], PROVIDED FURTHER, HOWEVER, THAT NOTWITHSTANDING ANY CONTRARY
PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL
PARTICIPATION, EACH FACILITY THAT RECEIVES A RATE ADJUSTMENT PURSUANT TO
THIS SUBDIVISION FOR THE PERIOD MAY FIRST, TWO THOUSAND TEN THROUGH
APRIL THIRTIETH, TWO THOUSAND ELEVEN SHALL HAVE ITS MEDICAID RATES
REDUCED FOR THE RATE PERIOD DECEMBER FIRST, TWO THOUSAND ELEVEN THROUGH
DECEMBER THIRTY-FIRST, TWO THOUSAND ELEVEN BY AN AMOUNT EQUAL IN AGGRE-
GATE TO THE AGGREGATE AMOUNT OF THE FUNDS SUCH FACILITY RECEIVED PURSU-
ANT TO THIS SUBDIVISION FOR THE PERIOD MAY FIRST, TWO THOUSAND TEN
THROUGH APRIL THIRTIETH, TWO THOUSAND ELEVEN.
S 101. The public health law is amended by adding a new section 2807-
dd to read as follows:
S 2807-DD. TEMPORARY NURSING HOME STABILITY CONTRIBUTIONS. 1.
NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW AND SUBJECT TO THE RECEIPT
OF ALL NECESSARY FEDERAL APPROVALS OR WAIVERS, FOR PERIODS ON AND AFTER
APRIL FIRST, TWO THOUSAND ELEVEN, A TEMPORARY NURSING HOME STABILITY
CONTRIBUTION SHALL BE IMPOSED ON THE GROSS RECEIPTS OF EACH RESIDENTIAL
HEALTH CARE FACILITY EQUAL TO FOUR TENTHS OF ONE PERCENT OF SUCH
RECEIPTS AND PROVIDED FURTHER, HOWEVER, THAT ON AND AFTER APRIL FIRST,
TWO THOUSAND TWELVE THROUGH OCTOBER THIRTY-FIRST, TWO THOUSAND TWELVE
SUCH CONTRIBUTIONS SHALL BE REDUCED TO TWO TENTHS OF ONE PERCENT, AND
PROVIDED FURTHER, HOWEVER, THAT ON AND AFTER NOVEMBER FIRST, TWO THOU-
SAND TWELVE, SUCH CONTRIBUTIONS SHALL BE REDUCED TO ZERO.
2. THE GROSS RECEIPTS SUBJECT TO THIS SECTION SHALL BE AS DEFINED IN
PARAGRAPH (B) OF SUBDIVISION THREE OF SECTION TWENTY-EIGHT HUNDRED
SEVEN-D OF THIS ARTICLE AND SHALL INCLUDE INCOME FROM ALL PATIENT CARE
S. 2809--D 181 A. 4009--D
SERVICES AND OTHER OPERATING INCOME ON A CASH BASIS, BUT EXCLUDING
REVENUE RECEIVED PURSUANT TO THE FEDERAL MEDICARE PROGRAM. THE CONTRIB-
UTIONS DESCRIBED IN THIS SECTION SHALL BE ADMINISTERED IN ACCORDANCE
WITH AND SUBJECT TO THE PROVISIONS OF SUBDIVISIONS FOUR, FIVE, SIX,
SEVEN, EIGHT, NINE AND TWELVE OF SECTION TWENTY-EIGHT HUNDRED SEVEN-D OF
THIS ARTICLE, PROVIDED, HOWEVER, THAT SUCH CONTRIBUTIONS SHALL NOT BE AN
ALLOWABLE COST IN THE DETERMINATION OF REIMBURSEMENT RATES OF PAYMENT
COMPUTED PURSUANT TO THIS ARTICLE.
S 102. 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-
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 such assessment shall be six percent, AND
FURTHER PROVIDED THAT FOR ALL SUCH GROSS RECEIPTS RECEIVED ON OR AFTER
APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND THIRTEEN SUCH ASSESSMENT SHALL BE SIX PERCENT.
