[ ] is old law to be omitted.
LBD12671-03-2
S. 6256--B 2 A. 9056--B
relation to establishing the supportive housing development reinvest-
ment program; to amend the social services law, in relation to appli-
cability of the assisted living program; to amend the social services
law, in relation to including podiatry services and lactation services
under the term medical assistance; to amend the public health law and
education law, in relation to medical prescriptions for limited
English proficient individuals; to amend the social services law, in
relation to education, outreach services and facilitated enrollment
activities for certain aged, blind and disabled persons; to amend the
public health law, in relation to including certain violations by a
pharmacy as professional misconduct; expanding prenatal care programs,
establishing the primary care service corps practitioner loan repay-
ment program, requiring changes in directors of not-for-profit corpo-
rations that operate hospitals to be approved by the department,
authorizing the commissioner of health to temporarily suspend or limit
hospital operating certificates, revoking of hospital operating
certificates, appointment and duties of temporary operators of a
general hospital or diagnostic and treatment center, authorizing
moneys in the medical indemnity fund to be invested in obligations of
the United States or the state or obligations where the principal and
interest are guaranteed by the United States or the state and moneys
distributed as non-Medicaid grants to non-major public academic
medical centers; to amend the social services law, in relation to
prescriptions of opioid analgesics and brand name drugs covered by
medical assistance; to amend the public health law, in relation to
notice requirement for preferred drug program, payment to the commis-
sioner of health by third-party payors, audit of payments to the
commissioner of health, electronic submission of reports by hospitals,
and changing the definition of eligible applicant; to amend the social
services law, in relation to medical assistance where relative is
absent or refuses or fails to provide necessary care; to amend the
public health law, in relation to third-party payor's election to make
payments; to amend the elder law, in relation to the elderly pharma-
ceutical insurance coverage program; to amend the public health law,
in relation to reserved bed days; to amend the social services law, in
relation to the personal care services worker recruitment and
retention program; to amend the public health law, in relation to the
tobacco control and insurance initiatives pool distributions; to amend
the social services law, in relation to certain public school
districts and state operated/state supported schools; to amend the
public health law, in relation to the licensure of home care services
agencies; to amend the social services law, in relation to managed
care programs; to amend the public health law, in relation to the
distribution of the professional education pools; to amend chapter 584
of the laws of 2011, amending the public authorities law, relating to
the powers and duties of the dormitory authority of the state of New
York relative to the establishment of subsidiaries for certain
purposes, in relation to the effectiveness thereof; to amend chapter
119 of the laws of 1997 relating to authorizing the department of
health to establish certain payments to general hospitals, in relation
to costs incurred in excess of revenues by general hospitals in
providing services in eligible programs to uninsured patients and
patients eligible for Medicaid assistance; to amend subdivision 1 of
section 92 of part H of chapter 59 of the laws of 2011, relating to
known and projected department of health state funds Medicaid expendi-
tures, in relation to the effectiveness thereof; to amend section 90
S. 6256--B 3 A. 9056--B
of part H of chapter 59 of the laws of 2011, relating to types of
appropriations exempt from certain reductions, in relation to certain
payments with regard to local governments; to amend section 1 of part
C of chapter 58 of the laws of 2005, relating to authorizing
reimbursements for expenditures made by or on behalf of social
services districts for medical assistance for needy persons and the
administration thereof, in relation to Medicaid reimbursement; and to
repeal certain provisions of the public health law, the social
services law and the elder law relating thereto (Part D); to amend the
public authorities law and the public officers law, in relation to the
establishment of the New York Health Benefit Exchange (Part E); to
amend chapter 58 of the laws of 2005 authorizing reimbursements for
expenditures made by or on behalf of social services districts for
medical assistance for needy persons and the administration thereof,
in relation to an administrative cap on such program; to amend chapter
59 of the laws of 2011, amending the public health law and other laws
relating to general hospital reimbursement for annual rates, in
relation to the cap on local Medicaid expenditures; and to amend the
social services law, in relation to the department assumption of
program administration for medical assistance (Part F); to amend the
public health law, in relation to regulations for computing hospital
inpatient rates and to amend chapter 58 of the laws of 2005 relating
to the preferred drug program, in relation to the effectiveness there-
of (Part G); 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
2012-2013 state fiscal year; and in relation to directing limits on
state reimbursement for executive compensation and administrative
costs (Part H); in relation to contracts by the office for people with
developmental disabilities made under section 1115 of the federal
social security act (Part I); to amend the mental hygiene law, the
public health law, the general municipal law, the education law, the
social services law, and the surrogate's court procedure act, in
relation to the office for people with developmental disabilities and
the creation of developmental disabilities regional offices and state
operations offices (Part J); to amend chapter 723 of the laws of 1989
amending the mental hygiene law and other laws relating to comprehen-
sive psychiatric emergency programs, in relation to extending the
repeal of certain provisions thereof (Part K); to permit the commis-
sioners of the department of health, the office of mental health, the
office of alcoholism and substance abuse services and the office for
people with developmental disabilities the regulatory flexibility to
more efficiently and effectively integrate health and behavioral
health services (Part L); to permit the office of mental health and
the state education department to enter into an agreement for purposes
of providing education programming for patients residing in hospitals
operated by the office of mental health who are between the ages of
five and twenty-one; and providing for the repeal of such provisions
upon expiration thereof (Part M); to amend the mental hygiene law and
the public health law, in relation to the statewide comprehensive
services plan for people with mental disabilities and in relation to
the local planning process; and to repeal certain provisions of the
mental hygiene law relating thereto (Part N); to amend the mental
hygiene law, in relation to the closure and the reduction in size of
certain facilities serving persons with mental illness (Part O); to
amend the mental hygiene law, in relation to amending procedures under
S. 6256--B 4 A. 9056--B
the sex offender management and treatment act, and to amend the penal
law, in relation to providing criminal penalties for certain
violations of orders of commitment and strict and intensive super-
vision and treatment (Part P); to amend the criminal procedure law, in
relation to providing for outpatient capacity restoration of felony
defendants, or restoration at psychiatric units of jails or article 28
hospitals (Part Q); to amend chapter 111 of the laws of 2010 relating
to the recovery of exempt income by the office of mental health for
community residences and family-based treatment programs, in relation
to the effectiveness thereof (Part R); and to amend the public health
law, in relation to consolidating the excess medical malpractice
liability coverage pool; and to repeal section 18 of chapter 266 of
the laws of 1986, amending the civil practice law and rules and other
laws relating to medical and dental malpractice, relating thereto
(Part S)
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 2012-2013
state fiscal year. Each component is wholly contained within a Part
identified as Parts A through S. 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 (a) of subdivision 2 of section 2544 of the
public health law, as added by chapter 428 of the laws of 1992, is
amended and a new paragraph (c) is added to read as follows:
(a) [The] SUBJECT TO THE PROVISIONS OF SECTION TWENTY-FIVE HUNDRED
FORTY-FIVE-A OF THIS TITLE, THE parent may select an evaluator from the
list of approved evaluators as described in section twenty-five hundred
forty-two of this title to conduct the evaluation. The parent or evalu-
ator shall immediately notify the early intervention official of such
selection. The evaluator may begin the evaluation no sooner than four
working days after such notification, unless otherwise approved by the
initial service coordinator.
(C) IF, IN CONSULTATION WITH THE EVALUATOR, THE SERVICE COORDINATOR
IDENTIFIES A CHILD THAT IS POTENTIALLY ELIGIBLE FOR PROGRAMS OR SERVICES
OFFERED BY OR UNDER THE AUSPICES OF THE OFFICE FOR PEOPLE WITH DEVELOP-
MENTAL DISABILITIES, THE SERVICE COORDINATOR SHALL, WITH PARENT CONSENT,
NOTIFY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES' REGIONAL
DEVELOPMENTAL DISABILITIES SERVICES OFFICE OF THE POTENTIAL ELIGIBILITY
OF SUCH CHILD FOR SAID PROGRAMS OR SERVICES.
S 2. Subdivision 1, the opening paragraph of subdivision 2 and subdi-
vision 7 of section 2545 of the public health law, as added by chapter
428 of the laws of 1992, are amended to read as follows:
S. 6256--B 5 A. 9056--B
1. If the evaluator determines that the infant or toddler is an eligi-
ble child, the early intervention official shall convene a meeting, at a
time and place convenient to the parent, consisting of the parent, such
official, the evaluator, A REPRESENTATIVE FROM THE CHILD'S INSURER OR
HEALTH MAINTENANCE ORGANIZATION, WHICH SHALL INCLUDE THE MEDICAL ASSIST-
ANCE PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTABLISHED IN TITLE
ONE-A OF THIS ARTICLE, OR ANY OTHER GOVERNMENTAL THIRD PARTY PAYOR, IF
THE CHILD HAS COVERAGE THROUGH AN INSURER OR HEALTH MAINTENANCE ORGAN-
IZATION AND THE REPRESENTATIVE IS AVAILABLE TO ATTEND THE MEETING ON THE
DATE AND TIME CHOSEN BY THE EARLY INTERVENTION OFFICIAL, the initial
service coordinator and any other persons who the parent or the initial
service coordinator, with the parent's consent, invite, provided that
such meeting shall be held no later than forty-five days from the date
that the early intervention official was first contacted regarding the
child, except under exceptional circumstances prescribed by the commis-
sioner. The early intervention official, at or prior to the time of
scheduling the meeting, shall inform the parent of the right to invite
any person to the meeting. IF THE REPRESENTATIVE FROM THE CHILD'S
INSURER OR HEALTH MAINTENANCE ORGANIZATION IS NOT AVAILABLE TO ATTEND
THE MEETING IN PERSON ON THE DATE AND TIME CHOSEN BY THE EARLY INTER-
VENTION OFFICIAL, ARRANGEMENTS MAY BE MADE FOR THE REPRESENTATIVE'S
INVOLVEMENT IN THE MEETING BY PARTICIPATION IN A TELEPHONE CONFERENCE
CALL OR BY OTHER MEANS.
The early intervention official, A REPRESENTATIVE FROM THE CHILD'S
INSURER OR HEALTH MAINTENANCE ORGANIZATION, WHICH SHALL INCLUDE THE
MEDICAL ASSISTANCE PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTAB-
LISHED IN TITLE ONE-A OF THIS ARTICLE, OR ANY OTHER GOVERNMENTAL THIRD
PARTY PAYOR, IF THE CHILD HAS COVERAGE THROUGH AN INSURER OR HEALTH
MAINTENANCE ORGANIZATION AND THE REPRESENTATIVE IS AVAILABLE TO ATTEND
THE MEETING ON THE DATE AND TIME CHOSEN BY THE EARLY INTERVENTION OFFI-
CIAL, initial service coordinator, parent and evaluator shall develop an
IFSP for an eligible child whose parents request services. The IFSP
shall be in writing and shall include, but not be limited to:
7. The IFSP shall be reviewed at six month intervals and shall be
evaluated annually by the early intervention official, A REPRESENTATIVE
FROM THE CHILD'S INSURER OR HEALTH MAINTENANCE ORGANIZATION, WHICH SHALL
INCLUDE THE MEDICAL ASSISTANCE PROGRAM OR THE CHILD HEALTH INSURANCE
PROGRAM ESTABLISHED IN TITLE ONE-A OF THIS ARTICLE, OR ANY OTHER GOVERN-
MENTAL THIRD PARTY PAYOR, IF THE CHILD HAS COVERAGE THROUGH AN INSURER
OR HEALTH MAINTENANCE ORGANIZATION AND THE REPRESENTATIVE IS AVAILABLE
TO PARTICIPATE IN THE REVIEW OR ATTEND ON THE DATE AND TIME CHOSEN BY
THE EARLY INTERVENTION OFFICIAL, THE service coordinator, the parent and
providers of services to the eligible child. Upon request of a parent,
the plan may be reviewed by such persons at more frequent intervals. IF
THE REPRESENTATIVE FROM THE CHILD'S INSURER OR HEALTH MAINTENANCE ORGAN-
IZATION IS NOT AVAILABLE TO PARTICIPATE IN THE REVIEW OR ATTEND IN
PERSON ON THE DATE AND TIME CHOSEN BY THE EARLY INTERVENTION OFFICIAL,
ARRANGEMENTS MAY BE MADE FOR THE REPRESENTATIVE'S INVOLVEMENT BY PARTIC-
IPATION IN A TELEPHONE CONFERENCE CALL OR BY OTHER MEANS.
S 2-a. Section 2545 of the public health law is amended by adding a
new subdivision 10 to read as follows:
10. THE SERVICE COORDINATOR SHALL ENSURE THAT THE IFSP, INCLUDING ANY
AMENDMENTS THERETO, IS IMPLEMENTED IN A TIMELY MANNER BUT NOT LATER THAN
THIRTY DAYS AFTER THE PROJECTED DATES FOR INITIATION OF THE SERVICES AS
SET FORTH IN THE PLAN.
S. 6256--B 6 A. 9056--B
S 3. The public health law is amended by adding a new section 2545-a
to read as follows:
S 2545-A. USE OF NETWORK PROVIDERS. FOR CHILDREN REFERRED TO THE
EARLY INTERVENTION PROGRAM ON OR AFTER JANUARY FIRST, TWO THOUSAND THIR-
TEEN, IF A CHILD HAS COVERAGE UNDER AN INSURANCE POLICY, PLAN OR
CONTRACT, INCLUDING COVERAGE AVAILABLE UNDER THE MEDICAL ASSISTANCE
PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTABLISHED IN TITLE ONE-A
OF THIS ARTICLE OR UNDER ANY OTHER GOVERNMENTAL THIRD PARTY PAYOR, AND
THE INSURANCE POLICY, PLAN OR CONTRACT PROVIDES COVERAGE FOR EVALUATIONS
OR SERVICES THAT MAY BE RENDERED TO THE CHILD UNDER THE EARLY INTER-
VENTION PROGRAM, THE SERVICE COORDINATOR, OR, IN ACCORDANCE WITH SECTION
TWENTY-FIVE HUNDRED FORTY-FOUR OF THIS TITLE, THE PARENT, WITH RESPECT
TO EVALUATIONS, SHALL SELECT A PROVIDER APPROVED BY THE DEPARTMENT AND
WITHIN THE INSURER'S OR HEALTH MAINTENANCE ORGANIZATION'S NETWORK, IF
APPLICABLE, FOR THE PROVISION OF SUCH EVALUATION OR SERVICES, PROVIDED
HOWEVER THAT THIS SUBDIVISION SHALL NOT APPLY UNDER THE FOLLOWING CONDI-
TIONS:
1. THERE IS NO PROVIDER IN THE INSURER'S OR HEALTH MAINTENANCE ORGAN-
IZATION'S NETWORK THAT IS AVAILABLE OR APPROPRIATE TO RECEIVE THE REFER-
RAL AND TO CONDUCT THE EVALUATION OR TO BEGIN PROVIDING SERVICES IN A
TIMELY MANNER IN ACCORDANCE WITH THE CHILD'S IFSP;
2. INSURANCE OR HEALTH PLAN BENEFITS HAVE BEEN EXHAUSTED; OR
3. THE CHILD HAS A DEMONSTRATED NEED, AS DETERMINED BY THE INSURER OR
HEALTH MAINTENANCE ORGANIZATION, IF APPLICABLE, FOR AN EVALUATION OR
SERVICE RENDERED BY A PROVIDER WHO DOES NOT HOLD AN AGREEMENT WITH THE
CHILD'S INSURER OR HEALTH MAINTENANCE ORGANIZATION FOR THE PROVISION OF
SUCH EVALUATION OR SERVICE.
S 4. Subdivision 2 of section 2547 of the public health law, as
amended by chapter 231 of the laws of 1993, is amended to read as
follows:
2. In addition to respite services provided pursuant to subdivision
one of this section and subject to the amounts appropriated therefor,
the state shall reimburse the municipality IN ACCORDANCE WITH THE
PERCENTAGE OF STATE AID REIMBURSEMENT FOR APPROVED COSTS AS SET FORTH IN
SUBDIVISION TWO OF SECTION TWENTY-FIVE HUNDRED FIFTY-SEVEN OF THIS
TITLE, for [fifty percent of] the costs of respite services provided to
eligible children and their families with the approval of the early
intervention official.
S 5. Section 2548 of the public health law, as amended by section 20
of part H of chapter 686 of the laws of 2003, is amended to read as
follows:
S 2548. Transition plan. To the extent that a toddler with a disabili-
ty is thought to be eligible for services pursuant to section forty-four
hundred ten of the education law, the [early intervention official]
SERVICE COORDINATOR shall notify in writing the committee on preschool
special education of the local school district in which an eligible
child resides of the potential transition of such child and, with
parental consent, arrange for a conference among the service coordina-
tor, the parent and the chairperson of the preschool committee on
special education or his or her designee at least ninety days before
such child would be eligible for services under section forty-four
hundred ten of the education law to review the child's program options
and to establish a transition plan, if appropriate. If a parent does not
consent to a conference with the service coordinator and the chairperson
of the preschool committee on special education or his or her designee
to determine whether the child should be referred for services under
S. 6256--B 7 A. 9056--B
section forty-four hundred ten of the education law, and the child is
not determined to be eligible by the committee on preschool special
education for such services prior to the child's third birthday, the
child's eligibility for early intervention program services shall end at
the child's third birthday.
S 6. Subdivision 2 of section 2550 of the public health law, as
amended by section 5 of part B3 of chapter 62 of the laws of 2003, is
amended to read as follows:
2. In meeting the requirements of subdivision one of this section, the
lead agency shall adopt and use proper methods of administering the
early intervention program, including:
(a) establishing standards for evaluators, service coordinators and
providers of early intervention services;
(b) approving, and periodically re-approving evaluators, service coor-
dinators and providers of early intervention services who meet depart-
ment standards; PROVIDED HOWEVER THAT THE DEPARTMENT MAY REQUIRE THAT
APPROVED EVALUATORS, SERVICE COORDINATORS AND PROVIDERS OF EARLY INTER-
VENTION SERVICES ENTER INTO AGREEMENTS WITH THE DEPARTMENT IN ORDER TO
CONDUCT EVALUATIONS OR RENDER SERVICE COORDINATION OR EARLY INTERVENTION
SERVICES IN THE EARLY INTERVENTION PROGRAM. SUCH AGREEMENTS SHALL SET
FORTH THE TERMS AND CONDITIONS OF PARTICIPATION IN THE PROGRAM. IF THE
DEPARTMENT REQUIRES THAT SUCH PROVIDERS ENTER INTO AGREEMENTS WITH THE
DEPARTMENT FOR PARTICIPATION IN THE PROGRAM, "APPROVAL" OR "APPROVED" AS
USED IN THIS TITLE SHALL MEAN A PROVIDER WHO IS APPROVED BY THE DEPART-
MENT IN ACCORDANCE WITH DEPARTMENT REGULATIONS AND HAS ENTERED INTO AN
AGREEMENT WITH THE DEPARTMENT FOR THE PROVISION OF EVALUATIONS, SERVICE
COORDINATION OR EARLY INTERVENTION SERVICES.
A LESS-THAN-ARMS-LENGTH RELATIONSHIP SHALL NOT EXIST BETWEEN THE
SERVICE COORDINATOR, EVALUATOR AND THE PROVIDER AUTHORIZED TO DELIVER
EARLY INTERVENTION SERVICES TO THE CHILD, UNLESS APPROVAL OF THE LEAD
AGENCY, IN CONSULTATION WITH THE EARLY INTERVENTION OFFICIAL, IS
OBTAINED. PROVIDED FURTHER THAT, UNLESS AUTHORIZED BY THE LEAD AGENCY,
IN CONSULTATION WITH THE EARLY INTERVENTION OFFICIAL, UPON A FINDING
THAT IT HAS BEEN DEMONSTRATED THAT AN APPROVED PROVIDER IS THE ONLY
APPROPRIATE PROVIDER AVAILABLE TO RENDER THE SERVICES RECOMMENDED FOR
SUCH CHILD, THE SERVICE COORDINATOR, THE EVALUATOR SELECTED BY THE
PARENT AND THE PROVIDER RECOMMENDED TO DELIVER SERVICES TO SUCH CHILD,
AND ANY AGENCY UNDER WHICH SUCH SERVICE COORDINATOR, EVALUATOR OR
PROVIDER IS EMPLOYED BY OR UNDER CONTRACT WITH, SHALL NOT BE THE SAME
ENTITY.
ALL APPROVED EVALUATORS AND PROVIDERS OF EARLY INTERVENTION SERVICES,
HEREINAFTER COLLECTIVELY REFERRED TO AS "PROVIDER" OR "PROVIDERS" FOR
PURPOSES OF THIS SUBPARAGRAPH, SHALL ESTABLISH AND MAINTAIN CONTRACTS OR
AGREEMENTS WITH A SUFFICIENT NUMBER OF INSURERS OR HEALTH MAINTENANCE
ORGANIZATIONS, INCLUDING THE MEDICAL ASSISTANCE PROGRAM OR THE CHILD
HEALTH INSURANCE PROGRAM ESTABLISHED UNDER TITLE ONE-A OF THIS ARTICLE,
AS DETERMINED NECESSARY BY THE COMMISSIONER TO MEET INSURER OR HEALTH
MAINTENANCE ORGANIZATION NETWORK ADEQUACY; PROVIDED, HOWEVER, THAT THE
DEPARTMENT MAY, IN ITS DISCRETION, APPROVE A PROVIDER WHO DOES NOT HAVE
A CONTRACT OR AGREEMENT WITH ONE OR MORE INSURERS OR HEALTH MAINTENANCE
ORGANIZATIONS IF THE PROVIDER RENDERS A SERVICE THAT MEETS A UNIQUE NEED
FOR SUCH SERVICE UNDER THE EARLY INTERVENTION PROGRAM. APPROVED PROVID-
ERS SHALL SUBMIT TO THE DEPARTMENT, INFORMATION AND DOCUMENTATION OF THE
INSURERS AND HEALTH MAINTENANCE ORGANIZATIONS, WITH WHICH THE PROVIDER
HOLDS AN AGREEMENT OR CONTRACT. A PROVIDER'S APPROVAL WITH THE DEPART-
MENT TO DELIVER EVALUATIONS OR EARLY INTERVENTION SERVICES SHALL TERMI-
S. 6256--B 8 A. 9056--B
NATE IF THE PROVIDER FAILS TO PROVIDE SUCH INFORMATION OR DOCUMENTATION
ACCEPTABLE TO THE DEPARTMENT OF ITS CONTRACTS OR AGREEMENTS WITH INSUR-
ERS OR HEALTH MAINTENANCE ORGANIZATIONS AS REQUESTED BY THE DEPARTMENT;
(c) [compiling and disseminating to the municipalities lists of
approved evaluators, service coordinators and providers of early inter-
vention services;
(d)] monitoring of agencies, institutions and organizations under this
title and agencies, institutions and organizations providing early
intervention services which are under the jurisdiction of a state early
intervention service agency;
[(e)] (D) enforcing any obligations imposed on those agencies under
this title or Part H of the federal individuals with disabilities educa-
tion act and its regulations;
[(f)] (E) providing training and technical assistance to those agen-
cies, institutions and organizations, including initial and ongoing
training and technical assistance to municipalities to help enable them
to identify, locate and evaluate eligible children, develop IFSPs,
ensure the provision of appropriate early intervention services, promote
the development of new services, where there is a demonstrated need for
such services and afford procedural safeguards to infants and toddlers
and their families;
[(g)] (F) correcting deficiencies that are identified through monitor-
ing; and
[(h)] (G) in monitoring early intervention services, the commissioner
shall provide municipalities with the results of any review of early
intervention services undertaken and shall provide the municipalities
with the opportunity to comment thereon.
S 7. Subdivision 7 of section 2551 of the public health law is
REPEALED, and subdivisions 8, 9 and 10 are renumbered subdivisions 7, 8
and 9.
S 8. Section 2552 of the public health law, as added by chapter 428
of the laws of 1992, subdivisions 2 and 3 as amended by chapter 231 of
the laws of 1993, and subdivision 4 as added by section 6 of part B3 of
chapter 62 of the laws of 2003, is amended to read as follows:
S 2552. Responsibility of municipality. 1. Each municipality shall be
responsible for ensuring that the early intervention services contained
in an IFSP are provided to eligible children and their families who
reside in such municipality [and may contract with approved providers of
early intervention services for such purpose]. THE SERVICE COORDINATOR
SHALL REPORT, IN A MANNER AND FORMAT AS DETERMINED BY THE MUNICIPALITY,
ON THE DELIVERY OF SERVICES TO AN ELIGIBLE CHILD IN ACCORDANCE WITH THE
ELIGIBLE CHILD'S IFSP. A MUNICIPALITY MAY REQUEST THAT THE PARENT SELECT
A NEW SERVICE COORDINATOR OR REQUIRE THAT THE SERVICE COORDINATOR SELECT
A NEW PROVIDER OF SERVICES IF THE MUNICIPALITY FINDS THAT THE SERVICE
COORDINATOR HAS NOT BEEN PERFORMING HIS OR HER RESPONSIBILITIES AS
REQUIRED BY THIS TITLE OR THAT SERVICES HAVE NOT BEEN PROVIDED IN
ACCORDANCE WITH THE ELIGIBLE CHILD'S IFSP.
2. [After consultation with early intervention officials, the commis-
sioner shall develop procedures to permit a municipality to contract or
otherwise make arrangements with other municipalities for an eligible
child and the child's family to receive services from such other munici-
palities.
3. The municipality shall monitor claims for service reimbursement
authorized by this title and shall verify such claims prior to payment.
The municipality shall inform the commissioner of discrepancies in bill-
ing and when payment is to be denied or withheld by the municipality.
S. 6256--B 9 A. 9056--B
4.] The early intervention official shall require an eligible child's
parent to furnish the parents' and eligible child's social security
numbers for the purpose of the department's and municipality's adminis-
tration of the program.
S 9. Subdivision 1 of section 2557 of the public health law, as
amended by section 4 of part C of chapter 1 of the laws of 2002, is
amended to read as follows:
1. The approved costs, OTHER THAN THOSE REIMBURSABLE IN ACCORDANCE
WITH SECTION TWENTY-FIVE HUNDRED FIFTY-NINE OF THIS TITLE, for [an
eligible] A child who receives an evaluation and early intervention
services pursuant to this title shall be a charge upon the municipality
wherein the eligible child resides or, where the services are covered by
the medical assistance program, upon the social services district of
fiscal responsibility with respect to those eligible children who are
also eligible for medical assistance. All approved costs shall be paid
in the first instance and at least quarterly by the appropriate govern-
ing body or officer of the municipality upon vouchers presented and
audited in the same manner as the case of other claims against the muni-
cipality. Notwithstanding the insurance law or regulations thereunder
relating to the permissible exclusion of payments for services under
governmental programs, no such exclusion shall apply with respect to
payments made pursuant to this title. Notwithstanding the insurance law
or any other law or agreement to the contrary, benefits under this title
shall be considered secondary to any [plan of insurance or state govern-
ment benefit program] INSURANCE POLICY, PLAN OR CONTRACT under which an
eligible child may have coverage, INCLUDING COVERAGE AVAILABLE UNDER THE
MEDICAL ASSISTANCE PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTAB-
LISHED IN TITLE ONE-A OF THIS ARTICLE, OR UNDER ANY OTHER GOVERNMENTAL
THIRD PARTY PAYOR. Nothing in this section shall increase or enhance
coverages provided for within an insurance contract subject to the
provisions of this title.
S 9-a. Subdivision 4 of section 2557 of the public health law is
REPEALED and subdivisions 2 and 5, subdivision 2 as added by chapter 428
of the laws of 1992 and subdivision 5 as added by section 7 of part B3
of chapter 62 of the laws of 2003, are amended to read as follows:
2. The department shall reimburse the approved costs paid by a munici-
pality for the purposes of this title, other than those reimbursable by
AN INSURER OR HEALTH MAINTENANCE ORGANIZATION, OR GOVERNMENTAL THIRD
PARTY PAYOR INCLUDING the medical assistance program or [by third party
payors] THE CHILD HEALTH INSURANCE PROGRAM ESTABLISHED IN TITLE ONE-A OF
THIS ARTICLE, in an amount of fifty percent of the amount expended in
accordance with the rules and regulations of the commissioner; PROVIDED,
HOWEVER, THAT IN THE DISCRETION OF THE DEPARTMENT AND WITH THE APPROVAL
OF THE DIRECTOR OF THE DIVISION OF THE BUDGET, THE DEPARTMENT MAY REIM-
BURSE MUNICIPALITIES IN AN AMOUNT GREATER THAN FIFTY PERCENT OF THE
AMOUNT EXPENDED. Such state reimbursement to the municipality shall not
be paid prior to April first of the year in which the approved costs are
paid by the municipality, PROVIDED, HOWEVER THAT, SUBJECT TO THE
APPROVAL OF THE DIRECTOR OF THE BUDGET, THE DEPARTMENT MAY PAY SUCH
STATE AID REIMBURSEMENT TO THE MUNICIPALITY PRIOR TO SUCH DATE.
5. [The department shall] (A) THE COMMISSIONER, IN HIS OR HER
DISCRETION, IS AUTHORIZED TO contract with [an independent organization]
ONE OR MORE ENTITIES to act as the fiscal agent for the department AND
MUNICIPALITIES WITH RESPECT TO FISCAL MANAGEMENT AND PAYMENT OF EARLY
INTERVENTION CLAIMS. MUNICIPALITIES SHALL GRANT SUFFICIENT AUTHORITY TO
THE FISCAL AGENT TO ACT ON THEIR BEHALF. MUNICIPALITIES, AND INDIVIDUAL
S. 6256--B 10 A. 9056--B
AND AGENCY PROVIDERS AS DEFINED BY THE COMMISSIONER IN REGULATION SHALL
UTILIZE SUCH FISCAL AGENT FOR PAYMENT OF EARLY INTERVENTION CLAIMS AS
DETERMINED BY THE DEPARTMENT AND SHALL PROVIDE SUCH INFORMATION AND
DOCUMENTATION AS REQUIRED BY THE DEPARTMENT AND NECESSARY FOR THE FISCAL
AGENT TO CARRY OUT ITS DUTIES.
(B) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTION ONE HUNDRED
TWELVE OR ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, SECTIONS ONE
HUNDRED FORTY-TWO AND ONE HUNDRED FORTY-THREE OF THE ECONOMIC DEVELOP-
MENT LAW, OR ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER IS
AUTHORIZED TO ENTER INTO A CONTRACT OR CONTRACTS UNDER PARAGRAPH (A) OF
THIS SUBDIVISION WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROC-
ESS, 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 A 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.
(C) PARAGRAPH (B) OF THIS SUBDIVISION SHALL APPLY ONLY TO THE INITIAL
CONTRACT OR CONTRACTS NECESSARY TO OBTAIN THE SERVICES OF A FISCAL AGENT
FOR EARLY INTERVENTION PROGRAM FISCAL MANAGEMENT AND PAYMENT OF EARLY
INTERVENTION CLAIMS AND SHALL NOT APPLY TO SUBSEQUENT CONTRACTS NEEDED
TO MAINTAIN SUCH SERVICES, AS DETERMINED BY THE COMMISSIONER IN HIS OR
HER DISCRETION. [A municipality may elect to utilize the services of
such organization for early intervention program fiscal management and
claiming as determined by the commissioner or may select an independent
agent to act as the fiscal agent for such municipality or may act as its
own fiscal agent.]
S 10. Subdivision 4 of section 2558 of the public health law, as added
by chapter 428 of the laws of 1992, is amended to read as follows:
4. Local contribution. The municipality of residence shall be finan-
cially responsible for the local contribution in the amount of fifty
percent of the [approved costs] AMOUNT EXPENDED PROVIDED, HOWEVER, THAT
IN THE DISCRETION OF THE DEPARTMENT AND WITH THE APPROVAL OF THE DIREC-
TOR OF THE DIVISION OF THE BUDGET, IN ACCORDANCE WITH SUBDIVISION TWO OF
SECTION TWENTY-FIVE HUNDRED FIFTY-SEVEN OF THIS TITLE, THE DEPARTMENT
MAY REQUIRE THAT MUNICIPALITIES BE FINANCIALLY RESPONSIBLE FOR A LOCAL
CONTRIBUTION IN AN AMOUNT LESS THAN FIFTY PERCENT OF THE AMOUNT
EXPENDED. The commissioner shall certify to the comptroller the amount
of the local contribution owed by each municipality to the state. The
comptroller shall deduct the amount of such local contribution first
from any moneys due the municipality pursuant to section twenty-five
hundred fifty-six of this title and then from any other moneys due or to
become due to the municipality.
S 11. Paragraphs (a), (c) and (d) of subdivision 3 of section 2559 of
the public health law, paragraph (a) as amended and paragraph (d) as
S. 6256--B 11 A. 9056--B
added by chapter 231 of the laws of 1993, subparagraphs (i) and (ii) of
paragraph (a) as added by chapter 406 of the laws of 2011, and paragraph
(c) as added by chapter 428 of the laws of 1992 are amended to read as
follows:
(a) Providers of EVALUATIONS AND early intervention services [and],
INCLUDING transportation services, HEREINAFTER COLLECTIVELY REFERRED TO
IN THIS SUBDIVISION AS "PROVIDER" OR "PROVIDERS", shall in the first
instance and where applicable, seek payment from all [third party payors
including governmental agencies] INSURERS AND HEALTH MAINTENANCE ORGAN-
IZATIONS, INCLUDING THE MEDICAL ASSISTANCE PROGRAM AND THE CHILD HEALTH
INSURANCE PROGRAM ESTABLISHED IN TITLE ONE-A OF THIS ARTICLE AND ANY
OTHER GOVERNMENTAL THIRD PARTY PAYORS prior to claiming payment from a
given municipality for EVALUATIONS CONDUCTED UNDER THE PROGRAM AND FOR
services rendered to eligible children, provided that, [for the purpose
of seeking payment from the medical assistance program or from other
third party payors, the municipality shall be deemed the provider of
such early intervention services to the extent that the provider has
promptly furnished to the municipality adequate and complete information
necessary to support the municipality billing, and provided further
that] the obligation to seek payment shall not apply to a payment from
[a third party payor] AN INSURER who is not prohibited from applying
such payment, and will apply such payment, to an annual or lifetime
limit specified in the insured's policy.
(i) Parents shall provide [and] the municipality [shall obtain] AND
SERVICE COORDINATOR information on any [plan of insurance] INSURANCE
POLICY, PLAN OR CONTRACT under which an eligible child has coverage.
(ii) Parents shall provide the municipality AND THE SERVICE COORDINA-
TOR with a written referral from a primary care provider as documenta-
tion, for eligible children, of the medical necessity of early inter-
vention services.
(III) PROVIDERS SHALL UTILIZE THE DEPARTMENT'S FISCAL AGENT AND DATA
SYSTEM FOR CLAIMING PAYMENT FROM INSURERS OR HEALTH MAINTENANCE ORGAN-
IZATIONS FOR EVALUATIONS AND SERVICES RENDERED UNDER THE EARLY INTER-
VENTION PROGRAM.
(IV) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR REGU-
LATION, PAYMENTS MADE BY ANY INSURER OR HEALTH MAINTENANCE ORGANIZATION
FOR EVALUATIONS AND SERVICES PROVIDED UNDER THE EARLY INTERVENTION
PROGRAM SHALL BE AT RATES ESTABLISHED UNDER AN AGREEMENT NEGOTIATED
BETWEEN THE INSURER OR HEALTH MAINTENANCE ORGANIZATION, IF APPLICABLE,
PROVIDED, HOWEVER, THAT IF THE INSURER OR HEALTH MAINTENANCE ORGANIZA-
TION MAINTAINS A NETWORK OF PROVIDERS AND A CHILD HAS A DEMONSTRATED
NEED, AS DETERMINED BY THE INSURER OR HEALTH MAINTENANCE ORGANIZATION,
IF APPLICABLE, FOR AN EVALUATION OR SERVICE RENDERED BY A PROVIDER WHO
IS NOT WITHIN THE INSURER OR HEALTH MAINTENANCE ORGANIZATION'S NETWORK,
PAYMENT TO SUCH OUT OF NETWORK PROVIDER SHALL BE MADE AT RATES ESTAB-
LISHED BY THE COMMISSIONER IN ACCORDANCE WITH REGULATION.
(V) PAYMENTS MADE BY ANY INSURER OR HEALTH MAINTENANCE PROGRAM SHALL
BE CONSIDERED PAYMENTS IN FULL FOR SUCH SERVICES AND THE PROVIDER SHALL
NOT SEEK ADDITIONAL PAYMENT FROM THE MUNICIPALITY, CHILD, OR HIS OR HER
PARENTS FOR ANY PORTION OF THE COSTS OF SAID SERVICES. NOTHING HEREIN
SHALL PROHIBIT AN INSURER OR HEALTH MAINTENANCE ORGANIZATION FROM APPLY-
ING A COPAYMENT, COINSURANCE OR DEDUCTIBLE AS SET FORTH IN THE POLICY OR
PLAN. PAYMENTS FOR COPAYMENTS, COINSURANCE OR DEDUCTIBLES SHALL BE MADE
IN ACCORDANCE WITH PARAGRAPH (B) OF THIS SUBDIVISION.
(VI) WHEN PAYMENT UNDER AN INSURANCE POLICY, PLAN OR CONTRACT IS NOT
AVAILABLE OR HAS BEEN EXHAUSTED, PROVIDERS SHALL SEEK PAYMENT FOR
S. 6256--B 12 A. 9056--B
SERVICES IN ACCORDANCE WITH SECTION TWENTY-FIVE HUNDRED FIFTY-SEVEN OF
THIS TITLE; PROVIDED, HOWEVER, THAT IF THE SERVICE PROVIDED IS A COVERED
BENEFIT UNDER THE POLICY, PLAN OR CONTRACT AND PAYMENT HAS BEEN DENIED
ON GROUNDS OTHER THAN THAT BENEFITS HAVE BEEN EXHAUSTED, THE PROVIDER
SHALL EXHAUST ALL APPEALS OF SAID DENIAL PRIOR TO CLAIMING PAYMENT TO
THE MUNICIPALITY FOR THE SERVICE IN ACCORDANCE WITH SECTION TWENTY-FIVE
HUNDRED FIFTY-SEVEN OF THIS TITLE. PROVIDERS SHALL NOT DISCONTINUE OR
DELAY SERVICES TO ELIGIBLE CHILDREN PENDING PAYMENT OF THE CLAIM OR
DETERMINATIONS OF ANY APPEAL DENIALS.
(c) Payments made for early intervention services under an insurance
policy or health benefit plan, INCLUDING PAYMENTS MADE BY THE MEDICAL
ASSISTANCE PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTABLISHED
UNDER TITLE ONE-A OF THIS ARTICLE OR OTHER GOVERNMENTAL THIRD PARTY
PAYOR, which are provided as part of an IFSP pursuant to section twen-
ty-five hundred forty-five of this title shall not be applied by the
insurer or plan administrator against any maximum lifetime or annual
limits specified in the policy or health benefits plan, pursuant to
section eleven of the chapter of the laws of nineteen hundred ninety-two
which added this title.
[(d) A municipality, or its designee, shall be subrogated, to the
extent of the expenditures by such municipality for early intervention
services furnished to persons eligible for benefits under this title, to
any rights such person may have or be entitled to from third party
reimbursement. The right of subrogation does not attach to benefits paid
or provided under any health insurance policy or health benefits plan
prior to receipt of written notice of the exercise of subrogation rights
by the insurer or plan administrator providing such benefits.]
S 12. Subdivision 7 of section 2510 of the public health law, as
amended by section 21 of part B of chapter 109 of the laws of 2010, is
amended to read as follows:
7. "Covered health care services" means: the services of physicians,
optometrists, nurses, nurse practitioners, midwives and other related
professional personnel which are provided on an outpatient basis,
including routine well-child visits; diagnosis and treatment of illness
and injury; inpatient health care services; laboratory tests; diagnostic
x-rays; prescription and non-prescription drugs and durable medical
equipment; radiation therapy; chemotherapy; hemodialysis; emergency room
services; hospice services; emergency, preventive and routine dental
care, including medically necessary orthodontia but excluding cosmetic
surgery; emergency, preventive and routine vision care, including
eyeglasses; speech and hearing services; and, inpatient and outpatient
mental health, alcohol and substance abuse services as defined by the
commissioner in consultation with the superintendent. "COVERED HEALTH
CARE SERVICES" SHALL ALSO INCLUDE EARLY INTERVENTION SERVICES PROVIDED
PURSUANT TO TITLE TWO-A OF THIS ARTICLE UP TO THE SCOPE AND LEVEL OF
COVERAGE FOR THE SAME SERVICES PROVIDED PURSUANT TO THIS SUBDIVISION, AS
DEFINED BY THE COMMISSIONER. "Covered health care services" shall not
include drugs, procedures and supplies for the treatment of erectile
dysfunction when provided to, or prescribed for use by, a person who is
required to register as a sex offender pursuant to article six-C of the
correction law, provided that any denial of coverage of such drugs,
procedures or supplies shall provide the patient with the means of
obtaining additional information concerning both the denial and the
means of challenging such denial.
S 13. Intentionally omitted.
S. 6256--B 13 A. 9056--B
S 14. Paragraph (b) of subdivision 5 of section 4403 of the public
health law is relettered paragraph (c), paragraph (c), as added by chap-
ter 705 of the laws of 1996, is amended and a new paragraph (b) is added
to read as follows:
(B) UPON THE EFFECTIVE DATE OF THIS PARAGRAPH AND AT THE TIME OF EVERY
THREE YEAR REVIEW BY THE COMMISSIONER AS SET FORTH IN PARAGRAPH (A) OF
THIS SUBDIVISION, AND UPON APPLICATION FOR EXPANSION OF SERVICE AREA,
THE HEALTH MAINTENANCE ORGANIZATION SHALL DEMONSTRATE THAT IT MAINTAINS
AN ADEQUATE NETWORK OF PROVIDERS WHO ARE APPROVED TO DELIVER EVALUATIONS
AND EARLY INTERVENTION PROGRAM SERVICES IN ACCORDANCE WITH TITLE II-A OF
ARTICLE TWENTY-FIVE OF THIS CHAPTER, BY SHOWING TO THE SATISFACTION OF
THE COMMISSIONER THAT (I) THERE ARE A SUFFICIENT NUMBER OF GEOGRAPH-
ICALLY ACCESSIBLE PARTICIPATING PROVIDERS; AND (II) THERE ARE SUFFICIENT
PROVIDERS IN EACH AREA OF SPECIALTY OF PRACTICE TO MEET THE NEEDS OF THE
ENROLLMENT POPULATION.
[(c)] (D) Each organization shall report on an annual basis the number
of enrollees and the number of participating providers in each organiza-
tion. EACH HEALTH MAINTENANCE ORGANIZATION SHALL MAKE PUBLICLY AVAIL-
ABLE AND UPDATE ON A QUARTERLY BASIS, THE NAMES OF PARTICIPATING PROVID-
ERS IN THE HEALTH MAINTENANCE ORGANIZATION'S NETWORK WHO ARE APPROVED TO
DELIVER EVALUATIONS AND EARLY INTERVENTION PROGRAM SERVICES IN ACCORD-
ANCE WITH TITLE II-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
S 15. Section 4406 of the public health law is amended by adding a new
subdivision 6 to read as follows:
6. (A) NO SUBSCRIBER CONTRACT OR BENEFIT PACKAGE SHALL EXCLUDE COVER-
AGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE BASIS THAT THE SERVICES
CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES UNDER TITLE II-A OF ARTI-
CLE TWENTY-FIVE OF THIS CHAPTER.
(B) WHERE A SUBSCRIBER CONTRACT OR BENEFIT PACKAGE PROVIDES COVERAGE
FOR A SERVICE THAT IS PROVIDED UNDER THE EARLY INTERVENTION PROGRAM AND
IS OTHERWISE COVERED UNDER THE SUBSCRIBER CONTRACT OR BENEFIT PACKAGE,
SUCH COVERAGE SHALL NOT BE APPLIED AGAINST ANY MAXIMUM ANNUAL OR LIFE-
TIME MONETARY LIMITS SET FORTH IN SUCH SUBSCRIBER CONTRACT OR BENEFIT
PACKAGE. VISIT LIMITATIONS AND OTHER TERMS AND CONDITIONS OF THE
SUBSCRIBER CONTRACT OR BENEFIT PACKAGE WILL CONTINUE TO APPLY TO EARLY
INTERVENTION SERVICES. HOWEVER, ANY VISITS USED FOR EARLY INTERVENTION
PROGRAM SERVICES SHALL NOT REDUCE THE NUMBER OF VISITS OTHERWISE AVAIL-
ABLE UNDER THE SUBSCRIBER CONTRACT OR BENEFIT PACKAGE FOR SUCH SERVICES
THAT ARE NOT PROVIDED UNDER THE EARLY INTERVENTION PROGRAM.
(C) THE HEALTH MAINTENANCE ORGANIZATION SHALL PROVIDE THE MUNICIPALITY
AND SERVICE COORDINATOR WITH INFORMATION ON THE EXTENT OF BENEFITS
AVAILABLE TO AN ENROLLEE UNDER SUCH SUBSCRIBER CONTRACT OR BENEFIT PACK-
AGE WITHIN FIFTEEN DAYS OF THE HEALTH MAINTENANCE ORGANIZATION'S RECEIPT
OF WRITTEN REQUEST AND NOTICE AUTHORIZING SUCH RELEASE.
(D) NO HEALTH MAINTENANCE ORGANIZATION SHALL REFUSE TO ISSUE A
SUBSCRIBER CONTRACT OR BENEFIT PACKAGE OR REFUSE TO RENEW A SUBSCRIBER
CONTRACT OR BENEFIT PACKAGE SOLELY BECAUSE THE APPLICANT OR ENROLLEE IS
RECEIVING SERVICES UNDER THE EARLY INTERVENTION PROGRAM.
(E) HEALTH MAINTENANCE ORGANIZATIONS SHALL ACCEPT CLAIMS SUBMITTED FOR
PAYMENT UNDER THE CONTRACT FROM A PROVIDER THROUGH THE DEPARTMENT'S
FISCAL AGENT AND DATA SYSTEM FOR SUCH CLAIMING. HEALTH MAINTENANCE
ORGANIZATIONS SHALL, IN A MANNER AND FORMAT AS REQUIRED BY THE DEPART-
MENT, PROVIDE THE DEPARTMENT WITH INFORMATION ON CLAIMS SUBMITTED FOR
EVALUATIONS AND EARLY INTERVENTION SERVICES PROVIDED TO CHILDREN UNDER
THE EARLY INTERVENTION PROGRAM AND DISPOSITION OF SUCH CLAIMS.
S. 6256--B 14 A. 9056--B
(F) WHERE A SUBSCRIBER CONTRACT OR BENEFIT PACKAGE PROVIDES COVERAGE
FOR AN EVALUATION OR SERVICE PROVIDED UNDER THE EARLY INTERVENTION
PROGRAM, REIMBURSEMENT FOR SUCH EVALUATION OR SERVICE SHALL BE AT RATES
NEGOTIATED BY THE HEALTH MAINTENANCE ORGANIZATION AND PROVIDER PROVIDED,
HOWEVER, THAT IF A CHILD HAS A DEMONSTRATED NEED, AS DETERMINED BY THE
HEALTH MAINTENANCE ORGANIZATION, FOR AN EVALUATION OR SERVICE RENDERED
BY A PROVIDER WHO DOES NOT HOLD AN AGREEMENT WITH THE CHILD'S HEALTH
MAINTENANCE ORGANIZATION FOR THE PROVISION OF SERVICES TO COVERED
PERSONS, PAYMENT TO SUCH OUT OF NETWORK PROVIDER SHALL BE MADE AT RATES
ESTABLISHED BY THE COMMISSIONER IN ACCORDANCE WITH REGULATION.
(G) HEALTH MAINTENANCE ORGANIZATIONS SHALL ENSURE THAT THE TERMS AND
CONDITIONS CONTAINED IN SUBSCRIBER CONTRACTS OR BENEFIT PACKAGES RELAT-
ING TO PROVISION OF SERVICES TO CHILDREN UNDER THE EARLY INTERVENTION
PROGRAM COMPLIES WITH TITLE II-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER
AND WITH STANDARDS SET FORTH IN PART C OF THE INDIVIDUALS WITH DISABILI-
TIES EDUCATION ACT, AS AMENDED BY THE INDIVIDUALS WITH DISABILITIES
EDUCATION IMPROVEMENT ACT OF 2004.
S 16. Intentionally omitted.
S 17. Subsections (c) and (e) of section 3235-a of the insurance law,
subsection (c) as amended and subsection (e) as added by chapter 406 of
the laws of 2011, are amended, and a new subsection (f) is added to read
as follows:
(c) [Any right of subrogation to benefits which a municipality is
entitled in accordance with paragraph (d) of subdivision three of
section twenty-five hundred fifty-nine of the public health law shall be
valid and enforceable to the extent benefits are available under any
accident and health insurance policy. The right of subrogation does not
attach to insurance benefits paid or provided under any accident and
health insurance policy prior to receipt by the insurer of written
notice from the municipality. Upon the insurer's receipt of written
request and notice from the municipality that such right of subrogation
has been granted to such municipality and that the insured has author-
ized the release of information to the municipality, the] THE insurer
shall provide the municipality AND SERVICE COORDINATOR with information
on the extent of benefits available to the covered person under such
policy WITHIN FIFTEEN DAYS OF THE INSURER'S RECEIPT OF WRITTEN REQUEST
AND NOTICE AUTHORIZING SUCH RELEASE.
(e) [Written claim for early intervention program services shall be
submitted by the municipality as the approved provider within one
hundred fifty days from the date of service.] WHERE A POLICY OF ACCIDENT
AND HEALTH INSURANCE, INCLUDING A CONTRACT ISSUED PURSUANT TO ARTICLE
FORTY-THREE OF THIS CHAPTER, UTILIZES A NETWORK OF PROVIDERS, THE INSUR-
ER SHALL DEMONSTRATE TO THE SUPERINTENDENT THAT IT MAINTAINS AN ADEQUATE
NETWORK OF PROVIDERS WHO ARE APPROVED TO DELIVER EVALUATIONS AND EARLY
INTERVENTION PROGRAM SERVICES IN ACCORDANCE WITH TITLE II-A OF ARTICLE
TWENTY-FIVE OF THE PUBLIC HEALTH LAW BY DOCUMENTING THAT (I) THERE ARE A
SUFFICIENT NUMBER OF GEOGRAPHICALLY ACCESSIBLE PARTICIPATING PROVIDERS;
AND (II) THERE ARE SUFFICIENT PROVIDERS IN EACH AREA OF SPECIALTY OF
PRACTICE TO MEET THE NEEDS OF THE ENROLLMENT POPULATION. WHERE A POLICY
OF ACCIDENT AND HEALTH INSURANCE, INCLUDING A CONTRACT ISSUED PURSUANT
TO ARTICLE FORTY-THREE OF THIS CHAPTER, PROVIDES COVERAGE FOR AN EVALU-
ATION OR SERVICE PROVIDED UNDER THE EARLY INTERVENTION PROGRAM,
REIMBURSEMENT FOR SUCH EVALUATION OR SERVICE SHALL BE AT RATES NEGOTI-
ATED BY THE INSURER AND PROVIDER, IF APPLICABLE, PROVIDED, HOWEVER, THAT
IF A CHILD HAS A DEMONSTRATED NEED FOR AN EVALUATION OR SERVICE RENDERED
BY A PROVIDER WHO DOES NOT HOLD AN AGREEMENT WITH THE CHILD'S INSURER
S. 6256--B 15 A. 9056--B
FOR THE PROVISION OF SERVICES TO COVERED PERSONS, PAYMENT TO SUCH
PROVIDER SHALL BE MADE AT RATES ESTABLISHED BY THE COMMISSIONER OF
HEALTH IN ACCORDANCE WITH REGULATION.
