[ ] is old law to be omitted.
LBD12676-01-4
S. 6914 2 A. 9205
the social services law, in relation to review of criminal history
information concerning prospective employees; to amend the public
health law, in relation to the provision of contact information relat-
ing to long term care; to amend the public health law and the state
finance law, in relation to the operation of the New York State donate
life registry; to amend the social services law and the public health
law, in relation to streamlining the application process for adult
care facilities and assisted living residences; to amend the public
health law, in relation to the long term home health care program; to
amend the public health law, in relation to resident working audits;
to amend chapter 58 of the laws of 2008 amending the elder law and
other laws relating to reimbursement to particular provider pharmacies
and prescription drug coverage, in relation to the effectiveness ther-
eof; and to repeal certain provisions of the public health law and the
state finance law relating thereto (Part A); to amend the New York
Health Care Reform Act of 1996, in relation to extending certain
provisions relating thereto; to amend the New York Health Care Reform
Act of 2000, in relation to extending the effectiveness of provisions
thereof; to amend the public health law, in relation to the distrib-
ution of pool allocations and graduate medical education; to amend
chapter 62 of the laws of 2003 amending the general business law and
other laws relating to enacting major components necessary to imple-
ment the state fiscal plan for the 2003-04 state fiscal year, in
relation to the deposit of certain funds; to amend the public health
law, in relation to health care initiative pool distributions; to
amend the social services law, in relation to extending payment
provisions for general hospitals; to amend chapter 600 of the laws of
1986 amending the public health law relating to the development of
pilot reimbursement programs for ambulatory care services, in relation
to the effectiveness of such chapter; to amend chapter 520 of the laws
of 1978 relating to providing for a comprehensive survey of health
care financing, education and illness prevention and creating councils
for the conduct thereof, in relation to extending the effectiveness of
portions thereof; to amend the public health law, in relation to
extending access to community health care services in rural areas; to
amend the public health law, in relation to rates of payment for
personal care service providers; to amend the public health law, in
relation to the assessment on covered lives; to amend the public
health law, in relation to the comprehensive diagnostic and treatment
centers indigent care program; to amend the public health law, in
relation to general hospital indigent pool and general hospital inpa-
tient reimbursement rates; to amend chapter 266 of the laws of 1986
amending the civil practice law and rules and other laws relating to
malpractice and professional medical conduct, in relation to extending
the applicability of certain provisions thereof; and to amend chapter
63 of the laws of 2001 amending chapter 20 of the laws of 2001 amend-
ing the military law and other laws relating to making appropriations
for the support of government, in relation to extending the applica-
bility of certain provisions thereof (Part B); to amend the social
services law, in relation to eliminating prescriber prevails for brand
name drugs with generic equivalents; directing the department of
health to develop new methodology for pharmacy reimbursement; to amend
the public health law, in relation to minimum supplemental rebates for
pharmaceutical manufacturers; to amend the social services law, in
relation to early refill of prescriptions; to amend the social
services law, in relation to emergency and non-emergency transporta-
S. 6914 3 A. 9205
tion; to amend section 45-c of part A of chapter 56 of the laws of
2013, relating to the report on the transition of behavioral health
services as a managed care benefit in the medical assistance program,
in relation to reports on the transition of behavior health services;
to amend the social services law, in relation to the integration of
behavioral and physical health clinic services; to amend part A of
chapter 56 of the laws of 2013 amending chapter 59 of the laws of 2011
amending the public health law and other laws relating to general
hospital reimbursement for annual rates relating to the cap on local
Medicaid expenditures, in relation to establishing rate protections
for behavioral health essential providers and the effectiveness there-
of; to amend section 1 of part H of chapter 111 of the laws of 2010,
relating to increasing Medicaid payments to providers through managed
care organizations and providing equivalent fees through an ambulatory
patient group methodology, in relation to transfer of funds and the
effectiveness thereof; to amend the social services law, in relation
to spousal support for the costs of community-based long term care; to
amend the social services law, in relation to fair hearings within the
Fully Integrated Duals Advantage program; to amend the public health
law, in relation to the establishment of a default rate for nursing
homes under managed care; to amend the public health law, in relation
to rates of payment for certified home health agencies and long term
home health care programs; to amend social services law in relation to
Community First Choice Option; to amend education law in relation to
developing training curricula to educate certain home health aides; to
amend public health law in relation to Development Disabilities Indi-
vidual Care and Support Organization; to amend the public health law,
in relation to rate setting methodologies for the ICD-10; to amend the
public health law, in relation to inpatient psych base years; to amend
the public health law, in relation to specialty inpatient base years;
to amend the public health law, in relation to inpatient psych base
years; to amend the public health law, in relation to hospital inpa-
tient base years; to amend 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 fund medicaid expenditures, in
relation to the determination of rates of payments by certain state
governmental agencies; to amend the social services law and the public
health law, in relation to requiring the use of an enrollment broker
for counties that are mandated Medicaid managed care and managed long
term care; to amend the public health law, in relation to establishing
vital access pools for licensed home care service agencies; to amend
the social services law, in relation to the expansion of the Medicaid
managed care advisory review panel; to amend part H of chapter 59 of
the laws of 2011 amending the public health law relating to general
hospital inpatient reimbursement for annual rates, in relation to the
across the board reduction of 2011; to amend the social services law,
in relation to establishing a health homes criminal justice initi-
ative; to amend the social services law, in relation to the transition
of children in foster care to managed care; to amend the social
services law and the state finance law, in relation to the establish-
ment of a basic health plan; to amend the social services law, in
relation to hospital presumptive eligibility under the affordable care
act; to amend the state finance law, in relation to a basic health
program trust fund and a state health innovation plan account; to
amend the social services law, in relation to spending down procedures
under the MAGI system of eligibility determination; to amend the
S. 6914 4 A. 9205
public health law, in relation to moving rate setting for child health
plus to the department of health; to amend the public health law, in
relation to eliminating the existing child health plus waiting period;
to amend chapter 2 of the laws of 1998, amending the public health law
and other laws relating to expanding the child health insurance plan,
in relation to allowing for the permanent expansion of child health
plus income and benefit provisions; to amend the public health law in
relation to potentially preventable negative outcomes; to amend the
public health law, in relation to a rural dentistry pilot program; to
amend chapter 779 of the laws of 1986, amending the social services
law relating to authorizing services for non-residents in adult homes,
residences for adults and enriched housing programs, in relation to
extending the authorization of non-resident services within adult
homes; to amend part C of chapter 58 of the laws of 2008, amending the
social services law and the public health law relating to adjustments
of rates, in relation to extending the utilization threshold
exemption; to amend chapter 19 of the laws of 1998, amending the
social services law relating to limiting the method of payment for
prescription drugs under the medical assistance program, in relation
to extending provisions related to dispensing fees; to amend the
public health law, in relation to rates of payment to residential
health care facilities; to amend chapter 731 of the laws of 1993,
amending the public health law and other laws relating to reimburse-
ment, delivery and capital cost of ambulatory health care services and
inpatient hospital services, in relation to the effectiveness thereof;
to amend chapter 904 of the laws of 1984, amending the public health
law and the social services law relating to encouraging comprehensive
health services, in relation to the effectiveness thereof; providing
for the repeal of certain provisions relating to the availability of
funds upon expiration thereof; providing for the repeal of certain
provisions relating to the availability of funds upon expiration ther-
eof; and to repeal certain provisions of the social services law and
the public health law relating thereto (Part C); to amend the educa-
tion law and the public health law, in relation to the practice of
pharmacy and the compounding of drugs, and establishing requirements
for the registration of outsourcing facilities in New York state (Part
D); to amend the mental hygiene law, in relation to establishing an
integrated employment plan (Part E); directing a report by the office
for people with developmental disabilities on the establishment of a
direct support professional credentialing pilot program (Part F); to
amend the mental hygiene law and the state finance law, in relation to
community mental health support and workforce reinvestment funds; and
to amend chapter 62 of the laws of 2003, amending the mental hygiene
law and the state finance law relating to the community mental health
support and workforce reinvestment program, the membership of subcom-
mittees for mental health of community services boards and the duties
of such subcommittees and creating the community mental health and
workforce reinvestment account, in relation to extending such
provisions relating thereto (Part G); to amend the insurance law, the
public health law and the financial services law, in relation to
establishing protections to prevent surprise medical bills including
network adequacy requirements, claim submission requirements, access
to out-of-network care and prohibition of excessive emergency charges
(Part H); and to amend chapter 57 of the laws of 2006, relating to
establishing a cost of living adjustment for designated human services
S. 6914 5 A. 9205
programs, in relation to forgoing such adjustment during the 2014-2015
state fiscal year (Part I)
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 2014-2015
state fiscal year. Each component is wholly contained within a Part
identified as Parts A through I. 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 1 of section 602 of the public
health law, as added by section 16 of part E of chapter 56 of the laws
of 2013, is amended to read as follows:
(a) Family health, which shall include activities designed to reduce
perinatal, infant and maternal mortality and morbidity and to promote
the health of infants, children, adolescents, and people of childbearing
age. Such activities shall include family centered perinatal services
and other services appropriate to promote the birth of a healthy baby to
a healthy mother, and services to assure that infants, young children,
and school age children are enrolled in appropriate health insurance
programs and other health benefit programs for which they are eligible,
and that the parents or guardians of such children are provided with
information concerning health care providers in their area that are
willing and able to provide health services to such children. Provision
of primary and preventive clinical health care services shall be eligi-
ble for state aid for uninsured persons under the age of twenty-one,
provided that the municipality makes good faith efforts to assist such
persons with insurance enrollment and only until such time as enrollment
becomes effective. PROVISION OF PRENATAL CLINICAL HEALTH CARE SERVICES
SHALL BE ELIGIBLE FOR STATE AID FOR UNINSURED WOMEN OF ANY AGE, PROVIDED
THAT THE MUNICIPALITY MAKES GOOD FAITH EFFORTS TO ASSIST SUCH WOMEN WITH
INSURANCE ENROLLMENT AND ONLY UNTIL SUCH TIME AS ENROLLMENT BECOMES
EFFECTIVE.
S 2. Subdivisions 1, 2, 2-a, 2-b, 2-c, 3 and 4 of section 2781 of the
public health law, subdivisions 1, 2, 3 and 4 as amended and subdivi-
sions 2-a, 2-b and 2-c as added by chapter 308 of the laws of 2010, are
amended to read as follows:
1. Except as provided in section three thousand one hundred twenty-one
of the civil practice law and rules, or unless otherwise specifically
authorized or required by a state or federal law, no person shall order
the performance of an HIV related test without first having received
[the written or, where authorized by this subdivision, oral,] informed
consent of the subject of the test who has capacity to consent or, when
the subject lacks capacity to consent, of a person authorized pursuant
to law to consent to health care for such individual. [When the test
S. 6914 6 A. 9205
being ordered is a rapid HIV test, such informed consent may be obtained
orally and shall be documented in the subject of the test's medical
record by the person ordering the performance of the test.] IN ORDER FOR
THERE TO BE INFORMED CONSENT, THE PERSON ORDERING THE TEST SHALL, PRIOR
TO OBTAINING INFORMED CONSENT, AT A MINIMUM ADVISE THE PROTECTED INDI-
VIDUAL THAT AN HIV-RELATED TEST IS BEING PERFORMED.
2. [Except where subdivision one of this section permits informed
consent to be obtained orally, informed consent to HIV related testing
shall consist of a statement consenting to HIV related testing signed by
the subject of the test who has capacity to consent or, when the subject
lacks capacity to consent, by a person authorized pursuant to law to
consent to health care for the subject after the subject or such other
person has received the information described in subdivision three of
this section.
2-a. Where a written consent to HIV related testing is included in a
signed general consent to medical care for the subject of the test or in
a signed consent to any health care service for the subject of the test,
the consent form shall have a clearly marked place adjacent to the
signature where the subject of the test, or, when the subject lacks
capacity to consent, a person authorized pursuant to law to consent to
health care for such individual, shall be given an opportunity to
specifically decline in writing HIV related testing on such general
consent.
2-b. A written or oral informed] INFORMED consent for HIV related
testing pursuant to this section shall be valid for such testing until
such consent is revoked [or expires by its terms]. Each time that an HIV
related test is ordered pursuant to informed consent in accordance with
this section, the physician or other person authorized pursuant to law
to order the performance of the HIV related test, or such person's
representative, shall orally notify the subject of the test or, when the
subject lacks capacity to consent, a person authorized pursuant to law
to consent to health care for such individual, that an HIV related test
will be conducted at such time, and shall note the notification in the
patient's record.
[2-c.] 2-A. The provisions of this section regarding [oral] informed
consent [for a rapid HIV test] shall not apply to tests performed in a
facility operated under the correction law. FOR TESTS CONDUCTED IN A
FACILITY UNDER THE CORRECTION LAW, INDIVIDUAL CONSENT FOR HIV RELATED
TESTING MUST BE IN WRITING.
3. [Prior to the execution of written, or obtaining and documenting
oral, informed consent, a] A person ordering the performance of an HIV
related test shall provide either directly or through a representative
to the subject of an HIV related test or, if the subject lacks capacity
to consent, to a person authorized pursuant to law to consent to health
care for the subject, an explanation that:
(a) HIV causes AIDS and can be transmitted through sexual activities
and needle-sharing, by pregnant women to their fetuses, and through
breastfeeding infants;
(b) there is treatment for HIV that can help an individual stay heal-
thy;
(c) individuals with HIV or AIDS can adopt safe practices to protect
uninfected and infected people in their lives from becoming infected or
multiply infected with HIV;
(d) testing is voluntary and can be done anonymously at a public test-
ing center;
(e) the law protects the confidentiality of HIV related test results;
S. 6914 7 A. 9205
(f) the law prohibits discrimination based on an individual's HIV
status and services are available to help with such consequences; and
(g) the law allows an individual's informed consent for HIV related
testing to be valid for such testing until such consent is revoked by
the subject of the HIV RELATED test [or expires by its terms].
Protocols shall be in place to ensure compliance with this section.
4. A person authorized pursuant to law to order the performance of an
HIV related test shall provide directly or through a representative to
the person seeking such test, an opportunity to remain anonymous [and to
provide written, informed consent or authorize documentation of oral
informed consent,] through use of a coded system with no linking of
individual identity to the test request or results. A health care
provider who is not authorized by the commissioner to provide HIV
related tests on an anonymous basis shall refer a person who requests an
anonymous test to a test site which does provide anonymous testing. The
provisions of this subdivision shall not apply to a health care provider
ordering the performance of an HIV related test on an individual
proposed for insurance coverage.
S 3. Section 2135 of the public health law, as amended by chapter 308
of the laws of 2010, is amended to read as follows:
S 2135. Confidentiality. All reports or information secured by the
department, municipal health commissioner or district health officer
under the provisions of this title shall be confidential except: (a) in
so far as is necessary to carry out the provisions of this title; (b)
when used in the aggregate, without patient specific identifying infor-
mation, in programs approved by the commissioner for the improvement of
the quality of medical care provided to persons with HIV/AIDS; [or] (c)
when used within the state or local health department by public health
disease programs to assess co-morbidity or completeness of reporting and
to direct program needs, in which case patient specific identifying
information shall not be disclosed outside the state or local health
department; OR (D) WHEN USED FOR PURPOSES OF PATIENT LINKAGE AND
RETENTION IN CARE, PATIENT SPECIFIC IDENTIFIED INFORMATION MAY BE SHARED
BETWEEN LOCAL AND STATE HEALTH DEPARTMENTS AND HEALTH CARE PROVIDERS
CURRENTLY TREATING THE PATIENT AS APPROVED BY THE COMMISSIONER.
S 4. Intentionally omitted.
S 5. Subdivision 1 of section 2411 of the public health law, as
amended by chapter 219 of the laws of 1997, paragraph (e) as amended by
chapter 106 of the laws of 2013, and paragraph (h) as amended by chapter
638 of the laws of 2008, is amended to read as follows:
1. The board shall:
(a) Survey state agencies, boards, programs and other state govern-
mental entities to assess what, if any, relevant data has been or is
being collected which may be of use to researchers engaged in breast[,
prostate or testicular] cancer research;
(b) Consistent with the survey conducted pursuant to paragraph (a) of
this subdivision, compile a list of data collected by state agencies
which may be of assistance to researchers engaged in breast[, prostate
or testicular] cancer research as established in section twenty-four
hundred twelve of this title;
(c) Consult with the Centers for Disease Control and Prevention, the
National Institutes of Health, the Federal Agency For Health Care Policy
and Research, the National Academy of Sciences and other organizations
or entities which may be involved in cancer research to solicit both
information regarding breast[, prostate and testicular] cancer research
S. 6914 8 A. 9205
projects that are currently being conducted and recommendations for
future research projects;
(d) Review requests made to the commissioner for access to information
pursuant to paragraph b of subdivision one of section 33-1203 and para-
graph c of subdivision two of section 33-1205 of the environmental
conservation law for use in human health related research projects. Such
data shall only be provided to researchers engaged in human health
related research. The request made by such researchers shall include a
copy of the research proposal or the research protocol approved by their
institution and copies of their institution's Institutional Review Board
(IRB) or equivalent review board approval of such proposal or protocol.
In the case of research conducted outside the auspices of an institution
by a researcher previously published in a peer-reviewed scientific jour-
nal, the board shall request copies of the research proposal and shall
deny access to the site-specific and nine-digit zip code pesticide data
if the board determines that such proposal does not follow accepted
scientific practice for the design of a research project. The board
shall establish guidelines to restrict the dissemination by researchers
of the name, address or other information that would otherwise identify
a commercial applicator or private applicator or any person who receives
the services of a commercial applicator;
(e) Solicit, receive, and review applications from public and private
agencies and organizations and qualified research institutions for
grants from the breast cancer research and education fund, created
pursuant to section ninety-seven-yy of the state finance law, to conduct
research or educational programs which focus on the causes, prevention,
screening, treatment and cure of breast cancer and may include, but are
not limited to mapping of breast cancer, and basic, behavioral, clin-
ical, demographic, environmental, epidemiologic and psychosocial
research. The board shall make recommendations to the commissioner, and
the commissioner shall, in his or her discretion, grant approval of
applications for grants from those applications recommended by the
board. The board shall consult with the Centers for Disease Control and
Prevention, the National Institutes of Health, the Federal Agency For
Health Care Policy and Research, the National Academy of Sciences,
breast cancer advocacy groups, and other organizations or entities which
may be involved in breast cancer research to solicit both information
regarding breast cancer research projects that are currently being
conducted and recommendations for future research projects. As used in
this section, "qualified research institution" may include academic
medical institutions, state or local government agencies, public or
private organizations within this state, and any other institution
approved by the department, which is conducting a breast cancer research
project or educational program. If a board member submits an application
for a grant from the breast cancer research and education fund, he or
she shall be prohibited from reviewing and making a recommendation on
the application;
(f) Consider, based on evolving scientific evidence, whether a corre-
lation exists between pesticide use and pesticide exposure. As part of
such consideration the board shall make recommendations as to methodol-
ogies which may be utilized to establish such correlation;
(g) After two years of implementation of pesticide reporting pursuant
to section 33-1205 of the environmental conservation law, the board
shall compare the percentage of agricultural crop production general use
pesticides being reported to the total amount of such pesticides being
used in this state as estimated by Cornell University, Cornell Cooper-
S. 6914 9 A. 9205
ative Extension, the department of environmental conservation, and the
Environmental Protection Agency;
(h) Meet at least six times in the first year, at the request of the
chair and at any other time as the chair deems necessary. The board
shall meet at least [four] TWO times a year AND AS NEEDED thereafter.
Provided, however, that at least one such meeting a year shall be a
public hearing, at which the general public may question and present
information and comments to the board with respect to the operation of
the health research science board, the breast cancer research and educa-
tion fund[, the prostate and testicular cancer research and education
fund], and pesticide reporting established pursuant to sections 33-1205
and 33-1207 of the environmental conservation law. At such hearing, the
commissioner of the department of environmental conservation or his or
her designee shall make a report to the board with respect to the effi-
ciency and utility of pesticide reporting established pursuant to
sections 33-1205 and 33-1207 of the environmental conservation law.
SHOULD THE EXISTING BYLAWS BE AMENDED BY THE BOARD, ANY SUCH AMENDMENTS
SHALL BE CONSISTENT WITH THE REVISIONS OF THIS PARAGRAPH;
S 5-a. Section 2413 of the public health law, as amended by chapter
219 of the laws of 1997, is amended to read as follows:
S 2413. Biennial report. The commissioner shall submit a report on or
before January first commencing in nineteen hundred ninety-nine, and
biennially thereafter, to the governor, the temporary president of the
senate and the speaker of the assembly concerning the operation of the
health research science board. Such report shall include recommendations
from the health research science board including, but not limited to,
the types of data that would be useful for breast[, prostate or testicu-
lar] cancer researchers and whether private citizen use of residential
pesticides should be added to the reporting requirements. The report
shall also include a summary of research requests granted or denied. In
addition, such report shall include an evaluation by the commissioner,
the commissioner of the department of environmental conservation and the
health research science board of the basis, efficiency and scientific
utility of the information derived from pesticide reporting pursuant to
sections 33-1205 and 33-1207 of the environmental conservation law and
recommend whether such system should be modified or continued. The
report shall include a summary of the comments and recommendations
presented by the public at the board's public hearings.
S 5-b. Section 97-yy of the state finance law is amended by adding a
new subdivision 2-b to read as follows:
2-B. ON OR BEFORE THE FIRST DAY OF FEBRUARY EACH YEAR, THE COMMISSION-
ER OF HEALTH SHALL PROVIDE A WRITTEN REPORT TO THE TEMPORARY PRESIDENT
OF THE SENATE, SPEAKER OF THE ASSEMBLY, CHAIR OF THE SENATE FINANCE
COMMITTEE, CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE, CHAIR OF THE
SENATE COMMITTEE ON HEALTH, AND CHAIR OF THE ASSEMBLY HEALTH COMMITTEE.
SUCH REPORT SHALL INCLUDE HOW THE MONIES OF THE FUND WERE UTILIZED
DURING THE PRECEDING CALENDAR YEAR, AND SHALL INCLUDE:
(I) THE AMOUNT OF MONEY DISPERSED FROM THE FUND;
(II) RECIPIENTS OF AWARDS FROM THE FUND;
(III) THE AMOUNT AWARDED TO EACH; AND
(IV) THE PURPOSES FOR WHICH SUCH AWARDS WERE GRANTED.
S 6. Section 2409-a of the public health law, as added by section 73
of part D of chapter 60 of the laws of 2012, is amended to read as
follows:
S 2409-a. Advisory council. 1. There is hereby established in the
department the [breast, cervical and ovarian] cancer detection and
S. 6914 10 A. 9205
education program advisory council, for the purpose of advising the
commissioner with regards to providing information to consumers,
patients, and health care providers relating, but not limited to,
breast, cervical, PROSTATE, TESTICULAR and ovarian cancer, including
signs and symptoms, risk factors, the benefits of prevention and early
detection, guideline concordant cancer screening and disease management,
options for diagnostic testing and treatment, new technologies, and
survivorship.
2. The advisory council shall: (A) make recommendations to the depart-
ment regarding the promotion and implementation of programs under
sections twenty-four hundred six and twenty-four hundred nine of this
title; AND (B) PRIOR TO THE DEPARTMENT PROVIDING GRANTS FROM THE NEW
YORK STATE PROSTATE AND TESTICULAR CANCER RESEARCH AND EDUCATION FUND,
CREATED PURSUANT TO SECTION NINETY-FIVE-E OF THE STATE FINANCE LAW,
ADVISE THE DEPARTMENT ON VARIOUS COMPONENTS OF THE DEPARTMENT'S SOLIC-
ITATION TO DISTRIBUTE SUCH FUNDS, INCLUDING BUT NOT LIMITED TO, THE
POTENTIAL USES OF THE FUNDS, THE ENTITIES THAT MAY BE ELIGIBLE TO APPLY
FOR THE FUNDS, THE RECOMMENDED CONTRACT DELIVERABLES FOR ENTITIES
RECEIVING THE FUNDS, THE RECOMMENDED GEOGRAPHIC DISTRIBUTION OF THE
FUNDS, AND THE RECOMMENDED AWARD AMOUNTS.
3. The commissioner shall appoint twenty-one voting members, which
shall include representation of health care professionals, consumers,
patients, ONE VOTING MEMBER WHO SHALL BE A PERSON WHO HAS OR HAS HAD
PROSTATE OR TESTICULAR CANCER, ONE VOTING MEMBER WHO SHALL BE A PERSON
WHO HAS OR HAS HAD BREAST, CERVICAL OR OVARIAN CANCER and other appro-
priate [interest] INTERESTS reflective of the diversity of the state,
with expertise in breast, cervical, PROSTATE, TESTICULAR and/or ovarian
cancer. The commissioner shall appoint one member as a chairperson. The
members of the council shall receive no compensation for their services,
but shall be allowed their actual and necessary expenses incurred in
performance of their duties.
4. A majority of the appointed voting membership of the board shall
constitute quorum.
5. The advisory council shall meet at least twice a year, at the
request of the department.
S 7. Section 95-e of the state finance law, as added by chapter 273 of
the laws of 2004, subdivision 2 as amended by section 1 of part A of
chapter 58 of the laws of 2004, is amended to read as follows:
S 95-e. New York [state] STATE prostate AND TESTICULAR cancer
research[, detection] and education fund. 1. There is hereby established
in the joint custody of the commissioner of taxation and finance and the
comptroller, a special fund to be known as the "New York [state] STATE
prostate AND TESTICULAR cancer research[, detection] and education
fund".
2. Such fund shall consist of all revenues received pursuant to the
provisions of SECTION FOUR HUNDRED FOUR-Q OF THE VEHICLE AND TRAFFIC
LAW, AS ADDED BY CHAPTER FIVE HUNDRED TWENTY-EIGHT OF THE LAWS OF NINE-
TEEN HUNDRED NINETY-NINE, AND sections two hundred nine-E and six
hundred thirty of the tax law, all revenues received pursuant to appro-
priations by the legislature, and all moneys appropriated, credited, or
transferred thereto from any other fund or source pursuant to law. For
each state fiscal year, there shall be appropriated to the fund by the
state, in addition to all other moneys required to be deposited into
such fund, an amount equal to the amounts of monies collected and depos-
ited into the fund pursuant to SECTION FOUR HUNDRED FOUR-Q OF THE VEHI-
CLE AND TRAFFIC LAW, AS ADDED BY CHAPTER FIVE HUNDRED TWENTY-EIGHT OF
S. 6914 11 A. 9205
THE LAWS OF NINETEEN HUNDRED NINETY-NINE, AND sections two hundred
[nine-e] NINE-E and six hundred thirty of the tax law during the preced-
ing calendar year, as certified by the comptroller. Nothing contained
herein shall prevent the state from receiving grants, gifts or bequests
for the purposes of the fund as defined in this section and depositing
them into the fund according to law. Any interest received by the comp-
troller on moneys on deposit in such fund shall be retained in and
become part of such fund.
3. (A) Moneys of the fund [shall be expended only to provide grants to
the New York State Coalition to Cure Prostate Cancer, a not-for-profit
corporation established in this state which is incorporated], FOLLOWING
APPROPRIATION BY THE LEGISLATURE AND ALLOCATION BY THE DIRECTOR OF THE
BUDGET, SHALL BE MADE AVAILABLE TO THE COMMISSIONER OF HEALTH TO PROVIDE
GRANTS for the purpose of advancing and financing prostate AND TESTICU-
LAR cancer research, [detection] SUPPORT PROGRAMS and education
projects. [To the extent practicable, the New York State Coalition to
Cure Prostate Cancer shall cooperate and coordinate its efforts with the
prostate and testicular cancer detection and education advisory council
established pursuant to section twenty-four hundred sixteen of the
public health law.]
(B) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTION ONE HUNDRED
SIXTY-THREE OF THE STATE FINANCE LAW, THE COMMISSIONER OF HEALTH IS
AUTHORIZED TO ENTER INTO A CONTRACT OR CONTRACTS UNDER PARAGRAPH (A) OF
THIS SUBDIVISION WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROC-
ESS, PROVIDED, HOWEVER, THAT:
(I) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
OF NO LESS THAN THIRTY DAYS:
(1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
TION IS FIRST POSTED ON THE WEBSITE; AND
(4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER OF HEALTH; AND
(III) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
PURPOSES OF THIS SECTION.
4. (A) On or before the first day of February each year, the comp-
troller shall certify to the governor, temporary president of the
senate, speaker of the assembly, chair of the senate finance committee
and chair of the assembly ways and means committee, the amount of money
deposited by source in the New York [state] STATE prostate AND TESTICU-
LAR cancer research[, detection] and education fund during the preceding
calendar year as the result of revenue derived pursuant to SECTION FOUR
HUNDRED FOUR-Q OF THE VEHICLE AND TRAFFIC LAW, AS ADDED BY CHAPTER FIVE
HUNDRED TWENTY-EIGHT OF THE LAWS OF NINETEEN HUNDRED NINETY-NINE, AND
sections two hundred nine-E and six hundred thirty of the tax law and
from all other sources.
(B) ON OR BEFORE THE FIRST DAY OF FEBRUARY EACH YEAR, THE COMMISSIONER
OF HEALTH SHALL PROVIDE A WRITTEN REPORT TO THE TEMPORARY PRESIDENT OF
THE SENATE, SPEAKER OF THE ASSEMBLY, CHAIR OF THE SENATE FINANCE COMMIT-
TEE, CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE, CHAIR OF THE SENATE
S. 6914 12 A. 9205
COMMITTEE ON HEALTH, AND CHAIR OF THE ASSEMBLY HEALTH COMMITTEE. SUCH
REPORT SHALL INCLUDE HOW MONIES OF THE FUND WERE UTILIZED DURING THE
PRECEDING CALENDAR YEAR AND SHALL INCLUDE:
(I) THE AMOUNT OF MONEY DISBURSED FROM THE FUND;
(II) RECIPIENTS OF AWARDS FROM THE FUND;
(III) THE AMOUNT AWARDED TO EACH; AND
(IV) THE PURPOSES FOR WHICH SUCH AWARDS WERE GRANTED.
5. [As a condition of receiving grants from the fund, the New York
State Coalition To Cure Prostate Cancer shall agree to issue and shall
issue, on or before the first day of February each year, a report
including, but not limited to, financial statements, financial reports
and reports on the issuance of grants. Such reports shall be delivered
to the governor and the chairs of the senate finance committee and the
assembly ways and means committee and shall also be made available to
the public. Such financial statements and reports shall be audited by a
nationally recognized accounting firm.
6.] Moneys shall be payable from the fund [to the New York State
Coalition to Cure Prostate Cancer] on the audit and warrant of the comp-
troller on vouchers approved by the comptroller.
S 7-a. Subdivision 2 of section 404-q of the vehicle and traffic law,
as added by chapter 528 of the laws of 1999, is amended to read as
follows:
2. A distinctive "drive for the cure" license plate issued pursuant to
this section shall be issued in the same manner as other number plates
upon the payment of the regular registration fee prescribed by section
four hundred one of this article, provided, however, that an additional
annual service charge of twenty-five dollars shall be charged for such
plate. Twelve dollars and fifty cents from each twenty-five dollars
received as annual service charges under this section shall be deposited
to the credit of the breast cancer research and education fund estab-
lished pursuant to section ninety-seven-yy of the state finance law and
shall be used for research and education programs undertaken pursuant to
section twenty-four hundred ten of the public health law. Twelve dollars
and fifty cents from each twenty-five dollars received as annual service
charges under this section shall be deposited to the credit of the NEW
YORK STATE prostate and testicular cancer research and education fund
established pursuant to section [ninety-seven-ccc] NINETY-FIVE-E of the
state finance law and shall be used for research and education programs
undertaken pursuant to section [ninety-seven-ccc] NINETY-FIVE-E of the
state finance law. Provided, however that one year after the effective
date of this section funds in the amount of six thousand dollars, or so
much thereof as may be available, shall be allocated to the department
to offset costs associated with the production of such license plates.
S 7-b. Section 97-ccc of the state finance law is REPEALED.
S 7-c. Section 209-E of the tax law, as added by chapter 273 of the
laws of 2004, is amended to read as follows:
S 209-E. Gift for prostate AND TESTICULAR cancer research[, detection]
and education. Effective for any tax year commencing on or after Janu-
ary first, two thousand four, a taxpayer in any taxable year may elect
to contribute to the support of the New York [state] STATE prostate AND
TESTICULAR cancer research[, detection] and education fund. Such
contribution shall be in any whole dollar amount and shall not reduce
the amount of the state tax owed by such taxpayer. The commissioner
shall include space on the corporate income tax return to enable a
taxpayer to make such contribution. Notwithstanding any other provision
of law, all revenues collected pursuant to this section shall be credit-
S. 6914 13 A. 9205
ed to the New York [state] STATE prostate AND TESTICULAR cancer
research[, detection] and education fund and shall be used only for
those purposes enumerated in section ninety-five-e of the state finance
law.
S 7-d. Section 630 of the tax law, as added by chapter 273 of the laws
of 2004, is amended to read as follows:
S 630. Gift for prostate AND TESTICULAR cancer research[, detection]
and education. Effective for any tax year commencing on or after Janu-
ary first, two thousand four, an individual in any taxable year may
elect to contribute to the New York [state] STATE prostate AND TESTICU-
LAR cancer research[, detection] and education fund. Such contribution
shall be in any whole dollar amount and shall not reduce the amount of
state tax owed by such individual. The commissioner shall include space
on the personal income tax return to enable a taxpayer to make such
contribution. Notwithstanding any other provision of law all revenues
collected pursuant to this section shall be credited to the New York
[state] STATE prostate AND TESTICULAR cancer research[, detection] and
education fund and used only for those purposes enumerated in section
ninety-five-e of the state finance law.
S 8. The public health law is amended by adding a new section 2825 to
read as follows:
S 2825. CAPITAL RESTRUCTURING FINANCING PROGRAM. 1. A CAPITAL RESTRUC-
TURING FINANCING PROGRAM IS HEREBY ESTABLISHED UNDER THE JOINT ADMINIS-
TRATION OF THE COMMISSIONER AND THE PRESIDENT OF THE DORMITORY AUTHORITY
OF THE STATE OF NEW YORK FOR THE PURPOSE OF ENHANCING THE QUALITY,
FINANCIAL VIABILITY AND EFFICIENCY OF NEW YORK'S HEALTH CARE DELIVERY
SYSTEM BY TRANSFORMING THE SYSTEM INTO A MORE RATIONAL PATIENT-CENTERED
CARE SYSTEM THAT PROMOTES POPULATION HEALTH AND IMPROVED WELL-BEING FOR
ALL NEW YORKERS. THE ISSUANCE OF ANY BONDS OR NOTES HEREUNDER SHALL
FURTHER BE SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE DIVISION OF
THE BUDGET, AND ANY PROJECTS FUNDED THROUGH THE ISSUANCE OF BONDS OR
NOTES HEREUNDER SHALL BE APPROVED BY THE NEW YORK STATE PUBLIC AUTHORI-
TIES CONTROL BOARD, AS REQUIRED UNDER SECTION FIFTY-ONE OF THE PUBLIC
AUTHORITIES LAW.
2. FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND TWENTY-ONE, FUNDS MADE AVAILABLE FOR EXPENDI-
TURE PURSUANT TO THIS SECTION MAY BE DISTRIBUTED BY THE COMMISSIONER AND
THE PRESIDENT OF THE AUTHORITY, IN CONSULTATION WITH THE COMMISSIONERS
OF THE OFFICE OF MENTAL HEALTH, OFFICE FOR PEOPLE WITH DEVELOPMENTAL
DISABILITIES AND OFFICE FOR ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, AS
APPLICABLE, FOR:
(A) CAPITAL GRANTS TO GENERAL HOSPITALS, RESIDENTIAL HEALTH CARE
FACILITIES, DIAGNOSTICS AND TREATMENT CENTERS, AND CLINICS LICENSED
PURSUANT TO THIS CHAPTER OR THE MENTAL HYGIENE LAW, ASSISTED LIVING
PROGRAMS, PRIMARY CARE PROVIDERS, AND HOME CARE PROVIDERS CERTIFIED OR
LICENSED PURSUANT TO ARTICLE THIRTY-SIX OF THIS CHAPTER (COLLECTIVELY
"APPLICANTS") THAT QUALIFY FOR PAYMENTS UNDER THE DELIVERY SYSTEM REFORM
INCENTIVE PAYMENT PROGRAM (DSRIP), IN WHICH CASE FUNDING UNDER THIS
PARAGRAPH SHALL BE REQUESTED IN SUCH APPLICANT'S DSRIP APPLICATION. SUCH
CAPITAL GRANT PROJECTS INCLUDE, BUT ARE NOT LIMITED TO; CLOSURES, MERG-
ERS, RESTRUCTURING, IMPROVEMENTS TO INFRASTRUCTURE, DEVELOPMENT OF
PRIMARY CARE SERVICE CAPACITY, DEVELOPMENT OF TELEHEALTH INFRASTRUCTURE,
THE PROMOTION OF INTEGRATED DELIVERY SYSTEMS THAT STRENGTHEN AND PROTECT
CONTINUED ACCESS TO ESSENTIAL HEALTH CARE SERVICES AND OTHER TRANSFORMA-
TIONAL PROJECTS AS DETERMINED BY THE COMMISSIONER AND THE PRESIDENT OF
THE AUTHORITY.
S. 6914 14 A. 9205
(B) CAPITAL GRANTS TO GENERAL HOSPITALS, RESIDENTIAL HEALTH CARE
FACILITIES, DIAGNOSTIC AND TREATMENT CENTERS, AND CLINICS LICENSED
PURSUANT TO THIS CHAPTER OR THE MENTAL HYGIENE LAW, ASSISTED LIVING
PROGRAMS, PRIMARY CARE PROVIDERS, HOME CARE PROVIDERS, CERTIFIED OR
LICENSED PURSUANT TO ARTICLE THIRTY-SIX OF THIS CHAPTER (COLLECTIVELY
"APPLICANTS") THAT ARE NON-QUALIFYING AND NON-PARTICIPATING APPLICANTS
UNDER PARAGRAPH (A) OF THIS SUBDIVISION, FOR CAPITAL NON-OPERATIONAL
WORKS OR PURPOSES THAT SUPPORT THE PURPOSES SET FORTH IN THIS SECTION.
SUCH CAPITAL GRANT PROJECTS INCLUDE, BUT ARE NOT LIMITED TO; CLOSURES,
MERGERS, RESTRUCTURING, IMPROVEMENTS TO INFRASTRUCTURE, DEVELOPMENT OF
PRIMARY CARE SERVICE CAPACITY, DEVELOPMENT OF TELEHEALTH INFRASTRUCTURE,
THE PROMOTION OF INTEGRATED DELIVERY SYSTEMS THAT STRENGTHEN AND PROTECT
CONTINUED ACCESS TO ESSENTIAL HEALTH CARE SERVICES.
3. THE COMMISSIONER AND THE PRESIDENT OF THE AUTHORITY SHALL ENTER
INTO AN AGREEMENT, SUBJECT TO APPROVAL BY THE DIRECTOR OF THE BUDGET AND
SUBJECT TO SECTION SIXTEEN HUNDRED EIGHTY-R OF THE PUBLIC AUTHORITIES
LAW, AS ADDED BY A CHAPTER OF THE LAWS OF TWO THOUSAND FOURTEEN, FOR THE
PURPOSES OF AWARDING, DISTRIBUTING, AND ADMINISTERING THE FUNDS MADE
AVAILABLE PURSUANT TO THIS SECTION.
(A) FOR CAPITAL GRANT PROJECTS UNDER PARAGRAPH (A) OF SUBDIVISION TWO
OF THIS SECTION, THE EVALUATION OF APPLICATIONS SHALL BE SUBMITTED
PURSUANT TO THE PROCESS DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION TWENTY
OF SECTION TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE; PROVIDED, HOWEV-
ER, THAT SUCH CAPITAL GRANT PROJECTS SHALL NOT BE SUBJECT TO REVIEW BY
THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES.
(B) FOR MONIES ALLOCATED UNDER PARAGRAPH (B) OF SUBDIVISION TWO OF
THIS SECTION:
(I) THE DEPARTMENT SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO LESS
THAN THIRTY DAYS:
(A) THE PROCESS BY WHICH SUCH APPLICATIONS SHALL BE REVIEWED;
(B) THE CRITERIA BY WHICH SUCH APPLICATIONS SHALL BE JUDGED; AND
(C) A LIST OF APPROVED AND DENIED APPLICATIONS SUBSEQUENT TO SUCH
DETERMINATION.
(II) THE EVALUATION OF APPLICATIONS SHALL BE REVIEWED BY THE DEPART-
MENT, PURSUANT TO A PROCESS TO BE DETERMINED BY THE DEPARTMENT. APPLICA-
TIONS SHALL THEN BE SUBJECT TO REVIEW BY THE PANEL ESTABLISHED PURSUANT
TO PARAGRAPH (B) OF SUBDIVISION TWENTY OF SECTION TWENTY-EIGHT HUNDRED
SEVEN OF THIS ARTICLE, WHICH SHALL SUBMIT ITS RECOMMENDATIONS TO THE
COMMISSIONER FOR FINAL DETERMINATION. DETERMINATION OF AWARDS FOR FUNDS
ALLOCATED UNDER PARAGRAPH (B) OF SUBDIVISION TWO OF THIS SECTION, SHALL
INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING CRITERIA:
(A) ELIGIBILITY REQUIREMENTS FOR APPLICANTS;
(B) STATEWIDE GEOGRAPHIC DISTRIBUTION OF FUNDS;
(C) MINIMUM AND MAXIMUM AMOUNTS OF FUNDING TO BE AWARDED UNDER THE
PROGRAM;
(D) THE RELATIONSHIP BETWEEN THE PROJECT PROPOSED BY AN APPLICANT AND
IDENTIFIED COMMUNITY NEED;
(E) THE EXTENT TO WHICH THE APPLICANT HAS ACCESS TO ALTERNATIVE
FINANCING;
(F) THE EXTENT TO WHICH THE PROPOSED PROJECT FURTHERS THE PURPOSES SET
FORTH IN THIS SECTION;
(G) THE EXTENT THAT THE PROPOSED PROJECT FURTHERS THE DEVELOPMENT OF
PRIMARY CARE;
(H) THE EXTENT TO WHICH THE PROPOSED PROJECT BENEFITS MEDICAID ENROL-
LEES AND UNINSURED INDIVIDUALS;
S. 6914 15 A. 9205
(I) THE EXTENT TO WHICH THE PROPOSED PROJECT ADDRESSES POTENTIAL RISK
TO PATIENT SAFETY AND WELFARE;
(J) THE EXTENT THAT THE PROPOSED PROJECT INVOLVES AN APPLICANT THAT
RECEIVES OR HAS APPLIED FOR A TEMPORARY RATE ADJUSTMENT PURSUANT TO
APPLICABLE REGULATIONS; AND
(K) THE EXTENT TO WHICH THE PROPOSED PROJECT WILL CONTRIBUTE TO THE
LONG TERM SUSTAINABILITY OF THE APPLICANT.
THE COMMISSIONER SHALL PROVIDE A REPORT ON A QUARTERLY BASIS TO THE
CHAIRS OF THE SENATE FINANCE, ASSEMBLY WAYS AND MEANS, SENATE HEALTH AND
ASSEMBLY HEALTH COMMITTEES. SUCH REPORTS SHALL BE SUBMITTED NO LATER
THAN SIXTY DAYS AFTER THE CLOSE OF THE QUARTER, AND SHALL CONFORM TO THE
REPORTING REQUIREMENTS OF SUBDIVISION TWENTY OF SECTION TWENTY-EIGHT
HUNDRED SEVEN OF THIS ARTICLE, AS APPLICABLE.
S 8-a. Subdivision 20 of section 2807 of the public health law, as
added by section 9 of part Q of chapter 56 of the laws of 2013, is
amended to read as follows:
20. (A) Notwithstanding any contrary provision of law and subject to
the receipt of all necessary federal approvals and the availability of
federal financial participation, the commissioner is authorized to enter
into agreements with SUNY downstate medical center, other public general
hospitals, and/or with the sponsoring local governments of such other
public general hospitals, under which such facilities and/or such local
government shall, by intergovernmental transfer, fund the non-federal
share of Medicaid funds made available for Delivery System Reform Incen-
tive Payments ("[DSRIPS] DSRIP") to such facilities. Such non-federal
share payments shall be deemed voluntary and, further, such payments
shall be excluded from computations made pursuant to section one of part
C of chapter fifty-eight of the laws of two thousand five, as amended.
In addition, the facilities, and/or the sponsoring local governments of
such facilities or the state may, by written notification to the other
parties to the agreement, cancel such agreement at any time prior to the
payment of the DSRIP funds. THE COMMISSIONER SHALL, TO THE MAXIMUM
DEGREE PRACTICABLE, AND TO THE EXTENT PERMITTED BY THE FEDERAL CENTERS
FOR MEDICARE AND MEDICAID SERVICES ("CMS"), ENSURE THAT THE DSRIP
PROGRAM IS IMPLEMENTED THROUGHOUT THE ENTIRE STATE.
(B) THE COMMISSIONER SHALL ESTABLISH AN ADVISORY PANEL TO PROVIDE
ASSISTANCE WITH REGARD TO THE DSRIP PROGRAM. THE PANEL SHALL BE CHARGED
WITH REVIEWING RECOMMENDATIONS FOR DSRIP FUNDING MADE BY THE STATE'S
CONTRACTED DSRIP ASSESSOR AND ADVISING THE COMMISSIONER REGARDING THE
RESULTS OF SUCH REVIEW. SUCH PANEL SHALL ALSO REVIEW APPLICATIONS UNDER
PARAGRAPH (B) OF SUBDIVISION TWO OF SECTION TWENTY-EIGHT HUNDRED TWEN-
TY-FIVE OF THIS ARTICLE. PANEL MEMBERSHIP SHALL BE COMPRISED OF INDIVID-
UALS WITH SIGNIFICANT HEALTH CARE SYSTEM EXPERIENCE. MEMBERS MAY NOT BE
ELECTED OFFICIALS OR EMPLOYED BY PROVIDERS THAT WOULD BENEFIT FROM DSRIP
FUNDING, AND MUST NOT HAVE ANY CONFLICT OF INTEREST THAT WOULD PREVENT
THEM FROM PROVIDING AN IMPARTIAL REVIEW OF DSRIP ASSESSOR RECOMMENDA-
TIONS. THE PANEL SHALL CONSIST OF MEMBERS APPOINTED BY THE COMMISSIONER
AND SHALL IN ADDITION CONSIST OF ONE MEMBER APPOINTED BY THE MAJORITY
LEADER OF THE NEW YORK STATE SENATE, AND ONE MEMBER APPOINTED BY THE
SPEAKER OF THE NEW YORK STATE ASSEMBLY. THE PANEL SHALL CARRY OUT THE
REVIEW OF DSRIP RECOMMENDATIONS IN STRICT ACCORDANCE WITH ALL REQUIRE-
MENTS SET FORTH IN THE STATE'S FEDERAL 1115 MEDICAID WAIVER STANDARD
TERMS AND CONDITIONS. THE PANEL SHALL SUBMIT ITS RECOMMENDATIONS TO THE
COMMISSIONER FOR FINAL DETERMINATION, IN ACCORDANCE WITH ALL REQUIRE-
MENTS SET FORTH IN THE STATE'S FEDERAL 1115 MEDICAID WAIVER STANDARD
TERMS AND CONDITIONS. THE COMMISSIONER MAY MODIFY THE REQUIREMENTS OF
S. 6914 16 A. 9205
THIS PARAGRAPH AND PARAGRAPH (C) OF THIS SUBDIVISION IF SUCH MODIFICA-
TIONS ARE REQUIRED BY THE FEDERAL CMS.
(C) FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND FOURTEEN, THE
COMMISSIONER SHALL PROVIDE A REPORT ON A QUARTERLY BASIS TO THE CHAIRS
OF THE SENATE FINANCE, ASSEMBLY WAYS AND MEANS, SENATE HEALTH AND ASSEM-
BLY HEALTH COMMITTEES WITH REGARD TO THE STATUS OF THE DSRIP PROGRAM.
SUCH REPORTS SHALL BE SUBMITTED NO LATER THAN SIXTY DAYS AFTER THE CLOSE
OF THE QUARTER, AND SHALL INCLUDE THE MOST CURRENT INFORMATION SUBMITTED
BY PROVIDERS TO THE STATE AND THE FEDERAL CMS. THE REPORTS SHALL
INCLUDE:
(I) ANALYSIS OF PROGRESS MADE TOWARD DSRIP GOALS;
(II) THE IMPACT ON THE STATE'S HEALTH CARE DELIVERY SYSTEM;
(III) INFORMATION ON THE NUMBER AND TYPES OF PROVIDERS WHO PARTIC-
IPATE;
(IV) PLANS AND PROGRESS FOR MONITORING PROVIDER COMPLIANCE WITH
REQUIREMENTS;
(V) A STATUS UPDATE ON PROJECT MILESTONE PROGRESS;
(VI) INFORMATION ON PROJECT SPENDING AND BUDGET;
(VII) ANALYSIS OF IMPACT ON MEDICAID BENEFICIARIES SERVED;
(VIII) A SUMMARY OF PUBLIC ENGAGEMENT AND PUBLIC COMMENTS RECEIVED;
(IX) A DESCRIPTION OF DSRIP FUNDING APPLICATIONS THAT WERE DENIED;
(X) A DESCRIPTION OF ALL REGULATION WAIVERS ISSUED PURSUANT TO PARA-
GRAPH (E) OF THIS SUBDIVISION; AND
(XI) A SUMMARY OF THE STATEWIDE GEOGRAPHIC DISTRIBUTION OF FUNDS.
(D) FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND FOURTEEN THE
COMMISSIONER SHALL PROMPTLY MAKE ALL DSRIP GOVERNING DOCUMENTS, INCLUD-
ING 1115 WAIVER STANDARD TERMS AND CONDITIONS, SUPPORTING ATTACHMENTS
AND DETAILED PROJECT DESCRIPTIONS, AND ALL MATERIALS MADE AVAILABLE TO
THE LEGISLATURE PURSUANT TO PARAGRAPH (C) OF THIS SUBDIVISION, AVAILABLE
ON THE DEPARTMENT'S WEBSITE. THE COMMISSIONER SHALL ALSO PROVIDE A
DETAILED OVERVIEW ON THE DEPARTMENT'S WEBSITE OF THE OPPORTUNITIES FOR
PUBLIC COMMENT ON THE DSRIP PROGRAM.