S 103. 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 FURTHER, HOWEVER, THAT INSOFAR AS SUCH ASSESSMENT IS IN EXCESS
OF SIX PERCENT IT SHALL NOT BE DEEMED A REIMBURSABLE COST AND SHALL NOT
BE REFLECTED IN SUCH RATES OF PAYMENT.
S 104. Subdivision 17-a of section 2808 of the public health law, as
amended by section 4 of part D of chapter 58 of the laws of 2009, is
amended to read as follows:
17-a. Notwithstanding any inconsistent provision of law or regulation
to the contrary, for purposes of establishing rates of payment by
governmental agencies for residential health care facilities for
services provided on and after January first, nineteen hundred ninety-
eight, the regional direct and indirect input price adjustment factors
to be applied to any such facility's rate calculation shall be based
upon the utilization of either nineteen hundred eighty-three, nineteen
hundred eighty-seven or nineteen hundred ninety-three calendar year
financial and statistical data and for periods beginning April first,
two thousand four through March thirty-first, two thousand nine based on
S. 2809--D 182 A. 4009--D
either nineteen hundred eighty-three, nineteen hundred eighty-seven,
nineteen hundred ninety-three or two thousand one calendar year finan-
cial and statistical data; provided, however, the state share amount for
the utilization of two thousand one calendar year data shall be no more
than twenty-two million dollars on a pro rata basis per calendar year.
The determination of which calendar year's data to utilize shall be
based upon a methodology that ensures that the particular year chosen by
each facility results in a factor that yields no less reimbursement to
the facility than would result from the use of any of the other three
years' data. Such methodology shall utilize the nineteen hundred eight-
y-three and nineteen hundred eighty-seven regional direct and indirect
input price adjustment factor corridor percentages in existence on Janu-
ary first, nineteen hundred ninety-seven as well as nineteen hundred
ninety-three regional direct and indirect input price adjustment factor
corridor percentage in existence on January first, two thousand four as
well as a two thousand one regional direct and indirect input price
adjustment factor corridor percentage calculated in the same manner as
the nineteen hundred ninety-three direct and indirect input price
adjustment factor corridor percentages in existence on January first,
two thousand four; provided, however, for rate periods on and after
April first, two thousand nine, the regional input price adjustment
factors shall be based on the case mix predicted staffing for registered
nurses, licensed practical nurses, nurses' aides, licensed therapists
and therapist aides. For the rate period beginning April first, two
thousand nine through [March thirty-first, two thousand ten,] THE DAY
IMMEDIATELY PRIOR TO THE DAY THE PROVISIONS OF SUBDIVISION TWO-C OF THIS
SECTION TAKE EFFECT, the regional direct and indirect input price
adjustment factors to be applied to a facility's rate calculation shall
be based upon the utilization of two thousand two calendar year finan-
cial and statistical data. Such methodology shall utilize two thousand
two regional direct and indirect input price adjustment factor corridor
percentages calculated in the same manner as the two thousand one
regional direct and indirect input price adjustment factor corridor
percentages in existence on December thirty-first, two thousand six
except that every region shall receive a corridor to reflect the
region's actual variation subject to a maximum statewide average vari-
able corridor percentage of ten percent.