(F) NOTHING IN THIS SECTION SHALL BE DEEMED TO LIMIT THE SUPERINTEN-
DENT'S AUTHORITY TO IMPOSE NETWORK ADEQUACY REQUIREMENTS ON INSURERS IN
GENERAL.
S 18. Subdivision 18 of section 4403 of the education law is REPEALED.
S 19. Paragraph f of subdivision 3 and the opening paragraph of para-
graph a of subdivision 9 of section 4410 of the education law, as
amended by chapter 82 of the laws of 1995, are amended to read as
follows:
f. After notification by [an early intervention official] A SERVICE
COORDINATOR, as defined in section twenty-five hundred forty-one of the
public health law, that a child receiving services pursuant to title
II-A of article twenty-five of the public health law potentially will
transition to receiving services under this section and that a confer-
ence is to be convened to review the child's program options and estab-
lish a transition plan, which conference must occur at least ninety days
before such child would be eligible for services under this section, the
chairperson of the committee on preschool special education of the local
school district or his or her designee in which such child resides shall
participate in the conference.
Providers of special services or programs shall apply to the commis-
sioner for program approval on a form prescribed by the commissioner;
such application shall include, but not be limited to, a listing of the
services to be provided, the population to be served, a plan for provid-
ing services in the least restrictive environment and a description of
its evaluation component, if any. [Providers of early intervention
services seeking approval pursuant to subdivision seven of section twen-
ty-five hundred fifty-one of the public health law shall apply to the
commissioner for such approval on a form prescribed by the commission-
er.] The commissioner shall approve programs in accordance with regu-
lations adopted for such purpose and shall periodically review such
programs at which time the commissioner shall provide the municipality
in which the program is located or for which the municipality bears
fiscal responsibility an opportunity for comment within thirty days of
the review. In collaboration with municipalities and representatives of
approved programs, the commissioner shall develop procedures for
conducting such reviews. Municipalities shall be allowed to participate
in such departmental review process. Such review shall be conducted by
individuals with appropriate experience as determined by the commission-
er and shall be conducted not more than once every three years.
S 20. Intentionally omitted.
S 21. Intentionally omitted.
S 22. Intentionally omitted.
S 23. This act shall take effect January 1, 2013; provided, however,
that:
1. the amendments to subdivision 7 of section 2510 of the public
health law made by section twelve of this act shall not affect the expi-
ration of such subdivision and shall be deemed to expire therewith;
2. the requirements contained in subparagraph (iv) of paragraph (a) of
subdivision 3 of section 2559 of the public health law, as added by
section eleven of this act, paragraph (f) of subdivision 6 of section
4406 of the public health law, as added by section fifteen of this act,
and subsection (e) of section 3235-a of the insurance law, as amended by
section seventeen of this act, as such sections pertain to requiring
S. 6256--B 16 A. 9056--B
that an insurer or health maintenance organization make payment to a
provider who is not within the insurer or health maintenance organiza-
tion's network at rates established by the commissioner of health in
accordance with regulation, if a child has a demonstrated need, as
determined by the insurer or health maintenance organization, if appli-
cable, for an evaluation or service rendered by a provider who is not
within the insurer or health maintenance organization's network, shall
apply only to policies, benefit packages and contracts issued, renewed,
modified, altered or amended on or after the effective date of such
sections of this act; and
3. sections two-a, four, five, seven, eight, nine-a, ten, eighteen and
nineteen of this act shall take effect April 1, 2013.
PART B
Section 1. Subdivisions 9, 10 and 11 of section 3555 of the public
authorities law, as added by chapter 5 of the laws of 1997, are amended
to read as follows:
9. to determine the conditions under which a physician may be extended
the privilege of practicing within a health facility under the jurisdic-
tion of the corporation, to promulgate internal policies for the conduct
of all persons, physicians and allied health practitioners within such
facility, and to appoint and grant privileges to qualified and competent
clinical practitioners; [and]
10. except as provided in this subdivision or as expressly limited by
any applicable state law or regulation, and in support of the powers
granted by subdivisions five and six of this section, to form and to
participate in the formation of one or more corporations, and to exer-
cise and perform such purposes, powers, duties, functions or activities
through one or more subsidiary corporations or other entities owned or
controlled wholly or in part by the corporation, which shall be formed
pursuant to the business corporation law, the limited liability company
law, the not-for-profit corporation law, or the partnership law; any
such subsidiary may be authorized to act as a general or limited partner
in a partnership or as a member of a limited liability company, and
enter into an arrangement calling for an initial and subsequent payment
or payments or contributions to capital by such subsidiary in consider-
ation of an interest in revenues or other contractual rights. An entity
shall be deemed a subsidiary corporation whenever and so long as (a)
more than half of any voting shares or other membership interest of such
subsidiary are owned or held by the corporation or (b) a majority of the
directors, trustees or members of such subsidiary are designees of the
corporation[.];
11. TO ACCEPT FUNDING FROM THE STATE PURSUANT TO PARAGRAPH (O) OF
SUBDIVISION ONE OF SECTION TWENTY-EIGHT HUNDRED SEVEN-V OF THE PUBLIC
HEALTH LAW OR PURSUANT TO SECTION TWENTY-EIGHT HUNDRED EIGHTEEN OF THE
PUBLIC HEALTH LAW, PROVIDED, HOWEVER, THAT AS A CONDITION FOR RECEIPT OF
SUCH FUNDS THE CORPORATION IS REQUIRED TO TAKE ALL NECESSARY AND APPRO-
PRIATE STEPS AND ARRANGEMENTS, INCLUDING BUT NOT LIMITED TO, ENTERING
INTO AN ARRANGEMENT FOR MERGER OR OTHER AFFILIATION WITH ONE OR MORE
HEALTH CARE, ACADEMIC OR OTHER ENTITIES, LOCATED WITHIN THE SAME
GEOGRAPHICAL REGION AS THE CORPORATION, FOR THE PURPOSE OF PROMOTING THE
CONTINUED FINANCIAL VIABILITY OF THE CORPORATION, PROTECTING AND PROMOT-
ING THE HEALTH OF THE PATIENTS SERVED BY ITS HEALTH FACILITIES AND, TO
THE EXTENT POSSIBLE, CONTRIBUTING TO THE ECONOMIC REVITALIZATION OF THE
REGION BY BECOMING OPERATIONALLY AND FISCALLY INDEPENDENT OF THE DEPART-
S. 6256--B 17 A. 9056--B
MENT OF HEALTH BY NO LATER THAN MARCH THIRTY-FIRST, TWO THOUSAND FOUR-
TEEN, AND PROVIDED FURTHER, HOWEVER, THAT THE COMMISSIONER OF HEALTH
SHALL MONITOR SUCH STEPS AND ARRANGEMENTS, ESTABLISH GOALS AND BENCH-
MARKS FOR THE ACHIEVEMENT OF SUCH INDEPENDENCE, INTERCEDE AS DEEMED
NECESSARY AND APPROPRIATE AND DELAY OR PRECLUDE THE CORPORATION'S
RECEIPT OF SUCH FUNDS IN THE EVENT THE COMMISSIONER OF HEALTH DETERMINES
THAT SUCH GOALS AND BENCHMARKS HAVE NOT BEEN MET.
12. No subsidiary of the corporation shall own, operate, manage or
control the existing research, education, acute inpatient or outpatient
facilities and services now operated by the Roswell Park Cancer Insti-
tute.
S 2. This act shall take effect April 1, 2012.
PART C
Section 1. The public health law is amended by adding a new section
4148 to read as follows:
S 4148. ELECTRONIC DEATH REGISTRATION SYSTEM. 1. LEGISLATIVE FINDINGS.
THE LEGISLATURE FINDS THAT IT IS NECESSARY TO UPDATE AND MODERNIZE THE
STATE'S SYSTEM OF FILING AND MAINTAINING INFORMATION AND DOCUMENTS
RELATED TO THE REGISTRATION OF DEATH. AN ELECTRONIC DEATH REGISTRATION
SYSTEM WILL PROMOTE ACCURACY AND PROVIDE FOR MORE TIMELY TRANSMISSION OF
DOCUMENTATION, PROMOTING EFFICIENCY IN THE OPERATIONS OF THE DEPARTMENT,
WHICH OVERSEES THE DEATH REGISTRATION FILING PROCESS; LOCAL REGISTRARS,
WHICH ACCEPT AND FILE CERTIFICATES OF DEATH AND ISSUE BURIAL AND REMOVAL
PERMITS; HEALTH CARE INSTITUTIONS AND PRACTITIONERS, CORONERS AND
MEDICAL EXAMINERS, WHICH PREPARE CERTIFICATES OF DEATH; AND LICENSED
FUNERAL DIRECTORS AND UNDERTAKERS, WHO REQUIRE PROMPT ACCESS TO CERTIF-
ICATES OF DEATH TO CONDUCT BURIALS AND FUNERALS IN A TIMELY FASHION.
LICENSED FUNERAL DIRECTORS AND UNDERTAKERS HAVE EXPRESSED THEIR INTEREST
IN PARTNERING WITH THE DEPARTMENT TO SUPPORT THE ESTABLISHMENT AND MAIN-
TENANCE OF SUCH SYSTEM THROUGH A CONTRIBUTION, TENDERED FOR EACH BURIAL
AND REMOVAL PERMIT ISSUED TO A LICENSED FUNERAL DIRECTOR OR UNDERTAKER,
IN THE AMOUNT OF TWENTY DOLLARS.
2. THE DEPARTMENT IS HEREBY AUTHORIZED AND DIRECTED TO DESIGN, IMPLE-
MENT AND MAINTAIN AN ELECTRONIC DEATH REGISTRATION SYSTEM FOR COLLECT-
ING, STORING, RECORDING, TRANSMITTING, AMENDING, CORRECTING AND AUTHEN-
TICATING INFORMATION, AS NECESSARY AND APPROPRIATE TO COMPLETE A DEATH
REGISTRATION, AND TO GENERATE SUCH DOCUMENTS AS DETERMINED BY THE
DEPARTMENT IN RELATION TO A DEATH OCCURRING IN THIS STATE. THE CONTRIB-
UTION REFERENCED IN SUBDIVISION ONE OF THIS SECTION SHALL BE COLLECTED
FOR EACH BURIAL OR REMOVAL PERMIT ISSUED ON OR AFTER THE EFFECTIVE DATE
OF THIS SECTION FROM THE LICENSED FUNERAL DIRECTOR OR UNDERTAKER TO WHOM
SUCH PERMIT IS ISSUED, IN THE MANNER SPECIFIED BY THE DEPARTMENT AND
SHALL BE USED SOLELY FOR THE PURPOSE SET FORTH IN SUBDIVISION 1 OF THIS
SECTION.
3. COMMENCING ON JANUARY FIRST, TWO THOUSAND FOURTEEN, OR AS SOON
THEREAFTER AS THE COMMISSIONER REASONABLY DETERMINES IS FEASIBLE IN
LIGHT OF THE INTENT OF THIS SECTION, THE DEPARTMENT SHALL REQUIRE THAT
DEATHS OCCURRING WITHIN THIS STATE MUST BE REGISTERED USING THE ELEC-
TRONIC DEATH REGISTRATION SYSTEM ESTABLISHED IN THIS SECTION. ELECTRONIC
DEATH REGISTRATION MAY BE PHASED IN, AS DETERMINED BY THE COMMISSIONER,
FOR DEATHS OCCURRING IN THE STATE UNTIL THE ELECTRONIC DEATH REGISTRA-
TION SYSTEM IS FULLY IMPLEMENTED IN THE STATE.
4. COMMENCING ON JANUARY FIRST, TWO THOUSAND FOURTEEN, OR ON SUCH DATE
DETERMINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION 3 OF THIS
S. 6256--B 18 A. 9056--B
SECTION, ALL PERSONS REQUIRED TO REGISTER A DEATH OR FILE A CERTIFICATE
OF DEATH UNDER THIS ARTICLE, AND SUCH OTHERS AS MAY BE AUTHORIZED BY THE
COMMISSIONER, SHALL HAVE ACCESS TO THE ELECTRONIC DEATH REGISTRATION
SYSTEM FOR THE PURPOSE OF ENTERING INFORMATION REQUIRED TO EXECUTE,
COMPLETE AND FILE A CERTIFICATE OF DEATH OR TO RETRIEVE SUCH INFORMATION
OR GENERATE DOCUMENTATION FROM THE ELECTRONIC DEATH REGISTRATION SYSTEM.
THE CONFIDENTIALITY PROVISIONS IN SECTION FORTY-ONE HUNDRED FORTY-SEVEN
OF THIS TITLE SHALL APPLY TO INFORMATION MAINTAINED IN THIS SYSTEM.
5. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, COMMENCING ON
OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, OR ON SUCH DATE DETER-
MINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION 3 OF THIS SECTION, ANY
REQUIREMENT OF THIS TITLE FOR A SIGNATURE OF ANY PERSON SHALL BE DEEMED
SATISFIED BY THE USE BY SUCH PERSON OF DIGITAL SIGNATURE PROVIDED SUCH
PERSON IS AUTHORIZED IN ACCORDANCE WITH THIS SECTION TO USE THE ELEC-
TRONIC DEATH REGISTRATION SYSTEM.
S 2. Subdivision 1 of section 4100-a of the public health law, as
amended by chapter 644 of the laws of 1988, is amended and a new subdi-
vision 5 is added to read as follows:
1. The term "certified copy" means a photographic reproduction in the
form of a photocopy or a microfilm print of the original certificate OR
ELECTRONICALLY PRODUCED PRINT OF THE ORIGINAL CERTIFICATE, COMMENCING ON
OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, and certified by the
commissioner, his designated representative, a local registrar [or his
deputy], DEPUTY REGISTRAR OR SUB-REGISTRAR as a true copy thereof.
5. THE TERM "ELECTRONIC DEATH REGISTRATION SYSTEM" MEANS THE DATA
SYSTEM CREATED AND MAINTAINED BY THE DEPARTMENT FOR COLLECTING, STORING,
RECORDING, TRANSMITTING, AMENDING, CORRECTING AND AUTHENTICATING INFOR-
MATION, AS NECESSARY AND APPROPRIATE TO COMPLETE A DEATH REGISTRATION,
AND TO GENERATE SUCH DOCUMENTS AS DETERMINED BY THE DEPARTMENT, INCLUD-
ING PERMITS OR CERTIFICATES, RELATING TO A DEATH OCCURRING IN THIS
STATE.
S 3. Subdivision 1 of section 4140 of the public health law is amended
to read as follows:
1. The death of each person who has died in this state shall be regis-
tered immediately and not later than seventy-two hours after death or
the finding of a dead human body, by filing with the registrar of the
district in which the death occurred or the body was found a certificate
of such death, [which certificate shall be upon the form] IN A MANNER
AND FORMAT AS prescribed by the commissioner, WHICH SHALL INCLUDE
THROUGH ELECTRONIC MEANS IN ACCORDANCE WITH SECTION FORTY-ONE HUNDRED
FORTY-EIGHT OF THIS TITLE.
S 4. Section 4141-a of the public health law, as amended by chapter
153 of the laws of 2011, is amended to read as follows:
S 4141-a. Death certificate; duties of hospital administrator. When a
death occurs in a hospital, except in those cases where certificates are
issued by coroners or medical examiners, the person in charge of such
hospital or his or her designated representative shall promptly present
the certificate to the physician or nurse practitioner in attendance, or
a physician or nurse practitioner acting in his or her behalf, who shall
promptly certify to the facts of death, provide the medical information
required by the certificate, sign the medical certificate of death, and
thereupon return such certificate to such person, so that the seventy-
two hour registration time limit prescribed in section four thousand one
hundred forty of this title can be met; PROVIDED, HOWEVER THAT COMMENC-
ING ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, OR ON SUCH DATE
DETERMINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION 3 OF SECTION 4148
S. 6256--B 19 A. 9056--B
OF THIS TITLE, INFORMATION AND SIGNATURES REQUIRED BY THIS SECTION SHALL
BE OBTAINED AND MADE IN ACCORDANCE WITH SECTION FORTY-ONE HUNDRED
FORTY-EIGHT OF THIS TITLE.
S 5. Section 4142 of the public health law is amended by adding a new
subdivision (e) to read as follows:
(E) NOTWITHSTANDING ANY CONTRARY PROVISIONS OF LAW AS MAY BE SET FORTH
IN THIS SECTION, COMMENCING ON OR AFTER JANUARY FIRST, TWO THOUSAND
FOURTEEN, OR ON SUCH DATE DETERMINED BY THE COMMISSIONER PURSUANT TO
SUBDIVISION 3 OF SECTION 4148 OF THIS TITLE, INFORMATION AND SIGNATURES
REQUIRED BY THIS SUBDIVISION SHALL BE OBTAINED AND MADE IN ACCORDANCE
WITH SECTION FORTY-ONE HUNDRED FORTY-EIGHT OF THIS TITLE.
S 6. Paragraph (b) of subdivision 2 and subdivisions 3 and 5 of
section 4144 of the public health law, paragraph (b) of subdivision 2 as
amended by chapter 153 of the laws of 2011, are amended to read as
follows:
(b) Verbal permission to remove a body of a deceased person from the
county in which death occurred or the body was found to a non-adjacent
county within the state of New York, as provided in subdivision one of
this section, shall be issued by the said registrar of vital statistics,
upon request by telephone of a licensed funeral director or undertaker
who holds a certificate of death signed by the attending physician or
nurse practitioner, OR FOR DEATHS OCCURRING ON OR AFTER JANUARY FIRST,
TWO THOUSAND FOURTEEN, OR ON SUCH DATE DETERMINED BY THE COMMISSIONER
PURSUANT TO SUBDIVISION 3 OF SECTION 4148 OF THIS TITLE, SUCH CERTIF-
ICATE OF DEATH SIGNED BY THE ATTENDING PHYSICIAN OR NURSE PRACTITIONER
IS AVAILABLE ELECTRONICALLY IN ACCORDANCE WITH SECTION FORTY-ONE HUNDRED
FORTY-EIGHT OF THIS TITLE, showing that the death resulted from natural
causes and was not a result of accidental, suicidal, homicidal or other
external causes.
3. No registrar of vital statistics shall receive any fee for the
issuance of burial or removal permits under this chapter EXCEPT AS
REFERENCED BY SECTION FORTY-ONE HUNDRED FORTY-EIGHT OF THIS TITLE AND
other than the compensation provided in this article.
5. If the interment, or other disposition of the body of a deceased
person is to be made within the state, the wording of the burial or
removal permit may be limited to a statement by the registrar, and over
his signature, that a satisfactory certificate of death, having been
filed with him, as required by law, permission is granted to inter,
remove or otherwise dispose of the body, stating the name, age, sex,
cause of death, and other necessary details [upon the form prescribed by
the commissioner] IN A MANNER AND FORMAT AS MAY BE REQUIRED BY THE
COMMISSIONER.
S 7. Subdivisions 1 and 4 of section 4161 of the public health law,
subdivision 1 as amended by chapter 589 of the laws of 1991 and subdivi-
sion 4 as amended by chapter 153 of the laws of 2011, are amended to
read as follows:
1. The certificate of fetal death and the report of fetal death shall
contain such information and be in such form as the commissioner may
prescribe; PROVIDED HOWEVER THAT COMMENCING ON OR AFTER JANUARY FIRST,
TWO THOUSAND FOURTEEN, OR ON SUCH DATE DETERMINED BY THE COMMISSIONER
PURSUANT TO SUBDIVISION 3 OF THIS SECTION, INFORMATION AND SIGNATURES
REQUIRED BY THIS SUBDIVISION SHALL BE OBTAINED AND MADE IN ACCORDANCE
WITH SECTION FORTY-ONE HUNDRED FORTY-EIGHT OF THIS ARTICLE, except that
unless requested by the woman neither the certificate nor the report of
fetal death shall contain the name of the woman, her social security
number or any other information which would permit her to be identified
S. 6256--B 20 A. 9056--B
except as provided in this subdivision. The report shall state that a
certificate of fetal death was filed with the commissioner and the date
of such filing. The commissioner shall develop a unique, confidential
identifier to be used on the certificate of fetal death to be used in
connection with the exercise of the commissioner's authority to monitor
the quality of care provided by any individual or entity licensed to
perform an abortion in this state and to permit coordination of data
concerning the medical history of the woman for purposes of conducting
surveillance scientific studies and research pursuant to the provisions
of paragraph (j) of subdivision one of section two hundred six of this
chapter.
4. When a fetal death occurs in a hospital, except in those cases
where certificates are issued by coroners or medical examiners, the
person in charge of such hospital or his or her designated represen-
tative shall promptly present the certificate to the physician or nurse
practitioner in attendance, or a physician or nurse practitioner acting
in his or her behalf, who shall promptly certify to the facts of birth
and of fetal death, provide the medical information required by the
certificate, sign the medical certificate of birth and death, and there-
upon return such certificate to such person, so that the seventy-two
hour registration time limit prescribed in section four thousand one
hundred sixty of this title can be met; PROVIDED, HOWEVER THAT COMMENC-
ING ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, OR ON SUCH DATE
DETERMINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION 3 OF SECTION 4148
OF THIS ARTICLE, INFORMATION AND SIGNATURES REQUIRED BY THIS SUBDIVISION
SHALL BE OBTAINED AND MADE IN ACCORDANCE WITH SECTION FORTY-ONE HUNDRED
FORTY-EIGHT OF THIS ARTICLE.
S 8. Subdivision 3 of section 4171 of the public health law is amended
to read as follows:
3. All certificates, either of birth or death, shall be written legi-
bly, in durable black ink, [and no] PROVIDED HOWEVER, THAT COMMENCING ON
OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, OR ON SUCH DATE DETER-
MINED BY THE COMMISSIONER PURSUANT TO SUBDIVISION 3 OF SECTION 4148 OF
THIS ARTICLE, DEATH CERTIFICATES SHALL BE COMPLETED IN ACCORDANCE WITH
SECTION FORTY-ONE HUNDRED FORTY-EIGHT OF THIS ARTICLE. NO certificate,
WHETHER FILED IN PAPER FORM OR DEATH CERTIFICATE FILED ELECTRONICALLY IN
ACCORDANCE WITH SECTION FORTY-ONE HUNDRED FORTY-EIGHT OF THIS ARTICLE,
shall be held to be complete and correct that does not supply all of the
items of information called for therein, or satisfactorily account for
their omission.
S 9. This act shall take effect immediately; provided, however, that
if chapter 153 of the laws of 2011 is not in effect on such date then
the amendments made to section 4141-a of the public health law, para-
graph (b) of subdivision 2 of section 4144 of the public health law and
subdivision 4 of section 4161 of the public health law by sections four,
six and seven of this act shall take effect on the same date and same
manner as chapter 153 of the laws of 2011, takes effect; provided
further that the commissioner of health is authorized to promulgate
regulations as necessary to implement the provisions of this act.
PART D
Section 1. The public health law is amended by adding a new section
2823 to read as follows:
S 2823. SUPPORTIVE HOUSING DEVELOPMENT REINVESTMENT PROGRAM. 1.
NOTWITHSTANDING SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE
S. 6256--B 21 A. 9056--B
OF THE STATE FINANCE LAW OR SECTIONS ONE HUNDRED FORTY-TWO AND ONE
HUNDRED FORTY-THREE OF THE ECONOMIC DEVELOPMENT LAW OR ANY OTHER CONTRA-
RY PROVISION OF LAW, REINVESTMENT FUNDS FOR SUPPORTIVE HOUSING FOR
VULNERABLE POPULATIONS SHALL BE ALLOCATED ANNUALLY BY THE COMMISSIONER
BASED UPON THE FOLLOWING CRITERIA:
(A) THE EFFICIENCY AND EFFECTIVENESS OF THE USE OF FUNDING FOR THE
DEVELOPMENT OF ADEQUATE AND ACCESSIBLE HOUSING TO SUPPORT VULNERABLE
PERSONS IN THE COMMUNITY AND TO ENSURE ACCESS TO SUPPORTS NECESSARY TO
MAXIMIZE EXPECTED OUTCOMES; AND
(B) OTHER RELEVANT FACTORS RELATING TO THE MAINTENANCE OF EXISTING
SUPPORTIVE HOUSING AND THE DEVELOPMENT OF NEW SUPPORTIVE HOUSING AND
ASSOCIATED SERVICES.
2. AMOUNTS PROVIDED PURSUANT TO THIS SECTION SHALL BE USED ONLY TO
FUND HOUSING DEVELOPMENT ACTIVITIES AND OTHER GENERAL PROGRAMMATIC
ACTIVITIES TO HELP ENSURE A STABLE SYSTEM OF SUPPORTIVE HOUSING FOR
VULNERABLE PERSONS IN THE COMMUNITY.
3. THE COMMISSIONER IS AUTHORIZED AND EMPOWERED TO MAKE INSPECTIONS
AND EXAMINE RECORDS OF ANY ENTITY FUNDED PURSUANT TO SUBDIVISION TWO OF
THIS SECTION. SUCH EXAMINATION SHALL INCLUDE ALL MEDICAL, SERVICE AND
FINANCIAL RECORDS, RECEIPTS, DISBURSEMENTS, CONTRACTS, LOANS AND OTHER
MONEYS RELATING TO THE FINANCIAL OPERATION OF THE PROVIDER.
4. THE AMOUNT OF SUPPORTIVE HOUSING DEVELOPMENT REINVESTMENT FUNDS FOR
THE DEPARTMENT SHALL BE ITEMIZED IN THE ANNUAL BUDGET IN AN AMOUNT
DETERMINED BY THE COMMISSIONER, SUBJECT TO THE APPROVAL OF THE DIRECTOR
OF THE BUDGET. THIS AMOUNT SHALL INCLUDE THE AMOUNT OF GENERAL FUND
SAVINGS DIRECTLY RELATED TO INPATIENT HOSPITAL AND NURSING HOME BED
DECERTIFICATION AND/OR FACILITY CLOSURE. THE METHODOLOGIES USED TO
CALCULATE THE SAVINGS SHALL BE DEVELOPED BY THE COMMISSIONER AND THE
DIRECTOR OF THE BUDGET. IN NO EVENT SHALL THE FULL ANNUAL VALUE OF
SUPPORTIVE HOUSING DEVELOPMENT REINVESTMENT PROGRAMS ATTRIBUTABLE TO
INPATIENT HOSPITAL AND NURSING HOME BED DECERTIFICATION AND/OR FACILITY
CLOSURE EXCEED THE TWELVE MONTH VALUE OF THE DEPARTMENT OF HEALTH GENER-
AL FUND REDUCTIONS RESULTING FROM SUCH DECERTIFICATION AND/OR FACILITY
CLOSURE.
5. THE ANNUAL SUPPORTIVE HOUSING DEVELOPMENT REINVESTMENT APPROPRI-
ATION SHALL REFLECT A PROPORTION OF THE AMOUNT OF GENERAL FUND SAVINGS
RESULTING FROM SUBDIVISION FOUR OF THIS SECTION. WITHIN ANY FISCAL YEAR
WHERE APPROPRIATION INCREASES ARE RECOMMENDED FOR THE SUPPORTIVE HOUSING
DEVELOPMENT REINVESTMENT PROGRAM, INSOFAR AS PROJECTED BED DECERTIF-
ICATION AND/OR FACILITY CLOSURES DO NOT OCCUR AS ESTIMATED, AND GENERAL
FUND SAVINGS DO NOT RESULT, THEN THE REINVESTMENT APPROPRIATIONS MAY BE
REDUCED IN THE NEXT YEAR'S ANNUAL BUDGET ITEMIZATION.
6. AMOUNTS MADE AVAILABLE TO THE SUPPORTIVE HOUSING DEVELOPMENT REIN-
VESTMENT PROGRAM OF THE DEPARTMENT SHALL BE SUBJECT TO ANNUAL APPROPRI-
ATIONS THEREFOR.
7. NO PROVISION IN THIS SECTION SHALL CREATE OR BE DEEMED TO CREATE
ANY RIGHT, INTEREST OR ENTITLEMENT TO SERVICES OR FUNDS THAT ARE SUBJECT
TO THIS SECTION, OR TO ANY OTHER SERVICES OR FUNDS, WHETHER TO INDIVID-
UALS, LOCALITIES, PROVIDERS OR OTHERS, INDIVIDUALLY OR COLLECTIVELY.
8. ALL APPROPRIATIONS FOR SUPPORTIVE HOUSING DEVELOPMENT SHALL BE
ADJUSTED IN THE FOLLOWING FISCAL YEAR TO REFLECT THE VARIANCE BETWEEN
THE INITIAL AND REVISED ESTIMATES OF BED DECERTIFICATION AND/OR FACILITY
CLOSURE.
9. THE COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE
EMERGENCY REGULATIONS, TO EFFECTUATE THE PROVISIONS OF THIS SECTION.
S. 6256--B 22 A. 9056--B
S 2. Paragraph (e) of subdivision 1 of section 461-l of the social
services law, as added by chapter 165 of the laws of 1991, is amended to
read as follows:
(e) "Services" shall mean all services for which full payment to an
assisted living program is included in the capitated rate of payment,
which shall include personal care services, home care services and such
other services as the commissioner in conjunction with the commissioner
of health determine by regulation must be included in the capitated rate
of payment, and which the assisted living program shall provide, or
arrange for the provision of, through contracts with a social services
district, [a] long term home health care [program or a] PROGRAMS, certi-
fied home health [agency, and] AGENCIES, AND/OR other qualified provid-
ers.
S 3. Paragraphs (b) and (d) of subdivision 2 of section 461-l of the
social services law, as added by chapter 165 of the laws of 1991 and
subparagraph (iii) of paragraph (d) as amended by chapter 569 of the
laws of 2000, are amended to read as follows:
(b) If an assisted living program itself is not a certified home
health agency or long term home health care program, the assisted living
program shall contract with [a] ONE OR MORE certified home health [agen-
cy or] AGENCIES AND/OR long term home health care [program] PROGRAMS for
the provision of services pursuant to article thirty-six of the public
health law. [An assisted living program shall contract with no more than
one certified home health agency or long term home health care program,
provided, however, that the commissioner and the commissioner of health
may approve additional contracts for good cause.]
(d) Patient services and care. (i) An assisted living program[, or if
the assisted living program itself does not include a long term home
health care program or certified home health agency an assisted living
program and a long term home health care program or certified home
health agency,] shall conduct an initial assessment to determine whether
a person would otherwise require placement in a residential health care
facility if not for the availability of the assisted living program and
is appropriate for admission to an assisted living program. The assisted
living program shall forward such assessment of a medical assistance
applicant or recipient to the appropriate social services district.
(ii) No person shall be determined eligible for and admitted to an
assisted living program unless the assisted living program [and the long
term home health care program or the certified home health care agency
agree, based on the initial assessment,] FINDS that the person meets the
criteria provided in paragraph (d) of subdivision one of this section
and unless the appropriate social services district prior authorizes
payment for services.
(iii) Appropriate services shall be provided to an eligible person
only in accordance with a plan of care which is based upon an initial
assessment and periodic reassessments conducted by an assisted living
program[, or if the assisted living program itself does not include a
long term home health care program or certified home health agency an
assisted living program and a long term home health care program or
certified home health agency]. A reassessment shall be conducted as
frequently as is required to respond to changes in the resident's condi-
tion and ensure immediate access to necessary and appropriate services
by the resident, but in no event less frequently than once every six
months. No person shall be admitted to or retained in an assisted living
program unless [the assisted living program, and long term home health
care program or certified home health agency are in agreement that] the
S. 6256--B 23 A. 9056--B
person can be safely and adequately cared for with the provision of
services determined by such assessment or reassessment.
S 4. Paragraph (i) of subdivision 3 of section 461-l of the social
services law is REPEALED.
S 5. Notwithstanding any contrary provision of law, inpatient hospi-
tals licensed pursuant to the Mental Hygiene Law by the Office of Mental
Health shall be subject to audit fees as set forth in regulations issued
by the Department of Health pursuant to S2807-c(35)(b)(xiii) of the
Public Health Law, with regard to cost reports submitted to the Depart-
ment of Health on and after April 1, 2012.
S 6. Subdivision 2 of section 365-a of the social services law is
amended by adding four new paragraphs (w), (x), (y) and (z) to read as
follows:
(W) PODIATRY SERVICES FOR INDIVIDUALS WITH A DIAGNOSIS OF DIABETES
MELLITUS; PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS PARAGRAPH SHALL
NOT TAKE EFFECT UNLESS ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND
REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION
IN THE COSTS OF HEALTH CARE SERVICES PROVIDED PURSUANT TO THIS PARA-
GRAPH.
(X) LACTATION COUNSELING SERVICES FOR PREGNANT AND POSTPARTUM WOMEN
WHEN SUCH SERVICES ARE ORDERED BY A PHYSICIAN, REGISTERED PHYSICIAN
ASSISTANT, REGISTERED NURSE PRACTITIONER, OR LICENSED MIDWIFE AND
PROVIDED BY A CERTIFIED LACTATION CONSULTANT, AS DETERMINED BY THE
COMMISSIONER OF HEALTH; PROVIDED, HOWEVER, THAT THE PROVISIONS OF THIS
PARAGRAPH SHALL NOT TAKE EFFECT UNLESS ALL NECESSARY APPROVALS UNDER
FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE FEDERAL FINAN-
CIAL PARTICIPATION IN THE COSTS OF HEALTH CARE SERVICES PROVIDED PURSU-
ANT TO THIS PARAGRAPH. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO
MODIFY ANY LICENSURE, CERTIFICATION OR SCOPE OF PRACTICE PROVISION UNDER
TITLE EIGHT OF THE EDUCATION LAW.
(Y) HARM REDUCTION COUNSELING AND SERVICES TO REDUCE OR MINIMIZE THE
ADVERSE HEALTH CONSEQUENCES ASSOCIATED WITH DRUG USE, PROVIDED BY A
QUALIFIED DRUG TREATMENT PROGRAM OR COMMUNITY-BASED ORGANIZATION, AS
DETERMINED BY THE COMMISSIONER OF HEALTH; PROVIDED, HOWEVER, THAT THE
PROVISIONS OF THIS PARAGRAPH SHALL NOT TAKE EFFECT UNLESS ALL NECESSARY
APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE
FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF HEALTH CARE SERVICES
PROVIDED PURSUANT TO THIS PARAGRAPH. NOTHING IN THIS PARAGRAPH SHALL BE
CONSTRUED TO MODIFY ANY LICENSURE, CERTIFICATION OR SCOPE OF PRACTICE
PROVISION UNDER TITLE EIGHT OF THE EDUCATION LAW.
(Z) HEPATITIS C WRAP-AROUND SERVICES TO PROMOTE CARE COORDINATION AND
INTEGRATION WHEN ORDERED BY A PHYSICIAN, REGISTERED PHYSICIAN ASSISTANT,
REGISTERED NURSE PRACTITIONER, OR LICENSED MIDWIFE, AND PROVIDED BY A
QUALIFIED PROFESSIONAL, AS DETERMINED BY THE COMMISSIONER OF HEALTH.
SUCH SERVICES MAY INCLUDE CLIENT OUTREACH, IDENTIFICATION AND RECRUIT-
MENT, HEPATITIS C EDUCATION AND COUNSELING, COORDINATION OF CARE AND
ADHERENCE TO TREATMENT, ASSISTANCE IN OBTAINING APPROPRIATE ENTITLEMENT
SERVICES, PEER SUPPORT AND OTHER SUPPORTIVE SERVICES; PROVIDED, HOWEVER,
THAT THE PROVISIONS OF THIS PARAGRAPH SHALL NOT TAKE EFFECT UNLESS ALL
NECESSARY APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED
TO RECEIVE FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF HEALTH CARE
SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH. NOTHING IN THIS PARAGRAPH
SHALL BE CONSTRUED TO MODIFY ANY LICENSURE, CERTIFICATION OR SCOPE OF
PRACTICE PROVISION UNDER TITLE EIGHT OF THE EDUCATION LAW.
S. 6256--B 24 A. 9056--B
S 7. Paragraph (g) of subdivision 2 of section 365-a of the social
services law, as amended by section 23 of part H of chapter 59 of the
laws of 2011, 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, OR, SUBJECT TO STANDARDS ESTAB-
LISHED BY THE COMMISSIONER, FOR PERSONS WITH A DIAGNOSIS OF HIV
INFECTION, AIDS OR HIV-RELATED ILLNESS; (iii) prescription footwear and
inserts are limited to coverage only when used as an integral part of a
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;
S 8. Subdivision 9 of section 4403-c of the public health law is
amended to read as follows:
9. Notwithstanding any other provision of law, a comprehensive HIV
special needs plan certified pursuant to this section shall limit
enrollment to HIV positive persons, [but may enroll related children up
to the age of nineteen] EXCEPT FOR THE FOLLOWING PERSONS WHO MAY BE
ENROLLED regardless of their HIV status[.]:
(A) RELATED CHILDREN UP TO THE AGE OF TWENTY-ONE; AND
(B) HIGH NEED POPULATIONS THAT WOULD BENEFIT FROM RECEIVING SERVICES
THROUGH A PLAN CERTIFIED PURSUANT TO THIS SECTION, AS DETERMINED BY THE
COMMISSIONER.
S 9. Paragraph (f) of subdivision 1 of section 367-a of the social
services law as added by section 1 of Part E of chapter 58 of the laws
of 2008, is amended to read as follows:
(f) Amounts payable under this title for medical assistance in the
form of outpatient mental health services under article thirty-one OR
OUTPATIENT CHEMICAL DEPENDENCE SERVICES INCLUDING OPIOID TREATMENT
SERVICES UNDER ARTICLE THIRTY-TWO of the mental hygiene law provided to
eligible persons who are also beneficiaries under part B of title XVIII
of the federal social security act shall not be less than the approved
medical assistance payment level less the amount payable under part B.
S 10. Paragraph (d) of subdivision 2 of section 3332 of the public
health law, as amended by chapter 178 of the laws of 2010, is amended
and a new paragraph (e) is added to read as follows:
(d) the date upon which such prescription was actually signed by the
prescribing practitioner[.]; AND
(E) IF THE PATIENT IS A LIMITED ENGLISH PROFICIENT INDIVIDUAL, AS
DEFINED IN SECTION THREE THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THIS
CHAPTER, INDICATION OF SUCH STATUS AND INDICATION OF THE PATIENT'S
PRIMARY LANGUAGE.
S 11. Section 3333 of the public health law is amended by adding a
new subdivision 6 to read as follows:
6. IF THE PHARMACIST KNOWS OR HAS REASON TO KNOW THAT THE PATIENT IS A
LIMITED ENGLISH PROFICIENT INDIVIDUAL, AS DEFINED IN SECTION THREE THOU-
S. 6256--B 25 A. 9056--B
SAND THREE HUNDRED NINETY-EIGHT-A OF THIS CHAPTER, THE PHARMACIST SHALL
PROVIDE FOR TRANSLATION OR OTHER LANGUAGE SERVICES AS REQUIRED IN
SECTION THREE THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THIS CHAPTER,
UNLESS DOING SO WOULD COMPROMISE THE CARE OF THE PATIENT.
S 12. Paragraphs (b) and (c) of subdivision 1 of section 3334 of the
public health law, as amended by chapter 178 of the laws of 2010, are
amended and a new paragraph (d) is added to read as follows:
(b) dispense the substance in conformity with the labeling require-
ments applicable to the type of prescription which would be required but
for the emergency; [and]
(c) make a good faith effort to verify the practitioner's identity, if
the practitioner is unknown to the pharmacist[.]; AND
(D) IF THE PHARMACIST KNOWS OR HAS REASON TO KNOW THAT THE PATIENT IS
A LIMITED ENGLISH PROFICIENT INDIVIDUAL, AS DEFINED IN SECTION THREE
THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THIS CHAPTER, THE PHARMACIST
SHALL PROVIDE FOR TRANSLATION OR OTHER LANGUAGE SERVICES AS REQUIRED IN
SECTION THREE THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THIS CHAPTER,
UNLESS DOING SO WOULD COMPROMISE THE CARE OF THE PATIENT.
S 13. Subdivision 1 of section 3337 of the public health law is
amended by adding a new paragraph (d) to read as follows:
(D) IF THE PHARMACIST KNOWS OR HAS REASON TO KNOW THAT THE PATIENT IS
A LIMITED ENGLISH PROFICIENT INDIVIDUAL, AS DEFINED IN SECTION THREE
THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THIS CHAPTER, THE PHARMACIST
SHALL PROVIDE FOR TRANSLATION OR OTHER LANGUAGE SERVICES AS REQUIRED IN
SECTION THREE THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THIS CHAPTER,
UNLESS DOING SO WOULD COMPROMISE THE CARE OF THE PATIENT.
S 14. Subdivision 1 of section 3338 of the public health law, as
amended by section 12 of part A of chapter 58 of the laws of 2004, is
amended to read as follows:
1. Official New York state prescription forms shall be prepared and
issued by the department in the FORMAT, manner and detail as the commis-
sioner in consultation with the commissioner of education may, by regu-
lation, require, and, each form shall be serialized. Such forms shall be
furnished to practitioners authorized to write such prescriptions and to
institutional dispensers. Such prescription blanks shall not be trans-
ferable.
S 15. Subdivision b of section 6804 of the education law, as added by
chapter 987 of the laws of 1971, is amended to read as follows:
b. To regulate and control the sale, distribution, character and stan-
dard of drugs, poisons, cosmetics, devices and new drugs, INCLUDING, BUT
NOT LIMITED TO, IN CONJUNCTION WITH THE COMMISSIONER OF HEALTH, THE
DEVELOPMENT OF REQUIREMENTS RELATED TO THE SALE, DISTRIBUTION, AND
DISPENSING OF DRUGS AND NEW DRUGS TO ADDRESS THE SPECIAL NEEDS OF
PERSONS WHO ARE ELDERLY, OF LIMITED VISION OR OF LIMITED ENGLISH PROFI-
CIENCY,
S 16. Section 6810 of the education law is amended by adding three new
subdivisions 10, 11 and 12 to read as follows:
10. COVERED PHARMACIES, AS DEFINED IN SECTION THREE THOUSAND THREE
HUNDRED NINETY-EIGHT-A OF THE PUBLIC HEALTH LAW, MUST PROVIDE TRANS-
LATION AND INTERPRETATION SERVICES FOR PATIENTS HAVING LIMITED PROFI-
CIENCY IN ENGLISH, SUBJECT TO REGULATIONS OF THE COMMISSIONER AND THE
PROVISIONS OF SECTION THREE THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THE
PUBLIC HEALTH LAW.
11. IF THE PATIENT IS LIMITED ENGLISH PROFICIENT, AS DEFINED IN
SECTION THREE THOUSAND THREE HUNDRED NINETY-EIGHT-A OF THE PUBLIC HEALTH
S. 6256--B 26 A. 9056--B
LAW, INDICATION OF SUCH STATUS AND INDICATION OF THE PATIENT'S PRIMARY
LANGUAGE.
12. IF THE PHARMACIST KNOWS OR HAS REASON TO KNOW THAT THE PATIENT IS
OF LIMITED ENGLISH PROFICIENCY, AS DEFINED IN SECTION THREE THOUSAND
THREE HUNDRED NINETY-EIGHT-A OF THE PUBLIC HEALTH LAW, THE PHARMACIST
SHALL PROVIDE FOR TRANSLATION OR OTHER LANGUAGE SERVICES AS REQUIRED IN
SUCH SECTION, UNLESS DOING SO WOULD COMPROMISE THE CARE OF THE PATIENT.
S 17. The public health law is amended by adding a new article 33-B to
read as follows:
ARTICLE 33-B
STANDARDS FOR PRESCRIPTION MEDICATIONS
SECTION 3398. APPLICATION.
3398-A. INTERPRETATION REQUIREMENTS FOR PRESCRIPTION DRUGS.
S 3398. APPLICATION. THIS ARTICLE APPLIES TO MEDICATIONS PRESCRIBED BY
PRACTITIONERS AUTHORIZED TO PRESCRIBE MEDICATIONS, INCLUDING BUT NOT
LIMITED TO CONTROLLED SUBSTANCES, PURSUANT TO TITLE EIGHT OF THE EDUCA-
TION LAW; PROVIDED, HOWEVER, THAT TO THE EXTENT THERE IS ANY CONFLICT
BETWEEN THE PROVISIONS OF THIS ARTICLE AND THE PROVISIONS OF ARTICLE
THIRTY-THREE OF THIS TITLE WITH RESPECT TO PRESCRIPTIONS FOR CONTROLLED
SUBSTANCES, THE PROVISIONS OF ARTICLE THIRTY-THREE OF THIS TITLE SHALL
CONTROL.
S 3398-A. INTERPRETATION REQUIREMENTS FOR PRESCRIPTION DRUGS. 1. FOR
THE PURPOSES OF THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOW-
ING MEANINGS:
(A) "COVERED PHARMACY" MEANS ANY PHARMACY THAT IS PART OF A GROUP OF
FIVE OR MORE PHARMACIES OWNED BY THE SAME CORPORATE ENTITY, OR WHICH IS
A MAIL ORDER PHARMACY. FOR PURPOSES OF THIS SECTION, "CORPORATE ENTITY"
SHALL INCLUDE RELATED SUBSIDIARIES, AFFILIATES, SUCCESSORS, OR ASSIGNEES
DOING BUSINESS AS OR OPERATING UNDER A COMMON NAME OR TRADING SYMBOL;
(B) "LIMITED ENGLISH PROFICIENT INDIVIDUAL" OR "LEP INDIVIDUAL" MEANS
AN INDIVIDUAL WHO IDENTIFIES AS BEING, OR IS EVIDENTLY, UNABLE TO SPEAK,
READ OR WRITE ENGLISH AT A LEVEL THAT PERMITS SUCH INDIVIDUAL TO UNDER-
STAND HEALTH RELATED AND PHARMACEUTICAL INFORMATION COMMUNICATED IN
ENGLISH;
(C)"TRANSLATE" SHALL MEAN THE CONVERSION OF A WRITTEN TEXT FROM ONE
LANGUAGE INTO AN EQUIVALENT WRITTEN TEXT IN ANOTHER LANGUAGE BY AN INDI-
VIDUAL COMPETENT TO DO SO AND UTILIZING ALL NECESSARY PHARMACEUTICAL AND
HEALTH-RELATED TERMINOLOGY;
(D) "COMPETENT ORAL INTERPRETATION" MEANS ORAL COMMUNICATION IN WHICH
A PERSON ACTING AS AN INTERPRETER COMPREHENDS A SPOKEN MESSAGE AND
RE-EXPRESSES THAT MESSAGE ACCURATELY IN ANOTHER LANGUAGE, UTILIZING ALL
NECESSARY PHARMACEUTICAL AND HEALTH-RELATED TERMINOLOGY, SO AS TO ENABLE
AN LEP INDIVIDUAL TO RECEIVE ALL NECESSARY INFORMATION IN THE LEP INDI-
VIDUAL'S PRIMARY LANGUAGE;
(E) "PHARMACY PRIMARY LANGUAGES" SHALL MEAN THE TOP SEVEN LANGUAGES
SPOKEN BY LEP INDIVIDUALS IN THIS STATE AS DETERMINED BIENNIALLY BY THE
STATE BOARD OF PHARMACY BASED ON DATA FROM THE MOST RECENT AMERICAN
COMMUNITY SURVEY FROM THE UNITED STATES CENSUS BUREAU AND OTHER RELEVANT
DATA SOURCES;
(F) "MAIL ORDER PHARMACY" SHALL MEAN A PHARMACY THAT DISPENSES MOST OF
ITS PRESCRIPTIONS THROUGH THE UNITED STATES POSTAL SERVICE OR OTHER
DELIVERY SERVICES.
2. (A) EVERY COVERED PHARMACY SHALL PROVIDE FREE, COMPETENT ORAL AND
WRITTEN INTERPRETATION SERVICES, TO EACH LEP INDIVIDUAL FILLING A
PRESCRIPTION AT OR THROUGH SUCH COVERED PHARMACY, IN THE LEP INDIVID-
UAL'S PRIMARY LANGUAGE FOR THE PURPOSE OF COUNSELING SUCH INDIVIDUAL
S. 6256--B 27 A. 9056--B
ABOUT HIS OR HER PRESCRIPTION MEDICATIONS AND INTERPRETING LABEL INFOR-
MATION, OR WHEN SOLICITING INFORMATION NECESSARY TO MAINTAIN A PATIENT
MEDICATION PROFILE, UNLESS THE LEP INDIVIDUAL IS OFFERED AND REFUSES
SUCH SERVICES;
(B) EVERY COVERED PHARMACY SHALL PROVIDE FREE, COMPETENT ORAL INTER-
PRETATION OF PRESCRIPTION MEDICATION LABELS, WARNING LABELS AND OTHER
WRITTEN MATERIAL TO EACH LEP INDIVIDUAL FILLING A PRESCRIPTION AT OR
THROUGH SUCH COVERED PHARMACY UNLESS THE LEP INDIVIDUAL IS OFFERED AND
REFUSES SUCH SERVICES, OR THE MEDICATION LABEL WARNING LABELS AND OTHER
WRITTEN MATERIALS HAVE ALREADY BEEN TRANSLATED INTO THE LANGUAGE SPOKEN
BY THE LEP INDIVIDUAL;
(C) THE SERVICES REQUIRED BY THIS SECTION MAY BE PROVIDED BY A STAFF
MEMBER OF THE COVERED PHARMACY OR A THIRD-PARTY CONTRACTOR. SUCH
SERVICES MUST BE PROVIDED ON AN IMMEDIATE BASIS BUT NEED NOT BE PROVIDED
IN-PERSON OR FACE-TO-FACE.