(E) NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, THE COMMIS-
SIONERS OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH, THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ARE AUTHORIZED TO WAIVE ANY
REGULATORY REQUIREMENTS AS ARE NECESSARY, CONSISTENT WITH APPLICABLE
LAW, TO ALLOW APPLICANTS UNDER THIS SUBDIVISION AND PARAGRAPH (A) OF
SUBDIVISION TWO OF SECTION TWENTY-EIGHT HUNDRED TWENTY-FIVE OF THIS
ARTICLE TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE EFFICIENT
IMPLEMENTATION OF THE PROPOSED PROJECT; PROVIDED, HOWEVER, THAT REGU-
LATIONS PERTAINING TO PATIENT SAFETY MAY NOT BE WAIVED, NOR SHALL ANY
REGULATIONS BE WAIVED IF SUCH WAIVER WOULD RISK PATIENT SAFETY. SUCH
WAIVER SHALL NOT EXCEED THE LIFE OF THE PROJECT OR SUCH SHORTER TIME
PERIODS AS THE AUTHORIZING COMMISSIONER MAY DETERMINE. ANY REGULATORY
RELIEF GRANTED PURSUANT TO THIS SUBDIVISION SHALL BE DESCRIBED, INCLUD-
ING EACH REGULATIONS WAIVED AND THE PROJECT IT RELATES TO, IN THE REPORT
PROVIDED PURSUANT TO PARAGRAPH (C) OF THIS SUBDIVISION.
S 8-b. Subdivision 21 of section 2807 of the public health law, as
added by section 10 of part Q of chapter 56 of the laws of 2013, is
amended to read as follows:
21. (A) Notwithstanding any contrary provision of law and subject to
the receipt of all necessary federal approvals and the availability of
federal financial participation, the commissioner is authorized to enter
into agreements with SUNY downstate medical center, other public general
hospitals, and/or with the sponsoring local governments of such other
S. 6914 17 A. 9205
public general hospitals, under which such facilities and/or such local
government shall, by intergovernmental transfer, fund the non-federal
share of Medicaid funds made available for implementation of Medicaid
Redesign Team initiatives. Such non-federal share payments shall be
deemed voluntary and, further, such payments shall be excluded from
computations made pursuant to section one of part C of chapter fifty-
eight of the laws of two thousand five, as amended. In addition, the
facilities, and/or the sponsoring local governments of such facilities
or the state may, by written notification to the other parties to the
agreement, cancel such agreement at any time prior to the payment of the
Medicaid Redesign Team initiatives funds.
(B) APPLICATIONS BY ELIGIBLE APPLICANTS FOR MEDICAID REDESIGN TEAM
INITIATIVES FUNDED BY MONIES MADE AVAILABLE PURSUANT TO PARAGRAPH (A) OF
THIS SUBDIVISION SHALL BE SUBMITTED FOR REVIEW TO THE ADVISORY PANEL
ESTABLISHED PURSUANT TO PARAGRAPH (B) OF SUBDIVISION TWENTY OF THIS
SECTION AND SUCH PANEL SHALL SUBMIT THEIR RECOMMENDATIONS TO THE COMMIS-
SIONER FOR FINAL DETERMINATION. FOR PERIODS ON AND AFTER APRIL FIRST,
TWO THOUSAND FOURTEEN, THE COMMISSIONER SHALL PROVIDE A REPORT ON A
QUARTERLY BASIS TO THE MAJORITY LEADER OF THE NEW YORK STATE SENATE AND
TO THE SPEAKER OF THE NEW YORK STATE ASSEMBLY WITH REGARD TO THE STATUS
OF SUCH APPLICATIONS AND APPROVED PROJECTS. SUCH REPORTS SHALL BE
SUBMITTED NO LATER THAN SIXTY DAYS AFTER THE CLOSE OF THE QUARTER, AND
SHALL INCLUDE THE MOST CURRENT INFORMATION SUBMITTED BY APPLICANTS TO
THE STATE. THE REPORTS SHALL BE SUBMITTED IN CONJUNCTION WITH AND AS A
PART OF THE REPORTS SUBMITTED PURSUANT TO PARAGRAPH (C) OF SUBDIVISION
TWENTY OF THIS SECTION AND SHALL INCLUDE:
(I) ANALYSIS OF PROGRESS MADE TOWARD PROJECT GOALS;
(II) THE IMPACT ON THE STATE'S HEALTH CARE DELIVERY SYSTEM;
(III) INFORMATION ON THE NUMBER AND TYPES OF PROVIDERS WHO PARTIC-
IPATE;
(IV) PLANS AND PROGRESS FOR MONITORING PROVIDER COMPLIANCE WITH
REQUIREMENTS;
(V) A STATUS UPDATE ON PROJECT MILESTONE PROGRESS;
(VI) INFORMATION ON PROJECT SPENDING AND BUDGET;
(VII) ANALYSIS OF IMPACT ON MEDICAID BENEFICIARIES SERVED;
(VIII) A SUMMARY OF PUBLIC ENGAGEMENT AND PUBLIC COMMENTS RECEIVED;
(IX) A DESCRIPTION OF APPLICATIONS THAT WERE DENIED;
(X) A DESCRIPTION OF ALL REGULATION WAIVERS ISSUED PURSUANT TO PARA-
GRAPH (E) OF THIS SUBDIVISION; AND
(XI) A SUMMARY OF THE STATEWIDE GEOGRAPHIC DISTRIBUTION OF FUNDS.
(C) THE COMMISSIONER SHALL MAKE ALL REPORTS PREPARED PURSUANT TO PARA-
GRAPH (B) OF THIS SUBDIVISION AND ALL SUPPORTING ATTACHMENTS AND MATERI-
ALS AVAILABLE ON THE DEPARTMENT'S WEBSITE.
(D) NOTWITHSTANDING ANY INCONSISTENT LAW TO THE CONTRARY, AND SUBJECT
TO FEDERAL FINANCIAL PARTICIPATION, AND SUBJECT TO AMOUNTS APPROPRIATED
FOR PURPOSES HEREIN, THE DEPARTMENT MAY DISTRIBUTE FUNDS TO MAKE RATE
ADJUSTMENTS FOR HEALTH HOME PROVIDERS AS DESCRIBED IN SECTION THREE
HUNDRED SIXTY-FIVE-L OF THE SOCIAL SERVICES LAW FOR MEMBER ENGAGEMENT,
STAFF TRAINING AND RETRAINING, HEALTH INFORMATION TECHNOLOGY IMPLEMENTA-
TION, JOINT GOVERNANCE TECHNICAL ASSISTANCE, AND OTHER SUCH PURPOSES AS
THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONERS OF THE OFFICE
OF MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES DETERMINES.
(E) NOTWITHSTANDING ANY PROVISIONS OF LAW TO THE CONTRARY, THE COMMIS-
SIONERS OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH, THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE OF
S. 6914 18 A. 9205
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ARE AUTHORIZED TO WAIVE ANY
REGULATORY REQUIREMENTS AS ARE NECESSARY, CONSISTENT WITH APPLICABLE
LAW, TO ALLOW APPLICANTS UNDER THIS SUBDIVISION AND PARAGRAPH (A) OF
SUBDIVISION TWO OF SECTION TWENTY-EIGHT HUNDRED TWENTY-FIVE OF THIS
ARTICLE TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE EFFICIENT
IMPLEMENTATION OF THE PROPOSED PROJECT; PROVIDED, HOWEVER, THAT REGU-
LATIONS PERTAINING TO PATIENT SAFETY MAY NOT BE WAIVED, NOT SHALL ANY
REGULATION BE WAIVED IF SUCH WAIVER WOULD RISK PATIENT SAFETY. SUCH
WAIVER SHALL NOT EXCEED THE LIFE OF THE PROJECT OR SUCH SHORTER TIME
PERIOD AS THE AUTHORIZING COMMISSIONER ANY DETERMINE. ANY REGULATORY
RELIEF GRANTED PURSUANT TO THIS SUBDIVISION SHALL BE DESCRIBED, INCLUD-
ING EACH REGULATION WAIVED AND THE PROJECT IT RELATES TO, IN THE REPORT
PROVIDED PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVISION.
S 9. Section 89-e of the state finance law is amended by adding a new
subdivision 2-b to read as follows:
(2-B) ON OR BEFORE THE FIRST DAY OF FEBRUARY EACH YEAR, THE COMMIS-
SIONER OF HEALTH SHALL PROVIDE A WRITTEN REPORT TO THE TEMPORARY PRESI-
DENT OF THE SENATE, SPEAKER OF THE ASSEMBLY, CHAIR OF THE SENATE FINANCE
COMMITTEE, CHAIR OF THE ASSEMBLY WAYS AND MEANS COMMITTEE, CHAIR OF THE
SENATE COMMITTEE ON HEALTH, AND CHAIR OF THE ASSEMBLY HEALTH COMMITTEE.
SUCH REPORT SHALL INCLUDE HOW THE MONIES OF THE FUND WERE UTILIZED
DURING THE PRECEDING CALENDAR YEAR AND SHALL INCLUDE:
(I) THE AMOUNT OF MONEY DISPERSED FROM THE FUND;
(II) RECIPIENTS OF AWARDS FROM THE FUND;
(III) THE AMOUNT AWARDED TO EACH; AND
(IV) THE PURPOSES FOR WHICH SUCH AWARDS WERE GRANTED.
S 10. Paragraph (c) of subdivision 1 of section 2815 of the public
health law, as added by chapter 639 of the laws of 1996, is amended to
read as follows:
(c) "Participating [general hospital] BORROWER" shall mean a not-for-
profit general hospital, A NOT-FOR-PROFIT DIAGNOSTIC CENTER, A NOT-FOR-
PROFIT TREATMENT CENTER, A NOT-FOR-PROFIT RESIDENTIAL HEALTH CARE FACIL-
ITY OR ANY OTHER NOT-FOR-PROFIT ENTITY IN POSSESSION OF A VALID
OPERATING CERTIFICATE ISSUED PURSUANT TO THIS ARTICLE, EACH organized
under the laws of this state, which has been approved for participation
in this program by the commissioner.
S 11. Paragraphs (b), (c), and (d) of subdivision 3 and subdivisions
3-a, 4, 5, and 6 of section 2815 of the public health law, as added by
chapter 639 of the laws of 1996, subdivision 3-a as added by chapter 1
of the laws of 1999, are amended to read as follows:
(b) for the development and implementation of business plans for
participating [general hospitals] BORROWERS, addressing the development
of service delivery strategies, including strategies for the formation
or strengthening of networks, affiliations or other business combina-
tions, designed to provide long-term financial stability within and
among participating [general hospitals] BORROWERS;
(c) for the expenditure or loan of funds by the authority from the
restructuring pool to reimburse the authority or the agency, where
appropriate, for the costs of engaging management, legal or accounting
consultants to identify, develop and implement improved strategies for
one or more participating [general hospitals] BORROWERS for implementing
the recommendations of such consultants, where appropriate, and for the
payment of debt service on bonds, notes or other obligations issued or
incurred by the authority or the agency to fund loans to one or more
participating [general hospitals] BORROWERS;
S. 6914 19 A. 9205
(d) for assurances that participating [general hospitals] BORROWERS
will address the recommendations of such consultants and furnish the
commissioner, the authority, and where applicable, the agency, with such
additional financial, management, legal and operational information as
each may deem necessary to monitor the performance of a participating
[general hospital] BORROWER; and
3-a. Any participating [general hospital] BORROWER may apply for
restructuring pool funds to the extent such funds are derived from
deposits made pursuant to paragraph (d) of subdivision one of section
twenty-eight hundred seven-l of this article, provided, however, that,
in reviewing such applications, the commissioner and the authority shall
consider the extent to which the applicant hospital has alternative
available sources of funds, including, but not limited to, funds avail-
able through affiliation agreements with other hospitals OR ENTITIES.
4. To the extent funds are available from a participating [general
hospital] BORROWER therefor, expenditures from the restructuring pool
shall be repaid to the restructuring pool from repayments received by
the authority, or the agency where applicable, from a participating
[general hospital] BORROWER pursuant to the terms of any financing
agreement, mortgage or loan document permitting the recovery from the
participating [general hospital] BORROWER of such expenditures. The
authority shall record and account for all such payments, which shall be
deposited in the restructuring pool.
5. Loans from the restructuring pool shall be made pursuant to an
agreement with the participating [general hospital] BORROWER specifying
the terms thereof, including repayment terms. The authority shall record
and account for all such repayments, which shall be deposited in the
restructuring pool. The authority shall notify the chair of the senate
finance committee, the director of the division of budget, the chair of
the assembly ways and means committee, THE CHAIR OF THE SENATE COMMITTEE
ON HEALTH, AND THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE, five days
prior to the making of a loan from the restructuring pool. The authority
shall also report quarterly to such chairpersons on the transactions in
the pool, including but not limited to RECEIPTS OR deposits to the pool,
DISBURSEMENTS OR loans made from the pool, investment income, and the
balance on hand as of the end of the month for each such quarter.
6. The commissioner is authorized, with the assistance and cooperation
of the authority, to provide a program of technical assistance to
participating [general hospitals] BORROWERS.
S 12. Subdivision 2 of section 242 of the elder law, as added by
section 5 of part T of chapter 56 of the laws of 2012, is amended to
read as follows:
2. Persons eligible for catastrophic coverage under section two
hundred forty-eight of this title shall include:
(a) any unmarried resident who is at least sixty-five years of age and
whose income for the calendar year immediately preceding the effective
date of the annual coverage period beginning on or after January first,
two thousand one, is more than twenty thousand and less than or equal to
[thirty-five] SEVENTY-FIVE thousand dollars. After the initial determi-
nation of eligibility, each eligible individual must be redetermined
eligible at least every twenty-four months; and
(b) any married resident who is at least sixty-five years of age and
whose income for the calendar year immediately preceding the effective
date of the annual coverage period when combined with the income in the
same calendar year of such married person's spouse beginning on or after
January first, two thousand one, is more than twenty-six thousand
S. 6914 20 A. 9205
dollars and less than or equal to [fifty] ONE HUNDRED thousand dollars.
After the initial determination of eligibility, each eligible individual
must be redetermined eligible at least every twenty-four months.
S 13. Paragraphs (a) and (b) of subdivision 2 of section 248 of the
elder law, as added by section 17 of part T of chapter 56 of the laws of
2012, are amended to read as follows:
(a) Annual personal covered drug expenditures for unmarried individual
eligible program participants:
individual income of $20,001 to $21,000 $530
individual income of $21,001 to $22,000 $550
individual income of $22,001 to $23,000 $580
individual income of $23,001 to $24,000 $720
individual income of $24,001 to $25,000 $750
individual income of $25,001 to $26,000 $780
individual income of $26,001 to $27,000 $810
individual income of $27,001 to $28,000 $840
individual income of $28,001 to $29,000 $870
individual income of $29,001 to $30,000 $900
individual income of $30,001 to $31,000 $930
individual income of $31,001 to $32,000 $960
individual income of $32,001 to $33,000 $1,160
individual income of $33,001 to $34,000 $1,190
individual income of $34,001 to $35,000 $1,230
INDIVIDUAL INCOME OF $35,001 TO $36,000 $1,260
INDIVIDUAL INCOME OF $36,001 TO $37,000 $1,290
INDIVIDUAL INCOME OF $37,001 TO $38,000 $1,320
INDIVIDUAL INCOME OF $38,001 TO $39,000 $1,350
INDIVIDUAL INCOME OF $39,001 TO $40,000 $1,380
INDIVIDUAL INCOME OF $40,001 TO $41,000 $1,410
INDIVIDUAL INCOME OF $41,001 TO $42,000 $1,440
INDIVIDUAL INCOME OF $42,001 TO $43,000 $1,470
INDIVIDUAL INCOME OF $43,001 TO $44,000 $1,500
INDIVIDUAL INCOME OF $44,001 TO $45,000 $1,530
INDIVIDUAL INCOME OF $45,001 TO $46,000 $1,560
INDIVIDUAL INCOME OF $46,001 TO $47,000 $1,590
INDIVIDUAL INCOME OF $47,001 TO $48,000 $1,620
INDIVIDUAL INCOME OF $48,001 TO $49,000 $1,650
INDIVIDUAL INCOME OF $49,001 TO $50,000 $1,680
INDIVIDUAL INCOME OF $50,001 TO $51,000 $1,710
INDIVIDUAL INCOME OF $51,001 TO $52,000 $1,740
INDIVIDUAL INCOME OF $52,001 TO $53,000 $1,770
INDIVIDUAL INCOME OF $53,001 TO $54,000 $1,800
INDIVIDUAL INCOME OF $54,001 TO $55,000 $1,830
INDIVIDUAL INCOME OF $55,001 TO $56,000 $1,860
INDIVIDUAL INCOME OF $56,001 TO $57,000 $1,890
INDIVIDUAL INCOME OF $57,001 TO $58,000 $1,920
INDIVIDUAL INCOME OF $58,001 TO $59,000 $1,950
INDIVIDUAL INCOME OF $59,001 TO $60,000 $1,980
INDIVIDUAL INCOME OF $60,001 TO $61,000 $2,010
INDIVIDUAL INCOME OF $61,001 TO $62,000 $2,040
INDIVIDUAL INCOME OF $62,001 TO $63,000 $2,070
INDIVIDUAL INCOME OF $63,001 TO $64,000 $2,100
INDIVIDUAL INCOME OF $64,001 TO $65,000 $2,130
INDIVIDUAL INCOME OF $65,001 TO $66,000 $2,160
INDIVIDUAL INCOME OF $66,001 TO $67,000 $2,190
INDIVIDUAL INCOME OF $67,001 TO $68,000 $2,220
S. 6914 21 A. 9205
INDIVIDUAL INCOME OF $68,001 TO $69,000 $2,250
INDIVIDUAL INCOME OF $69,001 TO $70,000 $2,280
INDIVIDUAL INCOME OF $70,001 TO $71,000 $2,310
INDIVIDUAL INCOME OF $71,001 TO $72,000 $2,340
INDIVIDUAL INCOME OF $72,001 TO $73,000 $2,370
INDIVIDUAL INCOME OF $73,001 TO $74,000 $2,400
INDIVIDUAL INCOME OF $74,001 TO $75,000 $2,430
(b) Annual personal covered drug expenditures for each married
individual eligible program participant:
joint income of $26,001 to $27,000 $650
joint income of $27,001 to $28,000 $675
joint income of $28,001 to $29,000 $700
joint income of $29,001 to $30,000 $725
joint income of $30,001 to $31,000 $900
joint income of $31,001 to $32,000 $930
joint income of $32,001 to $33,000 $960
joint income of $33,001 to $34,000 $990
joint income of $34,001 to $35,000 $1,020
joint income of $35,001 to $36,000 $1,050
joint income of $36,001 to $37,000 $1,080
joint income of $37,001 to $38,000 $1,110
joint income of $38,001 to $39,000 $1,140
joint income of $39,001 to $40,000 $1,170
joint income of $40,001 to $41,000 $1,200
joint income of $41,001 to $42,000 $1,230
joint income of $42,001 to $43,000 $1,260
joint income of $43,001 to $44,000 $1,290
joint income of $44,001 to $45,000 $1,320
joint income of $45,001 to $46,000 $1,575
joint income of $46,001 to $47,000 $1,610
joint income of $47,001 to $48,000 $1,645
joint income of $48,001 to $49,000 $1,680
joint income of $49,001 to $50,000 $1,715
JOINT INCOME OF $50,001 TO $51,000 $1,745
JOINT INCOME OF $51,001 TO $52,000 $1,775
JOINT INCOME OF $52,001 TO $53,000 $1,805
JOINT INCOME OF $53,001 TO $54,000 $1,835
JOINT INCOME OF $54,001 TO $55,000 $1,865
JOINT INCOME OF $55,001 TO $56,000 $1,895
JOINT INCOME OF $56,001 TO $57,000 $1,925
JOINT INCOME OF $57,001 TO $58,000 $1,955
JOINT INCOME OF $58,001 TO $59,000 $1,985
JOINT INCOME OF $59,001 TO $60,000 $2,015
JOINT INCOME OF $60,001 TO $61,000 $2,045
JOINT INCOME OF $61,001 TO $62,000 $2,075
JOINT INCOME OF $62,001 TO $63,000 $2,105
JOINT INCOME OF $63,001 TO $64,000 $2,135
JOINT INCOME OF $64,001 TO $65,000 $2,165
JOINT INCOME OF $65,001 TO $66,000 $2,195
JOINT INCOME OF $66,001 TO $67,000 $2,225
JOINT INCOME OF $67,001 TO $68,000 $2,255
JOINT INCOME OF $68,001 TO $69,000 $2,285
JOINT INCOME OF $69,001 TO $70,000 $2,315
JOINT INCOME OF $70,001 TO $71,000 $2,345
JOINT INCOME OF $71,001 TO $72,000 $2,375
JOINT INCOME OF $72,001 TO $73,000 $2,405
S. 6914 22 A. 9205
JOINT INCOME OF $73,001 TO $74,000 $2,435
JOINT INCOME OF $74,001 TO $75,000 $2,465
JOINT INCOME OF $75,001 TO $76,000 $2,495
JOINT INCOME OF $76,001 TO $77,000 $2,525
JOINT INCOME OF $77,001 TO $78,000 $2,555
JOINT INCOME OF $78,001 TO $79,000 $2,585
JOINT INCOME OF $79,001 TO $80,000 $2,615
JOINT INCOME OF $80,001 TO $81,000 $2,645
JOINT INCOME OF $81,001 TO $82,000 $2,675
JOINT INCOME OF $82,001 TO $83,000 $2,705
JOINT INCOME OF $83,001 TO $84,000 $2,735
JOINT INCOME OF $84,001 TO $85,000 $2,765
JOINT INCOME OF $85,001 TO $86,000 $2,795
JOINT INCOME OF $86,001 TO $87,000 $2,825
JOINT INCOME OF $87,001 TO $88,000 $2,855
JOINT INCOME OF $88,001 TO $89,000 $2,885
JOINT INCOME OF $89,001 TO $90,000 $2,915
JOINT INCOME OF $90,001 TO $91,000 $2,945
JOINT INCOME OF $91,001 TO $92,000 $2,975
JOINT INCOME OF $92,001 TO $93,000 $3,005
JOINT INCOME OF $93,001 TO $94,000 $3,035
JOINT INCOME OF $94,001 TO $95,000 $3,065
JOINT INCOME OF $95,001 TO $96,000 $3,095
JOINT INCOME OF $96,001 TO $97,000 $3,125
JOINT INCOME OF $97,001 TO $98,000 $3,155
JOINT INCOME OF $98,001 TO $99,000 $3,185
JOINT INCOME OF $99,001 TO $100,000 $3,215
S 14. Paragraphs (a) and (b) of subdivision 4 of section 248 of the
elder law, as added by section 17 of part T of chapter 56 of the laws of
2012, are amended to read as follows:
(a) Limits on co-payments by unmarried individual eligible program
participants:
individual income of $20,001 to $21,000 no more than $1,050
individual income of $21,001 to $22,000 no more than $1,100
individual income of $22,001 to $23,000 no more than $1,150
individual income of $23,001 to $24,000 no more than $1,200
individual income of $24,001 to $25,000 no more than $1,250
individual income of $25,001 to $26,000 no more than $1,300
individual income of $26,001 to $27,000 no more than $1,350
individual income of $27,001 to $28,000 no more than $1,400
individual income of $28,001 to $29,000 no more than $1,450
individual income of $29,001 to $30,000 no more than $1,500
individual income of $30,001 to $31,000 no more than $1,550
individual income of $31,001 to $32,000 no more than $1,600
individual income of $32,001 to $33,000 no more than $1,650
individual income of $33,001 to $34,000 no more than $1,700
individual income of $34,001 to no more than $1,750
[$35,000] $75,000
(b) Limits on co-payments by each married individual eligible program
participant:
joint income of $26,001 to $27,000 no more than $1,080
joint income of $27,001 to $28,000 no more than $1,120
joint income of $28,001 to $29,000 no more than $1,160
joint income of $29,001 to $30,000 no more than $1,200
joint income of $30,001 to $31,000 no more than $1,240
joint income of $31,001 to $32,000 no more than $1,280
S. 6914 23 A. 9205
joint income of $32,001 to $33,000 no more than $1,320
joint income of $33,001 to $34,000 no more than $1,360
joint income of $34,001 to $35,000 no more than $1,400
joint income of $35,001 to $36,000 no more than $1,440
joint income of $36,001 to $37,000 no more than $1,480
joint income of $37,001 to $38,000 no more than $1,520
joint income of $38,001 to $39,000 no more than $1,560
joint income of $39,001 to $40,000 no more than $1,600
joint income of $40,001 to $41,000 no more than $1,640
joint income of $41,001 to $42,000 no more than $1,680
joint income of $42,001 to $43,000 no more than $1,720
joint income of $43,001 to $44,000 no more than $1,760
joint income of $44,001 to $45,000 no more than $1,800
joint income of $45,001 to $46,000 no more than $1,840
joint income of $46,001 to $47,000 no more than $1,880
joint income of $47,001 to $48,000 no more than $1,920
joint income of $48,001 to $49,000 no more than $1,960
joint income of $49,001 to no more than $2,000
[$50,000] $100,000
S 15. Subdivision 1 of section 924 of the public health law, as added
by section 23 of part D of chapter 56 of the laws of 2012, is amended to
read as follows:
1. [The] NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS SECTION,
SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE
FINANCE LAW, OR ANY OTHER CONTRARY PROVISION OF LAW, THE commissioner is
authorized, within amounts available therefor, to make loan repayment
awards to eligible primary care service corps practitioners 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 thou-
sand dollars per year for any year in which such practitioners provide
full-time eligible obligated service, WITHOUT COMPETITIVE BID OR REQUEST
FOR PROPOSAL PROCESS.
S 16. Paragraph (b) of subdivision 18-a of section 206 of the public
health law, as amended by section 38-a of part H of chapter 59 of the
laws of 2011, is amended and paragraph (c) is added to read as follows:
(b) The commissioner shall:
(I) CONVENE A WORKGROUP TO:
(A) EVALUATE THE STATE'S HEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE
AND SYSTEMS, AS WELL AS OTHER RELATED PLANS AND PROJECTS DESIGNED TO
MAKE IMPROVEMENTS OR MODIFICATIONS TO SUCH INFRASTRUCTURE AND SYSTEMS
INCLUDING, BUT NOT LIMITED TO, THE ALL PAYOR DATABASE (APD), THE STATE
PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS), REGIONAL HEALTH
INFORMATION ORGANIZATIONS (RHIOS), THE STATEWIDE HEALTH INFORMATION
NETWORK OF NEW YORK (SHIN-NY) AND MEDICAL ASSISTANCE ELIGIBILITY
SYSTEMS; AND
(B) DEVELOP RECOMMENDATIONS FOR THE STATE TO MOVE TOWARD A COMPREHEN-
SIVE HEALTH CLAIMS AND CLINICAL DATABASE AIMED AT IMPROVING QUALITY OF
CARE, EFFICIENCY, COST OF CARE AND PATIENT SATISFACTION AVAILABLE IN A
SELF-SUSTAINABLE, NON-DUPLICATIVE, INTERACTIVE AND INTEROPERABLE MANNER
THAT ENSURES SAFEGUARDS FOR PRIVACY, CONFIDENTIALITY AND SECURITY;
(II) SUBMIT A REPORT TO THE GOVERNOR AND THE TEMPORARY PRESIDENT OF
THE SENATE AND THE SPEAKER OF THE ASSEMBLY, WHICH SHALL FULLY CONSIDER
THE EVALUATION AND RECOMMENDATIONS OF THE WORKGROUP, ON OR BEFORE DECEM-
BER FIRST, TWO THOUSAND FOURTEEN.
(C) THE MEMBERS OF THE WORKGROUP SHALL INCLUDE, AT A MINIMUM, THREE
MEMBERS WHO REPRESENT RHIOS, TWO MEMBERS EMPLOYED BY THE DEPARTMENT WHO
S. 6914 24 A. 9205
ARE INVOLVED IN THE DEVELOPMENT OF THE SHIN-NY AND THE APD, TWO MEMBERS
WHO REPRESENT PHYSICIANS, TWO MEMBERS WHO REPRESENT HOSPITALS, ONE
MEMBER WHO REPRESENTS FEDERALLY QUALIFIED HEALTH CENTERS, THE CHAIR OF
THE SENATE HEALTH COMMITTEE OR HIS OR HER DESIGNEE, THE CHAIR OF THE
ASSEMBLY HEALTH COMMITTEE OR HIS OR HER DESIGNEE, AND OTHER INDIVIDUALS
WITH EXPERTISE IN MATTERS RELEVANT TO THE CHARGE OF THE WORKGROUP.
(D) THE COMMISSIONER MAY make such rules and regulations as may be
necessary to implement federal policies and disburse funds as required
by the American Recovery and Reinvestment Act of 2009 and to promote the
development of a [statewide health information network of New York (]
SELF-SUFFICIENT SHIN-NY[)] to enable widespread, NON-DUPLICATIVE inter-
operability among disparate health information systems, including elec-
tronic health records, personal health records, health care claims,
PAYMENT and other administrative data, and public health information
systems, while protecting privacy and security. Such rules and regu-
lations shall include, but not be limited to, requirements for organiza-
tions covered by 42 U.S.C. 17938 or any other organizations that
exchange health information through the SHIN-NY OR ANY OTHER STATEWIDE
HEALTH INFORMATION SYSTEM RECOMMENDED BY THE WORKGROUP. THE COMMISSIONER
SHALL CONSIDER THE RECOMMENDATIONS OF THE WORKGROUP. IF THE COMMISSIONER
ACTS IN A MANNER INCONSISTENT WITH THE RECOMMENDATIONS OF THE WORKGROUP,
HE OR SHE SHALL PROVIDE THE REASONS THEREFOR.
S 17. Section 2818 of the public health law is amended to add a new
subdivision 8 to read as follows:
8. ON OR BEFORE DECEMBER FIRST, TWO THOUSAND FOURTEEN, THE DEPARTMENT
SHALL ISSUE A REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE
SENATE AND THE SPEAKER OF THE ASSEMBLY REGARDING GRANTS MADE PURSUANT TO
THIS SECTION TO SUPPORT HEALTH INFORMATION TECHNOLOGY.
S 18. The public health law is amended by adding a new section 2801-h
to read as follows:
S 2801-H. COMMUNITY FORUM ON ESTABLISHMENT OF CERTAIN FACILITIES IN
THE COUNTY OF BRONX. 1. FOR ANY PROPOSED FREE STANDING CLINIC, OUTPA-
TIENT HEALTH CARE FACILITY OR AMBULATORY HEALTH CARE CENTER THAT: (I)
IS TO BE OVER THREE STORIES IN HEIGHT OR TO CONTAIN OVER THIRTY THOUSAND
SQUARE FEET, (II) IS PROPOSED TO BE LOCATED IN THE COUNTY OF BRONX, AND
(III) IS SPONSORED, DIRECTLY OR INDIRECTLY, BY A HOSPITAL, THEN THE
SPONSORING HOSPITAL SHALL, PRIOR TO THE ESTABLISHMENT OF SUCH CLINIC,
FACILITY OR CENTER, FILE A NOTICE THEREOF WITH THE DEPARTMENT, THE
EDUCATION DEPARTMENT AND THE COMMUNITY BOARD OF THE LOCALITY IN WHICH
THE CLINIC, FACILITY OR CENTER IS TO BE ESTABLISHED.
2. NOT LESS THAN ONE HUNDRED EIGHTY DAYS NOR MORE THAN TWO HUNDRED
SEVENTY DAYS AFTER RECEIPT OF A SPONSORING HOSPITAL'S NOTICE PURSUANT TO
SUBDIVISION ONE OF THIS SECTION, THE COMMISSIONER SHALL HOLD A PUBLIC
COMMUNITY FORUM FOR THE PURPOSE OF OBTAINING PUBLIC AND COMMUNITY BOARD
INPUT CONCERNING THE ANTICIPATED IMPACT OF THE ESTABLISHMENT OF A FREE
STANDING CLINIC, OUTPATIENT HEALTH CARE FACILITY OR AMBULATORY HEALTH
CARE FACILITY. SUCH IMPACT MAY INCLUDE AND RELATE TO: (I) THE APPROPRI-
ATENESS OF THE SIZE, HEIGHT, BULK DIMENSIONS AND SCOPE OF SUCH CLINIC,
FACILITY OR CENTER WHEN COMPARED TO THE SURROUNDING PHYSICAL CHARACTER-
ISTICS AND SOCIAL FABRIC OF SUCH COMMUNITY, (II) THE PROVISION OF
ADEQUATE MOTOR VEHICLE PARKING TO ACCOMMODATE SUCH FACILITY NEEDS AND
WHICH DOES NOT DIMINISH THE CURRENT SUPPLY OF PARKING FOR NEARBY RESI-
DENTS OR INCREASE TRAFFIC CONGESTION NEAR SUCH FACILITY, (III) THE
CURRENT ACCESS TO APPROPRIATE MEDICAL FACILITIES OR THE PROVISION OF
ESSENTIAL MEDICAL SERVICES TO SUCH COMMUNITY, SERVICE AREA AND SURROUND-
ING COMMUNITIES, AND (IV) OPTIONS AND PROPOSALS TO AMELIORATE OR MITI-
S. 6914 25 A. 9205
GATE ANTICIPATED ADVERSE IMPACTS TO THE LOCAL COMMUNITY. THE COMMIS-
SIONER SHALL AFFORD COMMUNITY MEMBERS, REPRESENTATIVES OF THE LOCAL
COMMUNITY BOARD, LOCAL BUSINESSES AND CONSUMERS A REASONABLE OPPORTUNITY
TO SPEAK ABOUT RELEVANT MATTERS AT SUCH COMMUNITY FORUM. EVERY SUCH
FORUM SHALL BE HELD UPON NOT LESS THAN THIRTY DAYS NOTICE TO THE
AFFECTED COMMUNITY AND THE LOCAL COMMUNITY BOARD.
3. THE COMMISSIONER SHALL, PRIOR TO ESTABLISHING THE DATE, TIME AND
LOCATION OF THE PUBLIC COMMUNITY FORUM, CONSULT WITH, AND OBTAIN THE
ADVICE AND CONSENT OF THE APPROPRIATE COMMUNITY BOARD, AS TO ESTABLISH-
ING A CONVENIENT DATE, TIME AND LOCATION TO CONDUCT THE FORUM FOR THE
LOCALLY IMPACTED COMMUNITY. SUCH HEARING LOCATION SHALL BE WITHIN
REASONABLE PROXIMITY TO THE PROPOSED CLINIC, FACILITY OR CENTER, AND IN
SUITABLE FACILITIES THAT PROVIDE ADEQUATE ROOM AND ACCESS TO HEAR PUBLIC
COMMENTS PRESENTED.
4. NOT LATER THAN NINETY DAYS AFTER HOLDING A COMMUNITY FORUM THE
COMMISSIONER SHALL MAKE AVAILABLE TO THE PUBLIC ON THE DEPARTMENT'S
WEBSITE THE REASONS WHY SUCH FACILITY IS, BY A PREPONDERANCE OF THE
EVIDENCE, IN THE BEST INTERESTS OF THOSE WHO LIVE WITHIN THE LOCAL
COMMUNITY AND WITHIN THE LOCAL SERVICE AREA AS IT RELATES TO: (I) THE
APPROPRIATENESS OF THE SIZE, HEIGHT, BULK DIMENSIONS AND SCOPE OF SUCH
CLINIC, FACILITY OR CENTER WHEN COMPARED TO THE SURROUNDING PHYSICAL
CHARACTERISTICS AND SOCIAL FABRIC OF SUCH COMMUNITY, (II) THE PROVISION
OF ADEQUATE MOTOR VEHICLE PARKING TO ACCOMMODATE SUCH FACILITY NEEDS AND
WHICH DOES NOT DIMINISH THE CURRENT SUPPLY OF PARKING FOR NEARBY RESI-
DENTS OR INCREASE TRAFFIC CONGESTION NEAR SUCH FACILITY, AND (III) THE
CURRENT ACCESS TO APPROPRIATE MEDICAL FACILITIES OR THE PROVISION OF
ESSENTIAL MEDICAL SERVICES TO SUCH COMMUNITY, SERVICE AREA AND SURROUND-
ING COMMUNITIES.
5. AFTER DUE CONSIDERATION OF THE COMMENTS AT THE COMMUNITY FORUM AND
CONSULTATION WITH THE EDUCATION DEPARTMENT, THE COMMISSIONER SHALL
EITHER APPROVE, MODIFY OR DENY AUTHORIZATION FOR THE ESTABLISHMENT OF
ANY SUCH CLINIC, FACILITY OR CENTER.
S 19. For claims for payment submitted by early intervention providers
to third party payors between the period April 1, 2013 until June 30,
2013 in accordance with title 2-A of article 25 of the public health
law, for which the third party payor has not, on the effective date of
this section, made payment of the claim in whole or in part or rendered
a determination that it is not obligated to pay the claim, the provider
shall be authorized to seek payment of such claim from the municipality,
through the fiscal agent under contract with the department of health;
provided, however, that the provider shall continue to render any
assistance needed, and provide any information and documentation
requested by the third party payor to facilitate payment of the claim
even if the provider has already received payment from the municipality.
If such third party payor makes payment of the claim after the provider
has received payment from the municipality, the third party payment
shall be reconciled against future payments due the provider from the
municipality. This section shall only apply to claims submitted by
approved early intervention providers to third party payors during the
period April 1, 2013 until June 30, 2013 for which no payment or deter-
mination has been made, as specified in this section, on April 1, 2014.
Payment shall be made on the forty-fifth day after this act shall take
effect. The provisions in subdivision 2 of section 2557 of the public
health law that prohibit state reimbursement from being paid prior to
April first of the year in which the approved costs are paid by the
S. 6914 26 A. 9205
municipality shall not apply to the municipal payments made under this
section.
S 20. Article 29-D of the public health law is amended by adding a new
title 1-A to read as follows:
TITLE 1-A
SAFE PATIENT HANDLING
SECTION 2997-G. LEGISLATIVE INTENT.
2997-H. DEFINITIONS.
2997-I. SAFE PATIENT HANDLING WORKGROUP.
2997-J. DISSEMINATION OF BEST PRACTICES, EXAMPLES OF SAMPLE SAFE
PATIENT HANDLING POLICIES AND OTHER RESOURCES AND
TOOLS.
2997-K. SAFE PATIENT HANDLING COMMITTEES; PROGRAMS.
2997-L. ACTIVITIES.
S 2997-G. LEGISLATIVE INTENT. THE LEGISLATURE HEREBY FINDS AND
DECLARES THAT IT IS IN THE PUBLIC INTEREST FOR HEALTH CARE FACILITIES TO
IMPLEMENT SAFE PATIENT HANDLING POLICIES. THERE ARE MANY BENEFITS THAT
CAN BE DERIVED FROM SAFE PATIENT HANDLING PROGRAMS. PATIENTS BENEFIT
THROUGH IMPROVED QUALITY OF CARE AND QUALITY OF LIFE BY REDUCING THE
RISK OF INJURY. CAREGIVERS ALSO BENEFIT FROM THE REDUCED RISK OF CAREER
ENDING AND DEBILITATING INJURIES LEADING TO INCREASED MORALE, IMPROVED
JOB SATISFACTION, AND LONGEVITY IN THE PROFESSION. HEALTH CARE FACILI-
TIES MAY REALIZE A RETURN ON THEIR INVESTMENT THROUGH REDUCED WORKERS'
COMPENSATION MEDICAL AND INDEMNITY COSTS, REDUCED LOST WORKDAYS, AND
IMPROVED RECRUITMENT AND RETENTION OF CAREGIVERS. ALL OF THIS COULD LEAD
TO FISCAL IMPROVEMENT IN HEALTH CARE IN NEW YORK STATE.
S 2997-H. DEFINITIONS. FOR THE PURPOSES OF THIS TITLE:
1. "HEALTH CARE FACILITY" SHALL MEAN GENERAL HOSPITALS, RESIDENTIAL
HEALTH CARE FACILITIES, DIAGNOSTIC AND TREATMENT CENTERS, AND CLINICS
LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THIS CHAPTER, FACILITIES
WHICH PROVIDE HEALTH CARE SERVICES AND ARE LICENSED OR OPERATED PURSUANT
TO ARTICLE EIGHT OF THE EDUCATION LAW, ARTICLE NINETEEN-G OF THE EXECU-
TIVE LAW OR THE CORRECTION LAW, AND HOSPITALS AND SCHOOLS DEFINED IN
SECTION 1.03 OF THE MENTAL HYGIENE LAW.
2. "NURSE" SHALL MEAN A REGISTERED PROFESSIONAL NURSE OR A LICENSED
PRACTICAL NURSE AS DEFINED BY ARTICLE ONE HUNDRED THIRTY-NINE OF THE
EDUCATION LAW.
3. "DIRECT CARE WORKER" SHALL MEAN ANY EMPLOYEE OF A HEALTH CARE
FACILITY WHO IS RESPONSIBLE FOR PATIENT HANDLING OR PATIENT ASSESSMENT
AS A REGULAR OR INCIDENTAL PART OF HIS OR HER EMPLOYMENT, INCLUDING ANY
LICENSED OR UNLICENSED HEALTH CARE WORKER.
4. "EMPLOYEE REPRESENTATIVE" SHALL MEAN THE RECOGNIZED OR CERTIFIED
COLLECTIVE BARGAINING AGENT FOR NURSES OR DIRECT CARE WORKERS OF A
HEALTH CARE FACILITY.
5. "SAFE PATIENT HANDLING" SHALL MEAN THE USE OF ENGINEERING CONTROLS,
LIFTING AND TRANSFER AIDS, OR ASSISTIVE DEVICES BY STAFF TO PERFORM THE
ACTS OF LIFTING, TRANSFERRING AND REPOSITIONING HEALTH CARE PATIENTS AND
RESIDENTS.
6. "MUSCULOSKELETAL DISORDERS" SHALL MEAN CONDITIONS THAT INVOLVE THE
NERVES, TENDONS, MUSCLES AND SUPPORTING STRUCTURES OF THE BODY.
S 2997-I. SAFE PATIENT HANDLING WORKGROUP. 1. THE COMMISSIONER SHALL
ESTABLISH A SAFE PATIENT HANDLING WORKGROUP (REFERRED TO IN THIS SECTION
AS THE "WORKGROUP") WITHIN THE DEPARTMENT. THE WORKGROUP SHALL CONSIST
OF, AT THE MINIMUM, THE COMMISSIONER OR HIS OR HER DESIGNEE; THE COMMIS-
SIONER OF LABOR OR HIS OR HER DESIGNEE; REPRESENTATIVES OF HEALTH CARE
PROVIDER ORGANIZATIONS; REPRESENTATIVES FROM EMPLOYEE ORGANIZATIONS
S. 6914 27 A. 9205
REPRESENTING NURSES AND REPRESENTATIVES FROM EMPLOYEE ORGANIZATIONS
REPRESENTING DIRECT CARE WORKERS; REPRESENTATIVES OF NURSE EXECUTIVES;
REPRESENTATIVES WHO ARE CERTIFIED ERGONOMIST EVALUATION SPECIALISTS; AND
REPRESENTATIVES WHO HAVE EXPERTISE IN FIELDS OF DISCIPLINE RELATED TO
HEALTH CARE OR OCCUPATIONAL SAFETY.
2. WORKGROUP MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES
AS MEMBERS OF THE WORKGROUP, BUT SHALL BE REIMBURSED FOR ACTUAL AND
NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
3. THE WORKGROUP SHALL BE ESTABLISHED NO LATER THAN JANUARY FIRST, TWO
THOUSAND FIFTEEN.
4. THE WORKGROUP SHALL:
(A) REVIEW EXISTING SAFE PATIENT HANDLING PROGRAMS OR POLICIES,
INCLUDING DEMONSTRATION PROGRAMS PREVIOUSLY AUTHORIZED BY CHAPTER SEVEN
HUNDRED THIRTY-EIGHT OF THE LAWS OF TWO THOUSAND FIVE AND NATIONAL DATA
AND RESULTS;
(B) CONSULT WITH ANY ORGANIZATION, EDUCATIONAL INSTITUTION, OTHER
GOVERNMENT ENTITY OR AGENCY OR PERSON THAT THE WORKGROUP DETERMINES MAY
BE ABLE TO PROVIDE INFORMATION AND EXPERTISE ON THE DEVELOPMENT AND
IMPLEMENTATION OF SAFE PATIENT HANDLING PROGRAMS;
(C) IDENTIFY OR DEVELOP TRAINING MATERIALS FOR CONSIDERATION BY HEALTH
CARE FACILITIES; AND
(D) SUBMIT A REPORT TO THE COMMISSIONER BY JULY FIRST, TWO THOUSAND
FIFTEEN IDENTIFYING SAFE PATIENT HANDLING PROGRAM BEST PRACTICES,
PROVIDING EXAMPLES OF SAMPLE POLICIES, AND IDENTIFYING RESOURCES AND
TOOLS USEFUL FOR PROVIDERS TO MEET THE GOALS OF SAFE PATIENT HANDLING
POLICIES.
5. ALL STATE DEPARTMENTS, COMMISSIONS, AGENCIES, AND PUBLIC AUTHORI-
TIES SHALL PROVIDE THE WORKGROUP WITH ANY REASONABLY REQUESTED ASSIST-
ANCE OR ADVICE IN A TIMELY MANNER.
S 2997-J. DISSEMINATION OF BEST PRACTICES, EXAMPLES OF SAMPLE SAFE
PATIENT HANDLING POLICIES AND OTHER RESOURCES AND TOOLS. THE COMMISSION-
ER SHALL DISSEMINATE BEST PRACTICES, EXAMPLES OF SAMPLE SAFE PATIENT
HANDLING POLICIES, AND OTHER RESOURCES AND TOOLS TO HEALTH CARE FACILI-
TIES, TAKING INTO CONSIDERATION THE RECOMMENDATIONS OF THE SAFE PATIENT
HANDLING WORKGROUP. SUCH BEST PRACTICES, EXAMPLES OF SAMPLE SAFE PATIENT
HANDLING POLICIES, AND OTHER RESOURCES AND TOOLS SHALL BE MADE AVAILABLE
TO ALL FACILITIES COVERED BY THIS TITLE ON OR BEFORE JANUARY FIRST, TWO
THOUSAND SIXTEEN.
S 2997-K. SAFE PATIENT HANDLING COMMITTEES; PROGRAMS. 1. ON OR BEFORE
JANUARY FIRST, TWO THOUSAND SIXTEEN, EACH HEALTH CARE FACILITY SHALL
ESTABLISH A SAFE PATIENT HANDLING COMMITTEE (REFERRED TO IN THIS SECTION
AS A "COMMITTEE" EXCEPT WHERE THE CONTEXT CLEARLY REQUIRES OTHERWISE)
EITHER BY CREATING A NEW COMMITTEE OR ASSIGNING THE FUNCTIONS OF A SAFE
PATIENT HANDLING COMMITTEE TO AN EXISTING COMMITTEE, INCLUDING BUT NOT
LIMITED TO A SAFETY COMMITTEE OR QUALITY ASSURANCE COMMITTEE, OR SUBCOM-
MITTEE THEREOF. THE PURPOSE OF A COMMITTEE IS TO DESIGN AND RECOMMEND
THE PROCESS FOR IMPLEMENTING A SAFE PATIENT HANDLING PROGRAM FOR THE
HEALTH CARE FACILITY. THE COMMITTEE SHALL INCLUDE INDIVIDUALS WITH
EXPERTISE OR EXPERIENCE THAT IS RELEVANT TO SAFE PATIENT HANDLING,
INCLUDING RISK MANAGEMENT, NURSING, PURCHASING, OR OCCUPATIONAL SAFETY
AND HEALTH, AND IN FACILITIES WHERE THERE ARE EMPLOYEE REPRESENTATIVES,
AT LEAST ONE SHALL BE APPOINTED ON BEHALF OF NURSES AND AT LEAST ONE
SHALL BE APPOINTED ON BEHALF OF DIRECT CARE WORKERS. ONE HALF OF THE
MEMBERS OF THE COMMITTEE SHALL BE FRONTLINE NON-MANAGERIAL EMPLOYEES WHO
PROVIDE DIRECT CARE TO PATIENTS. AT LEAST ONE NON-MANAGERIAL NURSE AND
ONE NON-MANAGERIAL DIRECT CARE WORKER SHALL BE ON THE SAFE PATIENT
S. 6914 28 A. 9205
HANDLING COMMITTEE. IN HEALTH CARE FACILITIES WHERE A RESIDENT COUNCIL
IS ESTABLISHED, AND WHERE FEASIBLE, AT LEAST ONE MEMBER OF THE SAFE
PATIENT HANDLING COMMITTEE SHALL BE A REPRESENTATIVE FROM THE RESIDENT
COUNCIL. THE COMMITTEE SHALL HAVE TWO CO-CHAIRS WITH ONE FROM MANAGE-
MENT AND ONE FRONTLINE NON-MANAGERIAL NURSE OR DIRECT CARE WORKER.