S 105. Notwithstanding any inconsistent provision of sections 112 and
163 of the state finance law, or section 142 of the economic development
law, or any other law, the commissioner of health is authorized to enter
into a contract without a competitive bid or request for proposal proc-
ess for the purposes set forth in the Early Innovator federal grant
awarded to the department of health by the federal centers for medicare
and medicaid services pursuant to the Patient Protection and Affordable
Care Act (P.L. 111-148) and the Health Care and Education Reconciliation
Act of 2010 (P.L. 111-152), provided, however, that:
(i) the department of health shall post on its website, for a period
of no less than thirty days:
(1) a description of the proposed services to be provided pursuant to
the contract or contracts;
(2) the criteria for selection of a contractor or contractors which
shall include but not be limited to the ability of the contractor to
meet the federal grant requirements;
(3) the period of time during which a prospective contractor may seek
selection, which shall be no less than thirty days after such informa-
tion is first posted on the website; and
S. 2809--D 183 A. 4009--D
(4) the manner by which a prospective contractor may seek such
selection, which may include submission by electronic means;
(ii) all reasonable and responsive submissions that are received from
prospective contractors in timely fashion shall be reviewed by the
commissioner of health;
(iii) the commissioner of health shall select such contractor or
contractors that, in his or her discretion, are best suited to carry out
the purposes set forth in the Early Innovator federal grant awarded to
the department of health; and
(iv) prior to the execution of any resulting contract, the commission-
er of health shall submit a copy to the office of the state comptroller
for review and approval.
S 106. Section 2 of chapter 385 of the laws of 2008 amending the
insurance law relating to an exemption to certain provisions of law
relating to risk-based capital for property/casualty insurance companies
is amended to read as follows:
S 2. This act shall take effect immediately, and shall expire and be
deemed repealed [December 31, 2011] JUNE 30, 2014.
S 106-a. Subsection (c) of section 2343 of the insurance law, as
amended by section 27 of part B of chapter 58 of the laws of 2008, is
amended to read as follows:
(c) Notwithstanding any other provision of this chapter, no applica-
tion for an order of rehabilitation or liquidation of a domestic insurer
whose primary liability arises from the business of medical malpractice
insurance, as that term is defined in subsection (b) of section five
thousand five hundred one of this chapter, shall be made on the grounds
specified in subsection (a) or (c) of section seven thousand four
hundred two of this chapter at any time prior to June thirtieth, two
thousand [eleven] FOURTEEN.
S 107. Section 4 of chapter 19 of the laws of 1998, amending the
social services law relating to limiting the method of payment for
prescription drugs under the medical assistance program, as amended by
section 68 of part C of chapter 58 of the laws of 2008, is amended to
read as follows:
S 4. This act shall take effect 120 days after it shall have become a
law and shall expire and be deemed repealed March 31, [2012] 2014.
S 108. Notwithstanding any inconsistent provision of law, rule or
regulation, for purposes of implementing the provisions of the public
health law and the social services law, references to titles XIX and XXI
of the federal social security act in the public health law and the
social services law shall be deemed to include and also to mean any
successor titles thereto under the federal social security act.
S 109. Notwithstanding any inconsistent provision of law, rule or
regulation, 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 110. Severability clause. If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment shall not affect,
impair or invalidate the remainder thereof, but shall be confined in its
operation to the clause, sentence, paragraph, subdivision, section or
part thereof directly involved in the controversy in which such judgment
shall have been rendered. It is hereby declared to be the intent of the
S. 2809--D 184 A. 4009--D
legislature that this act would have been enacted even if such invalid
provisions had not been included herein.