3. EVERY COVERED PHARMACY SHALL CONSPICUOUSLY POST, AT OR ADJACENT TO
EACH COUNTER OVER WHICH PRESCRIPTION DRUGS ARE SOLD, AND EVERY MAIL
ORDER PHARMACY, SHALL INCLUDE IN THE PACKAGE IN WHICH PRESCRIPTION DRUGS
ARE DELIVERED, A NOTIFICATION OF THE RIGHT TO FREE LANGUAGE ASSISTANCE
SERVICES FOR LEP INDIVIDUALS AS PROVIDED FOR IN SUBDIVISION TWO OF THIS
SECTION. SUCH NOTIFICATIONS SHALL BE PROVIDED IN THE PHARMACY PRIMARY
LANGUAGES. THE SIZE, STYLE AND PLACEMENT OF SUCH NOTICE SHALL BE DETER-
MINED IN ACCORDANCE WITH RULES PROMULGATED BY THE COMMISSIONER.
4. ANY PERSON AGGRIEVED BY A FAILURE TO RECEIVE SERVICES REQUIRED BY
THIS SECTION SHALL HAVE A CAUSE OF ACTION ONLY AGAINST THE COVERED PHAR-
MACY IN ANY COURT OF COMPETENT JURISDICTION FOR DAMAGES, INCLUDING PUNI-
TIVE DAMAGES, AND FOR INJUNCTIVE RELIEF AND SUCH OTHER REMEDIES AS MAY
BE APPROPRIATE.
5. THIS SECTION SHALL PREEMPT ANY CONTRARY LOCAL LAW OR ORDINANCE,
EXCEPT THAT THIS SECTION SHALL NOT PREEMPT OR SUPERSEDE LOCAL LAWS OR
ORDINANCES IMPOSING ADDITIONAL OR STRICTER REQUIREMENTS RELATING TO
INTERPRETATION OR TRANSLATION SERVICES IN PHARMACIES.
S 18. Section 6509 of the education law is amended by adding a new
subdivision 15 to read as follows:
(15) A VIOLATION OF SUBDIVISION TWO OR THREE OF SECTION THIRTY-THREE
HUNDRED NINETY-EIGHT-A OF THE PUBLIC HEALTH LAW, BUT ONLY AS TO A PHAR-
MACY AND NOT AS TO AN INDIVIDUAL LICENSED PHARMACIST.
S 19. Subdivisions (f) and (g) of section 2522 of the public health
law, as amended by chapter 484 of the laws of 2009, are amended and a
new subdivision (h) is added to read as follows:
(f) follow-up of patient participation in prenatal care services;
[and]
(g) identification of regional perinatal health care system barriers
and limitations that lead to poor perinatal outcomes and development of
strategies to address such barriers and limitations[.]; AND
(H) COORDINATION OF SERVICE DELIVERY BY COMMUNITY-BASED ORGANIZATIONS
AMONG HEALTH CARE PROVIDERS AND HEALTH PLANS USING HEALTH INFORMATION
TECHNOLOGY AND UNIFORM SCREENING CRITERIA FOR PERINATAL RISK.
S 20. Intentionally Omitted.
S 21. Intentionally Omitted.
S 22. Section 366 of the social services law is amended by adding a
new subdivision 15 to read as follows:
15. (A) THE COMMISSIONER MAY CONTRACT WITH ONE OR MORE ENTITIES TO
ENGAGE IN EDUCATION, OUTREACH SERVICES, AND FACILITATED ENROLLMENT
ACTIVITIES FOR AGED, BLIND, AND DISABLED PERSONS WHO MAY BE ELIGIBLE FOR
COVERAGE UNDER THIS TITLE.
S. 6256--B 28 A. 9056--B
(B) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTIONS
ONE HUNDRED FORTY-TWO AND ONE HUNDRED FORTY-THREE OF THE ECONOMIC DEVEL-
OPMENT LAW, OR ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER IS
AUTHORIZED TO ENTER INTO A CONTRACT OR CONTRACTS UNDER THIS SUBDIVISION
WITHOUT A COMPETITIVE BID OR 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 SUBDIVISION.
S 23. The public health law is amended by adding a new article 9-B to
read as follows:
ARTICLE 9-B
PRIMARY CARE SERVICE CORPS PRACTITIONER LOAN REPAYMENT
PROGRAM
SECTION 923. DEFINITIONS.
924. PRIMARY CARE SERVICE CORPS PRACTITIONER LOAN REPAYMENT
PROGRAM.
S 923. DEFINITIONS. THE FOLLOWING WORDS OR PHRASES AS USED IN THIS
SECTION SHALL HAVE THE FOLLOWING MEANINGS:
1. "UNDERSERVED AREA" MEANS AN AREA OR MEDICALLY UNDERSERVED POPU-
LATION DESIGNATED BY THE COMMISSIONER AS HAVING A SHORTAGE OF PRIMARY
CARE PHYSICIANS, OTHER PRIMARY CARE PRACTITIONERS, DENTAL PRACTITIONERS
OR MENTAL HEALTH PRACTITIONERS.
2. "PRIMARY CARE SERVICE CORPS PRACTITIONER" MEANS A PHYSICIAN ASSIST-
ANT, NURSE PRACTITIONER, NURSE MIDWIFE, GENERAL OR PEDODONTIC DENTIST,
DENTAL HYGIENIST, CLINICAL PSYCHOLOGIST, LICENSED CLINICAL SOCIAL WORK-
ER, PSYCHIATRIC NURSE PRACTITIONER, LICENSED MARRIAGE AND FAMILY THERA-
PIST, OR A LICENSED MENTAL HEALTH COUNSELOR, WHO IS LICENSED, REGIS-
TERED, OR CERTIFIED TO PRACTICE IN NEW YORK STATE AND WHO PROVIDES
COORDINATED PRIMARY CARE SERVICES, INCLUDING, BUT NOT LIMITED TO, ORAL
HEALTH AND MENTAL HEALTH SERVICES.
3. "PHYSICIAN ASSISTANT" MEANS A PERSON WHO HAS BEEN REGISTERED AS
SUCH PURSUANT TO ARTICLE ONE HUNDRED THIRTY-ONE-B OF THE EDUCATION LAW.
4. "NURSE PRACTITIONER" MEANS A PERSON WHO HAS BEEN CERTIFIED AS SUCH
PURSUANT TO SECTION SIXTY-NINE HUNDRED TEN OF THE EDUCATION LAW.
5. "NURSE MIDWIFE" MEANS A PERSON WHO HAS BEEN LICENSED AS SUCH PURSU-
ANT TO SECTION SIXTY-NINE HUNDRED FIFTY-FIVE OF THE EDUCATION LAW.
6. "PSYCHOLOGIST" MEANS A PERSON WHO HAS BEEN LICENSED AS SUCH PURSU-
ANT TO SECTION SEVENTY-SIX HUNDRED THREE OF THE EDUCATION LAW.
7. "LICENSED CLINICAL SOCIAL WORKER" MEANS A PERSON WHO HAS BEEN
LICENSED AS SUCH PURSUANT TO SECTION SEVENTY-SEVEN HUNDRED TWO OF THE
EDUCATION LAW.
S. 6256--B 29 A. 9056--B
8. "PSYCHIATRIC NURSE PRACTITIONER" MEANS A NURSE PRACTITIONER WHO, BY
REASON OF TRAINING AND EXPERIENCE, PROVIDES A FULL SPECTRUM OF PSYCHIAT-
RIC CARE, ASSESSING, DIAGNOSING, AND MANAGING THE PREVENTION AND TREAT-
MENT OF PSYCHIATRIC DISORDERS AND MENTAL HEALTH PROBLEMS.
9. "LICENSED MARRIAGE AND FAMILY THERAPIST" MEANS A PERSON WHO HAS
BEEN LICENSED AS SUCH PURSUANT TO SECTION EIGHTY-FOUR HUNDRED THREE OF
THE EDUCATION LAW.
10. "LICENSED MENTAL HEALTH COUNSELOR" MEANS A PERSON WHO HAS BEEN
LICENSED AS SUCH PURSUANT TO SECTION EIGHTY-FOUR HUNDRED TWO OF THE
EDUCATION LAW.
11. "GENERAL OR PEDODONTIC DENTIST" MEANS A PERSON WHO HAS BEEN
LICENSED OR OTHERWISE AUTHORIZED TO PRACTICE DENTISTRY PURSUANT TO ARTI-
CLE ONE HUNDRED THIRTY-THREE OF THE EDUCATION LAW EXCLUDING ORTHODON-
TISTS, ENDODONTISTS AND PERIODONTISTS.
12. "DENTAL HYGIENIST" MEANS A PERSON WHO IS LICENSED TO PRACTICE
DENTAL HYGIENE PURSUANT TO SECTION SIXTY-SIX HUNDRED NINE OF THE EDUCA-
TION LAW.
S 924. PRIMARY CARE SERVICE CORPS PRACTITIONER LOAN REPAYMENT PROGRAM.
1. THE COMMISSIONER IS AUTHORIZED, WITHIN AMOUNTS AVAILABLE THEREFOR, TO
MAKE LOAN REPAYMENT AWARDS TO ELIGIBLE PRIMARY CARE SERVICE CORPS PRAC-
TITIONERS WHO AGREE TO PRACTICE FULL-TIME IN AN UNDERSERVED AREA IN NEW
YORK STATE, IN AMOUNTS TO BE DETERMINED BY THE COMMISSIONER, BUT NOT TO
EXCEED THIRTY-TWO THOUSAND DOLLARS PER YEAR FOR ANY YEAR IN WHICH SUCH
PRACTITIONERS PROVIDE FULL-TIME ELIGIBLE OBLIGATED SERVICE.
2. LOAN REPAYMENT AWARDS MADE TO A PRIMARY CARE SERVICE CORPS PRACTI-
TIONER PURSUANT TO SUBDIVISION ONE OF THIS SECTION SHALL NOT EXCEED THE
TOTAL QUALIFYING OUTSTANDING DEBT OF THE PRACTITIONER FROM STUDENT LOANS
TO COVER TUITION AND OTHER RELATED EDUCATIONAL EXPENSES, MADE BY OR
GUARANTEED BY THE FEDERAL OR STATE GOVERNMENT, OR MADE BY A LENDING OR
EDUCATIONAL INSTITUTION APPROVED UNDER TITLE IV OF THE FEDERAL HIGHER
EDUCATION ACT. LOAN REPAYMENT AWARDS SHALL BE USED SOLELY TO REPAY SUCH
OUTSTANDING DEBT.
3. IN THE EVENT THAT ANY COMMITMENT PURSUANT TO THE AGREEMENT REFER-
ENCED IN SUBDIVISION ONE OF THIS SECTION IS NOT FULFILLED, THE RECIPIENT
SHALL BE RESPONSIBLE FOR REPAYMENT IN AMOUNTS WHICH SHALL BE CALCULATED
IN ACCORDANCE WITH THE FORMULA SET FORTH IN SUBDIVISION (B) OF SECTION
TWO HUNDRED FIFTY-FOUR-O OF TITLE FORTY-TWO OF THE UNITED STATES CODE,
AS AMENDED.
4. THE COMMISSIONER IS AUTHORIZED TO APPLY ANY FUNDS AVAILABLE FOR
PURPOSES OF SUBDIVISION ONE OF THIS SECTION FOR USE AS MATCHING FUNDS
FOR ANY AVAILABLE FEDERAL GRANTS FOR THE PURPOSE OF ASSISTING STATES IN
OPERATING LOAN REPAYMENT PROGRAMS.
5. THE COMMISSIONER MAY POSTPONE, CHANGE OR WAIVE THE SERVICE OBLI-
GATION AND REPAYMENTS AMOUNTS SET FORTH IN SUBDIVISIONS ONE AND THREE OF
THIS SECTION, RESPECTIVELY, IN INDIVIDUAL CIRCUMSTANCES WHERE THERE IS
COMPELLING NEED OR HARDSHIP.
6. IN ORDER TO BE ELIGIBLE TO RECEIVE A LOAN REPAYMENT AWARD UNDER
THIS SECTION, A PRIMARY CARE SERVICE CORPS PRACTITIONER MUST MEET SITE
AND SERVICE ELIGIBILITY CRITERIA AS DETERMINED BY THE COMMISSIONER.
7. THE COMMISSIONER SHALL PROMULGATE REGULATIONS NECESSARY TO EFFECTU-
ATE THE PROVISIONS AND PURPOSES OF THIS ARTICLE.
S 24. Paragraph (a) of subdivision 4 of section 2801-a of the public
health law, as amended by section 57 of part A of chapter 58 of the laws
of 2010, is amended to read as follows:
(a) Any change in the person who is the operator of a hospital shall
be approved by the public health and health planning council in accord-
S. 6256--B 30 A. 9056--B
ance with the provisions of subdivisions two and three of this section.
NO CHANGE IN THE DIRECTORS OF A NOT-FOR-PROFIT CORPORATION THAT IS THE
OPERATOR OF A HOSPITAL SHALL BE EFFECTIVE UNLESS, AT LEAST ONE HUNDRED
TWENTY DAYS PRIOR TO THE INTENDED EFFECTIVE DATE THEREOF, THE CORPO-
RATION FULLY COMPLETES AND FILES WITH THE DEPARTMENT NOTICE ON A FORM,
TO BE DEVELOPED BY THE DEPARTMENT, WHICH SHALL DISCLOSE SUCH INFORMATION
AS MAY REASONABLY BE NECESSARY FOR THE DEPARTMENT TO DETERMINE WHETHER
IT SHOULD BAR THE CHANGE IN DIRECTORS. Notwithstanding any inconsistent
provision of this paragraph, any change by a natural person who is the
operator of a hospital seeking to transfer part of his or her interest
in such hospital to another person or persons so as to create a partner-
ship shall be approved in accordance with the provisions of paragraph
(b) of this subdivision.
S 25. Section 2806 of the public health law is amended by adding a new
subdivision 2-a to read as follows:
2-A. (A) THE COMMISSIONER MAY TEMPORARILY SUSPEND OR LIMIT AN OPERAT-
ING CERTIFICATE OF A NOT-FOR-PROFIT CORPORATION WITHOUT A HEARING UPON:
(I) THE COMMENCEMENT BY THE DEPARTMENT OF AN ACTION TO REVOKE, SUSPEND,
LIMIT OR ANNUL THE OPERATING CERTIFICATE PURSUANT TO PARAGRAPH (A) OF
SUBDIVISION ONE OF THIS SECTION DUE TO REPEATED VIOLATIONS OF THIS ARTI-
CLE OR RULES AND REGULATIONS PROMULGATED THEREUNDER; (II) THE INDICTMENT
ON FELONY CHARGES OF ANY MEMBER OF THE CORPORATION'S BOARD OF DIRECTORS
OR (III) NOTICE FROM THE ATTORNEY GENERAL OF AN ACTION TO REMOVE ANY
MEMBER OF THE CORPORATION'S BOARD OF DIRECTORS PURSUANT TO PARAGRAPH (D)
OF SECTION SEVEN HUNDRED SIX OF THE NOT-FOR-PROFIT CORPORATION LAW. SUCH
SUSPENSION OR LIMITATION OF THE OPERATING CERTIFICATE SHALL REMAIN
EFFECTIVE UNTIL THE RESOLUTION OF THE CRIMINAL ACTION THAT IS THE
SUBJECT OF THE INDICTMENT OR UNTIL THE RESOLUTION OF THE ACTION OF THE
ATTORNEY GENERAL, AS APPLICABLE.
(B) IN THE EVENT ONE OR MORE MEMBERS OF A BOARD OF DIRECTORS OF A
NOT-FOR-PROFIT CORPORATION ARE THE SUBJECT OF AN ACTION TO LIMIT AN
OPERATING CERTIFICATE PURSUANT TO PARAGRAPH (A) OF SUBDIVISION ONE OF
THIS SECTION, HAVE BEEN INDICTED ON FELONY CHARGES, OR ARE THE SUBJECT
OF AN ACTION FOR REMOVAL BY THE ATTORNEY GENERAL AS DESCRIBED IN PARA-
GRAPH (A) OF THIS SUBDIVISION, THE COMMISSIONER MAY, IN ADDITION TO HIS
OR HER OTHER POWERS, LIMIT THE EXISTING OPERATING CERTIFICATE OF SUCH
CORPORATION SO THAT IT SHALL APPLY ONLY TO THE REMAINING MEMBERS OF THE
BOARD OF DIRECTORS PROVIDED THAT: (I) EVERY SUCH PERSON SUBJECT TO AN
ACTION TO LIMIT THE OPERATING CERTIFICATE PURSUANT TO PARAGRAPH (A) OF
SUBDIVISION ONE OF THIS SECTION, EVERY SUCH INDICTED PERSON, OR EVERY
SUCH PERSON SUBJECT TO AN ACTION FOR REMOVAL SHALL IMMEDIATELY AND
COMPLETELY CEASE AND WITHDRAW FROM PARTICIPATION, IN ANY CAPACITY, IN
THE MANAGEMENT, GOVERNANCE OR OPERATION OF THE HOSPITAL; AND (II) THE
COMMISSIONER HAS FOUND THAT THE REMAINING MEMBERS OF THE BOARD OF DIREC-
TORS ARE OF SUCH CHARACTER, EXPERIENCE, COMPETENCE AND STANDING SO AS TO
GIVE REASONABLE ASSURANCE OF THEIR ABILITY TO CONDUCT THE AFFAIRS OF THE
CORPORATION IN ITS BEST INTERESTS AND IN THE PUBLIC INTEREST. IF THE
CONDITIONS SET FORTH IN SUBPARAGRAPHS (I) AND (II) OF THIS PARAGRAPH ARE
NOT MET, OR IF THE LIMITATION OF THE OPERATING CERTIFICATE UNDER THIS
PARAGRAPH RESULTS IN A BOARD OF DIRECTORS OF LESS THAN THREE MEMBERS,
THE COMMISSIONER SHALL TEMPORARILY SUSPEND THE OPERATING CERTIFICATE
PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVISION.
(C) NOTWITHSTANDING PARAGRAPHS (A) AND (B) OF THIS SUBDIVISION, WHERE
THE COMMISSIONER HAS FOUND THAT THE SUSPENSION OF A HOSPITAL OPERATING
CERTIFICATE PURSUANT TO THIS SECTION WOULD JEOPARDIZE EXISTING OR
CONTINUED ACCESS TO NECESSARY SERVICES WITHIN THE COMMUNITY, THE COMMIS-
S. 6256--B 31 A. 9056--B
SIONER MAY APPOINT TEMPORARY MEMBERS OF THE BOARD OF DIRECTORS TO OPER-
ATE AND MANAGE THE HOSPITAL UNDER THE EXISTING OPERATING CERTIFICATE,
UNTIL THE RESOLUTION OF THE CRIMINAL ACTION, ATTORNEY GENERAL ACTION OR
ACTION BY THE DEPARTMENT DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION,
AS APPLICABLE.
S 26. Paragraphs (a) and (b) of subdivision 5 of section 2806 of the
public health law, paragraph (a) as amended by section 20 of part LL of
chapter 56 of the laws of 2010 and paragraph (b) as amended by chapter
607 of the laws of 1981, are amended to read as follows:
(a) Except as provided in paragraphs (b) and (d) of this subdivision,
anything contained in this section or in a certificate of relief from
disabilities or a certificate of good conduct issued pursuant to article
twenty-three of the correction law to the contrary notwithstanding, a
hospital operating certificate of a hospital under control of a control-
ling person as defined in paragraph (a) of subdivision twelve of section
twenty-eight hundred one-a of this article, or under control of any
other entity, shall be revoked upon a finding by the department that
such controlling person or any individual, member of a partnership,
MEMBER OF A LIMITED LIABILITY COMPANY, MEMBER OF A BOARD OF DIRECTORS,
or shareholder of a corporation to whom or to which an operating certif-
icate has been issued, has been convicted of a class A, B or C felony,
or a felony related in any way to any activity or program subject to the
regulations, supervision, or administration of the department or of the
office of temporary and disability assistance or in violation of the
public officers law in a court of competent jurisdiction in the state,
or of a crime outside the state which, if committed within the state,
would have been a class A, B or C felony or a felony related in any way
to any activity or program subject to the regulations, supervision, or
administration of the department or of the office of temporary and disa-
bility assistance or in violation of the public officers law.
(b) In the event one or more members of a partnership, MEMBER OF A
LIMITED LIABILITY COMPANY, MEMBER OF A BOARD OF DIRECTORS, or sharehold-
ers of a corporation shall have been convicted of a felony as described
in paragraph (a) of this subdivision, the commissioner shall, in addi-
tion to his other powers, limit the existing operating certificate of
such partnership or corporation so that it shall apply only to the
remaining partner, MEMBER OF A LIMITED LIABILITY COMPANY, MEMBER OF A
BOARD OF DIRECTORS, or shareholders, as the case may be, provided that
every such convicted person immediately and completely ceases and with-
draws from participation, IN ANY CAPACITY, in the management and opera-
tion of the hospital, and further provided that an application for
approval of change of ownership, CHANGE OF BOARD MEMBERSHIP, or transfer
of stock is filed without delay in accordance with the pertinent
provisions of section twenty-eight hundred one-a of this [chapter] ARTI-
CLE.
S 27. The public health law is amended by adding a new section 2806-a
to read as follows:
S 2806-A. TEMPORARY OPERATOR. 1. FOR THE PURPOSES OF THIS SECTION:
(A) THE TERM "ADULT CARE FACILITY" SHALL MEAN AN ADULT HOME OR ENRICHED
HOUSING PROGRAM LICENSED PURSUANT TO ARTICLE SEVEN OF THE SOCIAL
SERVICES LAW OR AN ASSISTED LIVING RESIDENCE LICENSED PURSUANT TO ARTI-
CLE FORTY-SIX-B OF THIS CHAPTER; (B) THE TERM "ESTABLISHED OPERATOR"
SHALL MEAN THE OPERATOR OF AN ADULT CARE FACILITY, A GENERAL HOSPITAL OR
A DIAGNOSTIC AND TREATMENT CENTER THAT HAS BEEN ESTABLISHED AND ISSUED
AN OPERATING CERTIFICATE AS SUCH PURSUANT TO THIS ARTICLE; (C) THE TERM
"FACILITY" SHALL MEAN (I) A GENERAL HOSPITAL OR A DIAGNOSTIC AND TREAT-
S. 6256--B 32 A. 9056--B
MENT CENTER THAT HAS BEEN ISSUED AN OPERATING CERTIFICATE AS SUCH PURSU-
ANT TO THIS ARTICLE; OR (II) AN ADULT CARE FACILITY; AND (D) THE TERM
"TEMPORARY OPERATOR" SHALL MEAN ANY PERSON OR ENTITY THAT:
(I) AGREES TO OPERATE A FACILITY ON A TEMPORARY BASIS IN THE BEST
INTERESTS OF ITS RESIDENTS OR PATIENTS AND THE COMMUNITY SERVED BY THE
FACILITY; AND
(II) HAS DEMONSTRATED THAT HE OR SHE HAS THE CHARACTER, COMPETENCE AND
FINANCIAL ABILITY TO OPERATE THE FACILITY IN COMPLIANCE WITH APPLICABLE
STANDARDS.
2. (A) WHEN A STATEMENT OF DEFICIENCIES HAS BEEN ISSUED BY THE DEPART-
MENT AND UPON A DETERMINATION BY THE COMMISSIONER THAT THERE EXIST
SIGNIFICANT MANAGEMENT FAILURES, INCLUDING BUT NOT LIMITED TO ADMINIS-
TRATIVE, OPERATIONAL OR CLINICAL DEFICIENCIES OR FINANCIAL INSTABILITY,
IN A FACILITY THAT (I) SERIOUSLY ENDANGER THE LIFE, HEALTH OR SAFETY OF
RESIDENTS OR PATIENTS OR (II) JEOPARDIZE EXISTING OR CONTINUED ACCESS TO
NECESSARY SERVICES WITHIN THE COMMUNITY, HE OR SHE SHALL APPOINT A
TEMPORARY OPERATOR TO ASSUME SOLE CONTROL OVER AND SOLE RESPONSIBILITY
FOR THE OPERATIONS OF THAT FACILITY. THE APPOINTMENT OF A TEMPORARY
OPERATOR SHALL BE IN ADDITION TO ANY OTHER REMEDIES PROVIDED BY LAW.
(B) THE ESTABLISHED OPERATOR OF A FACILITY MAY AT ANY TIME REQUEST THE
COMMISSIONER TO APPOINT A TEMPORARY OPERATOR. UPON RECEIVING SUCH A
REQUEST, THE COMMISSIONER MAY, IF HE OR SHE DETERMINES THAT SUCH AN
ACTION IS NECESSARY TO RESTORE OR MAINTAIN THE PROVISION OF QUALITY CARE
TO THE RESIDENTS OR PATIENTS, ENTER INTO AN AGREEMENT WITH THE ESTAB-
LISHED OPERATOR FOR THE APPOINTMENT OF A TEMPORARY OPERATOR TO ASSUME
SOLE CONTROL OVER AND SOLE RESPONSIBILITY FOR THE OPERATIONS OF THAT
FACILITY.
3. A TEMPORARY OPERATOR APPOINTED PURSUANT TO THIS SECTION SHALL USE
HIS OR HER BEST EFFORTS TO CORRECT OR ELIMINATE ANY DEFICIENCIES,
MANAGEMENT FAILURES OR FINANCIAL INSTABILITY IN THE FACILITY AND TO
PROMOTE THE QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES IN THE
COMMUNITY SERVED BY THE FACILITY. SUCH CORRECTION OR ELIMINATION OF
DEFICIENCIES, MANAGEMENT FAILURES OR FINANCIAL INSTABILITY SHALL NOT
INCLUDE MAJOR ALTERATIONS OF THE PHYSICAL STRUCTURE OF THE FACILITY.
DURING THE TERM OF HIS OR HER APPOINTMENT, THE TEMPORARY OPERATOR SHALL
HAVE THE AUTHORITY TO DIRECT THE MANAGEMENT OF THE FACILITY IN ALL
ASPECTS OF OPERATION AND SHALL BE AFFORDED FULL ACCESS TO THE ACCOUNTS
AND RECORDS OF THE FACILITY. THE TEMPORARY OPERATOR SHALL, DURING THIS
PERIOD, OPERATE THE FACILITY IN SUCH A MANNER AS TO PROMOTE SAFETY AND
TO PROMOTE THE QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES OR
RESIDENTIAL CARE IN THE COMMUNITY SERVED BY THE FACILITY. THE TEMPORARY
OPERATOR SHALL HAVE THE POWER TO LET CONTRACTS THEREFOR OR INCUR
EXPENSES ON BEHALF OF THE FACILITY, PROVIDED THAT WHERE INDIVIDUAL ITEMS
OF REPAIRS, IMPROVEMENTS OR SUPPLIES EXCEED TEN THOUSAND DOLLARS, THE
TEMPORARY OPERATOR SHALL OBTAIN PRICE QUOTATIONS FROM AT LEAST THREE
REPUTABLE SOURCES. THE TEMPORARY OPERATOR SHALL NOT BE REQUIRED TO FILE
ANY BOND. NO SECURITY INTEREST IN ANY REAL OR PERSONAL PROPERTY COMPRIS-
ING THE FACILITY OR CONTAINED WITHIN THE FACILITY, OR IN ANY FIXTURE OF
THE FACILITY, SHALL BE IMPAIRED OR DIMINISHED IN PRIORITY BY THE TEMPO-
RARY OPERATOR. NEITHER THE TEMPORARY OPERATOR NOR THE DEPARTMENT SHALL
ENGAGE IN ANY ACTIVITY THAT CONSTITUTES A CONFISCATION OF PROPERTY WITH-
OUT THE PAYMENT OF FAIR COMPENSATION.
4. THE TEMPORARY OPERATOR SHALL BE ENTITLED TO A REASONABLE FEE, AS
DETERMINED BY THE COMMISSIONER, AND NECESSARY EXPENSES INCURRED DURING
HIS OR HER PERFORMANCE AS TEMPORARY OPERATOR, TO BE PAID FROM THE REVEN-
UE OF THE FACILITY. THE TEMPORARY OPERATOR SHALL COLLECT INCOMING
S. 6256--B 33 A. 9056--B
PAYMENTS FROM ALL SOURCES AND APPLY THEM FIRST TO THE REASONABLE FEE AND
TO COSTS INCURRED IN THE PERFORMANCE OF HIS OR HER FUNCTIONS AS TEMPO-
RARY OPERATOR. THE TEMPORARY OPERATOR SHALL BE LIABLE ONLY IN HIS OR HER
CAPACITY AS TEMPORARY OPERATOR FOR INJURY TO PERSON AND PROPERTY BY
REASON OF CONDITIONS OF THE FACILITY IN A CASE WHERE AN ESTABLISHED
OPERATOR WOULD HAVE BEEN LIABLE; HE OR SHE SHALL NOT HAVE ANY LIABILITY
IN HIS OR HER PERSONAL CAPACITY, EXCEPT FOR GROSS NEGLIGENCE AND INTEN-
TIONAL ACTS.
5. (A) THE INITIAL TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR
SHALL NOT EXCEED ONE HUNDRED EIGHTY DAYS. AFTER ONE HUNDRED EIGHTY DAYS,
IF THE COMMISSIONER DETERMINES THAT TERMINATION OF THE TEMPORARY OPERA-
TOR WOULD CAUSE SIGNIFICANT DETERIORATION OF THE QUALITY OF, OR ACCESS
TO, HEALTH CARE OR RESIDENTIAL CARE IN THE COMMUNITY OR THAT REAPPOINT-
MENT IS NECESSARY TO CORRECT THE DEFICIENCIES, MANAGEMENT FAILURE OR
FINANCIAL INSTABILITY THAT REQUIRED THE APPOINTMENT OF THE TEMPORARY
OPERATOR, THE COMMISSIONER MAY AUTHORIZE UP TO TWO ADDITIONAL NINETY DAY
TERMS. WITHIN FOURTEEN DAYS PRIOR TO THE TERMINATION OF EACH TERM OF
THE APPOINTMENT OF THE TEMPORARY OPERATOR, THE TEMPORARY OPERATOR SHALL
SUBMIT TO THE COMMISSIONER AND TO THE ESTABLISHED OPERATOR A REPORT
DESCRIBING THE ACTIONS TAKEN DURING THE APPOINTMENT TO ADDRESS SUCH
DEFICIENCIES, MANAGEMENT FAILURES AND/OR FINANCIAL INSTABILITY. THE
REPORT SHALL REFLECT BEST EFFORTS TO PRODUCE A FULL AND COMPLETE
ACCOUNTING.
(B) UPON THE COMPLETION OF THE TWO NINETY DAY TERMS REFERENCED IN
PARAGRAPH (A) OF THIS SUBDIVISION, IF THE COMMISSIONER DETERMINES THAT
TERMINATION OF THE TEMPORARY OPERATOR WOULD CAUSE SIGNIFICANT DETERI-
ORATION OF THE QUALITY OF, OR ACCESS TO, HEALTH CARE OR RESIDENTIAL CARE
IN THE COMMUNITY OR THAT REAPPOINTMENT IS NECESSARY TO CONTINUE THE
CORRECTION OF THE DEFICIENCIES, MANAGEMENT FAILURE OR FINANCIAL INSTA-
BILITY THAT REQUIRED THE APPOINTMENT OF THE TEMPORARY OPERATOR, THE
COMMISSIONER MAY REAPPOINT THE TEMPORARY OPERATOR FOR ADDITIONAL NINETY
DAY TERMS, PROVIDED THAT THE COMMISSIONER SHALL PROVIDE FOR NOTICE AND
THE OPPORTUNITY FOR A HEARING AS SET FORTH IN SUBDIVISION SIX OF THIS
SECTION.
(C) THE TERM OF THE INITIAL APPOINTMENT AND OF ANY SUBSEQUENT REAP-
POINTMENT MAY BE TERMINATED PRIOR TO THE EXPIRATION OF THE DESIGNATED
TERM, IF THE ESTABLISHED OPERATOR AND THE COMMISSIONER AGREE ON A PLAN
OF CORRECTION AND THE IMPLEMENTATION OF SUCH PLAN.
6. THE COMMISSIONER SHALL, UPON MAKING A DETERMINATION TO APPOINT A
TEMPORARY OPERATOR PURSUANT TO PARAGRAPH (A) OF SUBDIVISION TWO OF THIS
SECTION OR REAPPOINT A TEMPORARY OPERATOR FOR THE FIRST ADDITIONAL NINE-
TY DAY TERM PURSUANT TO PARAGRAPH (A) OF SUBDIVISION FIVE OF THIS
SECTION, CAUSE THE ESTABLISHED OPERATOR OF THE FACILITY TO BE NOTIFIED
OF THE DETERMINATION BY REGISTERED OR CERTIFIED MAIL ADDRESSED TO THE
PRINCIPAL OFFICE OF THE ESTABLISHED OPERATOR. IF THE COMMISSIONER DETER-
MINES THAT ADDITIONAL REAPPOINTMENTS PURSUANT TO PARAGRAPH (B) OF SUBDI-
VISION FIVE OF THIS SECTION ARE REQUIRED, THE COMMISSIONER SHALL AGAIN
CAUSE THE ESTABLISHED OPERATOR OF THE FACILITY TO BE NOTIFIED OF SUCH
DETERMINATION BY REGISTERED OR CERTIFIED MAIL ADDRESSED TO THE PRINCIPAL
OFFICE OF THE ESTABLISHED OPERATOR AT THE COMMENCEMENT OF THE FIRST OF
EVERY TWO ADDITIONAL TERMS. UPON RECEIPT OF SUCH NOTIFICATION AT THE
PRINCIPAL OFFICE OF THE ESTABLISHED OPERATOR AND BEFORE THE EXPIRATION
OF TEN DAYS THEREAFTER, THE ESTABLISHED OPERATOR MAY REQUEST AN ADMINIS-
TRATIVE HEARING ON THE DETERMINATION TO BEGIN NO LATER THAN SIXTY DAYS
FROM THE DATE OF THE APPOINTMENT OR REAPPOINTMENT OF THE TEMPORARY OPER-
ATOR. ANY SUCH HEARING SHALL BE STRICTLY LIMITED TO THE ISSUE OF WHETHER
S. 6256--B 34 A. 9056--B
THE DETERMINATION OF THE COMMISSIONER WHICH RESULTED IN THE APPOINTMENT
OR REAPPOINTMENT IS SUPPORTED BY SUBSTANTIAL EVIDENCE.
7. NO PROVISION CONTAINED IN THIS SECTION SHALL BE DEEMED TO RELIEVE
THE ESTABLISHED OPERATOR OR ANY OTHER PERSON OF ANY CIVIL OR CRIMINAL
LIABILITY INCURRED, OR ANY DUTY IMPOSED BY LAW, BY REASON OF ACTS OR
OMISSIONS OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON PRIOR TO THE
APPOINTMENT OF ANY TEMPORARY OPERATOR HEREUNDER; NOR SHALL ANYTHING
CONTAINED IN THIS SECTION BE CONSTRUED TO SUSPEND DURING THE TERM OF THE
APPOINTMENT OF THE TEMPORARY OPERATOR ANY OBLIGATION OF THE ESTABLISHED
OPERATOR OR ANY OTHER PERSON FOR THE PAYMENT OF TAXES OR OTHER OPERATING
AND MAINTENANCE EXPENSES OF THE FACILITY NOR OF THE ESTABLISHED OPERATOR
OR ANY OTHER PERSON FOR THE PAYMENT OF MORTGAGES OR LIENS.
S 28. Section 2 of chapter 584 of the laws of 2011, amending the
public authorities law, relating to the powers and duties of the dormi-
tory authority of the state of New York relative to the establishment of
subsidiaries for certain purposes, is amended to read as follows:
S 2. This act shall take effect immediately and shall expire and be
deemed repealed ON July 1, [2012] 2015; provided however, that the expi-
ration of this act shall not impair or otherwise affect any of the
powers, duties, responsibilities, functions, rights or liabilities of
any subsidiary duly created pursuant to subdivision twenty-five of
section 1678 of the public authorities law prior to such expiration.
S 29. Subdivision 1 of section 2999-i of the public health law, as
added by section 52 of part H of chapter 59 of the laws of 2011, is
amended to read as follows:
1. (A) 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 desig-
nee, as hereinafter provided. The fund shall be separate and apart from
any other fund and from all other state monies; PROVIDED, HOWEVER, THAT
MONIES OF THE FUND MAY BE INVESTED AS SET FORTH IN PARAGRAPH (B) OF THIS
SUBDIVISION. No monies from the fund shall be transferred 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.
(B) ANY MONIES OF THE FUND NOT REQUIRED FOR IMMEDIATE USE MAY, AT THE
DISCRETION OF THE COMMISSIONER OF FINANCIAL SERVICES IN CONSULTATION
WITH THE COMMISSIONER OF HEALTH AND THE DIRECTOR OF THE BUDGET, BE
INVESTED BY THE COMMISSIONER OF TAXATION AND FINANCE IN OBLIGATIONS OF
THE UNITED STATES OR THE STATE OR OBLIGATIONS THE PRINCIPAL AND INTEREST
OF WHICH ARE GUARANTEED BY THE UNITED STATES OR THE STATE. THE PROCEEDS
OF ANY SUCH INVESTMENT SHALL BE RETAINED BY THE FUND AS ASSETS TO BE
USED FOR THE PURPOSES OF THE FUND.
S 30. Subdivision 9 of section 2803 of the public health law is
REPEALED.
S 31. Paragraph (b) of subdivision 1-a of section 2802 of the public
health law, as amended by chapter 174 of the laws of 2011, is amended to
read as follows:
(b) repair or maintenance, regardless of cost, including routine
purchases and the acquisition of minor equipment undertaken in the
course of a hospital's inventory control functions; PROVIDED THAT FOR
PROJECTS UNDER THIS PARAGRAPH WITH A TOTAL COST OF UP TO SIX MILLION
DOLLARS, NO WRITTEN NOTICE SHALL BE REQUIRED;
S 32. Subdivision 1 of section 1 of chapter 119 of the laws of 1997
relating to authorizing the department of health to establish certain
S. 6256--B 35 A. 9056--B
payments to general hospitals, as amended by section 1 of part S2 of
chapter 62 of the laws of 2003, is amended to read as follows:
1. Notwithstanding any inconsistent provision of law or regulation,
effective for the period [April 1, 1997 through March 31, 1998] APRIL 1,
2012 THROUGH DECEMBER 31, 2012 and for annual periods beginning [April]
JANUARY 1 thereafter, the [department] DEPARTMENT of [health] HEALTH is
authorized to pay voluntary non-profit general hospitals as defined in
subdivision 10 of section 2801 of the public health law additional
payments for inpatient hospital services as medical assistance payments
pursuant to title 11 of article 5 of the social services law and federal
law and regulations governing disproportionate share payments, based on
the [amount of state aid for which such general hospitals are eligible
pursuant to articles 25, 26 and 41 of the mental hygiene law and as
identified in subdivision 2 of this section] COSTS INCURRED IN EXCESS OF
REVENUES BY GENERAL HOSPITALS IN PROVIDING SERVICES IN ELIGIBLE PROGRAMS
TO UNINSURED PATIENTS AND PATIENTS ELIGIBLE FOR MEDICAL ASSISTANCE.
Payment made pursuant to this section shall not exceed each such general
hospital's cost of providing services to uninsured patients and patients
eligible for medical assistance pursuant to title 11 of article 5 of the
social services law after taking into consideration all other medical
assistance received, including disproportionate share payments made to
such general hospital, and payments from or on behalf of such uninsured
patients, and shall also not exceed the total amount of state aid, iden-
tified by subdivision 2 of this section, available to such general
hospital by law. Payments made to such general hospitals pursuant to
this section shall be made in lieu of any state aid payments available
to such general hospital by law.
S 33. Subdivision 1 of section 241 of the elder law, as amended by
section 29 of part A of chapter 58 of the laws of 2008, is amended to
read as follows:
1. "Covered drug" shall mean a drug dispensed subject to a legally
authorized prescription pursuant to section sixty-eight hundred ten of
the education law, and insulin, an insulin syringe, or an insulin
needle. Such term shall not include: (a) any drug determined by the
commissioner of the federal food and drug administration to be ineffec-
tive or unsafe; (b) any drug dispensed in a package, or form of dosage
or administration, as to which the commissioner of health finally deter-
mines in accordance with the provisions of section two hundred fifty-two
of this title that a less expensive package, or form of dosage or admin-
istration, is available that is pharmaceutically equivalent and equiv-
alent in its therapeutic effect for the general health characteristics
of the eligible program participant population; (c) any device for the
aid or correction of vision; (d) any drug, including vitamins, which is
generally available without a physician's prescription; and (e) drugs
for the treatment of sexual or erectile dysfunction, unless such drugs
are used to treat a condition, other than sexual or erectile dysfunc-
tion, for which the drugs have been approved by the federal food and
drug administration; and (f) a brand name drug for which a multi-source
therapeutically and generically equivalent drug, as determined by the
federal food and drug administration, is available, unless previously
authorized by the elderly pharmaceutical insurance coverage program,
provided, however, that the [elderly pharmaceutical insurance coverage
panel] COMMISSIONER is authorized to exempt, for good cause shown, any
brand name drug from such restriction, and provided further that such
restriction shall not apply to any drug that is included on the
preferred drug list under section two hundred seventy-two of the public
S. 6256--B 36 A. 9056--B
health law or is in the clinical drug review program under section two
hundred seventy-four of the public health law to the extent that the
preferred drug program and the clinical drug review program are applied
to the elderly pharmaceutical insurance coverage program pursuant to
section two hundred seventy-five of the public health law, or to any
drug covered under a program participant's Medicare part D or other
primary insurance plan. Any of the drugs enumerated in the preceding
sentence shall be considered a covered drug or a prescription drug for
purposes of this article if it is added to the preferred drug list under
article two-A of the public health law. For the purpose of this title,
except as otherwise provided in this section, a covered drug shall be
dispensed in quantities no greater than a thirty day supply or one
hundred units, whichever is greater. In the case of a drug dispensed in
a form of administration other than a tablet or capsule, the maximum
allowed quantity shall be a thirty day supply; the [panel] COMMISSIONER
is authorized to approve exceptions to these limits for specific
products following consideration of recommendations from pharmaceutical
or medical experts regarding commonly packaged quantities, unusual forms
of administration, length of treatment or cost effectiveness. In the
case of a drug prescribed pursuant to section thirty-three hundred thir-
ty-two of the public health law to treat one of the conditions that have
been enumerated by the commissioner of health pursuant to regulation as
warranting the prescribing of greater than a thirty day supply, such
drug shall be dispensed in quantities not to exceed a three month
supply.
S 33-a. Subdivision 1 of section 241 of the elder law, as amended by
section 12 of part B of chapter 57 of the laws of 2006, is amended to
read as follows:
1. "Covered drug" shall mean a drug dispensed subject to a legally
authorized prescription pursuant to section sixty-eight hundred ten of
the education law, and insulin, an insulin syringe, or an insulin
needle. Such term shall not include: (a) any drug determined by the
commissioner of the federal food and drug administration to be ineffec-
tive or unsafe; (b) any drug dispensed in a package, or form of dosage
or administration, as to which the commissioner of health finally deter-
mines in accordance with the provisions of section two hundred fifty-two
of this title that a less expensive package, or form of dosage or admin-
istration, is available that is pharmaceutically equivalent and equiv-
alent in its therapeutic effect for the general health characteristics
of the eligible program participant population; (c) any device for the
aid or correction of vision, or any drug, including vitamins, which is
generally available without a physician's prescription; and (d) drugs
for the treatment of sexual or erectile dysfunction, unless such drugs
are used to treat a condition, other than sexual or erectile dysfunc-
tion, for which the drugs have been approved by the federal food and
drug administration. For the purpose of this title, except as otherwise
provided in this section, a covered drug shall be dispensed in quanti-
ties no greater than a thirty day supply or one hundred units, whichever
is greater. In the case of a drug dispensed in a form of administration
other than a tablet or capsule, the maximum allowed quantity shall be a
thirty day supply; the [panel] COMMISSIONER is authorized to approve
exceptions to these limits for specific products following consideration
of recommendations from pharmaceutical or medical experts regarding
commonly packaged quantities, unusual forms of administration, length of
treatment or cost effectiveness. In the case of a drug prescribed pursu-
ant to section thirty-three hundred thirty-two of the public health law
S. 6256--B 37 A. 9056--B
to treat one of the conditions that have been enumerated by the commis-
sioner of health pursuant to regulation as warranting the prescribing of
greater than a thirty day supply, such drug shall be dispensed in quan-
tities not to exceed a three month supply.
S 33-b. Paragraph (f) of subdivision 3 of section 242 of the elder
law, as amended by section 3-d of part A of chapter 59 of the laws of
2011, is amended to read as follows:
(f) As a condition of eligibility for benefits under this title, a
program participant is required to be enrolled in Medicare part D and to
maintain such enrollment. FOR UNMARRIED PARTICIPANTS WITH INDIVIDUAL
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.
S 33-c. Paragraph (b) of subdivision 2 of section 243 of the elder
law, as amended by section 3-g of part A of chapter 59 of the laws of
2011, is amended to read as follows:
(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 section two hundred forty-seven 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 adjust-
ments shall take effect;
S 33-d. Section 245 of the elder law is REPEALED.
S 33-e. Subdivision 1 of section 247 of the elder law, as added by
section 3-j of part A of chapter 59 of the laws of 2011, is amended 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] BE ENROLLED IN MEDICARE
PART D AND MAINTAIN SUCH ENROLLMENT.
S 33-f. Subdivision 1 of section 249 of the elder law, as amended by
section 111 of part C of chapter 58 of the laws of 2009, is amended to
read as follows:
1. The state shall offer an opportunity to participate in this program
to all provider pharmacies as defined in section two hundred forty-one
of this title, provided, however, that the participation of pharmacies
registered in the state pursuant to section sixty-eight hundred eight-b
of the education law shall be limited to state assistance provided under
this title for prescription drugs covered by a program participant's
medicare [or other] drug plan.
S 33-g. Subdivisions 1 and 2 of section 253 of the elder law are
amended to read as follows:
1. In counties having a population of seventy-five thousand or less
that are in proximity to the state boundary and which are determined by
the [executive director] COMMISSIONER OF HEALTH to be not adequately
served by provider pharmacies registered in New York, and in Fishers
S. 6256--B 38 A. 9056--B
Island in the town of Southold, Suffolk county, the [executive director]
COMMISSIONER may approve as provider pharmacies, pharmacies located in
New Jersey, Connecticut, Vermont, Pennsylvania or Massachusetts. Such
approvals shall be made after (a) consideration of the convenience and
necessity of New York residents in the rural areas served by such phar-
macies, (b) consideration of the quality of service of such pharmacies
and the standing of such pharmacies with the governmental board or agen-
cy of the state in which such pharmacy is located, (c) the [executive
director] COMMISSIONER shall give all licensed pharmacies within the
county notice of his or her intention to approve such out-of-state
provider pharmacies, and (d) the [executive director] COMMISSIONER has
held a public hearing at which he or she has determined factually that
the licensed pharmacies within such county are not adequately serving as
provider pharmacies.
2. The [executive director] COMMISSIONER OF HEALTH shall investigate
and determine whether certification shall be granted within ninety days
of the filing of an application for certification by the governing body
of any city, town or village, within a county determined by the [execu-
tive director] COMMISSIONER to be not adequately served by provider
pharmacies registered in New York pursuant to subdivision one of this
section, claiming to be lacking adequate pharmaceutical service.
S 34. Subdivision 25 of section 2808 of the public health law, as
added by section 31 of part B of chapter 109 of the laws of 2010,
subparagraph (iii) of paragraph (b) as amended and subparagraph (iv) of
paragraph (b) as added by section 69 of part H of chapter 59 of the laws
of 2011, is amended to read as follows:
25. Reserved bed days. (a) For purposes of this subdivision, a
"reserved bed day" is a day for which a governmental agency pays a resi-
dential health care facility to reserve a bed for a person eligible for
medical assistance pursuant to title eleven of article five of the
social services law while he or she is temporarily hospitalized or on
leave of absence from the facility.
(b) Notwithstanding any other provisions of this section or any other
law or regulation to the contrary, for reserved bed days provided on
behalf of persons twenty-one years of age or older:
(i) payments for reserved bed days shall be made at ninety-five
percent of the Medicaid rate otherwise payable to the facility for
services provided on behalf of such person;
(ii) payment to a facility for reserved bed days provided on behalf of
such person for temporary hospitalizations may not exceed fourteen days
in any twelve month period;
(iii) payment to a facility for reserved bed days provided on behalf
of such person for non-hospitalization leaves of absence may not exceed
ten days in any twelve month period[; 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].
(C)(I) NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SUBDIVISION OR
ANY OTHER LAW AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL
PARTICIPATION, FOR RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND
TWELVE, WITH REGARD TO SERVICES PROVIDED TO RESIDENTIAL HEALTH CARE
FACILITY RESIDENTS TWENTY-ONE YEARS OF AGE AND OLDER, THE COMMISSIONER
SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE EMERGENCY REGULATIONS,
EFFECTIVE FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND TWELVE,
ESTABLISHING REIMBURSEMENT RATES FOR RESERVED BED DAYS, PROVIDED, HOWEV-
S. 6256--B 39 A. 9056--B
ER, THAT SUCH REGULATIONS SHALL ACHIEVE AN AGGREGATE ANNUALIZED
REDUCTION IN REIMBURSEMENT FOR SUCH RESERVED BED DAYS OF NO LESS THAN
FORTY MILLION DOLLARS, AS DETERMINED BY THE COMMISSIONER.
(II) IN THE EVENT THE COMMISSIONER DETERMINES THAT FEDERAL FINANCIAL
PARTICIPATION WILL NOT BE AVAILABLE FOR RATE ADJUSTMENTS MADE PURSUANT
TO SUBPARAGRAPH (I) OF THIS PARAGRAPH OR REGULATIONS PROMULGATED THERE-
UNDER, THEN, FOR RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND
TWELVE, MEDICAID RATES FOR INPATIENT SERVICES SHALL NOT INCLUDE ANY
FACTOR OR PAYMENT AMOUNT FOR SUCH RESERVED BED DAYS WITH REGARD TO RESI-
DENTS TWENTY-ONE YEARS OF AGE AND OLDER.
(III) IN THE EVENT THE PROVISIONS OF SUBPARAGRAPH (II) OF THIS PARA-
GRAPH ARE INVOKED AND IMPLEMENTED BY THE COMMISSIONER, THEN THE COMMIS-
SIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE EMERGENCY REGU-
LATIONS, EFFECTIVE FOR RATE PERIODS ON OR AFTER APRIL FIRST, TWO
THOUSAND TWELVE, PROVIDING UPWARD REVISIONS TO MEDICAID RATES ISSUED
PURSUANT TO SUBDIVISION TWO-C OF THIS SECTION, PROVIDED, HOWEVER, THAT
SUCH UPWARD REVISIONS SHALL NOT IN AGGREGATE, AS DETERMINED BY THE
COMMISSIONER, EXCEED, ON AN ANNUAL BASIS, AN AMOUNT EQUAL TO CURRENT
ANNUAL MEDICAID PAYMENTS FOR RESERVED BED DAYS, LESS FORTY MILLION
DOLLARS.