2. ON OR BEFORE JANUARY FIRST, TWO THOUSAND SEVENTEEN, EACH HEALTH
CARE FACILITY, IN CONSULTATION WITH THE COMMITTEE, SHALL ESTABLISH A
SAFE PATIENT HANDLING PROGRAM. AS PART OF THIS PROGRAM, A HEALTH CARE
FACILITY SHALL:
(A) IMPLEMENT A SAFE PATIENT HANDLING POLICY, CONSIDERING THE ELEMENTS
OF THE SAMPLE SAFE PATIENT HANDLING POLICIES AND BEST PRACTICES DISSEM-
INATED BY THE COMMISSIONER, AS WELL AS THE TYPE OF FACILITY AND ITS
SERVICES, PATIENT POPULATIONS AND CARE PLANS, TYPES OF CAREGIVERS, AND
PHYSICAL ENVIRONMENT, FOR ALL SHIFTS AND UNITS OF THE HEALTH CARE FACIL-
ITY. IMPLEMENTATION OF THE SAFE PATIENT HANDLING POLICY MAY BE PHASED-
IN;
(B) CONDUCT A PATIENT HANDLING HAZARD ASSESSMENT. THIS ASSESSMENT
SHOULD CONSIDER SUCH VARIABLES AS PATIENT-HANDLING TASKS, TYPES OF NURS-
ING UNITS, PATIENT POPULATIONS AND THE PHYSICAL ENVIRONMENT OF PATIENT
CARE AREAS;
(C) DEVELOP A PROCESS TO IDENTIFY THE APPROPRIATE USE OF THE SAFE
PATIENT HANDLING POLICY BASED ON THE PATIENT'S PHYSICAL AND MEDICAL
CONDITION AND THE AVAILABILITY OF SAFE PATIENT HANDLING EQUIPMENT. THE
POLICY SHALL INCLUDE A MEANS TO ADDRESS CIRCUMSTANCES UNDER WHICH IT
WOULD BE CONTRAINDICATED BASED ON A PATIENT'S PHYSICAL, MEDICAL,
WEIGHT-BEARING, COGNITIVE AND/OR REHABILITATIVE STATUS TO USE LIFTING OR
TRANSFER AIDS OR ASSISTIVE DEVICES FOR PARTICULAR PATIENTS;
(D) PROVIDE INITIAL AND ON-GOING YEARLY TRAINING AND EDUCATION ON SAFE
PATIENT HANDLING FOR CURRENT EMPLOYEES AND NEW HIRES, AND ESTABLISH
PROCEDURES TO ENSURE THAT RETRAINING FOR THOSE FOUND TO BE DEFICIENT IS
PROVIDED AS NEEDED;
(E) SET UP AND UTILIZE A PROCESS FOR INCIDENT INVESTIGATION AND POST-
INVESTIGATION REVIEW WHICH MAY INCLUDE A PLAN OF CORRECTION AND IMPLE-
MENTATION OF CONTROLS;
(F) CONDUCT AN ANNUAL PERFORMANCE EVALUATION OF THE PROGRAM TO DETER-
MINE ITS EFFECTIVENESS, WITH THE RESULTS OF THE EVALUATION REPORTED TO
THE COMMITTEE. THE EVALUATION SHALL DETERMINE THE EXTENT TO WHICH IMPLE-
MENTATION OF THE PROGRAM HAS RESULTED IN A REDUCTION IN THE RISK OF
INJURY TO PATIENTS, MUSCULOSKELETAL DISORDER CLAIMS AND DAYS OF LOST
WORK ATTRIBUTABLE TO MUSCULOSKELETAL DISORDERS BY EMPLOYEES CAUSED BY
PATIENT HANDLING, AND INCLUDE RECOMMENDATIONS TO INCREASE THE PROGRAM'S
EFFECTIVENESS;
(G) WHEN DEVELOPING ARCHITECTURAL PLANS FOR CONSTRUCTING OR REMODELING
A HEALTH CARE FACILITY OR A UNIT OF A HEALTH CARE FACILITY IN WHICH
PATIENT HANDLING AND MOVEMENT OCCURS, CONSIDER THE FEASIBILITY OF INCOR-
PORATING PATIENT HANDLING EQUIPMENT OR THE PHYSICAL SPACE AND
CONSTRUCTION DESIGN NEEDED TO INCORPORATE THAT EQUIPMENT AT A LATER
DATE; AND
(H) DEVELOP A PROCESS BY WHICH EMPLOYEES MAY REFUSE TO PERFORM OR BE
INVOLVED IN PATIENT HANDLING OR MOVEMENT THAT THE EMPLOYEE REASONABLY
BELIEVES IN GOOD FAITH WILL EXPOSE A PATIENT OR HEALTH CARE FACILITY
EMPLOYEE TO AN UNACCEPTABLE RISK OF INJURY. SUCH PROCESS SHALL REQUIRE
THAT THE NURSE OR DIRECT CARE WORKER MAKE A GOOD FAITH EFFORT TO ENSURE
PATIENT SAFETY AND BRING THE MATTER TO THE ATTENTION OF THE FACILITY IN
A TIMELY MANNER. A HEALTH CARE FACILITY EMPLOYEE WHO REASONABLY AND IN
GOOD FAITH FOLLOWS THE PROCESS DEVELOPED BY THE HEALTH CARE FACILITY IN
S. 6914 29 A. 9205
ACCORDANCE WITH THIS SUBDIVISION SHALL NOT BE THE SUBJECT OF DISCIPLI-
NARY ACTION BY THE HEALTH CARE FACILITY FOR THE REFUSAL TO PERFORM OR BE
INVOLVED IN THE PATIENT HANDLING OR MOVEMENT.
S 2997-L. ACTIVITIES. THE ACTIVITIES ENUMERATED IN SECTION TWENTY-NINE
HUNDRED NINETY-SEVEN-K OF THIS TITLE SHALL BE UNDERTAKEN CONSISTENT WITH
SECTION TWENTY-EIGHT HUNDRED FIVE-J OF THIS CHAPTER BY A COVERED HEALTH
CARE PROVIDER AND SHALL BE DEEMED ACTIVITIES OF SUCH PROGRAM AS
DESCRIBED IN SUCH SECTION AND ANY AND ALL INFORMATION ATTRIBUTABLE TO
SUCH ACTIVITIES SHALL BE SUBJECT TO PROVISIONS OF SECTION TWENTY-EIGHT
HUNDRED FIVE-M OF THIS CHAPTER AND SECTION SIXTY-FIVE HUNDRED
TWENTY-SEVEN OF THE EDUCATION LAW.
S 21. Section 2304 of the insurance law is amended by adding a new
subsection (j) to read as follows:
(J)(1) ON OR BEFORE JULY FIRST, TWO THOUSAND SIXTEEN, THE DEPARTMENT
SHALL MAKE RULES ESTABLISHING REQUIREMENTS FOR HEALTH CARE FACILITIES TO
OBTAIN A REDUCED WORKER'S COMPENSATION RATE FOR SAFE PATIENT HANDLING
PROGRAMS IMPLEMENTED PURSUANT TO TITLE ONE-A OF ARTICLE TWENTY-NINE-A OF
THE PUBLIC HEALTH LAW.
(2) THE DEPARTMENT SHALL COMPLETE AN EVALUATION OF THE RESULTS OF THE
REDUCED RATE, INCLUDING CHANGES IN CLAIM FREQUENCY AND COSTS, AND SHALL
REPORT TO THE APPROPRIATE COMMITTEES OF THE LEGISLATURE ON OR BEFORE
DECEMBER FIRST, TWO THOUSAND EIGHTEEN AND AGAIN ON OR BEFORE DECEMBER
FIRST, TWO THOUSAND TWENTY.
S 22. Subdivision 6 of section 2899 of the public health law, as
amended by chapter 331 of the laws of 2006, is amended to read as
follows:
6. "Provider" shall mean any residential health care facility licensed
under article twenty-eight of this chapter; or any certified home health
agency, licensed home care services agency or long term home health care
program certified under article thirty-six of this chapter; OR ANY ADULT
CARE FACILITY LICENSED UNDER ARTICLE SEVEN OF THE SOCIAL SERVICES LAW.
S 23. Paragraph (a) of subdivision 9 of section 2899-a of the public
health law, as amended by chapter 331 of the laws of 2006, is amended to
read as follows:
(a) In the event that funds are appropriated in any given fiscal year
for the reimbursement for the costs of providing such criminal history
information, reimbursement shall be made available in an equitable and
direct manner for the projected cost of the fee established pursuant to
law by the division of criminal justice services for processing a crimi-
nal history information check, the fee imposed by the federal bureau of
investigation for a national criminal history check, and costs associ-
ated with obtaining the fingerprints to all providers licensed, but not
certified under article thirty-six of this chapter, AND ALL ADULT CARE
FACILITIES LICENSED UNDER ARTICLE SEVEN OF THE SOCIAL SERVICES LAW,
including those that are subject to this article and are unable to
access direct reimbursement from state and/or federal funded health
programs.
S 24. The social services law is amended by adding a new section 461-t
to read as follows:
S 461-T. REVIEW OF CRIMINAL HISTORY INFORMATION CONCERNING PROSPECTIVE
DIRECT CARE EMPLOYEES. EVERY ADULT CARE FACILITY SHALL CONDUCT A CRIMI-
NAL HISTORY RECORD CHECK OF PROSPECTIVE DIRECT CARE EMPLOYEES UTILIZING
THE PROCEDURES AND STANDARDS SET FORTH IN ARTICLE TWENTY-EIGHT-E OF THE
PUBLIC HEALTH LAW.
S 25. The public health law is amended by adding a new section 2997-e
to read as follows:
S. 6914 30 A. 9205
S 2997-E. PROVISION OF CONTACT INFORMATION RELATING TO LONG TERM CARE.
WHENEVER A HEALTH CARE PROVIDER OR PRACTITIONER MAKES A RECOMMENDATION
REGARDING THE NECESSITY OF LONG TERM CARE SERVICES OR A REFERRAL FOR THE
RECEIPT OF LONG TERM CARE SERVICES TO A PATIENT, THE PATIENT OR
PATIENT'S DESIGNATED REPRESENTATIVE SHALL BE PROVIDED BY THE HEALTH CARE
PROVIDER OR PRACTITIONER THE CONTACT INFORMATION FOR NY CONNECTS: CHOIC-
ES FOR LONG TERM CARE, ESTABLISHED PURSUANT TO SUBDIVISION EIGHT OF
SECTION TWO HUNDRED THREE OF THE ELDER LAW, THAT CORRESPONDS TO THE
PATIENT'S COUNTY OF RESIDENCE OR PROSPECTIVE COUNTY OF RESIDENCE BASED
ON THE PREFERENCE OF THE PATIENT.
S 26. Intentionally omitted.
S 27. Section 4310 of the public health law, as amended by chapter 639
of the laws of 2006, the section heading as separately amended by chap-
ter 640 of the laws of 2006, subdivisions 1 and 3 as amended by chapter
158 of the laws of 2012, subdivision 2 as separately amended by chapters
158 and 465 of the laws of 2012, is amended to read as follows:
S 4310. New York state donate life registry for organ, EYE and tissue
donations. 1. The department shall establish an organ, EYE, and tissue
donor registry, which shall be called and be referred to as the "donate
life registry", WHICH SHALL PROVIDE A MEANS TO MAKE AND REGISTER A GIFT
OF ORGANS, EYES AND TISSUES TO TAKE PLACE AFTER DEATH PURSUANT TO THIS
ARTICLE. [Such] THE DONATE LIFE registry shall contain a listing of all
donors who have declared their consent to make an anatomical gift.
2. THE COMMISSIONER MAY ENTER INTO A MULTI-YEAR CONTRACT FOR THE OPER-
ATION AND PROMOTION OF THE DONATE LIFE REGISTRY SUBJECT TO SUCH TERMS
AND CONDITIONS AS MAY BE CONTAINED WITHIN SUCH CONTRACT WITH A NOT-FOR-
PROFIT ORGANIZATION THAT HAS EXPERIENCE WORKING WITH ORGAN, EYE AND
TISSUE PROCUREMENT ORGANIZATIONS, HAS EXPERTISE IN CONDUCTING ORGAN, EYE
AND TISSUE DONOR PROMOTIONAL CAMPAIGNS, AND IS AFFILIATED WITH THE
ORGAN, EYE AND TISSUE DONATION COMMUNITY THROUGHOUT THE STATE. THE
CONTRACTOR MAY SUBCONTRACT AS NEEDED FOR THE EFFECTIVE PERFORMANCE OF
THE CONTRACT. ALL SUCH SUBCONTRACTORS AND THE TERMS OF SUCH SUBCONTRACTS
SHALL BE SUBJECT TO APPROVAL BY THE COMMISSIONER. ANY APPLICABLE STATE
AGENCY, INCLUDING, BUT NOT LIMITED TO, THE DEPARTMENT, THE DEPARTMENT OF
MOTOR VEHICLES AND THE BOARD OF ELECTIONS, SHALL COOPERATE IN THE
COLLECTION AND TRANSFER OF REGISTRANT DATA TO THE DONATE LIFE REGISTRY.
3. THE DUTIES OF THE CONTRACTOR SHALL INCLUDE, BUT NOT BE LIMITED TO,
THE FOLLOWING:
(A) THE DEVELOPMENT, IMPLEMENTATION AND MAINTENANCE OF THE DONATE LIFE
REGISTRY THAT INCLUDES ONLINE, MAILED AND OTHER FORMS OF ORGAN, EYE AND
TISSUE DONOR REGISTRATION, VERIFICATION, AMENDMENT AND REVOCATION;
(B) PREPARATION AND SUBMISSION OF A PLAN TO ENCOURAGE ORGAN, EYE AND
TISSUE DONATION THROUGH EDUCATION AND MARKETING EFFORTS AND OTHER RECOM-
MENDATIONS THAT WOULD STREAMLINE AND ENHANCE THE COST-EFFECTIVE OPERA-
TION OF THE DONATE LIFE REGISTRY;
(C) PROVISION OF WRITTEN OR ELECTRONIC NOTIFICATION OF REGISTRATION IN
THE DONATE LIFE REGISTRY TO AN INDIVIDUAL ENROLLING IN THE DONATE LIFE
REGISTRY; AND
(D) PREPARATION AND SUBMISSION OF AN ANNUAL WRITTEN REPORT TO THE
DEPARTMENT. SUCH REPORT SHALL INCLUDE:
(I) A PERFORMANCE MATRIX INCLUDING THE NUMBER OF REGISTRANTS ON THE
DONATE LIFE REGISTRY AND AN ANALYSIS OF THE REGISTRATION RATES, INCLUD-
ING BUT NOT LIMITED TO, LOCATION, METHOD OF REGISTRATION, DEMOGRAPHIC,
AND STATE COMPARISONS;
(II) THE CHARACTERISTICS OF REGISTRANTS AS DETERMINED FROM THE DONATE
LIFE REGISTRY INFORMATION;
S. 6914 31 A. 9205
(III) THE ANNUAL DOLLAR AMOUNT OF VOLUNTARY CONTRIBUTIONS RECEIVED BY
THE CONTRACTOR FOR THE PURPOSES OF MAINTAINING THE DONATE LIFE REGISTRY
AND/OR EDUCATIONAL AND PROMOTIONAL CAMPAIGNS AND INITIATIVES;
(IV) A DESCRIPTION OF THE PROMOTIONAL CAMPAIGNS AND INITIATIVES IMPLE-
MENTED DURING THE YEAR; AND
(V) ACCOUNTING STATEMENTS OF EXPENDITURES FOR THE PURPOSES OF MAIN-
TAINING THE DONATE LIFE REGISTRY AND PROMOTIONAL CAMPAIGNS AND INITI-
ATIVES.
4. (A) FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND FIFTEEN, PAYMENTS TO THE CONTRACTOR
SHALL BE PAID BY THE DEPARTMENT.
(B) FOR THE PERIOD BEGINNING APRIL FIRST, TWO THOUSAND FIFTEEN AND
THEREAFTER, PAYMENTS TO THE CONTRACTOR SHALL BE PAID BY THE DEPARTMENT
FROM FUNDS AVAILABLE FOR THESE PURPOSES, INCLUDING, BUT NOT LIMITED TO,
THE FUNDS DEPOSITED INTO THE LIFE PASS IT ON TRUST FUND PURSUANT TO
SECTION NINETY-FIVE-D OF THE STATE FINANCE LAW.
(C) IN ADDITION, THE CONTRACTOR MAY RECEIVE AND USE VOLUNTARY CONTRIB-
UTIONS.
5. (A) Such ORGAN, EYE AND TISSUE registration of consent to make an
anatomical gift can be made through [(a)]: (I) indication made on the
application or renewal form of a DRIVER'S license, [(b)] (II) indication
made on a non-driver identification card application or renewal form,
[(c) enrolling in the registry website maintained by the department,
which may include using an electronic signature subject to article three
of the state technology law, (d)] (III) indication made on a voter
registration form pursuant to subdivision five of section 5-210 of the
election law, (IV) ENROLLMENT THROUGH THE DONATE LIFE REGISTRY WEBSITE,
(V) PAPER ENROLLMENT SUBMITTED TO THE DONATE LIFE REGISTRY, or [(e)]
(VI) through any other method identified by the commissioner.
(B)(I) Where required by law for [consent] REGISTRATION forms
described in [paragraphs (a) and (b)] SUBPARAGRAPHS (I) AND (II) of
PARAGRAPH (A) OF this subdivision, the commissioner shall ensure that
space is provided on any [consent] REGISTRATION form so that the appli-
cant shall register or decline registration in the donate life registry
for organ, EYE and tissue donations under this section and that the
following is stated on the form in clear and conspicuous type:
"You must fill out the following section: Would you like to be added
to the Donate Life Registry? Check box for 'yes' or 'skip this ques-
tion'."
(II) The commissioner shall not maintain records of any person who
checks "skip this question". Failure to check a box shall not impair the
validity of an application, and failure to check "yes" or checking "skip
this question" shall not be construed to imply a wish not to donate. In
the case of an applicant under eighteen years of age, checking "yes"
shall not constitute consent to make an anatomical gift or registration
in the donate life registry. Where an applicant has previously consented
to make an anatomical gift or registered in the donate life registry,
checking "skip this question" or failing to check a box shall not impair
that consent or registration.
(C) ENROLLMENT OR AMENDMENT OR REVOCATION THROUGH THE DONATE LIFE
REGISTRY WEBSITE THROUGH ANY OF THE MEANS LISTED IN THIS SUBDIVISION MAY
BE SIGNED BY ELECTRONIC SIGNATURE, IN ACCORDANCE WITH THE PROVISIONS OF
ARTICLE THREE OF THE STATE TECHNOLOGY LAW, SUPPORTED BY THE USE OF SUIT-
ABLE MECHANISMS INCLUDING UNIQUE IDENTIFIERS TO PROVIDE CONFIDENCE IN
THE IDENTITY OF THE PERSON PROVIDING THE ELECTRONIC SIGNATURE. The
registration shall take effect upon the provision of written or elec-
S. 6914 32 A. 9205
tronic notice of the registration to the [person] INDIVIDUAL enrolling
in the DONATE LIFE registry.
[3. (a) Information contained in the registry shall be accessible to
(i) federally designated organ procurement organizations, (ii) eye and
tissue banks licensed by the department pursuant to article
forty-three-B of this chapter, and (iii) any other entity formally
approved by the commissioner.
(b) The information contained in the registry shall not be released to
any person except as expressly authorized by this section solely for the
purpose of identifying potential organ and tissue donors at or near the
time of death.
4. If the department had an established registry prior to the effec-
tive date of this section, it shall be deemed to meet the requirements
of this section.
5. The registry shall provide persons enrolled the opportunity to
specify which organs and tissues they want to donate and if the donation
can be used for transplantation, research, or both.]
(D) AMENDMENTS OR REVOCATIONS FROM THE DONATE LIFE REGISTRY SHALL BE
MADE BY THE FOLLOWING, SUBJECT TO THE REQUIREMENTS OF THE COMMISSIONER:
(I) REGISTRANTS SUBMITTING AN AMENDMENT OR REVOCATION IN WRITING TO
THE DONATE LIFE REGISTRY; OR
(II) REGISTRANTS SUBMITTING AN AMENDMENT OR REVOCATION ELECTRONICALLY
THROUGH THE DONATE LIFE REGISTRY WEBSITE.
(E) REMOVAL FROM THE DONATE LIFE REGISTRY SHALL NOT BE DEEMED A
REFUSAL OF ANY OTHER OR FUTURE ANATOMICAL GIFT.
(F) THE DONATE LIFE REGISTRY SHALL PROVIDE INDIVIDUALS ENROLLED THE
OPPORTUNITY TO SPECIFY WHICH ORGANS, EYES AND TISSUES THEY WANT TO
DONATE AND IF THE DONATION MAY BE USED FOR TRANSPLANTATION, RESEARCH, OR
BOTH.
6. [A person] AN INDIVIDUAL registered in the [organ and tissue]
DONATE LIFE registry before [the effective date of this subdivision]
JULY TWENTY-THIRD, TWO THOUSAND EIGHT shall be deemed to have expressed
intent to donate, until and unless he or she files an amendment to his
or her registration or a new registration expressing consent to donate.
7. [The commissioner shall contact each person registered before the
effective date of this subdivision in the organ and tissue registry in
writing to inform him or her that at the time he or she registered, the
registry was that of intent and that the registry is now one of consent,
to explain in clear and understandable terms the difference between
intent and consent, and to provide opportunity for the person to change
his or her registration to provide consent by amending his or her
current registration or executing a new registration.] (A) THE DONATE
LIFE REGISTRY SHALL BE MAINTAINED IN A MANNER THAT ALLOWS IMMEDIATE
ACCESS TO ORGAN, EYE AND TISSUE DONATION RECORDS TWENTY-FOUR HOURS A
DAY, SEVEN DAYS A WEEK TO THE CONTRACTOR, THE DEPARTMENT, FEDERALLY
DESIGNATED ORGAN PROCUREMENT ORGANIZATIONS, LICENSED EYE AND TISSUE
BANKS, AND SUCH OTHER ENTITIES WHICH MAY BE APPROVED BY THE DEPARTMENT
FOR ACCESS. ACCESS SHALL BE AVAILABLE TO REGISTRANTS TO CONFIRM THE
ACCURACY AND VALIDITY OF THEIR REGISTRATION AND TO AMEND OR REVOKE THEIR
REGISTRATION, SUBJECT TO REASONABLE PROCEDURES TO VERIFY IDENTITY.
(B) ACCESS TO THE DONATE LIFE REGISTRY SHALL HAVE SECURITY MEASURES
SET FORTH IN THE CONTRACT TO PROTECT THE INTEGRITY OF THE IDENTIFIABLE
DATA IN THE DONATE LIFE REGISTRY, WHICH MAY ONLY BE ACCESSED BY THE
PARTIES DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION AND ONLY FOR THE
PURPOSES OF DETERMINING DONOR STATUS AT OR NEAR THE TIME OF DEATH OF AN
INDIVIDUAL, BY THE DEPARTMENT FOR ANY PURPOSE, BY THE CONTRACTOR ONLY
S. 6914 33 A. 9205
FOR PURPOSES OF QUALITY ASSESSMENT AND IMPROVEMENT, TECHNICAL SUPPORT
AND DONOR SERVICES, OR BY INDIVIDUAL REGISTRANTS FOR THE PURPOSES OF
CONFIRMING THE ACCURACY AND VALIDITY OF THEIR REGISTRATION OR MAKING,
AMENDING OR REVOKING THEIR REGISTRATION.
(C) DE-IDENTIFIED INFORMATION MAY BE ACCESSED BY THE ENTITIES LISTED
IN PARAGRAPH (A) OF THIS SUBDIVISION OR THEIR DESIGNEES FOR PURPOSES OF
ANALYSIS, PROMOTION, EDUCATION, QUALITY IMPROVEMENT AND TECHNICAL
SUPPORT FOR THE DONATE LIFE REGISTRY. THE INFORMATION CONTAINED IN THE
REGISTRY SHALL NOT BE RELEASED TO ANY PERSON EXCEPT AS EXPRESSLY AUTHOR-
IZED BY THIS SECTION, SOLELY FOR THE PURPOSES SO AUTHORIZED.
8. The commissioner is authorized to promulgate rules and regulations
necessary to implement the provisions of this section.
9. AN INTERAGENCY WORK GROUP, COMPOSED OF THE COMMISSIONER, THE
COMMISSIONER OF THE DEPARTMENT OF MOTOR VEHICLES, A CHAIR OF THE BOARD
OF ELECTIONS, OR THEIR DESIGNEES, AND SUCH OTHER INDIVIDUALS AS MAY BE
DESIGNATED BY THE COMMISSIONER, SHALL BE ESTABLISHED TO MEET WITH THE
CONTRACTOR ANNUALLY AND AS NEEDED TO REVIEW THE STATUS OF THE DONATE
LIFE REGISTRY, TO EXAMINE THE STEPS THAT MIGHT BE TAKEN BY STATE AGEN-
CIES TO ENHANCE ITS PERFORMANCE AND TO MAKE RECOMMENDATIONS TO THE
CONTRACTOR.
S 28. Intentionally omitted.
S 29. Subdivision 3 of section 95-d of the state finance law, as added
by chapter 415 of the laws of 2003, is amended to read as follows:
3. Monies of the fund shall be expended only for organ transplant
research and education projects approved by the commissioner of health,
or to provide grants to not-for-profit corporations in this state which
are incorporated for the purpose of increasing and promoting organ and
tissue donation awareness PROVIDED, HOWEVER, BEGINNING APRIL FIRST, TWO
THOUSAND FIFTEEN, ANY REVENUES RECEIVED OR ANY MONIES APPROPRIATED,
CREDITED OR TRANSFERRED TO THE FUND ON AND AFTER MAY FIRST, TWO THOUSAND
FOURTEEN MAY ALSO BE EXPENDED TO SUPPORT THE MAINTENANCE AND OPERATION
OF THE DONATE LIFE REGISTRY IN ACCORDANCE WITH THE PROVISIONS OF SECTION
FORTY-THREE HUNDRED TEN OF THE PUBLIC HEALTH LAW.
S 30. Section 461-b of the social services law is amended by adding
two new subdivisions 9 and 10 to read as follows:
9. (A) THE PRIOR WRITTEN APPROVAL OF THE DEPARTMENT IS REQUIRED FOR:
(I) ANY TRANSFER, ASSIGNMENT OR OTHER DISPOSITION OF TEN PERCENT OR MORE
OF AN INTEREST OR VOTING RIGHTS IN A PARTNERSHIP, BUSINESS CORPORATION
OR LIMITED LIABILITY COMPANY WHICH IS THE OPERATOR OF AN ADULT CARE
FACILITY TO A NEW PARTNER, SHAREHOLDER OR MEMBER; OR (II) ANY TRANSFER,
ASSIGNMENT OR OTHER DISPOSITION OF INTEREST OR VOTING RIGHTS IN A PART-
NERSHIP, BUSINESS CORPORATION OR LIMITED LIABILITY COMPANY WHICH IS THE
OPERATOR OF AN ADULT CARE FACILITY WHICH RESULTS IN THE OWNERSHIP OR
CONTROL OF MORE THAN TEN PERCENT OF THE INTEREST OR VOTING RIGHTS THERE-
UNDER BY ANY PERSON WHO HAS NOT BEEN PREVIOUSLY APPROVED BY THE DEPART-
MENT FOR THAT OPERATOR.
(B) WITH RESPECT TO A TRANSFER, ASSIGNMENT OR DISPOSITION INVOLVING
LESS THAN TEN PERCENT OF AN INTEREST OR VOTING RIGHTS IN SUCH PARTNER-
SHIP, BUSINESS CORPORATION OR LIMITED LIABILITY COMPANY TO A NEW PART-
NER, SHAREHOLDER OR MEMBER, NO PRIOR APPROVAL OF THE DEPARTMENT SHALL BE
REQUIRED EXCEPT WHERE REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
HOWEVER, NO SUCH TRANSACTION SHALL BE EFFECTIVE UNLESS AT LEAST NINETY
DAYS PRIOR TO THE INTENDED EFFECTIVE DATE THEREOF, THE PARTNERSHIP,
BUSINESS CORPORATION OR LIMITED LIABILITY COMPANY 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
S. 6914 34 A. 9205
NECESSARY FOR THE DEPARTMENT TO DETERMINE WHETHER IT SHOULD PROHIBIT THE
TRANSACTION. WITHIN NINETY DAYS FROM THE DATE OF RECEIPT OF SUCH NOTICE,
THE DEPARTMENT MAY PROHIBIT ANY SUCH TRANSACTION UNDER THIS SUBPARAGRAPH
IF IT FINDS: (I) THERE ARE REASONABLE GROUNDS TO BELIEVE THE PROPOSED
TRANSACTION DOES NOT SATISFY THE CHARACTER AND COMPETENCE REVIEW, AS MAY
BE APPROPRIATE; OR (II) IF THE TRANSACTION, TOGETHER WITH ALL OTHER SUCH
TRANSACTIONS DURING ANY FIVE YEAR PERIOD, WOULD IN THE AGGREGATE,
INVOLVE TWENTY-FIVE PERCENT OR MORE OF THE INTEREST IN THE ENTITY THAT
CONSTITUTES THE OPERATOR. THE DEPARTMENT SHALL STATE THE SPECIFIC
REASONS FOR PROHIBITING ANY TRANSACTION UNDER THIS SUBPARAGRAPH AND
SHALL SO NOTIFY EACH PARTY TO THE PROPOSED TRANSACTION.
(C) WITH RESPECT TO A TRANSFER, ASSIGNMENT OR DISPOSITION OF AN INTER-
EST OR VOTING RIGHTS IN A PARTNERSHIP, BUSINESS CORPORATION OR LIMITED
LIABILITY COMPANY TO ANY EXISTING PARTNER, SHAREHOLDER OR MEMBER, NO
PRIOR APPROVAL OF THE DEPARTMENT SHALL BE REQUIRED. HOWEVER, IF THE
TRANSACTION INVOLVES THE WITHDRAWAL OF THE TRANSFEROR FROM THE PARTNER-
SHIP, BUSINESS CORPORATION OR LIMITED LIABILITY COMPANY, NO SUCH TRANS-
ACTION SHALL BE EFFECTIVE UNLESS AT LEAST NINETY DAYS PRIOR TO THE
INTENDED EFFECTIVE DATE THEREOF, THE PARTNERSHIP, BUSINESS CORPORATION
OR LIMITED LIABILITY COMPANY FULLY COMPLETES AND FILES WITH THE DEPART-
MENT NOTICE OF SUCH TRANSACTION. WITHIN NINETY DAYS FROM THE DATE OF
RECEIPT OF SUCH NOTICE, THE DEPARTMENT MAY PROHIBIT ANY SUCH TRANSACTION
UNDER THIS PARAGRAPH IF THE EQUITY POSITION OF THE PARTNERSHIP, BUSINESS
CORPORATION OR LIMITED LIABILITY COMPANY, DETERMINED IN ACCORDANCE WITH
GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, WOULD BE REDUCED AS A RESULT
OF THE TRANSFER, ASSIGNMENT OR DISPOSITION. THE DEPARTMENT SHALL STATE
THE SPECIFIC REASON FOR PROHIBITING ANY TRANSACTION UNDER THIS PARAGRAPH
AND SHALL SO NOTIFY EACH PARTY TO THE PROPOSED TRANSACTION.
10. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, THE DEPART-
MENT IS AUTHORIZED TO APPROVE A CERTIFICATE OF INCORPORATION OR ARTICLES
OF ORGANIZATION FOR ESTABLISHMENT OF AN ADULT CARE FACILITY ON AN EXPE-
DITED BASIS WHERE: (A) THE CERTIFICATE OF INCORPORATION OR ARTICLES OF
ORGANIZATION REFLECTS SOLELY A CHANGE IN THE FORM OF THE BUSINESS ORGAN-
IZATION OF AN EXISTING ENTITY WHICH HAD BEEN APPROVED BY THE DEPARTMENT
TO OPERATE AN ADULT CARE FACILITY; (B) EVERY INCORPORATOR, STOCKHOLDER,
MEMBER AND DIRECTOR OF THE NEW ENTITY SHALL HAVE BEEN AN OWNER, PARTNER,
INCORPORATOR, STOCKHOLDER, MEMBER OR DIRECTOR OF THE EXISTING ENTITY;
(C) THE DISTRIBUTION OF OWNERSHIP INTERESTS AND VOTING RIGHTS IN THE NEW
ENTITY SHALL BE THE SAME AS IN THE EXISTING ENTITY; AND (D) THERE SHALL
BE NO CHANGE IN THE OPERATOR OF THE ADULT CARE FACILITY OTHER THAN THE
FORM OF ITS BUSINESS ORGANIZATION, AS A RESULT OF THE APPROVAL OF SUCH
CERTIFICATE OF INCORPORATION OR ARTICLES OF ORGANIZATION. UPON
SUBMISSION, IF THE DEPARTMENT DOES NOT OBJECT TO THE PROPOSAL WITHIN
NINETY DAYS OF THE RECEIPT OF A COMPLETE APPLICATION, THE PROPOSAL WILL
BE DEEMED ACCEPTABLE TO THE DEPARTMENT AND AN AMENDED OPERATING CERTIF-
ICATE SHALL BE ISSUED.
S 31. Subdivisions 1 and 2 of section 461-k of the social services
law, as added by chapter 779 of the laws of 1986, are amended to read as
follows:
1. (a) "Services for non-residents in adult homes, residences for
adults and enriched housing programs" shall mean an organized program of
services which the facility is authorized to provide to residents of
such facility but which are provided to non-residents for the purpose of
restoring, maintaining or developing the capacity of aged or disabled
persons to remain in or return to the community. Such services may
include but shall not be limited to day programs and temporary residen-
S. 6914 35 A. 9205
tial care as defined herein. A person participating in a program of
services for non-residents in an adult care facility shall be considered
a resident of the facility and shall be afforded all the rights and
protections afforded residents of the facility under this chapter except
that the provisions of sections four hundred sixty-one-g and four
hundred sixty-one-h of this title relating to termination of admission
agreements shall not apply and that persons receiving services pursuant
to this section shall not be considered to be receiving residential care
as defined in section two hundred nine of this chapter for purposes of
determining eligibility for and the amount of supplemental security
income benefits and additional state payments.
(b) "Day programs" shall mean an organized program for non-residents
which shall include personal care, supervision and other adult services
which the facility is authorized to provide to residents of such facili-
ty which may include but are not limited to, activities, meals, informa-
tion and referral, and transportation services, provided in an adult
home, residence for adults or enriched housing program.
(c) "Temporary residential care" shall mean the provision of temporary
residential care of frail or disabled adults on behalf of or in the
absence of the caregiver for up to [six weeks] ONE HUNDRED TWENTY DAYS
in any twelve month period, provided in an adult home, residence for
adults or enriched housing program.
2. A program to provide services for non-residents in an adult care
facility may be established and operated in an adult home, residence for
adults or enriched housing program provided that such facility has a
current operating certificate issued in accordance with section four
hundred sixty-one-b of this title. No operator may establish and operate
a DAY program to provide services for non-residents, AS DEFINED IN
SUBPARAGRAPH (B) OF SUBDIVISION ONE OF THIS SECTION, unless the operator
has received the prior written approval of the department. The depart-
ment shall grant such approval TO OPERATE A DAY PROGRAM only to those
operators that are operating in compliance with applicable law and regu-
lations. NO OPERATOR MAY PROVIDE TEMPORARY RESIDENTIAL CARE AS DEFINED
IN SUBPARAGRAPH (C) OF SUBDIVISION ONE OF THIS SECTION, UNLESS THE OPER-
ATOR HAS NOTIFIED THE DEPARTMENT OF ITS INTENT TO DO SO.
S 32. Intentionally omitted.
S 33. Subdivision 4 of section 4656 of the public health law, as added
by chapter 2 of the laws of 2004, is amended to read as follows:
4. The department shall develop an expedited review and approval proc-
ess FOR APPLICATIONS FOR UP TO NINE ADDITIONAL BEDS TO AN EXISTING
ENHANCED OR SPECIAL NEEDS ASSISTED LIVING CERTIFICATE QUALIFIED AS BEING
IN GOOD STANDING UNDER SECTION FORTY-SIX HUNDRED FIFTY-THREE OF THIS
ARTICLE.
S 34. Paragraph (b) of subdivision 5 of section 3610 of the public
health law is REPEALED.
S 35. Subdivision 2 of section 3610 of the public health law, as
amended by section 65 of part A of chapter 58 of the laws of 2010, is
amended to read as follows:
2. A hospital, residential health care facility, or certified home
health agency seeking authorization to provide a long term home health
care program shall transmit to the commissioner an application setting
forth the scope of the proposed program. Such application shall be in a
format and shall be submitted in a quantity determined by the commis-
sioner. The commissioner shall transmit the application to the public
health and health planning council and to the health systems agency, if
any, having geographic jurisdiction of the area where the proposed
S. 6914 36 A. 9205
program is to be located. The application shall include a detailed
description of the proposed program including, but not limited to, the
following:
(a) an outline of the institution's or agency's plans for the program;
(b) the need for the proposed program;
(c) the number and types of personnel to be employed;
(d) the ability of the agency, hospital, or facility to provide the
program;
(e) the estimated number of visits to be provided;
(f) the geographic area in which the proposed programs will be
provided;
(g) any special or unusual services, programs, or equipment to be
provided;
(h) a demonstration that the proposed program is feasible and adequate
in terms of both short range and long range goals;
(i) such other information as the commissioner may require.
The health systems agency and the public health and health planning
council shall review the application and submit their recommendations to
the commissioner. At the time members of the public health and health
planning council are notified that an application is scheduled for
consideration, the applicant and the health systems agency shall be so
notified in writing. The health systems agency or the public health and
health planning council shall not recommend approval of the application
unless it is satisfied as to:
(a) the public need for the program at the time and place and under
the circumstances proposed;
(b) the financial resources of the provider of the proposed program
and its sources of future revenues;
(c) the ability of the proposed program to meet those standards estab-
lished for participation as a home health agency under title XVIII of
the federal Social Security Act; and
(d) such other matters as it shall deem pertinent.
After receiving and considering the recommendations of the public
health and health planning council and the health systems agency, the
commissioner shall make his or her determination. The commissioner shall
act upon an application after the public health and health planning
council and the health systems agency have had a reasonable time to
submit their recommendations. The commissioner shall not take any action
contrary to the advice of either until he or she affords to either an
opportunity to request a public hearing and, if so requested, a public
hearing shall be held. The commissioner shall not approve the applica-
tion unless he or she is satisfied as to the detailed description of the
proposed program and
(a) the public need for the existence of the program at the time and
place and under the circumstances proposed;
(b) the financial resources of the provider of the proposed program
and its sources of future revenues;
(c) the ability of the proposed program to meet those standards estab-
lished for participation as a home health agency under title XVIII of
the federal Social Security Act; and
(d) such other matters as he or she shall deem pertinent.
If the application is approved, the applicant shall be so notified in
writing. The commissioner's written approval of the application shall
constitute authorization to provide a long term home health care
program. [In making his or her authorization, the commissioner shall
stipulate the maximum number of persons which a provider of a long term
S. 6914 37 A. 9205
home health care program may serve.] If the commissioner proposes to
disapprove the application, he or she shall notify the applicant in
writing, stating his or her reasons for disapproval, and afford the
applicant an opportunity for a public hearing.
S 36. Intentionally omitted.
S 37. Section 32 of part A of chapter 58 of the laws of 2008, amending
the elder law and other laws relating to reimbursement to particular
provider pharmacies and prescription drug coverage, as amended by
section 26 of part A of chapter 59 of the laws of 2011, is amended to
read as follows:
S 32. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2008; provided
however, that sections one, six-a, nineteen, twenty, twenty-four, and
twenty-five of this act shall take effect July 1, 2008; provided however
that sections sixteen, seventeen and eighteen of this act shall expire
April 1, [2014] 2017; provided, however, that the amendments made by
section twenty-eight of this act shall take effect on the same date as
section 1 of chapter 281 of the laws of 2007 takes effect; provided
further, that sections twenty-nine, thirty, and thirty-one of this act
shall take effect October 1, 2008; provided further, that section twen-
ty-seven of this act shall take effect January 1, 2009; and provided
further, that section twenty-seven of this act shall expire and be
deemed repealed March 31, [2014] 2015; and provided, further, however,
that the amendments to subdivision 1 of section 241 of the education law
made by section twenty-nine of this act shall not affect the expiration
of such subdivision and shall be deemed to expire therewith and provided
that the amendments to section 272 of the public health law made by
section thirty of this act shall not affect the repeal of such section
and shall be deemed repealed therewith.
S 38. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2014; provided,
however, that the amendments to subdivisions 1 and 2 of section 461-k of
the social services law made by section thirty-one of this act shall not
affect the expiration of such section and shall be deemed to expire
therewith; and provided, further, that the amendments made to paragraph
(b) of subdivision 18-a of section 206 of the public health law made by
section sixteen of this act shall not affect the expiration of such
paragraph and shall be deemed to expire therewith.
PART B
Section 1. Subdivision 5 of section 168 of chapter 639 of the laws of
1996, constituting the New York Health Care Reform Act of 1996, as
amended by section 1 of part C of chapter 59 of the laws of 2011, is
amended to read as follows:
5. sections 2807-c, 2807-j, 2807-s and 2807-t of the public health
law, as amended or as added by this act, shall expire on December 31,
[2014] 2017, and shall be thereafter effective only in respect to any
act done on or before such date or action or proceeding arising out of
such act including continued collections of funds from assessments and
allowances and surcharges established pursuant to sections 2807-c,
2807-j, 2807-s and 2807-t of the public health law, and administration
and distributions of funds from pools established pursuant to sections
2807-c, 2807-j, 2807-k, 2807-l, 2807-m, 2807-s and 2807-t of the public
health law related to patient services provided before December 31,
S. 6914 38 A. 9205
[2014] 2017, and continued expenditure of funds authorized for programs
and grants until the exhaustion of funds therefor;
S 2. Subdivision 1 of section 138 of chapter 1 of the laws of 1999,
constituting the New York Health Care Reform Act of 2000, as amended by
section 2 of part C of chapter 59 of the laws of 2011, is amended to
read as follows:
1. sections 2807-c, 2807-j, 2807-s, and 2807-t of the public health
law, as amended by this act, shall expire on December 31, [2014] 2017,
and shall be thereafter effective only in respect to any act done before
such date or action or proceeding arising out of such act including
continued collections of funds from assessments and allowances and
surcharges established pursuant to sections 2807-c, 2807-j, 2807-s and
2807-t of the public health law, and administration and distributions of
funds from pools established pursuant to sections 2807-c, 2807-j,
2807-k, 2807-l, 2807-m, 2807-s, 2807-t, 2807-v and 2807-w of the public
health law, as amended or added by this act, related to patient services
provided before December 31, [2014] 2017, and continued expenditure of
funds authorized for programs and grants until the exhaustion of funds
therefor;
S 3. The opening paragraph, subparagraph (xiv) and (xv) of paragraph
(a), subparagraph (v) of paragraph (c) and paragraph (e) of subdivision
6 of section 2807-s of the public health law, the opening paragraph as
amended by section 4 of part A3 of chapter 62 of the laws of 2003,
subparagraphs (xiv) and (xv) of paragraph (a) as amended by section 5 of
part C of chapter 59 of the laws of 2011, subparagraph (v) of paragraph
(c) as amended by section 5-a of part C of chapter 59 of the laws of
2011 and paragraph (e) as amended by section 6 of part A3 of chapter 62
of the laws of 2003, subparagraphs (i) and (ii) of paragraph (e) as
amended by section 5-b of part C of chapter 59 of the laws of 2011, are
amended to read as follows:
The amount allocated to each region for purposes of calculating the
regional allowance percentage pursuant to this section for each year
during the period January first, nineteen hundred ninety-seven through
December thirty-first, nineteen hundred ninety-nine and the regional
assessments pursuant to section twenty-eight hundred seven-t of this
article for each year during the period January first, nineteen hundred
ninety-seven through December thirty-first, nineteen hundred ninety-nine
and for each year on and after January first, two thousand, shall be the
sum of the factors computed in paragraphs (b), (d) and (f) of this
subdivision, IF SUCH FACTORS ARE APPLICABLE TO A GIVEN YEAR, as follows:
(xiv) A gross annual statewide amount for the period January first,
two thousand nine through December thirty-first, two thousand [thirteen]
FOURTEEN, shall be nine hundred forty-four million dollars.
(xv) A gross ANNUAL statewide amount for the period January first, two
thousand [fourteen] FIFTEEN through [March] DECEMBER thirty-first, two
thousand [fourteen] SEVENTEEN, shall be [two hundred thirty-six] ONE
BILLION FORTY-FIVE million dollars.
(v) A further gross ANNUAL statewide amount for the period January
first, two thousand fourteen through [March] DECEMBER thirty-first, two
thousand fourteen, shall be [twenty-two] EIGHTY-NINE million [two
hundred fifty thousand] dollars.
(e) [(i)] A further gross annual statewide amount shall be twelve
million dollars for each period prior to January first, two thousand
[fourteen] FIFTEEN.
S. 6914 39 A. 9205
[(ii) A further gross statewide amount for the period January first,
two thousand fourteen through March thirty-first, two thousand fourteen
shall be three million dollars.]
S 4. Subparagraph (xiii) of paragraph (a) of subdivision 7 of section
2807-s of the public health law, as added by section 30 of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
(xiii) twenty-three million eight hundred thirty-six thousand dollars
each state fiscal year for the period April first, two thousand twelve
through March thirty-first, two thousand [fourteen] SEVENTEEN;
S 5. Subparagraphs (iv) and (v) of paragraph (a) of subdivision 9 of
section 2807-j of the public health law, as amended by section 3 of part
C of chapter 59 of the laws of 2011, are amended to read as follows:
(iv) seven hundred sixty-five million dollars annually of the funds
accumulated for the periods January first, two thousand through December
thirty-first, two thousand [thirteen] SIXTEEN, and
(v) one hundred ninety-one million two hundred fifty thousand dollars
of the funds accumulated for the period January first, two thousand
[fourteen] SEVENTEEN through March thirty-first, two thousand [fourteen]
SEVENTEEN.
S 6. Section 34 of part A3 of chapter 62 of the laws of 2003 amending
the general business law and other laws relating to enacting major
components necessary to implement the state fiscal plan for the 2003-04
state fiscal year, as amended by section 4 of part C of chapter 59 of
the laws of 2011, is amended to read as follows:
S 34. (1) Notwithstanding any inconsistent provision of law, rule or
regulation and effective April 1, 2008 through March 31, [2014] 2017,
the commissioner of health is authorized to transfer and the state comp-
troller is authorized and directed to receive for deposit to the credit
of the department of health's special revenue fund - other, health care
reform act (HCRA) resources fund - 061, provider collection monitoring
account, within amounts appropriated each year, those funds collected
and accumulated pursuant to section 2807-v of the public health law,
including income from invested funds, for the purpose of payment for
administrative costs of the department of health related to adminis-
tration of statutory duties for the collections and distributions
authorized by section 2807-v of the public health law.
(2) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the state comp-
troller is authorized and directed to receive for deposit to the credit
of the department of health's special revenue fund - other, health care
reform act (HCRA) resources fund - 061, provider collection monitoring
account, within amounts appropriated each year, those funds collected
and accumulated and interest earned through surcharges on payments for
health care services pursuant to section 2807-s of the public health law
and from assessments pursuant to section 2807-t of the public health law
for the purpose of payment for administrative costs of the department of
health related to administration of statutory duties for the collections
and distributions authorized by sections 2807-s, 2807-t, and 2807-m of
the public health law.
(3) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with the provisions of
paragraph (a) of subdivision 1 of section 2807-l of the public health
S. 6914 40 A. 9205
law for the purposes of payment for administrative costs of the depart-
ment of health related to the child health insurance plan program
authorized pursuant to title 1-A of article 25 of the public health law
into the special revenue funds - other, health care reform act (HCRA)
resources fund - 061, child health insurance account, established within
the department of health.
(4) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with the provisions of
paragraph (e) of subdivision 1 of section 2807-l of the public health
law for the purpose of payment for administrative costs of the depart-
ment of health related to the health occupation development and work-
place demonstration program established pursuant to section 2807-h and
the health workforce retraining program established pursuant to section
2807-g of the public health law into the special revenue funds - other,
health care reform act (HCRA) resources fund - 061, health occupation
development and workplace demonstration program account, established
within the department of health.
(5) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds allocated pursuant to paragraph (j) of subdivision 1 of section
2807-v of the public health law for the purpose of payment for adminis-
trative costs of the department of health related to administration of
the state's tobacco control programs and cancer services provided pursu-
ant to sections 2807-r and 1399-ii of the public health law into such
accounts established within the department of health for such purposes.
(6) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, the funds
authorized for distribution in accordance with the provisions of section
2807-l of the public health law for the purposes of payment for adminis-
trative costs of the department of health related to the programs funded
pursuant to section 2807-l of the public health law into the special
revenue funds - other, health care reform act (HCRA) resources fund -
061, pilot health insurance account, established within the department
of health.
(7) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with the provisions of
subparagraph (ii) of paragraph (f) of subdivision 19 of section 2807-c
of the public health law from monies accumulated and interest earned in
the bad debt and charity care and capital statewide pools through an
assessment charged to general hospitals pursuant to the provisions of
subdivision 18 of section 2807-c of the public health law and those
funds authorized for distribution in accordance with the provisions of
section 2807-l of the public health law for the purposes of payment for
administrative costs of the department of health related to programs
funded under section 2807-l of the public health law into the special
revenue funds - other, health care reform act (HCRA) resources fund -
S. 6914 41 A. 9205
061, primary care initiatives account, established within the department
of health.
(8) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized for distribution in accordance with section 2807-l of
the public health law for the purposes of payment for administrative
costs of the department of health related to programs funded under
section 2807-l of the public health law into the special revenue funds -
other, health care reform act (HCRA) resources fund - 061, health care
delivery administration account, established within the department of
health.
(9) Notwithstanding any inconsistent provision of law, rule or regu-
lation and effective April 1, 2008 through March 31, [2014] 2017, the
commissioner of health is authorized to transfer and the comptroller is
authorized to deposit, within amounts appropriated each year, those
funds authorized pursuant to sections 2807-d, 3614-a and 3614-b of the
public health law and section 367-i of the social services law and for
distribution in accordance with the provisions of subdivision 9 of
section 2807-j of the public health law for the purpose of payment for
administration of statutory duties for the collections and distributions
authorized by sections 2807-c, 2807-d, 2807-j, 2807-k, 2807-l, 3614-a
and 3614-b of the public health law and section 367-i of the social
services law into the special revenue funds - other, health care reform
act (HCRA) resources fund - 061, provider collection monitoring account,
established within the department of health.
S 7. Section 2807-l of the public health law, as amended by section 7
of part C of chapter 59 of the laws of 2011, is amended to read as
follows:
S 2807-l. Health care initiatives pool distributions. 1. Funds accumu-
lated in the health care initiatives pools pursuant to paragraph (b) of
subdivision nine of section twenty-eight hundred seven-j of this arti-
cle, or the health care reform act (HCRA) resources fund established
pursuant to section ninety-two-dd of the state finance law, whichever is
applicable, including income from invested funds, shall be distributed
or retained by the commissioner or by the state comptroller, as applica-
ble, in accordance with the following.