S 111. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2011; provided
however, that:
(a) regulations retroactive to April 1, 2011 may be promulgated for
the regulations authorized pursuant to sections three, ninety-eight,
twenty-six, thirty-six, thirty-five-a, and fifty of this act;
(b) the amendments to section 272 of the public health law, made by
sections nine and seventeen of this act shall not affect the repeal of
such section and shall expire and be deemed repealed therewith;
(c) the amendments to subdivision 9 of section 367-a of the social
services law, made by sections ten, ten-a, and ten-b of this act shall
not affect the expiration of such subdivision and shall be deemed to
expire therewith;
(d) the amendments to section 271 of the public health law, made by
sections thirteen, fourteen and fifteen of this act shall not affect the
repeal of such section and shall expire and be deemed repealed there-
with;
(e) the amendments to subparagraph (i) of paragraph (b-1) of subdivi-
sion 1 of section 2807-c of the public health law, made by section thir-
ty-two of this act shall not affect the expiration of such paragraph and
shall be deemed to expire therewith;
(f) the amendments to section 4403-f of the public health law, made by
sections forty-one, forty-one-a and forty-one-b of this act shall not
affect the repeal of such section and shall be deemed repealed there-
with;
(g) sections fifty and fifty-one of this act shall take effect on the
ninetieth day after it shall have become a law;
(h) sections five, twenty, twenty-one, twenty-seven, thirty-nine,
forty-one, forty-one-a, forty-one-b, forty-eight, fifty-four and fifty-
eight of this act shall take effect on the one hundred eightieth day
after it shall have become a law;
(i) the amendments to paragraph (b) and subparagraph (i) of paragraph
(g) of subdivision 7 of section 4403-f of the public health law made by
section forty-one-b of this act shall expire and be repealed April 1,
2015;
(j) the amendments to section 364-j of the social services law made by
sections nineteen, forty-two-b, forty-two-c, seventy-seven, seventy-sev-
en-a, seventy-eight, seventy-nine and eighty of this act shall not
affect the repeal of such section and shall be deemed repealed there-
with;
(k) the amendments to paragraph (k) of subdivision 2 of section 365-a
of the social services law made by section eighty-one of this act shall
not affect the expiration of such subdivision and shall be deemed to
expire therewith;
(l) sections thirteen, fourteen, fifteen and seventeen of this act
shall take effect May 1, 2011;
(m) section forty of this act shall take effect September 1, 2011;
(n) sections sixty-nine and eighty-two of this act shall take effect
on January 1, 2012 and, further, section eighty-two of this act shall
apply to taxable years beginning on or after January 1, 2012;
(o) sections thirty-eight and thirty-eight-a of this act shall expire
and be deemed repealed March 31, 2015;
(p) section ninety-one of this act shall take effect April 1, 2012;
S. 2809--D 185 A. 4009--D
(q) the operation of the fund established by section fifty-two of this
act shall commence on October 1, 2011; provided, however, that the
provisions of section fifty-two of this act shall apply to birth-related
neurological injury lawsuits as to which no judgment has been entered
and no settlement agreement has been entered into by the parties before
the date of enactment; provided, however, that notwithstanding any
inconsistent provision of law, nothing in this act shall be construed to
prevent a qualified plaintiff from obtaining medical care and assistance
through the medicaid program or services provided in private physician
practices on the basis of one hundred percent of the usual and customary
rates as defined by the commissioner of health in regulation during the
period of time subsequent to the date of enactment of this act and prior
to the date upon which the operation of such fund commences and, if such
costs are qualifying health costs as defined in this act, having such
costs paid from the fund; and provided, further, that the commissioner
of health shall be authorized to promulgate any regulations as necessary
to implement such sections prior to such effective date, including on an
emergency basis;
(r) sections fifty-two-a through fifty-two-h of this act shall take
effect on the ninetieth day after it shall have become law;
(s) the amendments to subdivision 7 of section 2807-s of the public
health law made by section thirty of this act shall not affect the expi-
ration of such section and shall be deemed to expire therewith;
(t) 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, provided that the (i) commis-
sioner of health (ii) the superintendent of financial services or, prior
to October 3, 2011, the superintendent of insurance, or (iii) any appro-
priate council may promulgate regulations including on an emergency
basis, necessary to implement this act, prior to its effective date and
may take any steps necessary to implement this act prior to its effec-
tive date;
(u) 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; and
(v) the provisions of this act shall become effective notwithstanding
the failure of the commissioner of health, the superintendent of finan-
cial services or, prior to October 3, 2011, the superintendent of insur-
ance or any council to adopt or amend or promulgate regulations imple-
menting this act.
S 2. Severability clause. If any clause, sentence, paragraph, subdivi-
sion, section or part of this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall be confined in
its operation to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would have been enacted even if such
invalid provisions had not been included herein.
S 3. This act shall take effect immediately provided, however, that
the applicable effective date of Parts A through H of this act shall be
as specifically set forth in the last section of such Parts.