S 35. Paragraphs (l) and (m) of subdivision 1 of section 367-q of the
social services law, as added by section 22 of part C of chapter 59 of
the laws of 2011, are amended to read as follows:
(l) for the period April first, two thousand twelve through March
thirty-first, two thousand thirteen, UP TO twenty-eight million five
hundred thousand dollars; and
(m) for the period April first, two thousand thirteen through March
thirty-first, two thousand fourteen, UP TO twenty-eight million five
hundred thousand dollars.
S 35-a. Clause (K) of subparagraph (i) of paragraph (bb) of subdivi-
sion 1 of section 2807-v of the public health law, as amended by section
8 of part C of chapter 59 of the laws of 2011, is amended to read as
follows:
(K) UP TO one hundred thirty-six million dollars each state fiscal
year for the period April first, two thousand eleven through March thir-
ty-first, two thousand fourteen.
S 35-b. Subparagraph (xi) of paragraph (cc) of subdivision 1 of
section 2807-v of the public health law, as amended by section 8 of part
C of chapter 59 of the laws of 2011, is amended to read as follows:
(xi) UP TO eleven million two hundred thousand dollars each state
fiscal year for the period April first, two thousand eleven through
March thirty-first, two thousand fourteen.
S 35-c. Subparagraph (vii) of paragraph (ccc) of subdivision 1 of
section 2807-v of the public health law, as amended by section 8 of part
C of chapter 59 of the laws of 2011, is amended to read as follows:
(vii) UP TO fifty million dollars each state fiscal year for the peri-
od April first, two thousand eleven through March thirty-first, two
thousand fourteen.
S 36. Paragraph (g-1) of subdivision 2 of section 365-a of the social
services law, as amended by section 23 of part H of chapter 59 of the
laws of 2011, is amended to read as follows:
(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
S. 6256--B 40 A. 9056--B
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, EXCEPT THAT
PRIOR AUTHORIZATION MAY BE DENIED IF THE DEPARTMENT, AFTER GIVING THE
PRESCRIBER A REASONABLE OPPORTUNITY TO PRESENT A JUSTIFICATION, DETER-
MINES THAT THE ADDITIONAL PRESCRIPTION IS NOT MEDICALLY NECESSARY;
medical assistance shall not include any drug provided on other than an
in-patient 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 37. Subdivision 6 of section 368-d of the social services law, as
added by section 6 of part H of chapter 59 of the laws of 2011, is
amended to read as follows:
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[/] AND state supported schools FOR BLIND
AND DEAF STUDENTS, whether it is advisable to claim federal reimburse-
ment for expenditures under this section as certified public expendi-
tures. In the event such claims are submitted, if federal reimbursement
received for certified public expenditures on behalf of medical assist-
ance 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 expendi-
tures 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 IN STATE FISCAL YEAR 2011-12, OR EXCEEDS ONE HUNDRED MILLION
DOLLARS IN STATE FISCAL YEAR 2012-13 OR ANY FISCAL YEAR THEREAFTER, the
excess amount shall be transferred to such [city] PUBLIC SCHOOL
DISTRICTS AND STATE OPERATED AND STATE SUPPORTED SCHOOLS FOR BLIND AND
DEAF STUDENTS IN AMOUNTS PROPORTIONAL TO THEIR PERCENTAGE CONTRIBUTION
TO THE STATEWIDE SAVINGS. 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. 6256--B 41 A. 9056--B
S 38. Subdivision 5 of section 368-e of the social services law, as
added by section 7 of part H of chapter 59 of the laws of 2011, is
amended to read as follows:
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 IN STATE FISCAL YEAR 2011-12, OR EXCEEDS ONE
HUNDRED MILLION DOLLARS IN STATE FISCAL YEAR 2012-13 OR ANY FISCAL YEAR
THEREAFTER, the excess amount shall be transferred to such [city] COUN-
TIES IN AMOUNTS PROPORTIONAL TO THEIR PERCENTAGE CONTRIBUTION TO THE
STATEWIDE SAVINGS. Any such excess amount transferred shall not be
considered a revenue received by such social services district in deter-
mining 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 39. Subparagraph (i) of paragraph (a-1) of subdivision 4 of section
365-a of the social services law, as amended by section 46 of part C of
chapter 58 of the laws of 2009, is amended to read as follows:
(i) a brand name drug for which a multi-source therapeutically and
generically equivalent drug, as determined by the federal food and drug
administration, is available, unless previously authorized by the
department of health. The commissioner of health is authorized to
exempt, for good cause shown, any brand name drug from the restrictions
imposed by this subparagraph[. This subparagraph shall not apply to any
drug that is in a therapeutic class included on the preferred drug list
under section two hundred seventy-two of the public health law or is in
the clinical drug review program under section two hundred seventy-four
of the public health law];
S 40. Subdivision 8 of section 272 of the public health law, as
amended by section 5 of part B of chapter 109 of the laws of 2010, is
amended to read as follows:
8. The commissioner shall provide notice of any recommendations devel-
oped by the committee regarding the preferred drug program, at least
five days before any final determination by the commissioner, by making
such information available on the department's website. [Such public
notice shall include: a summary of the deliberations of the committee; a
summary of the positions of those making public comments at meetings of
the committee; the response of the committee to those comments, if any;
and the findings and recommendations of the committee.]
S 41. Paragraphs (e), (f) and (g) of subdivision 1 of section 367-a of
the social services law, paragraph (e) as added by chapter 433 of the
laws of 1997, paragraph (f) as added by section 1 of part E of chapter
58 of the laws of 2008, paragraph (g) as added by section 65-a of part H
of chapter 59 of the laws of 2011, are amended to read as follows:
S. 6256--B 42 A. 9056--B
(e) Amounts payable under this title for medical assistance in the
form of clinic services pursuant to article twenty-eight of the public
health law and article sixteen of the mental hygiene law provided to
eligible persons DIAGNOSED WITH A DEVELOPMENTAL DISABILITY who are also
beneficiaries under part [b] B of title [xviii] XVIII of the federal
social security act [and who are also], OR PROVIDED TO PERSONS diagnosed
with a DEVELOPMENTAL disability WHO ARE QUALIFIED MEDICARE BENEFICIARIES
UNDER PART B OF TITLE XVIII OF SUCH ACT shall not be less than the
approved medical assistance payment level less the amount payable under
part [b] B.
(f) Amounts payable under this title for medical assistance in the
form of outpatient mental health services under article thirty-one of
the mental hygiene law provided to eligible persons who are also benefi-
ciaries under part B of title XVIII of the federal social security act
OR PROVIDED TO QUALIFIED MEDICARE BENEFICIARIES UNDER PART B OF TITLE
XVIII OF SUCH ACT shall not be less than the approved medical assistance
payment level less the amount payable under part B.
(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 OR PROVIDED TO QUALIFIED MEDICARE
BENEFICIARIES UNDER PART B OF TITLE XVIII OF SUCH ACT shall not exceed
the approved medical assistance payment level less the amount payable
under part B.
S 42. Subdivision 6 of section 2818 of the public health law, as added
by section 25-a of part A of chapter 59 of the laws of 2011, is amended
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, DIAGNOSTIC AND TREAT-
MENT CENTERS, 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] AWARD 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 43. Paragraph (a) of subdivision 8-a of section 2807-j of the public
health law, as amended by section 16 of part D of chapter 57 of the laws
of 2006, is amended to read as follows:
(a) Payments and reports submitted or required to be submitted to the
commissioner or to the commissioner's designee pursuant to this section
and section twenty-eight hundred seven-s of this article by designated
providers of services and by third-party payors which have elected to
make payments directly to the commissioner or to the commissioner's
designee in accordance with subdivision five-a of this section, shall be
subject to audit by the commissioner for a period of six years following
the close of the calendar year in which such payments and reports are
S. 6256--B 43 A. 9056--B
due, after which such payments shall be deemed final and not subject to
further adjustment or reconciliation, INCLUDING THROUGH OFFSET ADJUST-
MENTS OR RECONCILIATIONS MADE BY DESIGNATED PROVIDERS OF SERVICES OR BY
THIRD-PARTY PAYORS WITH REGARD TO SUBSEQUENT PAYMENTS, provided, howev-
er, that nothing herein shall be construed as precluding the commission-
er from pursuing collection of any such payments which are identified as
delinquent within such six year period, or which are identified as
delinquent as a result of an audit commenced within such six year peri-
od, or from conducting an audit of any adjustment or reconciliation made
by a designated provider of services or by a third party payor which has
elected to make such payments directly to the commissioner or the
commissioner's designee, OR FROM CONDUCTING AN AUDIT OF PAYMENTS MADE
PRIOR TO SUCH SIX YEAR PERIOD WHICH ARE FOUND TO BE COMMINGLED WITH
PAYMENTS WHICH ARE OTHERWISE SUBJECT TO TIMELY AUDIT PURSUANT TO THIS
SECTION.
S 44. Paragraph (a) of subdivision 10 of section 2807-t of the public
health law, as amended by section 17 of part D of chapter 57 of the laws
of 2006, is amended to read as follows:
(a) Payments and reports submitted or required to be submitted to the
commissioner or to the commissioner's designee pursuant to this section
by specified third-party payors shall be subject to audit by the commis-
sioner for a period of six years following the close of the calendar
year in which such payments and reports are due, after which such
payments shall be deemed final and not subject to further adjustment or
reconciliation, INCLUDING THROUGH OFFSET ADJUSTMENTS OR RECONCILIATIONS
MADE BY SUCH SPECIFIED THIRD-PARTY PAYORS WITH REGARD TO SUBSEQUENT
PAYMENTS, provided, however, that nothing herein shall be construed as
precluding the commissioner from pursuing collection of any such
payments which are identified as delinquent within such six year period,
or which are identified as delinquent as a result of an audit commenced
within such six year period, or from conducting an audit of any adjust-
ments and reconciliation made by a specified third party payor within
such six year period, OR FROM CONDUCTING AN AUDIT OF PAYMENTS MADE PRIOR
TO SUCH SIX YEAR PERIOD WHICH ARE FOUND TO BE COMMINGLED WITH PAYMENTS
WHICH ARE OTHERWISE SUBJECT TO TIMELY AUDIT PURSUANT TO THIS SECTION.
S 45. Subdivision 7 of section 2807-d of the public health law is
amended by adding a new paragraph (f) to read as follows:
(F) PAYMENTS AND REPORTS SUBMITTED OR REQUIRED TO BE SUBMITTED TO THE
COMMISSIONER OR TO THE COMMISSIONER'S DESIGNEE PURSUANT TO THIS SECTION
SHALL BE SUBJECT TO AUDIT BY THE COMMISSIONER FOR A PERIOD OF SIX YEARS
FOLLOWING THE CLOSE OF THE CALENDAR YEAR IN WHICH SUCH PAYMENTS AND
REPORTS ARE DUE, AFTER WHICH SUCH PAYMENTS SHALL BE DEEMED FINAL AND NOT
SUBJECT TO FURTHER ADJUSTMENT OR RECONCILIATION, INCLUDING THROUGH
OFFSET ADJUSTMENTS OR RECONCILIATIONS MADE TO SUBSEQUENT PAYMENTS MADE
PURSUANT TO THIS SECTION, PROVIDED, HOWEVER, THAT NOTHING HEREIN SHALL
BE CONSTRUED AS PRECLUDING THE COMMISSIONER FROM PURSUING COLLECTION OF
ANY SUCH PAYMENTS WHICH ARE IDENTIFIED AS DELINQUENT WITHIN SUCH SIX
YEAR PERIOD, OR WHICH ARE IDENTIFIED AS DELINQUENT AS A RESULT OF AN
AUDIT COMMENCED WITHIN SUCH SIX YEAR PERIOD, OR FROM CONDUCTING AN AUDIT
OF ANY ADJUSTMENT OR RECONCILIATION MADE BY A HOSPITAL.
S 46. Paragraph (f) of subdivision 18 of section 2807-c of the public
health law, as amended by section 15 of part D of chapter 57 of the laws
of 2006, is amended to read as follows:
(f) Payments of assessments and allowances required to be submitted by
general hospitals pursuant to this subdivision and subdivisions fourteen
and fourteen-b of this section and paragraph (a) of subdivision two of
S. 6256--B 44 A. 9056--B
section twenty-eight hundred seven-d of this article shall be subject to
audit by the commissioner for a period of six years following the close
of the calendar year in which such payments are due, after which such
payments shall be deemed final and not subject to further adjustment or
reconciliation, INCLUDING THROUGH OFFSET ADJUSTMENTS OR RECONCILIATIONS
MADE BY GENERAL HOSPITALS WITH REGARD TO SUBSEQUENT PAYMENTS, provided,
however, that nothing herein shall be construed as precluding the
commissioner from pursuing collection of any such assessments and allow-
ances which are identified as delinquent within such six year period, or
which are identified as delinquent as a result of an audit commenced
within such six year audit period, or from conducting an audit of any
adjustment or reconciliation made by a general hospital within such six
year period, OR FROM CONDUCTING AN AUDIT OF PAYMENTS MADE PRIOR TO SUCH
SIX YEAR PERIOD WHICH ARE FOUND TO BE COMMINGLED WITH PAYMENTS WHICH ARE
OTHERWISE SUBJECT TO TIMELY AUDIT PURSUANT TO THIS SECTION. General
hospitals which, in the course of such an audit, fail to produce data or
documentation requested in furtherance of such an audit, within thirty
days of such request may be assessed a civil penalty of up to ten thou-
sand dollars for each such failure, provided, however, that such civil
penalty shall not be imposed if the hospital demonstrates good cause for
such failure. The imposition of such civil penalties shall be subject
to the provisions of section twelve-a of this chapter.
S 47. Paragraph (e) of subdivision 2-a of section 2807 of the public
health law is amended by adding a new subparagraph (iii) to read as
follows:
(III) REGULATIONS ISSUED PURSUANT TO THIS PARAGRAPH MAY INCORPORATE
QUALITY RELATED MEASURES LIMITING OR EXCLUDING REIMBURSEMENT RELATED TO
POTENTIALLY PREVENTABLE CONDITIONS AND COMPLICATIONS.
S 48. Paragraph (c) of subdivision 7 of section 2807-d of the public
health law, as added by chapter 938 of the laws of 1990, is amended to
read as follows:
(c) The reports shall be in such form as may be prescribed by the
commissioner to accurately disclose information required to implement
this section, PROVIDED, HOWEVER, THAT FOR PERIODS ON AND AFTER JULY
FIRST, TWO THOUSAND TWELVE, SUCH REPORTS AND ANY ASSOCIATED CERTIF-
ICATIONS SHALL BE SUBMITTED ELECTRONICALLY IN A FORM AS MAY BE REQUIRED
BY THE COMMISSIONER.
S 48-a. Subparagraph (i) of paragraph (a) of subdivision 7 of section
2807-j of the public health law, as amended by section 36 of part B of
chapter 58 of the laws of 2008, is amended to read as follows;
(i) Every designated provider of services shall submit reports of net
patient service revenues received for or on account of patient services
for each month which shall be in such form as may be prescribed by the
commissioner to accurately disclose information required to implement
this section. For periods on and after January first, two thousand five,
reports by designated providers of services shall be submitted electron-
ically in a form as may be required by the commissioner; provided,
however, any designated provider of services is not prohibited from
submitting reports electronically on a voluntary basis prior to such
date, AND PROVIDED FURTHER, HOWEVER, THAT ALL SUCH ELECTRONIC
SUBMISSIONS SUBMITTED ON AND AFTER JULY FIRST, TWO THOUSAND TWELVE SHALL
BE VERIFIED WITH AN ELECTRONIC SIGNATURE AS PRESCRIBED BY THE COMMIS-
SIONER.
S 48-b. Subparagraph (ii) of paragraph (b) of subdivision 7 of section
2807-j of the public health law, as amended by section 25 of part A3 of
chapter 62 of the laws of 2003, is amended to read as follows:
S. 6256--B 45 A. 9056--B
(ii) For periods on and after July first, two thousand four, reports
submitted on a monthly basis by third-party payors in accordance with
subparagraph (i) of this paragraph and reports submitted on a monthly or
annual basis by payors acting in an administrative services capacity on
behalf of electing third-party payors in accordance with subparagraph
(i) of this paragraph shall be made electronically in a form as may be
required by the commissioner; provided, however, any third-party payor,
except payors acting in an administrative services capacity on behalf of
electing third-party payors, which, on or after January first, two thou-
sand four, elects to make payments directly to the commissioner or the
commissioner's designee pursuant to subdivision five of this section,
shall be subject to this subparagraph only after one full year of pool
payment experience which results in reports being submitted on a monthly
basis, AND PROVIDED FURTHER, HOWEVER, THAT ALL SUCH ELECTRONIC
SUBMISSIONS SUBMITTED ON AND AFTER JULY FIRST, TWO THOUSAND TWELVE SHALL
BE VERIFIED WITH AN ELECTRONIC SIGNATURE AS PRESCRIBED BY THE COMMIS-
SIONER. This subparagraph shall not be interpreted to prohibit any
third-party payor from submitting reports electronically on a voluntary
basis.
S 48-c. Subparagraph (ii) of paragraph (b) of subdivision 20 of
section 2807-c of the public health law, as added by section 26 of part
A3 of chapter 62 of the laws of 2003, is amended to read as follows:
(ii) For periods on and after January first, two thousand five,
reports submitted by general hospitals to implement the assessment set
forth in subdivision eighteen of this section shall be submitted elec-
tronically in a form as may be required by the commissioner; provided,
however, general hospitals are not prohibited from submitting reports
electronically on a voluntary basis prior to such date, AND PROVIDED
FURTHER, HOWEVER, THAT ALL SUCH ELECTRONIC SUBMISSIONS SUBMITTED ON AND
AFTER JULY FIRST, TWO THOUSAND TWELVE SHALL BE VERIFIED WITH AN ELEC-
TRONIC SIGNATURE AS PRESCRIBED BY THE COMMISSIONER.
S 49. Subdivision 8 of section 3605 of the public health law, as
added by chapter 959 of the laws of 1984, is amended to read as follows:
8. Agencies licensed pursuant to this section but not certified pursu-
ant to section three thousand six hundred eight of this article, shall
not be qualified to participate as a home health agency under the
provisions of title XVIII or XIX of the federal Social Security Act
provided, however, an agency which has a contract with a state agency or
its locally designated office OR, AS SPECIFIED BY THE COMMISSIONER, WITH
A MANAGED CARE ORGANIZATION PARTICIPATING IN THE MANAGED CARE PROGRAM
ESTABLISHED PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL
SERVICES LAW OR WITH A MANAGED LONG TERM CARE PLAN ESTABLISHED PURSUANT
TO SECTION FORTY-FOUR HUNDRED THREE-F OF THIS CHAPTER, may receive
reimbursement under title XIX of the federal Social Security Act.
S 50. Subdivision 6 of section 365-f of the social services law is
renumbered subdivision 7 and a new subdivision 6 is added to read as
follows:
6. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR ANY
OTHER CONTRARY PROVISION OF LAW, MANAGED CARE PROGRAMS ESTABLISHED
PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE AND MANAGED
LONG TERM CARE PLANS AND OTHER CARE COORDINATION MODELS ESTABLISHED
PURSUANT TO SECTION FOUR THOUSAND FOUR HUNDRED THREE-F OF THE PUBLIC
HEALTH LAW SHALL OFFER CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAMS TO
ENROLLEES.
S. 6256--B 46 A. 9056--B
S 51. Subparagraph (ii) 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:
(ii) In any social services district which has implemented a mandatory
managed care program pursuant to this section, the requirements of this
subparagraph shall apply to the extent consistent with federal law and
regulations. The department of health, may contract with one or more
independent organizations to provide enrollment counseling and enroll-
ment services, for participants required to enroll in managed care
programs, for each social services district [requesting the services of
an enrollment broker] WHICH HAS IMPLEMENTED A MANDATORY MANAGED CARE
PROGRAM. To select such organizations, the department of health shall
issue a request for proposals (RFP), shall evaluate proposals submitted
in response to such RFP and, pursuant to such RFP, shall award a
contract to one or more qualified and responsive organizations. Such
organizations shall not be owned, operated, or controlled by any govern-
mental agency, managed care provider, comprehensive HIV special needs
plan, mental health special needs plan, or medical services provider.
S 52. Paragraph (b) of subdivision 1 of section 4403-f of the public
health law is REPEALED and paragraphs (c) and (d), paragraph (c) as
relettered by section 7 of part C of chapter 58 of the laws of 2007, are
relettered paragraphs (b) and (c).
S 53. The opening paragraph of subdivision 2 of section 4403-f of the
public health law, as amended by section 8 of part C of chapter 58 of
the laws of 2007, is amended to read as follows:
An [eligible] applicant shall submit an application for a certificate
of authority to operate a managed long term care plan upon forms
prescribed by the commissioner. Such [eligible] applicant shall submit
information and documentation to the commissioner which shall include,
but not be limited to:
S 54. Paragraph (b) of subdivision 4 of section 4403-f of the public
health law, as added by section 5 of part C of chapter 58 of the laws of
2010, is amended to read as follows:
(b) Standards established pursuant to this subdivision shall be
adequate to protect the interests of enrollees in managed long term care
plans. The commissioner shall be satisfied that the [eligible] appli-
cant is financially sound, and has made adequate provisions to pay for
services.
S 55. Paragraph (c) of subdivision 6 of section 4403-f of the public
health law, as amended by section 41-b of part H of chapter 59 of the
laws of 2011, is amended to read as follows:
(c) 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
commissioner, 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.
S 56. Paragraph (a) of subdivision 3 of section 366 of the social
services law, as amended by chapter 110 of the laws of 1971, is amended
to read as follows:
(a) Medical assistance shall be furnished to applicants in cases
where, although such applicant has a responsible relative with suffi-
S. 6256--B 47 A. 9056--B
cient income and resources to provide medical assistance as determined
by the regulations of the department, the income and resources of the
responsible relative are not available to such applicant because of the
absence of such relative [or] AND the refusal or failure of such ABSENT
relative to provide the necessary care and assistance. In such cases,
however, the furnishing of such assistance shall create an implied
contract with such relative, and the cost thereof may be recovered from
such relative in accordance with title six of article three OF THIS
CHAPTER and other applicable provisions of law.
S 57. Subdivision 1 of section 92 of part H of chapter 59 of the laws
of 2011, amending the public health law and other laws relating to known
and projected department of health state funds Medicaid expenditures, is
amended to read as follows:
1. For state fiscal years 2011-12 [and 2012-13] THROUGH 2013-14, the
director of the budget, in consultation with the commissioner of health
referenced as "commissioner" for purposes of this section, shall assess
on a monthly basis, as reflected in monthly reports pursuant to subdivi-
sion 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 determines that such expenditures are expected to cause medicaid
disbursements for such period to exceed the projected department of
health medicaid state funds disbursements in the enacted budget finan-
cial 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 director of the budget to account for any changes in the
New York state federal medical assistance percentage amount established
pursuant to the federal social security act, changes in provider reven-
ues, REDUCTIONS TO LOCAL SOCIAL SERVICES DISTRICT MEDICAL ASSISTANCE
ADMINISTRATION, and beginning April 1, 2012 the operational costs of the
New York state medical indemnity fund.
S 58. Paragraph (b) of section 90 of part H of chapter 59 of the laws
of 2011, amending the public health law and other laws relating to types
of appropriations exempt from certain reductions, is amended to read as
follows:
(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; AND
(VI) PAYMENTS MADE WITH REGARD TO THE EARLY INTERVENTION PROGRAM
PURSUANT TO SECTION 2540 OF THE PUBLIC HEALTH LAW.
S. 6256--B 48 A. 9056--B
S 59. Subparagraph (ii) of paragraph (a) of subdivision 5 of section
2807-j of the public health law, as amended by section 23 of part A-3 of
chapter 62 of the laws of 2003, is amended to read as follows:
(ii) An election shall remain in effect unless revoked in writing by a
specified third-party payor, which revocation shall be effective on the
first day of the next [calendar year quarter] MONTH, provided that such
payor has provided notice of its intention to so revoke at least [thir-
ty] TWENTY days prior to the beginning of such [calendar quarter] MONTH.
S 60. Paragraph (b) of subdivision 5-a of section 2807-m of the public
health law is amended by adding a new clause (H) to read as follows:
(H) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION,
FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND THIRTEEN, ECRIP GRANT
AWARDS SHALL BE MADE IN ACCORDANCE WITH RULES AND REGULATIONS PROMULGAT-
ED BY THE COMMISSIONER.
S 61. Section 1 of part C of chapter 58 of the laws of 2005, relating
to authorizing reimbursements for expenditures made by or on behalf of
social services districts for medical assistance for needy persons and
the administration thereof, is amended by adding a new subdivision (h)
to read as follows:
(H) NOTWITHSTANDING THE PROVISIONS OF SECTION 368-A OF THE SOCIAL
SERVICES LAW OR ANY OTHER CONTRARY PROVISION OF LAW, NO REIMBURSEMENT
SHALL BE MADE FOR SOCIAL SERVICES DISTRICTS' CLAIMS SUBMITTED ON AND
AFTER THE EFFECTIVE DATE OF THIS PARAGRAPH, FOR DISTRICT EXPENDITURES
INCURRED PRIOR TO JANUARY 1, 2006, INCLUDING, BUT NOT LIMITED TO,
EXPENDITURES FOR SERVICES PROVIDED TO INDIVIDUALS WHO WERE ELIGIBLE FOR
MEDICAL ASSISTANCE PURSUANT TO SECTION THREE HUNDRED SIXTY-SIX OF THE
SOCIAL SERVICES LAW AS A RESULT OF A MENTAL DISABILITY, FORMERLY
REFERRED TO AS HUMAN SERVICES OVERBURDEN AID TO COUNTIES.
S 62. 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 63. 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 64. 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
legislature that this act would have been enacted even if such invalid
provisions had not been included herein.
S 65. This act shall take effect immediately, and shall be deemed to
have been in full force and effect on and after April 1, 2012, provided,
however, that:
(a) the commissioner of health may promulgate emergency regulations
necessary to effectuate the provisions of sections two, three and four
of this act; and
S. 6256--B 49 A. 9056--B
(a-1) provided, further, that the amendments to section 1 of chapter
119 of the laws of 1997 made by section thirty-two of this act, relating
to authorizing the department of health to establish certain payments to
general hospitals, shall be subject to the expiration of such chapter
and shall be deemed expired therewith;
(a-2) provided, further, that the amendments to subdivision 1 of
section 241 of the elder law made by section thirty-three of this act
shall be subject to the expiration and reversion of such subdivision
pursuant to section 79 of part C of chapter 58 of the laws of 2005, as
amended, when upon such date the provisions of section thirty-three-a of
this act shall take effect;
(b) the amendments to paragraph (a-1) of subdivision 4 of section
365-a of the social services law made by section thirty-nine of this act
shall not affect the expiration and reversion of such paragraph and
shall be deemed to expire therewith;
(c) provided, further, that the amendments to section 272 of the
public health law made by section forty of this act shall not affect the
repeal of such section and shall be deemed repealed therewith;
(d) provided, further, that the amendments to section 2807-j of the
public health law made by sections forty-three, forty-eight-a, forty-
eight-b and fifty-nine of this act shall not affect the expiration of
such section and shall be deemed to expire therewith;
(e) provided, further, that the amendments to section 2807-t of the
public health law made by section forty-four of this act shall not
affect the expiration of such section and shall be deemed to expire
therewith;
(f) provided, further, that the amendments to section 4403-f of the
public health law, made by sections fifty-two, fifty-three, fifty-four
and fifty-five of this act shall not affect the repeal of such section
and shall be deemed to repeal therewith;
(g) provided, further, that the amendments to subparagraph (ii) of
paragraph (e) of subdivision 4 of section 364-j of the social services
law made by section fifty-one of this act shall not affect the repeal of
such section and shall be deemed repealed therewith;
(h) provided, further, that sections ten, eleven, twelve, thirteen,
fourteen, fifteen, sixteen, seventeen and eighteen of this act shall
take effect April 1, 2013;
(i) provided, further, that any rules or regulations necessary to
implement the provisions of this act may be promulgated and any proce-
dures, forms, or instructions necessary for such implementation may be
adopted and issued on or after the date this act shall have become a
law;
(j) provided, further, that 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;
(k) provided, further, that the commissioner of health and the super-
intendent of financial services and any appropriate council may take any
steps necessary to implement this act prior to its effective date;
(k-1) provided, further, that the amendments to section 2802 of the
public health law made by section thirty-one of this act shall take
effect on the same date and in the same manner as section 1 of chapter
174 of the laws of 2011 takes effect, whichever is later;
(l) provided, further, that notwithstanding any inconsistent provision
of the state administrative procedure act or any other provision of law,
rule or regulation, the commissioner of health and the superintendent of
S. 6256--B 50 A. 9056--B
financial services 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; and
(m) provided, further, that the provisions of this act shall become
effective notwithstanding the failure of the commissioner of health or
the superintendent of financial services or any council to adopt or
amend or promulgate regulations implementing this act.
PART E
Section 1. This act shall be known and may be cited as the "New York
Health Benefit Exchange Act".
S 2. The public authorities law is amended by adding a new article
10-E to read as follows:
ARTICLE 10-E
NEW YORK HEALTH BENEFIT EXCHANGE
SECTION 3980. STATEMENT OF POLICY AND PURPOSES.
3981. DEFINITIONS.
3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE.
3983. GENERAL POWERS OF THE EXCHANGE.
3984. FUNCTIONS OF THE EXCHANGE.
3985. SPECIAL FUNCTIONS OF THE EXCHANGE RELATED TO HEALTH PLAN
CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT.
3986. REGIONAL ADVISORY COMMITTEES.
3987. FUNDING OF THE EXCHANGE.
3988. STUDIES AND RECOMMENDATIONS.
3989. TAX EXEMPTION AND TAX CONTRACT BY THE STATE.
3990. OFFICERS AND EMPLOYEES.
3991. LIMITATION OF LIABILITY; INDEMNIFICATION.
3992. CONTINGENCY FOR FEDERAL FUNDING.
3993. CONSTRUCTION.
S 3980. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS ARTICLE
IS TO ESTABLISH AN AMERICAN HEALTH BENEFIT EXCHANGE IN NEW YORK, IN
CONFORMANCE WITH THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT,
PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON-
CILIATION ACT OF 2010, PUBLIC LAW 111-152. THE EXCHANGE SHALL FACILI-
TATE ENROLLMENT IN HEALTH COVERAGE, THE PURCHASE AND SALE OF QUALIFIED
HEALTH PLANS IN THE INDIVIDUAL MARKET IN THIS STATE, AND ENROLL INDIVID-
UALS IN HEALTH COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH
FEDERAL LAW. THE EXCHANGE ALSO SHALL INCORPORATE A SMALL BUSINESS HEALTH
OPTIONS PROGRAM ("SHOP") TO ASSIST QUALIFIED EMPLOYERS IN FACILITATING
THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN
THE GROUP MARKET. IT IS THE INTENT OF THE LEGISLATURE, THROUGH THE
ESTABLISHMENT OF THE EXCHANGE, TO PROMOTE QUALITY AND AFFORDABLE HEALTH
COVERAGE AND CARE, REDUCE THE NUMBER OF UNINSURED PERSONS, PROVIDE A
TRANSPARENT MARKETPLACE, EDUCATE CONSUMERS AND ASSIST INDIVIDUALS WITH
ACCESS TO COVERAGE, PREMIUM ASSISTANCE TAX CREDITS AND COST-SHARING
REDUCTIONS.
S 3981. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE, THE FOLLOWING DEFI-
NITIONS SHALL APPLY:
1. "BOARD" OR "BOARD OF DIRECTORS" MEANS THE BOARD OF DIRECTORS OF THE
EXCHANGE.
2. "REGIONAL ADVISORY COMMITTEES" MEANS THE NEW YORK HEALTH BENEFIT
EXCHANGE REGIONAL ADVISORY COMMITTEES ESTABLISHED PURSUANT TO THIS ARTI-
CLE.
S. 6256--B 51 A. 9056--B
3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH.
4. "EXCHANGE" MEANS THE NEW YORK HEALTH BENEFIT EXCHANGE ESTABLISHED
PURSUANT TO THIS ARTICLE.
5. "FEDERAL ACT" MEANS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT,
PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON-
CILIATION ACT OF 2010, PUBLIC LAW 111-152, AND ANY REGULATIONS OR GUID-
ANCE ISSUED THEREUNDER.
6. "HEALTH PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE, OFFERED OR
ISSUED BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR REIM-
BURSE ANY OF THE COSTS OF HEALTH CARE SERVICES. HEALTH PLAN SHALL NOT
INCLUDE THE FOLLOWING:
(A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
TION THEREOF;
(B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE;
(C) LIABILITY INSURANCE, INCLUDING GENERAL LIABILITY INSURANCE AND
AUTOMOBILE LIABILITY INSURANCE;
(D) WORKERS' COMPENSATION OR SIMILAR INSURANCE;
(E) AUTOMOBILE NO-FAULT INSURANCE;
(F) CREDIT INSURANCE;
(G) OTHER SIMILAR INSURANCE COVERAGE, AS SPECIFIED IN FEDERAL REGU-
LATIONS, UNDER WHICH BENEFITS FOR MEDICAL CARE ARE SECONDARY OR INCI-
DENTAL TO OTHER INSURANCE BENEFITS;
(H) LIMITED SCOPE DENTAL OR VISION BENEFITS, BENEFITS FOR LONG-TERM
CARE INSURANCE, NURSING HOME INSURANCE, HOME CARE INSURANCE, OR ANY
COMBINATION THEREOF, OR SUCH OTHER SIMILAR, LIMITED BENEFITS HEALTH
INSURANCE AS SPECIFIED IN FEDERAL REGULATIONS, IF THE BENEFITS ARE
PROVIDED UNDER A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE
OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN;
(I) COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL INDEM-
NITY, OR OTHER FIXED INDEMNITY COVERAGE;
(J) MEDICARE SUPPLEMENTAL INSURANCE AS DEFINED IN SECTION 1882(G)(1)
OF THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE COVER-
AGE PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE, OR
SIMILAR SUPPLEMENTAL COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN IF IT
IS OFFERED AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE;
OR
(K) THE MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO TITLE FOUR OF
ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
7. "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO ARTICLE THIRTY-TWO
OR FORTY-THREE OF THE INSURANCE LAW, OR A HEALTH MAINTENANCE ORGANIZA-
TION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW
THAT CONTRACTS OR OFFERS TO CONTRACT TO PROVIDE, DELIVER, ARRANGE, PAY
OR REIMBURSE ANY OF THE COSTS OF HEALTH CARE SERVICES.
8. "QUALIFIED DENTAL PLAN" MEANS A LIMITED SCOPE DENTAL PLAN THAT IS
ISSUED BY AN INSURER AND CERTIFIED IN ACCORDANCE WITH SECTION
THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE.
9. "QUALIFIED EMPLOYER" MEANS A SMALL EMPLOYER THAT ELECTS TO MAKE ITS
FULL-TIME EMPLOYEES ELIGIBLE FOR ONE OR MORE QUALIFIED HEALTH PLANS
THROUGH THE EXCHANGE.
10. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED BY AN
INSURER AND CERTIFIED IN ACCORDANCE WITH SECTION THIRTY-NINE HUNDRED
EIGHTY-FIVE OF THIS ARTICLE.
11. "QUALIFIED INDIVIDUAL" MEANS AN INDIVIDUAL, INCLUDING A MINOR,
WHO:
(A) IS SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO INDI-
VIDUALS THROUGH THE EXCHANGE;
S. 6256--B 52 A. 9056--B
(B) RESIDES IN THIS STATE;
(C) AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN INCAR-
CERATION PENDING THE DISPOSITION OF CHARGES; AND
(D) IS, AND IS REASONABLY EXPECTED TO BE, FOR THE ENTIRE PERIOD FOR
WHICH ENROLLMENT IS SOUGHT, A CITIZEN OR NATIONAL OF THE UNITED STATES
OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
12. "SECRETARY" MEANS THE SECRETARY OF THE UNITED STATES DEPARTMENT OF
HEALTH AND HUMAN SERVICES.
13. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM DESIGNED TO
ASSIST QUALIFIED EMPLOYERS IN THIS STATE IN FACILITATING THE ENROLLMENT
OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET
IN THIS STATE.
14. "SMALL EMPLOYER" MEANS, FOR PLAN YEARS PRIOR TO JANUARY FIRST, TWO
THOUSAND SIXTEEN, AN EMPLOYER THAT EMPLOYED AN AVERAGE OF AT LEAST ONE
BUT NOT MORE THAN FIFTY EMPLOYEES ON BUSINESS DAYS DURING THE PRECEDING
CALENDAR YEAR. FOR PLAN YEARS BEGINNING ON AND AFTER JANUARY FIRST, TWO
THOUSAND SIXTEEN, SMALL EMPLOYER MEANS AN EMPLOYER THAT EMPLOYED AN
AVERAGE OF AT LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES ON BUSI-
NESS DAYS DURING THE PRECEDING CALENDAR YEAR. FOR PURPOSES OF THE DEFI-
NITION OF SMALL EMPLOYER:
(A) ALL PERSONS TREATED AS A SINGLE EMPLOYER UNDER SUBSECTION (B),
(C), (M) OR (O) OF SECTION 414 OF THE INTERNAL REVENUE CODE OF 1986
SHALL BE TREATED AS A SINGLE EMPLOYER;
(B) AN EMPLOYER AND ANY PREDECESSOR EMPLOYER SHALL BE TREATED AS A
SINGLE EMPLOYER;
(C) ALL EMPLOYEES SHALL BE COUNTED, INCLUDING PART-TIME EMPLOYEES AND
EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE THROUGH THE EMPLOYER;
(D) IF AN EMPLOYER WAS NOT IN EXISTENCE THROUGHOUT THE PRECEDING
CALENDAR YEAR, THEN THE DETERMINATION OF WHETHER THAT EMPLOYER IS A
SMALL EMPLOYER SHALL BE BASED UPON THE AVERAGE NUMBER OF EMPLOYEES THAT
THE EMPLOYER REASONABLY EXPECTS TO EMPLOY ON BUSINESS DAYS IN THE
CURRENT CALENDAR YEAR;
(E) IF A QUALIFIED EMPLOYER THAT MAKES ENROLLMENT IN QUALIFIED HEALTH
PLANS AVAILABLE TO ITS EMPLOYEES THROUGH THE EXCHANGE CEASES TO BE A
SMALL EMPLOYER BY REASON OF AN INCREASE IN THE NUMBER OF ITS EMPLOYEES,
THEN THE EMPLOYER SHALL CONTINUE TO BE TREATED AS A QUALIFIED EMPLOYER
FOR PURPOSES OF THIS ARTICLE FOR THE PERIOD BEGINNING WITH THE INCREASE
AND ENDING WITH THE FIRST DAY ON WHICH THE EMPLOYER DOES NOT MAKE SUCH
ENROLLMENT AVAILABLE TO ITS EMPLOYEES; AND
(F) NOTWITHSTANDING PARAGRAPHS (A) THROUGH (E) OF THIS SUBDIVISION, AN
EMPLOYER ALSO SHALL BE CONSIDERED A SMALL EMPLOYER IF THE COVERAGE IT
OFFERS WOULD BE CONSIDERED SMALL GROUP COVERAGE UNDER THE INSURANCE LAW
AND REGULATIONS PROMULGATED THEREUNDER PROVIDED THAT IT IS NOT OTHERWISE
PROHIBITED UNDER THE FEDERAL ACT.
15. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
INDIVIDUALS RECEIVE HEALTH INSURANCE COVERAGE ON BEHALF OF THEMSELVES
AND THEIR DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY A SMALL
EMPLOYER.
16. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
S 3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE. 1.
THERE IS HEREBY CREATED A PUBLIC BENEFIT CORPORATION TO BE KNOWN AS THE
NEW YORK HEALTH BENEFIT EXCHANGE. SUCH CORPORATION SHALL BE A BODY
CORPORATE AND POLITIC.
2. THE PURPOSE OF THE EXCHANGE IS TO FACILITATE THE PURCHASE AND SALE
OF QUALIFIED HEALTH PLANS, ASSIST QUALIFIED EMPLOYERS IN FACILITATING
THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS THROUGH THE
S. 6256--B 53 A. 9056--B
SMALL BUSINESS HEALTH OPTIONS PROGRAM, ENROLL INDIVIDUALS IN HEALTH
COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW AND
CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS ARTICLE.
3. (A) THE EXCHANGE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSIST-
ING OF NINE VOTING DIRECTORS, INCLUDING THE COMMISSIONER AND THE SUPER-
INTENDENT, WHO SHALL SERVE AS EX OFFICIO DIRECTORS.
(B) SEVEN DIRECTORS SHALL BE APPOINTED BY THE GOVERNOR, TWO OF WHOM
SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
THE SENATE AND TWO OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF
THE SPEAKER OF THE ASSEMBLY. EACH PERSON APPOINTED AS A DIRECTOR PURSU-
ANT TO THIS PARAGRAPH SHALL HAVE EXPERTISE IN ONE OR MORE OF THE FOLLOW-
ING AREAS:
(I) INDIVIDUAL HEALTH CARE COVERAGE;
(II) SMALL EMPLOYER HEALTH CARE COVERAGE;
(III) HEALTH BENEFITS ADMINISTRATION;
(IV) HEALTH CARE FINANCE;
(V) PUBLIC OR PRIVATE HEALTH CARE DELIVERY SYSTEMS; AND
(VI) PURCHASING HEALTH PLAN COVERAGE.
(C) RECOMMENDATIONS AND APPOINTMENTS SHALL TAKE INTO CONSIDERATION THE
EXPERTISE OF OTHER DIRECTORS RECOMMENDED AND APPOINTED PURSUANT TO THIS
SUBDIVISION, SO THAT THE BOARD COMPOSITION REFLECTS A DIVERSITY OF EXPE-
RIENCE AND COMPLIES WITH ANY REGULATIONS ISSUED BY THE SECRETARY PURSU-
ANT TO THE FEDERAL ACT.
(D) RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE AND THE
SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN THIRTY DAYS OF THE EFFEC-
TIVE DATE OF THIS ARTICLE, WITHIN SIXTY DAYS OF THE OCCURRENCE OF A
VACANCY OR WITHIN SIXTY DAYS PRIOR TO THE EXPIRATION OF A TERM.
4. THE GOVERNOR SHALL APPOINT A CHAIR OF THE BOARD FROM AMONG THE
DIRECTORS WHO SHALL BE SUBJECT TO THE ADVICE AND CONSENT OF THE SENATE.
ANY DIRECTOR APPOINTED BY THE GOVERNOR AS CHAIR OF THE BOARD MAY SERVE
AS ACTING CHAIR UNTIL SUCH TIME AS A VOTE FOR CONFIRMATION IS TAKEN BY
THE SENATE. NO DIRECTOR APPOINTED AS CHAIR SHALL SERVE AS CHAIR, OR
CONTINUE TO SERVE AS ACTING CHAIR, IF THE SENATE HAS VOTED NOT TO
CONFIRM SUCH DIRECTOR AS CHAIR.
5. (A) THE TERMS OF THE DIRECTORS, OTHER THAN THE EX OFFICIO DIREC-
TORS, SHALL BE THREE YEARS, PROVIDED, HOWEVER, THAT THE INITIAL TERMS OF
ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDATION OF THE TEMPORARY
PRESIDENT OF THE SENATE, ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDA-
TION OF THE SPEAKER OF THE ASSEMBLY, AND ONE OF THE DIRECTORS APPOINTED
BY THE GOVERNOR WITHOUT RECOMMENDATION SHALL BE FOR TWO YEARS.
(B) VACANCIES OCCURRING OTHERWISE THAN BY EXPIRATION OF TERM OF OFFICE
SHALL BE FILLED FOR THE UNEXPIRED TERM IN THE MANNER PROVIDED FOR
ORIGINAL APPOINTMENT.
6. THE DIRECTORS SHALL NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES
AS DIRECTORS.
7. (A) EACH DIRECTOR SHALL HAVE THE RESPONSIBILITY AND DUTY TO MEET
THE REQUIREMENTS OF THIS ARTICLE, THE FEDERAL ACT, AND ALL APPLICABLE
STATE AND FEDERAL LAWS AND REGULATIONS TO SERVE THE PUBLIC INTEREST OF
THE INDIVIDUALS AND SMALL BUSINESSES SEEKING HEALTH CARE COVERAGE
THROUGH THE EXCHANGE, CONSISTENT WITH SECTION TWENTY-EIGHT HUNDRED TWEN-
TY-FOUR OF THIS CHAPTER.
(B) EACH DIRECTOR SHALL BE A STATE OFFICER OR EMPLOYEE FOR THE
PURPOSES OF SECTIONS SEVENTY-THREE AND SEVENTY-FOUR OF THE PUBLIC OFFI-
CERS LAW.
(C) NO DIRECTOR MAY BE EMPLOYED OR OTHERWISE RETAINED BY THE EXCHANGE.
S. 6256--B 54 A. 9056--B
8. (A) THE BOARD MAY CREATE SUCH COMMITTEES AS THE BOARD DEEMS NECES-
SARY. THE FIRST MEETING OF THE BOARD SHALL BE HELD WITHIN FOURTEEN DAYS
AFTER ALL DIRECTORS ARE INITIALLY APPOINTED. AT THE FIRST MEETING OF
THE BOARD, AND AT THE FIRST MEETING IN EACH SUBSEQUENT YEAR, THE BOARD
SHALL ELECT FROM AMONG ITS MEMBERS A SECRETARY AND A TREASURER. THE
BOARD ALSO SHALL ELECT SUCH OTHER OFFICERS AS IT SHALL DEEM NECESSARY.
THE OFFICERS SO ELECTED SHALL HAVE SUCH POWERS AND DUTIES AS ARE
ASSIGNED BY THE BY-LAWS AND THIS CHAPTER.
(B) THE BOARD, AND ANY COMMITTEE THEREOF, MAY HOLD MEETINGS BY ELEC-
TRONIC MEANS CONSISTENT WITH ARTICLE SEVEN OF THE PUBLIC OFFICERS LAW.
S 3983. GENERAL POWERS OF THE EXCHANGE. THE EXCHANGE SHALL HAVE THE
FOLLOWING POWERS TO BE USED IN FURTHERANCE OF ITS CORPORATE PURPOSES:
1. TO SUE AND BE SUED AND TO PARTICIPATE IN ACTIONS AND PROCEEDINGS,
WHETHER JUDICIAL, ADMINISTRATIVE, ARBITRATIVE OR OTHERWISE;
2. TO HAVE A CORPORATE SEAL, AND TO ALTER SUCH SEAL AT PLEASURE, AND
TO USE IT BY CAUSING IT OR A FACSIMILE TO BE AFFIXED OR IMPRESSED OR
REPRODUCED IN ANY OTHER MANNER;
3. TO PURCHASE, RECEIVE, TAKE BY GRANT, GIFT, DEVISE, BEQUEST OR
OTHERWISE, LEASE, OR OTHERWISE ACQUIRE, OWN, HOLD, IMPROVE, EMPLOY, USE
AND OTHERWISE DEAL IN AND WITH, REAL OR PERSONAL PROPERTY, OR ANY INTER-
EST THEREIN, WHEREVER SITUATED;
4. TO SELL, CONVEY, LEASE, EXCHANGE, TRANSFER OR OTHERWISE DISPOSE OF,
OR MORTGAGE OR PLEDGE, OR CREATE A SECURITY INTEREST IN, ALL OR ANY OF
ITS PROPERTY, OR ANY INTEREST THEREIN, WHEREVER SITUATED;
5. TO MAKE CONTRACTS, GIVE GUARANTEES AND INCUR LIABILITIES, AND
BORROW MONEY; PROVIDED, HOWEVER, THAT THE EXCHANGE SHALL NOT ISSUE
BONDS;
6. TO INVEST AND REINVEST ITS FUNDS, AND TAKE AND HOLD REAL AND
PERSONAL PROPERTY AS SECURITY FOR THE PAYMENT OF FUNDS SO LOANED OR
INVESTED;
7. TO MAKE AND ALTER BY-LAWS FOR ITS ORGANIZATION AND MANAGEMENT;
8. TO MAKE AND ALTER RULES AND REGULATIONS AS NECESSARY TO IMPLEMENT
THE PROVISIONS OF THIS ARTICLE, SUBJECT TO THE PROVISIONS OF THE STATE
ADMINISTRATIVE PROCEDURE ACT;
9. TO HIRE EMPLOYEES, CONSISTENT WITH SECTION THIRTY-NINE HUNDRED
NINETY OF THIS ARTICLE;
10. TO DESIGNATE THE DEPOSITORIES OF ITS MONEY;
11. TO ESTABLISH ITS FISCAL YEAR;
12. TO INSURE OR OTHERWISE PROVIDE FOR THE INSURANCE OF THE EXCHANGE'S
PROPERTY OR OPERATIONS AND AGAINST SUCH OTHER RISKS AS THE EXCHANGE MAY
DEEM ADVISABLE;
13. TO RECEIVE AND SPEND MONEY FOR ANY OF ITS CORPORATE PURPOSES IN
ACCORDANCE WITH THIS ARTICLE; AND
14. TO APPLY FOR, ACCEPT THE AWARD OF, AND SPEND ANY AVAILABLE GRANT
MONEY.