(a) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions to programs to provide health care coverage for unin-
sured or underinsured children pursuant to sections twenty-five hundred
ten and twenty-five hundred eleven of this chapter from the respective
health care initiatives pools established for the following periods in
the following amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
up to one hundred twenty million six hundred thousand dollars;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, up to one hundred sixty-four million five hundred thousand
dollars;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
up to one hundred eighty-one million dollars;
S. 6914 42 A. 9205
(iv) from the pool for the period January first, two thousand through
December thirty-first, two thousand, two hundred seven million dollars;
(v) from the pool for the period January first, two thousand one
through December thirty-first, two thousand one, two hundred thirty-five
million dollars;
(vi) from the pool for the period January first, two thousand two
through December thirty-first, two thousand two, three hundred twenty-
four million dollars;
(vii) from the pool for the period January first, two thousand three
through December thirty-first, two thousand three, up to four hundred
fifty million three hundred thousand dollars;
(viii) from the pool for the period January first, two thousand four
through December thirty-first, two thousand four, up to four hundred
sixty million nine hundred thousand dollars;
(ix) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period January first, two thou-
sand five through December thirty-first, two thousand five, up to one
hundred fifty-three million eight hundred thousand dollars;
(x) from the health care reform act (HCRA) resources fund for the
period January first, two thousand six through December thirty-first,
two thousand six, up to three hundred twenty-five million four hundred
thousand dollars;
(xi) from the health care reform act (HCRA) resources fund for the
period January first, two thousand seven through December thirty-first,
two thousand seven, up to four hundred twenty-eight million fifty-nine
thousand dollars;
(xii) from the health care reform act (HCRA) resources fund for the
period January first, two thousand eight through December thirty-first,
two thousand ten, up to four hundred fifty-three million six hundred
seventy-four thousand dollars annually;
(xiii) from the health care reform act (HCRA) resources fund for the
period January first, two thousand eleven, through March thirty-first,
two thousand eleven, up to one hundred thirteen million four hundred
eighteen thousand dollars;
(xiv) from the health care reform act (HCRA) resources fund for the
period April first, two thousand eleven, through March thirty-first, two
thousand twelve, up to three hundred twenty-four million seven hundred
forty-four thousand dollars;
(xv) from the health care reform act (HCRA) resources fund for the
period April first, two thousand twelve, through March thirty-first, two
thousand thirteen, up to three hundred forty-six million four hundred
forty-four thousand dollars; [and]
(xvi) from the health care reform act (HCRA) resources fund for the
period April first, two thousand thirteen, through March thirty-first,
two thousand fourteen, up to three hundred seventy million six hundred
ninety-five thousand dollars[.]; AND
(XVII) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR EACH
STATE FISCAL YEAR FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND
FOURTEEN, WITHIN AMOUNTS APPROPRIATED.
(b) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions for health insurance programs under the individual
subsidy programs established pursuant to the expanded health care cover-
age act of nineteen hundred eighty-eight as amended, and for evaluation
of such programs from the respective health care initiatives pools or
S. 6914 43 A. 9205
the health care reform act (HCRA) resources fund, whichever is applica-
ble, established for the following periods in the following amounts:
(i) (A) an amount not to exceed six million dollars on an annualized
basis for the periods January first, nineteen hundred ninety-seven
through December thirty-first, nineteen hundred ninety-nine; up to six
million dollars for the period January first, two thousand through
December thirty-first, two thousand; up to five million dollars for the
period January first, two thousand one through December thirty-first,
two thousand one; up to four million dollars for the period January
first, two thousand two through December thirty-first, two thousand two;
up to two million six hundred thousand dollars for the period January
first, two thousand three through December thirty-first, two thousand
three; up to one million three hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four; up to six hundred seventy thousand dollars for the period
January first, two thousand five through June thirtieth, two thousand
five; up to one million three hundred thousand dollars for the period
April first, two thousand six through March thirty-first, two thousand
seven; and up to one million three hundred thousand dollars annually for
the period April first, two thousand seven through March thirty-first,
two thousand nine, shall be allocated to individual subsidy programs;
and
(B) an amount not to exceed seven million dollars on an annualized
basis for the periods during the period January first, nineteen hundred
ninety-seven through December thirty-first, nineteen hundred ninety-nine
and four million dollars annually for the periods January first, two
thousand through December thirty-first, two thousand two, and three
million dollars for the period January first, two thousand three through
December thirty-first, two thousand three, and two million dollars for
the period January first, two thousand four through December thirty-
first, two thousand four, and two million dollars for the period January
first, two thousand five through June thirtieth, two thousand five shall
be allocated to the catastrophic health care expense program.
(ii) Notwithstanding any law to the contrary, the characterizations of
the New York state small business health insurance partnership program
as in effect prior to June thirtieth, two thousand three, voucher
program as in effect prior to December thirty-first, two thousand one,
individual subsidy program as in effect prior to June thirtieth, two
thousand five, and catastrophic health care expense program, as in
effect prior to June thirtieth, two thousand five, may, for the purposes
of identifying matching funds for the community health care conversion
demonstration project described in a waiver of the provisions of title
XIX of the federal social security act granted to the state of New York
and dated July fifteenth, nineteen hundred ninety-seven, may continue to
be used to characterize the insurance programs in sections four thousand
three hundred twenty-one-a, four thousand three hundred twenty-two-a,
four thousand three hundred twenty-six and four thousand three hundred
twenty-seven of the insurance law, which are successor programs to these
programs.
(c) Up to seventy-eight million dollars shall be reserved and accumu-
lated from year to year from the pool for the period January first,
nineteen hundred ninety-seven through December thirty-first, nineteen
hundred ninety-seven, for purposes of public health programs, up to
seventy-six million dollars shall be reserved and accumulated from year
to year from the pools for the periods January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
S. 6914 44 A. 9205
eight and January first, nineteen hundred ninety-nine through December
thirty-first, nineteen hundred ninety-nine, up to eighty-four million
dollars shall be reserved and accumulated from year to year from the
pools for the period January first, two thousand through December thir-
ty-first, two thousand, up to eighty-five million dollars shall be
reserved and accumulated from year to year from the pools for the period
January first, two thousand one through December thirty-first, two thou-
sand one, up to eighty-six million dollars shall be reserved and accumu-
lated from year to year from the pools for the period January first, two
thousand two through December thirty-first, two thousand two, up to
eighty-six million one hundred fifty thousand dollars shall be reserved
and accumulated from year to year from the pools for the period January
first, two thousand three through December thirty-first, two thousand
three, up to fifty-eight million seven hundred eighty thousand dollars
shall be reserved and accumulated from year to year from the pools for
the period January first, two thousand four through December thirty-
first, two thousand four, up to sixty-eight million seven hundred thirty
thousand dollars shall be reserved and accumulated from year to year
from the pools or the health care reform act (HCRA) resources fund,
whichever is applicable, for the period January first, two thousand five
through December thirty-first, two thousand five, up to ninety-four
million three hundred fifty thousand dollars shall be reserved and accu-
mulated from year to year from the health care reform act (HCRA)
resources fund for the period January first, two thousand six through
December thirty-first, two thousand six, up to seventy million nine
hundred thirty-nine thousand dollars shall be reserved and accumulated
from year to year from the health care reform act (HCRA) resources fund
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven, up to fifty-five million six hundred
eighty-nine thousand dollars annually shall be reserved and accumulated
from year to year from the health care reform act (HCRA) resources fund
for the period January first, two thousand eight through December thir-
ty-first, two thousand ten, up to thirteen million nine hundred twenty-
two thousand dollars shall be reserved and accumulated from year to year
from the health care reform act (HCRA) resources fund for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven, and for periods on and after April first, two thousand
eleven [through March thirty-first, two thousand fourteen], up to fund-
ing amounts specified below and shall be available, including income
from invested funds, for:
(i) deposit by the commissioner, within amounts appropriated, and the
state comptroller is hereby authorized and directed to receive for
deposit to, to the credit of the department of health's special revenue
fund - other, hospital based grants program account or the health care
reform act (HCRA) resources fund, whichever is applicable, for purposes
of services and expenses related to general hospital based grant
programs, up to twenty-two million dollars annually from the nineteen
hundred ninety-seven pool, nineteen hundred ninety-eight pool, nineteen
hundred ninety-nine pool, two thousand pool, two thousand one pool and
two thousand two pool, respectively, up to twenty-two million dollars
from the two thousand three pool, up to ten million dollars for the
period January first, two thousand four through December thirty-first,
two thousand four, up to eleven million dollars for the period January
first, two thousand five through December thirty-first, two thousand
five, up to twenty-two million dollars for the period January first, two
thousand six through December thirty-first, two thousand six, up to
S. 6914 45 A. 9205
twenty-two million ninety-seven thousand dollars annually for the period
January first, two thousand seven through December thirty-first, two
thousand ten, up to five million five hundred twenty-four thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, up to thirteen million four hundred
forty-five thousand dollars for the period April first, two thousand
eleven through March thirty-first, two thousand twelve, and up to thir-
teen million three hundred seventy-five thousand dollars each state
fiscal year for the period April first, two thousand twelve through
March thirty-first, two thousand fourteen;
(ii) deposit by the commissioner, within amounts appropriated, and the
state comptroller is hereby authorized and directed to receive for
deposit to, to the credit of the emergency medical services training
account established in section ninety-seven-q of the state finance law
or the health care reform act (HCRA) resources fund, whichever is appli-
cable, up to sixteen million dollars on an annualized basis for the
periods January first, nineteen hundred ninety-seven through December
thirty-first, nineteen hundred ninety-nine, up to twenty million dollars
for the period January first, two thousand through December thirty-
first, two thousand, up to twenty-one million dollars for the period
January first, two thousand one through December thirty-first, two thou-
sand one, up to twenty-two million dollars for the period January first,
two thousand two through December thirty-first, two thousand two, up to
twenty-two million five hundred fifty thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three, up to nine million six hundred eighty thousand dollars
for the period January first, two thousand four through December thir-
ty-first, two thousand four, up to twelve million one hundred thirty
thousand dollars for the period January first, two thousand five through
December thirty-first, two thousand five, up to twenty-four million two
hundred fifty thousand dollars for the period January first, two thou-
sand six through December thirty-first, two thousand six, up to twenty
million four hundred ninety-two thousand dollars annually for the period
January first, two thousand seven through December thirty-first, two
thousand ten, up to five million one hundred twenty-three thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, up to eighteen million three hundred
fifty thousand dollars for the period April first, two thousand eleven
through March thirty-first, two thousand twelve, up to eighteen million
nine hundred fifty thousand dollars for the period April first, two
thousand twelve through March thirty-first, two thousand thirteen, [and]
up to nineteen million four hundred nineteen thousand dollars for the
period April first, two thousand thirteen through March thirty-first,
two thousand fourteen, AND UP TO NINETEEN MILLION SIX HUNDRED FIFTY-NINE
THOUSAND SEVEN HUNDRED DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD OF
APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND SEVENTEEN;
(iii) priority distributions by the commissioner up to thirty-two
million dollars on an annualized basis for the period January first, two
thousand through December thirty-first, two thousand four, up to thir-
ty-eight million dollars on an annualized basis for the period January
first, two thousand five through December thirty-first, two thousand
six, up to eighteen million two hundred fifty thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven, up to three million dollars annually for the period
January first, two thousand eight through December thirty-first, two
S. 6914 46 A. 9205
thousand ten, up to seven hundred fifty thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven, [and] up to two million nine hundred thousand dollars each
state fiscal year for the period April first, two thousand eleven
through March thirty-first, two thousand fourteen, AND UP TO TWO MILLION
NINE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND SEVENTEEN to be allocated (A) for the purposes established pursuant
to subparagraph (ii) of paragraph (f) of subdivision nineteen of section
twenty-eight hundred seven-c of this article as in effect on December
thirty-first, nineteen hundred ninety-six and as may thereafter be
amended, up to fifteen million dollars annually for the periods January
first, two thousand through December thirty-first, two thousand four, up
to twenty-one million dollars annually for the period January first, two
thousand five through December thirty-first, two thousand six, and up to
seven million five hundred thousand dollars for the period January
first, two thousand seven through March thirty-first, two thousand
seven;
(B) pursuant to a memorandum of understanding entered into by the
commissioner, the majority leader of the senate and the speaker of the
assembly, for the purposes outlined in such memorandum upon the recom-
mendation of the majority leader of the senate, up to eight million
five hundred thousand dollars annually for the period January first, two
thousand through December thirty-first, two thousand six, and up to four
million two hundred fifty thousand dollars for the period January first,
two thousand seven through June thirtieth, two thousand seven, and for
the purposes outlined in such memorandum upon the recommendation of the
speaker of the assembly, up to eight million five hundred thousand
dollars annually for the periods January first, two thousand through
December thirty-first, two thousand six, and up to four million two
hundred fifty thousand dollars for the period January first, two thou-
sand seven through June thirtieth, two thousand seven; and
(C) for services and expenses, including grants, related to emergency
assistance distributions as designated by the commissioner. Notwith-
standing section one hundred twelve or one hundred sixty-three of the
state finance law or any other contrary provision of law, such distrib-
utions shall be limited to providers or programs where, as determined by
the commissioner, emergency assistance is vital to protect the life or
safety of patients, to ensure the retention of facility caregivers or
other staff, or in instances where health facility operations are jeop-
ardized, or where the public health is jeopardized or other emergency
situations exist, up to three million dollars annually for the period
April first, two thousand seven through March thirty-first, two thousand
eleven, [and] up to two million nine hundred thousand dollars each state
fiscal year for the period April first, two thousand eleven through
March thirty-first, two thousand fourteen, AND UP TO TWO MILLION NINE
HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL
FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
SEVENTEEN. Upon any distribution of such funds, the commissioner shall
immediately notify the chair and ranking minority member of the senate
finance committee, the assembly ways and means committee, the senate
committee on health, and the assembly committee on health;
(iv) distributions by the commissioner related to poison control
centers pursuant to subdivision seven of section twenty-five hundred-d
of this chapter, up to five million dollars for the period January
first, nineteen hundred ninety-seven through December thirty-first,
S. 6914 47 A. 9205
nineteen hundred ninety-seven, up to three million dollars on an annual-
ized basis for the periods during the period January first, nineteen
hundred ninety-eight through December thirty-first, nineteen hundred
ninety-nine, up to five million dollars annually for the periods January
first, two thousand through December thirty-first, two thousand two, up
to four million six hundred thousand dollars annually for the periods
January first, two thousand three through December thirty-first, two
thousand four, up to five million one hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand six annually, up to five million one hundred thousand
dollars annually for the period January first, two thousand seven
through December thirty-first, two thousand nine, up to three million
six hundred thousand dollars for the period January first, two thousand
ten through December thirty-first, two thousand ten, up to seven hundred
seventy-five thousand dollars for the period January first, two thousand
eleven through March thirty-first, two thousand eleven, [and] up to two
million five hundred thousand dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen, AND UP TO THREE MILLION DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SEVENTEEN; and
(v) deposit by the commissioner, within amounts appropriated, and the
state comptroller is hereby authorized and directed to receive for
deposit to, to the credit of the department of health's special revenue
fund - other, miscellaneous special revenue fund - 339 maternal and
child HIV services account or the health care reform act (HCRA)
resources fund, whichever is applicable, for purposes of a special
program for HIV services for women and children, including adolescents
pursuant to section twenty-five hundred-f-one of [the public health law]
THIS CHAPTER, up to five million dollars annually for the periods Janu-
ary first, two thousand through December thirty-first, two thousand two,
up to five million dollars for the period January first, two thousand
three through December thirty-first, two thousand three, up to two
million five hundred thousand dollars for the period January first, two
thousand four through December thirty-first, two thousand four, up to
two million five hundred thousand dollars for the period January first,
two thousand five through December thirty-first, two thousand five, up
to five million dollars for the period January first, two thousand six
through December thirty-first, two thousand six, up to five million
dollars annually for the period January first, two thousand seven
through December thirty-first, two thousand ten, up to one million two
hundred fifty thousand dollars for the period January first, two thou-
sand eleven through March thirty-first, two thousand eleven, and up to
five million dollars each state fiscal year for the period April first,
two thousand eleven through March thirty-first, two thousand fourteen;
(d) (i) An amount of up to twenty million dollars annually for the
period January first, two thousand through December thirty-first, two
thousand six, up to ten million dollars for the period January first,
two thousand seven through June thirtieth, two thousand seven, up to
twenty million dollars annually for the period January first, two thou-
sand eight through December thirty-first, two thousand ten, up to five
million dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, [and] up to nineteen
million six hundred thousand dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen, AND UP TO NINETEEN MILLION SIX HUNDRED THOUSAND
S. 6914 48 A. 9205
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, shall be
transferred to the health facility restructuring pool established pursu-
ant to section twenty-eight hundred fifteen of this article;
(ii) provided, however, amounts transferred pursuant to subparagraph
(i) of this paragraph may be reduced in an amount to be approved by the
director of the budget to reflect the amount received from the federal
government under the state's 1115 waiver which is directed under its
terms and conditions to the health facility restructuring program.
(e) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions to organizations to support the health workforce
retraining program established pursuant to section twenty-eight hundred
seven-g of this article from the respective health care initiatives
pools established for the following periods in the following amounts
from the pools or the health care reform act (HCRA) resources fund,
whichever is applicable, during the period January first, nineteen
hundred ninety-seven through December thirty-first, nineteen hundred
ninety-nine, up to fifty million dollars on an annualized basis, up to
thirty million dollars for the period January first, two thousand
through December thirty-first, two thousand, up to forty million dollars
for the period January first, two thousand one through December thirty-
first, two thousand one, up to fifty million dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two, up to forty-one million one hundred fifty thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three, up to forty-one million one hundred fifty
thousand dollars for the period January first, two thousand four through
December thirty-first, two thousand four, up to fifty-eight million
three hundred sixty thousand dollars for the period January first, two
thousand five through December thirty-first, two thousand five, up to
fifty-two million three hundred sixty thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six, up to thirty-five million four hundred thousand dollars annu-
ally for the period January first, two thousand seven through December
thirty-first, two thousand ten, up to eight million eight hundred fifty
thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, [and] up to twenty-
eight million four hundred thousand dollars each state fiscal year for
the period April first, two thousand eleven through March thirty-first,
two thousand fourteen, AND UP TO TWENTY-SIX MILLION EIGHT HUNDRED SEVEN-
TEEN THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST,
TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVEN-
TEEN, less the amount of funds available for allocations for rate
adjustments for workforce training programs for payments by state
governmental agencies for inpatient hospital services.
(f) Funds shall be accumulated and transferred from as follows:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
(A) thirty-four million six hundred thousand dollars shall be trans-
ferred to funds reserved and accumulated pursuant to paragraph (b) of
subdivision nineteen of section twenty-eight hundred seven-c of this
article, and (B) eighty-two million dollars shall be transferred and
deposited and credited to the credit of the state general fund medical
assistance local assistance account;
S. 6914 49 A. 9205
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, eighty-two million dollars shall be transferred and deposited and
credited to the credit of the state general fund medical assistance
local assistance account;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
eighty-two million dollars shall be transferred and deposited and cred-
ited to the credit of the state general fund medical assistance local
assistance account;
(iv) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period January first, two thou-
sand through December thirty-first, two thousand four, eighty-two
million dollars annually, and for the period January first, two thousand
five through December thirty-first, two thousand five, eighty-two
million dollars, and for the period January first, two thousand six
through December thirty-first, two thousand six, eighty-two million
dollars, and for the period January first, two thousand seven through
December thirty-first, two thousand seven, eighty-two million dollars,
and for the period January first, two thousand eight through December
thirty-first, two thousand eight, ninety million seven hundred thousand
dollars shall be deposited by the commissioner, and the state comp-
troller is hereby authorized and directed to receive for deposit to the
credit of the state special revenue fund - other, HCRA transfer fund,
medical assistance account;
(v) from the health care reform act (HCRA) resources fund for the
period January first, two thousand nine through December thirty-first,
two thousand nine, one hundred eight million nine hundred seventy-five
thousand dollars, and for the period January first, two thousand ten
through December thirty-first, two thousand ten, one hundred twenty-six
million one hundred thousand dollars, for the period January first, two
thousand eleven through March thirty-first, two thousand eleven, twenty
million five hundred thousand dollars, and for each state fiscal year
for the period April first, two thousand eleven through March thirty-
first, two thousand fourteen, one hundred forty-six million four hundred
thousand dollars, shall be deposited by the commissioner, and the state
comptroller is hereby authorized and directed to receive for deposit, to
the credit of the state special revenue fund - other, HCRA transfer
fund, medical assistance account.
(g) Funds shall be transferred to primary health care services pools
created by the commissioner, and shall be available, including income
from invested funds, for distributions in accordance with former section
twenty-eight hundred seven-bb of this article from the respective health
care initiatives pools for the following periods in the following
percentage amounts of funds remaining after allocations in accordance
with paragraphs (a) through (f) of this subdivision:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
fifteen and eighty-seven-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, fifteen and eighty-seven-hundredths percent; and
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
sixteen and thirteen-hundredths percent.
S. 6914 50 A. 9205
(h) Funds shall be reserved and accumulated from year to year by the
commissioner and shall be available, including income from invested
funds, for purposes of primary care education and training pursuant to
article nine of this chapter from the respective health care initiatives
pools established for the following periods in the following percentage
amounts of funds remaining after allocations in accordance with para-
graphs (a) through (f) of this subdivision and shall be available for
distributions as follows:
(i) funds shall be reserved and accumulated:
(A) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
six and thirty-five-hundredths percent;
(B) from the pool for the period January first, nineteen hundred nine-
ty-eight through December thirty-first, nineteen hundred ninety-eight,
six and thirty-five-hundredths percent; and
(C) from the pool for the period January first, nineteen hundred nine-
ty-nine through December thirty-first, nineteen hundred ninety-nine, six
and forty-five-hundredths percent;
(ii) funds shall be available for distributions including income from
invested funds as follows:
(A) for purposes of the primary care physician loan repayment program
in accordance with section nine hundred three of this chapter, up to
five million dollars on an annualized basis;
(B) for purposes of the primary care practitioner scholarship program
in accordance with section nine hundred four of this chapter, up to two
million dollars on an annualized basis;
(C) for purposes of minority participation in medical education grants
in accordance with section nine hundred six of this chapter, up to one
million dollars on an annualized basis; and
(D) provided, however, that the commissioner may reallocate any funds
remaining or unallocated for distributions for the primary care practi-
tioner scholarship program in accordance with section nine hundred four
of this chapter.
(i) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for distrib-
utions in accordance with section twenty-nine hundred fifty-two and
section twenty-nine hundred fifty-eight of this chapter for rural health
care delivery development and rural health care access development,
respectively, from the respective health care initiatives pools or the
health care reform act (HCRA) resources fund, whichever is applicable,
for the following periods in the following percentage amounts of funds
remaining after allocations in accordance with paragraphs (a) through
(f) of this subdivision, and for periods on and after January first, two
thousand, in the following amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
thirteen and forty-nine-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, thirteen and forty-nine-hundredths percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
thirteen and seventy-one-hundredths percent;
(iv) from the pool for the periods January first, two thousand through
December thirty-first, two thousand two, seventeen million dollars annu-
ally, and for the period January first, two thousand three through
S. 6914 51 A. 9205
December thirty-first, two thousand three, up to fifteen million eight
hundred fifty thousand dollars;
(v) from the pool or the health care reform act (HCRA) resources fund,
whichever is applicable, for the period January first, two thousand four
through December thirty-first, two thousand four, up to fifteen million
eight hundred fifty thousand dollars, [and] for the period January
first, two thousand five through December thirty-first, two thousand
five, up to nineteen million two hundred thousand dollars, [and] for the
period January first, two thousand six through December thirty-first,
two thousand six, up to nineteen million two hundred thousand dollars,
for the period January first, two thousand seven through December thir-
ty-first, two thousand ten, up to eighteen million one hundred fifty
thousand dollars annually, for the period January first, two thousand
eleven through March thirty-first, two thousand eleven, up to four
million five hundred thirty-eight thousand dollars, [and] for each state
fiscal year for the period April first, two thousand eleven through
March thirty-first, two thousand fourteen, up to sixteen million two
hundred thousand dollars, AND UP TO SIXTEEN MILLION TWO HUNDRED THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(j) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions related to health information and health care quality
improvement pursuant to former section twenty-eight hundred seven-n of
this article from the respective health care initiatives pools estab-
lished for the following periods in the following percentage amounts of
funds remaining after allocations in accordance with paragraphs (a)
through (f) of this subdivision:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
six and thirty-five-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, six and thirty-five-hundredths percent; and
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
six and forty-five-hundredths percent.
(k) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for allo-
cations and distributions in accordance with section twenty-eight
hundred seven-p of this article for diagnostic and treatment center
uncompensated care from the respective health care initiatives pools or
the health care reform act (HCRA) resources fund, whichever is applica-
ble, for the following periods in the following percentage amounts of
funds remaining after allocations in accordance with paragraphs (a)
through (f) of this subdivision, and for periods on and after January
first, two thousand, in the following amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
thirty-eight and one-tenth percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, thirty-eight and one-tenth percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine through December thirty-first, nineteen hundred ninety-nine,
thirty-eight and seventy-one-hundredths percent;
S. 6914 52 A. 9205
(iv) from the pool for the periods January first, two thousand through
December thirty-first, two thousand two, forty-eight million dollars
annually, and for the period January first, two thousand three through
June thirtieth, two thousand three, twenty-four million dollars;
(v) (A) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period July first, two thousand
three through December thirty-first, two thousand three, up to six
million dollars, for the period January first, two thousand four through
December thirty-first, two thousand six, up to twelve million dollars
annually, for the period January first, two thousand seven through
December thirty-first, two thousand thirteen, up to forty-eight million
dollars annually, [and] for the period January first, two thousand four-
teen through March thirty-first, two thousand fourteen, up to twelve
million dollars AND FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, UP TO FORTY-EIGHT
MILLION DOLLARS ANNUALLY;
(B) from the health care reform act (HCRA) resources fund for the
period January first, two thousand six through December thirty-first,
two thousand six, an additional seven million five hundred thousand
dollars, for the period January first, two thousand seven through Decem-
ber thirty-first, two thousand thirteen, an additional seven million
five hundred thousand dollars annually, [and] for the period January
first, two thousand fourteen through March thirty-first, two thousand
fourteen, an additional one million eight hundred seventy-five thousand
dollars, AND FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, AN ADDITIONAL SEVEN MILLION
FIVE HUNDRED THOUSAND DOLLARS ANNUALLY for voluntary non-profit diagnos-
tic and treatment center uncompensated care in accordance with subdivi-
sion four-c of section twenty-eight hundred seven-p of this article; and
(vi) funds reserved and accumulated pursuant to this paragraph for
periods on and after July first, two thousand three, shall be deposited
by the commissioner, within amounts appropriated, and the state comp-
troller is hereby authorized and directed to receive for deposit to the
credit of the state special revenue funds - other, HCRA transfer fund,
medical assistance account, for purposes of funding the state share of
rate adjustments made pursuant to section twenty-eight hundred seven-p
of this article, provided, however, that in the event federal financial
participation is not available for rate adjustments made pursuant to
paragraph (b) of subdivision one of section twenty-eight hundred seven-p
of this article, funds shall be distributed pursuant to paragraph (a) of
subdivision one of section twenty-eight hundred seven-p of this article
from the respective health care initiatives pools or the health care
reform act (HCRA) resources fund, whichever is applicable.
(l) Funds shall be reserved and accumulated from year to year by the
commissioner and shall be available, including income from invested
funds, for transfer to and allocation for services and expenses for the
payment of benefits to recipients of drugs under the AIDS drug assist-
ance program (ADAP) - HIV uninsured care program as administered by
Health Research Incorporated from the respective health care initi-
atives pools or the health care reform act (HCRA) resources fund, which-
ever is applicable, established for the following periods in the follow-
ing percentage amounts of funds remaining after allocations in
accordance with paragraphs (a) through (f) of this subdivision, and for
periods on and after January first, two thousand, in the following
amounts:
S. 6914 53 A. 9205
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
nine and fifty-two-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, nine and fifty-two-hundredths percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine and December thirty-first, nineteen hundred ninety-nine,
nine and sixty-eight-hundredths percent;
(iv) from the pool for the periods January first, two thousand through
December thirty-first, two thousand two, up to twelve million dollars
annually, and for the period January first, two thousand three through
December thirty-first, two thousand three, up to forty million dollars;
and
(v) from the pool or the health care reform act (HCRA) resources fund,
whichever is applicable, for the periods January first, two thousand
four through December thirty-first, two thousand four, up to fifty-six
million dollars, for the period January first, two thousand five through
December thirty-first, two thousand six, up to sixty million dollars
annually, for the period January first, two thousand seven through
December thirty-first, two thousand ten, up to sixty million dollars
annually, for the period January first, two thousand eleven through
March thirty-first, two thousand eleven, up to fifteen million dollars,
[and] each state fiscal year for the period April first, two thousand
eleven through March thirty-first, two thousand fourteen, up to forty-
two million three hundred thousand dollars AND UP TO FORTY-ONE MILLION
FIFTY THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL
FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
SEVENTEEN.
(m) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of distributions pursuant to section twenty-eight hundred seven-r of
this article for cancer related services from the respective health care
initiatives pools or the health care reform act (HCRA) resources fund,
whichever is applicable, established for the following periods in the
following percentage amounts of funds remaining after allocations in
accordance with paragraphs (a) through (f) of this subdivision, and for
periods on and after January first, two thousand, in the following
amounts:
(i) from the pool for the period January first, nineteen hundred nine-
ty-seven through December thirty-first, nineteen hundred ninety-seven,
seven and ninety-four-hundredths percent;
(ii) from the pool for the period January first, nineteen hundred
ninety-eight through December thirty-first, nineteen hundred ninety-
eight, seven and ninety-four-hundredths percent;
(iii) from the pool for the period January first, nineteen hundred
ninety-nine and December thirty-first, nineteen hundred ninety-nine, six
and forty-five-hundredths percent;
(iv) from the pool for the period January first, two thousand through
December thirty-first, two thousand two, up to ten million dollars on an
annual basis;
(v) from the pool for the period January first, two thousand three
through December thirty-first, two thousand four, up to eight million
nine hundred fifty thousand dollars on an annual basis;
(vi) from the pool or the health care reform act (HCRA) resources
fund, whichever is applicable, for the period January first, two thou-
S. 6914 54 A. 9205
sand five through December thirty-first, two thousand six, up to ten
million fifty thousand dollars on an annual basis, for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand ten, up to nineteen million dollars annually, and for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven, up to four million seven hundred fifty thousand dollars.
(n) Funds shall be accumulated and transferred from the health care
reform act (HCRA) resources fund as follows: for the period April first,
two thousand seven through March thirty-first, two thousand eight, and
on an annual basis for the periods April first, two thousand eight
through November thirtieth, two thousand nine, funds within amounts
appropriated shall be transferred and deposited and credited to the
credit of the state special revenue funds - other, HCRA transfer fund,
medical assistance account, for purposes of funding the state share of
rate adjustments made to public and voluntary hospitals in accordance
with paragraphs (i) and (j) of subdivision one of section twenty-eight
hundred seven-c of this article.
2. Notwithstanding any inconsistent provision of law, rule or regu-
lation, any funds accumulated in the health care initiatives pools
pursuant to paragraph (b) of subdivision nine of section twenty-eight
hundred seven-j of this article, as a result of surcharges, assessments
or other obligations during the periods January first, nineteen hundred
ninety-seven through December thirty-first, nineteen hundred ninety-
nine, which are unused or uncommitted for distributions pursuant to this
section shall be reserved and accumulated from year to year by the
commissioner and, within amounts appropriated, transferred and deposited
into the special revenue funds - other, miscellaneous special revenue
fund - 339, child health insurance account or any successor fund or
account, for purposes of distributions to implement the child health
insurance program established pursuant to sections twenty-five hundred
ten and twenty-five hundred eleven of this chapter for periods on and
after January first, two thousand one; provided, however, funds reserved
and accumulated for priority distributions pursuant to subparagraph
(iii) of paragraph (c) of subdivision one of this section shall not be
transferred and deposited into such account pursuant to this subdivi-
sion; and provided further, however, that any unused or uncommitted pool
funds accumulated and allocated pursuant to paragraph (j) of subdivision
one of this section shall be distributed for purposes of the health
information and quality improvement act of 2000.
3. Revenue from distributions pursuant to this section shall not be
included in gross revenue received for purposes of the assessments
pursuant to subdivision eighteen of section twenty-eight hundred seven-c
of this article, subject to the provisions of paragraph (e) of subdivi-
sion eighteen of section twenty-eight hundred seven-c of this article,
and shall not be included in gross revenue received for purposes of the
assessments pursuant to section twenty-eight hundred seven-d of this
article, subject to the provisions of subdivision twelve of section
twenty-eight hundred seven-d of this article.
S 8. Section 2807-v of the public health law, as amended by section 5
of part B of chapter 58 of the laws of 2008, subdivision 1 as amended by
section 8 of part C of chapter 59 of the laws of 2011, clause (K) of
subparagraph (i) of paragraph (bb) of subdivision 1 as amended by
section 35-a, subparagraph (xi) of paragraph (cc) of subdivision 1 as
amended by section 35-b and subparagraph (vii) of paragraph (ccc) of
subdivision 1 as amended by section 35-c of part D of chapter 56 of the
laws of 2012, paragraph (fff) of subdivision 1 as separately amended by
S. 6914 55 A. 9205
section 16 of part A of chapter 59 of the laws of 2011, and paragraph
(iii) of subdivision 1 as added by section 52-b of part H of chapter 59
of the laws of 2011, is amended to read as follows:
S 2807-v. Tobacco control and insurance initiatives pool distrib-
utions. 1. Funds accumulated in the tobacco control and insurance
initiatives pool or in the health care reform act (HCRA) resources fund
established pursuant to section ninety-two-dd of the state finance law,
whichever is applicable, including income from invested funds, shall be
distributed or retained by the commissioner or by the state comptroller,
as applicable, in accordance with the following:
(a) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medicaid fraud hotline and
medicaid administration account, or any successor fund or account, for
purposes of services and expenses related to the toll-free medicaid
fraud hotline established pursuant to section one hundred eight of chap-
ter one of the laws of nineteen hundred ninety-nine from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts: four hundred thousand dollars annually
for the periods January first, two thousand through December thirty-
first, two thousand two, up to four hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three, up to four hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four, up to four hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five, up to four hundred thousand dollars for the period January first,
two thousand six through December thirty-first, two thousand six, up to
four hundred thousand dollars for the period January first, two thousand
seven through December thirty-first, two thousand seven, up to four
hundred thousand dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, up to four
hundred thousand dollars for the period January first, two thousand nine
through December thirty-first, two thousand nine, up to four hundred
thousand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten, up to one hundred thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven and within amounts appropriated on and
after April first, two thousand eleven.
(b) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of payment of audits or audit contracts necessary to determine payor and
provider compliance with requirements set forth in sections twenty-eight
hundred seven-j, twenty-eight hundred seven-s and twenty-eight hundred
seven-t of this article from the tobacco control and insurance initi-
atives pool established for the following periods in the following
amounts: five million six hundred thousand dollars annually for the
periods January first, two thousand through December thirty-first, two
thousand two, up to five million dollars for the period January first,
two thousand three through December thirty-first, two thousand three, up
to five million dollars for the period January first, two thousand four
through December thirty-first, two thousand four, up to five million
dollars for the period January first, two thousand five through December
thirty first, two thousand five, up to five million dollars for the
period January first, two thousand six through December thirty-first,
S. 6914 56 A. 9205
two thousand six, up to seven million eight hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven, and up to eight million three hundred twen-
ty-five thousand dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, up to eight
million five hundred thousand dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine, up to
eight million five hundred thousand dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten,
up to two million one hundred twenty-five thousand dollars for the peri-
od January first, two thousand eleven through March thirty-first, two
thousand eleven, [and] up to fourteen million seven hundred thousand
dollars each state fiscal year for the period April first, two thousand
eleven through March thirty-first, two thousand fourteen, AND UP TO
ELEVEN MILLION ONE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR
THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(c) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, enhanced community services
account, or any successor fund or account, for mental health services
programs for case management services for adults and children; supported
housing; home and community based waiver services; family based treat-
ment; family support services; mobile mental health teams; transitional
housing; and community oversight, established pursuant to articles seven
and forty-one of the mental hygiene law and subdivision nine of section
three hundred sixty-six of the social services law; and for comprehen-
sive care centers for eating disorders pursuant to the former section
twenty-seven hundred ninety-nine-l of this chapter, provided however
that, for such centers, funds in the amount of five hundred thousand
dollars on an annualized basis shall be transferred from the enhanced
community services account, or any successor fund or account, and depos-
ited into the fund established by section ninety-five-e of the state
finance law; from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) forty-eight million dollars to be reserved, to be retained or for
distribution pursuant to a chapter of the laws of two thousand, for the
period January first, two thousand through December thirty-first, two
thousand;
(ii) eighty-seven million dollars to be reserved, to be retained or
for distribution pursuant to a chapter of the laws of two thousand one,
for the period January first, two thousand one through December thirty-
first, two thousand one;
(iii) eighty-seven million dollars to be reserved, to be retained or
for distribution pursuant to a chapter of the laws of two thousand two,
for the period January first, two thousand two through December thirty-
first, two thousand two;
(iv) eighty-eight million dollars to be reserved, to be retained or
for distribution pursuant to a chapter of the laws of two thousand
three, for the period January first, two thousand three through December
thirty-first, two thousand three;
(v) eighty-eight million dollars, plus five hundred thousand dollars,
to be reserved, to be retained or for distribution pursuant to a chapter
of the laws of two thousand four, and pursuant to the former section
twenty-seven hundred ninety-nine-l of this chapter, for the period Janu-
S. 6914 57 A. 9205
ary first, two thousand four through December thirty-first, two thousand
four;
(vi) eighty-eight million dollars, plus five hundred thousand dollars,
to be reserved, to be retained or for distribution pursuant to a chapter
of the laws of two thousand five, and pursuant to the former section
twenty-seven hundred ninety-nine-l of this chapter, for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(vii) eighty-eight million dollars, plus five hundred thousand
dollars, to be reserved, to be retained or for distribution pursuant to
a chapter of the laws of two thousand six, and pursuant to FORMER
section twenty-seven hundred ninety-nine-l of this chapter, for the
period January first, two thousand six through December thirty-first,
two thousand six;
(viii) eighty-six million four hundred thousand dollars, plus five
hundred thousand dollars, to be reserved, to be retained or for distrib-
ution pursuant to a chapter of the laws of two thousand seven and pursu-
ant to the former section twenty-seven hundred ninety-nine-l of this
chapter, for the period January first, two thousand seven through Decem-
ber thirty-first, two thousand seven; and
(ix) twenty-two million nine hundred thirteen thousand dollars, plus
one hundred twenty-five thousand dollars, to be reserved, to be retained
or for distribution pursuant to a chapter of the laws of two thousand
eight and pursuant to the former section twenty-seven hundred ninety-
nine-l of this chapter, for the period January first, two thousand eight
through March thirty-first, two thousand eight.
(d) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of services and expenses related to the family health plus program
including up to two and one-half million dollars annually for the period
January first, two thousand through December thirty-first, two thousand
two, for administration and marketing costs associated with such program
established pursuant to clause (A) of subparagraph (v) of paragraph (a)
of subdivision two of section three hundred sixty-nine-ee of the social
services law from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) three million five hundred thousand dollars for the period January
first, two thousand through December thirty-first, two thousand;
(ii) twenty-seven million dollars for the period January first, two
thousand one through December thirty-first, two thousand one; and
(iii) fifty-seven million dollars for the period January first, two
thousand two through December thirty-first, two thousand two.
(e) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of services and expenses related to the family health plus program
including up to two and one-half million dollars annually for the period
January first, two thousand through December thirty-first, two thousand
two for administration and marketing costs associated with such program
established pursuant to clause (B) of subparagraph (v) of paragraph (a)
of subdivision two of section three hundred sixty-nine-ee of the social
S. 6914 58 A. 9205
services law from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) two million five hundred thousand dollars for the period January
first, two thousand through December thirty-first, two thousand;
(ii) thirty million five hundred thousand dollars for the period Janu-
ary first, two thousand one through December thirty-first, two thousand
one; and
(iii) sixty-six million dollars for the period January first, two
thousand two through December thirty-first, two thousand two.
(f) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medicaid fraud hotline and
medicaid administration account, or any successor fund or account, for
purposes of payment of administrative expenses of the department related
to the family health plus program established pursuant to section three
hundred sixty-nine-ee of the social services law from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts: five hundred thousand dollars on an
annual basis for the periods January first, two thousand through Decem-
ber thirty-first, two thousand six, five hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven, and five hundred thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight, five hundred thousand dollars for the period January
first, two thousand nine through December thirty-first, two thousand
nine, five hundred thousand dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten, one
hundred twenty-five thousand dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven and
within amounts appropriated on and after April first, two thousand elev-
en.
(g) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the health maintenance organization
direct pay market program established pursuant to sections forty-three
hundred twenty-one-a and forty-three hundred twenty-two-a of the insur-
ance law from the tobacco control and insurance initiatives pool estab-
lished for the following periods in the following amounts:
(i) up to thirty-five million dollars for the period January first,
two thousand through December thirty-first, two thousand of which fifty
percentum shall be allocated to the program pursuant to section four
thousand three hundred twenty-one-a of the insurance law and fifty
percentum to the program pursuant to section four thousand three hundred
twenty-two-a of the insurance law;
(ii) up to thirty-six million dollars for the period January first,
two thousand one through December thirty-first, two thousand one of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum to the program pursuant to section four thousand
three hundred twenty-two-a of the insurance law;
(iii) up to thirty-nine million dollars for the period January first,
two thousand two through December thirty-first, two thousand two of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
S. 6914 59 A. 9205
and fifty percentum to the program pursuant to section four thousand
three hundred twenty-two-a of the insurance law;
(iv) up to forty million dollars for the period January first, two
thousand three through December thirty-first, two thousand three of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum to the program pursuant to section four thousand
three hundred twenty-two-a of the insurance law;
(v) up to forty million dollars for the period January first, two
thousand four through December thirty-first, two thousand four of which
fifty percentum shall be allocated to the program pursuant to section
four thousand three hundred twenty-one-a of the insurance law and fifty
percentum to the program pursuant to section four thousand three hundred
twenty-two-a of the insurance law;
(vi) up to forty million dollars for the period January first, two
thousand five through December thirty-first, two thousand five of which
fifty percentum shall be allocated to the program pursuant to section
four thousand three hundred twenty-one-a of the insurance law and fifty
percentum to the program pursuant to section four thousand three hundred
twenty-two-a of the insurance law;
(vii) up to forty million dollars for the period January first, two
thousand six through December thirty-first, two thousand six of which
fifty percentum shall be allocated to the program pursuant to section
four thousand three hundred twenty-one-a of the insurance law and fifty
percentum shall be allocated to the program pursuant to section four
thousand three hundred twenty-two-a of the insurance law;
(viii) up to forty million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven of
which fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty percentum shall be allocated to the program pursuant to
section four thousand three hundred twenty-two-a of the insurance law;
and
(ix) up to forty million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight of
which fifty per centum shall be allocated to the program pursuant to
section four thousand three hundred twenty-one-a of the insurance law
and fifty per centum shall be allocated to the program pursuant to
section four thousand three hundred twenty-two-a of the insurance law.
(h) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the healthy New York individual
program established pursuant to sections four thousand three hundred
twenty-six and four thousand three hundred twenty-seven of the insurance
law from the tobacco control and insurance initiatives pool established
for the following periods in the following amounts:
(i) up to six million dollars for the period January first, two thou-
sand one through December thirty-first, two thousand one;
(ii) up to twenty-nine million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iii) up to five million one hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iv) up to twenty-four million six hundred thousand dollars for the
period January first, two thousand four through December thirty-first,
two thousand four;
S. 6914 60 A. 9205
(v) up to thirty-four million six hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand five;
(vi) up to fifty-four million eight hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six;
(vii) up to sixty-one million seven hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(viii) up to one hundred three million seven hundred fifty thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight.
(i) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the healthy New York group program
established pursuant to sections four thousand three hundred twenty-six
and four thousand three hundred twenty-seven of the insurance law from
the tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) up to thirty-four million dollars for the period January first,
two thousand one through December thirty-first, two thousand one;
(ii) up to seventy-seven million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iii) up to ten million five hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iv) up to twenty-four million six hundred thousand dollars for the
period January first, two thousand four through December thirty-first,
two thousand four;
(v) up to thirty-four million six hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand five;
(vi) up to fifty-four million eight hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six;
(vii) up to sixty-one million seven hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(viii) up to one hundred three million seven hundred fifty thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight.
(i-1) Notwithstanding the provisions of paragraphs (h) and (i) of this
subdivision, the commissioner shall reserve and accumulate up to two
million five hundred thousand dollars annually for the periods January
first, two thousand four through December thirty-first, two thousand
six, one million four hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, two million dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, from funds
otherwise available for distribution under such paragraphs for the
services and expenses related to the pilot program for entertainment
industry employees included in subsection (b) of section one thousand
one hundred twenty-two of the insurance law, and an additional seven
hundred thousand dollars annually for the periods January first, two
thousand four through December thirty-first, two thousand six, an addi-
tional three hundred thousand dollars for the period January first, two
S. 6914 61 A. 9205
thousand seven through June thirtieth, two thousand seven for services
and expenses related to the pilot program for displaced workers included
in subsection (c) of section one thousand one hundred twenty-two of the
insurance law.
(j) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of services and expenses related to the tobacco use prevention and
control program established pursuant to sections thirteen hundred nine-
ty-nine-ii and thirteen hundred ninety-nine-jj of this chapter, from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) up to thirty million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to forty million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to forty million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
(iv) up to thirty-six million nine hundred fifty thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(v) up to thirty-six million nine hundred fifty thousand dollars for
the period January first, two thousand four through December thirty-
first, two thousand four;
(vi) up to forty million six hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(vii) up to eighty-one million nine hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six, provided, however, that within amounts appropriated, a
portion of such funds may be transferred to the Roswell Park Cancer
Institute Corporation to support costs associated with cancer research;
(viii) up to ninety-four million one hundred fifty thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven, provided, however, that within amounts
appropriated, a portion of such funds may be transferred to the Roswell
Park Cancer Institute Corporation to support costs associated with
cancer research;
(ix) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand eight through December thirty-
first, two thousand eight;
(x) up to ninety-four million one hundred fifty thousand dollars for
the period January first, two thousand nine through December thirty-
first, two thousand nine;
(xi) up to eighty-seven million seven hundred seventy-five thousand
dollars for the period January first, two thousand ten through December
thirty-first, two thousand ten;
(xii) up to twenty-one million four hundred twelve thousand dollars
for the period January first, two thousand eleven through March thirty-
first, two thousand eleven; [and]
(xiii) up to fifty-two million one hundred thousand dollars each state
fiscal year for the period April first, two thousand eleven through
March thirty-first, two thousand fourteen; AND
(XIV) UP TO SIX MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND SEVENTEEN.
S. 6914 62 A. 9205
(k) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, health care services account,
or any successor fund or account, for purposes of services and expenses
related to public health programs, including comprehensive care centers
for eating disorders pursuant to the former section twenty-seven hundred
ninety-nine-l of this chapter, provided however that, for such centers,
funds in the amount of five hundred thousand dollars on an annualized
basis shall be transferred from the health care services account, or any
successor fund or account, and deposited into the fund established by
section ninety-five-e of the state finance law for periods prior to
March thirty-first, two thousand eleven, from the tobacco control and
insurance initiatives pool established for the following periods in the
following amounts:
(i) up to thirty-one million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to forty-one million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to eighty-one million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iv) one hundred twenty-two million five hundred thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(v) one hundred eight million five hundred seventy-five thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand four through December thirty-first, two
thousand four;
(vi) ninety-one million eight hundred thousand dollars, plus an addi-
tional five hundred thousand dollars, for the period January first, two
thousand five through December thirty-first, two thousand five;
(vii) one hundred fifty-six million six hundred thousand dollars, plus
an additional five hundred thousand dollars, for the period January
first, two thousand six through December thirty-first, two thousand six;
(viii) one hundred fifty-one million four hundred thousand dollars,
plus an additional five hundred thousand dollars, for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(ix) one hundred sixteen million nine hundred forty-nine thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand eight through December thirty-first, two
thousand eight;
(x) one hundred sixteen million nine hundred forty-nine thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand nine through December thirty-first, two
thousand nine;
(xi) one hundred sixteen million nine hundred forty-nine thousand
dollars, plus an additional five hundred thousand dollars, for the peri-
od January first, two thousand ten through December thirty-first, two
thousand ten;
(xii) twenty-nine million two hundred thirty-seven thousand two
hundred fifty dollars, plus an additional one hundred twenty-five thou-
sand dollars, for the period January first, two thousand eleven through
March thirty-first, two thousand eleven;
S. 6914 63 A. 9205
(xiii) one hundred twenty million thirty-eight thousand dollars for
the period April first, two thousand eleven through March thirty-first,
two thousand twelve; and
(xiv) one hundred nineteen million four hundred seven thousand dollars
each state fiscal year for the period April first, two thousand twelve
through March thirty-first, two thousand fourteen.
(l) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the personal care and certified home health agency rate or fee
increases established pursuant to subdivision three of section three
hundred sixty-seven-o of the social services law from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) twenty-three million two hundred thousand dollars for the period
January first, two thousand through December thirty-first, two thousand;
(ii) twenty-three million two hundred thousand dollars for the period
January first, two thousand one through December thirty-first, two thou-
sand one;
(iii) twenty-three million two hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(iv) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(v) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand four through December thirty-first,
two thousand four;
(vi) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand five through December thirty-first,
two thousand five;
(vii) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six;
(viii) up to sixty-five million two hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(ix) up to sixteen million three hundred thousand dollars for the
period January first, two thousand eight through March thirty-first, two
thousand eight.
(m) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of services and expenses related to home care workers insurance
pilot demonstration programs established pursuant to subdivision two of
section three hundred sixty-seven-o of the social services law from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) three million eight hundred thousand dollars for the period Janu-
ary first, two thousand through December thirty-first, two thousand;
S. 6914 64 A. 9205
(ii) three million eight hundred thousand dollars for the period Janu-
ary first, two thousand one through December thirty-first, two thousand
one;
(iii) three million eight hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(iv) up to three million eight hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(v) up to three million eight hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(vi) up to three million eight hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(vii) up to three million eight hundred thousand dollars for the peri-
od January first, two thousand six through December thirty-first, two
thousand six;
(viii) up to three million eight hundred thousand dollars for the
period January first, two thousand seven through December thirty-first,
two thousand seven; and
(ix) up to nine hundred fifty thousand dollars for the period January
first, two thousand eight through March thirty-first, two thousand
eight.
