Assembly Bill A4441

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

                                  4441

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            February 3, 2011
                               ___________

Introduced  by M. of A. BOYLE -- read once and referred to the Committee
  on Aging

AN ACT to amend the elder law,  in  relation  to  establishing  an  EPIC
  spend-down program

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

  Section 1. Subdivision 3 of section 242 of the elder law is renumbered
subdivision 4 and a new subdivision 3 is added to read as follows:
  3. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, SENIORS
WHO DO NOT QUALIFY FOR EPIC BASED ON INCOME MAY  QUALIFY  FOR  THE  EPIC
SPEND-DOWN  PROGRAM  IF  CERTAIN  ELIGIBILITY  REQUIREMENTS  ESTABLISHED
PURSUANT TO PARAGRAPHS (A) AND (B) OF THIS SUBDIVISION ARE MET.
  (A) ANY UNMARRIED RESIDENT WHO IS AT LEAST SIXTY-FIVE YEARS OF AGE AND
WHOSE INCOME FOR THE CALENDAR YEAR IMMEDIATELY PRECEDING  THE  EFFECTIVE
DATE  OF  ANNUAL  COVERAGE  FOR THE PERIOD BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND TWELVE, IS MORE THAN THIRTY-FIVE  THOUSAND  DOLLARS,
BUT DOES NOT EXCEED THE SUM OF FORTY THOUSAND DOLLARS, SHALL QUALIFY FOR
THE  EPIC  SPEND-DOWN  PROGRAM  PROVIDED  THAT SUCH INDIVIDUAL SPENDS AT
LEAST FIVE THOUSAND DOLLARS  IN  OUT-OF-POCKET  PHARMACEUTICAL  EXPENSES
WHICH  SHALL  BE  DOCUMENTED  ON FORMS PRESCRIBED BY THE COMMISSIONER OF
HEALTH. AFTER THE INITIAL DETERMINATION OF  ELIGIBILITY,  EACH  ELIGIBLE
INDIVIDUAL MUST REAPPLY ANNUALLY FOR CONTINUED ELIGIBILITY.
  (B)  ANY  MARRIED RESIDENT WHO IS AT LEAST SIXTY-FIVE YEARS OF AGE AND
WHOSE INCOME FOR THE CALENDAR YEAR IMMEDIATELY PRECEDING  THE  EFFECTIVE
DATE  OF  ANNUAL  COVERAGE  FOR THE PERIOD BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND TWELVE, IS MORE THAN  FIFTY  THOUSAND  DOLLARS,  BUT
DOES  NOT  EXCEED  THE SUM OF FIFTY-FIVE THOUSAND DOLLARS, SHALL QUALIFY
FOR THE EPIC SPEND-DOWN PROGRAM IF SUCH INDIVIDUAL SPENDS AT  LEAST  TEN
THOUSAND DOLLARS IN OUT-OF-POCKET PHARMACEUTICAL EXPENSES WHICH SHALL BE
DOCUMENTED  ON FORMS PRESCRIBED BY THE COMMISSIONER OF HEALTH. AFTER THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06985-01-1

              

A. 4441                             2

INITIAL DETERMINATION OF  ELIGIBILITY,  EACH  ELIGIBLE  INDIVIDUAL  MUST
REAPPLY ANNUALLY FOR CONTINUED ELIGIBILITY.
  (C)  INDIVIDUALS  WHO  MEET  THE  REQUIREMENTS  OF THE EPIC SPEND-DOWN
PROGRAM SHALL BE ELIGIBLE FOR PROGRAM BENEFITS  AS  IF  THE  INDIVIDUALS
QUALIFIED  FOR  THE HIGHEST INCOME LEVEL UNDER THE CATASTROPHIC COVERAGE
PURSUANT TO SUBDIVISION TWO OF THIS  SECTION  AND  SECTION  TWO  HUNDRED
FORTY-EIGHT  OF  THIS  TITLE.  FOR  THE PURPOSES OF THIS SUBDIVISION ALL
DEDUCTIBLE REQUIREMENTS SHALL BE WAIVED FOR ELIGIBLE INDIVIDUALS.
  (D) FOR THE PURPOSES OF THIS  SUBDIVISION,  "OUT-OF-POCKET  PHARMACEU-
TICAL  EXPENSES"  MEANS  PHARMACEUTICAL  COSTS  THAT  WOULD OTHERWISE BE
COVERED BY THE EPIC PROGRAM IF SUCH INDIVIDUAL OR INDIVIDUALS WOULD HAVE
MET THE ORIGINAL INCOME REQUIREMENTS OF THIS SECTION.
  (E) THE COMMISSIONER OF HEALTH IS HEREBY DIRECTED TO DEVELOP A  STAND-
ARDIZED  FORM  TO  BE  PROVIDED  TO ELIGIBLE PERSONS FOR THE PURPOSES OF
LEGAL DOCUMENTATION AND VERIFICATION  OF  OUT-OF-POCKET  EXPENSES.  SUCH
FORM SHALL BE AFFIXED TO THE EPIC APPLICATION.
  S 2. This act shall take effect on January 1, 2012.