S 3984. FUNCTIONS OF THE EXCHANGE. THE EXCHANGE SHALL:
1. (A) MAKE AVAILABLE QUALIFIED HEALTH PLANS TO QUALIFIED INDIVIDUALS
AND QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOU-
SAND FOURTEEN, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED PLANS SHALL
NOT BECOME EFFECTIVE PRIOR TO SUCH DATE AND SHALL NOT MAKE AVAILABLE ANY
HEALTH PLAN THAT IS NOT A QUALIFIED HEALTH PLAN;
(B) MAKE AVAILABLE QUALIFIED DENTAL PLANS TO QUALIFIED INDIVIDUALS AND
QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOUSAND
FOURTEEN, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED DENTAL PLANS SHALL
NOT BECOME EFFECTIVE PRIOR TO SUCH DATE, EITHER SEPARATELY OR IN
CONJUNCTION WITH A QUALIFIED HEALTH PLAN, IF SUCH PLAN PROVIDES PEDIA-
S. 6256--B 55 A. 9056--B
TRIC DENTAL BENEFITS MEETING THE REQUIREMENTS OF SECTION 1302(B)(1)(J)
OF THE FEDERAL ACT;
2. ASSIGN A RATING TO EACH QUALIFIED HEALTH PLAN OFFERED THROUGH THE
EXCHANGE IN ACCORDANCE WITH THE CRITERIA DEVELOPED BY THE SECRETARY
PURSUANT TO SECTION 1311(C)(3) OF THE FEDERAL ACT, AND DETERMINE EACH
QUALIFIED HEALTH PLAN'S LEVEL OF COVERAGE IN ACCORDANCE WITH REGULATIONS
ISSUED BY THE SECRETARY PURSUANT TO SECTION 1302(D)(2)(A) OF THE FEDERAL
ACT;
3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
IN THE EXCHANGE, INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE
ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE ACT;
4. PROVIDE FOR ENROLLMENT PERIODS PURSUANT TO THE FEDERAL ACT OR THE
INSURANCE LAW, WHICHEVER IS IN THE BEST INTEREST OF QUALIFIED INDIVID-
UALS AND QUALIFIED EMPLOYERS, AFTER THE INITIAL ENROLLMENT PERIOD HAS
BEEN ESTABLISHED AS REQUIRED IN THE FEDERAL ACT; PROVIDED, HOWEVER, THAT
IF ENROLLMENT PERIODS PURSUANT TO THE INSURANCE LAW CONFLICT WITH RULES
ADOPTED BY THE SECRETARY, THEN ENROLLMENT PERIODS PURSUANT TO THE FEDER-
AL ACT SHALL APPLY;
5. IMPLEMENT PROCEDURES FOR THE CERTIFICATION, RECERTIFICATION AND
DECERTIFICATION OF HEALTH PLANS AS QUALIFIED HEALTH PLANS, CONSISTENT
WITH GUIDELINES DEVELOPED BY THE SECRETARY PURSUANT TO SECTION 1311(C)
OF THE FEDERAL ACT AND SECTION THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS
ARTICLE;
6. REQUIRE QUALIFIED HEALTH PLANS TO OFFER THOSE BENEFITS DETERMINED
BY THE SECRETARY TO BE ESSENTIAL HEALTH BENEFITS PURSUANT TO SECTION
1302(B) OF THE FEDERAL ACT (EXCEPT AS PROVIDED IN PARAGRAPH (B) OF
SUBDIVISION ONE OF SECTION THREE THOUSAND NINE HUNDRED EIGHTY-FIVE OF
THIS ARTICLE) AND SUCH ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT
TO THE INSURANCE LAW, PROVIDED THAT THE STATE HAS ASSUMED THE COST OF
SUCH ADDITIONAL BENEFITS AS REQUIRED UNDER SECTION 1311(D)(3)(B) OF THE
FEDERAL ACT;
7. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE EXCHANGE DO
NOT CHARGE AN INDIVIDUAL A FEE OR PENALTY FOR TERMINATION OF COVERAGE;
8. PROVIDE FOR THE OPERATION OF A TOLL-FREE TELEPHONE HOTLINE TO
RESPOND TO REQUESTS FOR ASSISTANCE;
9. MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES AND PROSPEC-
TIVE ENROLLEES OF QUALIFIED HEALTH PLANS MAY OBTAIN STANDARDIZED COMPAR-
ATIVE INFORMATION ON SUCH PLANS AND PUBLIC HEALTH PROGRAMS;
10. ESTABLISH AND MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO
DETERMINE THE ACTUAL COST OF COVERAGE AFTER THE APPLICATION OF ANY
PREMIUM TAX CREDIT UNDER SECTION 36B OF THE INTERNAL REVENUE CODE OF
1986 AND ANY COST-SHARING REDUCTION UNDER SECTION 1402 OF THE FEDERAL
ACT;
11. ESTABLISH A PROGRAM UNDER WHICH THE EXCHANGE AWARDS GRANTS TO
ENTITIES TO SERVE AS NAVIGATORS, IN ACCORDANCE WITH SECTION 1311(I) OF
THE FEDERAL ACT AND REGULATIONS ADOPTED THEREUNDER;
12. IN ACCORDANCE WITH SECTION 1413 OF THE FEDERAL ACT, INFORM INDI-
VIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID PROGRAM UNDER TITLE
XIX OF THE SOCIAL SECURITY ACT, THE CHILDREN'S HEALTH INSURANCE PROGRAM
(CHIP) UNDER TITLE XXI OF THE SOCIAL SECURITY ACT OR ANY APPLICABLE
STATE OR LOCAL PUBLIC HEALTH INSURANCE PROGRAM AND IF, THROUGH SCREENING
OF THE APPLICATION BY THE EXCHANGE, THE EXCHANGE DETERMINES THAT SUCH
INDIVIDUALS ARE ELIGIBLE FOR ANY SUCH PROGRAM, ENROLL SUCH INDIVIDUALS
IN SUCH PROGRAM;
13. PURSUANT TO SECTION 1411 OF THE FEDERAL ACT, GRANT A CERTIFICATION
ATTESTING THAT, FOR PURPOSES OF THE INDIVIDUAL RESPONSIBILITY PENALTY
S. 6256--B 56 A. 9056--B
UNDER SECTION 5000A OF THE INTERNAL REVENUE CODE OF 1986, AN INDIVIDUAL
IS EXEMPT FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR FROM THE
PENALTY IMPOSED BY THAT SECTION BECAUSE:
(A) THERE IS NO AFFORDABLE QUALIFIED HEALTH PLAN AVAILABLE THROUGH THE
EXCHANGE OR THE INDIVIDUAL'S EMPLOYER, COVERING THE INDIVIDUAL; OR
(B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR PENALTY;
14. TRANSMIT TO THE SECRETARY OF THE UNITED STATES DEPARTMENT OF THE
TREASURY:
(A) A LIST OF THE INDIVIDUALS TO WHOM THE EXCHANGE GRANTED A CERTIF-
ICATION UNDER SUBDIVISION THIRTEEN OF THIS SECTION, INCLUDING THE NAME
AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL;
(B) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL WHO
WAS AN EMPLOYEE OF AN EMPLOYER WHO WAS DETERMINED TO BE ELIGIBLE FOR THE
PREMIUM TAX CREDIT UNDER SECTION 36B OF THE INTERNAL REVENUE CODE OF
1986 BECAUSE:
(I) THE EMPLOYER DID NOT PROVIDE MINIMUM ESSENTIAL COVERAGE AS DETER-
MINED BY THE SECRETARY PURSUANT TO SECTION 1311(D) OF THE FEDERAL ACT;
OR
(II) THE EMPLOYER PROVIDED THE MINIMUM ESSENTIAL COVERAGE AS DETER-
MINED BY THE SECRETARY PURSUANT TO SECTION 1311(D) OF THE FEDERAL ACT,
BUT IT WAS DETERMINED UNDER SECTION 36B(C)(2)(C) OF THE INTERNAL REVENUE
CODE OF 1986 TO EITHER BE UNAFFORDABLE TO THE EMPLOYEE OR TO NOT PROVIDE
THE REQUIRED MINIMUM ACTUARIAL VALUE; AND
(C) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF:
(I) EACH INDIVIDUAL WHO NOTIFIES THE EXCHANGE PURSUANT TO SECTION
1411(B)(4) OF THE FEDERAL ACT THAT HE OR SHE HAS CHANGED EMPLOYERS; AND
(II) EACH INDIVIDUAL WHO CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN
DURING A PLAN YEAR AND THE EFFECTIVE DATE OF THAT CESSATION;
15. PROVIDE TO EACH EMPLOYER THE NAME OF EACH EMPLOYEE OF THE EMPLOYER
DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION FOURTEEN OF THIS SECTION WHO
CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN DURING A PLAN YEAR AND THE
EFFECTIVE DATE OF THE CESSATION;
16. OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") PURSUANT
TO SECTION 1311 OF THE FEDERAL ACT THROUGH WHICH QUALIFIED EMPLOYERS
ACCESS COVERAGE FOR THEIR EMPLOYEES, AND MAY:
(A) PERMIT QUALIFIED EMPLOYERS TO SPECIFY A LEVEL OF COVERAGE SO THEIR
EMPLOYEES MAY ENROLL IN ANY QUALIFIED HEALTH PLAN OFFERED THROUGH THE
SHOP AT THE SPECIFIED LEVEL OF COVERAGE OR, UNLESS PROHIBITED BY THE
FEDERAL ACT, PROVIDE A SPECIFIC AMOUNT OR OTHER PAYMENT FORMULATED IN
ACCORDANCE WITH THE FEDERAL ACT TO BE USED AS PART OF AN EMPLOYEE CHOICE
PLAN; AND
(B) PROVIDE PREMIUM AGGREGATION AND OTHER RELATED SERVICES TO MINIMIZE
ADMINISTRATIVE BURDENS FOR QUALIFIED EMPLOYERS;
17. ENTER INTO AGREEMENTS AS NECESSARY WITH: (A) FEDERAL AND STATE
AGENCIES AND OTHER STATE EXCHANGES TO CARRY OUT ITS RESPONSIBILITIES
UNDER THIS ARTICLE, PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE
PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY INFORMATION TO BE
SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS; AND
(B) LOCAL DEPARTMENTS OF SOCIAL SERVICES TO COORDINATE ENROLLMENT IN
OTHER SOCIAL SERVICES PROGRAMS, AS APPROPRIATE, PROVIDED SUCH AGREEMENTS
INCLUDE ADEQUATE PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY
INFORMATION TO BE SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND
REGULATIONS;
18. PERFORM DUTIES REQUIRED BY THE SECRETARY OR THE SECRETARY OF THE
UNITED STATES DEPARTMENT OF THE TREASURY RELATED TO DETERMINING ELIGI-
S. 6256--B 57 A. 9056--B
BILITY FOR PREMIUM TAX CREDITS, REDUCED COST-SHARING, OR INDIVIDUAL
RESPONSIBILITY REQUIREMENT EXEMPTIONS;
19. MEET FINANCIAL INTEGRITY REQUIREMENTS UNDER SECTION 1313 OF THE
FEDERAL ACT AND THIS CHAPTER, INCLUDING:
(A) KEEPING AN ACCURATE ACCOUNTING OF ALL ACTIVITIES, RECEIPTS, AND
EXPENDITURES AND ANNUALLY SUBMITTING TO THE SECRETARY A REPORT CONCERN-
ING SUCH ACCOUNTINGS, WITH A COPY OF SUCH REPORT PROVIDED TO THE GOVER-
NOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEM-
BLY; AND
(B) FULLY COOPERATING WITH ANY INVESTIGATION CONDUCTED BY THE SECRE-
TARY PURSUANT TO THE SECRETARY'S AUTHORITY UNDER SECTION 1313 OF THE
FEDERAL ACT AND ALLOWING THE SECRETARY, IN COORDINATION WITH THE INSPEC-
TOR GENERAL OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN
SERVICES, TO:
(I) INVESTIGATE THE AFFAIRS OF THE EXCHANGE;
(II) EXAMINE THE PROPERTIES AND RECORDS OF THE EXCHANGE; AND
(III) REQUIRE PERIODIC REPORTS IN RELATION TO THE ACTIVITIES UNDERTAK-
EN BY THE EXCHANGE;
20. (A) CONSULT WITH THE REGIONAL ADVISORY COMMITTEES ESTABLISHED
PURSUANT TO SECTION THIRTY-NINE HUNDRED EIGHTY-SIX OF THIS ARTICLE; AND
(B) CONSULT WITH STAKEHOLDERS RELEVANT TO CARRYING OUT THE ACTIVITIES
REQUIRED UNDER THIS ARTICLE, INCLUDING BUT NOT LIMITED TO:
(I) HEALTH CARE CONSUMERS WHO ARE ENROLLEES IN HEALTH PLANS;
(II) INDIVIDUALS AND ENTITIES WITH EXPERIENCE IN FACILITATING ENROLL-
MENT IN HEALTH PLANS;
(III) REPRESENTATIVES OF SMALL BUSINESSES AND SELF-EMPLOYED INDIVID-
UALS;
(IV) STATE MEDICAID OFFICES, INCLUDING LOCAL DEPARTMENTS OF SOCIAL
SERVICES;
(V) ADVOCATES FOR ENROLLING HARD TO REACH POPULATIONS;
(VI) HEALTH CARE PROVIDERS; AND
(VII) INSURERS;
21. SUBMIT INFORMATION PROVIDED BY EXCHANGE APPLICANTS FOR VERIFICA-
TION AS REQUIRED BY SECTION 1411(C) OF THE FEDERAL ACT;
22. ESTABLISH RULES AND REGULATIONS, PURSUANT TO SUBDIVISION EIGHT OF
SECTION THIRTY-NINE HUNDRED EIGHTY-THREE OF THIS ARTICLE, THAT DO NOT
CONFLICT WITH OR PREVENT THE APPLICATION OF REGULATIONS PROMULGATED BY
THE SECRETARY; AND
23. DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE OPPORTUNITIES
FOR APPEAL AND REDETERMINATION IN ACCORDANCE WITH THE REQUIREMENTS OF
SECTIONS 1411 AND 1413 OF THE FEDERAL ACT.
S 3985. SPECIAL FUNCTIONS OF THE EXCHANGE RELATED TO HEALTH PLAN
CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT. 1. HEALTH PLANS
CERTIFIED BY THE EXCHANGE SHALL MEET THE FOLLOWING REQUIREMENTS:
(A) THE INSURER OFFERING THE HEALTH PLAN:
(I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER AND
MEETS THE REQUIREMENTS OF SECTION 1301(A)(1)(C)(I) OF THE FEDERAL ACT
AND ANY GUIDANCE ISSUED THEREUNDER;
(II) OFFERS AT LEAST ONE QUALIFIED HEALTH PLAN IN EACH OF THE SILVER
AND GOLD LEVELS;
(III) HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT OF
ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
LAW AND THE PUBLIC HEALTH LAW;
(IV) DOES NOT CHARGE ANY CANCELLATION FEES OR PENALTIES IN VIOLATION
OF SUBDIVISION SEVEN OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS
ARTICLE; AND
S. 6256--B 58 A. 9056--B
(V) COMPLIES WITH THE REGULATIONS DEVELOPED BY THE SECRETARY UNDER
SECTION 1311(C) OF THE FEDERAL ACT AND SUCH OTHER REQUIREMENTS AS THE
EXCHANGE MAY ESTABLISH;
(B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS PACK-
AGE DESCRIBED IN SECTION 1302(A) OF THE FEDERAL ACT AND INCLUDES SUCH
ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO THE INSURANCE LAW,
PROVIDED THAT THE STATE HAS ASSUMED THE COST OF SUCH ADDITIONAL BENEFITS
AS REQUIRED UNDER SECTION 1311(D)(3)(B) OF THE FEDERAL ACT, EXCEPT THAT
THE HEALTH PLAN SHALL NOT BE REQUIRED TO PROVIDE ESSENTIAL BENEFITS THAT
DUPLICATE THE MINIMUM BENEFITS OF QUALIFIED DENTAL PLANS IF:
(A) THE EXCHANGE HAS DETERMINED THAT AT LEAST ONE QUALIFIED DENTAL
PLAN IS AVAILABLE TO SUPPLEMENT THE HEALTH PLAN'S COVERAGE; AND
(B) THE INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE
HEALTH PLAN, IN A FORM APPROVED BY THE EXCHANGE, THAT THE PLAN DOES NOT
PROVIDE THE FULL RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT QUALI-
FIED DENTAL PLANS PROVIDING THOSE BENEFITS AND OTHER DENTAL BENEFITS NOT
COVERED BY THE PLAN ARE OFFERED THROUGH THE EXCHANGE;
(II) PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE AS DEFINED IN
SECTION 1302(D) OF THE FEDERAL ACT, UNLESS THE PLAN IS CERTIFIED AS A
QUALIFIED CATASTROPHIC PLAN, AS DEFINED IN SECTION 1302(E) OF THE FEDER-
AL ACT, AND SHALL ONLY BE OFFERED TO INDIVIDUALS ELIGIBLE FOR
CATASTROPHIC COVERAGE;
(III) HAS COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO
NOT EXCEED THE LIMITS ESTABLISHED UNDER SECTION 1302(C) OF THE FEDERAL
ACT AND ANY REQUIREMENTS OF THE EXCHANGE;
(IV) COMPLIES WITH REGULATIONS PROMULGATED BY THE SECRETARY PURSUANT
TO SECTION 1311(C) OF THE FEDERAL ACT, WHICH INCLUDE MINIMUM STANDARDS
IN THE AREAS OF MARKETING PRACTICES, NETWORK ADEQUACY, ESSENTIAL COMMU-
NITY PROVIDERS IN UNDERSERVED AREAS, ACCREDITATION, QUALITY IMPROVEMENT,
UNIFORM ENROLLMENT FORMS AND DESCRIPTIONS OF COVERAGE AND INFORMATION ON
QUALITY MEASURES FOR HEALTH BENEFIT PLAN PERFORMANCE;
(V) COMPLIES WITH THE INSURANCE LAW AND THE PUBLIC HEALTH LAW REQUIRE-
MENTS APPLICABLE TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGU-
LATIONS PROMULGATED PURSUANT THERETO THAT DO NOT CONFLICT WITH OR
PREVENT THE APPLICATION OF FEDERAL REQUIREMENTS; AND
(C) THE EXCHANGE DETERMINES THAT MAKING THE HEALTH PLAN AVAILABLE
THROUGH THE EXCHANGE IS IN THE INTEREST OF QUALIFIED INDIVIDUALS AND
QUALIFIED EMPLOYERS IN THIS STATE.
2. THE EXCHANGE SHALL NOT EXCLUDE A HEALTH PLAN:
(A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;
(B) THROUGH THE IMPOSITION OF PREMIUM PRICE CONTROLS BY THE EXCHANGE;
OR
(C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE EXCHANGE DETERMINES ARE
INAPPROPRIATE OR TOO COSTLY.
3. THE EXCHANGE SHALL REQUIRE EACH INSURER CERTIFIED OR SEEKING
CERTIFICATION OF A HEALTH PLAN AS A QUALIFIED HEALTH PLAN TO:
(A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE TO THE EXCHANGE
PRIOR TO IMPLEMENTATION OF SUCH INCREASE. THE INSURER SHALL PROMINENTLY
POST THE INFORMATION ON ITS INTERNET WEBSITE; PROVIDED, HOWEVER, THAT IF
INFORMATION SUBMITTED TO THE SUPERINTENDENT AS A JUSTIFICATION FOR A
PREMIUM RATE ADJUSTMENT PURSUANT TO THE INSURANCE LAW, OR INFORMATION
POSTED TO AN INSURER'S INTERNET WEBSITE, OTHERWISE MEETS FEDERAL
REQUIREMENTS, THEN SUBMISSION OF A COPY OF THE SAME JUSTIFICATION TO THE
EXCHANGE OR USE OF THE SAME POSTING SHALL BE DEEMED SUFFICIENT TO MEET
THE REQUIREMENTS OF THIS SECTION. THE EXCHANGE SHALL TAKE THIS INFORMA-
S. 6256--B 59 A. 9056--B
TION, AND THE INFORMATION AND THE RECOMMENDATIONS PROVIDED TO THE
EXCHANGE BY THE SUPERINTENDENT UNDER SECTION 1003 OF THE FEDERAL ACT
(RELATING TO PATTERNS OR PRACTICES OF EXCESSIVE OR UNJUSTIFIED PREMIUM
INCREASES), INTO CONSIDERATION WHEN DETERMINING WHETHER TO ALLOW THE
INSURER TO MAKE HEALTH PLANS AVAILABLE THROUGH THE EXCHANGE. SUCH RATE
INCREASES SHALL BE SUBJECT TO THE PRIOR APPROVAL OF THE SUPERINTENDENT
PURSUANT TO THE INSURANCE LAW;
(B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE EXCHANGE, THE
SECRETARY AND THE SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
(A) CLAIMS PAYMENT POLICIES AND PRACTICES;
(B) PERIODIC FINANCIAL DISCLOSURES;
(C) DATA ON ENROLLMENT AND DISENROLLMENT;
(D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
(E) DATA ON RATING PRACTICES;
(F) INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY OUT-
OF-NETWORK COVERAGE;
(G) INFORMATION ON ENROLLEE AND PARTICIPANT RIGHTS UNDER TITLE I OF
THE FEDERAL ACT; AND
(H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY THE SECRETARY;
(II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE, AS THAT TERM
IS DEFINED IN SECTION 1311(E)(3)(B) OF THE FEDERAL ACT, AND IN GUIDANCE
JOINTLY ISSUED THEREUNDER BY THE SECRETARY AND THE FEDERAL SECRETARY OF
LABOR; AND
(C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
INDIVIDUAL, THE AMOUNT OF COST-SHARING, INCLUDING DEDUCTIBLES, COPAY-
MENTS, AND COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN OR COVERAGE
THAT THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO THE
FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
A MINIMUM, THIS INFORMATION SHALL BE MADE AVAILABLE TO THE INDIVIDUAL
THROUGH AN INTERNET WEBSITE AND THROUGH OTHER MEANS FOR INDIVIDUALS
WITHOUT ACCESS TO THE INTERNET; PROVIDED, HOWEVER, THAT TO THE EXTENT
THAT REQUIREMENTS UNDER THE INSURANCE LAW OR THE PUBLIC HEALTH LAW MEET
THE STANDARDS OF THE FEDERAL ACT, AN INSURER'S COMPLIANCE WITH SUCH
STATE REQUIREMENTS SHALL BE SUFFICIENT TO MEET THE REQUIREMENTS OF THIS
SECTION.
4. (A) THE PROVISIONS OF THIS ARTICLE THAT APPLY TO QUALIFIED HEALTH
PLANS ALSO SHALL APPLY TO THE EXTENT RELEVANT TO QUALIFIED DENTAL PLANS
EXCEPT AS MODIFIED IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPHS (B)
AND (C) OF THIS SUBDIVISION OR OTHERWISE REQUIRED BY THE EXCHANGE.
(B) THE QUALIFIED DENTAL PLAN SHALL BE LIMITED TO DENTAL AND ORAL
HEALTH BENEFITS, WITHOUT SUBSTANTIALLY DUPLICATING THE BENEFITS TYPICAL-
LY OFFERED BY HEALTH BENEFIT PLANS WITHOUT DENTAL COVERAGE, AND SHALL
INCLUDE, AT A MINIMUM, THE ESSENTIAL PEDIATRIC DENTAL BENEFITS
PRESCRIBED BY THE SECRETARY PURSUANT TO SECTION 1302(B)(1)(J) OF THE
FEDERAL ACT, AND SUCH OTHER DENTAL BENEFITS AS THE EXCHANGE OR SECRETARY
MAY SPECIFY IN REGULATIONS.
(C) INSURERS MAY JOINTLY OFFER A COMPREHENSIVE PLAN THROUGH THE
EXCHANGE IN WHICH AN INSURER PROVIDES THE DENTAL BENEFITS THROUGH A
QUALIFIED DENTAL PLAN AND AN INSURER PROVIDES THE OTHER BENEFITS THROUGH
A QUALIFIED HEALTH PLAN, PROVIDED THAT THE PLANS ARE PRICED SEPARATELY
AND ALSO ARE MADE AVAILABLE FOR PURCHASE SEPARATELY AT THE SAME PRICE.
S 3986. REGIONAL ADVISORY COMMITTEES. 1. THERE ARE HEREBY CREATED THE
NEW YORK HEALTH BENEFIT EXCHANGE REGIONAL ADVISORY COMMITTEES ("ADVISORY
COMMITTEES"). ONE REGIONAL ADVISORY COMMITTEE SHALL BE ESTABLISHED WITH-
IN EACH OF FIVE REGIONS, TO BE KNOWN AS THE "NEW YORK CITY REGION,"
"METROPOLITAN SUBURBAN REGION," "NORTHERN REGION," "CENTRAL REGION" AND
S. 6256--B 60 A. 9056--B
"WESTERN REGION." THE BOARD SHALL DETERMINE THE COUNTIES THAT MAKE UP
SUCH REGIONS.
2. EACH REGIONAL ADVISORY COMMITTEE SHALL BE COMPRISED OF FIVE MEMBERS
APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED UPON THE
RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE AND ONE OF WHOM
SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEM-
BLY.
3. TERMS SHALL BE THREE YEARS. MEMBERS SHALL SERVE UNTIL THEIR
SUCCESSORS ARE APPOINTED. MEMBERS MAY SERVE UP TO TWO CONSECUTIVE TERMS.
4. VACANCIES SHALL BE FILLED IN THE SAME MANNER AS ORIGINAL APPOINT-
MENTS, AND SUCCESSORS SHALL SERVE FOR THE REMAINDER OF THE UNEXPIRED
TERM TO WHICH THEY ARE APPOINTED.
5. RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE AND THE
SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
DATE OF THIS ARTICLE OR THE OCCURRENCE OF A VACANCY, OR WITHIN SIXTY
DAYS PRIOR TO THE EXPIRATION OF A TERM.
6. THE MEMBERS OF EACH REGIONAL ADVISORY COMMITTEE SHALL INCLUDE:
(A) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
TWO FROM ANY SINGLE CATEGORY:
(I) HEALTH PLAN CONSUMER ADVOCATES;
(II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
(III) HEALTH CARE PROVIDER REPRESENTATIVES;
(IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
(B) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
ONE FROM EITHER CATEGORY:
(I) LICENSED INSURANCE PRODUCERS; AND
(II) REPRESENTATIVES OF LABOR ORGANIZATIONS.
7. THE BOARD SHALL SELECT THE CHAIR OF EACH REGIONAL ADVISORY COMMIT-
TEE FROM AMONG THE MEMBERS OF SUCH COMMITTEE. THE BOARD SHALL ADOPT
RULES FOR THE GOVERNANCE OF THE REGIONAL ADVISORY COMMITTEES AND EACH
REGIONAL ADVISORY COMMITTEE SHALL MEET AT LEAST ONCE EACH QUARTER AND AT
SUCH OTHER TIMES AS DETERMINED BY THE BOARD TO BE NECESSARY.
8. MEMBERS OF THE REGIONAL ADVISORY COMMITTEES SHALL SERVE WITHOUT
COMPENSATION.
9. THE REGIONAL ADVISORY COMMITTEES SHALL MAKE FINDINGS AND RECOMMEN-
DATIONS REGARDING REGIONAL VARIATIONS IN THE OPERATION OF THE EXCHANGE,
WHICH SHALL BE SUBMITTED TO THE BOARD OF DIRECTORS, POSTED ON THE
WEBSITE OF THE EXCHANGE, AND CONSIDERED BY THE BOARD IN A REASONABLY
TIMELY FASHION. SUCH FINDINGS AND RECOMMENDATIONS SHALL BE MADE ON AN
ANNUAL BASIS, ON A DATE DETERMINED BY THE BOARD, AND AT SUCH OTHER TIMES
AS THE BOARD OR ANY REGIONAL ADVISORY COMMITTEE DEEMS APPROPRIATE.
S 3987. FUNDING OF THE EXCHANGE. 1. THE EXCHANGE SHALL BE FINANCIALLY
SELF-SUFFICIENT BY JANUARY FIRST, TWO THOUSAND FIFTEEN.
2. THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND
SHALL REPORT ITS RECOMMENDATIONS UPON, THE OPTIONS TO GENERATE FUNDING
FOR THE ONGOING OPERATION OF THE EXCHANGE, AS PROVIDED FOR IN SUBDIVI-
SION EIGHT OF SECTION THIRTY-NINE HUNDRED EIGHTY-EIGHT OF THIS ARTICLE
AND SUBJECT TO THE PROVISIONS OF SUBDIVISIONS FOURTEEN AND FIFTEEN OF
SUCH SECTION.
3. THE EXCHANGE SHALL PUBLISH ON ITS INTERNET WEBSITE THE FEES AND
ANY OTHER PAYMENTS REQUIRED BY THE EXCHANGE, AND THE ADMINISTRATIVE
COSTS OF THE EXCHANGE, TO EDUCATE CONSUMERS ON SUCH COSTS AND THE AMOUNT
OF MONIES LOST TO WASTE, FRAUD AND ABUSE.
4. THE EXCHANGE SHALL NOT UTILIZE ANY FUNDS INTENDED FOR THE ADMINIS-
TRATIVE AND OPERATIONAL EXPENSES OF THE EXCHANGE FOR STAFF RETREATS,
PROMOTIONAL GIVEAWAYS, EXCESSIVE EXECUTIVE COMPENSATION, OR PROMOTION OF
S. 6256--B 61 A. 9056--B
FEDERAL OR STATE LEGISLATIVE AND REGULATORY MODIFICATIONS PURSUANT TO
SECTION 1411(C) OF THE FEDERAL ACT.
5. THE MONEYS OF THE EXCHANGE SHALL, EXCEPT AS OTHERWISE PROVIDED IN
THIS SECTION, BE DEPOSITED IN A GENERAL ACCOUNT CALLED THE NEW YORK
HEALTH BENEFIT EXCHANGE ACCOUNT AND SUCH OTHER ACCOUNTS AS THE EXCHANGE
MAY DEEM NECESSARY, PURSUANT TO RESOLUTION OF THE BOARD, FOR THE TRANS-
ACTION OF ITS BUSINESS AND SHALL BE PAID OUT AS AUTHORIZED BY THE CHAIR
OF THE BOARD OR BY SUCH OTHER PERSON OR PERSONS AS THE CHAIR MAY DESIG-
NATE.
6. NO FUNDS OF THE EXCHANGE SHALL BE TRANSFERRED TO THE GENERAL FUND
OR ANY SPECIAL REVENUE FUND OR SHALL BE USED FOR ANY PURPOSE OTHER THAN
THE PURPOSES SET FORTH IN THIS ARTICLE. NO FUNDS SHALL BE TRANSFERRED
FROM THE GENERAL FUND OR ANY SPECIAL REVENUE FUND TO THE EXCHANGE WITH-
OUT AN APPROPRIATION.
7. THE ACCOUNTS OF THE EXCHANGE SHALL BE SUBJECT TO SUPERVISION OF THE
COMPTROLLER AND SUCH ACCOUNTS SHALL INCLUDE RECEIPTS, EXPENDITURES,
CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
EXCHANGE.
8. NOTWITHSTANDING ANY LAW TO THE CONTRARY, AND IN ACCORDANCE WITH
SECTION FOUR OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF
THE BUDGET, IN CONSULTATION WITH THE COMMISSIONER, THE SUPERINTENDENT
AND THE CHAIR OF THE BOARD, THE COMPTROLLER IS HEREBY AUTHORIZED AND
DIRECTED TO SUBALLOCATE OR TRANSFER SPECIAL REVENUE FEDERAL FUNDS APPRO-
PRIATED TO THE DEPARTMENT OF HEALTH FOR PLANNING AND IMPLEMENTING VARI-
OUS HEALTHCARE AND INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL
LEGISLATION, INCLUDING, BUT NOT LIMITED 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) TO THE NEW YORK STATE HEALTH
BENEFIT EXCHANGE. MONEYS SUBALLOCATED OR TRANSFERRED PURSUANT TO THIS
SECTION SHALL BE PAID OUT OF THE FUND UPON AUDIT AND WARRANT OF THE
STATE COMPTROLLER ON VOUCHERS CERTIFIED OR APPROVED BY THE EXCHANGE.
S 3988. STUDIES AND RECOMMENDATIONS. 1. (A) THE EXCHANGE SHALL
CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE RECOMMENDA-
TIONS UPON, THE ESSENTIAL HEALTH BENEFITS IDENTIFIED BY THE SECRETARY
PURSUANT TO SECTION 1302(B) OF THE FEDERAL ACT AND OF THE BENEFITS
REQUIRED UNDER THE INSURANCE LAW OR REGULATIONS PROMULGATED THEREUNDER
THAT ARE NOT DETERMINED BY THE SECRETARY TO BE ESSENTIAL HEALTH BENE-
FITS. SUCH STUDY AND RECOMMENDATIONS SHALL ADDRESS MATTERS INCLUDING BUT
NOT LIMITED TO:
(I) WHETHER THE ESSENTIAL HEALTH BENEFITS REQUIRED TO BE INCLUDED IN
POLICIES AND CONTRACTS SOLD THROUGH THE EXCHANGE SHOULD BE SOLD TO SIMI-
LARLY SITUATED INDIVIDUALS AND GROUPS PURCHASING COVERAGE OUTSIDE OF THE
EXCHANGE;
(II) WHETHER ANY BENEFITS REQUIRED UNDER THE INSURANCE LAW OR REGU-
LATIONS PROMULGATED THEREUNDER THAT ARE NOT IDENTIFIED AS ESSENTIAL
HEALTH BENEFITS BY THE SECRETARY SHOULD NO LONGER BE REQUIRED IN POLI-
CIES OR CONTRACTS SOLD EITHER THROUGH THE EXCHANGE OR TO SIMILARLY SITU-
ATED INDIVIDUALS AND GROUPS OUTSIDE OF THE EXCHANGE;
(III) THE COSTS OF EXTENDING ANY BENEFITS REQUIRED UNDER THE INSURANCE
LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLICIES AND CONTRACTS SOLD
THROUGH THE EXCHANGE; AND
(IV) MECHANISMS TO FINANCE ANY COSTS PURSUANT TO SECTION
1311(D)(3)(B)(II) OF THE FEDERAL ACT OF EXTENDING ANY BENEFITS REQUIRED
UNDER THE INSURANCE LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLI-
CIES AND CONTRACTS SOLD THROUGH THE EXCHANGE.
S. 6256--B 62 A. 9056--B
(B) IN MAKING ITS RECOMMENDATIONS, THE EXCHANGE SHALL CONSIDER THE
INDIVIDUAL AND SMALL GROUP MARKETS OUTSIDE OF THE EXCHANGE AND CONSIDER
APPROACHES TO PREVENT MARKETPLACE DISRUPTION, REMAIN CONSISTENT WITH THE
EXCHANGE AND AVOID ANTI-SELECTION.
(C) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
2. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON: (I) WHETHER INSURERS PARTICIPATING
IN THE EXCHANGE SHOULD BE REQUIRED TO OFFER ALL HEALTH PLANS SOLD IN THE
EXCHANGE TO INDIVIDUALS OR SMALL GROUPS PURCHASING COVERAGE OUTSIDE OF
THE EXCHANGE;
(II) WHETHER THE INDIVIDUAL AND SMALL GROUP MARKETS SHOULD BE PLACED
ENTIRELY INSIDE THE EXCHANGE;
(III) WHETHER THE BENEFITS IN THE INDIVIDUAL AND SMALL GROUP MARKETS
SHOULD BE STANDARDIZED INSIDE THE EXCHANGE OR INSIDE AND OUTSIDE THE
EXCHANGE;
(IV) HOW TO DEVELOP AND IMPLEMENT THE TRANSITIONAL REINSURANCE PROGRAM
FOR THE INDIVIDUAL MARKET AND ANY OTHER RISK ADJUSTMENT MECHANISMS
DEVELOPED IN ACCORDANCE WITH SECTIONS 1341, 1342 AND 1343 OF THE FEDERAL
ACT;
(V) WHETHER TO MERGE THE INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE
MARKETS FOR RATING PURPOSES INCLUDING AN ANALYSIS OF THE IMPACT SUCH
MERGER WOULD HAVE ON PREMIUMS;
(VI) WHETHER TO INCREASE THE SIZE OF SMALL EMPLOYERS FROM AN AVERAGE
OF AT LEAST ONE BUT NOT MORE THAN FIFTY EMPLOYEES TO AN AVERAGE OF AT
LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES PRIOR TO JANUARY
FIRST, TWO THOUSAND SIXTEEN;
(VII) HOW TO ACCOUNT FOR SOLE PROPRIETORS IN DEFINING "SMALL EMPLOY-
ERS"; AND
(VIII) WHETHER TO REVISE THE DEFINITION OF "SMALL EMPLOYER" OUTSIDE
THE EXCHANGE TO BE CONSISTENT WITH THE DEFINITION AS IT APPLIES WITHIN
THE EXCHANGE.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
3. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, WHETHER THE STATE SHOULD ESTABLISH
A BASIC HEALTH PLAN PROGRAM IDENTIFIED BY THE SECRETARY PURSUANT TO
SECTION 1331 OF THE FEDERAL ACT.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
4. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, THE ADVANTAGES AND DISADVANTAGES OF
THE EXCHANGE SERVING AS AN ACTIVE PURCHASER, A SELECTIVE CONTRACTOR, OR
CLEARINGHOUSE OF INSURANCE.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
5. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, (I) THE ANTICIPATED ANNUAL OPERAT-
ING EXPENSES OF THE EXCHANGE, INCLUDING BUT NOT LIMITED TO THE DEVELOP-
MENT OF ANY MULTI-YEAR FINANCIAL MODELS; AND (II) THE OPTIONS TO GENER-
ATE FUNDING FOR THE ONGOING OPERATION AND SELF-SUFFICIENCY OF THE
S. 6256--B 63 A. 9056--B
EXCHANGE INCLUDING BUT NOT LIMITED TO ASSESSMENTS UPON INSURERS AND
PROVIDERS.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
6. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, THE BENCHMARK BENEFITS IDENTIFIED
BY THE SECRETARY AND OF THE BENEFITS REQUIRED UNDER THE PUBLIC HEALTH
LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER
THAT ARE NOT DETERMINED BY THE SECRETARY TO BE BENCHMARK BENEFITS. SUCH
STUDY AND RECOMMENDATIONS SHALL ADDRESS MATTERS INCLUDING BUT NOT LIMIT-
ED TO:
(I) WHETHER ANY BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE
SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER THAT ARE NOT
IDENTIFIED AS BENCHMARK BENEFITS BY THE SECRETARY SHOULD CONTINUE TO BE
REQUIRED AS COVERED BENEFITS AVAILABLE TO NEWLY MEDICAID-ELIGIBLE INDI-
VIDUALS INSIDE THE EXCHANGE;
(II) THE COSTS OF EXTENDING ANY BENEFITS REQUIRED UNDER THE PUBLIC
HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THERE-
UNDER AS COVERED BENEFITS AVAILABLE TO NEWLY MEDICAID-ELIGIBLE INDIVID-
UALS THROUGH THE EXCHANGE; AND
(III) MECHANISMS TO FINANCE ANY COSTS PURSUANT TO THE FEDERAL ACT OF
EXTENDING ANY BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE
SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLICIES
AND CONTRACTS SOLD THROUGH THE EXCHANGE.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
7. (A) THE EXCHANGE SHALL MAKE RECOMMENDATIONS UPON THE IMPACT OF THE
ESTABLISHMENT AND OPERATION OF THE EXCHANGE ON THE HEALTHY NEW YORK
PROGRAM ESTABLISHED PURSUANT TO SECTION FORTY-THREE HUNDRED TWENTY-SIX
OF THE INSURANCE LAW AND THE FAMILY HEALTH PLUS EMPLOYER PARTNERSHIP
PROGRAM ESTABLISHED PURSUANT TO SECTION THREE HUNDRED SIXTY-NINE-FF OF
THE SOCIAL SERVICES LAW.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
8. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, PROCEDURES UNDER WHICH LICENSED
HEALTH INSURANCE PRODUCERS, CHAMBERS OF COMMERCE AND BUSINESS ASSOCI-
ATIONS MAY ENROLL INDIVIDUALS AND EMPLOYERS IN ANY QUALIFIED HEALTH PLAN
IN THE INDIVIDUAL OR SMALL GROUP MARKET AS SOON AS THE PLAN IS OFFERED
THROUGH THE EXCHANGE; AND TO ASSIST INDIVIDUALS IN APPLYING FOR PREMIUM
TAX CREDITS AND COST-SHARING REDUCTIONS FOR PLANS SOLD THROUGH THE
EXCHANGE; AND
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
9. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, THE CRITERIA FOR ELIGIBILITY TO
SERVE AS A NAVIGATOR FOR PURPOSES OF SECTION 1311(I) OF THE FEDERAL ACT,
ANY GUIDANCE ISSUED THEREUNDER AND SUBDIVISION FOURTEEN OF SECTION THIR-
TY-NINE HUNDRED EIGHTY-FOUR OF THIS ARTICLE.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
S. 6256--B 64 A. 9056--B
10. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY
OF, AND SHALL MAKE RECOMMENDATIONS UPON, THE ROLE OF THE EXCHANGE IN
DECREASING HEALTH DISPARITIES IN HEALTH CARE SERVICES AND PERFORMANCE,
INCLUDING BUT NOT LIMITED TO DISPARITIES ON THE BASIS OF RACE OR ETHNIC-
ITY, IN ACCORDANCE WITH SECTION FORTY-THREE HUNDRED TWO OF THE FEDERAL
ACT.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
11. (A) THE EXCHANGE SHALL MAKE RECOMMENDATIONS UPON WHETHER AND TO
WHAT EXTENT HEALTH SAVINGS ACCOUNTS SHOULD BE OFFERED THROUGH THE
EXCHANGE.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE AUGUST FIRST, TWO THOUSAND TWELVE.
12. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY
OF, AND SHALL MAKE RECOMMENDATIONS UPON, WHETHER TO ALLOW LARGE EMPLOY-
ERS TO PARTICIPATE IN THE EXCHANGE BEGINNING JANUARY FIRST, TWO THOUSAND
SEVENTEEN, AND SHALL TAKE INTO ACCOUNT ANY EXCESS OF PREMIUM GROWTH
OUTSIDE OF THE EXCHANGE AS COMPARED TO THE RATE OF SUCH GROWTH INSIDE
THE EXCHANGE.
(B) THE EXCHANGE SHALL SUBMIT ITS RECOMMENDATIONS TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR
BEFORE DECEMBER FIRST, TWO THOUSAND FIFTEEN.
13. THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
AND SHALL MAKE RECOMMENDATIONS UPON, THE INTEGRATION OF PUBLIC HEALTH
INSURANCE PROGRAMS, INCLUDING MEDICAID, CHILD HEALTH PLUS, AND FAMILY
HEALTH PLUS WITHIN THE EXCHANGE, WHICH MAY INCLUDE SUCH REPORTS AS ARE
PERIODICALLY SUBMITTED TO THE SECRETARY, ON OR BEFORE AUGUST FIRST, TWO
THOUSAND TWELVE.
14. NOTWITHSTANDING ANY PROVISION OF SUBDIVISIONS ONE THROUGH THIRTEEN
OF THIS SECTION, IF THE EXCHANGE DETERMINES THAT ANY RECOMMENDATIONS
REQUIRED UNDER ANY SUCH SUBDIVISION CANNOT BE SUBMITTED BY THE SPECIFIED
DATE BECAUSE FEDERAL GUIDANCE OR REGULATIONS NECESSARY TO COMPLETE SUCH
RECOMMENDATIONS HAS NOT BEEN ISSUED, THE EXCHANGE MAY ESTABLISH A NEW
AND REASONABLE DATE FOR SUCH COMPLETION AND SUBMISSION.
15. (A) ANY OF THE STUDIES REQUIRED UNDER THIS SECTION MAY BE COMBINED
WITH OTHER STUDIES REQUIRED UNDER THIS SECTION OR OTHERWISE UNDERTAKEN
BY THE EXCHANGE TO THE EXTENT FEASIBLE AND TIMELY.
(B) IN LIEU OF CONDUCTING OR CAUSING TO BE CONDUCTED ANY OF THE
STUDIES REQUIRED UNDER THIS SECTION, THE EXCHANGE MAY RELY UPON ANY
OTHER STUDY OR STUDIES, IN WHOLE OR IN PART, COMPLETED PRIOR TO THE DATE
ON WHICH THE EXCHANGE SUBMITS ITS RECOMMENDATIONS, IF THE EXCHANGE
DETERMINES THAT SUCH STUDY OR STUDIES ARE SUFFICIENTLY RELIABLE.
16. THE EXCHANGE SHALL HAVE NO AUTHORITY, WHETHER EXPRESS OR IMPLIED,
TO IMPLEMENT ANY RECOMMENDATION ON THE ISSUES SET FORTH IN SUBDIVISIONS
ONE THROUGH TWELVE OF THIS SECTION WITHOUT FURTHER STATUTORY AUTHORITY;
PROVIDED, HOWEVER, THAT NOTHING IN THIS SUBDIVISION SHALL BE DEEMED TO
ALTER ANY POWERS EXPRESSLY GRANTED ELSEWHERE IN THIS ARTICLE.
S 3989. TAX EXEMPTION AND TAX CONTRACT BY THE STATE. 1. IT IS HEREBY
DETERMINED THAT THE CREATION OF THE EXCHANGE AND THE FULFILLMENT OF ITS
CORPORATE PURPOSES IS IN ALL RESPECTS FOR THE BENEFIT OF THE PEOPLE OF
THIS STATE AND IS A PUBLIC PURPOSE. ACCORDINGLY, THE EXCHANGE SHALL BE
REGARDED AS PERFORMING AN ESSENTIAL GOVERNMENTAL FUNCTION IN THE EXER-
CISE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, AND THE EXCHANGE
SHALL NOT BE REQUIRED TO PAY ANY FEES, TAXES, SPECIAL AD VALOREM LEVIES
S. 6256--B 65 A. 9056--B
OR ASSESSMENTS OF ANY KIND, WHETHER STATE OR LOCAL, INCLUDING BUT NOT
LIMITED TO FEES, TAXES, SPECIAL AD VALOREM LEVIES OR ASSESSMENTS ON REAL
PROPERTY, FRANCHISE TAXES, SALES TAXES, TRANSFER TAXES, MORTGAGE TAXES
OR OTHER TAXES, UPON OR WITH RESPECT TO ANY PROPERTY OWNED BY IT OR
UNDER ITS JURISDICTION, CONTROL OR SUPERVISION, OR UPON THE USES THERE-
OF, OR UPON OR WITH RESPECT TO ITS ACTIVITIES OR OPERATIONS IN FURTHER-
ANCE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, OR UPON OR WITH
RESPECT TO ANY FARES, TOLLS, RENTALS, RATES, CHARGES, FEES, REVENUES OR
OTHER INCOME RECEIVED BY THE EXCHANGE.
2. THE EXCHANGE MAY PAY, OR MAY ENTER INTO AGREEMENTS WITH ANY COUNTY
OR MUNICIPALITY TO PAY, A SUM OR SUMS ANNUALLY OR OTHERWISE OR TO
PROVIDE OTHER CONSIDERATIONS WITH RESPECT TO REAL PROPERTY OWNED BY THE
EXCHANGE LOCATED WITHIN SUCH COUNTY OR MUNICIPALITY.
S 3990. OFFICERS AND EMPLOYEES. 1. THE BOARD SHALL HAVE THE POWER TO
APPOINT EMPLOYEES TO SERVE AS SENIOR MANAGERIAL STAFF OF THE EXCHANGE AS
NECESSARY, WHO SHALL BE DESIGNATED TO BE IN THE EXEMPT CLASS OF CIVIL
SERVICE. THE BOARD SHALL ALSO HAVE THE POWER TO FIX THE SALARIES OF SUCH
EMPLOYEES.
2. ANY NEWLY HIRED EMPLOYEES WHO ARE NOT DESIGNATED TO BE IN THE
EXEMPT CLASS OF CIVIL SERVICE PURSUANT TO SUBDIVISION ONE OF THIS
SECTION AND WHO ARE NOT SUBJECT TO THE TRANSFER PROVISIONS SET FORTH IN
SUBDIVISIONS FOUR, FIVE AND SIX OF THIS SECTION SHALL BE CONSIDERED FOR
PURPOSES OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW TO BE PUBLIC
EMPLOYEES IN THE CIVIL SERVICE OF THE STATE, AND SHALL BE ASSIGNED TO
THE APPROPRIATE COLLECTIVE BARGAINING UNIT BY THE EXCHANGE IN THE SAME
MANNER AND CONSISTENT WITH THOSE EMPLOYEES DESCRIBED IN SUBDIVISION SIX
OF THIS SECTION.
3. ANY PUBLIC OFFICER OR EMPLOYEE OF A STATE DEPARTMENT, AGENCY OR
COMMISSION MAY BE TRANSFERRED TO THE EXCHANGE WITHOUT EXAMINATION AND
WITHOUT LOSS OF ANY CIVIL SERVICE STATUS OR RIGHTS TO A COMPARABLE
OFFICE, POSITION OR EMPLOYMENT WITH THE EXCHANGE; PROVIDED, HOWEVER, NO
SUCH TRANSFER MAY BE MADE WITHOUT THE CONSENT OF THE HEAD OF THE DEPART-
MENT, AGENCY OR COMMISSION. TRANSFERS SHALL BE MADE PURSUANT TO SUBDI-
VISION TWO OF SECTION SEVENTY OF THE CIVIL SERVICE LAW.
4. THE SALARY OR COMPENSATION OF ANY SUCH OFFICER OR EMPLOYEE, AFTER
SUCH TRANSFER, SHALL BE PAID BY THE EXCHANGE.
5. ANY OFFICER OR EMPLOYEE TRANSFERRED TO THE EXCHANGE PURSUANT TO
THIS SECTION, WHO ARE MEMBERS OF OR BENEFIT UNDER ANY EXISTING PENSION
OR RETIREMENT FUND OR SYSTEM, SHALL CONTINUE TO HAVE ALL RIGHTS, PRIVI-
LEGES, OBLIGATIONS AND STATUS WITH RESPECT TO SUCH FUND OR SYSTEM AS ARE
NOW PRESCRIBED BY LAW, BUT DURING THE PERIOD OF THEIR EMPLOYMENT BY THE
EXCHANGE, ALL CONTRIBUTIONS TO SUCH FUNDS OR SYSTEMS TO BE PAID BY THE
EMPLOYER ON ACCOUNT OF SUCH OFFICERS OR EMPLOYEES SHALL BE PAID BY THE
EXCHANGE.
6. A TRANSFERRED EMPLOYEE SHALL REMAIN IN THE SAME COLLECTIVE BARGAIN-
ING UNIT AS WAS THE CASE PRIOR TO HIS OR HER TRANSFER; SUCCESSOR EMPLOY-
EES TO THE POSITIONS HELD BY SUCH TRANSFERRED EMPLOYEES SHALL, CONSIST-
ENT WITH THE PROVISIONS OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW, BE
INCLUDED IN THE SAME UNIT AS THEIR PREDECESSORS. EMPLOYEES SERVING IN
POSITIONS IN NEWLY CREATED TITLES SHALL BE ASSIGNED TO THE SAME COLLEC-
TIVE BARGAINING UNIT AS THEY WOULD HAVE BEEN ASSIGNED TO WERE SUCH
TITLES CREATED PRIOR TO THE ESTABLISHMENT OF THE EXCHANGE. NOTHING
CONTAINED IN THIS ARTICLE SHALL BE CONSTRUED (A) TO DIMINISH THE RIGHTS
OF EMPLOYEES PURSUANT TO A COLLECTIVE BARGAINING AGREEMENT OR (B) TO
AFFECT EXISTING LAW WITH RESPECT TO AN APPLICATION TO THE PUBLIC EMPLOY-
S. 6256--B 66 A. 9056--B
MENT RELATIONS BOARD SEEKING A DESIGNATION BY THE BOARD THAT CERTAIN
PERSONS ARE MANAGERIAL OR CONFIDENTIAL.