(n) Funds shall be transferred by the commissioner and shall be depos-
ited to the credit of the special revenue funds - other, miscellaneous
special revenue fund - 339, elderly pharmaceutical insurance coverage
program premium account authorized pursuant to the provisions of title
three of article two of the elder law, or any successor fund or account,
for funding state expenses relating to the program from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) one hundred seven million dollars for the period January first,
two thousand through December thirty-first, two thousand;
(ii) one hundred sixty-four million dollars for the period January
first, two thousand one through December thirty-first, two thousand one;
(iii) three hundred twenty-two million seven hundred thousand dollars
for the period January first, two thousand two through December thirty-
first, two thousand two;
(iv) four hundred thirty-three million three hundred thousand dollars
for the period January first, two thousand three through December thir-
ty-first, two thousand three;
(v) five hundred four million one hundred fifty thousand dollars for
the period January first, two thousand four through December thirty-
first, two thousand four;
(vi) five hundred sixty-six million eight hundred thousand dollars for
the period January first, two thousand five through December thirty-
first, two thousand five;
(vii) six hundred three million one hundred fifty thousand dollars for
the period January first, two thousand six through December thirty-
first, two thousand six;
(viii) six hundred sixty million eight hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven;
S. 6914 65 A. 9205
(ix) three hundred sixty-seven million four hundred sixty-three thou-
sand dollars for the period January first, two thousand eight through
December thirty-first, two thousand eight;
(x) three hundred thirty-four million eight hundred twenty-five thou-
sand dollars for the period January first, two thousand nine through
December thirty-first, two thousand nine;
(xi) three hundred forty-four million nine hundred thousand dollars
for the period January first, two thousand ten through December thirty-
first, two thousand ten;
(xii) eighty-seven million seven hundred eighty-eight thousand dollars
for the period January first, two thousand eleven through March thirty-
first, two thousand eleven;
(xiii) one hundred forty-three million one hundred fifty thousand
dollars for the period April first, two thousand eleven through March
thirty-first, two thousand twelve;
(xiv) one hundred twenty million nine hundred fifty thousand dollars
for the period April first, two thousand twelve through March thirty-
first, two thousand thirteen; [and]
(xv) one hundred twenty-eight million eight hundred fifty thousand
dollars for the period April first, two thousand thirteen through March
thirty-first, two thousand fourteen[.]; AND
(XVI) ONE HUNDRED TWENTY-SEVEN MILLION FOUR HUNDRED SIXTEEN THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(o) Funds shall be reserved and accumulated and shall be transferred
to the Roswell Park Cancer Institute Corporation, from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) up to ninety million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) up to sixty million dollars for the period January first, two
thousand one through December thirty-first, two thousand one;
(iii) up to eighty-five million dollars for the period January first,
two thousand two through December thirty-first, two thousand two;
(iv) eighty-five million two hundred fifty thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(v) seventy-eight million dollars for the period January first, two
thousand four through December thirty-first, two thousand four;
(vi) seventy-eight million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(vii) ninety-one million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(viii) seventy-eight million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(ix) seventy-eight million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(x) seventy-eight million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(xi) seventy-eight million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten;
(xii) nineteen million five hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven; [and]
S. 6914 66 A. 9205
(xiii) sixty-nine million eight hundred forty thousand dollars each
state fiscal year for the period April first, two thousand eleven
through March thirty-first, two thousand fourteen[.]; AND
(XIV) UP TO NINETY-SIX MILLION SIX HUNDRED THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(p) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, indigent care fund - 068, indigent care account,
or any successor fund or account, for purposes of providing a medicaid
disproportionate share payment from the high need indigent care adjust-
ment pool established pursuant to section twenty-eight hundred seven-w
of this article, from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) eighty-two million dollars annually for the periods January first,
two thousand through December thirty-first, two thousand two;
(ii) up to eighty-two million dollars for the period January first,
two thousand three through December thirty-first, two thousand three;
(iii) up to eighty-two million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(iv) up to eighty-two million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to eighty-two million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(vi) up to eighty-two million dollars for the period January first,
two thousand seven through December thirty-first, two thousand seven;
(vii) up to eighty-two million dollars for the period January first,
two thousand eight through December thirty-first, two thousand eight;
(viii) up to eighty-two million dollars for the period January first,
two thousand nine through December thirty-first, two thousand nine;
(ix) up to eighty-two million dollars for the period January first,
two thousand ten through December thirty-first, two thousand ten;
(x) up to twenty million five hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven; and
(xi) up to eighty-two million dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen.
(q) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of providing distributions to eligible school based health centers
established pursuant to section eighty-eight of chapter one of the laws
of nineteen hundred ninety-nine, from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
(i) seven million dollars annually for the period January first, two
thousand through December thirty-first, two thousand two;
(ii) up to seven million dollars for the period January first, two
thousand three through December thirty-first, two thousand three;
(iii) up to seven million dollars for the period January first, two
thousand four through December thirty-first, two thousand four;
(iv) up to seven million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(v) up to seven million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
S. 6914 67 A. 9205
(vi) up to seven million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(vii) up to seven million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(viii) up to seven million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(ix) up to seven million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten;
(x) up to one million seven hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven; [and]
(xi) up to five million six hundred thousand dollars each state fiscal
year for the period April first, two thousand eleven through March thir-
ty-first, two thousand fourteen[.]; AND
(XII) UP TO FIVE MILLION TWO HUNDRED EIGHTY-EIGHTY THOUSAND DOLLARS
EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN
THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(r) Funds shall be deposited by the commissioner within amounts appro-
priated, and the state comptroller is hereby authorized and directed to
receive for deposit to the credit of the state special revenue funds -
other, HCRA transfer fund, medical assistance account, or any successor
fund or account, for purposes of providing distributions for supplemen-
tary medical insurance for Medicare part B premiums, physicians
services, outpatient services, medical equipment, supplies and other
health services, from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) forty-three million dollars for the period January first, two
thousand through December thirty-first, two thousand;
(ii) sixty-one million dollars for the period January first, two thou-
sand one through December thirty-first, two thousand one;
(iii) sixty-five million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
(iv) sixty-seven million five hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(v) sixty-eight million dollars for the period January first, two
thousand four through December thirty-first, two thousand four;
(vi) sixty-eight million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(vii) sixty-eight million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(viii) seventeen million five hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(ix) sixty-eight million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(x) sixty-eight million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(xi) sixty-eight million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten;
(xii) seventeen million dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven; and
(xiii) sixty-eight million dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen.
S. 6914 68 A. 9205
(s) Funds shall be deposited by the commissioner within amounts appro-
priated, and the state comptroller is hereby authorized and directed to
receive for deposit to the credit of the state special revenue funds -
other, HCRA transfer fund, medical assistance account, or any successor
fund or account, for purposes of providing distributions pursuant to
paragraphs (s-5), (s-6), (s-7) and (s-8) of subdivision eleven of
section twenty-eight hundred seven-c of this article from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) eighteen million dollars for the period January first, two thou-
sand through December thirty-first, two thousand;
(ii) twenty-four million dollars annually for the periods January
first, two thousand one through December thirty-first, two thousand two;
(iii) up to twenty-four million dollars for the period January first,
two thousand three through December thirty-first, two thousand three;
(iv) up to twenty-four million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(v) up to twenty-four million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(vi) up to twenty-four million dollars for the period January first,
two thousand six through December thirty-first, two thousand six;
(vii) up to twenty-four million dollars for the period January first,
two thousand seven through December thirty-first, two thousand seven;
(viii) up to twenty-four million dollars for the period January first,
two thousand eight through December thirty-first, two thousand eight;
and
(ix) up to twenty-two million dollars for the period January first,
two thousand nine through November thirtieth, two thousand nine.
(t) Funds shall be reserved and accumulated from year to year by the
commissioner and shall be made available, including income from invested
funds:
(i) For the purpose of making grants to a state owned and operated
medical school which does not have a state owned and operated hospital
on site and available for teaching purposes. Notwithstanding sections
one hundred twelve and one hundred sixty-three of the state finance law,
such grants shall be made in the amount of up to five hundred thousand
dollars for the period January first, two thousand through December
thirty-first, two thousand;
(ii) For the purpose of making grants to medical schools pursuant to
section eighty-six-a of chapter one of the laws of nineteen hundred
ninety-nine in the sum of up to four million dollars for the period
January first, two thousand through December thirty-first, two thousand;
and
(iii) The funds disbursed pursuant to subparagraphs (i) and (ii) of
this paragraph from the tobacco control and insurance initiatives pool
are contingent upon meeting all funding amounts established pursuant to
paragraphs (a), (b), (c), (d), (e), (f), (l), (m), (n), (p), (q), (r)
and (s) of this subdivision, paragraph (a) of subdivision nine of
section twenty-eight hundred seven-j of this article, and paragraphs
(a), (i) and (k) of subdivision one of section twenty-eight hundred
seven-l of this article.
(u) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
S. 6914 69 A. 9205
share of services and expenses related to the nursing home quality
improvement demonstration program established pursuant to section twen-
ty-eight hundred eight-d of this article from the tobacco control and
insurance initiatives pool established for the following periods in the
following amounts:
(i) up to twenty-five million dollars for the period beginning April
first, two thousand two and ending December thirty-first, two thousand
two, and on an annualized basis, for each annual period thereafter
beginning January first, two thousand three and ending December thirty-
first, two thousand four;
(ii) up to eighteen million seven hundred fifty thousand dollars for
the period January first, two thousand five through December thirty-
first, two thousand five; and
(iii) up to fifty-six million five hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six.
(v) Funds shall be transferred by the commissioner and shall be depos-
ited to the credit of the hospital excess liability pool created pursu-
ant to section eighteen of chapter two hundred sixty-six of the laws of
nineteen hundred eighty-six, or any successor fund or account, for
purposes of expenses related to the purchase of excess medical malprac-
tice insurance and the cost of administrating the pool, including costs
associated with the risk management program established pursuant to
section forty-two of part A of chapter one of the laws of two thousand
two required by paragraph (a) of subdivision one of section eighteen of
chapter two hundred sixty-six of the laws of nineteen hundred eighty-six
as may be amended from time to time, from the tobacco control and insur-
ance initiatives pool established for the following periods in the
following amounts:
(i) up to fifty million dollars or so much as is needed for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(ii) up to seventy-six million seven hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(iii) up to sixty-five million dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(iv) up to sixty-five million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to one hundred thirteen million eight hundred thousand dollars
for the period January first, two thousand six through December thirty-
first, two thousand six;
(vi) up to one hundred thirty million dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(vii) up to one hundred thirty million dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight;
(viii) up to one hundred thirty million dollars for the period January
first, two thousand nine through December thirty-first, two thousand
nine;
(ix) up to one hundred thirty million dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
(x) up to thirty-two million five hundred thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven; [and]
S. 6914 70 A. 9205
(xi) up to one hundred twenty-seven million four hundred thousand
dollars each state fiscal year for the period April first, two thousand
eleven through March thirty-first, two thousand fourteen[.]; AND
(XII) UP TO ONE HUNDRED TWENTY-SEVEN MILLION FOUR HUNDRED THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(w) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the treatment of breast and cervical cancer pursuant to para-
graph (v) of subdivision four of section three hundred sixty-six of the
social services law, from the tobacco control and insurance initiatives
pool established for the following periods in the following amounts:
(i) up to four hundred fifty thousand dollars for the period January
first, two thousand two through December thirty-first, two thousand two;
(ii) up to two million one hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) up to two million one hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) up to two million one hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) up to two million one hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) up to two million one hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) up to two million one hundred thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) up to two million one hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) up to two million one hundred thousand dollars for the period
January first, two thousand ten through December thirty-first, two thou-
sand ten;
(x) up to five hundred twenty-five thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven; [and]
(xi) up to two million one hundred thousand dollars each state fiscal
year for the period April first, two thousand eleven through March thir-
ty-first, two thousand fourteen[.]; AND
(XII) UP TO TWO MILLION ONE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(x) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the non-public general hospital rates increases for recruitment
S. 6914 71 A. 9205
and retention of health care workers from the tobacco control and insur-
ance initiatives pool established for the following periods in the
following amounts:
(i) twenty-seven million one hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) fifty million eight hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) sixty-nine million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) sixty-nine million three hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) sixty-nine million three hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) sixty-five million three hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) sixty-one million one hundred fifty thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight; and
(viii) forty-eight million seven hundred twenty-one thousand dollars
for the period January first, two thousand nine through November thirti-
eth, two thousand nine.
(y) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to public general hospitals for recruitment and retention of
health care workers pursuant to paragraph (b) of subdivision thirty of
section twenty-eight hundred seven-c of this article from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) eighteen million five hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) thirty-seven million four hundred thousand dollars on an annual-
ized basis for the period January first, two thousand three through
December thirty-first, two thousand three;
(iii) fifty-two million two hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) fifty-two million two hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) fifty-two million two hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) forty-nine million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(vii) forty-nine million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight; and
(viii) twelve million two hundred fifty thousand dollars for the peri-
od January first, two thousand nine through March thirty-first, two
thousand nine.
S. 6914 72 A. 9205
Provided, however, amounts pursuant to this paragraph may be reduced
in an amount to be approved by the director of the budget to reflect
amounts received from the federal government under the state's 1115
waiver which are directed under its terms and conditions to the health
workforce recruitment and retention program.
(z) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the non-public residential health care facility rate increases
for recruitment and retention of health care workers pursuant to para-
graph (a) of subdivision eighteen of section twenty-eight hundred eight
of this article from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) twenty-one million five hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) thirty-three million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand three through
December thirty-first, two thousand three;
(iii) forty-six million three hundred thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) forty-six million three hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) forty-six million three hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) thirty million nine hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(vii) twenty-four million seven hundred thousand dollars for the peri-
od January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) twelve million three hundred seventy-five thousand dollars for
the period January first, two thousand nine through December thirty-
first, two thousand nine;
(ix) nine million three hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten; and
(x) two million three hundred twenty-five thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven.
(aa) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to public residential health care facilities for recruitment
and retention of health care workers pursuant to paragraph (b) of subdi-
vision eighteen of section twenty-eight hundred eight of this article
from the tobacco control and insurance initiatives pool established for
the following periods in the following amounts:
(i) seven million five hundred thousand dollars on an annualized basis
for the period January first, two thousand two through December thirty-
first, two thousand two;
S. 6914 73 A. 9205
(ii) eleven million seven hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) sixteen million two hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) sixteen million two hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(v) sixteen million two hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six;
(vi) ten million eight hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(vii) six million seven hundred fifty thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight; and
(viii) one million three hundred fifty thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine.
(bb)(i) Funds shall be deposited by the commissioner, within amounts
appropriated, and subject to the availability of federal financial
participation, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for the purpose of supporting the
state share of adjustments to Medicaid rates of payment for personal
care services provided pursuant to paragraph (e) of subdivision two of
section three hundred sixty-five-a of the social services law, for local
social service districts which include a city with a population of over
one million persons and computed and distributed in accordance with
memorandums of understanding to be entered into between the state of New
York and such local social service districts for the purpose of support-
ing the recruitment and retention of personal care service workers or
any worker with direct patient care responsibility, from the tobacco
control and insurance initiatives pool established for the following
periods and the following amounts:
(A) forty-four million dollars, on an annualized basis, for the period
April first, two thousand two through December thirty-first, two thou-
sand two;
(B) seventy-four million dollars, on an annualized basis, for the
period January first, two thousand three through December thirty-first,
two thousand three;
(C) one hundred four million dollars, on an annualized basis, for the
period January first, two thousand four through December thirty-first,
two thousand four;
(D) one hundred thirty-six million dollars, on an annualized basis,
for the period January first, two thousand five through December thir-
ty-first, two thousand five;
(E) one hundred thirty-six million dollars, on an annualized basis,
for the period January first, two thousand six through December thirty-
first, two thousand six;
(F) one hundred thirty-six million dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
S. 6914 74 A. 9205
(G) one hundred thirty-six million dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight;
(H) one hundred thirty-six million dollars for the period January
first, two thousand nine through December thirty-first, two thousand
nine;
(I) one hundred thirty-six million dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
(J) thirty-four million dollars for the period January first, two
thousand eleven through March thirty-first, two thousand eleven; [and]
(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[.]; AND
(L) UP TO ONE HUNDRED THIRTY-SIX MILLION DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN THROUGH
APRIL FIRST, TWO THOUSAND SEVENTEEN.
(ii) Adjustments to Medicaid rates made pursuant to this paragraph
shall not, in aggregate, exceed the following amounts for the following
periods:
(A) for the period April first, two thousand two through December
thirty-first, two thousand two, one hundred ten million dollars;
(B) for the period January first, two thousand three through December
thirty-first, two thousand three, one hundred eighty-five million
dollars;
(C) for the period January first, two thousand four through December
thirty-first, two thousand four, two hundred sixty million dollars;
(D) for the period January first, two thousand five through December
thirty-first, two thousand five, three hundred forty million dollars;
(E) for the period January first, two thousand six through December
thirty-first, two thousand six, three hundred forty million dollars;
(F) for the period January first, two thousand seven through December
thirty-first, two thousand seven, three hundred forty million dollars;
(G) for the period January first, two thousand eight through December
thirty-first, two thousand eight, three hundred forty million dollars;
(H) for the period January first, two thousand nine through December
thirty-first, two thousand nine, three hundred forty million dollars;
(I) for the period January first, two thousand ten through December
thirty-first, two thousand ten, three hundred forty million dollars;
(J) for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, eighty-five million dollars; [and]
(K) for each state fiscal year within the period April first, two
thousand eleven through March thirty-first, two thousand fourteen, three
hundred forty million dollars[.]; AND
(L) FOR EACH STATE FISCAL YEAR WITHIN THE PERIOD APRIL FIRST, TWO
THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN,
THREE HUNDRED FORTY MILLION DOLLARS.
(iii) Personal care service providers which have their rates adjusted
pursuant to this paragraph shall use such funds for the purpose of
recruitment and retention of non-supervisory personal care services
workers or any worker with direct patient care responsibility only and
are prohibited from using such funds for any other purpose. Each such
personal care services provider shall submit, at a time and in a manner
to be determined by the commissioner, a written certification attesting
that such funds will be used solely for the purpose of recruitment and
retention of non-supervisory personal care services workers or any work-
er with direct patient care responsibility. The commissioner is author-
S. 6914 75 A. 9205
ized to audit each such provider to ensure compliance with the written
certification required by this subdivision and shall recoup any funds
determined to have been used for purposes other than recruitment and
retention of non-supervisory personal care services workers or any work-
er with direct patient care responsibility. Such recoupment shall be in
addition to any other penalties provided by law.
(cc) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for the purpose of supporting the
state share of adjustments to Medicaid rates of payment for personal
care services provided pursuant to paragraph (e) of subdivision two of
section three hundred sixty-five-a of the social services law, for local
social service districts which shall not include a city with a popu-
lation of over one million persons for the purpose of supporting the
personal care services worker recruitment and retention program as
established pursuant to section three hundred sixty-seven-q of the
social services law, from the tobacco control and insurance initiatives
pool established for the following periods and the following amounts:
(i) two million eight hundred thousand dollars for the period April
first, two thousand two through December thirty-first, two thousand two;
(ii) five million six hundred thousand dollars, on an annualized
basis, for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) eight million four hundred thousand dollars, on an annualized
basis, for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) ten million eight hundred thousand dollars, on an annualized
basis, for the period January first, two thousand five through December
thirty-first, two thousand five;
(v) ten million eight hundred thousand dollars, on an annualized
basis, for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) eleven million two hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(vii) eleven million two hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight;
(viii) eleven million two hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) eleven million two hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten;
(x) two million eight hundred thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven; [and]
(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[.]; AND
(XII) UP TO ELEVEN MILLION TWO HUNDRED THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
S. 6914 76 A. 9205
(dd) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for purposes of funding the state share
of Medicaid expenditures for physician services from the tobacco control
and insurance initiatives pool established for the following periods in
the following amounts:
(i) up to fifty-two million dollars for the period January first, two
thousand two through December thirty-first, two thousand two;
(ii) eighty-one million two hundred thousand dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) eighty-five million two hundred thousand dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) eighty-five million two hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) eighty-five million two hundred thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) eighty-five million two hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) eighty-five million two hundred thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) eighty-five million two hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) eighty-five million two hundred thousand dollars for the period
January first, two thousand ten through December thirty-first, two thou-
sand ten;
(x) twenty-one million three hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven; and
(xi) eighty-five million two hundred thousand dollars each state
fiscal year for the period April first, two thousand eleven through
March thirty-first, two thousand fourteen.
(ee) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for purposes of funding the state share
of the free-standing diagnostic and treatment center rate increases for
recruitment and retention of health care workers pursuant to subdivision
seventeen of section twenty-eight hundred seven of this article from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) three million two hundred fifty thousand dollars for the period
April first, two thousand two through December thirty-first, two thou-
sand two;
(ii) three million two hundred fifty thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
S. 6914 77 A. 9205
(iii) three million two hundred fifty thousand dollars on an annual-
ized basis for the period January first, two thousand four through
December thirty-first, two thousand four;
(iv) three million two hundred fifty thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) three million two hundred fifty thousand dollars for the period
January first, two thousand six through December thirty-first, two thou-
sand six;
(vi) three million two hundred fifty thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) three million four hundred thirty-eight thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight;
(viii) two million four hundred fifty thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) one million five hundred thousand dollars for the period January
first, two thousand ten through December thirty-first, two thousand ten;
and
(x) three hundred twenty-five thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven.
(ff) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for purposes of funding the state share
of Medicaid expenditures for disabled persons as authorized pursuant to
FORMER subparagraphs twelve and thirteen of paragraph (a) of subdivision
one of section three hundred sixty-six of the social services law from
the tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) one million eight hundred thousand dollars for the period April
first, two thousand two through December thirty-first, two thousand two;
(ii) sixteen million four hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) eighteen million seven hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) thirty million six hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(v) thirty million six hundred thousand dollars for the period January
first, two thousand six through December thirty-first, two thousand six;
(vi) thirty million six hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(vii) fifteen million dollars for the period January first, two thou-
sand eight through December thirty-first, two thousand eight;
(viii) fifteen million dollars for the period January first, two thou-
sand nine through December thirty-first, two thousand nine;
(ix) fifteen million dollars for the period January first, two thou-
sand ten through December thirty-first, two thousand ten;
S. 6914 78 A. 9205
(x) three million seven hundred fifty thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven; [and]
(xi) fifteen million dollars each state fiscal year for the period
April first, two thousand eleven through March thirty-first, two thou-
sand fourteen[.]; AND
(XII) FIFTEEN MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND SEVENTEEN.
(gg) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to non-public general hospitals pursuant to paragraph (c) of
subdivision thirty of section twenty-eight hundred seven-c of this arti-
cle from the tobacco control and insurance initiatives pool established
for the following periods in the following amounts:
(i) up to one million three hundred thousand dollars on an annualized
basis for the period January first, two thousand two through December
thirty-first, two thousand two;
(ii) up to three million two hundred thousand dollars on an annualized
basis for the period January first, two thousand three through December
thirty-first, two thousand three;
(iii) up to five million six hundred thousand dollars on an annualized
basis for the period January first, two thousand four through December
thirty-first, two thousand four;
(iv) up to eight million six hundred thousand dollars for the period
January first, two thousand five through December thirty-first, two
thousand five;
(v) up to eight million six hundred thousand dollars on an annualized
basis for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) up to two million six hundred thousand dollars for the period
January first, two thousand seven through December thirty-first, two
thousand seven;
(vii) up to two million six hundred thousand dollars for the period
January first, two thousand eight through December thirty-first, two
thousand eight;
(viii) up to two million six hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
(ix) up to two million six hundred thousand dollars for the period
January first, two thousand ten through December thirty-first, two thou-
sand ten; and
(x) up to six hundred fifty thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven.
(hh) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the special revenue
fund - other, HCRA transfer fund, medical assistance account for
purposes of providing financial assistance to residential health care
facilities pursuant to subdivisions nineteen and twenty-one of section
twenty-eight hundred eight of this article, from the tobacco control and
insurance initiatives pool established for the following periods in the
following amounts:
(i) for the period April first, two thousand two through December
thirty-first, two thousand two, ten million dollars;
S. 6914 79 A. 9205
(ii) for the period January first, two thousand three through December
thirty-first, two thousand three, nine million four hundred fifty thou-
sand dollars;
(iii) for the period January first, two thousand four through December
thirty-first, two thousand four, nine million three hundred fifty thou-
sand dollars;
(iv) up to fifteen million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(v) up to fifteen million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(vi) up to fifteen million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven;
(vii) up to fifteen million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(viii) up to fifteen million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(ix) up to fifteen million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten;
(x) up to three million seven hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven; and
(xi) fifteen million dollars each state fiscal year for the period
April first, two thousand eleven through March thirty-first, two thou-
sand fourteen.
(ii) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for the purpose of supporting the
state share of Medicaid expenditures for disabled persons as authorized
by sections 1619 (a) and (b) of the federal social security act pursuant
to the tobacco control and insurance initiatives pool established for
the following periods in the following amounts:
(i) six million four hundred thousand dollars for the period April
first, two thousand two through December thirty-first, two thousand two;
(ii) eight million five hundred thousand dollars, for the period Janu-
ary first, two thousand three through December thirty-first, two thou-
sand three;
(iii) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand four through December thirty-first, two thousand
four;
(iv) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand five through December thirty-first, two thousand
five;
(v) eight million five hundred thousand dollars for the period January
first, two thousand six through December thirty-first, two thousand six;
(vi) eight million six hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven;
(vii) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight;
(viii) eight million five hundred thousand dollars for the period
January first, two thousand nine through December thirty-first, two
thousand nine;
S. 6914 80 A. 9205
(ix) eight million five hundred thousand dollars for the period Janu-
ary first, two thousand ten through December thirty-first, two thousand
ten;
(x) two million one hundred twenty-five thousand dollars for the peri-
od January first, two thousand eleven through March thirty-first, two
thousand eleven; [and]
(xi) eight million five hundred thousand dollars each state fiscal
year for the period April first, two thousand eleven through March thir-
ty-first, two thousand fourteen[.]; AND
(XII) EIGHT MILLION FIVE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
(jj) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purposes of a grant program to improve access to infertility services,
treatments and procedures, from the tobacco control and insurance initi-
atives pool established for the period January first, two thousand two
through December thirty-first, two thousand two in the amount of nine
million one hundred seventy-five thousand dollars, for the period April
first, two thousand six through March thirty-first, two thousand seven
in the amount of five million dollars, for the period April first, two
thousand seven through March thirty-first, two thousand eight in the
amount of five million dollars, for the period April first, two thousand
eight through March thirty-first, two thousand nine in the amount of
five million dollars, and for the period April first, two thousand nine
through March thirty-first, two thousand ten in the amount of five
million dollars, for the period April first, two thousand ten through
March thirty-first, two thousand eleven in the amount of two million two
hundred thousand dollars, and for the period April first, two thousand
eleven through March thirty-first, two thousand twelve up to one million
one hundred thousand dollars.
(kk) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds -- other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of Medical Assistance Program expenditures from the tobacco
control and insurance initiatives pool established for the following
periods in the following amounts:
(i) thirty-eight million eight hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(ii) up to two hundred ninety-five million dollars for the period
January first, two thousand three through December thirty-first, two
thousand three;
(iii) up to four hundred seventy-two million dollars for the period
January first, two thousand four through December thirty-first, two
thousand four;
(iv) up to nine hundred million dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(v) up to eight hundred sixty-six million three hundred thousand
dollars for the period January first, two thousand six through December
thirty-first, two thousand six;
(vi) up to six hundred sixteen million seven hundred thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven;
S. 6914 81 A. 9205
(vii) up to five hundred seventy-eight million nine hundred twenty-
five thousand dollars for the period January first, two thousand eight
through December thirty-first, two thousand eight; and
(viii) within amounts appropriated on and after January first, two
thousand nine.
(ll) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds -- other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of Medicaid expenditures related to the city of New York from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) eighty-two million seven hundred thousand dollars for the period
January first, two thousand two through December thirty-first, two thou-
sand two;
(ii) one hundred twenty-four million six hundred thousand dollars for
the period January first, two thousand three through December thirty-
first, two thousand three;
(iii) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand four through December thir-
ty-first, two thousand four;
(iv) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand five through December thir-
ty-first, two thousand five;
(v) one hundred twenty-four million seven hundred thousand dollars for
the period January first, two thousand six through December thirty-
first, two thousand six;
(vi) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand seven through December thir-
ty-first, two thousand seven;
(vii) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand eight through December thir-
ty-first, two thousand eight;
(viii) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand nine through December thir-
ty-first, two thousand nine;
(ix) one hundred twenty-four million seven hundred thousand dollars
for the period January first, two thousand ten through December thirty-
first, two thousand ten;
(x) thirty-one million one hundred seventy-five thousand dollars for
the period January first, two thousand eleven through March thirty-
first, two thousand eleven; and
(xi) one hundred twenty-four million seven hundred thousand dollars
each state fiscal year for the period April first, two thousand eleven
through March thirty-first, two thousand fourteen.
(mm) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding specified
percentages of the state share of services and expenses related to the
family health plus program in accordance with the following schedule:
(i) (A) for the period January first, two thousand three through
December thirty-first, two thousand four, one hundred percent of the
state share;
S. 6914 82 A. 9205
(B) for the period January first, two thousand five through December
thirty-first, two thousand five, seventy-five percent of the state
share; and,
(C) for periods beginning on and after January first, two thousand
six, fifty percent of the state share.
(ii) Funding for the family health plus program will include up to
five million dollars annually for the period January first, two thousand
three through December thirty-first, two thousand six, up to five
million dollars for the period January first, two thousand seven through
December thirty-first, two thousand seven, up to seven million two
hundred thousand dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight, up to seven
million two hundred thousand dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine, up to
seven million two hundred thousand dollars for the period January first,
two thousand ten through December thirty-first, two thousand ten, up to
one million eight hundred thousand dollars for the period January first,
two thousand eleven through March thirty-first, two thousand eleven, up
to six million forty-nine thousand dollars for the period April first,
two thousand eleven through March thirty-first, two thousand twelve, up
to six million two hundred eighty-nine thousand dollars for the period
April first, two thousand twelve through March thirty-first, two thou-
sand thirteen, and up to six million four hundred sixty-one thousand
dollars for the period April first, two thousand thirteen through March
thirty-first, two thousand fourteen, for administration and marketing
costs associated with such program established pursuant to clauses (A)
and (B) of subparagraph (v) of paragraph (a) of subdivision two of
section three hundred sixty-nine-ee of the social services law from the
tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(A) one hundred ninety million six hundred thousand dollars for the
period January first, two thousand three through December thirty-first,
two thousand three;
(B) three hundred seventy-four million dollars for the period January
first, two thousand four through December thirty-first, two thousand
four;
(C) five hundred thirty-eight million four hundred thousand dollars
for the period January first, two thousand five through December thir-
ty-first, two thousand five;
(D) three hundred eighteen million seven hundred seventy-five thousand
dollars for the period January first, two thousand six through December
thirty-first, two thousand six;
(E) four hundred eighty-two million eight hundred thousand dollars for
the period January first, two thousand seven through December thirty-
first, two thousand seven;
(F) five hundred seventy million twenty-five thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight;
(G) six hundred ten million seven hundred twenty-five thousand dollars
for the period January first, two thousand nine through December thir-
ty-first, two thousand nine;
(H) six hundred twenty-seven million two hundred seventy-five thousand
dollars for the period January first, two thousand ten through December
thirty-first, two thousand ten;
S. 6914 83 A. 9205
(I) one hundred fifty-seven million eight hundred seventy-five thou-
sand dollars for the period January first, two thousand eleven through
March thirty-first, two thousand eleven;
(J) six hundred twenty-eight million four hundred thousand dollars for
the period April first, two thousand eleven through March thirty-first,
two thousand twelve;
(K) six hundred fifty million four hundred thousand dollars for the
period April first, two thousand twelve through March thirty-first, two
thousand thirteen; [and]
(L) six hundred fifty million four hundred thousand dollars for the
period April first, two thousand thirteen through March thirty-first,
two thousand fourteen[.]; AND
(M) UP TO THREE HUNDRED TEN MILLION FIVE HUNDRED NINETY-FIVE THOUSAND
DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FIFTEEN.
(nn) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, health care services account,
or any successor fund or account, for purposes related to adult home
initiatives for medicaid eligible residents of residential facilities
licensed pursuant to section four hundred sixty-b of the social services
law from the tobacco control and insurance initiatives pool established
for the following periods in the following amounts:
(i) up to four million dollars for the period January first, two thou-
sand three through December thirty-first, two thousand three;
(ii) up to six million dollars for the period January first, two thou-
sand four through December thirty-first, two thousand four;
(iii) up to eight million dollars for the period January first, two
thousand five through December thirty-first, two thousand five,
provided, however, that up to five million two hundred fifty thousand
dollars of such funds shall be received by the comptroller and deposited
to the credit of the special revenue fund - other / aid to localities,
HCRA transfer fund - 061, enhanced community services account - 05, or
any successor fund or account, for the purposes set forth in this para-
graph;
(iv) up to eight million dollars for the period January first, two
thousand six through December thirty-first, two thousand six, provided,
however, that up to five million two hundred fifty thousand dollars of
such funds shall be received by the comptroller and deposited to the
credit of the special revenue fund - other / aid to localities, HCRA
transfer fund - 061, enhanced community services account - 05, or any
successor fund or account, for the purposes set forth in this paragraph;
(v) up to eight million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven,
provided, however, that up to five million two hundred fifty thousand
dollars of such funds shall be received by the comptroller and deposited
to the credit of the special revenue fund - other / aid to localities,
HCRA transfer fund - 061, enhanced community services account - 05, or
any successor fund or account, for the purposes set forth in this para-
graph;
(vi) up to two million seven hundred fifty thousand dollars for the
period January first, two thousand eight through December thirty-first,
two thousand eight;
S. 6914 84 A. 9205
(vii) up to two million seven hundred fifty thousand dollars for the
period January first, two thousand nine through December thirty-first,
two thousand nine;
(viii) up to two million seven hundred fifty thousand dollars for the
period January first, two thousand ten through December thirty-first,
two thousand ten; and
(ix) up to six hundred eighty-eight thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven.
(oo) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of grants to non-public general hospitals pursuant to paragraph (e) of
subdivision twenty-five of section twenty-eight hundred seven-c of this
article from the tobacco control and insurance initiatives pool estab-
lished for the following periods in the following amounts:
(i) up to five million dollars on an annualized basis for the period
January first, two thousand four through December thirty-first, two
thousand four;
(ii) up to five million dollars for the period January first, two
thousand five through December thirty-first, two thousand five;
(iii) up to five million dollars for the period January first, two
thousand six through December thirty-first, two thousand six;
(iv) up to five million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven; [and]
(v) up to five million dollars for the period January first, two thou-
sand eight through December thirty-first, two thousand eight;
(vi) up to five million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine;
(vii) up to five million dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten; and
(viii) up to one million two hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven.
(pp) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purpose of supporting the provision of tax credits for long term care
insurance pursuant to subdivision one of section one hundred ninety of
the tax law, paragraph (a) of subdivision twenty-five-a of section two
hundred ten of such law, subsection (aa) of section six hundred six of
such law, paragraph one of subsection (k) of section fourteen hundred
fifty-six of such law and paragraph one of subdivision (m) of section
fifteen hundred eleven of such law, in the following amounts:
(i) ten million dollars for the period January first, two thousand
four through December thirty-first, two thousand four;
(ii) ten million dollars for the period January first, two thousand
five through December thirty-first, two thousand five;
(iii) ten million dollars for the period January first, two thousand
six through December thirty-first, two thousand six; and
(iv) five million dollars for the period January first, two thousand
seven through June thirtieth, two thousand seven.
(qq) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purpose of supporting the long-term care insurance education and
outreach program established pursuant to section two hundred seventeen-a
of the elder law for the following periods in the following amounts:
S. 6914 85 A. 9205
(i) up to five million dollars for the period January first, two thou-
sand four through December thirty-first, two thousand four; of such
funds one million nine hundred fifty thousand dollars shall be made
available to the department for the purpose of developing, implementing
and administering the long-term care insurance education and outreach
program and three million fifty thousand dollars shall be deposited by
the commissioner, within amounts appropriated, and the comptroller is
hereby authorized and directed to receive for deposit to the credit of
the special revenue funds - other, HCRA transfer fund, long term care
insurance resource center account of the state office for the aging or
any future account designated for the purpose of implementing the long
term care insurance education and outreach program and providing the
long term care insurance resource centers with the necessary resources
to carry out their operations;
(ii) up to five million dollars for the period January first, two
thousand five through December thirty-first, two thousand five; of such
funds one million nine hundred fifty thousand dollars shall be made
available to the department for the purpose of developing, implementing
and administering the long-term care insurance education and outreach
program and three million fifty thousand dollars shall be deposited by
the commissioner, within amounts appropriated, and the comptroller is
hereby authorized and directed to receive for deposit to the credit of
the special revenue funds - other, HCRA transfer fund, long term care
insurance resource center account of the state office for the aging or
any future account designated for the purpose of implementing the long
term care insurance education and outreach program and providing the
long term care insurance resource centers with the necessary resources
to carry out their operations;
(iii) up to five million dollars for the period January first, two
thousand six through December thirty-first, two thousand six; of such
funds one million nine hundred fifty thousand dollars shall be made
available to the department for the purpose of developing, implementing
and administering the long-term care insurance education and outreach
program and three million fifty thousand dollars shall be made available
to the office for the aging for the purpose of providing the long term
care insurance resource centers with the necessary resources to carry
out their operations;
(iv) up to five million dollars for the period January first, two
thousand seven through December thirty-first, two thousand seven; of
such funds one million nine hundred fifty thousand dollars shall be made
available to the department for the purpose of developing, implementing
and administering the long-term care insurance education and outreach
program and three million fifty thousand dollars shall be made available
to the office for the aging for the purpose of providing the long term
care insurance resource centers with the necessary resources to carry
out their operations;
(v) up to five million dollars for the period January first, two thou-
sand eight through December thirty-first, two thousand eight; of such
funds one million nine hundred fifty thousand dollars shall be made
available to the department for the purpose of developing, implementing
and administering the long term care insurance education and outreach
program and three million fifty thousand dollars shall be made available
to the office for the aging for the purpose of providing the long term
care insurance resource centers with the necessary resources to carry
out their operations;
S. 6914 86 A. 9205
(vi) up to five million dollars for the period January first, two
thousand nine through December thirty-first, two thousand nine; of such
funds one million nine hundred fifty thousand dollars shall be made
available to the department for the purpose of developing, implementing
and administering the long-term care insurance education and outreach
program and three million fifty thousand dollars shall be made available
to the office for the aging for the purpose of providing the long-term
care insurance resource centers with the necessary resources to carry
out their operations;
(vii) up to four hundred eighty-eight thousand dollars for the period
January first, two thousand ten through March thirty-first, two thousand
ten; of such funds four hundred eighty-eight thousand dollars shall be
made available to the department for the purpose of developing, imple-
menting and administering the long-term care insurance education and
outreach program.
(rr) Funds shall be reserved and accumulated from the tobacco control
and insurance initiatives pool and shall be available, including income
from invested funds, for the purpose of supporting expenses related to
implementation of the provisions of title III of article twenty-nine-D
of this chapter, for the following periods and in the following amounts:
(i) up to ten million dollars for the period January first, two thou-
sand six through December thirty-first, two thousand six;
(ii) up to ten million dollars for the period January first, two thou-
sand seven through December thirty-first, two thousand seven;
(iii) up to ten million dollars for the period January first, two
thousand eight through December thirty-first, two thousand eight;
(iv) up to ten million dollars for the period January first, two thou-
sand nine through December thirty-first, two thousand nine;
(v) up to ten million dollars for the period January first, two thou-
sand ten through December thirty-first, two thousand ten; and
(vi) up to two million five hundred thousand dollars for the period
January first, two thousand eleven through March thirty-first, two thou-
sand eleven.
(ss) Funds shall be reserved and accumulated from the tobacco control
and insurance initiatives pool and used for a health care stabilization
program established by the commissioner for the purposes of stabilizing
critical health care providers and health care programs whose ability to
continue to provide appropriate services are threatened by financial or
other challenges, in the amount of up to twenty-eight million dollars
for the period July first, two thousand four through June thirtieth, two
thousand five. Notwithstanding the provisions of section one hundred
twelve of the state finance law or any other inconsistent provision of
the state finance law or any other law, funds available for distribution
pursuant to this paragraph may be allocated and distributed by the
commissioner, or the state comptroller as applicable without a compet-
itive bid or request for proposal process. Considerations relied upon by
the commissioner in determining the allocation and distribution of these
funds shall include, but not be limited to, the following: (i) the
importance of the provider or program in meeting critical health care
needs in the community in which it operates; (ii) the provider or
program provision of care to under-served populations; (iii) the quality
of the care or services the provider or program delivers; (iv) the abil-
ity of the provider or program to continue to deliver an appropriate
level of care or services if additional funding is made available; (v)
the ability of the provider or program to access, in a timely manner,
alternative sources of funding, including other sources of government
S. 6914 87 A. 9205
funding; (vi) the ability of other providers or programs in the communi-
ty to meet the community health care needs; (vii) whether the provider
or program has an appropriate plan to improve its financial condition;
and (viii) whether additional funding would permit the provider or
program to consolidate, relocate, or close programs or services where
such actions would result in greater stability and efficiency in the
delivery of needed health care services or programs.
(tt) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of providing grants for two long term care demonstration projects
designed to test new models for the delivery of long term care services
established pursuant to section twenty-eight hundred seven-x of this
chapter, for the following periods and in the following amounts:
(i) up to five hundred thousand dollars for the period January first,
two thousand four through December thirty-first, two thousand four;
(ii) up to five hundred thousand dollars for the period January first,
two thousand five through December thirty-first, two thousand five;
(iii) up to five hundred thousand dollars for the period January
first, two thousand six through December thirty-first, two thousand six;
(iv) up to one million dollars for the period January first, two thou-
sand seven through December thirty-first, two thousand seven; and
(v) up to two hundred fifty thousand dollars for the period January
first, two thousand eight through March thirty-first, two thousand
eight.
(uu) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for the
purpose of supporting disease management and telemedicine demonstration
programs authorized pursuant to section twenty-one hundred eleven of
this chapter for the following periods in the following amounts:
(i) five million dollars for the period January first, two thousand
four through December thirty-first, two thousand four, of which three
million dollars shall be available for disease management demonstration
programs and two million dollars shall be available for telemedicine
demonstration programs;
(ii) five million dollars for the period January first, two thousand
five through December thirty-first, two thousand five, of which three
million dollars shall be available for disease management demonstration
programs and two million dollars shall be available for telemedicine
demonstration programs;
(iii) nine million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six, of which seven million five hundred thousand dollars shall be
available for disease management demonstration programs and two million
dollars shall be available for telemedicine demonstration programs;
(iv) nine million five hundred thousand dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, of which seven million five hundred thousand dollars shall be
available for disease management demonstration programs and one million
dollars shall be available for telemedicine demonstration programs;
(v) nine million five hundred thousand dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight, of which seven million five hundred thousand dollars shall be
available for disease management demonstration programs and two million
dollars shall be available for telemedicine demonstration programs;
(vi) seven million eight hundred thirty-three thousand three hundred
thirty-three dollars for the period January first, two thousand nine
S. 6914 88 A. 9205
through December thirty-first, two thousand nine, of which seven million
five hundred thousand dollars shall be available for disease management
demonstration programs and three hundred thirty-three thousand three
hundred thirty-three dollars shall be available for telemedicine demon-
stration programs for the period January first, two thousand nine
through March first, two thousand nine;
(vii) one million eight hundred seventy-five thousand dollars for the
period January first, two thousand ten through March thirty-first, two
thousand ten shall be available for disease management demonstration
programs.
(ww) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the general hospital rates increases for recruitment and
retention of health care workers pursuant to paragraph (e) of subdivi-
sion thirty of section twenty-eight hundred seven-c of this article from
the tobacco control and insurance initiatives pool established for the
following periods in the following amounts:
(i) sixty million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five; and
(ii) sixty million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six.
(xx) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of the general hospital rates increases for rural hospitals pursu-
ant to subdivision thirty-two of section twenty-eight hundred seven-c of
this article from the tobacco control and insurance initiatives pool
established for the following periods in the following amounts:
(i) three million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five;
(ii) three million five hundred thousand dollars for the period Janu-
ary first, two thousand six through December thirty-first, two thousand
six;
(iii) three million five hundred thousand dollars for the period Janu-
ary first, two thousand seven through December thirty-first, two thou-
sand seven;
(iv) three million five hundred thousand dollars for the period Janu-
ary first, two thousand eight through December thirty-first, two thou-
sand eight; and
(v) three million two hundred eight thousand dollars for the period
January first, two thousand nine through November thirtieth, two thou-
sand nine.
(yy) Funds shall be reserved and accumulated from year to year and
shall be available, within amounts appropriated and notwithstanding
section one hundred twelve of the state finance law and any other
contrary provision of law, for the purpose of supporting grants not to
exceed five million dollars to be made by the commissioner without a
competitive bid or request for proposal process, in support of the
S. 6914 89 A. 9205
delivery of critically needed health care services, to health care
providers located in the counties of Erie and Niagara which executed a
memorandum of closing and conducted a merger closing in escrow on Novem-
ber twenty-fourth, nineteen hundred ninety-seven and which entered into
a settlement dated December thirtieth, two thousand four for a loss on
disposal of assets under the provisions of title XVIII of the federal
social security act applicable to mergers occurring prior to December
first, nineteen hundred ninety-seven.
(zz) Funds shall be reserved and accumulated from year to year and
shall be available, within amounts appropriated, for the purpose of
supporting expenditures authorized pursuant to section twenty-eight
hundred eighteen of this article from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
(i) six million five hundred thousand dollars for the period January
first, two thousand five through December thirty-first, two thousand
five;
(ii) one hundred eight million three hundred thousand dollars for the
period January first, two thousand six through December thirty-first,
two thousand six, provided, however, that within amounts appropriated in
the two thousand six through two thousand seven state fiscal year, a
portion of such funds may be transferred to the Roswell Park Cancer
Institute Corporation to fund capital costs;
(iii) one hundred seventy-one million dollars for the period January
first, two thousand seven through December thirty-first, two thousand
seven, provided, however, that within amounts appropriated in the two
thousand six through two thousand seven state fiscal year, a portion of
such funds may be transferred to the Roswell Park Cancer Institute
Corporation to fund capital costs;
(iv) one hundred seventy-one million five hundred thousand dollars for
the period January first, two thousand eight through December thirty-
first, two thousand eight;
(v) one hundred twenty-eight million seven hundred fifty thousand
dollars for the period January first, two thousand nine through December
thirty-first, two thousand nine;
(vi) one hundred thirty-one million three hundred seventy-five thou-
sand dollars for the period January first, two thousand ten through
December thirty-first, two thousand ten;
(vii) thirty-four million two hundred fifty thousand dollars for the
period January first, two thousand eleven through March thirty-first,
two thousand eleven;
(viii) four hundred thirty-three million three hundred sixty-six thou-
sand dollars for the period April first, two thousand eleven through
March thirty-first, two thousand twelve;
(ix) one hundred fifty million eight hundred six thousand dollars for
the period April first, two thousand twelve through March thirty-first,
two thousand thirteen; [and]
(x) seventy-eight million seventy-one thousand dollars for the period
April first, two thousand thirteen through March thirty-first, two thou-
sand fourteen.
(aaa) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for services
and expenses related to school based health centers, in an amount up to
three million five hundred thousand dollars for the period April first,
two thousand six through March thirty-first, two thousand seven, up to
three million five hundred thousand dollars for the period April first,
S. 6914 90 A. 9205
two thousand seven through March thirty-first, two thousand eight, up to
three million five hundred thousand dollars for the period April first,
two thousand eight through March thirty-first, two thousand nine, up to
three million five hundred thousand dollars for the period April first,
two thousand nine through March thirty-first, two thousand ten, up to
three million five hundred thousand dollars for the period April first,
two thousand ten through March thirty-first, two thousand eleven, [and]
up to two million eight hundred thousand dollars each state fiscal year
for the period April first, two thousand eleven through March thirty-
first, two thousand fourteen, AND UP TO TWO MILLION SIX HUNDRED
FORTY-FOUR THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL
FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
SEVENTEEN. The total amount of funds provided herein shall be distrib-
uted as grants based on the ratio of each provider's total enrollment
for all sites to the total enrollment of all providers. This formula
shall be applied to the total amount provided herein.
(bbb) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, for purposes
of awarding grants to operators of adult homes, enriched housing
programs and residences through the enhancing abilities and life experi-
ence (EnAbLe) program to provide for the installation, operation and
maintenance of air conditioning in resident rooms, consistent with this
paragraph, in an amount up to two million dollars for the period April
first, two thousand six through March thirty-first, two thousand seven,
up to three million eight hundred thousand dollars for the period April
first, two thousand seven through March thirty-first, two thousand
eight, up to three million eight hundred thousand dollars for the period
April first, two thousand eight through March thirty-first, two thousand
nine, up to three million eight hundred thousand dollars for the period
April first, two thousand nine through March thirty-first, two thousand
ten, and up to three million eight hundred thousand dollars for the
period April first, two thousand ten through March thirty-first, two
thousand eleven. Residents shall not be charged utility cost for the use
of air conditioners supplied under the EnAbLe program. All such air
conditioners must be operated in occupied resident rooms consistent with
requirements applicable to common areas.
(ccc) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of increases in the rates for certified home health agencies, long
term home health care programs, AIDS home care programs, hospice
programs and managed long term care plans and approved managed long term
care operating demonstrations as defined in section forty-four hundred
three-f of this chapter for recruitment and retention of health care
workers pursuant to subdivisions nine and ten of section thirty-six
hundred fourteen of this chapter from the tobacco control and insurance
initiatives pool established for the following periods in the following
amounts:
(i) twenty-five million dollars for the period June first, two thou-
sand six through December thirty-first, two thousand six;
(ii) fifty million dollars for the period January first, two thousand
seven through December thirty-first, two thousand seven;
(iii) fifty million dollars for the period January first, two thousand
eight through December thirty-first, two thousand eight;
S. 6914 91 A. 9205
(iv) fifty million dollars for the period January first, two thousand
nine through December thirty-first, two thousand nine;
(v) fifty million dollars for the period January first, two thousand
ten through December thirty-first, two thousand ten;
(vi) twelve million five hundred thousand dollars for the period Janu-
ary first, two thousand eleven through March thirty-first, two thousand
eleven; [and]
(vii) 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[.]; AND
(VIII) UP TO FIFTY MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND SEVENTEEN.