S 3991. LIMITATION OF LIABILITY; INDEMNIFICATION. THE PROVISIONS OF
SECTIONS SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW SHALL BE
APPLICABLE TO EXCHANGE EMPLOYEES, AS SUCH TERM IS DEFINED IN SECTIONS
SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW; PROVIDED, HOWEVER,
THAT NOTHING CONTAINED WITHIN THIS SECTION SHALL BE DEEMED TO PERMIT THE
EXCHANGE TO EXTEND THE PROVISIONS OF SECTIONS SEVENTEEN AND NINETEEN OF
THE PUBLIC OFFICERS LAW UPON ANY INDEPENDENT CONTRACTOR.
S 3992. CONTINGENCY FOR FEDERAL FUNDING. THE IMPLEMENTATION OF THE
PROVISIONS OF THIS ARTICLE SHALL BE CONTINGENT, AS DETERMINED BY THE
DIRECTOR OF THE BUDGET, ON THE AVAILABILITY OF SUFFICIENT FEDERAL FINAN-
CIAL SUPPORT FOR THE PLANNING AND IMPLEMENTATION OF HEALTH CARE AND
INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL LEGISLATION TO ESTAB-
LISH AND IMPLEMENT THE HEALTH BENEFIT EXCHANGE.
S 3993. CONSTRUCTION. NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
THE EXCHANGE PURSUANT HERETO, SHALL BE CONSTRUED TO:
1. PREEMPT OR SUPERSEDE THE AUTHORITY OF THE SUPERINTENDENT OR THE
COMMISSIONER; OR
2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
THE PUBLIC HEALTH LAW OR THE INSURANCE LAW AND REGULATIONS PROMULGATED
THEREUNDER.
S 3. Subdivision 1 of section 17 of the public officers law is amended
by adding a new paragraph (x) to read as follows:
(X) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE
DIRECTORS, OFFICERS AND EMPLOYEES OF THE NEW YORK HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
LAW.
S 4. Subdivision 1 of section 19 of the public officers law is amended
by adding a new paragraph (j) to read as follows:
(J) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE
DIRECTORS, OFFICERS AND EMPLOYEES OF THE NEW YORK HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
LAW.
S 5. If any provision or application of this act shall be held to be
invalid, or to violate or be inconsistent with any applicable federal
law or regulation, that shall not affect other provisions or applica-
tions of this act which can be given effect without that provision or
application; and to that end, the provisions and applications of this
act are severable; provided, however, that nothing in this section shall
be deemed to invalidate the provisions of section 3992 of the public
authorities law, as added by section two of this act.
S 6. If the federal act is held to be unconstitutional by the supreme
court of the United States or repealed by the United States Congress,
the legislature shall convene within 180 days of such decision or
congressional act to consider appropriate legislative options.
S 7. This act shall take effect immediately; provided, however, that
until such time as the members of the board of directors of the New York
health benefit exchange are initially appointed pursuant to section 3982
of the public authorities law, as added by section two of this act, and
the first meeting of such board is convened, nothing in this act shall
be deemed to prevent the commissioner of health or the superintendent of
financial services from applying for, accepting the award of, and spend-
ing any available grant money pertaining to the establishment or opera-
tion of such exchange for purposes consistent with this act or, at any
S. 6256--B 67 A. 9056--B
time, from accepting or spending grant money awarded prior to the enact-
ment of this act.
PART F
Section 1. Section 1 of part C of chapter 58 of the laws of 2005,
authorizing reimbursements for expenditures made by or on behalf of
social services districts for medical assistance for needy persons and
the administration thereof, is amended by adding a new subdivision (c-1)
to read as follows:
(C-1) NOTWITHSTANDING ANY PROVISIONS OF SUBDIVISION (C) OF THIS
SECTION TO THE CONTRARY, EFFECTIVE APRIL 1, 2013, FOR THE PERIOD JANUARY
1, 2013 THROUGH DECEMBER 31, 2013 AND FOR EACH CALENDAR YEAR THEREAFTER,
THE MEDICAL ASSISTANCE EXPENDITURE AMOUNT FOR THE SOCIAL SERVICES
DISTRICT FOR SUCH PERIOD SHALL BE EQUAL TO THE PREVIOUS CALENDAR YEAR'S
MEDICAL ASSISTANCE EXPENDITURE AMOUNT, EXCEPT THAT:
(1) FOR THE PERIOD JANUARY 1, 2013 THROUGH DECEMBER 31, 2013, THE
PREVIOUS CALENDAR YEAR MEDICAL ASSISTANCE EXPENDITURE AMOUNT WILL BE
INCREASED BY 2%;
(2) FOR THE PERIOD JANUARY 1, 2014 THROUGH DECEMBER 31, 2014, THE
PREVIOUS CALENDAR YEAR MEDICAL ASSISTANCE EXPENDITURE AMOUNT WILL BE
INCREASED BY 1%.
S 2. Paragraph (iii) of subdivision (g) of section 1 of part C of
chapter 58 of the laws of 2005, authorizing reimbursements for expendi-
tures made by or on behalf of social services districts for medical
assistance for needy persons and the administration thereof, as amended
by section 59 of part A of chapter 57 of the laws of 2006, is amended to
read as follows:
(iii) During each state fiscal year subject to the provisions of this
section AND PRIOR TO STATE FISCAL YEAR 2015-16, the commissioner shall
maintain an accounting, for each social services district, of the net
amounts that would have been expended by, or on behalf of, such district
had the social services district medical assistance shares provisions in
effect on January 1, 2005 been applied to such district. For purposes
of this paragraph, fifty percent of the payments made by New York State
to the secretary of the federal department of health and human services
pursuant to section 1935(c) of the social security act shall be deemed
to be payments made on behalf of social services districts; such fifty
percent share shall be apportioned to each district in the same ratio as
the number of "full-benefit dual eligible individuals," as that term is
defined in section 1935(c)(6) of such act, for whom such district has
fiscal responsibility pursuant to section 365 of the social services
law, relates to the total of such individuals for whom districts have
fiscal responsibility. As soon as practicable after the conclusion of
each such fiscal year, but in no event later than six months after the
conclusion of each such fiscal year, the commissioner shall reconcile
such net amounts with such fiscal year's social services district
expenditure cap amount. Such reconciliation shall be based on actual
expenditures made by or on behalf of social services districts, and
revenues received by social services districts, during such fiscal year
and shall be made without regard to expenditures made, and revenues
received, outside such fiscal year that are related to services provided
during, or prior to, such fiscal year. The commissioner shall pay to
each social services district the amount, if any, by which such
district's expenditure cap amount exceeds such net amount.
S. 6256--B 68 A. 9056--B
S 3. Paragraph (i) of subdivision (b) of section 2 of part C of chap-
ter 58 of the laws of 2005, authorizing reimbursements for expenditures
made by or on behalf of social services districts for medical assistance
for needy persons and the administration thereof, is amended and a new
paragraph (iii) is added to read as follows:
(i) A social services district shall exercise the option described in
this section through the adoption of a resolution by its local legisla-
tive body, in the form set forth in subparagraph (ii) of this paragraph,
to elect the medical assistance reimbursement methodology set forth in
paragraph (a) of this section and to elect the tax intercept methodology
set forth in subdivision (f) of section 1261 of the tax law or subdivi-
sion (g) of section 1261 and subdivision (h) of section 1313 of the tax
law, as applicable. A social services district, acting through its local
legislative body, is hereby authorized to adopt such a resolution. Such
a resolution shall be effective only if it is adopted exactly as set
forth in subparagraph (ii) of this paragraph no later than September 30,
2007, and a certified copy of such resolution is mailed to the commis-
sioner of health by certified mail by such date. The commissioner of
health shall, no later than October 31, 2007, certify to the commission-
er of taxation and finance a list of those social services districts
which have elected the option described in this section. A social
services district [shall have no authority to rescind the exercise of]
THAT ELECTED the option described in this section, ACTING THROUGH ITS
LOCAL LEGISLATIVE BODY, MAY REPEAL THAT ELECTION BY ADOPTING A RESOL-
UTION EXACTLY AS SET FORTH IN PARAGRAPH (III) OF THIS SUBDIVISION AND
MAILING A CERTIFIED COPY OF SUCH REPEAL RESOLUTION TO THE COMMISSIONER
OF HEALTH NO LATER THAN JANUARY 1, 2013. THE COMMISSIONER OF HEALTH
SHALL, WITHIN TWO WEEKS OF RECEIVING ANY SUCH COPY OF A CERTIFIED REPEAL
RESOLUTION BY CERTIFIED MAIL FROM A SOCIAL SERVICES DISTRICT, CERTIFY IN
WRITING TO THE COMMISSIONER OF TAXATION AND FINANCE THE NAME OF ANY SUCH
SOCIAL SERVICES DISTRICT THAT ADOPTED SUCH A RESOLUTION TO REPEAL ITS
ELECTION. UPON RECEIVING SUCH WRITTEN CERTIFICATION, THE COMMISSIONER OF
TAXATION AND FINANCE SHALL NO LONGER CALCULATE THE MEDICAID AMOUNT OF
SUCH COUNTY UNDER SUBDIVISION (F) OF SECTION 1261 OF THE TAX LAW, AND
THE AMOUNT DUE SUCH COUNTY UNDER SUBDIVISION (C) OF SUCH SECTION 1261
SHALL NO LONGER BE REDUCED BY SUCH MEDICAID AMOUNT, EFFECTIVE THE FIRST
DAY OF THE MONTH NEXT COMMENCING AT LEAST 10 DAYS AFTER THE COMMISSIONER
OF TAXATION AND FINANCE HAS RECEIVED SUCH WRITTEN CERTIFICATION. IF
EVERY SOCIAL SERVICE DISTRICT THAT ELECTED SUCH OPTION REPEALS ITS
ELECTION AND THE COMMISSIONER OF HEALTH CERTIFIES IN WRITING TO THE
COMMISSIONER OF TAXATION AND FINANCE THAT EVERY SUCH SOCIAL SERVICES
DISTRICT HAS REPEALED ITS ELECTION, THEN SUBDIVISIONS (F) AND (G) OF
SECTION 1261 AND SUBDIVISION (H) OF SECTION 1313 OF THE TAX LAW TAX
SHALL BE REPEALED AND THE PHRASE "OR A TAX REVENUE INTERCEPT AMOUNT
CALCULATED PURSUANT TO SUBDIVISION (F) OR (G) OF SECTION 1261 OF THE TAX
LAW" IN SECTION FOUR OF THIS ACT SHALL BE DELETED, EFFECTIVE THE FIRST
DAY OF THE MONTH NEXT COMMENCING AT LEAST 10 DAYS AFTER THE DATE ON
WHICH THE COMMISSIONER OF TAXATION AND FINANCE RECEIVES SUCH WRITTEN
CERTIFICATION FROM THE COMMISSIONER OF HEALTH. AT THE SAME TIME THAT THE
COMMISSIONER OF HEALTH MAKES SUCH CERTIFICATION TO THE COMMISSIONER OF
TAXATION AND FINANCE THAT EVERY COUNTY HAS REPEALED ITS ELECTION, THE
COMMISSIONER OF HEALTH SHALL ALSO NOTIFY THE LEGISLATIVE BILL DRAFTING
COMMISSION THAT EVERY SOCIAL SERVICE DISTRICT THAT ELECTED SUCH OPTION
HAS REPEALED ITS ELECTION IN ORDER THAT THE LEGISLATIVE BILL DRAFTING
COMMISSION MAY MAINTAIN AN ACCURATE AND TIMELY DATA BASE OF THE OFFICIAL
TEXT OF THE LAWS OF THE STATE OF NEW YORK IN FURTHERANCE OF EFFECTING
S. 6256--B 69 A. 9056--B
THE PROVISIONS OF SECTION 44 OF THE LEGISLATIVE LAW AND SECTION 70-B OF
THE PUBLIC OFFICERS LAW.
(III) FORM OF RESOLUTION.
BE IT ENACTED BY THE (COUNTY) OF (INSERT COUNTY'S NAME) AS FOLLOWS:
SECTION ONE. THE (COUNTY) OF (INSERT COUNTY'S NAME) HEREBY REPEALS ITS
ELECTION IN 2007 OF THE MEDICAL ASSISTANCE REIMBURSEMENT OPTION AND
REVENUE INTERCEPT FOR MEDICAID PURPOSES DESCRIBED IN SECTION 2 OF CHAP-
TER 58 OF THE LAWS OF 2005.
SECTION 2. THIS RESOLUTION SHALL TAKE EFFECT IMMEDIATELY.
S 4. Part C of chapter 58 of the laws of 2005, authorizing reimburse-
ments for expenditures made by or on behalf of social services districts
for medical assistance for needy persons and the administration thereof,
is amended by adding a new section 4-a to read as follows:
S 4-A. (A) FOR STATE FISCAL YEAR 2012-13, AND FOR EACH STATE FISCAL
YEAR THEREAFTER, A SOCIAL SERVICES DISTRICT WILL BE REIMBURSED BY THE
STATE FOR THE FULL NON-FEDERAL SHARE OF EXPENDITURES BY THE DISTRICT FOR
THE ADMINISTRATION OF THE MEDICAL ASSISTANCE PROGRAM, NOT TO EXCEED THE
ADMINISTRATIVE CAP AMOUNT DETERMINED IN ACCORDANCE WITH SUBDIVISION (B)
OF THIS SECTION. ANY PORTION OF THE NON-FEDERAL SHARE OF SUCH EXPENDI-
TURES IN EXCESS OF THE ADMINISTRATIVE CAP AMOUNT SHALL BE THE RESPONSI-
BILITY OF THE SOCIAL SERVICES DISTRICT AND SHALL BE IN ADDITION TO THE
MEDICAL ASSISTANCE EXPENDITURE AMOUNT CALCULATED IN ACCORDANCE WITH
SUBDIVISIONS (B), (C), (C-1), AND (D) OF SECTION ONE OF THIS ACT. BEGIN-
NING IN STATE FISCAL YEAR 2013-14, NO REIMBURSEMENT WILL BE MADE FOR
ADMINISTRATIVE EXPENDITURES IN EXCESS OF SUCH CAP.
(B) THE ADMINISTRATIVE CAP AMOUNT FOR A SOCIAL SERVICES DISTRICT SHALL
BE EQUAL TO A PERCENTAGE OF THE AMOUNT INCLUDED IN THE STATE FISCAL YEAR
2011-12 ENACTED BUDGET FOR THE NON-FEDERAL SHARE OF MEDICAL ASSISTANCE
ADMINISTRATIVE COSTS PURSUANT TO THIS SECTION. EACH SOCIAL SERVICES
DISTRICT'S PERCENTAGE SHALL BE EQUAL TO THE PERCENTAGE OF MEDICAL
ASSISTANCE ADMINISTRATIVE COSTS CLAIMED BY SUCH DISTRICT IN THE 2011
CALENDAR YEAR IN RELATION TO ALL OTHER SOCIAL SERVICES DISTRICTS.
(C) NOTWITHSTANDING THE PROVISIONS OF SUBDIVISION (B) OF THIS SECTION,
THE COMMISSIONER OF HEALTH MAY, AT HIS OR HER SOLE DISCRETION, REDUCE A
SOCIAL SERVICES DISTRICT'S ADMINISTRATIVE CAP AMOUNT TO ACCOUNT FOR A
REDUCTION IN THE SCOPE OR VOLUME OF THE DISTRICT'S ADMINISTRATIVE
RESPONSIBILITIES, INCLUDING BUT NOT LIMITED TO SUCH A REDUCTION RESULT-
ING FROM THE PROCESS OF CONVERTING THE MEDICAL ASSISTANCE PROGRAM TO A
DEPARTMENT-ADMINISTERED PROGRAM PURSUANT TO SECTION 365-N OF THE SOCIAL
SERVICES LAW.
S 5. Section 91 of part H of chapter 59 of the laws of 2011 amending
the public health law and other laws relating to general hospital
reimbursement for annual rates is amended to read as follows:
S 91. 1. 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.
2. EXCEPT AS PROVIDED IN SUBDIVISION THREE OF THIS SECTION, FOR STATE
FISCAL YEAR 2013-14 AND FOR EACH FISCAL YEAR THEREAFTER, THE SPENDING
LIMIT CALCULATED PURSUANT TO SUBDIVISION ONE OF THIS SECTION SHALL BE
INCREASED BY AN AMOUNT EQUAL TO THE DIFFERENCE BETWEEN THE TOTAL SOCIAL
SERVICES DISTRICT MEDICAL ASSISTANCE EXPENDITURE AMOUNTS CALCULATED FOR
SUCH PERIOD IN CONFORMANCE WITH SUBDIVISIONS (B), (C), (C-1), AND (D) OF
S. 6256--B 70 A. 9056--B
SECTION 1 OF PART C OF CHAPTER 58 OF THE LAWS OF 2005 AND THE TOTAL
SOCIAL SERVICES DISTRICT MEDICAL EXPENDITURE AMOUNTS THAT WOULD HAVE
RESULTED IF THE PROVISIONS OF SUBDIVISION (C-1) OF SUCH SECTION HAD NOT
BEEN APPLIED.
3. WITH RESPECT TO A SOCIAL SERVICES DISTRICT THAT RESCINDS THE EXER-
CISE OF THE OPTION PROVIDED IN PARAGRAPH (I) OF SUBDIVISION (B) OF
SECTION 2 OF PART C OF CHAPTER 58 OF THE LAWS OF 2005, FOR STATE FISCAL
YEAR 2013-14 AND FOR EACH FISCAL YEAR THEREAFTER, THE SPENDING LIMIT
CALCULATED PURSUANT TO SUBDIVISION ONE OF THIS SECTION SHALL BE REDUCED
BY THE AMOUNT OF THE MEDICAL ASSISTANCE EXPENDITURE AMOUNT CALCULATED
FOR SUCH DISTRICT FOR SUCH PERIOD.
S 6. The social services law is amended by adding a new section 365-n
to read as follows:
S 365-N. DEPARTMENT ASSUMPTION OF PROGRAM ADMINISTRATION. 1. LEGISLA-
TIVE INTENT. (A) THE LEGISLATURE FINDS THAT TO ENSURE THE MEDICAL
ASSISTANCE PROGRAM CONTINUES TO FUNCTION IN AN EFFICIENT MANNER TO MAKE
HIGH QUALITY MEDICAL CARE, SERVICES, AND SUPPLIES AVAILABLE TO ELIGIBLE
PERSONS, AND TO ACHIEVE TIMELY COMPLIANCE WITH THE REQUIREMENTS OF THE
PATIENT PROTECTION AND AFFORDABLE CARE ACT RELATED TO THE EXPANSION OF
THE MEDICAL ASSISTANCE PROGRAM AND THE CREATION OF A HEALTH CARE
EXCHANGE, IT IS NECESSARY TO CONVERT THE PROGRAM OF MEDICAL ASSISTANCE
FROM ONE PRIMARILY ADMINISTERED BY SOCIAL SERVICES DISTRICTS, UNDER THE
SUPERVISION OF THE DEPARTMENT OF HEALTH ("DEPARTMENT"), TO ONE ADMINIS-
TERED BY THE DEPARTMENT, WITH SUCH ASSISTANCE FROM SOCIAL SERVICES
DISTRICTS AS THE COMMISSIONER OF HEALTH ("COMMISSIONER") MAY DETERMINE
NECESSARY, AND THAT SUCH CONVERSION SHOULD BE COMPLETED BY APRIL FIRST,
TWO THOUSAND EIGHTEEN. RECOGNIZING THE COMPLEXITY AND DIFFICULTY OF
COMPLETING THIS CONVERSION WITHIN SUCH TIME FRAME, IT IS THE INTENT OF
THE LEGISLATURE TO GRANT THE COMMISSIONER BROAD AUTHORITY AND FLEXIBILI-
TY TO TAKE ACTIONS NECESSARY TO ACHIEVE THIS GOAL, AS DETERMINED BY THE
COMMISSIONER, AND TO HAVE THE PROVISIONS OF THIS SECTION CONSTRUED IN
LIGHT OF THE AUTHORITY AND FLEXIBILITY SO GRANTED. THE ADMINISTRATION OF
THE PROGRAM BY THE DEPARTMENT MAY BE ACCOMPLISHED THROUGH THE USE OF
DEPARTMENT STAFF, CONTRACTED ENTITIES, OR SOME COMBINATION THEREOF, AS
DETERMINED ADVISABLE BY THE COMMISSIONER TO ACHIEVE THE GOALS OF THIS
SECTION, SUBJECT TO THE LIMITATIONS PRESCRIBED HEREIN. THE COMMISSIONER
WILL CONSULT WITH SOCIAL SERVICES DISTRICTS IN FORMULATING THE OPTIMAL
PLAN FOR IMPLEMENTING THIS CONVERSION.
(B) THE LEGISLATURE FURTHER FINDS THAT THE CONTINUED, UNINTERRUPTED,
ADEQUATE AND EFFICIENT OPERATION OF FUNCTIONS RELATED TO MEDICAL ASSIST-
ANCE ELIGIBILITY AND COVERED BENEFITS IS NECESSARY FOR THE GENERAL
WELFARE OF THE PEOPLE OF THE STATE; THAT SUCH OPERATION INVOLVES AND
REQUIRES PERSONNEL WITH TRAINING, PRACTICAL EXPERIENCE AND KNOWLEDGE IN
MEDICAL ASSISTANCE ELIGIBILITY AND COVERED BENEFITS; AND THAT REQUIRING
COMPETITIVE EXAMINATION FOR APPOINTMENT OF PERSONS CURRENTLY PERFORMING
SUCH FUNCTIONS IN COUNTIES IN THE STATE TO POSITIONS IN THE CLASSIFIED
SERVICE OF THE STATE UPON THE ASSUMPTION OF SUCH FUNCTIONS BY THE
DEPARTMENT WOULD IRREPARABLY DISRUPT, DELAY AND IMPEDE OPERATIONS AND
INTERRUPT THE CONTINUANCE AND PERFORMANCE OF IMPORTANT SERVICES.
2. NOTWITHSTANDING THE PROVISIONS OF TITLE TWO OF ARTICLE THREE OF
THIS CHAPTER OR OF SECTION THREE HUNDRED SIXTY-FIVE OF THIS TITLE OR OF
ANY OTHER LAW TO THE CONTRARY, THE COMMISSIONER IS AUTHORIZED TO TAKE
ANY AND ALL ACTIONS NECESSARY TO TRANSFER RESPONSIBILITY FOR THE ADMIN-
ISTRATION OF THE MEDICAL ASSISTANCE PROGRAM FROM SOCIAL SERVICES
DISTRICTS TO THE DEPARTMENT.
S. 6256--B 71 A. 9056--B
3. FOR PURPOSES OF THIS SECTION, ADMINISTRATION OF THE MEDICAL ASSIST-
ANCE PROGRAM INCLUDES PROCESSING APPLICATIONS FOR BENEFITS AND SERVICES
AVAILABLE UNDER THIS TITLE AND TITLE ELEVEN-D OF THIS ARTICLE, MAKING
DETERMINATIONS OF INITIAL AND ONGOING ELIGIBILITY FOR SUCH BENEFITS AND
SERVICES AND MAKING COVERAGE DETERMINATIONS WITH RESPECT TO BENEFITS AND
SERVICES REQUIRING PRIOR AUTHORIZATION, NOTIFYING APPLICANTS AND RECIPI-
ENTS OF THESE DETERMINATIONS AND OF THEIR RIGHTS AND RESPONSIBILITIES,
AUTHORIZING BENEFITS AND SERVICES FOR PERSONS FOUND ELIGIBLE, EXERCISING
SUBROGATION RIGHTS WITH RESPECT TO AMOUNTS RECEIVED FROM INSURANCE
CARRIERS OR OTHER LIABLE THIRD PARTIES, IMPOSING LIENS AND PURSUING
RECOVERIES, AND ANY OTHER TASKS AND FUNCTIONS IDENTIFIED BY THE COMMIS-
SIONER.
4. NOTWITHSTANDING THE PROVISIONS OF THE CIVIL SERVICE LAW OR ANY
PROVISIONS TO THE CONTRARY CONTAINED IN ANY GENERAL, SPECIAL, OR LOCAL
LAWS, ALL LAWFUL APPOINTEES OF A COUNTY PERFORMING FUNCTIONS RELATED TO
MEDICAL ASSISTANCE ELIGIBILITY AND COVERED BENEFITS AS OF THE EFFECTIVE
DATE OF THIS SECTION WILL BE ELIGIBLE TO TRANSFER TO APPROPRIATE POSI-
TIONS IN THE DEPARTMENT OF HEALTH CLASSIFIED TO PERFORM SUCH FUNCTIONS
WITHOUT FURTHER EXAMINATION OR QUALIFICATION AND, UPON SUCH TRANSFER,
WILL HAVE ALL THE RIGHTS AND PRIVILEGES OF THE JURISDICTIONAL CLASSI-
FICATION TO WHICH SUCH POSITIONS MAY BE ALLOCATED IN THE CLASSIFIED
SERVICE OF THE STATE.
5. SUBJECT TO THE PROVISIONS OF SUBDIVISIONS SIX AND SEVEN OF THIS
SECTION, THE COMMISSIONER MAY CONTRACT WITH ONE OR MORE ENTITIES,
INCLUDING UNITS OF LOCAL GOVERNMENT, FOR THE PURPOSE OF EXERCISING HIS
OR HER AUTHORITY UNDER THIS SECTION. SUCH ENTITIES MAY BE CONTRACTED TO
PERFORM ALL OR A PORTION OF THE FUNCTIONS DESCRIBED IN SUBDIVISION THREE
OF THIS SECTION, AND MAY PERFORM SUCH FUNCTIONS WITH RESPECT TO THE
ENTIRE STATE OR WITH RESPECT TO A SPECIFIC REGION OR REGIONS, AS DETER-
MINED BY THE COMMISSIONER. IN NO EVENT, HOWEVER, SHALL THE DEPARTMENT,
BY MEANS OF SUCH A CONTRACT, DELEGATE ITS AUTHORITY TO EXERCISE ADMINIS-
TRATIVE DISCRETION IN THE ADMINISTRATION OR SUPERVISION OF THE STATE
PLAN FOR MEDICAL ASSISTANCE SUBMITTED PURSUANT TO SECTION THREE HUNDRED
SIXTY-THREE-A OF THIS TITLE, OR TO ISSUE POLICIES, RULES, AND REGU-
LATIONS ON PROGRAM MATTERS, NOR MAY ANY CONTRACTED ENTITY BE GIVEN THE
AUTHORITY TO CHANGE OR DISAPPROVE ANY ADMINISTRATIVE DECISION OF THE
DEPARTMENT, OR OTHERWISE SUBSTITUTE THE ENTITY'S JUDGMENT FOR THAT OF
THE DEPARTMENT WITH RESPECT TO THE APPLICATION OF POLICIES, RULES, AND
REGULATIONS ISSUED BY THE DEPARTMENT.
6. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTIONS
ONE HUNDRED FORTY-TWO AND ONE HUNDRED FORTY-THREE OF THE ECONOMIC DEVEL-
OPMENT LAW, OR ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER IS
AUTHORIZED TO AMEND THE TERMS OF EXISTING CONTRACTS, INCLUDING A
CONTRACT ENTERED INTO PURSUANT TO SUBDIVISION TWENTY-FOUR OF SECTION TWO
HUNDRED SIX OF THE PUBLIC HEALTH LAW, AS ADDED BY SECTION THIRTY-NINE OF
PART C OF CHAPTER FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND EIGHT, WITHOUT
A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS, UPON A DETERMINATION
THAT THE EXISTING CONTRACTOR IS QUALIFIED TO PROVIDE ASSISTANCE WITH ONE
OR MORE FUNCTIONS RELATED TO THE ADMINISTRATION OF THE MEDICAL ASSIST-
ANCE PROGRAM OR TO ACHIEVING THE GOALS OF THIS SECTION.
7. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTIONS
ONE HUNDRED FORTY-TWO AND ONE HUNDRED FORTY-THREE OF THE ECONOMIC DEVEL-
OPMENT LAW, OR ANY OTHER CONTRARY PROVISION OF LAW, THE COMMISSIONER IS
AUTHORIZED TO ENTER INTO A CONTRACT OR CONTRACTS UNDER THIS SUBDIVISION
S. 6256--B 72 A. 9056--B
WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED,
HOWEVER, THAT WITH RESPECT TO A CONTRACT WITH AN ENTITY OTHER THAN A
LOCAL UNIT OF GOVERNMENT:
(A) THE DEPARTMENT 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; AND
(C) THE COMMISSIONER SHALL SELECT SUCH CONTRACTOR OR CONTRACTORS THAT,
IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE PURPOSES OF THIS
SECTION.
8. THE COMMISSIONER SHALL PROMULGATE SUCH REGULATIONS AS MAY BE NECES-
SARY TO CARRY OUT THE PROVISIONS OF THIS SECTION, WHICH REGULATIONS MAY
BE PROMULGATED ON AN EMERGENCY BASIS. IN ADDITION, THE COMMISSIONER
SHALL MAKE ANY AMENDMENTS TO THE STATE PLAN FOR MEDICAL ASSISTANCE, OR
DEVELOP AND SUBMIT AN APPLICATION FOR ANY WAIVER OR APPROVAL UNDER THE
FEDERAL SOCIAL SECURITY ACT, THAT MAY BE NECESSARY TO CARRY OUT THE
PROVISIONS OF THIS SECTION.
S 7. Subdivision 7 of section 369 of the social services law, as added
by section 71-a of part C of chapter 58 of the laws of 2008, is amended
to read as follows:
7. Notwithstanding any provision of law to the contrary, the depart-
ment [may commence] SHALL, WHEN IT DETERMINES NECESSARY PROGRAM FEATURES
ARE IN PLACE, ASSUME SOLE RESPONSIBILITY FOR COMMENCING actions or
proceedings in accordance with the provisions of this section, sections
one hundred one, one hundred four, one hundred four-b, paragraph (a) of
subdivision three of section three hundred sixty-six, subparagraph one
of paragraph (h) of subdivision four of section three hundred sixty-six,
and paragraph (b) of subdivision two of section three hundred sixty-sev-
en-a of this chapter, to recover the cost of medical assistance
furnished pursuant to this title and title eleven-D of this article. The
department is authorized to contract with an entity that shall conduct
activities on behalf of the department pursuant to this subdivision.
PRIOR TO ASSUMING SUCH RESPONSIBILITY FROM A SOCIAL SERVICES DISTRICT,
THE DEPARTMENT OF HEALTH SHALL, IN CONSULTATION WITH THE DISTRICT,
DEFINE THE SCOPE OF THE SERVICES THE DISTRICT WILL BE REQUIRED TO
PERFORM ON BEHALF OF THE DEPARTMENT OF HEALTH PURSUANT TO THIS SUBDIVI-
SION.
S 8. 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 9. 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
S. 6256--B 73 A. 9056--B
or certification of rates of payment, are hereby suspended and without
force or effect for purposes of implementing the provisions of this act.
S 10. 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
legislature that this act would have been enacted even if such invalid
provisions had not been included herein.
S 11. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2012, provided
that:
1. section one of this act shall take effect April 1, 2013;
2. 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;
3. 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;
4. the commissioner of health and the superintendent of financial
services and any appropriate council may take any steps necessary to
implement this act prior to its effective date;
5. notwithstanding any inconsistent provision of the state administra-
tive procedure act or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of financial services
and any appropriate council is authorized to adopt or amend or promul-
gate 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;
6. the amendment to section 91 of part H of chapter 59 of the laws of
2011, amending the public health law and other laws relating to general
hospital reimbursement for annual rates, made by section five of this
act shall take effect on the same date and in the same manner as such
section takes effect;
7. the provisions of this act shall become effective notwithstanding
the failure of the commissioner of health or the superintendent of
financial services or any council to adopt or amend or promulgate regu-
lations implementing this act.
PART G
Section 1. Subdivision 1 of section 79 of part C of chapter 58 of the
laws of 2005 relating to the preferred drug program is amended and a new
subdivision 1-a is added to read as follows:
1. sections ten [through], ELEVEN, TWELVE AND fifteen of this act
shall expire and be deemed repealed on and after June 15, [2012] 2019;
1-A. SECTION FOURTEEN OF THIS ACT SHALL EXPIRE AND BE DEEMED REPEALED
ON AND AFTER JUNE 15, 2012;
S 2. Subparagraph (v) of paragraph (b) of subdivision 35 of section
2807-c of the public health law, as amended by section 35-a of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
(v) such regulations shall incorporate quality related measures,
including, but not limited to, potentially preventable re-admissions
S. 6256--B 74 A. 9056--B
(PPRs) and provide for rate adjustments 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 comparison of the actual and 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 thirty-first, two thousand eleven
and no less than fifty-one million dollars for [the period] ANNUAL PERI-
ODS BEGINNING April first, two thousand eleven through March thirty-
first, two thousand [twelve] THIRTEEN, provided further that such aggre-
gate 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] THIRTEEN and as a result of decreased PPNOs during the period
April first, two thousand eleven through March thirty-first, two thou-
sand [twelve] THIRTEEN; and provided further that for the period July
first, two thousand ten through March thirty-first, two thousand
[twelve] THIRTEEN, 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 July
first, two thousand eleven the commissioner shall enter into consulta-
tions with representatives of the health care facilities subject to this
section regarding potential prospective revisions to applicable method-
ologies and benchmarks set forth in regulations issued pursuant to this
subparagraph;
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, 2012.
PART H
Section 1. 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 59
of the laws of 2011, is amended to read as follows:
S 4. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2006; provided
section one of this act shall expire and be deemed repealed April 1,
[2015] 2012; provided, further, that sections two and three of this act
shall expire and be deemed repealed December 31, 2009.
S 2. Notwithstanding any other provision of law to the contrary,
effective April 1, 2013 and annually thereafter, state agencies includ-
ing, but not limited to, the office for people with developmental disa-
bilities, office of mental health, office of alcoholism and substance
abuse services, office of children and family services, office of tempo-
rary and disability assistance, department of health, office for the
aging, division of criminal justice services, office of victim services,
and state education department that operate, license, certify, or fund
providers of services shall develop and calculate annual adjustments to
established payments to providers of such services, based on factors to
be determined by the commissioner of the agency. Such adjustments shall
be based on performance metrics to be developed by the commissioners of
such agencies which shall include, but not be limited to the following
S. 6256--B 75 A. 9056--B
to the extent practicable: the actual costs of providing such services,
the percentages of administrative costs, the determination and levels of
executive compensation, and such other criteria as such commissioners
may determine. Such annual adjustments shall be subject to any necessary
federal approvals and restrictions. The amount of any annual adjustment
and the metrics used to determine such adjustment shall be subject to
the review and approval of the director of the budget.
S 3. Notwithstanding any other provision of law to the contrary,
commencing on April 1, 2012, the commissioner or director of each state
agency subject to section two of this act shall have the authority,
subject to approval by the director of the budget, to promulgate regu-
lations or to address by other means the extent and nature of a provid-
er's administrative costs and executive compensation which shall be
eligible to be reimbursed with state financial assistance or state-au-
thorized payments for operating expenses. Each agency shall require that
providers of services that receive reimbursements directly or indirectly
from such agency must comply with the following restrictions:
(a) No less than seventy-five percent of the state financial assist-
ance or state-authorized payments for operating expenses shall be
directed to provide direct care or services rather than to support the
costs of administration, as these terms are defined by the applicable
state agency in implementing these requirements. This percentage shall
increase by five percent each year until it shall, no later than April
1, 2015, remain at no less than eighty-five percent thereafter.
(b) To the extent practicable, reimbursement shall not be provided for
compensation paid or given to any executive by such provider in an
amount greater than $199,000 per annum; provided, however, that the
commissioner of each state agency shall have discretion to adjust this
figure annually based on appropriate factors subject to the approval of
the director of the budget, but in no event shall such figure exceed
Level I of the federal government's Rates of Basic Pay for the Executive
Schedule promulgated by the United States Office of Personnel Manage-
ment. The applicable state agency shall define these terms as necessary
in implementing these requirements.
A provider's failure to comply with the requirements established by
the applicable state agency may, in the sole discretion of the commis-
sioner of each state agency, form the basis for termination or non-rene-
wal of the agency's contract with or continued support of the provider.
Upon a showing of good cause, a provider may be granted a waiver from
compliance with these requirements in whole or in part subject to the
approval of the applicable state agency and the director of the budget.
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, 2012.
PART I
Section 1. 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 commissioner of developmental disabili-
ties, pursuant to a pilot program established in accordance with an
application made under section 1115 of the federal social security act,
42 U.S.C. 1315, is authorized to enter into a contract or contracts
without a competitive bid or request for proposal process, with the
approval of the director of the budget, provided, however, that:
S. 6256--B 76 A. 9056--B
(a) the office for people with developmental disabilities shall post
on its website, for a period of not less than thirty days, a pilot
application, and the following information:
(i) a description of the proposed services to be provided pursuant to
the pilot program;
(ii) the procedure for application to participate in the pilot program
and criteria for selection of an applicant to participate in the pilot
program;
(iii) the period of time during which an applicant 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 an applicant may seek such selection, which
may include submission by electronic means;
(b) all reasonable and responsive submissions that are received from
applicants in a timely fashion shall be reviewed by the commissioner;
and
(c) the commissioner of developmental disabilities shall select such
applicant or applicants that, in the commissioner's discretion, have
demonstrated the ability to effectively, efficiently, and economically
provide services pursuant to the pilot program; 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 2. This act shall take effect immediately.
PART J
Section 1. Section 13.17 of the mental hygiene law, as added by chap-
ter 978 of the laws of 1977, the section heading as amended by chapter
168 of the laws of 2010, subdivisions (b) and (d) as amended by chapter
37 of the laws of 2011, and subdivision (c) as amended by chapter 538 of
the laws of 1987, is amended to read as follows:
S 13.17 Programs, services, and operations [of facilities] in the office
for people with developmental disabilities.
(a) The commissioner shall establish policy and procedures for the
organization, administration, and [operation of the facilities] SERVICE
DELIVERY SYSTEM under his OR HER jurisdiction[. He] AND shall make
provision for the effective rendition of SUPPORTS AND services to
[patients by such facilities or office personnel] INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES.
(b) [There shall be in the office the developmental disabilities
services offices named below serving the areas either currently or
previously served by a school, for the care and treatment of persons
with developmental disabilities and for research and teaching in the
science and skills required for the care and treatment of such persons
with developmental disabilities:
Bernard M. Fineson Developmental Disabilities Services Office
Brooklyn Developmental Disabilities Services Office
Broome Developmental Disabilities Services Office
Capital District Developmental Disabilities Services Office
Central New York Developmental Disabilities Services Office
Finger Lakes Developmental Disabilities Services Office
Institute for Basic Research in Developmental Disabilities
Hudson Valley Developmental Disabilities Services Office
Metro New York Developmental Disabilities Services Office
S. 6256--B 77 A. 9056--B
Long Island Developmental Disabilities Services Office
Sunmount Developmental Disabilities Services Office
Taconic Developmental Disabilities Services Office
Western New York Developmental Disabilities Services Office
Staten Island Developmental Disabilities Services Office
The New York State Institute for Basic Research in Developmental Disa-
bilities is designated as an institute for the conduct of medical
research and other scientific investigation directed towards furthering
knowledge of the etiology, diagnosis, treatment and prevention of devel-
opmental disabilities.
(c)] The commissioner shall establish [the areas which each facility
or], AT HIS OR HER DISCRETION, developmental disabilities [services
office under his jurisdiction shall serve and the categories of clients
which shall be served thereby] REGIONAL OFFICES AND SHALL ESTABLISH
STATE OPERATIONS OFFICES THAT PROVIDE FOR THE DIRECT DELIVERY OF
SUPPORTS AND SERVICES BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISA-
BILITIES.
[(d)] (C) The commissioner may [permit] AUTHORIZE other offices of the
department and any public or private non-profit organization or poli-
tical subdivision of the state to [operate programs for persons] DELIVER
SUPPORTS AND SERVICES TO INDIVIDUALS with developmental disabilities[,
not inconsistent with the programs and objectives of the office in any
facility under his jurisdiction. The commissioner may permit any facili-
ty under his jurisdiction to operate programs for persons with mental
disabilities, not inconsistent with programs and objectives of the
department, under contracts or agreements with other offices within the
department].
S 2. Section 13.19 of the mental hygiene law, as added by chapter 978
of the laws of 1977, subdivisions (a) and (d) as amended by chapter 168
of the laws of 2010, and subdivision (e) as added by chapter 307 of the
laws of 1979, is amended to read as follows:
S 13.19 Personnel of the office; regulations.
(a) The commissioner may, within the amounts appropriated therefor,
appoint and remove in accordance with law and applicable rules of the
state civil service commission, such officers and employees of the
office for people with developmental disabilities [and school and facil-
ity officers and employees who are designated managerial or confidential
pursuant to article fourteen of the civil service law] as are necessary
for efficient administration. THE COMMISSIONER SHALL, IN EXERCISING HIS
OR HER APPOINTING AUTHORITY, TAKE, CONSISTENT WITH ARTICLE
TWENTY-THREE-A OF THE CORRECTION LAW, ALL REASONABLE AND NECESSARY STEPS
TO ENSURE THAT ANY SUCH PERSON SO APPOINTED HAS NOT PREVIOUSLY ENGAGED
IN ANY ACT IN VIOLATION OF ANY LAW WHICH COULD COMPROMISE THE HEALTH AND
SAFETY OF INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES.
(b) [The director of a hospital or institute in the office shall have
professional qualifications and experience to be prescribed by the
commissioner.
(c)] Notwithstanding the provisions of any other law, the [positions]
POSITION of [psychiatrist III and] deputy director in [any] AN office
facility may be filled BY NEW HIRE OR by promotion open to employees [of
all such facilities] who possess the minimum qualifications for the
[respective positions. Promotion lists which are established for those
positions shall be general eligible promotion lists from which names are
certified in the order of final earned ratings and from which certif-
ication shall not be subdivided by the facility or department in which
S. 6256--B 78 A. 9056--B
such persons are employed. Nothing in this subdivision shall prevent the
use of open competitive examinations] POSITION.
[(d)] (C) The use of volunteers [at facilities] in the office for
people with developmental disabilities shall be encouraged. The commis-
sioner may establish regulations governing such volunteer services.
[(e)] (D) Where, and to the extent that, an agreement between the
state and an employee organization entered into pursuant to article
fourteen of the civil service law so provides, the commissioner is
authorized to implement the provisions of such agreement relating to
discipline consistent with the terms thereof.
S 3. Section 13.21 of the mental hygiene law, as added by chapter 978
of the laws of 1977, the section heading and subdivisions (a) and (c) as
amended by chapter 168 of the laws of 2010, subdivision (b) as amended
by chapter 558 of the laws of 2011, subdivision (d) as added by chapter
355 of the laws of 1987 and subdivision (e) as added by chapter 492 of
the laws of 1978 and as relettered by chapter 355 of the laws of 1987,
is amended to read as follows:
S 13.21 Directors of [schools] STATE OPERATIONS OFFICES AND DEVELOP-
MENTAL DISABILITIES REGIONAL OFFICES in the office for people
with developmental disabilities.
(a) The [director] DIRECTORS of [a school] BOTH THE STATE OPERATIONS
OFFICES AND DEVELOPMENTAL DISABILITIES REGIONAL OFFICES in the office
for people with developmental disabilities shall be appointed by the
commissioner [and shall be its chief executive officer. The director of
a school shall be the director of the developmental disabilities
services office serving the areas designated by the commissioner in
regulation, and in such context, the term facility shall also refer to
such developmental disabilities services office]. Each such director
shall be in the non-competitive class and designated as confidential as
defined by subdivision two-a of section forty-two of the civil service
law and shall serve at the pleasure of the commissioner. [Except for
school and facility officers and employees for which subdivision (a) of
section 13.19 of this article makes the commissioner the appointing and
removing authority, the director of a school shall have the power, with-
in amounts appropriated therefor, to appoint and remove in accordance
with law and applicable rules of the state civil service commission such
officers and employees of the facility of which he or she is director as
are necessary for its efficient administration. He or she shall in exer-
cising his or her appointing authority take, consistent with article
twenty-three-A of the correction law, all reasonable and necessary steps
to insure that any such person so appointed has not previously engaged
in any act in violation of any law which could compromise the health and
safety of patients in the facility of which he or she is director.] He
or she shall manage the [facility, and administer its personnel system,]
STATE OPERATIONS OFFICE OR DEVELOPMENTAL DISABILITIES REGIONAL OFFICE
subject to applicable law, the regulations of the commissioner, and the
rules of the state civil service commission. [Before the commissioner
shall issue any such regulation or any amendment or revision thereof, he
or she shall consult with the directors of schools in the office regard-
ing its suitability.] The [director] DIRECTORS OF THE DEVELOPMENTAL
DISABILITIES REGIONAL OFFICES AND STATE OPERATIONS OFFICES shall main-
tain effective [supervision] OVERSIGHT of all parts of [the facility and
over all persons employed therein or coming thereon and] THEIR RESPEC-
TIVE OFFICES. THE DIRECTORS OF STATE OPERATIONS OFFICES shall generally
[direct] PROVIDE FOR the [care and treatment of patients. Directors
presently serving at facilities of the office shall continue to serve
S. 6256--B 79 A. 9056--B
under the terms of their original appointment] ADMINISTRATION OF
SUPPORTS AND SERVICES TO INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES IN
STATE OPERATED PROGRAMS. DIRECTORS OF REGIONAL OFFICES SHALL GENERALLY
OVERSEE THE ADMINISTRATION OF SUPPORTS AND SERVICES TO INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES IN SETTINGS OUTSIDE THE STATE OPERATED
PROGRAMS.
(b) Such [director] DIRECTORS shall have the responsibility of seeing
that there is humane treatment of [the patients at his facility and
shall investigate every case of alleged patient abuse or mistreatment]
INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES RECEIVING SERVICES IN
SETTINGS OPERATED, LICENSED, CERTIFIED, FUNDED OR APPROVED BY THIS
OFFICE. [The] A director OF STATE OPERATIONS shall notify immediately,
and in any event within three working days the board of visitors of the
facility and the mental hygiene legal service located in the same judi-
cial department as [the hospital, school or institution] THE STATE OPER-
ATIONS OFFICE of every complaint of patient abuse or mistreatment and
shall inform the board and the mental hygiene legal service of the
results of his OR HER investigation. If it appears that a crime may have
been committed, the STATE OPERATIONS director shall give notice thereof
to the district attorney or other appropriate law enforcement official
as soon as possible, and in any event within three working days unless
it appears that the crime includes an employee, intern, volunteer,
consultant, contractor, or visitor and the alleged conduct caused phys-
ical injury or the patient was subject to unauthorized sexual contact,
or if it appears the crime is endangering the welfare of an incompetent
or physically disabled person pursuant to section 260.25 of the penal
law, or if the crime was any felony under state or federal law, then the
district attorney or other appropriate law enforcement official must be
contacted immediately, and in any event no later than twenty-four hours.
(c) In any investigation into the treatment and care of [patients]
INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES or the conduct, performance,
or neglect of duty of officers or employees, the [director of a school
in the office for people with developmental disabilities] COMMISSIONER
OR HIS OR HER DESIGNEE shall be authorized to subpoena witnesses, compel
their attendance, administer oaths to witnesses, examine witnesses under
oath, and require the production of any books or papers deemed relevant
to the inquiry or investigation. A subpoena issued under this section
shall be regulated by the civil practice law and rules.
(d) [Such] THE director of a [school] STATE OPERATIONS OFFICE shall be
responsible for the provision of STATE OPERATED community developmental
disabilities services, in those areas that the commissioner may assign.
Such responsibility shall, consistent with article forty-one of this
chapter, include the operation of STATE OPERATED facilities[,] AND the
development of needed facilities[, and the provision of assistance to
service providers in such areas and any necessarily related activities.
All powers and duties as set forth in this section shall apply to such
responsibilities]. REGIONAL DIRECTORS SHALL BE RESPONSIBLE FOR THE
PROVISION OF COMMUNITY DEVELOPMENTAL DISABILITIES SERVICES TO INDIVID-
UALS IN SETTINGS OTHER THEN STATE OPERATED PROGRAMS. THE REGIONAL DIREC-
TOR'S RESPONSIBILITY SHALL, CONSISTENT WITH ARTICLE FORTY-ONE OF THIS
CHAPTER, INCLUDE THE OVERSIGHT OF FACILITIES AND PROGRAMS OTHER THAN
THOSE OPERATED BY THE STATE.
(e) Each [facility] STATE OPERATIONS director of the office shall,
upon notice from the commissioner or upon knowledge that programs of
such facility may be contracted or terminated, implement procedures to
S. 6256--B 80 A. 9056--B
ensure timely notification to affected employees. Such procedures shall
include, but not be limited to:
(1) dissemination and posting of all decisions, policies and proce-
dures with respect to all aspects of such actions and their impact on
facility staff; and
(2) compliance with all requirements and protection of employee rights
pursuant to collective bargaining agreements with the designated legal
representative of the employees and the civil service law.
S 4. Section 13.33 of the mental hygiene law, as added by chapter 978
of the laws of 1977, subdivision (a) as amended by chapter 37 of the
laws of 2011, subdivision (d) as amended by chapter 686 of the laws of
1995, subdivisions (f) and (h) as amended by chapter 175 of the laws of
1986, subdivision (i) as amended by chapter 14 of the laws of 1990,
paragraph 1 of subdivision (i) as amended by chapter 75 of the laws of
1992, paragraph 2 of subdivision (i) and subdivision (m) as amended by
chapter 168 of the laws of 2010, subdivision (j) as amended by chapter
264 of the laws of 1980 and subdivisions (j) and (k) as relettered by
chapter 84 of the laws of 1980, subdivision (l) as amended by chapter
406 of the laws of 1994, and subdivision (n) as amended by chapter 662
of the laws of 1995, is amended to read as follows:
S 13.33 Boards of visitors.
(a) Each [developmental disabilities services] STATE OPERATIONS office
under the jurisdiction of the commissioner shall have a MINIMUM OF ONE
board of visitors consisting of at least seven but not more than four-
teen members[; provided, however, that the Central New York develop-
mental disabilities services office shall have a board of visitors
consisting of at least ten, but not more than seventeen members; and
that the Finger Lakes developmental disabilities services office shall
have a board of visitors consisting of at least fourteen, but not more
than twenty-one members. When a school is replaced by a developmental
disabilities services office, the members of that school's board of
visitors shall continue to serve their terms as the board of visitors
for the new developmental disabilities services office]. Members
appointed or reappointed after the effective date of this chapter shall
be appointed by the governor, by and with the advice and consent of the
senate. Members shall be appointed for four year terms to expire on the
thirty-first day of December of the fourth year of the term of office
provided however, when more than three terms expire in any one year,
members may be appointed for terms of fewer years as designated by the
governor so that no more than three members' terms expire in any one
year. All terms of office shall expire on the thirty-first day of Decem-
ber of the designated year. A member whose term has expired shall,
however, remain in office until such member's successor has been
appointed and has taken office, or until such member shall have resigned
or have been removed from office in the manner hereinafter provided.