(ddd) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for the deposit to the credit of the state special
revenue funds - other, HCRA transfer fund, medical assistance account,
or any successor fund or account, for purposes of funding the state
share of increases in the medical assistance rates for providers for
purposes of enhancing the provision, quality and/or efficiency of home
care services pursuant to subdivision eleven of section thirty-six
hundred fourteen of this chapter from the tobacco control and insurance
initiatives pool established for the following period in the amount of
eight million dollars for the period April first, two thousand six
through December thirty-first, two thousand six.
(eee) Funds shall be reserved and accumulated from year to year and
shall be available, including income from invested funds, to the Center
for Functional Genomics at the State University of New York at Albany,
for the purposes of the Adirondack network for cancer education and
research in rural communities grant program to improve access to health
care and shall be made available from the tobacco control and insurance
initiatives pool established for the following period in the amount of
up to five million dollars for the period January first, two thousand
six through December thirty-first, two thousand six.
(fff) Funds shall be made available to the empire state stem cell fund
established by section ninety-nine-p of the state finance law within
amounts appropriated up to fifty million dollars annually and shall not
exceed five hundred million dollars in total.
(ggg) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for the purpose of supporting the state
share of Medicaid expenditures for hospital translation services as
authorized pursuant to paragraph (k) of subdivision one of section twen-
ty-eight hundred seven-c of this article from the tobacco control and
initiatives pool established for the following periods in the following
amounts:
(i) sixteen million dollars for the period July first, two thousand
eight through December thirty-first, two thousand eight; and
(ii) fourteen million seven hundred thousand dollars for the period
January first, two thousand nine through November thirtieth, two thou-
sand nine.
(hhh) Funds shall be deposited by the commissioner, within amounts
appropriated, and the state comptroller is hereby authorized and
directed to receive for deposit to the credit of the state special
S. 6914 92 A. 9205
revenue fund - other, HCRA transfer fund, medical assistance account, or
any successor fund or account, for the purpose of supporting the state
share of Medicaid expenditures for adjustments to inpatient rates of
payment for general hospitals located in the counties of Nassau and
Suffolk as authorized pursuant to paragraph (l) of subdivision one of
section twenty-eight hundred seven-c of this article from the tobacco
control and initiatives pool established for the following periods in
the following amounts:
(i) two million five hundred thousand dollars for the period April
first, two thousand eight through December thirty-first, two thousand
eight; and
(ii) two million two hundred ninety-two thousand dollars for the peri-
od January first, two thousand nine through November thirtieth, two
thousand nine.
(iii) Funds shall be reserved and set aside and accumulated from year
to year and shall be made available, including income from investment
funds, for the purpose of supporting the New York state medical indem-
nity fund as authorized pursuant to title four of article twenty-nine-D
of this chapter, for the following periods and in the following amounts,
provided, however, that the commissioner is authorized to seek waiver
authority from the federal centers for medicare and Medicaid for the
purpose of securing Medicaid federal financial participation for such
program, in which case the funding authorized pursuant to this paragraph
shall be utilized as the non-federal share for such payments:
Thirty million dollars for the period April first, two thousand eleven
through March thirty-first, two thousand twelve.
2. (a) For periods prior to January first, two thousand five, the
commissioner is authorized to contract with the article forty-three
insurance law plans, or such other contractors as the commissioner shall
designate, to receive and distribute funds from the tobacco control and
insurance initiatives pool established pursuant to this section. In the
event contracts with the article forty-three insurance law plans or
other commissioner's designees are effectuated, the commissioner shall
conduct annual audits of the receipt and distribution of such funds. The
reasonable costs and expenses of an administrator as approved by the
commissioner, not to exceed for personnel services on an annual basis
five hundred thousand dollars, for collection and distribution of funds
pursuant to this section shall be paid from such funds.
(b) Notwithstanding any inconsistent provision of section one hundred
twelve or one hundred sixty-three of the state finance law or any other
law, at the discretion of the commissioner without a competitive bid or
request for proposal process, contracts in effect for administration of
pools established pursuant to sections twenty-eight hundred seven-k,
twenty-eight hundred seven-l and twenty-eight hundred seven-m of this
article for the period January first, nineteen hundred ninety-nine
through December thirty-first, nineteen hundred ninety-nine may be
extended to provide for administration pursuant to this section and may
be amended as may be necessary.
S 9. Subdivisions 5-a and 7 of section 2807-m of the public health
law, as added by section 75-c of part C of chapter 58 of the laws of
2008, the paragraph heading of paragraph (b) and the second undesignated
paragraph of paragraph (b) of subdivision 5-a as amended by section 4 of
part B of chapter 109 of the laws of 2010, the opening paragraph of
paragraph (b), subparagraphs (C), (D) and (G) of paragraph (b), and
paragraphs (c), (f) and (g) of subdivision 5-a as amended by section 26
of part C of chapter 59 of the laws of 2011, subparagraph (H) of para-
S. 6914 93 A. 9205
graph (b) of subdivision 5-a as added by section 60 of part D of chapter
56 of the laws of 2012, paragraphs (d) and (e) of subdivision 5-a as
amended by section 53 of part D of chapter 56 of the laws of 2012 and
paragraph (e-1) of subdivision 5-a as added by section 54 of part D of
chapter 56 of the laws of 2012, and subdivision 7 as amended by section
26-a of part C of chapter 59 of the laws of 2011, are amended to read as
follows:
5-a. Graduate medical education innovations pool. (a) Supplemental
distributions. (i) Thirty-one million dollars for the period January
first, two thousand eight through December thirty-first, two thousand
eight, shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
and shall be available for distributions pursuant to subdivision five of
this section and in accordance with section 86-1.89 of title 10 of the
codes, rules and regulations of the state of New York as in effect on
January first, two thousand eight; provided, however, for purposes of
funding the empire clinical research investigation program (ECRIP) in
accordance with paragraph eight of subdivision (e) and paragraph two of
subdivision (f) of section 86-1.89 of title 10 of the codes, rules and
regulations of the state of New York, distributions shall be made using
two regions defined as New York city and the rest of the state and the
dollar amount set forth in subparagraph (i) of paragraph two of subdivi-
sion (f) of section 86-1.89 of title 10 of the codes, rules and regu-
lations of the state of New York shall be increased from sixty thousand
dollars to seventy-five thousand dollars.
(ii) For periods on and after January first, two thousand nine,
supplemental distributions pursuant to subdivision five of this section
and in accordance with section 86-1.89 of title 10 of the codes, rules
and regulations of the state of New York shall no longer be made and the
provisions of section 86-1.89 of title 10 of the codes, rules and regu-
lations of the state of New York shall be null and void.
(b) Empire clinical research investigator program (ECRIP). Nine
million one hundred twenty thousand dollars annually for the period
January first, two thousand nine through December thirty-first, two
thousand ten, and two million two hundred eighty thousand dollars for
the period January first, two thousand eleven, [and] THROUGH MARCH THIR-
TY-FIRST, TWO THOUSAND ELEVEN, nine million one hundred twenty thousand
dollars each state fiscal year for the period April first, two thousand
eleven through March thirty-first, two thousand fourteen, [through March
thirty-first, two thousand eleven,] AND UP TO EIGHT MILLION SIX HUNDRED
TWELVE THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL
FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
SEVENTEEN, shall be set aside and reserved by the commissioner from the
regional pools established pursuant to subdivision two of this section
to be allocated regionally with two-thirds of the available funding
going to New York city and one-third of the available funding going to
the rest of the state and shall be available for distribution as
follows:
Distributions shall first be made to consortia and teaching general
hospitals for the empire clinical research investigator program (ECRIP)
to help secure federal funding for biomedical research, train clinical
researchers, recruit national leaders as faculty to act as mentors, and
train residents and fellows in biomedical research skills based on
hospital-specific data submitted to the commissioner by consortia and
teaching general hospitals in accordance with clause (G) of this subpar-
S. 6914 94 A. 9205
agraph. Such distributions shall be made in accordance with the follow-
ing methodology:
(A) The greatest number of clinical research positions for which a
consortium or teaching general hospital may be funded pursuant to this
subparagraph shall be one percent of the total number of residents
training at the consortium or teaching general hospital on July first,
two thousand eight for the period January first, two thousand nine
through December thirty-first, two thousand nine rounded up to the near-
est one position.
(B) Distributions made to a consortium or teaching general hospital
shall equal the product of the total number of clinical research posi-
tions submitted by a consortium or teaching general hospital and
accepted by the commissioner as meeting the criteria set forth in para-
graph (b) of subdivision one of this section, subject to the reduction
calculation set forth in clause (C) of this subparagraph, times one
hundred ten thousand dollars.
(C) If the dollar amount for the total number of clinical research
positions in the region calculated pursuant to clause (B) of this
subparagraph exceeds the total amount appropriated for purposes of this
paragraph, including clinical research positions that continue from and
were funded in prior distribution periods, the commissioner shall elimi-
nate one-half of the clinical research positions submitted by each
consortium or teaching general hospital rounded down to the nearest one
position. Such reduction shall be repeated until the dollar amount for
the total number of clinical research positions in the region does not
exceed the total amount appropriated for purposes of this paragraph. If
the repeated reduction of the total number of clinical research posi-
tions in the region by one-half does not render a total funding amount
that is equal to or less than the total amount reserved for that region
within the appropriation, the funding for each clinical research posi-
tion in that region shall be reduced proportionally in one thousand
dollar increments until the total dollar amount for the total number of
clinical research positions in that region does not exceed the total
amount reserved for that region within the appropriation. Any reduction
in funding will be effective for the duration of the award. No clinical
research positions that continue from and were funded in prior distrib-
ution periods shall be eliminated or reduced by such methodology.
(D) Each consortium or teaching general hospital shall receive its
annual distribution amount in accordance with the following:
(I) Each consortium or teaching general hospital with a one-year ECRIP
award shall receive its annual distribution amount in full upon
completion of the requirements set forth in items (I) and (II) of clause
(G) of this subparagraph. The requirements set forth in items (IV) and
(V) of clause (G) of this subparagraph must be completed by the consor-
tium or teaching general hospital in order for the consortium or teach-
ing general hospital to be eligible to apply for ECRIP funding in any
subsequent funding cycle.
(II) Each consortium or teaching general hospital with a two-year
ECRIP award shall receive its first annual distribution amount in full
upon completion of the requirements set forth in items (I) and (II) of
clause (G) of this subparagraph. Each consortium or teaching general
hospital will receive its second annual distribution amount in full upon
completion of the requirements set forth in item (III) of clause (G) of
this subparagraph. The requirements set forth in items (IV) and (V) of
clause (G) of this subparagraph must be completed by the consortium or
teaching general hospital in order for the consortium or teaching gener-
S. 6914 95 A. 9205
al hospital to be eligible to apply for ECRIP funding in any subsequent
funding cycle.
(E) Each consortium or teaching general hospital receiving distrib-
utions pursuant to this subparagraph shall reserve seventy-five thousand
dollars to primarily fund salary and fringe benefits of the clinical
research position with the remainder going to fund the development of
faculty who are involved in biomedical research, training and clinical
care.
(F) Undistributed or returned funds available to fund clinical
research positions pursuant to this paragraph for a distribution period
shall be available to fund clinical research positions in a subsequent
distribution period.
(G) In order to be eligible for distributions pursuant to this subpar-
agraph, each consortium and teaching general hospital shall provide to
the commissioner by July first of each distribution period, the follow-
ing data and information on a hospital-specific basis. Such data and
information shall be certified as to accuracy and completeness by the
chief executive officer, chief financial officer or chair of the consor-
tium governing body of each consortium or teaching general hospital and
shall be maintained by each consortium and teaching general hospital for
five years from the date of submission:
(I) For each clinical research position, information on the type,
scope, training objectives, institutional support, clinical research
experience of the sponsor-mentor, plans for submitting research outcomes
to peer reviewed journals and at scientific meetings, including a meet-
ing sponsored by the department, the name of a principal contact person
responsible for tracking the career development of researchers placed in
clinical research positions, as defined in paragraph (c) of subdivision
one of this section, and who is authorized to certify to the commission-
er that all the requirements of the clinical research training objec-
tives set forth in this subparagraph shall be met. Such certification
shall be provided by July first of each distribution period;
(II) For each clinical research position, information on the name,
citizenship status, medical education and training, and medical license
number of the researcher, if applicable, shall be provided by December
thirty-first of the calendar year following the distribution period;
(III) Information on the status of the clinical research plan, accom-
plishments, changes in research activities, progress, and performance of
the researcher shall be provided upon completion of one-half of the
award term;
(IV) A final report detailing training experiences, accomplishments,
activities and performance of the clinical researcher, and data, meth-
ods, results and analyses of the clinical research plan shall be
provided three months after the clinical research position ends; and
(V) Tracking information concerning past researchers, including but
not limited to (A) background information, (B) employment history, (C)
research status, (D) current research activities, (E) publications and
presentations, (F) research support, and (G) any other information
necessary to track the researcher; and
(VI) Any other data or information required by the commissioner to
implement this subparagraph.
(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. Such regulations shall, at a minimum:
S. 6914 96 A. 9205
(1) provide that ECRIP grant awards shall be made with the objective
of securing federal funding for biomedical research, training clinical
researchers, recruiting national leaders as faculty to act as mentors,
and training residents and fellows in biomedical research skills;
(2) provide that ECRIP grant applicants may include interdisciplinary
research teams comprised of teaching general hospitals acting in collab-
oration with entities including but not limited to medical centers,
hospitals, universities and local health departments;
(3) provide that applications for ECRIP grant awards shall be based on
such information requested by the commissioner, which shall include but
not be limited to hospital-specific data;
(4) establish the qualifications for investigators and other staff
required for grant projects eligible for ECRIP grant awards; and
(5) establish a methodology for the distribution of funds under ECRIP
grant awards.
(c) Ambulatory care training. Four million nine hundred thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight, four million nine hundred thousand
dollars for the period January first, two thousand nine through December
thirty-first, two thousand nine, four million nine hundred thousand
dollars for the period January first, two thousand ten through December
thirty-first, two thousand ten, one million two hundred twenty-five
thousand dollars for the period January first, two thousand eleven
through March thirty-first, two thousand eleven, [and] four million
three hundred thousand dollars each state fiscal year for the period
April first, two thousand eleven through March thirty-first, two thou-
sand fourteen, AND UP TO FOUR MILLION SIXTY THOUSAND DOLLARS EACH STATE
FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH
MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, shall be set aside and
reserved by the commissioner from the regional pools established pursu-
ant to subdivision two of this section and shall be available for
distributions to sponsoring institutions to be directed to support clin-
ical training of medical students and residents in free-standing ambula-
tory care settings, including community health centers and private prac-
tices. Such funding shall be allocated regionally with two-thirds of the
available funding going to New York city and one-third of the available
funding going to the rest of the state and shall be distributed to spon-
soring institutions in each region pursuant to a request for application
or request for proposal process with preference being given to sponsor-
ing institutions which provide training in sites located in underserved
rural or inner-city areas and those that include medical students in
such training.
(d) Physician loan repayment program. One million nine hundred sixty
thousand dollars for the period January first, two thousand eight
through December thirty-first, two thousand eight, one million nine
hundred sixty thousand dollars for the period January first, two thou-
sand nine through December thirty-first, two thousand nine, one million
nine hundred sixty thousand dollars for the period January first, two
thousand ten through December thirty-first, two thousand ten, four
hundred ninety thousand dollars for the period January first, two thou-
sand eleven through March thirty-first, two thousand eleven, [and] one
million seven hundred thousand dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen, AND UP TO ONE MILLION SEVEN HUNDRED FIVE THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, shall be
S. 6914 97 A. 9205
set aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section and shall be
available for purposes of physician loan repayment in accordance with
subdivision ten of this section. 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, such
funding shall be allocated regionally with one-third of available funds
going to New York city and two-thirds of available funds going to the
rest of the state and shall be distributed in a manner to be determined
by the commissioner without a competitive bid or request for proposal
process as follows:
(i) Funding shall first be awarded to repay loans of up to twenty-five
physicians who train in primary care or specialty tracks in teaching
general hospitals, and who enter and remain in primary care or specialty
practices in underserved communities, as determined by the commissioner.
(ii) After distributions in accordance with subparagraph (i) of this
paragraph, all remaining funds shall be awarded to repay loans of physi-
cians who enter and remain in primary care or specialty practices in
underserved communities, as determined by the commissioner, including
but not limited to physicians working in general hospitals, or other
health care facilities.
(iii) In no case shall less than fifty percent of the funds available
pursuant to this paragraph be distributed in accordance with subpara-
graphs (i) and (ii) of this paragraph to physicians identified by gener-
al hospitals.
(e) Physician practice support. Four million nine hundred thousand
dollars for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand eight, four million nine hundred thousand
dollars annually for the period January first, two thousand nine through
December thirty-first, two thousand ten, one million two hundred twen-
ty-five thousand dollars for the period January first, two thousand
eleven through March thirty-first, two thousand eleven, [and] four
million three hundred thousand dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen, AND UP TO FOUR MILLION THREE HUNDRED SIXTY THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, shall be
set aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section and shall be
available for purposes of physician practice support. 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, such funding shall be allocated regionally with one-
third of available funds going to New York city and two-thirds of avail-
able funds going to the rest of the state and shall be distributed in a
manner to be determined by the commissioner without a competitive bid or
request for proposal process as follows:
(i) Preference in funding shall first be accorded to teaching general
hospitals for up to twenty-five awards, to support costs incurred by
physicians trained in primary or specialty tracks who thereafter estab-
lish or join practices in underserved communities, as determined by the
commissioner.
(ii) After distributions in accordance with subparagraph (i) of this
paragraph, all remaining funds shall be awarded to physicians to support
the cost of establishing or joining practices in underserved communi-
ties, as determined by the commissioner, and to hospitals and other
S. 6914 98 A. 9205
health care providers to recruit new physicians to provide services in
underserved communities, as determined by the commissioner.
(iii) In no case shall less than fifty percent of the funds available
pursuant to this paragraph be distributed to general hospitals in
accordance with subparagraphs (i) and (ii) of this paragraph.
(e-1) Work group. For funding available pursuant to paragraphs (d) and
(e) of this subdivision:
(i) The department shall appoint a work group from recommendations
made by associations representing physicians, general hospitals and
other health care facilities to develop a streamlined application proc-
ess by June first, two thousand twelve.
(ii) Subject to available funding, applications shall be accepted on a
continuous basis. The department shall provide technical assistance to
applicants to facilitate their completion of applications. An applicant
shall be notified in writing by the department within ten days of
receipt of an application as to whether the application is complete and
if the application is incomplete, what information is outstanding. The
department shall act on an application within thirty days of receipt of
a complete application.
(f) Study on physician workforce. Five hundred ninety thousand dollars
annually for the period January first, two thousand eight through Decem-
ber thirty-first, two thousand ten, one hundred forty-eight thousand
dollars for the period January first, two thousand eleven through March
thirty-first, two thousand eleven, [and] five hundred sixteen thousand
dollars each state fiscal year for the period April first, two thousand
eleven through March thirty-first, two thousand fourteen, AND UP TO FOUR
HUNDRED EIGHTY-SEVEN THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST,
TWO THOUSAND SEVENTEEN, shall be set aside and reserved by the commis-
sioner from the regional pools established pursuant to subdivision two
of this section and shall be available to fund a study of physician
workforce needs and solutions including, but not limited to, an analysis
of residency programs and projected physician workforce and community
needs. The commissioner shall enter into agreements with one or more
organizations to conduct such study based on a request for proposal
process.
(g) Diversity in medicine/post-baccalaureate program. Notwithstanding
any inconsistent provision of section one hundred twelve or one hundred
sixty-three of the state finance law or any other law, one million nine
hundred sixty thousand dollars annually for the period January first,
two thousand eight through December thirty-first, two thousand ten, four
hundred ninety thousand dollars for the period January first, two thou-
sand eleven through March thirty-first, two thousand eleven, [and] one
million seven hundred thousand dollars each state fiscal year for the
period April first, two thousand eleven through March thirty-first, two
thousand fourteen, AND UP TO ONE MILLION SIX HUNDRED FIVE THOUSAND
DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN, shall be
set aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section and shall be
available for distributions to the Associated Medical Schools of New
York to fund its diversity program including existing and new post-bac-
calaureate programs for minority and economically disadvantaged students
and encourage participation from all medical schools in New York. The
associated medical schools of New York shall report to the commissioner
S. 6914 99 A. 9205
on an annual basis regarding the use of funds for such purpose in such
form and manner as specified by the commissioner.
(h) In the event there are undistributed funds within amounts made
available for distributions pursuant to this subdivision, such funds may
be reallocated and distributed in current or subsequent distribution
periods in a manner determined by the commissioner for any purpose set
forth in this subdivision.
7. Notwithstanding any inconsistent provision of section one hundred
twelve or one hundred sixty-three of the state finance law or any other
law, up to one million dollars for the period January first, two thou-
sand through December thirty-first, two thousand, one million six
hundred thousand dollars annually for the periods January first, two
thousand one through December thirty-first, two thousand eight, one
million five hundred thousand dollars annually for the periods January
first, two thousand nine through December thirty-first, two thousand
ten, three hundred seventy-five thousand dollars for the period January
first, two thousand eleven through March thirty-first, two thousand
eleven, [and] one million three hundred twenty thousand dollars each
state fiscal year for the period April first, two thousand eleven
through March thirty-first, two thousand fourteen, AND UP TO TWO MILLION
SEVENTY-SEVEN THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND SEVENTEEN, shall be set aside and reserved by the commissioner from
the regional pools established pursuant to subdivision two of this
section and shall be available for distributions to the New York state
area health education center program for the purpose of expanding commu-
nity-based training of medical students. In addition, one million
dollars annually for the period January first, two thousand eight
through December thirty-first, two thousand ten, two hundred fifty thou-
sand dollars for the period January first, two thousand eleven through
March thirty-first, two thousand eleven, and eight hundred eighty thou-
sand dollars each state fiscal year for the period April first, two
thousand eleven through March thirty-first, two thousand fourteen, shall
be set aside and reserved by the commissioner from the regional pools
established pursuant to subdivision two of this section and shall be
available for distributions to the New York state area health education
center program for the purpose of post-secondary training of health care
professionals who will achieve specific program outcomes within the New
York state area health education center program. The New York state area
health education center program shall report to the commissioner on an
annual basis regarding the use of funds for each purpose in such form
and manner as specified by the commissioner.
S 10. Paragraph (a) of subdivision 12 of section 367-b of the social
services law, as amended by section 10 of part C of chapter 59 of the
laws of 2011, is amended to read as follows:
(a) For the purpose of regulating cash flow for general hospitals, the
department shall develop and implement a payment methodology to provide
for timely payments for inpatient hospital services eligible for case
based payments per discharge based on diagnosis-related groups provided
during the period January first, nineteen hundred eighty-eight through
March thirty-first two thousand [fourteen] SEVENTEEN, by such hospitals
which elect to participate in the system.
S 11. Section 2 of chapter 600 of the laws of 1986 amending the public
health law relating to the development of pilot reimbursement programs
for ambulatory care services, as amended by section 11 of part C of
chapter 59 of the laws of 2011, is amended to read as follows:
S. 6914 100 A. 9205
S 2. This act shall take effect immediately, except that this act
shall expire and be of no further force and effect on and after April 1,
[2014] 2017; provided, however, that the commissioner of health shall
submit a report to the governor and the legislature detailing the objec-
tive, impact, design and computation of any pilot reimbursement program
established pursuant to this act, on or before March 31, 1994 and annu-
ally thereafter. Such report shall include an assessment of the finan-
cial impact of such payment system on providers, as well as the impact
of such system on access to care.
S 12. Paragraph (i) of subdivision (b) of section 1 of chapter 520 of
the laws of 1978, relating to providing for a comprehensive survey of
health care financing, education and illness prevention and creating
councils for the conduct thereof, as amended by section 12 of part C of
chapter 59 of the laws of 2011, is amended to read as follows:
(i) oversight and evaluation of the inpatient financing system in
place for 1988 through March 31, [2014] 2017, and the appropriateness
and effectiveness of the bad debt and charity care financing provisions;
S 13. Paragraph (i) of subdivision 9 of section 3614 of the public
health law, as added by section 23 of part C of chapter 59 of the laws
of 2011, is amended and three new paragraphs (j), (k) and (l) are added
to read as follows:
(i) for the period April first, two thousand thirteen through March
thirty-first, two thousand fourteen, up to one hundred million
dollars[.];
(J) FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FIFTEEN, UP TO ONE HUNDRED MILLION DOLLARS;
(K) FOR THE PERIOD APRIL FIRST, TWO THOUSAND FIFTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SIXTEEN, UP TO ONE HUNDRED MILLION DOLLARS;
(L) FOR THE PERIOD APRIL FIRST, TWO THOUSAND SIXTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SEVENTEEN, UP TO ONE HUNDRED MILLION DOLLARS.
S 14. Paragraphs (1) and (m) of subdivision 1 of section 367-q of the
social services law, as amended by section 35 of part D of chapter 56 of
the laws of 2012, are amended and three new paragraphs (n), (o) and (p)
are added 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[.];
(N) FOR THE PERIOD APRIL FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND FIFTEEN, UP TO TWENTY-EIGHT MILLION FIVE
HUNDRED THOUSAND DOLLARS;
(O) FOR THE PERIOD APRIL FIRST, TWO THOUSAND FIFTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SIXTEEN, UP TO TWENTY-EIGHT MILLION FIVE
HUNDRED THOUSAND DOLLARS; AND
(P) FOR THE PERIOD APRIL FIRST, TWO THOUSAND SIXTEEN THROUGH MARCH
THIRTY-FIRST, TWO THOUSAND SEVENTEEN, UP TO TWENTY-EIGHT MILLION FIVE
HUNDRED THOUSAND DOLLARS.
S 15. Subdivision 6 of section 2807-t of the public health law, as
added by chapter 639 of the laws of 1996, is amended to read as follows:
6. Prospective adjustments. (A) The commissioner shall annually recon-
cile the sum of the actual payments made to the commissioner or the
commissioner's designee for each region pursuant to section twenty-eight
hundred seven-s of this article and pursuant to this section for the
prior year with the regional allocation of the gross annual statewide
S. 6914 101 A. 9205
amount specified in subdivision six of section twenty-eight hundred
seven-s of this article for such prior year. The difference between the
actual amount raised for a region and the regional allocation of the
specified gross annual amount for such prior year shall be applied as a
prospective adjustment to the regional allocation of the specified gross
annual payment amount for such region for the year next following the
calculation of the reconciliation. The authorized dollar value of the
adjustments shall be the same as if calculated retrospectively.
(B) NOTWITHSTANDING THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
SION, FOR COVERED LIVES ASSESSMENT RATE PERIODS ON AND AFTER JANUARY
FIRST, TWO THOUSAND FIFTEEN THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND
SEVENTEEN, FOR AMOUNTS COLLECTED IN THE AGGREGATE IN EXCESS OF ONE
BILLION FORTY-FIVE MILLION DOLLARS ON AN ANNUAL BASIS, PROSPECTIVE
ADJUSTMENTS SHALL BE SUSPENDED IF THE ANNUAL RECONCILIATION CALCULATION
FROM THE PRIOR YEAR WOULD OTHERWISE RESULT IN A DECREASE TO THE REGIONAL
ALLOCATION OF THE SPECIFIED GROSS ANNUAL PAYMENT AMOUNT FOR THAT REGION,
PROVIDED, HOWEVER, THAT SUCH SUSPENSION SHALL BE LIFTED UPON A DETERMI-
NATION BY THE COMMISSIONER, IN CONSULTATION WITH THE DIRECTOR OF THE
BUDGET, THAT SIXTY-FIVE MILLION DOLLARS IN AGGREGATE COLLECTIONS ON AN
ANNUAL BASIS OVER AND ABOVE ONE BILLION FORTY-FIVE MILLION DOLLARS ON AN
ANNUAL BASIS HAVE BEEN RESERVED AND SET ASIDE FOR DEPOSIT IN THE HCRA
RESOURCES FUND. ANY AMOUNTS COLLECTED IN THE AGGREGATE AT OR BELOW ONE
BILLION FORTY-FIVE MILLION DOLLARS ON AN ANNUAL BASIS, SHALL BE SUBJECT
TO REGIONAL ADJUSTMENTS RECONCILING ANY DECREASES OR INCREASES TO THE
REGIONAL ALLOCATION IN ACCORDANCE WITH PARAGRAPH (A) OF THIS SUBDIVI-
SION.
S 16. Subdivision 4-c of section 2807-p of the public health law, as
amended by section 27 of part C of chapter 59 of the laws of 2011, is
amended to read as follows:
4-c. Notwithstanding any provision of law to the contrary, the commis-
sioner shall make additional payments for uncompensated care to volun-
tary non-profit diagnostic and treatment centers that are eligible for
distributions under subdivision four of this section in the following
amounts: for the period June first, two thousand six through December
thirty-first, two thousand six, in the amount of seven million five
hundred thousand dollars, for the period January first, two thousand
seven through December thirty-first, two thousand seven, seven million
five hundred thousand dollars, for the period January first, two thou-
sand eight through December thirty-first, two thousand eight, seven
million five hundred thousand dollars, for the period January first, two
thousand nine through December thirty-first, two thousand nine, fifteen
million five hundred thousand dollars, for the period January first, two
thousand ten through December thirty-first, two thousand ten, seven
million five hundred thousand dollars, for the period January first, two
thousand eleven though December thirty-first, two thousand eleven, seven
million five hundred thousand dollars, for the period January first, two
thousand twelve through December thirty-first, two thousand twelve,
seven million five hundred thousand dollars, for the period January
first, two thousand thirteen through December thirty-first, two thousand
thirteen, seven million five hundred thousand dollars, FOR THE PERIOD
JANUARY FIRST, TWO THOUSAND FOURTEEN THROUGH DECEMBER THIRTY-FIRST, TWO
THOUSAND FOURTEEN, SEVEN MILLION FIVE HUNDRED THOUSAND DOLLARS, FOR THE
PERIOD JANUARY FIRST, TWO THOUSAND FIFTEEN THROUGH DECEMBER
THIRTY-FIRST, TWO THOUSAND FIFTEEN, SEVEN MILLION FIVE HUNDRED THOUSAND
DOLLARS, FOR THE PERIOD JANUARY FIRST TWO THOUSAND SIXTEEN THROUGH
DECEMBER THIRTY-FIRST, TWO THOUSAND SIXTEEN, SEVEN MILLION FIVE HUNDRED
S. 6914 102 A. 9205
THOUSAND DOLLARS, and for the period January first, two thousand [four-
teen] SEVENTEEN through March thirty-first, two thousand [fourteen]
SEVENTEEN, in the amount of one million [eight hundred seventy-five] SIX
HUNDRED thousand dollars, provided, however, that for periods on and
after January first, two thousand eight, such additional payments shall
be distributed to voluntary, non-profit diagnostic and treatment centers
and to public diagnostic and treatment centers in accordance with para-
graph (g) of subdivision four of this section. In the event that federal
financial participation is available for rate adjustments pursuant to
this section, the commissioner shall make such payments as additional
adjustments to rates of payment for voluntary non-profit diagnostic and
treatment centers that are eligible for distributions under subdivision
four-a of this section in the following amounts: for the period June
first, two thousand six through December thirty-first, two thousand six,
fifteen million dollars in the aggregate, and for the period January
first, two thousand seven through June thirtieth, two thousand seven,
seven million five hundred thousand dollars in the aggregate. The
amounts allocated pursuant to this paragraph shall be aggregated with
and distributed pursuant to the same methodology applicable to the
amounts allocated to such diagnostic and treatment centers for such
periods pursuant to subdivision four of this section if federal finan-
cial participation is not available, or pursuant to subdivision four-a
of this section if federal financial participation is available.
Notwithstanding section three hundred sixty-eight-a of the social
services law, there shall be no local share in a medical assistance
payment adjustment under this subdivision.
S 17. Subdivision 9 of section 2807-k of the public health law, as
added by chapter 639 of the laws of 1996, is amended to read as follows:
9. In order for a general hospital to participate in the distribution
of funds from the pool, the general hospital must implement minimum
collection policies and procedures approved by the commissioner [and
must be in compliance with bad debt and charity care reporting require-
ments established pursuant to this article].
S 17-a. Paragraph (d) of subdivision 16 of section 2807-c of the
public health law, as amended by chapter 731 of the laws of 1993, is
amended to read as follows:
(d) In order for a general hospital to participate in the distribution
of funds from the pools, the general hospital must implement collection
policies and procedures approved by the commissioner [and must be in
compliance with bad debt and charity care reporting requirements estab-
lished pursuant to this article].
S 18. Paragraph (a) of subdivision 1 of section 18 of chapter 266 of
the laws of 1986, amending the civil practice law and rules and other
laws relating to malpractice and professional medical conduct, as
amended by section 15 of part C of chapter 59 of the laws of 2011, is
amended to read as follows:
(a) The superintendent of insurance and the commissioner of health or
their designee shall, from funds available in the hospital excess
liability pool created pursuant to subdivision 5 of this section,
purchase a policy or policies for excess insurance coverage, as author-
ized by paragraph 1 of subsection (e) of section 5502 of the insurance
law; or from an insurer, other than an insurer described in section 5502
of the insurance law, duly authorized to write such coverage and actual-
ly writing medical malpractice insurance in this state; or shall
purchase equivalent excess coverage in a form previously approved by the
superintendent of insurance for purposes of providing equivalent excess
S. 6914 103 A. 9205
coverage in accordance with section 19 of chapter 294 of the laws of
1985, for medical or dental malpractice occurrences between July 1, 1986
and June 30, 1987, between July 1, 1987 and June 30, 1988, between July
1, 1988 and June 30, 1989, between July 1, 1989 and June 30, 1990,
between July 1, 1990 and June 30, 1991, between July 1, 1991 and June
30, 1992, between July 1, 1992 and June 30, 1993, between July 1, 1993
and June 30, 1994, between July 1, 1994 and June 30, 1995, between July
1, 1995 and June 30, 1996, between July 1, 1996 and June 30, 1997,
between July 1, 1997 and June 30, 1998, between July 1, 1998 and June
30, 1999, between July 1, 1999 and June 30, 2000, between July 1, 2000
and June 30, 2001, between July 1, 2001 and June 30, 2002, between July
1, 2002 and June 30, 2003, between July 1, 2003 and June 30, 2004,
between July 1, 2004 and June 30, 2005, between July 1, 2005 and June
30, 2006, between July 1, 2006 and June 30, 2007, between July 1, 2007
and June 30, 2008, between July 1, 2008 and June 30, 2009, between July
1, 2009 and June 30, 2010, between July 1, 2010 and June 30, 2011,
between July 1, 2011 and June 30, 2012, between July 1, 2012 and June
30, 2013 [and], between July 1, 2013 and June 30, 2014, AND BETWEEN JULY
1, 2014 AND JUNE 30, 2015 or reimburse the hospital where the hospital
purchases equivalent excess coverage as defined in subparagraph (i) of
paragraph (a) of subdivision 1-a of this section for medical or dental
malpractice occurrences between July 1, 1987 and June 30, 1988, between
July 1, 1988 and June 30, 1989, between July 1, 1989 and June 30, 1990,
between July 1, 1990 and June 30, 1991, between July 1, 1991 and June
30, 1992, between July 1, 1992 and June 30, 1993, between July 1, 1993
and June 30, 1994, between July 1, 1994 and June 30, 1995, between July
1, 1995 and June 30, 1996, between July 1, 1996 and June 30, 1997,
between July 1, 1997 and June 30, 1998, between July 1, 1998 and June
30, 1999, between July 1, 1999 and June 30, 2000, between July 1, 2000
and June 30, 2001, between July 1, 2001 and June 30, 2002, between July
1, 2002 and June 30, 2003, between July 1, 2003 and June 30, 2004,
between July 1, 2004 and June 30, 2005, between July 1, 2005 and June
30, 2006, between July 1, 2006 and June 30, 2007, between July 1, 2007
and June 30, 2008, between July 1, 2008 and June 30, 2009, between July
1, 2009 and June 30, 2010, between July 1, 2010 and June 30, 2011,
between July 1, 2011 and June 30, 2012, between July 1, 2012 and June
30, 2013 [and], between July 1, 2013 and June 30, 2014, AND BETWEEN JULY
1, 2014 AND JUNE 30, 2015 for physicians or dentists certified as eligi-
ble for each such period or periods pursuant to subdivision 2 of this
section by a general hospital licensed pursuant to article 28 of the
public health law; provided that no single insurer shall write more than
fifty percent of the total excess premium for a given policy year; and
provided, however, that such eligible physicians or dentists must have
in force an individual policy, from an insurer licensed in this state of
primary malpractice insurance coverage in amounts of no less than one
million three hundred thousand dollars for each claimant and three
million nine hundred thousand dollars for all claimants under that poli-
cy during the period of such excess coverage for such occurrences or be
endorsed as additional insureds under a hospital professional liability
policy which is offered through a voluntary attending physician ("chan-
neling") program previously permitted by the superintendent of insurance
during the period of such excess coverage for such occurrences. During
such period, such policy for excess coverage or such equivalent excess
coverage shall, when combined with the physician's or dentist's primary
malpractice insurance coverage or coverage provided through a voluntary
attending physician ("channeling") program, total an aggregate level of
S. 6914 104 A. 9205
two million three hundred thousand dollars for each claimant and six
million nine hundred thousand dollars for all claimants from all such
policies with respect to occurrences in each of such years provided,
however, if the cost of primary malpractice insurance coverage in excess
of one million dollars, but below the excess medical malpractice insur-
ance coverage provided pursuant to this act, exceeds the rate of nine
percent per annum, then the required level of primary malpractice insur-
ance coverage in excess of one million dollars for each claimant shall
be in an amount of not less than the dollar amount of such coverage
available at nine percent per annum; the required level of such coverage
for all claimants under that policy shall be in an amount not less than
three times the dollar amount of coverage for each claimant; and excess
coverage, when combined with such primary malpractice insurance cover-
age, shall increase the aggregate level for each claimant by one million
dollars and three million dollars for all claimants; and provided
further, that, with respect to policies of primary medical malpractice
coverage that include occurrences between April 1, 2002 and June 30,
2002, such requirement that coverage be in amounts no less than one
million three hundred thousand dollars for each claimant and three
million nine hundred thousand dollars for all claimants for such occur-
rences shall be effective April 1, 2002.
S 19. Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
amending the civil practice law and rules and other laws relating to
malpractice and professional medical conduct, as amended by section 16
of part C of chapter 59 of the laws of 2011, is amended to read as
follows:
(3)(a) The superintendent of insurance shall determine and certify to
each general hospital and to the commissioner of health the cost of
excess malpractice insurance for medical or dental malpractice occur-
rences between July 1, 1986 and June 30, 1987, between July 1, 1988 and
June 30, 1989, between July 1, 1989 and June 30, 1990, between July 1,
1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, between
July 1, 1992 and June 30, 1993, between July 1, 1993 and June 30, 1994,
between July 1, 1994 and June 30, 1995, between July 1, 1995 and June
30, 1996, between July 1, 1996 and June 30, 1997, between July 1, 1997
and June 30, 1998, between July 1, 1998 and June 30, 1999, between July
1, 1999 and June 30, 2000, between July 1, 2000 and June 30, 2001,
between July 1, 2001 and June 30, 2002, between July 1, 2002 and June
30, 2003, between July 1, 2003 and June 30, 2004, between July 1, 2004
and June 30, 2005, between July 1, 2005 and June 30, 2006, between July
1, 2006 and June 30, 2007, between July 1, 2007 and June 30, 2008,
between July 1, 2008 and June 30, 2009, between July 1, 2009 and June
30, 2010, between July 1, 2010 and June 30, 2011, between July 1, 2011
and June 30, 2012, between July 1, 2012 and June 30, 2013, and between
July 1, 2013 and June 30, 2014, AND BETWEEN JULY 1, 2014 AND JUNE 30,
2015 allocable to each general hospital for physicians or dentists
certified as eligible for purchase of a policy for excess insurance
coverage by such general hospital in accordance with subdivision 2 of
this section, and may amend such determination and certification as
necessary.
(b) The superintendent of insurance shall determine and certify to
each general hospital and to the commissioner of health the cost of
excess malpractice insurance or equivalent excess coverage for medical
or dental malpractice occurrences between July 1, 1987 and June 30,
1988, between July 1, 1988 and June 30, 1989, between July 1, 1989 and
June 30, 1990, between July 1, 1990 and June 30, 1991, between July 1,
S. 6914 105 A. 9205
1991 and June 30, 1992, between July 1, 1992 and June 30, 1993, between
July 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995,
between July 1, 1995 and June 30, 1996, between July 1, 1996 and June
30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998
and June 30, 1999, between July 1, 1999 and June 30, 2000, between July
1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002,
between July 1, 2002 and June 30, 2003, between July 1, 2003 and June
30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005
and June 30, 2006, between July 1, 2006 and June 30, 2007, between July
1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009,
between July 1, 2009 and June 30, 2010, between July 1, 2010 and June
30, 2011, between July 1, 2011 and June 30, 2012, between July 1, 2012
and June 30, 2013, [and] between July 1, 2013 and June 30, 2014, AND
BETWEEN JULY 1, 2014 AND JUNE 30, 2015 allocable to each general hospi-
tal for physicians or dentists certified as eligible for purchase of a
policy for excess insurance coverage or equivalent excess coverage by
such general hospital in accordance with subdivision 2 of this section,
and may amend such determination and certification as necessary. The
superintendent of insurance shall determine and certify to each general
hospital and to the commissioner of health the ratable share of such
cost allocable to the period July 1, 1987 to December 31, 1987, to the
period January 1, 1988 to June 30, 1988, to the period July 1, 1988 to
December 31, 1988, to the period January 1, 1989 to June 30, 1989, to
the period July 1, 1989 to December 31, 1989, to the period January 1,
1990 to June 30, 1990, to the period July 1, 1990 to December 31, 1990,
to the period January 1, 1991 to June 30, 1991, to the period July 1,
1991 to December 31, 1991, to the period January 1, 1992 to June 30,
1992, to the period July 1, 1992 to December 31, 1992, to the period
January 1, 1993 to June 30, 1993, to the period July 1, 1993 to December
31, 1993, to the period January 1, 1994 to June 30, 1994, to the period
July 1, 1994 to December 31, 1994, to the period January 1, 1995 to June
30, 1995, to the period July 1, 1995 to December 31, 1995, to the period
January 1, 1996 to June 30, 1996, to the period July 1, 1996 to December
31, 1996, to the period January 1, 1997 to June 30, 1997, to the period
July 1, 1997 to December 31, 1997, to the period January 1, 1998 to June
30, 1998, to the period July 1, 1998 to December 31, 1998, to the period
January 1, 1999 to June 30, 1999, to the period July 1, 1999 to December
31, 1999, to the period January 1, 2000 to June 30, 2000, to the period
July 1, 2000 to December 31, 2000, to the period January 1, 2001 to June
30, 2001, to the period July 1, 2001 to June 30, 2002, to the period
July 1, 2002 to June 30, 2003, to the period July 1, 2003 to June 30,
2004, to the period July 1, 2004 to June 30, 2005, to the period July 1,
2005 and June 30, 2006, to the period July 1, 2006 and June 30, 2007, to
the period July 1, 2007 and June 30, 2008, to the period July 1, 2008
and June 30, 2009, to the period July 1, 2009 and June 30, 2010, to the
period July 1, 2010 and June 30, 2011, to the period July 1, 2011 and
June 30, 2012, to the period July 1, 2012 and June 30, 2013, [and] to
the period July 1, 2013 and June 30, 2014, AND TO THE PERIOD JULY 1,
2014 AND JUNE 30, 2015.
S 20. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of
section 18 of chapter 266 of the laws of 1986, amending the civil prac-
tice law and rules and other laws relating to malpractice and profes-
sional medical conduct, as amended by section 17 of part C of chapter 59
of the laws of 2011, are amended to read as follows:
(a) To the extent funds available to the hospital excess liability
pool pursuant to subdivision 5 of this section as amended, and pursuant
S. 6914 106 A. 9205
to section 6 of part J of chapter 63 of the laws of 2001, as may from
time to time be amended, which amended this subdivision, are insuffi-
cient to meet the costs of excess insurance coverage or equivalent
excess coverage for coverage periods during the period July 1, 1992 to
June 30, 1993, during the period July 1, 1993 to June 30, 1994, during
the period July 1, 1994 to June 30, 1995, during the period July 1, 1995
to June 30, 1996, during the period July 1, 1996 to June 30, 1997,
during the period July 1, 1997 to June 30, 1998, during the period July
1, 1998 to June 30, 1999, during the period July 1, 1999 to June 30,
2000, during the period July 1, 2000 to June 30, 2001, during the period
July 1, 2001 to October 29, 2001, during the period April 1, 2002 to
June 30, 2002, during the period July 1, 2002 to June 30, 2003, during
the period July 1, 2003 to June 30, 2004, during the period July 1, 2004
to June 30, 2005, during the period July 1, 2005 to June 30, 2006,
during the period July 1, 2006 to June 30, 2007, during the period July
1, 2007 to June 30, 2008, during the period July 1, 2008 to June 30,
2009, during the period July 1, 2009 to June 30, 2010, during the period
July 1, 2010 to June 30, 2011, during the period July 1, 2011 to June
30, 2012, during the period July 1, 2012 to June 30, 2013, [and] during
the period July 1, 2013 to June 30, 2014, AND DURING THE PERIOD JULY 1,
2014 TO JUNE 30, 2015 allocated or reallocated in accordance with para-
graph (a) of subdivision 4-a of this section to rates of payment appli-
cable to state governmental agencies, 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 to the sum of the total
cost of such coverage for all physicians applied to such insufficiency.
(b) Each provider of excess insurance coverage or equivalent excess
coverage covering the period July 1, 1992 to June 30, 1993, or covering
the period July 1, 1993 to June 30, 1994, or covering the period July 1,
1994 to June 30, 1995, or covering the period July 1, 1995 to June 30,
1996, or covering the period July 1, 1996 to June 30, 1997, or covering
the period July 1, 1997 to June 30, 1998, or covering the period July 1,
1998 to June 30, 1999, or covering the period July 1, 1999 to June 30,
2000, or covering the period July 1, 2000 to June 30, 2001, or covering
the period July 1, 2001 to October 29, 2001, or covering the period
April 1, 2002 to June 30, 2002, or covering the period July 1, 2002 to
June 30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
covering the period July 1, 2004 to June 30, 2005, or covering the peri-
od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
June 30, 2007, or covering the period July 1, 2007 to June 30, 2008, or
covering the period July 1, 2008 to June 30, 2009, or covering the peri-
od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
June 30, 2011, or covering the period July 1, 2011 to June 30, 2012, or
covering the period July 1, 2012 to June 30, 2013, or covering the peri-
od July 1, 2013 to June 30, 2014, OR COVERING THE PERIOD JULY 1, 2014 TO
JUNE 30, 2015 shall notify a covered physician or dentist by mail,
mailed to the address shown on the last application for excess insurance
coverage or equivalent excess coverage, of the amount due to such
provider from such physician or dentist for such coverage period deter-
mined in accordance with paragraph (a) of this subdivision. Such amount
shall be due from such physician or dentist to such provider of excess
insurance coverage or equivalent excess coverage in a time and manner
determined by the superintendent of insurance.
S. 6914 107 A. 9205
(c) If a physician or dentist liable for payment of a portion of the
costs of excess insurance coverage or equivalent excess coverage cover-
ing the period July 1, 1992 to June 30, 1993, or covering the period
July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to
June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or
covering the period July 1, 1996 to June 30, 1997, or covering the peri-
od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
covering the period July 1, 2000 to June 30, 2001, or covering the peri-
od July 1, 2001 to October 29, 2001, or covering the period April 1,
2002 to June 30, 2002, or covering the period July 1, 2002 to June 30,
2003, or covering the period July 1, 2003 to June 30, 2004, or covering
the period July 1, 2004 to June 30, 2005, or covering the period July 1,
2005 to June 30, 2006, or covering the period July 1, 2006 to June 30,
2007, or covering the period July 1, 2007 to June 30, 2008, or covering
the period July 1, 2008 to June 30, 2009, or covering the period July 1,
2009 to June 30, 2010, or covering the period July 1, 2010 to June 30,
2011, or covering the period July 1, 2011 to June 30, 2012, or covering
the period July 1, 2012 to June 30, 2013, or covering the period July 1,
2013 to June 30, 2014, OR COVERING THE PERIOD JULY 1, 2014 TO JUNE 30,
2015 determined in accordance with paragraph (a) of this subdivision
fails, refuses or neglects to make payment to the provider of excess
insurance coverage or equivalent excess coverage in such time and manner
as determined by the superintendent of insurance pursuant to paragraph
(b) of this subdivision, excess insurance coverage or equivalent excess
coverage purchased for such physician or dentist in accordance with this
section for such coverage period shall be cancelled and shall be null
and void as of the first day on or after the 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 insurance and the commis-
sioner of health or their designee of each physician and dentist eligi-
ble for purchase of a policy for excess insurance coverage or equivalent
excess coverage covering the period July 1, 1992 to June 30, 1993, or
covering the period July 1, 1993 to June 30, 1994, or covering the peri-
od July 1, 1994 to June 30, 1995, or covering the period July 1, 1995 to
June 30, 1996, or covering the period July 1, 1996 to June 30, 1997, or
covering the period July 1, 1997 to June 30, 1998, or covering the peri-
od July 1, 1998 to June 30, 1999, or covering the period July 1, 1999 to
June 30, 2000, or covering the period July 1, 2000 to June 30, 2001, or
covering the period July 1, 2001 to October 29, 2001, or covering the
period April 1, 2002 to June 30, 2002, or covering the period July 1,
2002 to June 30, 2003, or covering the period July 1, 2003 to June 30,
2004, or covering the period July 1, 2004 to June 30, 2005, or covering
the period July 1, 2005 to June 30, 2006, or covering the period July 1,
2006 to June 30, 2007, or covering the period July 1, 2007 to June 30,
2008, or covering the period July 1, 2008 to June 30, 2009, or covering
the period July 1, 2009 to June 30, 2010, or covering the period July 1,
2010 to June 30, 2011, or covering the period July 1, 2011 to June 30,
2012, or covering the period July 1, 2012 to June 30, 2013, or covering
the period July 1, 2013 to June 30, 2014, OR COVERING THE PERIOD JULY 1,
2014 TO JUNE 30, 2015 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.
S. 6914 108 A. 9205
(e) A provider of excess insurance coverage or equivalent excess
coverage shall refund to the hospital excess liability pool any amount
allocable to the period July 1, 1992 to June 30, 1993, and to the period
July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June
30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the
period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to
the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
to June 30, 2001, and to the period July 1, 2001 to October 29, 2001,
and to the period April 1, 2002 to June 30, 2002, and to the period July
1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30,
2004, and to the period July 1, 2004 to June 30, 2005, and to the period
July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June
30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the
period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
June 30, 2010, and to the period July 1, 2010 to June 30, 2011, and to
the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012
to June 30, 2013, and to the period July 1, 2013 to June 30, 2014, AND
TO THE PERIOD JULY 1, 2014 TO JUNE 30, 2015 received from the hospital
excess liability pool for purchase of excess insurance coverage or
equivalent excess coverage covering the period July 1, 1992 to June 30,
1993, and covering the period July 1, 1993 to June 30, 1994, and cover-
ing the period July 1, 1994 to June 30, 1995, and covering the period
July 1, 1995 to June 30, 1996, and covering the period July 1, 1996 to
June 30, 1997, and covering the period July 1, 1997 to June 30, 1998,
and covering the period July 1, 1998 to June 30, 1999, and covering the
period July 1, 1999 to June 30, 2000, and covering the period July 1,
2000 to June 30, 2001, and covering the period July 1, 2001 to October
29, 2001, and covering the period April 1, 2002 to June 30, 2002, and
covering the period July 1, 2002 to June 30, 2003, and covering the
period July 1, 2003 to June 30, 2004, and covering the period July 1,
2004 to June 30, 2005, and covering the period July 1, 2005 to June 30,
2006, and covering the period July 1, 2006 to June 30, 2007, and cover-
ing the period July 1, 2007 to June 30, 2008, and covering the period
July 1, 2008 to June 30, 2009, and covering the period July 1, 2009 to
June 30, 2010, and covering the period July 1, 2010 to June 30, 2011,
and covering the period July 1, 2011 to June 30, 2012, and covering the
period July 1, 2012 to June 30, 2013, and covering the period July 1,
2013 to June 30, 2014, AND COVERING THE PERIOD JULY 1, 2014 TO JUNE 30,
2015 for a physician or dentist where such excess insurance coverage or
equivalent excess coverage is cancelled in accordance with paragraph (c)
of this subdivision.