Should any member resign or be removed from office, the governor shall
promptly submit, for senate consent, a successor candidate to fill the
remaining term of the vacated office. A visitor may be removed by the
governor for cause after notice and an opportunity for a hearing on the
charges. In making appointments to boards of visitors, the governor
shall endeavor to ensure that the membership of each such board shall
adequately reflect the composition of the community or communities
served by the [facility] STATE OPERATIONS OFFICE, that the membership of
each such board includes at least three individuals who are parents or
relatives of patients or of former patients and that the remainder
includes only those persons, including former patients, who shall have
S. 6256--B 81 A. 9056--B
expressed an active interest in, or shall have obtained professional
knowledge in the care of persons with developmental disabilities or in
developmental disability endeavors generally.
(b) No elected state officer or member of the legislature may serve as
a visitor.
(c) If the [facility] STATE OPERATIONS OFFICE serves an area, as
established by the regulations of the commissioner, the visitors shall
reside at the time of appointment or reappointment in such area. [If no
specific area is designated, the visitors shall reside at the time of
appointment or reappointment in the developmental disabilities area,
established by the commissioner, in which the facility is located.]
(d) Each board shall, at the first meeting of each calendar year elect
one member to serve as president of the board and one member to serve as
secretary; provided however, that no member may serve for more than two
consecutive years as president.
(e) Visitors shall not receive compensation but shall be reimbursed
for their actual expenses in connection with their service as visitors.
(f) (1) Each board of visitors shall hold six bi-monthly regular meet-
ings annually, but a greater number of regular meetings may be scheduled
by the board. Each board of visitors shall establish in their by-laws or
otherwise, in writing, whether these six meetings shall be held during
months represented by odd numbers or months represented by even numbers.
The president of the board shall notify the chairman of the commission
on quality of care [for the mentally disabled] AND ADVOCACY FOR PERSONS
WITH DISABILITIES and the [facility] STATE OPERATIONS director of the
determination made concerning the designated months for the six
bi-monthly regular meetings. The president of the board, the commission-
er, the director, or the members as determined by the rules of the board
may call special meetings. The board may require the director to submit
a report at each meeting. Each board shall keep a record of its
proceedings and activities. A member of a board of visitors who has
failed to attend three consecutive bi-monthly regular meetings shall be
considered to have vacated his office unless otherwise ordered by the
governor. The board shall cause notice of any of its public meetings to
be sent to the mental hygiene legal service located in the same judicial
department as the school. The mental hygiene legal service may send a
representative to any such public meeting, and may request the board to
review patient complaints or investigate alleged incidents of abuse or
mistreatment. The board shall notify the appropriate representative of
the mental hygiene legal service of the board's actions and findings in
relation to any such request.
(2) The president of the board of visitors shall notify a member by
certified or registered mail return receipt requested when such member
of the board has failed to attend any two consecutive bi-monthly regular
meetings. This notice shall be sent within ten days following the second
meeting and shall include the dates of the two meetings which were
missed, the date of the next bi-monthly regular meeting, and a statement
concerning the consequences of failure to attend the next meeting.
(3) Within three days after the third consecutive absence at a
bi-monthly regular meeting by a member, the president of the board of
visitors shall notify, in writing, the governor, the commissioner, the
chairman of the commission on quality of care [for the mentally disa-
bled] AND ADVOCACY FOR PERSONS WITH DISABILITIES and the [facility]
STATE OPERATIONS director of such absences. The president of the board
of visitors shall send a copy of this notice by registered or certified
mail return receipt requested to the member to whom it pertains. The
S. 6256--B 82 A. 9056--B
member may petition the governor to excuse his absences. If the governor
does not excuse the absences within forty-five days of the date of the
third consecutive meeting absence, the office of the member shall be
deemed vacated.
(g) Upon the request of the commissioner or the director, or upon the
board's initiative, the board shall consult, advise, and work with the
director with respect to community relations, conditions at the STATE
OPERATED facility, preliminary plans for construction and alterations,
and programs and activities of the STATE OPERATED facility.
(h) Each board or any member of the board may visit and inspect [the]
A STATE OPERATED facility WHICH IS IN THE CATCHMENT AREA OF THE STATE
OPERATIONS REGION IN WHICH SUCH MEMBER OR MEMBERS SERVE at any time
without prior notice and may report on conditions to the governor, to
the commissioner and to the chairman of the state commission on quality
of care [for the mentally disabled] AND ADVOCACY FOR PERSONS WITH DISA-
BILITIES. In addition, each board shall ensure that a member or commit-
tee of members shall inspect [the] SUCH facility once every three months
without prior notice. A report on conditions may be submitted to the
governor, to the commissioner or to the chairman of the state commission
on quality of care [for the mentally disabled] AND ADVOCACY FOR PERSONS
WITH DISABILITIES. Each board member shall visit and inspect [the] ANY
SUCH facility at least twice during each calendar year. Within thirty
days after the conclusion of each calendar year, the president of the
board of visitors shall notify the governor, the commissioner, the
chairman of the commission on quality of care [for the mentally disa-
bled] AND ADVOCACY FOR PERSONS WITH DISABILITIES, and the [facility]
STATE OPERATIONS director, if any member of the board has failed to
visit and inspect [the] ANY SUCH facility at least twice during that
year. The president of the board of visitors shall send a copy of this
notice by certified or registered mail return receipt requested to the
member to whom it pertains. A member of a board of visitors who has
failed to visit and inspect [the] A facility at least twice a year shall
be considered to have vacated his OR HER office unless otherwise ordered
by the governor within forty-five days after the end of the calendar
year. The board shall have the power to investigate all charges against
the STATE OPERATIONS director and all cases of alleged patient abuse or
mistreatment made against any employee and shall have the power to
interview patients and employees of the [facility] FACILITIES in pursuit
of such investigations. In conducting such an investigation, the board
shall have the power, in accordance with the civil practice law and
rules, to subpoena witnesses, compel their testimony, administer oaths
to witnesses, examine witnesses under oath, and require the production
of any books or papers deemed relevant to the investigation. A board or
a member may include in the report or separately at any time any matter
pertaining to the management and affairs of [the facility] SUCH FACILI-
TIES and may make recommendations to the governor, to the commissioner
and to the chairman of the state commission on quality of care [for the
mentally disabled] AND ADVOCACY FOR PERSONS WITH DISABILITIES. Each
board member shall enter in a book, kept at each SUCH facility for that
purpose, the date of each visit.
(i) (1) Any member or members of the board may visit and inspect a
family care home, which is within the catchment area of the [school on
the board of] STATE OPERATIONS REGION IN which such member or members
serve. Such member or members shall be granted access to such facility
and to all books, records and data pertaining to such facility deemed
necessary for carrying out the purposes of such visit. Information,
S. 6256--B 83 A. 9056--B
books, records or data which are confidential as provided by law shall
be kept confidential and any limitations on the release thereof imposed
by law upon the party furnishing the information, books, records or data
shall apply to such member or members of the board. After any such
visits or inspections, a report containing findings and recommendations
may be submitted to the governor, to the commissioner or to the state
commission on quality of care [for the mentally disabled] AND ADVOCACY
FOR PERSONS WITH DISABILITIES.
(2) Any member or members of the board may visit and inspect a commu-
nity residence operated by the office for people with developmental
disabilities, which is within the catchment area of the [school on the
board of] STATE OPERATIONS REGION IN which such member or members serve.
Such member or members shall be granted access to such facility and to
all books, records and data pertaining to such facility deemed necessary
for carrying out the purposes of such visit and inspection. Information,
books, records or data which are confidential as provided by law shall
be kept confidential and any limitations on the release thereof imposed
by law upon the party furnishing the information, books, records or data
shall apply to such member or members of the board. After any such
visits or inspection, a report containing findings and recommendations
shall be submitted promptly to the commissioner and to the chairman of
the state commission on quality of care and advocacy for persons with
disabilities.
(j) Once each year, each board shall make an independent assessment of
conditions at [the facility] SUCH FACILITIES and shall submit a report
on the assessment and recommendations to the governor, to the commis-
sioner and to the chairman of the state commission on quality of care
[for the mentally disabled] AND ADVOCACY FOR PERSONS WITH DISABILITIES.
(k) The commissioner shall notify the board of visitors of a [school]
FACILITY under his OR HER jurisdiction of the proposed appointment of a
STATE OPERATIONS director [to such facility] or the proposed transfer of
a STATE OPERATIONS director [from such facility], with a request that
the board report an expression of its opinion of the appointment or
transfer and, if it objects thereto, the reasons for such objection.
(l) The commissioner shall appoint representatives of the office
[department] to serve as liaison between the office and the boards of
visitors. At least once each year the commissioner shall meet with the
boards collectively. The commissioner, or his OR HER designee, shall
meet quarterly with representatives of boards of visitors.
(m) Members of the boards of visitors shall be considered officers of
the office for people with developmental disabilities for the purposes
of sections seventy-three, to the extent provided therein, and seventy-
four of the public officers law relating to business or professional
activities by state officers and employees and the code of ethics.
(n) Each member shall attend, within one year of the initial appoint-
ment or any subsequent reappointment, an orientation training program
provided by the commission on quality of care [for the mentally disa-
bled] AND ADVOCACY FOR PERSONS WITH DISABILITIES for members of boards
of visitors. The chairman of the commission on quality of care [for the
mentally disabled] AND ADVOCACY FOR PERSONS WITH DISABILITIES shall
notify the governor and the appointed member of any such member's fail-
ure to attend such a training program. A member who has failed to attend
such a training program scheduled for such member shall be considered to
have vacated his office unless otherwise ordered by the governor within
forty-five days after the notice.
S. 6256--B 84 A. 9056--B
S 5. Paragraph (c) of subdivision 3 of section 2963 of the public
health law, as added by chapter 818 of the laws of 1987, is amended to
read as follows:
(c) If the attending physician determines that a patient lacks capaci-
ty because of a developmental disability, the concurring determination
required by paragraph (a) of this subdivision shall be provided by a
physician or psychologist employed by [a school named in section 13.17
of the mental hygiene law] THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL
DISABILITIES, or who has been employed for a minimum of two years to
render care and service in a facility operated or licensed by the office
[of mental retardation and] FOR PEOPLE WITH developmental disabilities,
or who has been approved by the commissioner of [mental retardation and]
developmental disabilities in accordance with regulations promulgated by
such commissioner. Such regulations shall require that a physician or
psychologist possess specialized training or three years experience in
treating developmental disabilities.
S 6. Paragraph (c) of subdivision 2 of section 2981 of the public
health law, as added by chapter 752 of the laws of 1990, is amended to
read as follows:
(c) For persons who reside in a mental hygiene facility operated or
licensed by the office [of mental retardation and] FOR PEOPLE WITH
developmental disabilities, at least one witness shall be an individual
who is not affiliated with the facility and at least one witness shall
be a physician or clinical psychologist who either is employed by [a
school named in section 13.17 of the mental hygiene law] THE OFFICE FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES or who has been employed for a
minimum of two years to render care and service in a facility operated
or licensed by the office [of mental retardation and] FOR PEOPLE WITH
developmental disabilities, or who has been approved by the commissioner
of [mental retardation and] developmental disabilities in accordance
with regulations approved by the commissioner. Such regulations shall
require that a physician or clinical psychologist possess specialized
training or three years experience in treating developmental disabili-
ties.
S 7. Paragraph (c) of subdivision 1 of section 2983 of the public
health law, as added by chapter 752 of the laws of 1990, is amended to
read as follows:
(c) If the attending physician determines that a patient lacks capaci-
ty because of a developmental disability, the attending physician who
makes the determination must be, or must consult, for the purpose of
confirming the determination, with a physician or clinical psychologist
who either is employed by [a school named in section 13.17 of the mental
hygiene law] THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, or
who has been employed for a minimum of two years to render care and
service in a facility operated or licensed by the office [of mental
retardation and] FOR PEOPLE WITH developmental disabilities, or who has
been approved by the commissioner of [mental retardation and] develop-
mental disabilities in accordance with regulations promulgated by such
commissioner. Such regulations shall require that a physician or clin-
ical psychologist possess specialized training or three years experience
in treating developmental disabilities. A record of such consultation
shall be included in the patient's medical record.
S 8. Subparagraph ii of paragraph c of subdivision 3 of section 2994-c
of the public health law, as added by chapter 8 of the laws of 2010, is
amended to read as follows:
S. 6256--B 85 A. 9056--B
(ii) If the attending physician makes an initial determination that a
patient lacks decision-making capacity because of mental retardation or
a developmental disability, either such physician must have the follow-
ing qualifications, or another professional with the following quali-
fications must independently determine whether the patient lacks deci-
sion-making capacity: a physician or clinical psychologist who either is
employed by [a school named in section 13.17 of the mental hygiene law,
or who has been employed for a minimum of two years to render care and
service in a facility operated or licensed by] the office [of mental
retardation and] FOR PEOPLE WITH developmental disabilities, or who has
been approved by the commissioner of [mental retardation and] develop-
mental disabilities in accordance with regulations promulgated by such
commissioner. Such regulations shall require that a physician or clin-
ical psychologist possess specialized training or three years experience
in treating developmental disabilities. A record of such consultation
shall be included in the patient's medical record.
S 9. Subdivision 10 of section 2994-aa of the public health law, as
added by chapter 8 of the laws of 2010, is amended to read as follows:
10. "Hospital" means a general hospital as defined in subdivision ten
of section twenty-eight hundred one of this chapter and a residential
health care facility as defined in subdivision three of section twenty-
eight hundred one of this chapter or a hospital as defined in subdivi-
sion ten of section 1.03 of the mental hygiene law [or a school named in
section 13.17 of the mental hygiene law].
S 10. Subdivision 6 of section 2994-dd of the public health law, as
added by chapter 8 of the laws of 2010, is amended to read as follows:
6. The commissioner may authorize the use of one or more alternative
forms for issuing a nonhospital order not to resuscitate (in place of
the standard form prescribed by the commissioner under subdivision two
of this section). Such alternative form or forms may also be used to
issue a non-hospital do not intubate order. Any such alternative forms
intended for use for persons with [mental retardation or] developmental
disabilities or persons with mental illness who are incapable of making
their own health care decisions or who have a guardian of the person
appointed pursuant to article eighty-one of the mental hygiene law or
article seventeen-A of the surrogate's court procedure act must also be
approved by the commissioner of [mental retardation and] developmental
disabilities or the commissioner of mental health, as appropriate. An
alternative form under this subdivision shall otherwise conform with
applicable federal and state law. This subdivision does not limit,
restrict or impair the use of an alternative form for issuing an order
not to resuscitate in a general hospital or residential health care
facility under article twenty-eight of this chapter or a hospital under
subdivision ten of section 1.03 of the mental hygiene law [or a school
under section 13.17 of the mental hygiene law].
S 11. Subparagraph (B) of paragraph (vi) of subdivision (c) of section
958 of the general municipal law, as amended by chapter 708 of the laws
of 1993, is amended to read as follows:
(B) a state-operated hospital or facility listed in [sections] SECTION
7.17 [or 13.17] of the mental hygiene law OR A FACILITY OPERATED BY THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, which has been desig-
nated by either the commissioner of mental health or the commissioner of
[mental retardation and] developmental disabilities for contraction or
discontinuance. Provided however, that not more than one-third of the
zones designated pursuant to paragraph (iii) or (iv) of subdivision (b)
S. 6256--B 86 A. 9056--B
of section nine hundred sixty OF THIS ARTICLE, shall be based on appli-
cations filed pursuant to THIS paragraph [(vi) of this subdivision].
S 12. Paragraph (b) of subdivision 4 of section 6810 of the education
law, as added by chapter 519 of the laws of 2002, is amended to read as
follows:
(b) Oral prescriptions for patients in general hospitals, nursing
homes, residential health care facilities as defined in section twenty-
eight hundred one of the public health law, hospitals as defined in
subdivision ten of section 1.03 of the mental hygiene law, or [develop-
mental centers or developmental disabilities services offices listed in
subdivision (b) of section 13.17 of the mental hygiene law] FACILITIES
OPERATED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, may
be communicated to a pharmacist serving as a vendor of pharmaceutical
services based upon a contractual arrangement by an agent designated by
and under the direction of the prescriber or the institution. Such agent
shall be a health care practitioner currently licensed and registered
under this title.
S 13. Paragraph (b) of subdivision 7 of section 6810 of the education
law, as amended by chapter 519 of the laws of 2002, is amended to read
as follows:
(b) With respect to drugs other than controlled substances, the
provisions of this subdivision shall not apply to pharmacists employed
by or providing services under contract to general hospitals, nursing
homes, residential health care facilities as defined in section twenty-
eight hundred one of the public health law, hospitals as defined in
subdivision ten of section 1.03 of the mental hygiene law, or [develop-
mental centers or developmental disabilities services offices listed in
subdivision (b) of section 13.17 of the mental hygiene law] FACILITIES
OPERATED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, who
dispense drugs in the course of said employment or in the course of
providing such services under contract. With respect to such pharma-
cists, each prescription shall be transcribed on a patient specific
prescription form.
S 14. Paragraph 1 of subdivision (b) of section 5.05 of the mental
hygiene law, as amended by chapter 168 of the laws of 2010, is amended
to read as follows:
(1) The commissioners of the office of mental health, the office for
people with developmental disabilities and the office of alcoholism and
substance abuse services shall constitute an inter-office coordinating
council which, consistent with the autonomy of each office for matters
within its jurisdiction, shall ensure that the state policy for the
prevention, care, treatment and rehabilitation of individuals with
mental illness and developmental disabilities, alcoholism, alcohol
abuse, substance abuse, substance dependence, and chemical dependence is
planned, developed and implemented comprehensively; that gaps in
services to individuals with multiple disabilities are eliminated and
that no person is denied treatment and services because he or she has
more than one disability; that procedures for the regulation of programs
which offer care and treatment for more than one class of persons with
mental disabilities be coordinated between the offices having jurisdic-
tion over such programs; and that research projects of the institutes,
as identified in section 7.17 [or 13.17] of this chapter OR AS OPERATED
BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, are coordi-
nated to maximize the success and cost effectiveness of such projects
and to eliminate wasteful duplication.
S. 6256--B 87 A. 9056--B
S 15. Subdivision (b) of section 13.11 of the mental hygiene law, as
added by chapter 978 of the laws of 1977, is amended to read as follows:
(b) The commissioner shall control the organization of the office and
may continue, establish, discontinue, expand, and contract facilities
under his OR HER jurisdiction. [The facilities set forth in section
13.17 may not be discontinued by the commissioner.] Units and facilities
shall have such functions, duties, and responsibilities as may be
assigned to them by the commissioner.
S 16. Subdivisions 1 and 2 of section 13.34 of the mental hygiene law,
as amended by chapter 542 of the laws of 2011, are amended to read as
follows:
1. There shall be at each developmental center facility [listed in
section 13.17 of this article], an ombudsman who shall be an employee of
the commission on quality of care and advocacy for persons with disabil-
ities under article forty-five of this chapter and who shall be respon-
sible for receiving and responding to any complaints regarding individ-
ual clients residing in such facility. The ombudsman shall have the
following powers and duties:
i. to advise and consult with parents, guardians, correspondents and
other interested persons with respect to any complaints, or issues
related to the conditions of clients' residents;
ii. to review and attempt to remedy specific complaints with responsi-
ble and appropriate staff;
iii. where it appears that care has not been rendered as required by
applicable standards to refer the complaint to the appropriate agency or
body for its attention;
iv. to receive and keep confidential any complaint, information or
inquiry from any source. The records of the ombudsman shall be confiden-
tial, and shall not be available to the public;
v. to advise and consult with the board of visitors of the develop-
mental center served by the ombudsman with respect to any complaints or
issues relating to conditions of client's residence and to regularly
attend the meetings of such board; and
vi. to meet with the commissioner, or a representative of the commis-
sioner, on a quarterly basis regarding systemic issues in the ombuds-
man's jurisdiction.
2. The president of the board of visitors of each [developmental
center facility listed in section 13.17 of this article] REGION IN THE
CATCHMENT AREA OF THE STATE OPERATIONS REGION IN WHICH SUCH MEMBER
SERVES, shall, in consultation with the members of such board, recommend
three persons to serve as ombudsman at the facility. In making such
recommendation, the president shall also consider the expressed opinion
of parents, guardians and correspondents of clients residing at such
facility. The persons so recommended as ombudsman shall have expressed
an active interest or shall have had professional knowledge in advocat-
ing for persons who are mentally disabled. The commission on quality of
care and advocacy for persons with disabilities shall select one of the
recommended persons as ombudsman. The ombudsman may only be removed from
office for just cause. An individual appointed as ombudsman shall be an
exempt class employee as defined by section forty-one of the civil
service law and may be removed by the commissioner upon the recommenda-
tion of the president of the board of visitors, for cause after notice
and opportunity for a hearing on the charges.
S 17. Subdivision 1 of section 157 of the social services law, as
amended by section 43 of part B of chapter 436 of the laws of 1997, is
amended to read as follows:
S. 6256--B 88 A. 9056--B
1. Safety net assistance means allowances pursuant to section one
hundred thirty-one-a OF THIS ARTICLE for all support, maintenance and
need, and costs of suitable training in a trade to enable a person to
become self-supporting, furnished eligible needy persons in accordance
with applicable provisions of law, by a municipal corporation, or a town
where safety net assistance is a town charge, to persons or their depen-
dents in their abode or habitation whenever possible and includes such
relief granted to veterans under existing laws but does not include
hospital or institutional care, except as otherwise provided in this
subdivision, or family assistance or medical assistance for needy
persons granted under titles ten and eleven OF THIS ARTICLE, respective-
ly, or aid to persons receiving federal supplemental security income
payments and/or additional state payments. Safety net assistance may
also be provided in a family home or boarding home, operated in compli-
ance with the regulations of the department, and on and after January
first, nineteen hundred seventy-four, in facilities in which a person is
receiving family care or residential care, as those terms are used in
title six of [article five of] this [chapter] ARTICLE, and to persons
receiving care in a facility supervised by the office of alcoholism and
substance abuse SERVICES or in a residential facility for the mentally
disabled approved, licensed or operated by the office of mental health
or the office [of mental retardation and] FOR PEOPLE WITH developmental
disabilities, other than those facilities defined in [sections] SECTION
7.17 [and 13.17] of the mental hygiene law, IN A DEVELOPMENTAL CENTER
FACILITY OPERATED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILI-
TIES or residential care centers for adults operated by the office of
mental health, when such type of care is deemed necessary. Payments to
such homes and facilities for care and maintenance provided by them
shall be at rates established pursuant to law and regulations of the
department. The department, however, shall not establish rates of
payment to such homes or facilities without approval of the director of
the budget.
S 18. Subparagraph (i) of paragraph (a) and clause A of subparagraph
(i) of paragraph (e) of subdivision 4 of section 1750-b of the surro-
gate's court procedure act, as added by chapter 500 of the laws of 2002,
are amended to read as follows:
(i) be employed by [a developmental disabilities services office named
in section 13.17 of the mental hygiene law] THE OFFICE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES, or
A. be employed by [a developmental disabilities services office named
in section 13.17 of the mental hygiene law] THE OFFICE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES, or
S 19. (a) Wherever the terms "directors of office facilities" or
"directors of schools" or "director of facilities" appear in the mental
hygiene law in reference to a facility operated by the office for people
with developmental disabilities, such terms are hereby changed to
"directors of state operations offices".
(b) Wherever the term "developmental disabilities services offices"
appears in the mental hygiene law, such term is hereby changed to "state
operations office".
(c) The legislative bill drafting commission is hereby directed to
effectuate this provision, and shall be guided by a memorandum of
instruction setting forth the specific provisions of law to be amended.
Such memorandum shall be transmitted to the legislative bill drafting
commission within sixty days of enactment of this provision. Such memo-
randum shall be issued jointly by the governor, the temporary president
S. 6256--B 89 A. 9056--B
of the senate and the speaker of the assembly, or by the delegate of
each.
S 20. This act shall take effect immediately.
PART K
Section 1. Sections 19 and 21 of chapter 723 of the laws of 1989
amending the mental hygiene law and other laws relating to comprehensive
psychiatric emergency programs, as amended by section 1 of part F of
chapter 58 of the laws of 2008, are amended to read as follows:
S 19. Notwithstanding any other provision of law, the commissioner of
mental health shall, until July 1, [2012] 2016, be solely authorized, in
his or her discretion, to designate those general hospitals, local
governmental units and voluntary agencies which may apply and be consid-
ered for the approval and issuance of an operating certificate pursuant
to article 31 of the mental hygiene law for the operation of a compre-
hensive psychiatric emergency program.
S 21. This act shall take effect immediately, and sections one, two
and four through twenty of this act shall remain in full force and
effect, until July 1, [2012] 2016, at which time the amendments and
additions made by such sections of this act shall be deemed to be
repealed, and any provision of law amended by any of such sections of
this act shall revert to its text as it existed prior to the effective
date of this act.
S 2. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2012.
PART L
Section 1. Legislative findings. It is the finding of the legislature
that the integration and coordination of physical and behavioral health
services results in an improvement in the quality of services being
provided to recipients, with a resultant improvement in outcomes and
reduction in the costs of care. It is the further finding of the legis-
lature that the reduction or elimination of redundant or unnecessary
licensing and oversight requirements and procedures will facilitate the
provision of integrated and coordinated care and result in a more effi-
cient use of governmental resources.
S 2. (a) Notwithstanding any law, rule or regulation to the contrary,
two or more of the commissioners of the department of health, the office
of mental health, the office of alcoholism and substance abuse services
or the office for people with developmental disabilities are jointly
authorized to establish operating, reporting and construction require-
ments, as well as joint survey requirements and procedures for entities
that:
(1) can demonstrate experience and competence in the delivery of
health, mental health, alcohol and substance abuse services and/or
services to persons with developmental disabilities and the capacity to
offer the integrated delivery of such services at locations as may be
approved by two or more of the respective commissioners; and
(2) meet the standards that may be established by the respective
commissioners for the provision of such services; provided, however,
that an entity meeting the standards established pursuant to this
section shall not be required to be an integrated service provider
pursuant to subdivision 7 of section 365-l of the social services law.
S. 6256--B 90 A. 9056--B
(b) In establishing one or more sets of joint requirements or proce-
dures for entities described in this section, the commissioners of the
department of health, the office of mental health, the office of alco-
holism and substance abuse services, and/or the office for people with
developmental disabilities are authorized to waive any regulatory
requirements, or to determine that compliance with another commission-
er's regulatory requirements shall be deemed to meet the regulatory
requirements of his or her agency, as may be necessary or desirable to
avoid duplication of requirements and/or to permit the integrated deliv-
ery of health and behavioral health services in an efficient and effec-
tive manner.
(c) The authority granted the commissioners in this section is
intended to complement and supplement the authority granted to such
commissioners pursuant to subdivision 7 of section 365-l of the social
services law.
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, 2012.
PART M
Section 1. Legislative findings. It is the finding of the legislature
that patients hospitalized in facilities operated by the office of
mental health who are between the ages of five and twenty-one are enti-
tled to receive an education comparable to that which they would other-
wise be entitled to receive in their local school districts pursuant to
the education law and the regulations of the commissioner of education.
S 2. (a) Notwithstanding any other provision of law to the contrary,
the office of mental health shall be authorized to enter into an agree-
ment with the state education department for the purposes of providing
education programming and services for patients residing in hospitals
operated by the office of mental health who are between the ages of five
and twenty-one, that is comparable to that which they would otherwise be
entitled to receive in their local school districts pursuant to the
education law and the regulations of the commissioner. The commissioner
of education shall be authorized to require local school districts,
including the school district located in a city with a million persons
or more, and/or boards of cooperative educational services to provide
such comparable educational programming and services, provided, however,
the commissioner of mental health shall be authorized to contract
directly with local school districts, including the school district
located in a city with a million persons or more, and/or boards of coop-
erative educational services to provide such comparable educational
programming and services. Such comparable education programming and
services for such children shall be authorized to be provided, in the
2012-2013 and 2013-2014 and 2014-2015 school years within a city with a
population of a million persons or more, and in the 2013-2014 and 2014-
2015 school year in the rest of the state, in accordance with implemen-
tation standards issued by the commissioner of education, and in accord-
ance with a plan for educational services jointly approved by the
commissioners of education and mental health.
(b) The commissioner of education, or pursuant to contract the commis-
sioner of mental health, shall reimburse districts and boards of cooper-
ative educational services for unreimbursed, approved expenses for the
cost of such programming and services for such children pursuant to this
section, as may be determined through a reimbursement methodology devel-
S. 6256--B 91 A. 9056--B
oped by the commissioner of education and approved by the director of
the budget.
(c) The commissioner of mental health, with the approval of the direc-
tor of the budget, shall be authorized to transfer funding to the
commissioner of education for the provision of educational programming
and services to patients residing in hospitals operated by the office of
mental health who are between the ages of five and twenty-one.
S 3. The commissioners of education and mental health shall jointly
submit to the governor and to the temporary president of the senate and
the speaker of the assembly a report by February 1, 2015, which shall
state whether additional actions should be taken to ensure that children
who are patients residing in hospitals operated by the office of mental
health receive education programming and services that are comparable to
that which they would otherwise be entitled to receive in their local
school districts pursuant to education law and the regulations of the
commissioner. Such commissioners shall also recommend whether this act
should be amended and whether it should be made permanent.
S 4. This act shall take effect July 1, 2012 and shall expire June 30,
2015 when upon such date the provisions of this act shall be deemed
repealed.
PART N
Section 1. Section 1.03 of the mental hygiene law is amended by adding
two new subdivisions 56 and 57 to read as follows:
56. "SUBSTANCE USE DISORDER" MEANS THE MISUSE, DEPENDENCE, OR
ADDICTION TO ALCOHOL AND/OR LEGAL OR ILLEGAL DRUGS LEADING TO EFFECTS
THAT ARE DETRIMENTAL TO THE INDIVIDUAL'S PHYSICAL AND MENTAL HEALTH, OR
THE WELFARE OF OTHERS AND SHALL INCLUDE ALCOHOLISM, ALCOHOL ABUSE,
SUBSTANCE ABUSE, SUBSTANCE DEPENDENCE, CHEMICAL ABUSE, AND/OR CHEMICAL
DEPENDENCE.
57. "SUBSTANCE USE DISORDER SERVICES" SHALL MEAN AND INCLUDE EXAMINA-
TION, EVALUATION, DIAGNOSIS, CARE, TREATMENT, REHABILITATION, OR TRAIN-
ING OF PERSONS WITH SUBSTANCE USE DISORDERS AND THEIR FAMILIES OR
SIGNIFICANT OTHERS.
S 2. The mental hygiene law is amended by adding a new section 5.06 to
read as follows:
S 5.06 BEHAVIORAL HEALTH SERVICES ADVISORY COUNCIL.
(A) THERE IS HEREBY CREATED WITHIN THE DEPARTMENT A BEHAVIORAL HEALTH
SERVICES ADVISORY COUNCIL, THE PURPOSE OF WHICH SHALL BE TO ADVISE THE
OFFICES OF MENTAL HEALTH AND ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ON
MATTERS RELATING TO THE PROVISION OF BEHAVIORAL HEALTH SERVICES; ISSUES
OF JOINT CONCERN TO THE OFFICES, INCLUDING THE INTEGRATION OF VARIOUS
BEHAVIORAL HEALTH SERVICES AND THE INTEGRATION OF BEHAVIORAL HEALTH
SERVICES WITH HEALTH SERVICES; AND ISSUES RELATED TO THE DELIVERY OF
BEHAVIORAL HEALTH SERVICES THAT ARE RESPONSIVE TO LOCAL, STATE AND
FEDERAL CONCERNS. THE COUNCIL SHALL CONSIST OF THE COMMISSIONER OF
MENTAL HEALTH AND THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES WHO SHALL NOT HAVE THE RIGHT TO VOTE, THE CHAIR OF THE CONFER-
ENCE OF LOCAL MENTAL HYGIENE DIRECTORS OR HIS OR HER DESIGNEE, AND TWEN-
TY-EIGHT MEMBERS APPOINTED BY THE GOVERNOR. MEMBERS SHALL BE APPOINTED
ONLY IF THEY HAVE PROFESSIONAL KNOWLEDGE IN THE CARE OF PERSONS RECEIV-
ING BEHAVIORAL HEALTH SERVICES, OR AN ACTIVE INTEREST IN THE BEHAVIORAL
HEALTH SERVICES SYSTEM.
(B) THE GOVERNOR SHALL DESIGNATE ONE OF THE MEMBERS OF THE COUNCIL AS
CHAIR. AT LEAST ONE-HALF OF THE MEMBERS OF THE COUNCIL SHALL NOT BE
S. 6256--B 92 A. 9056--B
PROVIDERS OF BEHAVIORAL HEALTH SERVICES. MEMBERSHIP SHALL REFLECT A
BALANCED REPRESENTATION OF PERSONS WITH INTERESTS IN MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES AND SHALL INCLUDE:
(1) AT LEAST FIVE CURRENT OR FORMER CONSUMERS OF BEHAVIORAL HEALTH
SERVICES;
(2) AT LEAST THREE INDIVIDUALS WHO ARE PARENTS OR RELATIVES OF CURRENT
OR FORMER CONSUMERS OF BEHAVIORAL HEALTH SERVICES;
(3) AT LEAST THREE MEMBERS WHO ARE NOT PROVIDERS OF BEHAVIORAL HEALTH
SERVICES AND WHO REPRESENT NON-GOVERNMENTAL ORGANIZATIONS, SUCH AS NOT-
FOR-PROFIT ENTITIES REPRESENTING HEALTH OR BEHAVIORAL HEALTH CARE
EMPLOYEES, OR OTHER ORGANIZATIONS CONCERNED WITH THE PROVISION OF BEHAV-
IORAL HEALTH SERVICES;
(4) AT LEAST FIVE REPRESENTATIVES OF PROVIDERS OF SERVICES TO PERSONS
WITH MENTAL ILLNESS AND AT LEAST FIVE REPRESENTATIVES OF PROVIDERS OF
SERVICES TO PERSONS WITH SUBSTANCE USE DISORDERS, AT LEAST TWO OF WHOM
SHALL BE PHYSICIANS;
(5) ONE MEMBER APPOINTED ON THE RECOMMENDATION OF THE DIRECTOR OF THE
DIVISION OF VETERANS' AFFAIRS;
(6) ONE MEMBER APPOINTED ON THE RECOMMENDATION OF THE ADJUTANT GENERAL
OF THE DIVISION OF MILITARY AND NAVAL AFFAIRS;
(7) AT LEAST THREE REPRESENTATIVES OF LOCAL GOVERNMENTS OR OTHER STATE
AND LOCAL AGENCIES CONCERNED WITH THE PROVISION OF BEHAVIORAL HEALTH
SERVICES; AND
(8) AT LEAST TWO MEMBERS WHO ARE ALSO MEMBERS OF THE PUBLIC HEALTH AND
HEALTH PLANNING COUNCIL PURSUANT TO SECTION TWO HUNDRED TWENTY OF THE
PUBLIC HEALTH LAW.
(C) MEMBERS SHALL BE APPOINTED FOR TERMS OF THREE YEARS PROVIDED,
HOWEVER, THAT OF THE MEMBERS FIRST APPOINTED, ONE-THIRD SHALL BE
APPOINTED FOR ONE YEAR TERMS AND ONE-THIRD SHALL BE APPOINTED FOR TWO
YEAR TERMS. VACANCIES SHALL BE FILLED IN THE SAME MANNER AS ORIGINAL
APPOINTMENTS FOR THE REMAINDER OF ANY UNEXPIRED TERM. NO PERSON SHALL BE
AN APPOINTED MEMBER OF THE COUNCIL FOR MORE THAN SIX YEARS IN ANY PERIOD
OF TWELVE CONSECUTIVE YEARS.
(D) THE COUNCIL SHALL MEET AT LEAST FOUR TIMES IN EACH FULL CALENDAR
YEAR. THE COUNCIL SHALL MEET AT THE REQUEST OF ITS CHAIR OR EITHER
COMMISSIONER.
(E) THE COUNCIL SHALL ESTABLISH SUCH COMMITTEES AS IT DEEMS NECESSARY
TO ADDRESS THE SERVICE NEEDS OF SPECIAL POPULATIONS AND TO ADDRESS
PARTICULAR SUBJECTS OF IMPORTANCE IN THE DEVELOPMENT AND MANAGEMENT OF
BEHAVIORAL HEALTH SERVICES.
(F) THE COUNCIL MAY CONSIDER ANY MATTER RELATING TO THE IMPROVEMENT OF
BEHAVIORAL HEALTH SERVICES IN THE STATE AND SHALL ADVISE THE COMMISSION-
ERS ON ANY SUCH MATTER, INCLUDING, BUT NOT LIMITED TO:
(1) CARE AND SERVICES TO PERSONS WITH BEHAVIORAL HEALTH DISORDERS,
INCLUDING SPECIAL AND UNDERSERVED POPULATIONS AS DETERMINED BY THE
COMMISSIONER;
(2) FINANCING BEHAVIORAL HEALTH SERVICES;
(3) INTEGRATION OF BEHAVIORAL HEALTH SERVICES WITH HEALTH SERVICES;
(4) CARE AND SERVICES FOR PERSONS WITH CO-OCCURRING DISORDERS OR
MULTIPLE DISABILITIES;
(5) PREVENTION OF BEHAVIORAL HEALTH DISORDERS; AND
(6) IMPROVEMENT OF CARE IN STATE OPERATED OR COMMUNITY BASED PROGRAMS,
RECRUITMENT, EDUCATION AND TRAINING OF QUALIFIED DIRECT CARE PERSONNEL,
AND PROTECTION OF THE INTERESTS OF EMPLOYEES AFFECTED BY ADJUSTMENTS IN
THE BEHAVIORAL HEALTH SERVICE SYSTEM.
S. 6256--B 93 A. 9056--B
(G) THE COUNCIL SHALL, IN COOPERATION WITH THE COMMISSIONERS, ESTAB-
LISH STATEWIDE GOALS AND OBJECTIVES FOR SERVICES TO PERSONS WITH BEHAV-
IORAL HEALTH DISORDERS, PURSUANT TO SECTION 5.07 OF THIS ARTICLE.
(H) (1) THE COUNCIL SHALL REVIEW THE PORTION OF THE STATEWIDE PLAN TO
BE DEVELOPED AND UPDATED ANNUALLY BY THE COMMISSIONERS PURSUANT TO
SECTION 5.07 OF THIS ARTICLE AND REPORT ITS RECOMMENDATIONS THEREON TO
THE COMMISSIONERS.
(2) THE COUNCIL SHALL REVIEW ANY MENTAL HEALTH OR SUBSTANCE USE COMPO-
NENT OF STATEWIDE HEALTH PLANS DEVELOPED IN ACCORDANCE WITH ANY APPLICA-
BLE FEDERAL LAW AND SHALL REPORT ITS RECOMMENDATIONS THEREON TO THE
COMMISSIONERS.
(I) THE COUNCIL SHALL REVIEW APPLICATIONS FILED IN ACCORDANCE WITH:
(1) SECTION 31.22 OF THIS CHAPTER FOR APPROVAL OF INCORPORATION OR
ESTABLISHMENT OF A FACILITY, AND SECTION 31.23 OF THIS CHAPTER FOR
APPROVAL OF THE CONSTRUCTION OF A FACILITY FOR WHICH APPROVAL FROM THE
COMMISSIONER OF MENTAL HEALTH IS REQUIRED; AND
(2) SECTION 32.29 OR 32.31 OF THIS CHAPTER FOR APPROVAL OF INCORPO-
RATION OR ESTABLISHMENT OR CONSTRUCTION OF A FACILITY FOR WHICH APPROVAL
TO OPERATE IS REQUIRED FROM THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE
ABUSE SERVICES PURSUANT TO ARTICLE THIRTY-TWO OF THIS CHAPTER, AND AS
OTHERWISE REQUESTED BY SUCH COMMISSIONER;
(J) AT LEAST SIXTY DAYS PRIOR TO THE COMMISSIONERS' FINAL APPROVAL OF
RULES AND REGULATIONS UNDER THEIR RESPECTIVE JURISDICTION, OTHER THAN
EMERGENCY RULES AND REGULATIONS AND REGULATIONS PROMULGATED PURSUANT TO
SECTION 43.01 OF THIS CHAPTER, THE COMMISSIONERS SHALL SUBMIT SUCH
PROPOSED RULES AND REGULATIONS TO THE COUNCIL FOR ITS REVIEW. THE COUN-
CIL SHALL REVIEW ALL PROPOSED RULES AND REGULATIONS AND REPORT ITS
RECOMMENDATIONS THEREON TO THE COMMISSIONERS WITHIN SIXTY DAYS. THE
COMMISSIONER HAVING STATUTORY JURISDICTION OVER THE PROPOSED RULE OR
REGULATION SHALL NOT ACT IN A MANNER INCONSISTENT WITH THE RECOMMENDA-
TIONS OF THE COUNCIL WITHOUT FIRST APPEARING BEFORE THE COUNCIL TO
REPORT THE REASONS THEREFOR. THE COUNCIL, UPON A MAJORITY VOTE OF ITS
MEMBERS, MAY REQUIRE THAT AN ALTERNATIVE APPROACH TO THE PROPOSED RULES
AND REGULATIONS BE PUBLISHED WITH THE NOTICE OF THE PROPOSED RULES AND
REGULATIONS PURSUANT TO SECTION TWO HUNDRED TWO OF THE STATE ADMINISTRA-
TIVE PROCEDURE ACT. WHEN AN ALTERNATIVE APPROACH IS PUBLISHED PURSUANT
TO THIS SECTION, THE COMMISSIONER HAVING STATUTORY JURISDICTION OF THE
SUBJECT PROPOSED RULE OR REGULATION SHALL STATE THE REASONS FOR NOT
SELECTING SUCH ALTERNATIVE APPROACH.
(K) THE COUNCIL, BY A MAJORITY VOTE OF ITS MEMBERS, MAY PROPOSE RULES
AND REGULATIONS ON ANY MATTER WITHIN THE REGULATORY JURISDICTION OF THE
OFFICES OF MENTAL HEALTH OR ALCOHOLISM AND SUBSTANCE ABUSE SERVICES,
OTHER THAN ESTABLISHMENT OF FEE SCHEDULES PURSUANT TO SECTION 43.01 OF
THIS CHAPTER, AND FORWARD SUCH PROPOSED RULES AND REGULATIONS TO BOTH
COMMISSIONERS FOR REVIEW AND CONSIDERATION, PROVIDED, HOWEVER, THAT ONLY
THE APPROVAL OF THE COMMISSIONER WITH STATUTORY JURISDICTION OF THE
PROPOSED RULE OR REGULATION SHALL BE REQUIRED. PRIOR TO SUCH COMMISSION-
ER'S FINAL APPROVAL AND PROMULGATION OF SUCH PROPOSED RULES AND REGU-
LATIONS, IF SUCH RULES AND REGULATIONS ARE MODIFIED IN ANY RESPECT, THEY
SHALL BE SUBMITTED TO THE COUNCIL PURSUANT TO SUBDIVISION (J) OF THIS
SECTION. IF SUCH COMMISSIONER DETERMINES NOT TO PROMULGATE SUCH PROPOSED
RULES AND REGULATIONS, THE COMMISSIONER SHALL APPEAR BEFORE THE COUNCIL
TO REPORT THE REASONS THEREFOR.
(L) THE MEMBERS OF THE COUNCIL SHALL RECEIVE NO COMPENSATION FOR THEIR
SERVICES BUT SHALL BE REIMBURSED FOR EXPENSES ACTUALLY AND NECESSARILY
INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
S. 6256--B 94 A. 9056--B
(M) THE COMMISSIONERS, UPON REQUEST OF THE COUNCIL, SHALL DESIGNATE
ONE OR MORE OFFICERS OR EMPLOYEES FROM EITHER OR BOTH OFFICES TO PROVIDE
ADMINISTRATIVE SUPPORT SERVICES TO THE COUNCIL, AND MAY ASSIGN FROM TIME
TO TIME SUCH OTHER EMPLOYEES AS THE COUNCIL MAY REQUEST.
(N) NO CIVIL ACTION SHALL BE BROUGHT IN ANY COURT AGAINST ANY MEMBER
OF THE BEHAVIORAL HEALTH SERVICES ADVISORY COUNCIL FOR ANY ACT DONE,
FAILURE TO ACT, OR STATEMENT OR OPINION MADE, WHILE DISCHARGING HIS OR
HER DUTIES AS A MEMBER OF THE COUNCIL, WITHOUT LEAVE FROM A JUSTICE OF
THE SUPREME COURT, FIRST HAD AND OBTAINED. IN ANY EVENT SUCH MEMBER
SHALL NOT BE LIABLE FOR DAMAGES IN ANY SUCH ACTION IF HE OR SHE SHALL
HAVE ACTED IN GOOD FAITH, WITH REASONABLE CARE AND UPON PROBABLE CAUSE.
MEMBERS OF THE COUNCIL SHALL BE CONSIDERED PUBLIC OFFICERS FOR THE
PURPOSES OF SECTION SEVENTEEN OF THE PUBLIC OFFICERS LAW.
(O) THE COUNCIL MAY ESTABLISH SUCH COMMITTEES AS IT DEEMS NECESSARY.
(P) THE COUNCIL MAY ESTABLISH WRITTEN BYLAWS.
(Q) FOR PURPOSES OF THIS SECTION, "BEHAVIORAL HEALTH SERVICES" SHALL
MEAN EXAMINATION, DIAGNOSIS, CARE, TREATMENT, REHABILITATION, OR TRAIN-
ING FOR PERSONS WITH MENTAL ILLNESS AND/OR FOR PERSONS WITH SUBSTANCE
USE OR COMPULSIVE GAMBLING DISORDERS.
S 3. The section heading, subdivision (a), the opening paragraph and
paragraphs 1 and 3 of subdivision (b) and subdivision (c) of section
5.07 of the mental hygiene law, the section heading as amended by chap-
ter 55 of the laws of 1992, subdivision (a), the opening paragraph and
paragraphs 1 and 3 of subdivision (b) and subdivision (c) as amended by
chapter 223 of the laws of 1992, paragraph 1 of subdivision (a) as
amended by chapter 37 of the laws of 2011, the opening paragraph of
paragraph 1 of subdivision (b) as amended by chapter 168 of the laws of
2010, subparagraphs h and i as amended and subparagraph j of paragraph 1
of subdivision (b) as added by chapter 413 of the laws of 2009 and para-
graph 3 of subdivision (b) as renumbered by chapter 322 of the laws of
1992, are amended to read as follows:
Establishment of [statewide goals and objectives;] statewide comprehen-
sive plans of services for [the mentally disabled] PERSONS WITH
MENTAL DISABILITIES.
(a) (1) The [mental health] BEHAVIORAL HEALTH services ADVISORY coun-
cil and the advisory [councils] COUNCIL on developmental disabilities
[and alcoholism and substance abuse services] shall [each establish]
PROVIDE RECOMMENDATIONS FOR statewide PRIORITIES AND goals [and objec-
tives] to guide comprehensive planning, resource allocation and evalu-
ation processes for state and local services for persons with mental
illness, developmental disabilities [and], AND/OR those [suffering from
chemical abuse or dependence, respectively] WITH SUBSTANCE USE OR
COMPULSIVE GAMBLING DISORDERS. Such goals and objectives shall:
a. be measurable in terms of attainment AND FOCUSED ON OUTCOMES FOR
THOSE BEING SERVED;
b. be DEVELOPED IN COLLABORATION WITH, AND communicated to, providers
of services, department facilities, consumers and consumer represen-
tatives, and other appropriate state and local governmental agencies;
c. [require that all state and local public and private services for
persons with mental disabilities be organized, staffed and financed to
best meet the needs of all persons with mental disabilities whether
receiving in-patient or non in-patient services;
d.] reflect the partnership between state and local governmental
units; and
S. 6256--B 95 A. 9056--B
[e.] D. emphasize [that gaps in services be filled and that services
are provided to persons with mental disabilities] THE NEED TO INTEGRATE
BEHAVIORAL HEALTH AND HEALTH SERVICES.
(2) Such advisory councils shall [establish, review, augment or delete
from such goals and objectives, as appropriate,] ACCOMPLISH THEIR DUTIES
by means of a [continuing annual goal-setting] process which is:
a. open, visible and accessible to the public; and
b. consistent with the statewide AND FEDERALLY MANDATED planning,
appropriation and evaluation processes and activities for services to
[the mentally disabled] PERSONS WITH MENTAL DISABILITIES.
(3) The advisory councils are hereby empowered to hold public hearings
and meetings to enable them to accomplish their duties.
Statewide comprehensive plan for services to [the mentally disabled]
PERSONS WITH MENTAL DISABILITIES.
(1) The office of mental health, the office for people with develop-
mental disabilities and the office of alcoholism and substance abuse
services shall [each] formulate a statewide comprehensive [five-year]
plan for the provision of all state and local services for persons with
mental illness [and], developmental disabilities, [and] AND/OR those
[suffering from alcoholism and] WITH substance [abuse, respectively] USE
OR COMPULSIVE GAMBLING DISORDERS. [Each] THE STATEWIDE COMPREHENSIVE
plan shall be [formulated from] BASED UPON AN ANALYSIS OF local [compre-
hensive] SERVICES plans developed by each local governmental unit, with
participation of consumers, consumer groups, providers of services and
departmental facilities [furnishing] THAT FURNISH services to individ-
uals with mental disabilities [of the area] in conformance with state-
wide PRIORITIES AND goals [and objectives] established [by] WITH RECOM-
MENDATIONS OF the advisory council of each office. [Each] THE plan
shall:
a. identify [needs and problems which must be addressed during the
next ensuing five years which such plan encompasses] STATEWIDE PRIORI-
TIES;
b. specify [time-limited] STATEWIDE goals [to meet those needs] THAT
REFLECT THE STATEWIDE PRIORITIES AND ARE FOCUSED ON OBTAINING POSITIVE
MEASURABLE OUTCOMES;
c. [identify resources to achieve the goals, including but not limited
to resource reallocations;
d. establish] PROPOSE STRATEGIES AND INITIATIVES TO ADDRESS THE prior-
ities [for resource allocation] AND FACILITATE ACHIEVEMENT OF STATEWIDE
GOALS;
[e. define the authority and responsibility for state and local
participation in the delivery of services] D. IDENTIFY SERVICES AND
SUPPORTS, WHICH MAY INCLUDE PROGRAMS RUN OR LED BY PEERS, THAT ARE
DESIGNED TO PROMOTE THE HEALTH AND WELLNESS OF PERSONS WITH MENTAL
ILLNESS, DEVELOPMENTAL DISABILITIES, AND/OR SUBSTANCE USE OR COMPULSIVE
GAMBLING DISORDERS;
[f. propose programs to achieve the goals, which programs may include
direct services, development of multi-purpose facilities, contracts for
services, and innovative financial and organizational relationships with
public and private providers;
g. identify services and programs that assist the informal caregiver
to care for the mentally disabled; make recommendations to enhance the
ability of the informal caregiver to continue providing care; and devel-
op strategies for creating informal caregivers for clients in the commu-
nity who do not have a system in place;
S. 6256--B 96 A. 9056--B
h. analyze] E. PROVIDE ANALYSIS OF current and anticipated utilization
of state and local, and public and private facilities [and], programs,
SERVICES, AND/OR SUPPORTS;
[i.] F. encourage and promote PERSON-CENTERED, CULTURALLY AND LINGUIS-
TICALLY COMPETENT community-based programs, SERVICES, AND/OR SUPPORTS
which reflect the partnership between state and local governmental
units; and
[j.] G. include progress reports on the implementation of both short-
term and long-term recommendations of the children's plan required
pursuant to section four hundred eighty-three-f of the social services
law.