S 21. Section 40 of chapter 266 of the laws of 1986, amending the
civil practice law and rules and other laws relating to malpractice and
professional medical conduct, as amended by section 18 of part C of
chapter 59 of the laws of 2011, is amended to read as follows:
S 40. The superintendent of insurance shall establish rates for poli-
cies providing coverage for physicians and surgeons medical malpractice
for the periods commencing July 1, 1985 and ending June 30, [2014] 2015;
provided, however, that notwithstanding any other provision of law, the
superintendent shall not establish or approve any increase in rates for
the period commencing July 1, 2009 and ending June 30, 2010. The super-
intendent shall direct insurers to establish segregated accounts for
premiums, payments, reserves and investment income attributable to such
premium periods and shall require periodic reports by the insurers
regarding claims and expenses attributable to such periods to monitor
S. 6914 109 A. 9205
whether such accounts will be sufficient to meet incurred claims and
expenses. On or after July 1, 1989, the superintendent shall impose a
surcharge on premiums to satisfy a projected deficiency that is attrib-
utable to the premium levels established pursuant to this section for
such periods; provided, however, that such annual surcharge shall not
exceed eight percent of the established rate until July 1, [2014] 2015,
at which time and thereafter such surcharge shall not exceed twenty-five
percent of the approved adequate rate, and that such annual surcharges
shall continue for such period of time as shall be sufficient to satisfy
such deficiency. The superintendent shall not impose such surcharge
during the period commencing July 1, 2009 and ending June 30, 2010. On
and after July 1, 1989, the surcharge prescribed by this section shall
be retained by insurers to the extent that they insured physicians and
surgeons during the July 1, 1985 through June 30, [2014] 2015 policy
periods; in the event and to the extent physicians and surgeons were
insured by another insurer during such periods, all or a pro rata share
of the surcharge, as the case may be, shall be remitted to such other
insurer in accordance with rules and regulations to be promulgated by
the superintendent. Surcharges collected from physicians and surgeons
who were not insured during such policy periods shall be apportioned
among all insurers in proportion to the premium written by each insurer
during such policy periods; if a physician or surgeon was insured by an
insurer subject to rates established by the superintendent during such
policy periods, and at any time thereafter a hospital, health mainte-
nance organization, employer or institution is responsible for respond-
ing in damages for liability arising out of such physician's or
surgeon's practice of medicine, such responsible entity shall also remit
to such prior insurer the equivalent amount that would then be collected
as a surcharge if the physician or surgeon had continued to remain
insured by such prior insurer. In the event any insurer that provided
coverage during such policy periods is in liquidation, the
property/casualty insurance security fund shall receive the portion of
surcharges to which the insurer in liquidation would have been entitled.
The surcharges authorized herein shall be deemed to be income earned for
the purposes of section 2303 of the insurance law. The superintendent,
in establishing adequate rates and in determining any projected defi-
ciency pursuant to the requirements of this section and the insurance
law, shall give substantial weight, determined in his discretion and
judgment, to the prospective anticipated effect of any regulations
promulgated and laws enacted and the public benefit of stabilizing
malpractice rates and minimizing rate level fluctuation during the peri-
od of time necessary for the development of more reliable statistical
experience as to the efficacy of such laws and regulations affecting
medical, dental or podiatric malpractice enacted or promulgated in 1985,
1986, by this act and at any other time. Notwithstanding any provision
of the insurance law, rates already established and to be established by
the superintendent pursuant to this section are deemed adequate if such
rates would be adequate when taken together with the maximum authorized
annual surcharges to be imposed for a reasonable period of time whether
or not any such annual surcharge has been actually imposed as of the
establishment of such rates.
S 22. Section 5 and subdivisions (a) and (e) of section 6 of part J of
chapter 63 of the laws of 2001, amending chapter 20 of the laws of 2001
amending the military law and other laws relating to making appropri-
ations for the support of government, as amended by section 20 of part C
of chapter 59 of the laws of 2011, are amended to read as follows:
S. 6914 110 A. 9205
S 5. The superintendent of insurance and the commissioner of health
shall determine, no later than June 15, 2002, June 15, 2003, June 15,
2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008, June
15, 2009, June 15, 2010, June 15, 2011, June 15, 2012, June 15, 2013,
[and] June 15, 2014, AND JUNE 15, 2015 the amount of funds available in
the hospital excess liability pool, created pursuant to section 18 of
chapter 266 of the laws of 1986, and whether such funds are sufficient
for purposes of purchasing excess insurance coverage for eligible
participating physicians and dentists during the period July 1, 2001 to
June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003 to June
30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to June 30,
2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June 30,
2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 30,
2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
2014, OR JULY 1, 2014 TO JUNE 30, 2015, as applicable.
(a) This section shall be effective only upon a determination, pursu-
ant to section five of this act, by the superintendent of insurance and
the commissioner of health, and a certification of such determination to
the state director of the budget, the chair of the senate committee on
finance and the chair of the assembly committee on ways and means, that
the amount of funds in the hospital excess liability pool, created
pursuant to section 18 of chapter 266 of the laws of 1986, is insuffi-
cient for purposes of purchasing excess insurance coverage for eligible
participating physicians and dentists during the period July 1, 2001 to
June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003 to June
30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to June 30,
2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June 30,
2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 30,
2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
2014, OR JULY 1, 2014 TO JUNE 30, 2015, as applicable.
(e) The commissioner of health shall transfer for deposit to the
hospital excess liability pool created pursuant to section 18 of chapter
266 of the laws of 1986 such amounts as directed by the superintendent
of insurance for the purchase of excess liability insurance coverage for
eligible participating physicians and dentists for the policy year July
1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1,
2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005
to June 30, 2006, or July 1, 2006 to June 30, 2007, as applicable, and
the cost of administering the hospital excess liability pool for such
applicable policy year, pursuant to the program established in chapter
266 of the laws of 1986, as amended, no later than June 15, 2002, June
15, 2003, June 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007,
June 15, 2008, June 15, 2009, June 15, 2010, June 15, 2011, June 15,
2012, June 15, 2013, [and] June 15, 2014, AND JUNE 15, 2015, as applica-
ble.
S 23. Notwithstanding any law, rule or regulation to the contrary,
only physicians or dentists who were eligible, and for whom the super-
intendent of financial services and the commissioner of health, or their
designee, purchased, with funds available in the hospital excess liabil-
ity pool, a full or partial policy for excess coverage or equivalent
excess coverage for the coverage period ending the thirtieth of June,
two thousand fourteen, shall be eligible to apply for such coverage for
the coverage period beginning the first of July, two thousand fourteen;
provided, however, if the total number of physicians or dentists for
S. 6914 111 A. 9205
whom such excess coverage or equivalent excess coverage was purchased
for the policy year ending the thirtieth of June, two thousand fourteen
exceeds the total number of physicians or dentists certified as eligible
for the coverage period beginning the first of July, two thousand four-
teen, then the general hospitals may certify additional eligible physi-
cians or dentists in a number equal to such general hospital's propor-
tional share of the total number of physicians or dentists for whom
excess coverage or equivalent excess coverage was purchased with funds
available in the hospital excess liability pool as of the thirtieth of
June, two thousand fourteen, as applied to the difference between the
number of eligible physicians or dentists for whom a policy for excess
coverage or equivalent excess coverage was purchased for the coverage
period ending the thirtieth of June, two thousand fourteen and the
number of such eligible physicians or dentists who have applied for
excess coverage or equivalent excess coverage for the coverage period
beginning the first of July, two thousand fourteen.
S 24. 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 25. 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 26. 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 27. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2014, provided
that:
(a) any rules or regulations necessary to implement the provisions of
this act may be promulgated and any procedures, forms, or instructions
necessary for such implementation may be adopted and issued on or after
the date this act shall have become a law;
(b) this act shall not be construed to alter, change, affect, impair
or defeat any right, obligations, duties or interests accrued, incurred
or conferred prior to the effective date of this act;
(c) the commissioner of health and the superintendent of financial
services and any appropriate council may take any steps necessary to
implement this act prior to its effective date;
(d) notwithstanding any inconsistent provision of the state adminis-
trative procedure act or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of 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
S. 6914 112 A. 9205
determines necessary to implement any provision of this act on its
effective date;
(e) the provisions of this act shall become effective notwithstanding
the failure of the commissioner of health or the superintendent of
financial services or any council to adopt or amend or promulgate regu-
lations implementing this act;
(f) the amendments to sections 2807-s and 2807-j of the public health
law made by sections three, four and five, respectively, of this act
shall not affect the expiration of such sections and shall expire there-
with;
(g) the amendments to paragraph (i-l) of subdivision 1 of section
2807-v of the public health law made by section eight of this act shall
not affect the repeal of such paragraph and shall be deemed repealed
therewith; and
(h) the amendments to subdivision 6 of section 2807-t of the public
health law made by section fifteen of this act shall not affect the
expiration of such section and shall be deemed to expire therewith.
PART C
Section 1. Notwithstanding any provision of law to the contrary, the
department of health is directed to consult with all interested stake-
holders, for the purpose of developing a new methodology of reimburse-
ment for pharmacies. The department of health shall develop a transpar-
ent methodology that provides an adequate level of reimbursement for
pharmacies.
S 2. Subparagraphs (i) and (ii) of paragraph (b) of subdivision 9 of
section 367-a of the social services law, as amended by section 10 of
part H of chapter 59 of the laws of 2011, is amended to read as follows:
(i) if the drug dispensed is a multiple source prescription drug for
which an upper limit has been set by the federal centers for medicare
and medicaid services, the lower of: (A) an amount equal to the specific
upper limit set by such federal agency for the multiple source
prescription drug; (B) the estimated acquisition cost of such drug to
pharmacies which, for purposes of this subparagraph, shall mean the
average wholesale price of a prescription drug based on the package size
dispensed from, as reported by the prescription drug pricing service
used by the department, less twenty-five percent thereof; (C) the maxi-
mum acquisition cost, if any, established pursuant to paragraph (e) of
this subdivision, PROVIDED THAT THE METHODOLOGY USED BY THE DEPARTMENT
TO ESTABLISH A MAXIMUM ACQUISITION COST SHALL NOT INCLUDE AVERAGE ACQUI-
SITION COST AS DETERMINED BY DEPARTMENT SURVEYS; OR (D) the dispensing
pharmacy's usual and customary price charged to the general public; [or
(E) the average acquisition cost if available;] and
(ii) if the drug dispensed is a multiple source prescription drug or a
brand-name prescription drug for which no specific upper limit has been
set by such federal agency, the lower of the estimated acquisition cost
of such drug to pharmacies[, the average acquisition cost if available]
or the dispensing pharmacy's usual and customary price charged to the
general public. For sole and multiple source brand name drugs, estimated
acquisition cost means the average wholesale price of a prescription
drug based upon the package size dispensed from, as reported by the
prescription drug pricing service used by the department, less seventeen
percent thereof or the wholesale acquisition cost of a prescription drug
based upon package size dispensed from, as reported by the prescription
drug pricing service used by the department, minus zero and forty-one
S. 6914 113 A. 9205
hundredths percent thereof, and updated monthly by the department. For
multiple source generic drugs, estimated acquisition cost means the
lower of [the average acquisition cost,] the average wholesale price of
a prescription drug based on the package size dispensed from, as
reported by the prescription drug pricing service used by the depart-
ment, less twenty-five percent thereof, or the maximum acquisition cost,
if any, established pursuant to paragraph (e) of this subdivision,
PROVIDED THAT THE METHODOLOGY USED BY THE DEPARTMENT TO ESTABLISH A
MAXIMUM ACQUISITION COST SHALL NOT INCLUDE AVERAGE ACQUISITION COST AS
DETERMINED BY DEPARTMENT SURVEYS.
S 3. Paragraph (f) of subdivision 9 of section 367-a of the social
services law, as added by section 10-b of part H of chapter 59 of the
laws of 2011, is amended to read as follows:
[(f) Notwithstanding any inconsistent provision of law or regulation
to the contrary, the commissioner shall have the authority to establish
the amount of payments and dispensing fees under this title for those
drugs which may not be dispensed without a prescription as required by
section sixty-eight hundred ten of the education law and for which
payment is authorized pursuant to paragraph (g) of subdivision two of
section three hundred sixty-five-a of this title. The commissioner shall
not change the amounts of or method for such payments or dispensing fees
on or after April first, two thousand eleven unless notice is given
sixty days in advance of such change to the chairs of the committees on
senate finance, assembly ways and means, senate health, and assembly
health.]
S 4. Intentionally omitted.
S 5. 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
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] MORE THAN A TEN DAY SUPPLY OF THE PREVI-
OUSLY DISPENSED AMOUNT SHOULD REMAIN were the product used as normally
indicated; provided further that the commissioner of health is author-
ized to require prior authorization of prescriptions of opioid analges-
ics in excess of four prescriptions in a thirty-day period in accordance
with section two hundred seventy-three of the public health law; medical
assistance shall not include any drug provided on other than an in-pa-
tient basis for which a recipient is charged or a claim is made in the
case of a prescription drug, in excess of the maximum reimbursable
amounts to be established by department regulations in accordance with
standards established by the secretary of the United States department
of health and human services, or, in the case of a drug not requiring a
prescription, in excess of the maximum reimbursable amount established
S. 6914 114 A. 9205
by the commissioner of health pursuant to paragraph (a) of subdivision
four of this section;
S 6. Paragraph (i) of subdivision 9 of section 367-a of the social
services law is REPEALED.
S 7. Section 365-h of the social services law is amended by adding a
new subdivision 5 to read as follows:
5. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW, AND SUBJECT TO
FEDERAL FINANCIAL PARTICIPATION, THE COMMISSIONER OF HEALTH SHALL MAKE
ADJUSTMENTS TO PAYMENTS UNDER THIS SECTION, FOR THE PURPOSES OF PROVID-
ING INCREASED ACCESS TO MEDICAID NON-EMERGENCY TRANSPORTATION IN RURAL
COMMUNITIES. UP TO TWO MILLION DOLLARS SHALL BE AVAILABLE FOR SUCH
PURPOSES.
S 8. The opening paragraph of subdivision 1 and subdivision 3 of
section 367-s of the social services law, as amended by section 38 of
part C of chapter 58 of the laws of 2008, are amended to read as
follows:
Notwithstanding any provision of law to the contrary, a supplemental
medical assistance payment shall be made on an annual basis to providers
of emergency medical transportation services in an aggregate amount not
to exceed four million dollars for two thousand six, six million dollars
for two thousand seven [and], six million dollars for two thousand
eight, AND SIX MILLION DOLLARS FOR THE PERIOD MAY FIRST, TWO THOUSAND
FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FIFTEEN pursuant to
the following methodology:
3. If all necessary approvals under federal law and regulation are not
obtained to receive federal financial participation in the payments
authorized by this section, payments under this section shall be made in
an aggregate amount not to exceed two million dollars for two thousand
six, three million dollars for two thousand seven [and], three million
dollars for two thousand eight AND THREE MILLION DOLLARS FOR THE PERIOD
MAY FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
SAND FIFTEEN. In such case, the multiplier set forth in paragraph (b)
of subdivision one of this section shall be deemed to be two million
dollars or three million dollars as applicable to the annual period.
S 9. Subparagraph (iii) of paragraph (c) of subdivision 6 of section
367-a of the social services law, as amended by section 47 of part C of
chapter 58 of the laws of 2009, is amended to read as follows:
(iii) Notwithstanding any other provision of this paragraph, co-
payments charged for each generic prescription drug dispensed shall be
one dollar and for each brand name prescription drug dispensed shall be
three dollars; provided, however, that the co-payments charged for each
brand name prescription drug on the preferred drug list established
pursuant to section two hundred seventy-two of the public health law OR,
FOR MANAGED CARE PROVIDERS OPERATING PURSUANT TO SECTION THREE HUNDRED
SIXTY-FOUR-J OF THIS TITLE, FOR EACH BRAND NAME PRESCRIPTION DRUG ON A
MANAGED CARE PROVIDER'S FORMULARY THAT SUCH PROVIDER HAS DESIGNATED AS A
PREFERRED DRUG, and the co-payments charged for each brand name
prescription drug reimbursed pursuant to subparagraph (ii) of paragraph
(a-1) of subdivision four of section three hundred sixty-five-a of this
title shall be one dollar.
S 10. Notwithstanding any inconsistent provision of law to the contra-
ry, funds shall be made available to the commissioner of the office of
mental health and the commissioner of the office of alcoholism and
substance abuse services, in consultation with the commissioner of
health and approved by the director of the budget, and pursuant to
appropriations made therefor in an amount equal to the savings achieved
S. 6914 115 A. 9205
by the reductions described herein, to implement allocation plans devel-
oped by such commissioners, in consultation with the voluntary agencies
providing behavioral health services and local governmental units, as
defined in section 41.03 of the mental hygiene law, of the areas
impacted by reductions of inpatient behavioral health services, and
which shall describe behavioral health services, including mental health
and substance use disorder services, that are designed to amend service
needs resulting from the reduction of inpatient behavioral health
services provided under the Medicaid program by programs licensed pursu-
ant to article 31 or 32 of the mental hygiene law. Such programs may
include programs that are licensed pursuant to both article 31 of the
mental hygiene law and article 28 of the public health law, or certified
under both article 32 of the mental hygiene law and article 28 of the
public health law. The commissioner of health shall include details
regarding the implementation of reinvestment allocation plans pursuant
to reductions of inpatient behavioral health services in the annual
report required under section 45-c of part A of chapter 56 of the laws
of 2013.
S 11. Section 365-m of the social services law is amended by adding a
new subdivision 5 to read as follows:
5. PURSUANT TO APPROPRIATIONS, THE DEPARTMENT OF HEALTH SHALL REINVEST
FUNDS ALLOCATED FOR BEHAVIORAL HEALTH SERVICES, WHICH ARE GENERAL FUND
SAVINGS DIRECTLY RELATED TO SAVINGS REALIZED THROUGH THE TRANSITION OF
POPULATIONS COVERED BY THIS SECTION FROM THE APPLICABLE MEDICAID
FEE-FOR-SERVICE SYSTEM TO A MANAGED CARE MODEL, INCLUDING SAVINGS
RESULTING FROM THE REDUCTION OF INPATIENT AND OUTPATIENT BEHAVIORAL
HEALTH SERVICES PROVIDED UNDER THE MEDICAID PROGRAMS LICENSED OR CERTI-
FIED PURSUANT TO ARTICLE THIRTY-ONE OR THIRTY-TWO OF THE MENTAL HYGIENE
LAW, OR PROGRAMS THAT ARE LICENSED PURSUANT TO BOTH ARTICLE THIRTY-ONE
OF THE MENTAL HYGIENE LAW AND ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH
LAW, OR CERTIFIED UNDER BOTH ARTICLE THIRTY-TWO OF THE MENTAL HYGIENE
LAW AND ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, FOR THE PURPOSE
OF INCREASING INVESTMENT IN COMMUNITY BASED BEHAVIORAL HEALTH SERVICES,
INCLUDING RESIDENTIAL SERVICES CERTIFIED BY THE OFFICE OF ALCOHOLISM AND
SUBSTANCE ABUSE SERVICES. THE METHODOLOGIES USED TO CALCULATE THE
SAVINGS SHALL BE DEVELOPED BY THE COMMISSIONER OF HEALTH AND THE DIREC-
TOR OF THE BUDGET IN CONSULTATION WITH THE COMMISSIONERS OF THE OFFICE
OF MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES. IN NO EVENT SHALL THE FULL ANNUAL VALUE OF THE COMMUNITY BASED
BEHAVIORAL HEALTH SERVICE REINVESTMENT SAVINGS ATTRIBUTABLE TO THE TRAN-
SITION TO MANAGED CARE EXCEED THE TWELVE MONTH VALUE OF THE DEPARTMENT
OF HEALTH GENERAL FUND REDUCTIONS RESULTING FROM SUCH TRANSITION. WITHIN
ANY FISCAL YEAR WHERE APPROPRIATION INCREASES ARE RECOMMENDED FOR REIN-
VESTMENT, INSOFAR AS MANAGED CARE TRANSITION SAVINGS DO NOT OCCUR AS
ESTIMATED, AND GENERAL FUND SAVINGS DO NOT RESULT, THEN SPENDING FOR
SUCH REINVESTMENT MAY BE REDUCED IN THE NEXT YEAR'S ANNUAL BUDGET ITEMI-
ZATION. THE COMMISSIONER OF HEALTH SHALL PROMULGATE REGULATIONS, AND
PRIOR TO OCTOBER FIRST, TWO THOUSAND FIFTEEN, MAY PROMULGATE EMERGENCY
REGULATIONS AS REQUIRED TO DISTRIBUTE FUNDS PURSUANT TO THIS SUBDIVI-
SION; PROVIDED, HOWEVER, THAT ANY EMERGENCY REGULATIONS PROMULGATED
PURSUANT TO THIS SECTION SHALL EXPIRE NO LATER THAN DECEMBER
THIRTY-FIRST, TWO THOUSAND FIFTEEN. THE COMMISSIONER SHALL INCLUDE
DETAILED DESCRIPTIONS OF THE METHODOLOGY USED TO CALCULATE SAVINGS FOR
REINVESTMENT, THE RESULTS OF APPLYING SUCH METHODOLOGIES, THE DETAILS
REGARDING IMPLEMENTATION OF SUCH REINVESTMENT PURSUANT TO THIS SECTION,
AND ANY REGULATIONS PROMULGATED UNDER THIS SUBDIVISION, IN THE ANNUAL
S. 6914 116 A. 9205
REPORT REQUIRED UNDER SECTION FORTY-FIVE-C OF PART A OF CHAPTER
FIFTY-SIX OF THE LAWS OF TWO THOUSAND THIRTEEN.
S 12. Notwithstanding any law, rule, or regulation to the contrary,
the commissioner of health, in consultation with the commissioner of the
office of mental health and the commissioner of the office of alcoholism
and substance abuse services, is authorized to establish an evidence-
based, collaborative care clinical delivery model in clinics licensed
under article 28 of the public health law, for the purpose of improving
the detection of depression and other diagnosed mental or substance use
disorders and the treatment of individuals with such conditions in an
integrated manner. Such commissioner shall be authorized to develop
criteria for the designation of clinics to be providers of collaborative
care services. At a minimum, such designated clinics shall provide
screening for depression and substance use disorders, medical diagnosis
of patients who screen positive, evidence-based depression care and
substance use disorder referrals, ongoing tracking of patient progress,
care management, and a designated behavioral health practitioner who
consults with the care manager and primary care physician. The rates of
payment and billing rules for this service will be developed by the
commissioner of health, in consultation with the commissioner of the
office of mental health and the commissioner of the office of alcoholism
and substance abuse services, and with the approval of the director of
the budget. Such commissioners are authorized to waive any duplicative
regulatory requirements as may be necessary to allow this service to
function in an effective and efficient manner; provided, however, that
regulations pertaining to patient safety may not be waived, nor shall
any regulation be waived if such waiver would risk patient safety. Such
waiver shall not exceed the life of the project, or such shorter time
period as the authorizing commissioner may determine. The commissioner
of health shall include details regarding the implementation of the
collaborative care clinical delivery model, including any regulations
waived and the frequency and rationale for such waivers, in the annual
report under section 45-c of part A of chapter 56 of the laws of 2013.
S 12-a. Paragraph (c) of subdivision 2 of section 365-a of the social
services law, as amended by section 24 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
(c) out-patient hospital or clinic services in facilities operated in
compliance with applicable provisions of this chapter, the public health
law, the mental hygiene law and other laws, including any provisions
thereof requiring an operating certificate or license, including facili-
ties authorized by the appropriate licensing authority to provide inte-
grated mental health services, and/or alcoholism and substance abuse
services, and/or physical health services, and/or services to persons
with developmental disabilities, when such services are provided at a
single location or service site, or where such facilities are not
conveniently accessible, in any hospital located [without] WITHIN the
state and care and services in a day treatment program operated by the
department of mental hygiene or by a voluntary agency under an agreement
with such department in that part of a public institution operated and
approved pursuant to law as an intermediate care facility for persons
with developmental disabilities; AND PROVIDED, THAT THE COMMISSIONERS OF
HEALTH, MENTAL HEALTH, ALCOHOLISM AND SUBSTANCE ABUSE SERVICES AND THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES MAY ISSUE REGULATIONS,
INCLUDING EMERGENCY REGULATIONS PROMULGATED PRIOR TO OCTOBER FIRST, TWO
THOUSAND FIFTEEN THAT ARE REQUIRED TO FACILITATE THE ESTABLISHMENT OF
INTEGRATED SERVICES CLINICS. ANY SUCH REGULATIONS PROMULGATED UNDER THIS
S. 6914 117 A. 9205
PARAGRAPH SHALL BE DESCRIBED IN THE ANNUAL REPORT REQUIRED PURSUANT TO
SECTION FORTY-FIVE-C OF PART A OF CHAPTER FIFTY-SIX OF THE LAWS OF TWO
THOUSAND THIRTEEN;
S 13. Section 48-a of part A of chapter 56 of the laws of 2013 amend-
ing chapter 59 of the laws of 2011 amending the public health law and
other laws relating to general hospital reimbursement for annual rates
relating to the cap on local Medicaid expenditures, is amended to read
as follows:
S 48-a. Notwithstanding any contrary provision of law, the [commis-
sioner] COMMISSIONERS OF THE OFFICE of alcoholism and substance abuse
services [is] AND THE OFFICE OF MENTAL HEALTH ARE authorized, subject to
the approval of the director of the budget, to transfer to the commis-
sioner of health state funds to be utilized as the state share for the
purpose of increasing payments under the medicaid program to managed
care organizations licensed under article 44 of the public health law or
under article 43 of the insurance law. Such managed care organizations
shall utilize such funds for the purpose of reimbursing [hospital-based
and free-standing chemical dependence outpatient and opioid treatment
clinics] PROVIDERS licensed pursuant to article 28 of the public health
law or article 31 OR 32 of the mental hygiene law for [chemical depend-
ency] AMBULATORY BEHAVIORAL HEALTH services, as determined by the
commissioner of health, in consultation with the commissioner of alco-
holism and substance abuse services AND THE COMMISSIONER OF THE OFFICE
OF MENTAL HEALTH, provided to medicaid eligible outpatients. Such
reimbursement shall be in the form of fees for such services which are
equivalent to the payments established for such services under the ambu-
latory patient group (APG) rate-setting methodology as utilized by the
department of health [or by], the office of alcoholism and substance
abuse services, OR THE OFFICE OF MENTAL HEALTH for rate-setting
purposes; provided, however, that the increase to such fees that shall
result from the provisions of this section shall not, in the aggregate
and as determined by the commissioner of health, in consultation with
the commissioner of alcoholism and substance abuse services AND THE
COMMISSIONER OF THE OFFICE OF MENTAL HEALTH, be greater than the
increased funds made available pursuant to this section. THE INCREASE
OF SUCH AMBULATORY BEHAVIORAL HEALTH FEES TO PROVIDERS AVAILABLE UNDER
THIS SECTION SHALL BE FOR ALL RATE PERIODS ON AND AFTER THE EFFECTIVE
DATE OF THE CHAPTER OF THE LAWS OF 2014 WHICH AMENDED THIS SECTION
THROUGH DECEMBER 31, 2016 FOR PATIENTS IN THE CITY OF NEW YORK, FOR ALL
RATE PERIODS ON AND AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS
OF 2014 WHICH AMENDED THIS SECTION THROUGH JUNE 30, 2017 FOR PATIENTS
OUTSIDE THE CITY OF NEW YORK, AND FOR ALL RATE PERIODS ON AND AFTER THE
EFFECTIVE DATE OF SUCH CHAPTER OF THE LAWS OF 2014 WHICH AMENDED THIS
SECTION THROUGH DECEMBER 31, 2017 FOR ALL SERVICES PROVIDED TO PERSONS
UNDER THE AGE OF TWENTY-ONE; PROVIDED, HOWEVER, THAT MANAGED CARE ORGAN-
IZATIONS AND PROVIDERS MAY NEGOTIATE DIFFERENT RATES AND METHODS OF
PAYMENT DURING SUCH PERIODS DESCRIBED ABOVE, SUBJECT TO THE APPROVAL OF
THE DEPARTMENT OF HEALTH. THE DEPARTMENT OF HEALTH SHALL CONSULT WITH
THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES AND THE OFFICE OF
MENTAL HEALTH IN DETERMINING WHETHER SUCH ALTERNATIVE RATES SHALL BE
APPROVED. The commissioner of health may, in consultation with the
commissioner of alcoholism and substance abuse services AND THE COMMIS-
SIONER OF THE OFFICE OF MENTAL HEALTH, promulgate regulations, including
emergency regulations PROMULGATED PRIOR TO OCTOBER 1, 2015 TO ESTABLISH
RATES FOR AMBULATORY BEHAVIORAL HEALTH SERVICES, as are necessary to
implement the provisions of this section. RATES PROMULGATED UNDER THIS
S. 6914 118 A. 9205
SECTION SHALL BE INCLUDED IN THE REPORT REQUIRED UNDER SECTION 45-C OF
PART A OF THIS CHAPTER.
S 14. Subdivision 8 of section 84 of part A of chapter 56 of the laws
of 2013, amending chapter 59 of the laws of 2011 amending the public
health law and other laws relating to general hospital reimbursement for
annual rates relating to the cap on local Medicaid expenditures, is
amended to read as follows:
8. section forty-eight-a of this act shall expire and be deemed
repealed [March 31, 2016] JANUARY 1, 2018;
S 15. Section 1 of part H of chapter 111 of the laws of 2010 relating
to increasing Medicaid payments to providers through managed care organ-
izations and providing equivalent fees through an ambulatory patient
group methodology, is amended to read as follows:
Section 1. Notwithstanding any contrary provision of law, the
[commissioner] COMMISSIONERS of mental health [is] AND ALCOHOLISM AND
SUBSTANCE ABUSE SERVICES ARE authorized, subject to the approval of the
director of the budget, to transfer to the commissioner of health state
funds to be utilized as the state share for the purpose of increasing
payments under the medicaid program to managed care organizations
licensed under article 44 of the public health law or under article 43
of the insurance law. Such managed care organizations shall utilize such
funds for the purpose of reimbursing [hospital-based and free-standing
clinics] PROVIDERS licensed pursuant to article 28 of the public health
law, OR pursuant to article 31 OR ARTICLE 32 of the mental hygiene law
[or pursuant to both such provisions of law for outpatient mental health
services] FOR AMBULATORY BEHAVIORAL HEALTH SERVICES, as determined by
the commissioner of health in consultation with the commissioner of
mental health AND COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES, provided to medicaid eligible outpatients. Such reimbursement
shall be in the form of fees for such services which are equivalent to
the payments established for such services under the ambulatory patient
group (APG) rate-setting methodology as utilized by the department of
health or by the office of mental health OR OFFICE OF ALCOHOLISM AND
SUBSTANCE ABUSE SERVICES for rate-setting purposes; provided, however,
that the increase to such fees that shall result from the provisions of
this section shall not, in the aggregate and as determined by the
commissioner of health in consultation with the [commissioner] COMMIS-
SIONERS of mental health AND ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, be
greater than the increased funds made available pursuant to this
section. THE INCREASE OF SUCH BEHAVIORAL HEALTH FEES TO PROVIDERS AVAIL-
ABLE UNDER THIS SECTION SHALL BE FOR ALL RATE PERIODS ON AND AFTER THE
EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF 2014 WHICH AMENDED THIS
SECTION THROUGH DECEMBER 31, 2016 FOR PATIENTS IN THE CITY OF NEW YORK,
FOR ALL RATE PERIODS ON AND AFTER THE EFFECTIVE DATE OF THE CHAPTER OF
THE LAWS OF 2014 WHICH AMENDED THIS SECTION THROUGH JUNE 30, 2017 FOR
PATIENTS OUTSIDE THE CITY OF NEW YORK, AND FOR ALL RATE PERIODS ON AND
AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF 2014 WHICH
AMENDED THIS SECTION THROUGH DECEMBER 31, 2017 FOR ALL SERVICES PROVIDED
TO PERSONS UNDER THE AGE OF TWENTY-ONE; PROVIDED, HOWEVER, THAT MANAGED
CARE ORGANIZATIONS AND PROVIDERS MAY NEGOTIATE DIFFERENT RATES AND METH-
ODS OF PAYMENT DURING SUCH PERIODS DESCRIBED, SUBJECT TO THE APPROVAL OF
THE DEPARTMENT OF HEALTH. THE DEPARTMENT OF HEALTH SHALL CONSULT WITH
THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES AND THE OFFICE OF
MENTAL HEALTH IN DETERMINING WHETHER SUCH ALTERNATIVE RATES SHALL BE
APPROVED. The commissioner of health may, in consultation with the
[commissioner] COMMISSIONERS of mental health AND ALCOHOLISM AND
S. 6914 119 A. 9205
SUBSTANCE ABUSE SERVICES, promulgate regulations, including emergency
regulations PROMULGATED PRIOR TO OCTOBER 1, 2013 THAT ESTABLISH RATES
FOR BEHAVIORAL HEALTH SERVICES, as are necessary to implement the
provisions of this section. RATES PROMULGATED UNDER THIS SECTION SHALL
BE INCLUDED IN THE REPORT REQUIRED UNDER SECTION 45-C OF PART A OF CHAP-
TER 56 OF THE LAWS OF 2013.
S 16. Section 2 of part H of chapter 111 of the laws of 2010, relating
to increasing Medicaid payments to providers through managed care organ-
izations and providing equivalent fees through an ambulatory patient
group methodology, as amended by section 49 of part A of chapter 56 of
the laws of 2013, is amended to read as follows:
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, 2010, and shall
expire on [March 31, 2016] JANUARY 1, 2018.
S 16-a. Section 45-c of part A of chapter 56 of the laws of 2013,
relating to the report on the transition of behavioral health services
as a managed care benefit in the medical assistance program, is amended
to read as follows:
S 45-c. The commissioner of health in consultation with the commis-
sioners of the office of mental health and the office of alcoholism and
substance abuse SERVICES shall prepare a report on the transition of
behavioral health services as a managed care benefit in the medical
assistance program. Such report shall examine (i) the adequacy of
rates; (ii) the ability of managed care plans to arrange and manage
covered services for eligible enrollees; (iii) the ability of managed
care plans to provide an adequate network of providers to meet the needs
of enrollees; (iv) the use of evidence based tools or guidelines by
managed care plans when determining the appropriate level of care or
coverage for enrollees; (v) the ability of managed care plans to provide
eligible enrollees with both the appropriate amount and type of
services; (vi) the quality assurance mechanisms used by managed care
plans, including processes to ensure enrollee satisfaction; (vii) the
manner in which managed care plans address the cultural and linguistic
needs of enrollees; [and] (viii) any other quality of care criteria
deemed appropriate by the commissioners to ensure the adequacy of rates,
continuity of care and the quality of life, health, and safety of enrol-
lees during the transition of the behavioral health benefit; (IX)
DETAILS REGARDING THE IMPLEMENTATION OF REINVESTMENT ALLOCATION PLANS
PURSUANT TO REDUCTIONS OF INPATIENT BEHAVIORAL HEALTH SERVICES INCLUD-
ING, BUT NOT LIMITED, TO THE LOCATION AND SCOPE OF SERVICE REDUCTIONS
RESULTING FROM THE REDUCTION OR CLOSURE OF PROGRAMS LICENSED PURSUANT TO
ARTICLE 31 OR 32 OF THE MENTAL HYGIENE LAW AND A DESCRIPTION OF SERVICES
TO BE FUNDED PURSUANT TO ALLOCATION PLANS; (X) DETAILED DESCRIPTIONS OF
THE METHODOLOGY USED TO CALCULATE THE AMOUNT OF SAVINGS RESULTING FROM
THE TRANSITION OF INDIVIDUALS INTO MANAGED CARE REALIZED UNDER SUBDIVI-
SION 5 OF SECTION 365-M OF THE SOCIAL SERVICES LAW, AND THE MANNER IN
WHICH THE REINVESTMENT WILL ADDRESS THE SERVICE NEEDS; (XI) DETAILS
REGARDING THE IMPLEMENTATION OF THE COLLABORATIVE CARE CLINICAL DELIVERY
MODEL; (XII) A DESCRIPTION OF, AND RATIONALE FOR, ANY WAIVER OF EXISTING
REGULATIONS OR ANY PROMULGATION OF EMERGENCY REGULATIONS PURSUANT TO THE
BEHAVIORAL HEALTH SERVICES TRANSITION AUTHORIZED BY SECTIONS 10 THROUGH
17 OF PART C OF A CHAPTER OF THE LAWS OF 2014 WHICH AMENDED THIS
SECTION, RELATING TO THE IMPLEMENTATION OF THE HEALTH AND MENTAL HYGIENE
BUDGET; (XIII) IMPLEMENTATION OF INFRASTRUCTURE AND ORGANIZATIONAL
MODIFICATIONS AND INVESTMENTS IN HEALTH INFORMATION TECHNOLOGY AND
TRAINING AND TECHNICAL ASSISTANCE; AND (XIV) DETAILS REGARDING THE
S. 6914 120 A. 9205
IMPLEMENTATION OF THE PLAN TO TRANSITION ADULT AND CHILDREN'S BEHAVIORAL
HEALTH PROVIDERS AND SERVICES INTO MANAGED CARE. [The report shall be
submitted no later than April first, two thousand sixteen to the gover-
nor, the temporary president of the senate, the speaker of the assembly,
the minority leader of the senate, and the minority leader of the assem-
bly.] THE REPORT SHALL BE SUBMITTED ON AN ANNUAL BASIS TO THE GOVERNOR,
THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE
MINORITY LEADER OF THE SENATE, THE MINORITY LEADER OF THE ASSEMBLY, AND
THE BEHAVIORAL HEALTH SUBCOMMITTEE OF THE MEDICAID REDESIGN TEAM, NO
LATER THAN JANUARY FIRST OF EACH YEAR.
S 16-b. Section 84 of part A of chapter 56 of the laws of 2013, amend-
ing the public health law and other laws relating to state health mental
hygiene budget for the 2013-14 state fiscal year, is amended by adding a
new subdivision 7-a to read as follows:
7-A. SECTION FORTY-FIVE-C OF THIS ACT SHALL EXPIRE AND BE DEEMED
REPEALED JANUARY 1, 2018;
S 17. Subject to the availability of federal financial participation,
the commissioner of health is authorized, within amounts appropriated,
to distribute funds to local governmental units, as defined in section
41.03 of the mental hygiene law, to Medicaid managed care plans certi-
fied by the department of health, health homes designated by such
department, and individual behavioral health providers and consortiums
of such providers licensed or certified by the office of mental health
or the office of alcoholism and substance abuse services to prepare for
the transition of adult and children's behavioral health providers and
services into managed care. The use of such funds may include, but not
be limited to, infrastructure and organizational modifications and
investments in health information technology and training and technical
assistance. Such funds shall be distributed pursuant to a plan to be
developed by the commissioner of health, in consultation with the
commissioners of the office of mental health and the office of alcohol-
ism and substance abuse services. In developing such plan, such commis-
sioners may take into account the size and scope of a grantee's oper-
ations as a factor relevant to eligibility for, and the amount of, such
funds. The commissioner of health is authorized to audit recipients of
funds under this section to ensure compliance and to recoup any funds
determined to have been used for purposes other than as described herein
or otherwise approved by such commissioners. The commissioners shall
include details regarding the implementation of the plan to transition
adult and children's behavioral health providers and services into
managed care in the annual report required under section 45-c of part A
of chapter 56 of the laws of 2013.
S 18. The commissioner of health is authorized to establish a disabil-
ity clinician advisory group of experienced clinicians and clinic admin-
istrators who have an understanding of the comprehensive needs of people
with disabilities. Such group shall provide the commissioner and the
department of health with information and data on the effect of poli-
cies, including proposed regulations or statutes, and of fiscal
proposals, including rate setting and appropriations, on the delivery of
supports and services for individuals with disabilities including but
not limited to the role of specialty services.
S 19. Paragraph (i) of subdivision 38 of section 2 of the social
services law, as added by section 63 of part H of chapter 59 of the laws
of 2011, is amended to read as follows:
(i) "Participating provider" means a certified home health agency,
long term home health agency or personal care provider with total medi-
S. 6914 121 A. 9205
caid reimbursements, INCLUDING REIMBURSEMENTS THROUGH THE MANAGED CARE
PROGRAM ESTABLISHED PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF
THIS CHAPTER, exceeding fifteen million dollars per calendar year.
S 20. The opening paragraph of section 363-e of the social services
law, as added by section 64 of part H of chapter 59 of the laws of 2011,
is amended to read as follows:
THE DEPARTMENT OF HEALTH AND THE OFFICE OF THE MEDICAID INSPECTOR
GENERAL SHALL JOINTLY DEVELOP REQUIREMENTS FOR PRECLAIM REVIEW. Every
service or item within a claim OR ENCOUNTER submitted by a participating
provider shall be reviewed and verified by a verification organization
prior to submission of a claim OR ENCOUNTER to the department of health
OR TO A MANAGED CARE PROVIDER AS DEFINED IN PARAGRAPH (B) OF SUBDIVISION
ONE OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE. The verifica-
tion organization shall declare each service or item to be verified or
unverified. Each participating provider shall receive and maintain
reports from the verification organization which shall contain data on:
S 21. The opening paragraph of subdivision 1 of section 20-c of the
social services law, as added by section 151 of part B of chapter 436 of
the laws of 1997, is amended to read as follows:
(A) Except as otherwise specified in the appropriation for system
support and information services program in the office of temporary
disability assistance within the department of family assistance, OR AS
AUTHORIZED BY SUBDIVISION TWO-A OF SECTION TWENTY-TWO OF THIS ARTICLE,
the department shall not enter into any contract with a private entity
under which that entity would perform any of the public assistance and
care eligibility determination functions, duties or obligations of the
department as set forth in this chapter.
S 22. Section 22 of the social services law is amended by adding a new
subdivision 2-a to read as follows:
2-A. WITH REGARD TO FAIR HEARINGS HELD IN CONNECTION WITH APPEALS
UNDER THE FULLY INTEGRATED DUALS ADVANTAGE DEMONSTRATION PROGRAM, THE
COMMISSIONER MAY CONTRACT FOR THE SOLE PURPOSE OF ASSISTING STAFF OF THE
OFFICE FOR SUCH PURPOSE.
S 23. Subdivision 2-c of section 2808 of the public health law is
amended by adding a new paragraph (e) to read as follows:
(E) WITH THE EXCEPTION OF THOSE ENROLLEES COVERED UNDER A PAYMENT RATE
METHODOLOGY AGREEMENT NEGOTIATED WITH A RESIDENTIAL HEALTH CARE FACILI-
TY, PAYMENTS FOR INPATIENT RESIDENTIAL HEALTH CARE FACILITY SERVICES
PROVIDED TO PATIENTS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO TITLE
ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW MADE BY ORGANIZATIONS
OPERATING IN ACCORDANCE WITH THE PROVISIONS OF ARTICLE FORTY-FOUR OF
THIS CHAPTER OR BY HEALTH MAINTENANCE ORGANIZATIONS ORGANIZED AND OPER-
ATING IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE INSURANCE LAW, SHALL
BE THE RATES OF PAYMENT THAT WOULD BE PAID FOR SUCH PATIENTS UNDER THE
MEDICAL ASSISTANCE PROGRAM AS DETERMINED PURSUANT TO THIS SECTION AND
SUBDIVISION TEN OF SECTION TWENTY-EIGHT HUNDRED SEVEN-D OF THIS ARTICLE
AND AS IN EFFECT AT THE TIME SUCH SERVICES WERE PROVIDED. THE PROVISIONS
OF THIS PARAGRAPH SHALL NOT APPLY TO PAYMENTS FOR PATIENTS WHOSE PLACE-
MENT IN A RESIDENTIAL HEALTH CARE FACILITY IS FOR THE PURPOSE OF RECEIV-
ING TIME-LIMITED REHABILITATION, TO BE FOLLOWED BY DISCHARGE FROM THE
FACILITY, DURING THE PERIOD SUCH TIME-LIMITED SERVICES ARE PROVIDED.
S 24. Section 365-f of the social services law is amended by adding a
new subdivision 9 to read as follows:
9. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR PERIODS ON AND
AFTER APRIL FIRST, TWO THOUSAND FOURTEEN, THE COMMISSIONER IS AUTHORIZED
S. 6914 122 A. 9205
TO MAKE TEMPORARY PERIODIC LUMP-SUM MEDICAID PAYMENTS TO FISCAL INTERME-
DIARIES PRINCIPALLY ENGAGED IN PROVIDING CONSUMER DIRECTED PERSONAL
ASSISTANCE SERVICES TO MEDICAID PATIENTS, IN ACCORDANCE WITH THE FOLLOW-
ING:
(A) ELIGIBLE FISCAL INTERMEDIARIES SHALL INCLUDE:
(I) PROVIDERS UNDERGOING CLOSURE OR SUBSTANTIAL REDUCTION IN THE
VOLUME OF CARE;
(II) PROVIDERS IMPACTED BY THE CLOSURE OF OTHER HEALTH CARE PROVIDERS;
(III) PROVIDERS SUBJECT TO MERGERS, ACQUISITIONS, CONSOLIDATIONS OR
RESTRUCTURING;
(IV) PROVIDERS IMPACTED BY THE MERGER, ACQUISITION, CONSOLIDATION OR
RESTRUCTURING OF OTHER HEALTH CARE PROVIDERS;
(V) PROVIDERS SEEKING TO ENSURE THAT ACCESS TO CARE IS MAINTAINED OR
INCREASED; OR
(VI) ON OR AFTER JANUARY FIRST, TWO THOUSAND FIFTEEN, PROVIDERS
IMPACTED BY CHANGES TO THE FAIR LABOR STANDARDS ACT REQUIRING OVERTIME
PAY FOR PERSONAL ASSISTANTS WORKING IN EXCESS OF FORTY HOURS PER WEEK.
(B) PROVIDERS SEEKING MEDICAID PAYMENTS UNDER THIS SUBDIVISION SHALL
DEMONSTRATE THROUGH SUBMISSION OF A WRITTEN PROPOSAL TO THE COMMISSIONER
THAT THE ADDITIONAL RESOURCES PROVIDED BY SUCH MEDICAID PAYMENTS WILL
ACHIEVE ONE OR MORE OF THE FOLLOWING:
(I) PROTECT OR ENHANCE ACCESS TO CARE;
(II) PROTECT OR ENHANCE QUALITY OF CARE;
(III) IMPROVE THE COST EFFECTIVENESS OF THE DELIVERY OF HEALTH CARE
SERVICES; OR
(IV) OTHERWISE PROTECT OR ENHANCE THE HEALTH CARE DELIVERY SYSTEM, AS
DETERMINED BY THE COMMISSIONER.
(C)(I) SUCH WRITTEN PROPOSAL SHALL BE SUBMITTED TO THE COMMISSIONER AT
LEAST SIXTY DAYS PRIOR TO THE REQUESTED COMMENCEMENT OF SUCH MEDICAID
PAYMENTS AND SHALL INCLUDE A PROPOSED BUDGET TO ACHIEVE THE GOALS OF THE
PROPOSAL. ANY MEDICAID PAYMENTS ISSUED PURSUANT TO THIS SUBDIVISION
SHALL BE MADE OVER A SPECIFIED PERIOD OF TIME, AS DETERMINED BY THE
COMMISSIONER, OF UP TO THREE YEARS. AT THE END OF THE SPECIFIED
TIME-FRAME SUCH PAYMENTS SHALL CEASE. THE COMMISSIONER MAY ESTABLISH, AS
A CONDITION OF RECEIVING SUCH MEDICAID PAYMENTS, BENCHMARKS AND GOALS TO
BE ACHIEVED IN CONFORMITY WITH THE PROVIDER'S WRITTEN PROPOSAL AS
APPROVED BY THE COMMISSIONER AND MAY ALSO REQUIRE THAT THE PROVIDER
SUBMIT SUCH PERIODIC REPORTS CONCERNING THE ACHIEVEMENT OF SUCH BENCH-
MARKS AND GOALS AS THE COMMISSIONER DEEMS NECESSARY. FAILURE TO ACHIEVE
SATISFACTORY PROGRESS, AS DETERMINED BY THE COMMISSIONER, IN ACCOMPLISH-
ING SUCH BENCHMARKS AND GOALS SHALL BE A BASIS FOR ENDING THE PROVIDER'S
MEDICAID PAYMENTS PRIOR TO THE END OF THE SPECIFIED TIMEFRAME.