(3) The commissioners of each of the offices shall be responsible for
the development of such statewide [five-year] plan for services within
the jurisdiction of their respective offices and after giving due notice
shall conduct one or more public hearings on such plan. The BEHAVIORAL
HEALTH SERVICES advisory council [of each office] AND THE ADVISORY COUN-
CIL ON DEVELOPMENTAL DISABILITIES shall review the statewide [five year]
COMPREHENSIVE plan developed by such office OR OFFICES and report its
recommendations thereon to such commissioner OR COMMISSIONERS. Each
commissioner shall submit the plan, with appropriate modifications, to
the governor no later than the first day of [October] NOVEMBER of each
year in order that such plan may be considered with the estimates of the
offices for the preparation of the executive budget of the state of New
York for the next succeeding state fiscal year. [Each commissioner
shall also submit such plan to the legislature. The statewide plan] SUCH
PLANS SHALL ALSO BE POSTED TO THE WEBSITE OF EACH OFFICE. STATEWIDE
PLANS shall [be reassessed and updated at least annually to encompass
the next ensuing five years to] ensure responsiveness to changing needs
and goals and [to] SHALL reflect the development of new information and
the completion of program evaluations. [An interim report detailing the
commissioner's actions in fulfilling the requirements of this section in
preparation of the plan and modifications in the plan of services being
considered by the commissioner shall be submitted to the governor and
the legislature on or before the fifteenth day of February of each year.
Such interim report shall include, but need not be limited to:
(a) actions to include participation of consumers, consumer groups,
providers of services and departmental facilities, as required by this
subdivision; and
(b) any modifications in the plan of services being considered by the
commissioner, to include: (i) compelling budgetary, programmatic or
clinical justifications or other major appropriate reason for any
significant new statewide programs or policy changes from a prior
(approved) five year comprehensive plan; and (ii) procedures to involve
or inform local governmental units of such actions or plans.
(c) Three year capital plan. (1) On or before July first of each year,
the commissioners of the offices of the department of mental hygiene
shall each submit to the advisory council of their respective offices a
statewide three year capital plan for facilities within the jurisdiction
of their respective offices. The capital plan shall set forth the
projects proposed to be designed, constructed, acquired, reconstructed,
rehabilitated or otherwise substantially altered pursuant to appropri-
ation to meet the capital development needs of the respective agencies
for the next ensuing three years; the years of such plan shall corre-
spond to the years of the statewide five year plan as required by subdi-
vision (b) of this section.
S. 6256--B 97 A. 9056--B
(2) Such plan for each office shall include but not be limited to a
detailed project schedule indicating the location by county or borough
and estimated cost of each project, the anticipated dates on which the
design and construction of the project is to commence, the proposed
method of financing for the project, the estimated economic life of the
project and whether the proposed project constitutes design, new
construction or rehabilitation.
(3) Such plan shall further specify for each project whether the
project is to be a residential or nonresidential facility, a state or
voluntary operated facility, and, the number of clients, by source of
clients, proposed to utilize the facility. The information on the source
of the client shall include but not be limited to identification of
clients currently living independently, or at home with families, or
with caretakers, clients defined by their respective agencies as special
populations, or clients currently residing in an institutional setting
under the jurisdiction of the offices of the department.
(4) The advisory council of the appropriate office shall review such
plan and report its recommendation to the commissioner for inclusion,
provided, however, that the mental health services council shall forward
its comments on the capital plan of the office of mental health to the
mental health planning council which shall forward such recommendations
after review to the commissioner of mental health. The commissioner
shall submit his or her plan with the formal recommendations of the
advisory council of his or her office and any subsequent appropriate
modifications to the governor no later than the first day of October of
each year or concurrent with the annual submission of estimates and
information required by section one of article seven of the constitution
in order that such plans shall be considered with the estimates of the
offices for the preparation of the executive budget of the state of New
York for the next succeeding state fiscal year. The commissioners shall
also submit such plans to the chairmen of the senate finance committee
and the assembly ways and means committee.
(5) Each statewide three year capital plan for facilities shall be
evaluated and revised annually to encompass the fiscal year then in
progress and the next ensuing two fiscal years to ensure responsiveness
to the changing needs and goals of the department, and to reflect the
development of new information and project completion.]
S 4. Section 7.05 of the mental hygiene law is REPEALED.
S 5. Subdivision (c) of section 13.05 of the mental hygiene law, as
amended by chapter 37 of the laws of 2011, is amended to read as
follows:
(c) The developmental disabilities advisory council shall have no
executive, administrative or appointive duties. The council shall have
the duty to foster public understanding and acceptance of developmental
disabilities. It shall, in cooperation with the commissioner of develop-
mental disabilities, [establish] PROVIDE RECOMMENDATIONS FOR statewide
PRIORITIES AND goals [and objectives] for services for individuals with
developmental disabilities and shall advise the commissioner on matters
related to development and implementation of the [OPWDD's triennial
state developmental disabilities] STATEWIDE comprehensive plan as
required under [paragraph two of subdivision (b) of] section 5.07 of
this chapter. The advisory council shall have the power to consider any
matter relating to the improvement of the state developmental disabili-
ties program and shall advise the commissioner of developmental disabil-
ities thereon and on any matter relating to the performance of their
duties with relation to individuals with developmental disabilities and
S. 6256--B 98 A. 9056--B
on policies, goals, budget and operation of developmental disabilities
services.
S 6. Section 19.05 of the mental hygiene law is REPEALED.
S 7. Subdivision (c) of section 41.16 of the mental hygiene law, as
amended by section 16 of part E of chapter 111 of the laws of 2010, is
amended to read as follows:
(c) A local services plan shall be developed, in accordance with the
regulations of the commissioner or commissioners of the office or
offices of the department having jurisdiction of the services by the
local governmental unit or units which shall direct and administer a
local comprehensive planning process for its geographic area, consistent
with statewide goals and objectives established pursuant to section 5.07
of this chapter. The planning process shall involve the directors of any
department facilities, directors of hospital based mental health
services, directors of community mental health centers, THE DIRECTOR OF
THE LOCAL OFFICE FOR THE AGING OR HIS OR HER REPRESENTATIVE, consumers,
consumer groups, voluntary agencies, other providers of services, and
local correctional facilities and other local criminal justice agencies.
The local governmental unit, or units, shall determine the proposed
local services plan to be submitted for approval. If any provider of
services including facilities in the department, or any representative
of the consumer or community interests within the local planning proc-
ess, disputes any element of the proposed plan for the area which it
serves, the objection shall be presented in writing to the director of
the local governmental unit. If such dispute cannot be resolved to the
satisfaction of all parties, the director shall determine the plan to be
submitted. If requested and supplied by the objecting party, a written
objection to the plan shall be appended thereto and transmitted to the
single agent of the department jointly designated by the commissioners.
S 8. Section 220 of the public health law, as amended by section 45
of part A of chapter 58 of the laws of 2010, is amended to read as
follows:
S 220. Public health and health planning council; appointment of
members. There shall continue to be in the department a public health
and health planning council to consist of the commissioner and fourteen
members to be appointed by the governor with the advice and consent of
the senate; provided that effective December first, two thousand ten,
the membership of the council shall consist of the commissioner and
twenty-four members to be appointed by the governor with the advice and
consent of the senate. Membership on the council shall be reflective of
the diversity of the state's population including, but not limited to,
the various geographic areas and population densities throughout the
state. The members shall include representatives of the public health
system, health care providers that comprise the state's health care
delivery system, individuals with expertise in the clinical and adminis-
trative aspects of health care delivery, issues affecting health care
consumers, health planning, health care financing and reimbursement,
health care regulation and compliance, and public health practice and at
least two members shall also be members of the [mental] BEHAVIORAL
health services ADVISORY council; at least four members shall be repre-
sentatives of general hospitals or nursing homes; and at least one
member shall be a representative of each of the following groups: home
care agencies, diagnostic and treatment centers, health care payors,
labor organizations for health care employees, and health care consumer
advocacy organizations.
S. 6256--B 99 A. 9056--B
S 9. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2012; provided,
however, that sections one through six of this act shall take effect on
the one hundred twentieth day after it shall have become a law.
PART O
Section 1. Subdivision (b) of section 7.17 of the mental hygiene law,
as amended by section 1 of part G of chapter 59 of the laws of 2011, is
amended to read as follows:
(b) There shall be in the office the hospitals named below for the
care, treatment and rehabilitation of persons with mental illness and
for research and teaching in the science and skills required for the
care, treatment and rehabilitation of such 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 Center
Queens Children's Psychiatric Center]
NEW YORK CITY CHILDREN'S 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
facility operated by the office to provide community-based mental health
services for children with serious emotional disturbances.]
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 to close, consolidate, reduce, transfer or other-
wise redesign services of hospitals, other facilities and programs oper-
ated by the office of mental health, and to implement significant
service reductions and reconfigurations according to this section as
S. 6256--B 100 A. 9056--B
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. One of the intents of actions taken that result
in closure, consolidation, reduction, transfer or other redesign
services of hospitals is to reinvest appropriate levels of funding for
community based mental health services and programs as determined by the
commissioner of mental health with approval from the director of the
division of the budget.
(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, which shall include but not be limited to, closures of wards
at a state-operated psychiatric center or the conversion 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 nonutilization or under utilization of
beds, and the efficient operation of facilities.
(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 execu-
tive officer of the county in which the facility is located, and shall
post such notice upon its public website. The commissioner shall be
authorized 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 relative quality of the care and
treatment provided by the hospital, as may be informed by internal or
external quality or accreditation reviews; (3) the current and antic-
ipated 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 children, or other specialized services, such as
forensic services; (4) the availability of staff sufficient to address
the current and anticipated long term service needs; (5) the long term
capital investment required to ensure that the facility meets relevant
state and federal regulatory and capital construction requirements, and
national accreditation standards; (6) the proximity of the facility to
other facilities with space that could accommodate anticipated need, the
relative cost of any necessary renovations of such space, the relative
potential operating efficiency of such facilities, and the size, scope
and types of services provided by the other facilities; (7) anticipated
savings based upon economies of scale or other factors; (8) 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; (9) the obligations of the state
to place persons with mental disabilities in community settings rather
than in institutions, when appropriate; and (10) 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. 6256--B 101 A. 9056--B
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 immediately and shall be deemed to
have been in full force and effect on and after April 1, 2012; provided
that the date for the closure of Kingsboro psychiatric center shall be
on a date certified by the commissioner of mental health.
PART P
Section 1. Subdivision (o) of section 10.03 of the mental hygiene law,
as amended by chapter 168 of the laws of 2010, is amended to read as
follows:
(o) "Secure treatment facility" means a facility or a portion of a
facility, designated by the commissioner, that may include a facility
located on the grounds of a correctional facility, that is staffed with
personnel from the office of mental health or the office for people with
developmental disabilities for the purposes of providing care and treat-
ment to persons confined under this article, and persons defined in
paragraph five of subdivision (g) of this section. Personnel from these
same agencies may provide security services, provided that such staff
are adequately trained in security methods and so equipped as to mini-
mize the risk or danger of escape. THE COMMISSIONER SHALL HAVE THE
DISCRETION TO ENTER INTO AGREEMENTS FOR THE PROVISION OF CARE AND TREAT-
MENT TO PERSONS HELD AT A SECURE TREATMENT FACILITY PURSUANT TO THIS
ARTICLE, OR FOR THE PROVISION OF APPROPRIATE SECURITY SERVICES, BY INDI-
VIDUALS WHO ARE NOT PERSONNEL OF SUCH AGENCIES.
S 2. Subdivision (k) of section 10.06 of the mental hygiene law, as
amended by section 118-c of subpart B of part C of chapter 62 of the
laws of 2011, is amended to read as follows:
(k) At the conclusion of the hearing, the court shall determine wheth-
er there is probable cause to believe that the respondent is a sex
offender requiring civil management. If the court determines that proba-
ble cause has not been established, the court shall issue an order
dismissing the petition, and the respondent's release shall be in
accordance with other applicable provisions of law. If the court deter-
mines that probable cause has been established: (i) the court shall
order that the respondent be committed to a secure treatment facility
designated by the commissioner for care, treatment and control upon his
or her release, provided, however, that a respondent who otherwise would
be required to be transferred to a secure treatment facility [may,]
SHALL REMAIN IN THE CUSTODY OF THE DEPARTMENT OF CORRECTIONS AND COMMU-
NITY SUPERVISION PENDING THE OUTCOME OF THE PROCEEDINGS UNDER THIS ARTI-
CLE UNTIL HE OR SHE HAS REACHED THE MAXIMUM EXPIRATION OF HIS OR HER
SENTENCE OR HAS BEEN APPROVED FOR RELEASE TO PAROLE SUPERVISION BY THE
STATE BOARD OF PAROLE, PROVIDED, FURTHER THAT A RESPONDENT MAY, upon a
written consent signed by the respondent and his or her counsel, consent
to remain in the custody of the department of corrections and community
S. 6256--B 102 A. 9056--B
supervision pending the outcome of the proceedings under this article,
and that such consent may be revoked in writing at any time; (ii) the
court shall set a date for trial in accordance with subdivision (a) of
section 10.07 of this article; and (iii) the respondent shall not be
released pending the completion of such trial.
S 3. Subdivision (f) of section 10.07 of the mental hygiene law, as
added by chapter 7 of the laws of 2007, is amended to read as follows:
(f) If the jury, or the court if a jury trial is waived, determines
that the respondent is a detained sex offender who suffers from a mental
abnormality, then the court shall consider whether the respondent is a
dangerous sex offender requiring confinement or a sex offender requiring
strict and intensive supervision. The parties may offer additional
evidence, and the court shall hear argument, as to that issue. If the
court finds by clear and convincing evidence that the respondent has a
mental abnormality involving such a strong predisposition to commit sex
offenses, and such an inability to control behavior, that the respondent
is likely to be a danger to others and to commit sex offenses if not
confined to a secure treatment facility, then the court shall find the
respondent to be a dangerous sex offender requiring confinement. In such
case, the respondent shall be committed to a secure treatment facility
for care, treatment, and control until such time as he or she no longer
requires confinement. FAILURE OF A DANGEROUS SEX OFFENDER REQUIRING
CONFINEMENT TO MEANINGFULLY PARTICIPATE IN TREATMENT IN A SECURE TREAT-
MENT FACILITY SHALL CONSTITUTE A VIOLATION OF THE ORDER OF CONFINEMENT.
If the court does not find that the respondent is a dangerous sex offen-
der requiring confinement, then the court shall make a finding of dispo-
sition that the respondent is a sex offender requiring strict and inten-
sive supervision, and the respondent shall be subject to a regimen of
strict and intensive supervision and treatment in accordance with
section 10.11 of this article. In making a finding of disposition, the
court shall consider the conditions that would be imposed upon the
respondent if subject to a regimen of strict and intensive supervision,
and all available information about the prospects for the respondent's
possible re-entry into the community.
S 4. Section 10.08 of the mental hygiene law is amended by adding a
new subdivision (i) to read as follows:
(I) AT ANY PROCEEDING CONDUCTED PURSUANT TO THIS ARTICLE OTHER THAN A
TRIAL CONDUCTED PURSUANT TO SECTION 10.07 OF THIS ARTICLE, THE RESPOND-
ENT OR ANY WITNESS SHALL BE PERMITTED, UPON GOOD CAUSE SHOWN, TO MAKE AN
ELECTRONIC APPEARANCE IN THE COURT BY MEANS OF AN INDEPENDENT AUDIO-VI-
SUAL SYSTEM, AS THAT TERM IS DEFINED IN SUBDIVISION ONE OF SECTION
182.10 OF THE CRIMINAL PROCEDURE LAW, FOR PURPOSES OF A COURT APPEARANCE
OR FOR GIVING TESTIMONY. IT SHALL CONSTITUTE GOOD CAUSE THAT A WITNESS
IS CURRENTLY EMPLOYED BY THE STATE AT A SECURE TREATMENT FACILITY OR
ANOTHER WORK LOCATION, UNLESS THERE ARE COMPELLING CIRCUMSTANCES REQUIR-
ING THE WITNESS'S PERSONAL PRESENCE AT THE COURT PROCEEDING. FOR
PURPOSES OF THIS SUBDIVISION, AN "ELECTRONIC APPEARANCE" MEANS AN
APPEARANCE AT WHICH A PARTICIPANT IS NOT PRESENT IN THE COURT, BUT IN
WHICH: (I) ALL OF THE PARTICIPANTS ARE ABLE TO SEE AND HEAR THE SIMUL-
TANEOUS REPRODUCTIONS OF THE VOICES AND IMAGES OF THE JUDGE, COUNSEL,
RESPONDENT OR ANY OTHER APPROPRIATE PARTICIPANT, AND (II) COUNSEL IS
PRESENT WITH THE RESPONDENT OR THE RESPONDENT AND COUNSEL ARE ABLE TO
SEE AND HEAR EACH OTHER AND ENGAGE IN PRIVATE CONVERSATION. WHEN A
RESPONDENT OR A WITNESS MAKES AN ELECTRONIC APPEARANCE, THE COURT
STENOGRAPHER SHALL RECORD ANY STATEMENTS IN THE SAME MANNER AS IF THE
RESPONDENT OR WITNESS HAD MADE A PERSONAL APPEARANCE. NOTHING IN THIS
S. 6256--B 103 A. 9056--B
SUBDIVISION SHALL BE CONSTRUED TO PROHIBIT THE RESPONDENT OR ANY WITNESS
FROM MAKING AN ELECTRONIC APPEARANCE IN THE COURT AT A TRIAL CONDUCTED
PURSUANT TO SECTION 10.07 OF THIS ARTICLE BY MEANS OF AN INDEPENDENT
AUDIO-VISUAL SYSTEM, UPON GOOD CAUSE SHOWN AND CONSENT OF THE PARTIES.
S 5. The section heading and subdivisions (a), (b), (c), (d), and (f)
of section 10.09 of the mental hygiene law, as added by chapter 7 of the
laws of 2007, are amended to read as follows:
[Annual] BIENNIAL examinations and petitions for discharge.
(a) The commissioner shall provide the respondent and counsel for
respondent with [an annual] A BIENNIAL written notice of the right to
petition the court for discharge. The notice shall contain a form for
the waiver of the right to petition for discharge.
(b) The commissioner shall also assure that each respondent committed
under this article shall have an examination for evaluation of his or
her mental condition made at least once every [year] TWO YEARS by a
psychiatric examiner who shall report to the commissioner his or her
written findings as to whether the respondent is currently a dangerous
sex offender requiring confinement. At such time, the respondent also
shall have the right to be evaluated by an independent psychiatric exam-
iner. If the respondent is financially unable to obtain an examiner,
the court shall appoint an examiner of the respondent's choice to be
paid within the limits prescribed by law. Following such evaluation,
each psychiatric examiner shall report his or her findings in writing to
the commissioner and to counsel for respondent. The commissioner shall
review relevant records and reports, along with the findings of the
psychiatric examiners, and shall make a determination in writing as to
whether the respondent is currently a dangerous sex offender requiring
confinement.
(c) The commissioner shall [annually] BIENNIALLY forward the notice
and waiver form, along with a report including the commissioner's writ-
ten determination and the findings of the psychiatric examination, to
the supreme or county court where the respondent is located.
(d) The court shall hold an evidentiary hearing as to retention of the
respondent within forty-five days if it appears from one of the [annual]
BIENNIAL submissions to the court under subdivision (c) of this section
(i) that the respondent has petitioned, or has not affirmatively waived
the right to petition, for discharge, or (ii) that even if the respond-
ent has waived the right to petition, and the commissioner has deter-
mined that the respondent remains a dangerous sex offender requiring
confinement, the court finds on the basis of the materials described in
subdivision (b) of this section that there is a substantial issue as to
whether the respondent remains a dangerous sex offender requiring
confinement. At an evidentiary hearing on that issue under this subdivi-
sion, the attorney general shall have the burden of proof.
(f) The respondent may at any time petition the court for discharge
and/or release to the community under a regimen of strict and intensive
supervision and treatment. Upon review of the respondent's petition,
other than in connection with [annual] BIENNIAL reviews as described in
subdivisions (a), (b) and (d) of this section, the court may order that
an evidentiary hearing be held, or may deny an evidentiary hearing and
deny the petition upon a finding that the petition is frivolous or does
not provide sufficient basis for reexamination prior to the next [annu-
al] BIENNIAL review. If the court orders an evidentiary hearing under
this subdivision, the attorney general shall have the burden of proof as
to whether the respondent is currently a dangerous sex offender requir-
ing confinement.
S. 6256--B 104 A. 9056--B
S 6. Subdivision (a) of section 10.10 of the mental hygiene law, as
added by chapter 7 of the laws of 2007, is amended to read as follows:
(a) If the respondent is found to be a dangerous sex offender requir-
ing confinement and committed to a secure treatment facility, that
facility shall provide care, treatment, and control of the respondent
until such time that a court discharges the respondent in accordance
with the provisions of this article. FAILURE OF A DANGEROUS SEX OFFENDER
REQUIRING CONFINEMENT TO MEANINGFULLY PARTICIPATE IN TREATMENT IN A
SECURE TREATMENT FACILITY SHALL CONSTITUTE A VIOLATION OF THE ORDER OF
CONFINEMENT.
S 7. Subdivision (c) of section 10.11 of the mental hygiene law, as
amended by section 118-e of subpart B of part C of chapter 62 of the
laws of 2011, is amended to read as follows:
(c) An order for a regimen of strict and intensive supervision and
treatment places the person in the custody and control of the department
of corrections and community supervision. A person ordered to undergo a
regimen of strict and intensive supervision and treatment pursuant to
this article is subject to lawful conditions set by the court and the
department of corrections and community supervision. A VIOLATION OF A
CONDITION OF THE REGIMEN OF STRICT AND INTENSIVE SUPERVISION AND TREAT-
MENT FOR A PERSON UNDER COMMUNITY SUPERVISION, AS DEFINED IN SUBDIVISION
THREE OF SECTION TWO HUNDRED FIFTY-NINE OF THE EXECUTIVE LAW, MAY BE THE
BASIS FOR REVOCATION OF PAROLE PURSUANT TO SECTION TWO HUNDRED
FIFTY-NINE-I OF THE EXECUTIVE LAW. A PERSON WHO INTENTIONALLY VIOLATES A
MATERIAL CONDITION OF THE REGIMEN OF STRICT AND INTENSIVE SUPERVISION
AND TREATMENT SHALL BE GUILTY OF A CLASS E FELONY.
S 8. Section 120.05 of the penal law is amended by adding a new subdi-
vision 13 to read as follows:
13. HAVING BEEN FOUND TO BE A SEX OFFENDER REQUIRING CIVIL MANAGEMENT
AND WHILE CONFINED IN A SECURE TREATMENT FACILITY, AS DEFINED IN SECTION
7.18 OF THE MENTAL HYGIENE LAW, WITH INTENT TO CAUSE PHYSICAL INJURY TO
ANOTHER PERSON, HE CAUSES SUCH INJURY TO SUCH PERSON OR TO A THIRD
PERSON.
S 9. This act shall take effect immediately.
PART Q
Section 1. Section 730.10 of the criminal procedure law is amended by
adding a new subdivision 9 to read as follows:
9. "APPROPRIATE INSTITUTION" MEANS: (A) A HOSPITAL OPERATED BY THE
OFFICE OF MENTAL HEALTH OR A DEVELOPMENTAL CENTER OPERATED BY THE OFFICE
FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES; (B) A LOCAL CORRECTIONAL
FACILITY, AS SUCH TERMS ARE DEFINED IN SECTION TWO OF THE CORRECTION
LAW, WHICH OPERATES A MENTAL HEALTH UNIT; OR (C) A HOSPITAL LICENSED BY
THE DEPARTMENT OF HEALTH WHICH OPERATES A PSYCHIATRIC UNIT LICENSED BY
THE OFFICE OF MENTAL HEALTH, AS DETERMINED BY THE COMMISSIONER.
S 2. Subdivision 1 of section 730.40 of the criminal procedure law, as
amended by chapter 231 of the laws of 2008, is amended to read as
follows:
1. When a local criminal court, following a hearing conducted pursuant
to subdivision three or four of section 730.30, is satisfied that the
defendant is not an incapacitated person, the criminal action against
him OR HER must proceed. If it is satisfied that the defendant is an
incapacitated person, or if no motion for such a hearing is made, such
court must issue a final or temporary order of observation committing
him OR HER to the custody of the commissioner for care and treatment in
S. 6256--B 105 A. 9056--B
an appropriate institution for a period not to exceed ninety days from
the date of the order, provided, however, that the commissioner may
designate an appropriate hospital for placement of a defendant for whom
a final order of observation has been issued, where such hospital is
licensed by the office of mental health and has agreed to accept, upon
referral by the commissioner, defendants subject to final orders of
observation issued under this subdivision. When a local criminal court
accusatory instrument other than a felony complaint has been filed
against the defendant, such court must issue a final order of observa-
tion[; when]. WHEN a felony complaint has been filed against the defend-
ant, such court must issue a temporary order of observation COMMITTING
HIM OR HER TO THE JURISDICTION OF THE COMMISSIONER FOR CARE AND TREAT-
MENT IN AN APPROPRIATE INSTITUTION OR ON AN OUT-PATIENT BASIS FOR A
PERIOD NOT TO EXCEED NINETY DAYS FROM THE DATE OF SUCH ORDER, except
that, with the consent of the district attorney, it may issue a final
order of observation.
S 3. Subdivision 1 of section 730.50 of the criminal procedure law, as
amended by chapter 231 of the laws of 2008, is amended to read as
follows:
1. When a superior court, following a hearing conducted pursuant to
subdivision three or four of section 730.30, is satisfied that the
defendant is not an incapacitated person, the criminal action against
him OR HER must proceed. If it is satisfied that the defendant is an
incapacitated person, or if no motion for such a hearing is made, it
must adjudicate him OR HER an incapacitated person, and must issue a
final order of observation or an order of commitment. When the indict-
ment does not charge a felony or when the defendant has been convicted
of an offense other than a felony, such court (a) must issue a final
order of observation committing the defendant to the custody of the
commissioner for care and treatment in an appropriate institution for a
period not to exceed ninety days from the date of such order, provided,
however, that the commissioner may designate an appropriate hospital for
placement of a defendant for whom a final order of observation has been
issued, where such hospital is licensed by the office of mental health
and has agreed to accept, upon referral by the commissioner, defendants
subject to final orders of observation issued under this subdivision,
and (b) must dismiss the indictment filed in such court against the
defendant, and such dismissal constitutes a bar to any further prose-
cution of the charge or charges contained in such indictment. When the
indictment charges a felony or when the defendant has been convicted of
a felony, it must issue an order of commitment committing the defendant
to the [custody] JURISDICTION of the commissioner for care and treatment
in an appropriate institution OR ON AN OUT-PATIENT BASIS for a period
not to exceed one year from the date of such order. Upon the issuance of
an order of commitment, the court must exonerate the defendant's bail if
he OR SHE was previously at liberty on bail; PROVIDED, HOWEVER, THAT
EXONERATION OF BAIL IS NOT REQUIRED WHEN A DEFENDANT IS COMMITTED TO THE
JURISDICTION OF THE COMMISSIONER FOR CARE AND TREATMENT ON AN OUT-PA-
TIENT BASIS.
S 4. This act shall take effect immediately.
PART R
Section 1. Section 1 of part D of chapter 111 of the laws of 2010
relating to the recovery of exempt income by the office of mental health
S. 6256--B 106 A. 9056--B
for community residences and family-based treatment programs is amended
to read as follows:
Section 1. The office of mental health is authorized to recover fund-
ing from community residences and family-based treatment providers
licensed by the office of mental health, consistent with contractual
obligations of such providers, and notwithstanding any other inconsist-
ent provision of law to the contrary, in an amount equal to 50 percent
of the income received by such providers which exceeds the fixed amount
of annual Medicaid revenue limitations, as established by the commis-
sioner of mental health. Recovery of such excess income shall be for the
following fiscal periods: for programs in counties located outside of
the city of New York, the applicable fiscal periods shall be January 1,
2003 through December 31, 2009 AND JANUARY 1, 2011 THROUGH DECEMBER 31,
2013; and for programs located within the city of New York, the applica-
ble fiscal periods shall be July 1, 2003 through June 30, 2010 AND JULY
1, 2011 THROUGH JUNE 30, 2013.
S 2. This act shall take effect immediately.
PART S
Section 1. Section 18 of chapter 266 of the laws of 1986, amending the
civil practice law and rules and other laws relating to medical and
dental malpractice, is REPEALED.
S 2. Any rules or regulations promulgated by the superintendent of
insurance or the commissioner of health pursuant to the provisions of
section 18 of chapter 266 of the laws of 1986 shall survive such repeal,
and shall be applicable to the excess medical malpractice liability
coverage pool and related provisions as created by section three of this
act.
The repeal of section 18 of chapter 266 of the laws of 1986 as effec-
tuated by section one of this act shall not affect the rights or obli-
gations of any physician, dentist, insurer or general hospital related
to excess or equivalent excess coverage purchased pursuant to the
provisions of section 18 of chapter 266 of the laws of 1986 that were in
effect prior to the date this act takes effect; nor shall the repeal of
section 18 of chapter 266 of the laws of 1986 as effectuated by section
one of this act affect the rights or obligations of any claimant against
excess or equivalent excess coverage that was purchased pursuant to the
provisions of section 18 of chapter 266 of the laws of 1986 that were in
effect prior to the date this act takes effect.
S 3. The public health law is amended by adding a new section 23 to
read as follows:
S 23. EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL. 1. THE
HOSPITAL EXCESS LIABILITY POOL ESTABLISHED BY SUBDIVISION FIVE OF
SECTION EIGHTEEN OF CHAPTER TWO HUNDRED SIXTY-SIX OF THE LAWS OF NINE-
TEEN HUNDRED EIGHTY-SIX, AS AMENDED BY CHAPTER TWO HUNDRED FIFTY-SIX OF
THE LAWS OF NINETEEN HUNDRED NINETY-THREE SHALL BE CONTINUED AND IS
HEREBY RENAMED THE "EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL."
THE EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL SHALL BE OVERSEEN
BY THE SUPERINTENDENT OF FINANCIAL SERVICES AND THE COMMISSIONER, AND
SHALL CONSIST OF FUNDS CURRENTLY IN OR OWED TO THE EXCESS LIABILITY POOL
AS OF THE EFFECTIVE DATE OF THIS SECTION, AND FUNDS APPROPRIATED FOR THE
PURPOSES OF THE EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL.
2. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTIONS
ONE HUNDRED FORTY-TWO AND ONE HUNDRED FORTY-THREE OF THE ECONOMIC DEVEL-
S. 6256--B 107 A. 9056--B
OPMENT LAW, OR ANY OTHER CONTRARY PROVISION OF LAW, THE SUPERINTENDENT
OF FINANCIAL SERVICES MAY ENTER INTO A CONTRACT OR CONTRACTS UNDER THIS
SUBDIVISION WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS,
PROVIDED, HOWEVER, THAT:
(A) THE DEPARTMENT OF FINANCIAL SERVICES 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
SUPERINTENDENT OF FINANCIAL SERVICES; AND
(C) THE SUPERINTENDENT OF FINANCIAL SERVICES SHALL SELECT SUCH
CONTRACTOR OR CONTRACTORS THAT, IN THE SUPERINTENDENT OF FINANCIAL
SERVICES' DISCRETION, ARE BEST SUITED TO SERVE THE PURPOSES OF THIS
SUBDIVISION.
3. (A) THE SUPERINTENDENT OF FINANCIAL SERVICES AND THE COMMISSIONER
OR THEIR DESIGNEES SHALL, FROM FUNDS AVAILABLE IN THE EXCESS MEDICAL
MALPRACTICE LIABILITY COVERAGE POOL CREATED PURSUANT TO SUBDIVISION ONE
OF THIS SECTION, PURCHASE A POLICY OR POLICIES FOR EXCESS INSURANCE
COVERAGE, OR FOR EQUIVALENT EXCESS COVERAGE, FOR MEDICAL OR DENTAL MALP-
RACTICE OCCURRENCES BETWEEN THE FIRST OF JULY OF A GIVEN YEAR AND ENDING
THE THIRTIETH OF JUNE OF THE NEXT SUCCEEDING YEAR, OR TO REIMBURSE A
GENERAL HOSPITAL WHERE THE HOSPITAL PURCHASES EQUIVALENT EXCESS COVERAGE
FOR MEDICAL OR DENTAL MALPRACTICE OCCURRENCES BETWEEN THE FIRST OF JULY
IN A GIVEN YEAR AND ENDING THE THIRTIETH OF JUNE IN THE SUCCEEDING YEAR
FOR ELIGIBLE PHYSICIANS OR DENTISTS AS CERTIFIED BY A GENERAL HOSPITAL
LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THIS CHAPTER FOR EACH SUCH
PERIOD OR PERIODS.
(B) SUCH POLICIES MAY BE PURCHASED PURSUANT TO SECTION FIVE THOUSAND
FIVE HUNDRED TWO OF THE INSURANCE LAW, OR FROM AN INSURER, DULY LICENSED
IN THIS STATE TO WRITE PERSONAL INJURY LIABILITY INSURANCE AND ACTUALLY
WRITING MEDICAL MALPRACTICE INSURANCE IN THIS STATE.
(C) NO SINGLE INSURER SHALL WRITE MORE THAN FIFTY PERCENT OF THE TOTAL
EXCESS PREMIUM FOR A GIVEN POLICY YEAR, UNLESS UPON REQUEST BY THE
INSURER, THE SUPERINTENDENT OF FINANCIAL SERVICES IN WRITING DETERMINED
THAT EXCEEDING SUCH LIMIT WOULD NOT BE HARMFUL TO THE POLICYHOLDER AND
THE PEOPLE OF THE STATE.
4. (A) FOR THE PURPOSES OF THIS SECTION, "ELIGIBLE PHYSICIAN OR
DENTIST" SHALL A MEAN A PHYSICIAN OR DENTIST, EXCLUDING A FACULTY PRAC-
TICE PHYSICIAN OR DENTIST, WHO:
(I) IS PRIMARILY ENGAGED IN THE PRIVATE PRACTICE OF MEDICINE, OR IS AN
EMPLOYEE OF AN ELIGIBLE HOSPITAL;
(II) HAS PROFESSIONAL PRIVILEGES IN THE GENERAL HOSPITAL THAT IS
CERTIFYING THE PHYSICIAN'S OR DENTIST'S ELIGIBILITY;
(III) IS PROVIDING EMERGENCY MEDICAL OR DENTAL SERVICES, INCLUDING
EMERGENCY MEDICAL SCREENING EXAMINATIONS, TREATMENT FOR EMERGENCY
MEDICAL CONDITIONS, INCLUDING LABOR AND DELIVERY, OR TREATMENT FOR EMER-
GENCY DENTAL CONDITIONS TO PERSONS IN NEED OF SUCH TREATMENT AT THE
GENERAL HOSPITAL THAT IS CERTIFYING THEIR ELIGIBILITY; AND
S. 6256--B 108 A. 9056--B
(IV) (1) HAS IN FORCE COVERAGE UNDER AN INDIVIDUAL POLICY OR GROUP
POLICY WRITTEN IN ACCORDANCE WITH THE PROVISIONS OF THE INSURANCE LAW,
PAID FOR SOLELY BY SUCH PHYSICIAN OR DENTIST OR HIS OR HER PRIVATE PRAC-
TICE, FROM AN INSURER LICENSED IN THIS STATE TO WRITE PERSONAL INJURY
LIABILITY INSURANCE, 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 POLICY AND COVERING THE SAME TIME PERIOD AS THE
EXCESS INSURANCE COVERAGE;
(2) IN THE CASE OF AN EMPLOYEE OF AN ELIGIBLE HOSPITAL, HAS IN FORCE
AN INDIVIDUAL POLICY OR GROUP POLICY WRITTEN IN ACCORDANCE WITH THE
PROVISIONS OF THE INSURANCE LAW, PARTIALLY OR FULLY PURCHASED BY AN
ELIGIBLE HOSPITAL, FROM AN INSURER LICENSED IN THIS STATE TO WRITE
PERSONAL INJURY LIABILITY INSURANCE, 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 POLICY AND COVERING THE SAME TIME
PERIOD AS THE EXCESS INSURANCE COVERAGE; OR
(3) IS ENDORSED AS AN ADDITIONAL INSURED UNDER A VOLUNTARY ATTENDING
PHYSICIAN ("CHANNELING") PROGRAM PREVIOUSLY PERMITTED BY THE SUPERINTEN-
DENT OF INSURANCE AND COVERING THE SAME TIME PERIOD AS THE EQUIVALENT
EXCESS COVERAGE.
(B) THE EXCESS COVERAGE OR 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 PREVIOUSLY PERMITTED BY THE SUPERINTENDENT OF
INSURANCE, TOTAL AN AGGREGATE LEVEL OF COVERAGE OF TWO MILLION THREE
HUNDRED THOUSAND DOLLARS FOR EACH CLAIMANT AND SIX MILLION NINE HUNDRED
THOUSAND DOLLARS FOR ALL CLAIMANTS WITH RESPECT TO OCCURRENCES DURING
THE POLICY PERIOD.
(C) THE EQUIVALENT EXCESS COVERAGE SHALL PROVIDE FOR PAYMENT ONLY
AFTER COVERAGE AVAILABLE THROUGH THE VOLUNTARY ATTENDING PHYSICIAN
("CHANNELING") PROGRAM HAS BEEN EXHAUSTED DURING THE POLICY PERIOD.
(D) IN THE EVENT THAT AN ELIGIBLE PHYSICIAN OR DENTIST HAS PROFES-
SIONAL PRIVILEGES IN MORE THAN ONE GENERAL HOSPITAL, THE CERTIFICATION
OF THE PHYSICIAN'S OR DENTIST'S ELIGIBILITY SHALL BE PROVIDED BY THE
GENERAL HOSPITAL DESIGNATED BY SUCH PHYSICIAN OR DENTIST AS THE GENERAL
HOSPITAL WITH WHICH THE PHYSICIAN OR DENTIST IS PRIMARILY AFFILIATED, AS
MAY BE DEFINED PURSUANT TO REGULATIONS PROMULGATED BY THE COMMISSIONER.
5. FOR THE PURPOSES OF THIS SECTION THE TERM "ELIGIBLE HOSPITAL" SHALL
MEAN A GENERAL HOSPITAL THAT HAS BEEN DETERMINED BY THE COMMISSIONER IN
CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL SERVICES TO:
(A) HAVE ADEQUATELY DEMONSTRATED THAT HIGH COSTS FOR, OR LACK OF
AVAILABILITY OF, MEDICAL MALPRACTICE LIABILITY COVERAGE HAVE IMPAIRED
THE HOSPITAL'S ABILITY TO ATTRACT AND RETAIN PHYSICIANS AND DENTISTS
PRACTICING IN FIELDS FOR WHICH THERE IS HIGH DEMAND BASED ON THE RATIO
OF PATIENT VOLUME TO AVAILABLE PHYSICIANS; AND
(B) BE A VITAL ACCESS PROVIDER; AND
(C) HAVE ADEQUATELY DEMONSTRATED THAT THE GENERAL HOSPITAL IS IN
FINANCIAL DISTRESS.
6. FOR THE PURPOSES OF THIS SECTION "EQUIVALENT EXCESS COVERAGE" SHALL
MEAN A POLICY OR POLICIES OF INSURANCE FOR A PHYSICIAN OR DENTIST
INSURED UNDER A VOLUNTARY ATTENDING PHYSICIAN ("CHANNELING") PROGRAM
PREVIOUSLY PERMITTED BY THE SUPERINTENDENT OF INSURANCE INSURING A
PHYSICIAN OR DENTIST AGAINST MEDICAL OR DENTAL MALPRACTICE WITH AN
AGGREGATE LEVEL OF COVERAGE PROVIDING NOT LESS THAN TWO MILLION THREE
S. 6256--B 109 A. 9056--B
HUNDRED THOUSAND DOLLARS FOR EACH CLAIMANT AND SIX MILLION NINE HUNDRED
THOUSAND DOLLARS FOR ALL CLAIMANTS DURING THE POLICY PERIOD. SUCH COVER-
AGE LIMITS SHALL BE REDUCED BY PAYMENTS MADE ON BEHALF OF SUCH PHYSICIAN
OR DENTIST UNDER A HOSPITAL PROFESSIONAL LIABILITY POLICY WRITTEN PURSU-
ANT TO A VOLUNTARY ATTENDING PHYSICIAN ("CHANNELING") PROGRAM PREVIOUSLY
PERMITTED BY THE SUPERINTENDENT OF INSURANCE, IN AN AMOUNT NOT TO EXCEED
TWO MILLION THREE HUNDRED THOUSAND DOLLARS FOR EACH CLAIMANT AND SIX
MILLION NINE HUNDRED THOUSAND DOLLARS FOR ALL CLAIMANTS DURING SUCH
POLICY PERIOD FOR EACH SUCH PHYSICIAN OR DENTIST.
7. FOR THE PURPOSES OF THIS SECTION, A PHYSICIAN OR DENTIST IN THE
"PRIVATE PRACTICE OF MEDICINE" SHALL MEAN A PHYSICIAN OR DENTIST WHO
RECEIVES THE LARGEST PERCENTAGE OF HIS OR HER INCOME DERIVED FROM THE
PROVISION OF MEDICAL SERVICES, FROM BILLS:
(A) ISSUED DIRECTLY BY THE PHYSICIAN OR DENTIST;
(B) ISSUED DIRECTLY BY A CORPORATION, ORGANIZED FOR THE PURPOSE OF
PROVIDING MEDICAL OR DENTAL CARE, THAT IS NOT OWNED BY, AND IS NOT A
SUBSIDIARY OF, A GENERAL HOSPITAL, OR ISSUED BY A VENDOR CONTRACTED BY
THAT CORPORATION FOR THE PURPOSES OF BILLING, FOR SERVICES RENDERED BY
THE PHYSICIAN OR DENTIST; OR
(C) ISSUED BY A GENERAL HOSPITAL FOR SERVICES RENDERED BY A PHYSICIAN
OR DENTIST WHO HAS IN FORCE AN INDIVIDUAL MEDICAL MALPRACTICE INSURANCE
POLICY THAT IS PURCHASED SOLELY BY THE PHYSICIAN OR DENTIST OR AN ORGAN-
IZATION DESCRIBED IN PARAGRAPH (B) OF THIS SUBDIVISION, FROM AN INSURER
LICENSED IN THIS STATE TO WRITE PERSONAL INJURY LIABILITY INSURANCE, OF
PRIMARY MEDICAL 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.
8. (A) TO THE EXTENT FUNDS AVAILABLE TO THE EXCESS MEDICAL MALPRACTICE
LIABILITY COVERAGE POOL PURSUANT TO SUBDIVISION ONE OF THIS SECTION ARE
INSUFFICIENT TO MEET THE COSTS OF EXCESS INSURANCE COVERAGE OR EQUIV-
ALENT EXCESS COVERAGE FOR COVERAGE PERIODS DURING THE PERIOD BETWEEN
JULY FIRST OF A GIVEN YEAR AND JUNE THIRTIETH OF THE NEXT SUCCEEDING
YEAR, BEGINNING JULY FIRST, TWO THOUSAND TWELVE AND ENDING JUNE THIRTI-
ETH, TWO THOUSAND FOURTEEN EACH PHYSICIAN OR DENTIST FOR WHOM A POLICY
FOR EXCESS INSURANCE COVERAGE 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 OR DENTIST TO THE SUM OF THE TOTAL COST
OF SUCH COVERAGE FOR ALL PHYSICIANS OR DENTISTS APPLIED TO SUCH INSUFFI-
CIENCY.
(B) EACH PROVIDER OF EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS
COVERAGE COVERING THE PERIOD BETWEEN JULY FIRST OF A GIVEN YEAR AND JUNE
THIRTIETH OF THE NEXT SUCCEEDING YEAR, BEGINNING JULY FIRST, TWO THOU-
SAND TWELVE AND ENDING JUNE THIRTIETH, TWO THOUSAND FOURTEEN SHALL NOTI-
FY 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 PARA-
GRAPH (A) OF THIS SUBDIVISION. SUCH AMOUNT SHALL BE DUE FROM SUCH PHYSI-
CIAN OR DENTIST TO SUCH PROVIDER OF EXCESS INSURANCE COVERAGE OR EQUIV-
ALENT EXCESS COVERAGE IN A TIME AND MANNER DETERMINED BY THE
SUPERINTENDENT OF FINANCIAL SERVICES.
(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 BETWEEN JULY FIRST OF A GIVEN YEAR AND JUNE THIRTIETH OF
S. 6256--B 110 A. 9056--B
THE NEXT SUCCEEDING YEAR, BEGINNING JULY FIRST, TWO THOUSAND TWELVE AND
ENDING JUNE THIRTIETH, TWO THOUSAND FOURTEEN 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 SUPERINTEN-
DENT OF FINANCIAL SERVICES PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVI-
SION, 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 COMMENCEMENT 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 FINANCIAL SERVICES AND THE
COMMISSIONER OR THEIR DESIGNEE OF EACH PHYSICIAN AND DENTIST ELIGIBLE
FOR PURCHASE OF A POLICY FOR EXCESS INSURANCE COVERAGE OR EQUIVALENT
EXCESS COVERAGE COVERING THE PERIOD BETWEEN JULY FIRST OF A GIVEN YEAR
AND JUNE THIRTIETH OF THE NEXT SUCCEEDING YEAR, BEGINNING JULY FIRST,
TWO THOUSAND TWELVE AND ENDING JUNE THIRTIETH, TWO THOUSAND FOURTEEN
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 EXCESS MEDICAL MALPRACTICE LIABILITY COVER-
AGE POOL ANY AMOUNT ALLOCABLE TO THE PERIOD BETWEEN JULY FIRST OF A
GIVEN YEAR AND JUNE THIRTIETH OF THE NEXT SUCCEEDING YEAR, BEGINNING
JULY FIRST, TWO THOUSAND TWELVE AND ENDING JUNE THIRTIETH, TWO THOUSAND
FOURTEEN RECEIVED FROM THE EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE
POOL FOR PURCHASE OF EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS
COVERAGE COVERING THE PERIOD BETWEEN JULY FIRST OF A GIVEN YEAR AND JUNE
THIRTIETH OF THE NEXT SUCCEEDING YEAR, BEGINNING JULY FIRST, TWO THOU-
SAND TWELVE AND ENDING JUNE THIRTIETH, TWO THOUSAND FOURTEEN FOR A
PHYSICIAN OR DENTIST WHERE SUCH EXCESS INSURANCE COVERAGE OR EQUIVALENT
EXCESS COVERAGE IS CANCELLED IN ACCORDANCE WITH PARAGRAPH (C) OF THIS
SUBDIVISION.
(F) A POLICY OR POLICIES OF EXCESS MEDICAL MALPRACTICE COVERAGE ISSUED
TO OR ON BEHALF OF AN ELIGIBLE PHYSICIAN OR DENTIST PURSUANT TO THIS
SECTION SHALL BE WRITTEN UPON AND GIVE EFFECT TO THE CHOICE OF AN INSUR-
ER BY THE PHYSICIAN OR DENTIST, PROVIDED, HOWEVER, THAT SUCH CHOICE
SHALL BE MADE AMONG INSURERS WRITING EXCESS COVERAGE POLICIES IN ACCORD-
ANCE WITH THIS SECTION AND FURTHER PROVIDED THAT NO PHYSICIAN OR DENTIST
SHALL BE COMPELLED TO BE INSURED BY AN INSURER PROVIDING PRIMARY COVER-
AGE NOR SHALL SUCH INSURER PROVIDING SUCH PRIMARY COVERAGE BE COMPELLED
TO WRITE COVERAGE OF SUCH ELIGIBLE PHYSICIAN OR DENTIST FOR SUCH EXCESS
COVERAGE, IN WHICH CASE THE ELIGIBLE PHYSICIAN OR DENTIST MAY SELECT
ANOTHER INSURER WRITING SUCH EXCESS COVERAGE IN ACCORDANCE WITH THIS
SECTION.
9. ANY INSURER ISSUING POLICIES OF EXCESS OR EQUIVALENT EXCESS COVER-
AGE IN ACCORDANCE WITH SUBDIVISION ONE OF THIS SECTION MAY, NOTWITH-
STANDING ANY PROVISIONS OF THE INSURANCE LAW, RETURN TO THE STATE, IN
WHOLE OR IN PART, THE MONEYS REIMBURSED BY THE STATE IN ACCORDANCE WITH
THIS SECTION FOR SPECIFIED POLICY PERIODS, UPON A CERTIFICATION TO THE
INSURER BY THE SUPERINTENDENT OF FINANCIAL SERVICES THAT THERE IS A
REASONABLE LIKELIHOOD ON AN ACTUARIAL BASIS THAT THE MONEYS RETURNED
WILL NOT BE NEEDED TO PAY FOR THE EXPECTED LIABILITIES INCURRED BY THE
INSURER FOR SUCH POLICY PERIODS.
S. 6256--B 111 A. 9056--B
10. THE SUPERINTENDENT OF FINANCIAL SERVICES AND THE COMMISSIONER MAY
ADOPT AND MAY AMEND SUCH REGULATIONS AS ARE NECESSARY TO EFFECTUATE THE
PROVISIONS OF THIS SECTION.
S 4. This act shall take effect immediately.
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 S of this act shall be
as specifically set forth in the last section of such Parts.