(II) THE COMMISSIONER MAY REQUIRE THAT APPLICATIONS SUBMITTED PURSUANT
TO THIS SUBDIVISION BE SUBMITTED IN RESPONSE TO AND IN ACCORDANCE WITH A
REQUEST FOR APPLICATIONS OR A REQUEST FOR PROPOSALS ISSUED BY THE
COMMISSIONER.
S 25. Section 3605 of the public health law is amended by adding a new
subdivision 14 to read as follows:
14. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR PERIODS ON AND
AFTER APRIL FIRST, TWO THOUSAND FOURTEEN, THE COMMISSIONER IS AUTHORIZED
TO MAKE TEMPORARY PERIODIC LUMP-SUM MEDICAID PAYMENTS TO LICENSED HOME
CARE SERVICE AGENCIES ("LHCSA") PRINCIPALLY ENGAGED IN PROVIDING HOME
HEALTH SERVICES TO MEDICAID PATIENTS, IN ACCORDANCE WITH THE FOLLOWING:
(A) ELIGIBLE LHCSA PROVIDERS SHALL INCLUDE:
(I) PROVIDERS UNDERGOING CLOSURE;
S. 6914 123 A. 9205
(II) PROVIDERS IMPACTED BY THE CLOSURE OF OTHER HEALTH CARE PROVIDERS;
(III) PROVIDERS SUBJECT TO MERGERS, ACQUISITIONS, CONSOLIDATIONS OR
RESTRUCTURING;
(IV) PROVIDERS IMPACTED BY THE MERGER, ACQUISITION, CONSOLIDATION OR
RESTRUCTURING OF OTHER HEALTH CARE PROVIDERS; OR
(V) PROVIDERS SEEKING TO ENSURE THAT ACCESS TO CARE IS MAINTAINED.
(B) PROVIDERS SEEKING MEDICAID PAYMENTS UNDER THIS SUBDIVISION SHALL
DEMONSTRATE THROUGH SUBMISSION OF A WRITTEN PROPOSAL TO THE COMMISSIONER
THAT THE ADDITIONAL RESOURCES PROVIDED BY SUCH MEDICAID PAYMENTS WILL
ACHIEVE ONE OR MORE OF THE FOLLOWING:
(I) PROTECT OR ENHANCE ACCESS TO CARE;
(II) PROTECT OR ENHANCE QUALITY OF CARE;
(III) IMPROVE THE COST EFFECTIVENESS OF THE DELIVERY OF HEALTH CARE
SERVICES; OR
(IV) OTHERWISE PROTECT OR ENHANCE THE HEALTH CARE DELIVERY SYSTEM, AS
DETERMINED BY THE COMMISSIONER.
(C) (I) SUCH WRITTEN PROPOSAL SHALL BE SUBMITTED TO THE COMMISSIONER
AT LEAST SIXTY DAYS PRIOR TO THE REQUESTED COMMENCEMENT OF SUCH MEDICAID
PAYMENTS AND SHALL INCLUDE A PROPOSED BUDGET TO ACHIEVE THE GOALS OF THE
PROPOSAL. ANY MEDICAID PAYMENTS ISSUED PURSUANT TO THIS SUBDIVISION
SHALL BE MADE OVER A SPECIFIED PERIOD OF TIME, AS DETERMINED BY THE
COMMISSIONER, OF UP TO THREE YEARS. AT THE END OF THE SPECIFIED TIME-
FRAME SUCH PAYMENTS SHALL CEASE. THE COMMISSIONER MAY ESTABLISH, AS A
CONDITION OF RECEIVING SUCH MEDICAID PAYMENTS, BENCHMARKS AND GOALS TO
BE ACHIEVED IN CONFORMITY WITH THE PROVIDER'S WRITTEN PROPOSAL AS
APPROVED BY THE COMMISSIONER AND MAY ALSO REQUIRE THAT THE PROVIDER
SUBMIT SUCH PERIODIC REPORTS CONCERNING THE ACHIEVEMENT OF SUCH BENCH-
MARKS AND GOALS AS THE COMMISSIONER DEEMS NECESSARY. FAILURE TO ACHIEVE
SATISFACTORY PROGRESS, AS DETERMINED BY THE COMMISSIONER, IN ACCOMPLISH-
ING SUCH BENCHMARKS AND GOALS SHALL BE A BASIS FOR ENDING THE PROVIDER'S
MEDICAID PAYMENTS PRIOR TO THE END OF THE SPECIFIED TIMEFRAME.
(II) THE COMMISSIONER MAY REQUIRE THAT APPLICATIONS SUBMITTED PURSUANT
TO THIS SUBDIVISION BE SUBMITTED IN RESPONSE TO AND IN ACCORDANCE WITH A
REQUEST FOR APPLICATIONS OR A REQUEST FOR PROPOSALS ISSUED BY THE
COMMISSIONER.
S 26. Section 3614 of the public health law is amended by adding a new
subdivision 14 to read as follows:
14. (A) NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW AND SUBJECT TO
THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR PERIODS ON AND
AFTER MARCH FIRST, TWO THOUSAND FOURTEEN THE COMMISSIONER SHALL ADJUST
MEDICAID RATES OF PAYMENT FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH
AGENCIES TO ADDRESS COST INCREASES STEMMING FROM THE WAGE INCREASES
REQUIRED BY IMPLEMENTATION OF THE PROVISIONS OF SECTION THIRTY-SIX
HUNDRED FOURTEEN-C OF THIS ARTICLE. SUCH RATE ADJUSTMENTS SHALL BE BASED
ON A COMPARISON, AS DETERMINED BY THE COMMISSIONER, OF THE HOURLY
COMPENSATION LEVELS FOR HOME HEALTH AIDES AND PERSONAL CARE AIDES AS
REFLECTED IN THE EXISTING MEDICAID RATES FOR CERTIFIED HOME HEALTH AGEN-
CIES TO THE HOURLY COMPENSATION LEVELS INCURRED AS A RESULT OF COMPLYING
WITH THE PROVISIONS OF SECTION THIRTY-SIX HUNDRED FOURTEEN-C OF THIS
ARTICLE.
(B) NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR PERIODS ON AND
AFTER MARCH FIRST, TWO THOUSAND FOURTEEN THE COMMISSIONER SHALL ADJUST
MEDICAID RATES OF PAYMENT FOR SERVICES PROVIDED BY LONG TERM HOME HEALTH
CARE PROGRAMS TO ADDRESS COST INCREASES STEMMING FROM THE WAGE INCREASES
REQUIRED BY IMPLEMENTATION OF THE PROVISIONS OF SECTION THIRTY-SIX
S. 6914 124 A. 9205
HUNDRED FOURTEEN-C OF THIS ARTICLE. SUCH RATE ADJUSTMENTS SHALL BE BASED
ON A COMPARISON, AS DETERMINED BY THE COMMISSIONER, OF THE HOURLY
COMPENSATION LEVELS FOR HOME HEALTH AIDES AND PERSONAL CARE AIDES AS
REFLECTED IN THE EXISTING MEDICAID RATES FOR LONG TERM HOME HEALTH CARE
PROGRAMS TO THE HOURLY COMPENSATION LEVELS INCURRED AS A RESULT OF
COMPLYING WITH THE PROVISIONS OF SECTION THIRTY-SIX HUNDRED FOURTEEN-C
OF THIS ARTICLE.
S 26-a. Paragraph (d) of subdivision 2-c of section 2808 of the public
health law, as added by section 95 of part H of chapter 59 of the laws
of 2011, is amended to read as follows:
(d) The commissioner shall promulgate regulations, and may promulgate
emergency regulations, to implement the provisions of this subdivision.
Such regulations shall be developed in consultation with the nursing
home industry and advocates for residential health care facility resi-
dents and, further, the commissioner shall provide notification concern-
ing such regulations to the chairs of the senate and assembly health
committees, the chair of the senate finance committee and the chair of
the assembly ways and means committee. Such regulations shall include
provisions for rate adjustments or payment enhancements to facilitate a
minimum four-year transition of facilities to the rate-setting methodol-
ogy established by this subdivision and may also include, but not be
limited to, provisions for facilitating quality improvements in residen-
tial health care facilities. FOR PURPOSES OF FACILITATING QUALITY
IMPROVEMENTS THROUGH THE ESTABLISHMENT OF A NURSING HOME QUALITY POOL,
THOSE FACILITIES THAT CONTRIBUTE TO THE QUALITY POOL, BUT ARE DEEMED
INELIGIBLE FOR QUALITY POOL PAYMENTS DUE EXCLUSIVELY TO A SPECIFIC CASE
OF EMPLOYEE MISCONDUCT, SHALL NEVERTHELESS BE ELIGIBLE FOR A QUALITY
POOL PAYMENT IF THE FACILITY PROPERLY REPORTED THE INCIDENT, DID NOT
RECEIVE A SURVEY CITATION FROM THE COMMISSIONER OR THE CENTERS FOR MEDI-
CARE AND MEDICAID SERVICES ESTABLISHING THE FACILITY'S CULPABILITY WITH
REGARD TO SUCH MISCONDUCT AND, BUT FOR THE SPECIFIC CASE OF EMPLOYEE
MISCONDUCT, THE FACILITY WOULD HAVE OTHERWISE RECEIVED A QUALITY POOL
PAYMENT. REGULATIONS PERTAINING TO THE FACILITATION OF QUALITY IMPROVE-
MENT MAY BE MADE EFFECTIVE FOR PERIODS ON AND AFTER JANUARY FIRST, TWO
THOUSAND THIRTEEN.
S 27. The public health law is amended by adding a new section 2826 to
read as follows:
S 2826. TEMPORARY ADJUSTMENT TO REIMBURSEMENT RATES. (A) NOTWITH-
STANDING ANY PROVISION OF LAW TO THE CONTRARY, WITHIN FUNDS APPROPRIATED
AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, THE
COMMISSIONER MAY GRANT APPROVAL OF A TEMPORARY ADJUSTMENT TO THE NON-CA-
PITAL COMPONENTS OF RATES, OR MAKE TEMPORARY LUMP-SUM MEDICAID PAYMENTS,
TO ELIGIBLE GENERAL HOSPITALS, SKILLED NURSING FACILITIES, CLINICS AND
HOME CARE PROVIDERS, PROVIDED HOWEVER, THAT SHOULD FEDERAL FINANCIAL
PARTICIPATION NOT BE AVAILABLE FOR ANY ELIGIBLE PROVIDER, THEN PAYMENTS
PURSUANT TO THIS SUBDIVISION MAY BE MADE AS GRANTS AND SHALL NOT BE
DEEMED TO BE MEDICAL ASSISTANCE PAYMENTS.
(B) ELIGIBLE PROVIDERS SHALL INCLUDE:
(I) PROVIDERS UNDERGOING CLOSURE;
(II) PROVIDERS IMPACTED BY THE CLOSURE OF OTHER HEALTH CARE PROVIDERS;
(III) PROVIDERS SUBJECT TO MERGERS, ACQUISITIONS, CONSOLIDATIONS OR
RESTRUCTURING; OR
(IV) PROVIDERS IMPACTED BY THE MERGER, ACQUISITION, CONSOLIDATION OR
RESTRUCTURING OF OTHER HEALTH CARE PROVIDERS.
(C) PROVIDERS SEEKING TEMPORARY RATE ADJUSTMENTS UNDER THIS SECTION
SHALL DEMONSTRATE THROUGH SUBMISSION OF A WRITTEN PROPOSAL TO THE
S. 6914 125 A. 9205
COMMISSIONER THAT THE ADDITIONAL RESOURCES PROVIDED BY A TEMPORARY RATE
ADJUSTMENT WILL ACHIEVE ONE OR MORE OF THE FOLLOWING:
(I) PROTECT OR ENHANCE ACCESS TO CARE;
(II) PROTECT OR ENHANCE QUALITY OF CARE;
(III) IMPROVE THE COST EFFECTIVENESS OF THE DELIVERY OF HEALTH CARE
SERVICES; OR
(IV) OTHERWISE PROTECT OR ENHANCE THE HEALTH CARE DELIVERY SYSTEM, AS
DETERMINED BY THE COMMISSIONER.
(D) (I) SUCH WRITTEN PROPOSAL SHALL BE SUBMITTED TO THE COMMISSIONER
AT LEAST SIXTY DAYS PRIOR TO THE REQUESTED EFFECTIVE DATE OF THE TEMPO-
RARY RATE ADJUSTMENT, AND SHALL INCLUDE A PROPOSED BUDGET TO ACHIEVE THE
GOALS OF THE PROPOSAL. ANY MEDICAID PAYMENT ISSUED PURSUANT TO THIS
SECTION SHALL BE IN EFFECT FOR A SPECIFIED PERIOD OF TIME AS DETERMINED
BY THE COMMISSIONER, OF UP TO THREE YEARS. AT THE END OF THE SPECIFIED
TIMEFRAME SUCH PAYMENTS OR ADJUSTMENTS TO THE NON-CAPITAL COMPONENT OF
RATES SHALL CEASE, AND THE PROVIDER SHALL BE REIMBURSED IN ACCORDANCE
WITH THE OTHERWISE APPLICABLE RATE-SETTING METHODOLOGY AS SET FORTH IN
APPLICABLE STATUTES AND REGULATIONS. THE COMMISSIONER MAY ESTABLISH, AS
A CONDITION OF RECEIVING SUCH TEMPORARY RATE ADJUSTMENTS OR GRANTS,
BENCHMARKS AND GOALS TO BE ACHIEVED IN CONFORMITY WITH THE PROVIDER'S
WRITTEN PROPOSAL AS APPROVED BY THE COMMISSIONER AND MAY ALSO REQUIRE
THAT THE FACILITY SUBMIT SUCH PERIODIC REPORTS CONCERNING THE ACHIEVE-
MENT OF SUCH BENCHMARKS AND GOALS AS THE COMMISSIONER DEEMS NECESSARY.
FAILURE TO ACHIEVE SATISFACTORY PROGRESS, AS DETERMINED BY THE COMMIS-
SIONER, IN ACCOMPLISHING SUCH BENCHMARKS AND GOALS SHALL BE A BASIS FOR
ENDING THE FACILITY'S TEMPORARY RATE ADJUSTMENT OR GRANT PRIOR TO THE
END OF THE SPECIFIED TIMEFRAME. (II) THE COMMISSIONER MAY REQUIRE THAT
APPLICATIONS SUBMITTED PURSUANT TO THIS SECTION BE SUBMITTED IN RESPONSE
TO AND IN ACCORDANCE WITH A REQUEST FOR APPLICATIONS OR A REQUEST FOR
PROPOSALS ISSUED BY THE COMMISSIONER.
(E) NOTWITHSTANDING ANY LAW TO THE CONTRARY, GENERAL HOSPITALS DEFINED
AS CRITICAL ACCESS HOSPITALS PURSUANT TO TITLE XVIII OF THE FEDERAL
SOCIAL SECURITY ACT SHALL BE ALLOCATED NO LESS THAN FIVE MILLION DOLLARS
ANNUALLY PURSUANT TO THIS SECTION. THE DEPARTMENT OF HEALTH SHALL
PROVIDE A REPORT TO THE GOVERNOR AND LEGISLATURE NO LATER THAN DECEMBER
FIRST, TWO THOUSAND FOURTEEN PROVIDING RECOMMENDATIONS ON HOW TO ENSURE
THE FINANCIAL STABILITY OF, AND PRESERVE PATIENT ACCESS TO, CRITICAL
ACCESS HOSPITALS.
S 27-a. Subdivision 2 of section 365-a of the social services law is
amended by adding a new paragraph (bb) to read as follows:
(BB) SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION,
SERVICES AND SUPPORTS AUTHORIZED BY THE FEDERAL REGULATIONS GOVERNING
THE HOME AND COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS STATE PLAN
OPTION (COMMUNITY FIRST CHOICE) PURSUANT TO 42 U.S.C. S 1396N(K).
S 27-b. Section 365-f of the social services law is amended by adding
a new subdivision 8 to read as follows:
8. SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, THE
PROVISIONS OF THIS SECTION GOVERNING CONSUMER DIRECTED PERSONAL ASSIST-
ANCE SERVICES SHALL ALSO APPLY TO SUCH SERVICES WHEN OFFERED UNDER THE
HOME AND COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS STATE PLAN
OPTION (COMMUNITY FIRST CHOICE) PURSUANT TO 42 U.S.C. S 1396N(K).
S 27-c. Subparagraph (iii) of paragraph a of subdivision 1 of section
6908 of the education law, as amended by chapter 160 of the laws of
2003, is amended to read as follows:
(iii) the providing of care by a person acting in the place of a
person exempt under clause (i) of this paragraph, but who does hold
S. 6914 126 A. 9205
himself or herself out as one who accepts employment for performing such
care, where nursing services are under the instruction of a licensed
nurse, or under the instruction of a patient or family or household
member determined by a registered professional nurse to be self-direct-
ing and capable of providing such instruction, and [any remuneration is]
SERVICES ARE provided under section three hundred sixty-five-f of the
social services law; or
S 27-d. Intentionally omitted.
S 27-e. Intentionally omitted.
S 27-f. Intentionally omitted.
S 27-h. Section 57-c of part A of chapter 56 of the laws of 2013,
relating to establishing the home and community-based care work group,
is amended to read as follows:
S 57-c. Home and community based care workgroup. The commissioner of
health shall convene a home and community based care workgroup to exam-
ine and make recommendations on issues which include, but are not limit-
ed to:
a. State and federal regulatory requirements and related policy guide-
lines (including the applicability of the federal conditions of partic-
ipation);
b. Efficient home and community based care delivery, including tele-
health and hospice services; [and]
c. Alignment of functions between managed care entities and home and
community based providers[.]; AND
D. BEST PRACTICE FOR CLEAN CLAIMS AND RELATED DISPUTE RESOLUTION.
The workgroup shall be 11 members. The members of the workgroup shall
including providers, plans and representatives of consumers and direct
caregivers with relevant expertise.
The commissioner of health, or his or her designee shall chair the
workgroup and department of health and other executive agencies and
offices shall provide relevant data and other information as is neces-
sary for the group to perform its duties.
The commissioner of health shall convene this workgroup by May 15,
[2013] 2014 and the group shall issue [a report] PERIODIC REPORTS with
recommendations by March 1, 2014, SEPTEMBER 1, 2014 AND FEBRUARY 28,
2015.
S 28. Subdivision 35 of section 2807-c of the public health law is
amended by adding a new paragraph (j) to read as follows:
(J) NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW, WITH REGARD TO
INPATIENT AND OUTPATIENT MEDICAID RATES OF PAYMENT FOR GENERAL HOSPITAL
SERVICES, THE COMMISSIONER MAY MAKE SUCH ADJUSTMENTS TO SUCH RATES AND
TO THE METHODOLOGY FOR COMPUTING SUCH RATES AS IS NECESSARY TO ACHIEVE
NO AGGREGATE, NET INCREASE OR DECREASE IN OVERALL MEDICAID EXPENDITURES
RELATED TO THE IMPLEMENTATION OF THE INTERNATIONAL CLASSIFICATION OF
DISEASES VERSION 10 (ICD-10) CODING SYSTEM ON OR ABOUT OCTOBER FIRST,
TWO THOUSAND FOURTEEN, AS COMPARED TO SUCH AGGREGATE EXPENDITURES FROM
THE TWELVE-MONTH PERIOD IMMEDIATELY PRIOR TO SUCH IMPLEMENTATION.
S 29. Subparagraph (i) of paragraph (e-1) of subdivision 4 of section
2807-c of the public health law, as amended by section 41 of part B of
chapter 58 of the laws of 2010, is amended to read as follows:
(i) For rate periods on and after April first, two thousand ten, the
commissioner, in consultation with the commissioner of the office of
mental health, shall promulgate regulations, and may promulgate emergen-
cy regulations, establishing methodologies for determining the operating
cost components of rates of payments for services described in this
paragraph. Such regulations shall utilize two thousand five operating
S. 6914 127 A. 9205
costs as submitted to the department prior to July first, two thousand
nine and shall provide for methodologies establishing per diem inpatient
rates that utilize case mix adjustment mechanisms. Such regulations
shall contain criteria for adjustments based on length of stay AND MAY
ALSO PROVIDE FOR A BASE YEAR UPDATE, PROVIDED, HOWEVER, THAT SUCH BASE
YEAR UPDATE SHALL TAKE EFFECT NO EARLIER THAN APRIL FIRST, TWO THOUSAND
FIFTEEN, AND PROVIDED FURTHER, HOWEVER, THAT THE COMMISSIONER MAY MAKE
SUCH ADJUSTMENTS TO SUCH UTILIZATION AND TO THE METHODOLOGY FOR COMPUT-
ING SUCH RATES AS IS NECESSARY TO ACHIEVE NO AGGREGATE, NET GROWTH IN
OVERALL MEDICAID EXPENDITURES RELATED TO SUCH RATES, AS COMPARED TO SUCH
AGGREGATE EXPENDITURES FROM THE PRIOR YEAR. IN DETERMINING THE UPDATED
BASE YEAR TO BE UTILIZED PURSUANT TO THIS SUBPARAGRAPH, THE COMMISSIONER
SHALL TAKE INTO ACCOUNT THE BASE YEAR DETERMINED IN ACCORDANCE WITH
PARAGRAPH (C) OF SUBDIVISION THIRTY-FIVE OF THIS SECTION.
S 30. Subparagraph (vii) of paragraph (e-2) of subdivision 4 of
section 2807-c of the public health law, as added by section 13 of part
C of chapter 58 of the laws of 2009, is amended to read as follows:
(vii) The commissioner may promulgate regulations, including emergency
regulations, implementing the provisions of this paragraph, AND,
FURTHER, SUCH REGULATIONS MAY PROVIDE FOR AN UPDATE OF THE BASE YEAR
COSTS AND STATISTICS USED TO COMPUTE SUCH RATES, PROVIDED, HOWEVER, THAT
SUCH BASE YEAR UPDATE SHALL TAKE EFFECT NO EARLIER THAN APRIL FIRST, TWO
THOUSAND FIFTEEN, AND PROVIDED FURTHER, HOWEVER, THAT THE COMMISSIONER
MAY MAKE SUCH ADJUSTMENTS TO SUCH UTILIZATION AND TO THE METHODOLOGY FOR
COMPUTING SUCH RATES AS IS NECESSARY TO ACHIEVE NO AGGREGATE, NET GROWTH
IN OVERALL MEDICAID EXPENDITURES RELATED TO SUCH RATES, AS COMPARED TO
SUCH AGGREGATE EXPENDITURES FROM THE PRIOR YEAR. IN DETERMINING THE
UPDATED BASE YEAR TO BE UTILIZED PURSUANT TO THIS SUBPARAGRAPH, THE
COMMISSIONER SHALL TAKE INTO ACCOUNT THE BASE YEAR DETERMINED IN ACCORD-
ANCE WITH PARAGRAPH (C) OF SUBDIVISION THIRTY-FIVE OF THIS SECTION.
S 31. Paragraph (l) of subdivision 4 of section 2807-c of the public
health law is amended by adding a new subparagraph (v) to read as
follows:
(V) THE COMMISSIONER MAY PROMULGATE REGULATIONS, INCLUDING EMERGENCY
REGULATIONS, PROVIDING FOR AN UPDATE OF THE BASE YEAR COSTS AND STATIS-
TICS USED TO COMPUTE RATES OF PAYMENT PURSUANT TO THIS PARAGRAPH,
PROVIDED, HOWEVER, THAT SUCH BASE YEAR UPDATE SHALL TAKE EFFECT NO
EARLIER THAN APRIL FIRST, TWO THOUSAND FIFTEEN, AND PROVIDED FURTHER,
HOWEVER, THAT THE COMMISSIONER MAY MAKE SUCH ADJUSTMENTS TO SUCH UTILI-
ZATION AND TO THE METHODOLOGY FOR COMPUTING SUCH RATES AS IS NECESSARY
TO ACHIEVE NO AGGREGATE, NET GROWTH IN OVERALL MEDICAID EXPENDITURES
RELATED TO SUCH RATES, AS COMPARED TO SUCH AGGREGATE EXPENDITURES FROM
THE PRIOR YEAR. IN DETERMINING THE UPDATED BASE YEAR TO BE UTILIZED
PURSUANT TO THIS SUBPARAGRAPH, THE COMMISSIONER SHALL TAKE INTO ACCOUNT
THE BASE YEAR DETERMINED IN ACCORDANCE WITH PARAGRAPH (C) OF SUBDIVISION
THIRTY-FIVE OF THIS SECTION.
S 32. Paragraph (c) of subdivision 35 of section 2807-c of the public
health law, as amended by section 26 of part A of chapter 56 of the laws
of 2013, is amended to read as follows:
(c) The base period reported costs and statistics used for rate-set-
ting for operating cost components, including the weights assigned to
diagnostic related groups, shall be updated no less frequently than
every four years and the new base period shall be no more than four
years prior to the first applicable rate period that utilizes such new
base period provided, however, that the first updated base period shall
S. 6914 128 A. 9205
begin on [January] OR AFTER APRIL first, two thousand fourteen, BUT NO
LATER THAN JULY FIRST, TWO THOUSAND FOURTEEN.
S 32-a. Notwithstanding any contrary provision of law, the commission-
er of health shall establish a workgroup to review and investigate Medi-
caid inpatient rate-setting methodologies with regard to hospitals whose
rates are governed by paragraphs (e-1), (e-2) and (l) of subdivision 4
of section 2807-c of the public health law and with particular regard to
the impact of the utilization of updated base years in the computation
of such rates. The workgroup shall contain designated staff of the
department of health, representatives of hospital associations and such
other interested stakeholders as determined by the commissioner. The
commissioner shall consider the recommendations of such workgroup in
determining proposed revised rates reflecting the utilization of such
updated base years and shall make such proposed revised rates available
to the chairs of the senate and assembly health committees no less than
thirty days prior to the effective date for such rates. Such updated
base years shall be implemented for rate periods commending no earlier
than April 1, 2015.
S 33. 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 fund medicaid expenditures, as
amended by section 3 of part A of chapter 56 of the laws of 2013, is
amended to read as follows:
1. For state fiscal years 2011-12 through [2014-15] 2015-16, 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. Such projections may be adjusted
by the director of the budget to account for increased or expedited
department of health state funds medicaid expenditures as a result of a
natural or other type of disaster, including a governmental declaration
of emergency.
S 33-a. Subdivision 5 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 fund medicaid expendi-
tures, as amended by section 3 of part A of chapter 56 of the laws of
2013, is amended and three new subdivisions 6, 7, and 8 are added to
read as follows:
S. 6914 129 A. 9205
5. The [department of health] COMMISSIONER OF HEALTH, IN CONSULTATION
WITH THE DIRECTOR OF BUDGET, shall prepare a monthly report that sets
forth:
(a) known and projected department of health medicaid expenditures as
described in subdivision one of this section, and factors that could
result in medicaid disbursements for the relevant state fiscal year to
exceed the projected department of health state funds disbursements in
the enacted budget financial plan pursuant to subdivision 3 of section
23 of the state finance law, including spending increases or decreases
due to: enrollment fluctuations, rate changes, utilization changes, MRT
investments, and shift of beneficiaries to managed care; and variations
in offline medicaid payments; [and]
(b) the actions taken to implement any medicaid savings allocation
plan implemented pursuant to subdivision four of this section, including
information concerning the impact of such actions on each category of
service and each geographic region of the state. [Each such monthly
report shall be provided to the chairs of the senate finance and the
assembly ways and means committees and shall be posted on the department
of health's website in a timely manner.]
(C) THE PRICE, TO INCLUDE THE BASE RATE PLUS ANY UPCOMING RATE ADJUST-
MENT; UTILIZATION, TO INCLUDE CURRENT ENROLLMENT, PROJECTED ENROLLMENT
CHANGES AND ACUITY; AND MEDICAID REDESIGN TEAM INITIATIVES, ONE-TIME
INITIATIVES AND OTHER INITIATIVES DESCRIBING THE PROPOSED BUDGET ACTION
IMPACT, ANY PRIOR YEAR INITIATIVE WITH CURRENT AND FUTURE YEAR IMPACTS
FOR THE FOLLOWING CATEGORIES OF SPENDING:
(I) INPATIENT;
(II) OUTPATIENT;
(III) EMERGENCY ROOM;
(IV) CLINIC;
(V) NURSING HOMES;
(VI) OTHER LONG TERM CARE;
(VII) MEDICAID MANAGED CARE;
(VIII) FAMILY HEALTH PLUS;
(IX) PHARMACY;
(X) TRANSPORTATION;
(XI) DENTAL;
(XII) NON-INSTITUTIONAL AND ALL OTHER CATEGORIES;
(XIII) AFFORDABLE HOUSING;
(XIV) VITAL ACCESS PROVIDER SERVICES;
(XV) BEHAVIORAL HEALTH VITAL ACCESS PROVIDER SERVICES;
(XVI) HEALTH HOME ESTABLISHMENT GRANTS;
(XVII) GRANTS FOR FACILITATING TRANSITION OF BEHAVIORAL HEALTH SERVICE
TO MANAGED CARE;
(XVIII) FINGER LAKES HEALTH SERVICES AGENCY;
(XIX) THE TRANSITION OF VULNERABLE POPULATIONS TO MANAGED CARE;
(XX) AUDIT RECOVERIES AND SETTLEMENTS; AND
(D) WHERE PRICE AND UTILIZATION ARE NOT APPLICABLE, DETAIL SHALL BE
PROVIDED ON SPENDING, TO INCLUDE BUT NOT BE LIMITED TO:
(I) DEMOGRAPHIC INFORMATION OF TARGETED RECIPIENTS;
(II) NUMBER OF RECIPIENTS;
(III) AWARD AMOUNTS;
(IV) TIMING OF AWARDS; AND
(V) THE IMPACT OF MEDICAID REDESIGN TEAM AND/OR ONE-TIME INITIATIVES.
INFORMATION REQUIRED BY PARAGRAPHS (A) AND (B) OF THIS SUBDIVISION
SHALL BE PROVIDED TO THE CHAIRS OF THE SENATE FINANCE AND THE ASSEMBLY
S. 6914 130 A. 9205
WAYS AND MEANS COMMITTEES, AND SHALL BE POSTED ON THE DEPARTMENT OF
HEALTH'S WEBSITE IN THE TIMELY MANNER.
(E) BEGINNING ON JULY 1, 2014, ADDITIONAL INFORMATION REQUIRED BY
PARAGRAPHS (C) AND (D) OF THIS SUBDIVISION SHALL BE PROVIDED TO THE
GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE
ASSEMBLY, THE CHAIR OF THE SENATE FINANCE COMMITTEE, THE CHAIR OF THE
ASSEMBLY WAYS AND MEANS COMMITTEE, AND THE CHAIRS OF THE SENATE AND
ASSEMBLY HEALTH COMMITTEES.
(F) ANY PROJECTED MEDICAID SAVINGS DETERMINED BY THE COMMISSIONER OF
HEALTH PURSUANT TO SECTION 34 OF PART C OF A CHAPTER OF THE LAWS OF
2014, RELATING TO THE IMPLEMENTATION OF THE HEALTH AND MENTAL HYGIENE
BUDGET, AND THE PROPOSED ALLOCATION PLAN WITH REGARD TO SUCH SAVINGS.
6. THE COMMISSIONER OF HEALTH AND THE DIRECTOR OF THE BUDGET SHALL
MAKE APPROPRIATE STAFF AVAILABLE TO MEET WITH THE CHAIRS OF THE HEALTH
COMMITTEES OF THE NEW YORK STATE SENATE AND THE NEW YORK STATE ASSEMBLY,
OR THEIR DESIGNEES, UPON THEIR REQUEST AND WITH REASONABLE NOTICE, TO
REVIEW EACH MONTHLY REPORT, AS DESCRIBED IN THIS SUBDIVISION.
7. THE COMMISSIONER OF HEALTH SHALL MAKE TRAINING AVAILABLE TO DESIG-
NATED LEGISLATIVE STAFF WITH REGARD TO THE SKILLS AND TECHNIQUES NEEDED
TO EFFECTIVELY ACCESS AND REVIEW RELEVANT MEDICAID DATA BASES UNDER THE
CONTROL OF THE DEPARTMENT OF HEALTH, UPON THEIR REQUEST AND WITH REASON-
ABLE NOTICE.
8. THE MONTHLY REPORTS AS DESCRIBED IN SUBDIVISION FIVE OF THIS
SECTION AND RELATED DOCUMENTS PROVIDED TO THE NEW YORK STATE LEGISLATURE
SHALL BE POSTED ON THE WEBSITE MAINTAINED BY THE DEPARTMENT OF HEALTH.
S 34. Notwithstanding any contrary provision of law and subject to the
availability of federal financial participation, for state fiscal years
beginning on and after April 1, 2014, the commissioner of health, in
consultation with the director of the budget, shall, prior to January
first of each year, determine the extent of savings that have been
achieved as a result of the application of the provisions of sections 91
and 92 of part H of chapter 59 of the laws of 2011, as amended, and
shall further determine the availability of such savings for distrib-
ution during the last quarter of such state fiscal year. In determining
such savings the commissioner of health, in consultation with the direc-
tor of the budget, may exempt the medical assistance administration
program from distributions under this section. The commissioner of
health, in consultation with the director of the budget, may distribute
funds up to an amount equal to such available savings in accordance with
an allocation plan that utilizes a methodology that distributes such
funds proportionately among providers and plans in New York's Medicaid
program. In developing such allocation plan the commissioner of health
shall seek the input of the legislature, as well as organizations
representing health care providers, consumers, businesses, workers,
health care insurers and others with relevant expertise. Such allocation
plan shall utilize three years of the most recently available system-
wide expenditure data reflecting both MMIS and managed care encounters.
Distributions to managed care plans shall be based on the administrative
outlays stemming from participation in the Medicaid program. The commis-
sioner of health may impose minimum threshold amounts in determining
provider eligibility for distributions pursuant to this section. No less
than fifty percent of the amount available for distribution shall be
made available for the purpose of assisting eligible providers utilizing
the methodology outlined above. The remainder of the distributions
pursuant to this section shall be made available for the purposes of
ensuring a minimum level of assistance to financially distressed and
S. 6914 131 A. 9205
critically needed providers as identified by the commissioner. The
commissioner of health shall post the Medicaid savings allocation plan
on the department of health's website and shall provide written copies
of such plan to the chairs of the senate finance and the assembly ways
and means committees at least 30 days before the date on which implemen-
tation is expected to begin. The commissioner of health is authorized to
seek such federal approvals as may be required to effectuate the
provisions of this section, including, but not limited to, to permit
payment of such distributions as lumps sums and to secure waivers from
otherwise applicable federal upper payment limit restrictions on such
payments. The provisions of this section are subject to the reporting
requirements set forth in paragraph (e) of subdivision 5 of section 92
of part H of chapter 59 of the laws of 2011, as amended by section 33-a
of part C of a chapter of the laws of 2014, relating to implementation
of the health and mental hygiene budget.
S 34-a. Subdivision 1 of section 206 of the public health law is
amended by adding a new paragraph (u) to read as follows:
(U) THE COMMISSIONER SHALL PROVIDE A WRITTEN OR ELECTRONIC COPY OF ANY
STATE PLAN AMENDMENT SUBMITTED TO THE CENTERS FOR MEDICARE AND MEDICAID
SERVICES TO THE CHAIR OF THE SENATE STANDING COMMITTEE ON HEALTH AND THE
CHAIR OF THE ASSEMBLY HEALTH COMMITTEE, NO LATER THAN FIVE BUSINESS DAYS
FROM THE DATE OF MAILING OR SUBMISSION.
S 35. Subdivision 9 of section 365-l of the social services law, as
added by section 6 of part A of chapter 56 of the laws of 2013, is
amended to read as follows:
9. [Any] THE contract [or contracts] entered into by the commissioner
of health prior to January first, two thousand thirteen pursuant to
subdivision eight of this section may be amended or modified without the
need for a competitive bid or request for proposal process, and without
regard to the provisions of sections one hundred twelve and one hundred
sixty-three of the state finance law, section one hundred forty-two of
the economic development law, or any other provision of law, to allow
the purchase of additional personnel and services, subject to available
funding, for the limited purpose of assisting the department of health
with implementing the Balancing Incentive Program, the Fully Integrated
Duals Advantage Program, the Vital Access Provider Program, the Medicaid
waiver amendment associated with the public hospital transformation, the
addition of behavioral health services as a managed care plan benefit,
THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT PLAN, ACTIVITIES TO FACILI-
TATE THE TRANSITION OF VULNERABLE POPULATIONS TO MANAGED CARE and/or any
workgroups required to be established by the chapter of the laws of two
thousand thirteen that added this subdivision.
S 36. 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 fund medicaid expenditures, is amended by
adding a new subdivision 6 to read as follows:
6. THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE DIVISION OF
THE BUDGET SHALL, UPON SUBMISSION OF THE EXECUTIVE BUDGET TO THE LEGIS-
LATURE, PROVIDE A DETAILED ACCOUNTING OF THE STATE MEDICAID GLOBAL CAP
ON THE CLOSE OUT OF THE PRIOR YEAR, A CURRENT YEAR RE-ESTIMATE, THE
PROSPECTIVE TWO-YEAR ESTIMATE AND ANY OTHER INFORMATION DEEMED NECESSARY
AND APPROPRIATE.
S 37. Notwithstanding any provision of law to the contrary, the
department of health and its designees, in consultation with the assem-
bly and the senate health committees and their designees, and the divi-
sion of budget and its designees, shall explore the feasibility and
S. 6914 132 A. 9205
efficacy of codifying in consolidated law the provisions of section 92
of part H of chapter 59 of the laws of 2011, and other such related laws
and shall make such recommendations regarding codification by no later
than June 1, 2014.
S 38. Subdivision (a) of section 90 of part H of chapter 59 of the
laws of 2011, amending the public health law and other laws, relating to
general hospital inpatient reimbursement for annual rates, as amended by
section 1 of part A of chapter 56 of the laws of 2013, is amended to
read as follows:
(a) (1) Notwithstanding any other provision of law to the contrary,
for the state fiscal years beginning April 1, 2011 and ending on March
31, [2015] 2014, all Medicaid payments made for services provided on and
after April 1, 2011, shall, except as hereinafter provided, be subject
to a uniform two percent reduction and such reduction shall be applied,
to the extent practicable, in equal amounts during the fiscal year,
provided, however, that an alternative method may be considered at the
discretion of the commissioner of health and the director of the budget
based upon consultation with the health care industry including but not
limited to, a uniform reduction in Medicaid rates of payments or other
reductions provided that any method selected achieves up to $345,000,000
in Medicaid state share savings in state fiscal year 2011-12 and up to
$357,000,000 annually in state fiscal years 2012-13[,] AND 2013-14 [and
2014-15] except as hereinafter provided, for services provided on and
after April 1, 2011 through March 31, [2015] 2014. Any alternative meth-
ods to achieve the reduction must be provided in writing and shall be
filed with the senate finance committee and the assembly ways and means
committee not less than thirty days before the date on which implementa-
tion is expected to begin. Nothing in this section shall be deemed to
prevent all or part of such alternative reduction plan from taking
effect retroactively, to the extent permitted by the federal centers for
medicare and medicaid services.
(2) ALTERNATIVE METHODS OF COST CONTAINMENT AS AUTHORIZED AND IMPLE-
MENTED PURSUANT TO PARAGRAPH ONE OF THIS SUBDIVISION SHALL CONTINUE TO
BE APPLIED AND MAINTAINED FOR PERIODS ON AND AFTER APRIL 1, 2014,
PROVIDED, HOWEVER, THAT THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH
THE DIRECTOR OF THE BUDGET, IS AUTHORIZED TO TERMINATE SUCH ALTERNATIVE
METHODS UPON A FINDING THAT THEY ARE NO LONGER NECESSARY TO MAINTAIN
ESSENTIAL COST SAVINGS.
S 39. Subdivisions (a) and (b) of section 364-jj of the social
services law, as amended by section 80-a of part A of chapter 56 of the
laws of 2013, are amended to read as follows:
(a) There is hereby established a special advisory review panel on
Medicaid managed care. The panel shall consist of [twelve] SIXTEEN
members who shall be appointed as follows: [four] SIX by the governor,
one of which shall serve as the chair; [three] FOUR each by the tempo-
rary president of the senate and the speaker of the assembly; and one
each by the minority leader of the senate and the minority leader of the
assembly. At least three members of such panel shall be members of the
joint advisory panel established under section 13.40 of the mental
hygiene law. THE PANEL SHALL INCLUDE A CONSUMER REPRESENTATIVE FOR INDI-
VIDUALS WITH BEHAVIORAL HEALTH NEEDS, A CONSUMER REPRESENTATIVE FOR
INDIVIDUALS WHO ARE DUALLY ELIGIBLE FOR MEDICARE AND MEDICAID, A REPRE-
SENTATIVE OF ENTITIES THAT PROVIDE OR ARRANGE FOR THE PROVISION OF
SERVICES TO INDIVIDUALS WITH BEHAVIORAL HEALTH NEEDS, AND A REPRESEN-
TATIVE OF ENTITIES THAT PROVIDE OR ARRANGE FOR THE PROVISION OF SERVICES
TO INDIVIDUALS WHO ARE DUALLY ELIGIBLE FOR MEDICARE AND MEDICAID.
S. 6914 133 A. 9205
Members shall serve without compensation but shall be reimbursed for
appropriate expenses. The department shall provide technical assistance
and access to data as is required for the panel to effectuate the
mission and purposes established herein.
(b) The panel shall:
(i) determine whether there is sufficient managed care provider
participation in the Medicaid managed care program;
(ii) determine whether managed care providers meet proper enrollment
targets that permit as many Medicaid recipients as possible to make
their own health plan decisions, thus minimizing the number of automatic
assignments;
(iii) review the phase-in schedule for enrollment, of managed care
providers under both the voluntary and mandatory programs;
(iv) assess the impact of managed care provider marketing and enroll-
ment strategies, and the public education campaign conducted in New York
city, on enrollees participation in Medicaid managed care plans;
(v) evaluate the adequacy of managed care provider capacity by review-
ing established capacity measurements and monitoring actual access to
plan practitioners;
(vi) examine the cost implications of populations excluded and
exempted from Medicaid managed care;
(vii) EVALUATE THE ADEQUACY AND APPROPRIATENESS OF PROGRAM MATERIALS;
(VIII) EXAMINE TRENDS IN SERVICE DENIALS;
(IX) ASSESS THE ACCESS TO CARE FOR PEOPLE WITH DISABILITIES;
(X) in accordance with the recommendations of the joint advisory coun-
cil established pursuant to section 13.40 of the mental hygiene law,
advise the commissioners of health and developmental disabilities with
respect to the oversight of DISCOs and of health maintenance organiza-
tions and managed long term care plans providing services authorized,
funded, approved or certified by the office for people with develop-
mental disabilities, and review all managed care options provided to
persons with developmental disabilities, including: the adequacy of
support for habilitation services; the record of compliance with
requirements for person-centered planning, person-centered services and
community integration; the adequacy of rates paid to providers in
accordance with the provisions of paragraph 1 of subdivision four of
section forty-four hundred three of the public health law, paragraph
(a-2) of subdivision eight of section forty-four hundred three of the
public health law or paragraph (a-2) of subdivision twelve of section
forty-four hundred three-f of the public health law; and the quality of
life, health, safety and community integration of persons with develop-
mental disabilities enrolled in managed care; and
[(viii)] (XI) examine other issues as it deems appropriate.
S 40. Subdivision 6 of section 368-d of the social services law, as
amended by section 37 of part D of chapter 56 of the laws of 2012, 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 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 recip-
ients whose assistance and care are the responsibility of a social
services district results in a decrease in the state share of annual
S. 6914 134 A. 9205
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 five of section three hundred sixty-eight-e of this title exceeds
one hundred fifty million dollars for the period April 1, 2011 through
March 31, 2013, or exceeds one hundred million dollars in state fiscal
[year 2012-13 or any fiscal year thereafter] YEARS 2013-14 AND 2014-15,
the excess amount shall be transferred to such 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; AN AMOUNT EQUAL TO THIRTEEN AND FIVE HUNDREDTHS
PERCENT OF ANY DECREASE IN THE STATE SHARE OF ANNUAL EXPENDITURES PURSU-
ANT TO THIS SECTION FOR SUCH RECIPIENTS IN STATE FISCAL YEAR 2015-16 AND
ANY FISCAL YEAR THEREAFTER SHALL BE TRANSFERRED TO SUCH PUBLIC SCHOOL
DISTRICTS IN AMOUNTS PROPORTIONAL TO THEIR PERCENTAGE CONTRIBUTION TO
THE STATEWIDE SAVINGS. Any [such excess] amount transferred PURSUANT TO
THIS SECTION shall not be considered a revenue received by such social
services district in determining the district's actual medical assist-
ance expenditures for purposes of paragraph (b) of section one of part C
of chapter fifty-eight of the laws of two thousand five.
S 41. Subdivision 5 of section 368-e of the social services law, as
amended by section 38 of part D of chapter 56 of the laws of 2012, 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, results in a decrease in the
state share of annual expenditures pursuant to this section for such
recipients, then to the extent that the amount of any such decrease when
combined with any decrease in the state share of annual expenditures
described in subdivision six of section three hundred sixty-eight-d of
this title exceeds one hundred fifty million dollars for the period
April 1, 2011 through March 31, 2013, or exceeds one hundred million
dollars in state fiscal [year 2012-13 or any fiscal year thereafter]
YEARS 2013-14 AND 2014-15, the excess amount shall be transferred to
such counties in amounts proportional to their percentage contribution
to the statewide savings; AN AMOUNT EQUAL TO THIRTEEN AND FIVE
HUNDREDTHS PERCENT OF ANY DECREASE IN THE STATE SHARE OF ANNUAL EXPENDI-
TURES PURSUANT TO THIS SECTION FOR SUCH RECIPIENTS IN STATE FISCAL YEAR
2015-16 AND ANY FISCAL YEAR THEREAFTER SHALL BE TRANSFERRED TO SUCH
COUNTIES IN AMOUNTS PROPORTIONAL TO THEIR PERCENTAGE CONTRIBUTION TO THE
STATEWIDE SAVINGS. Any [such excess] amount transferred PURSUANT TO
THIS SECTION shall not be considered a revenue received by such social
services district in determining the district's actual medical assist-
ance expenditures for purposes of paragraph (b) of section one of part C
of chapter fifty-eight of the laws of two thousand five.
S 42. Subdivision 8 of section 365-a of the social services law, as
added by section 46-a of part B of chapter 58 of the laws of 2009, is
amended to read as follows:
S. 6914 135 A. 9205
8. When a non-governmental entity is authorized by the department
pursuant to contract or subcontract to make prior authorization or prior
approval determinations that may be required for any item of medical
assistance, a recipient may challenge any action taken or failure to act
in connection with a prior authorization or prior approval determination
as if such determination were made by a government entity, and shall be
entitled to the same medical assistance benefits and standards and to
the same notice and procedural due process rights, including a right to
a fair hearing and aid continuing pursuant to section twenty-two of this
chapter, as if the prior authorization or prior approval determination
were made by a government entity, WITHOUT REGARD TO EXPIRATION OF THE
PRIOR SERVICE AUTHORIZATION.
S 43. Subparagraph (ii) of paragraph (a) of subdivision 7 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:
(ii) Notwithstanding any inconsistent provision of the social services
law to the contrary, the commissioner shall, pursuant to regulation,
determine whether and the extent to which the applicable provisions of
the social services law or regulations relating to approvals and author-
izations of, and utilization limitations on, health and long term care
services reimbursed pursuant to title XIX of the federal social security
act, including, but not limited to, fiscal assessment requirements, are
inconsistent with the flexibility necessary for the efficient adminis-
tration of managed long term care plans and such regulations shall
provide that such provisions shall not be applicable to enrollees or
managed long term care plans, provided that such determinations are
consistent with applicable federal law and regulation, AND SUBJECT TO
THE PROVISIONS OF SUBDIVISION EIGHT OF SECTION THREE HUNDRED
SIXTY-FIVE-A OF THE SOCIAL SERVICES LAW.
S 44. The social services law is amended by adding a new section 398-b
to read as follows:
S 398-B. TRANSITION TO MANAGED CARE. 1. NOTWITHSTANDING ANY INCONSIST-
ENT PROVISION OF LAW TO THE CONTRARY AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, THE COMMISSIONER IS AUTHORIZED TO MAKE
GRANTS FROM A GROSS AMOUNT OF FIVE MILLION DOLLARS TO FACILITATE THE
TRANSITION OF FOSTER CARE CHILDREN PLACED WITH VOLUNTARY FOSTER CARE
AGENCIES TO MANAGED CARE. THE USE OF SUCH FUNDS MAY INCLUDE PROVIDING
TRAINING AND CONSULTING SERVICES TO VOLUNTARY AGENCIES TO ACCESS READ-
INESS AND MAKE NECESSARY INFRASTRUCTURE AND ORGANIZATIONAL MODIFICA-
TIONS, COLLECTING SERVICE UTILIZATION AND OTHER DATA FROM VOLUNTARY
AGENCIES AND OTHER ENTITIES, AND MAKING INVESTMENTS IN HEALTH INFORMA-
TION TECHNOLOGY, INCLUDING THE INFRASTRUCTURE NECESSARY TO ESTABLISH AND
MAINTAIN ELECTRONIC HEALTH RECORDS. SUCH FUNDS SHALL BE DISTRIBUTED
PURSUANT TO A FORMULA TO BE DEVELOPED BY THE COMMISSIONER OF HEALTH, IN
CONSULTATION WITH THE COMMISSIONER OF THE OFFICE OF FAMILY AND CHILD
SERVICES. IN DEVELOPING SUCH FORMULA THE COMMISSIONERS MAY TAKE INTO
ACCOUNT SIZE AND SCOPE OF PROVIDER OPERATIONS AS A FACTOR RELEVANT TO
ELIGIBILITY FOR SUCH FUNDS. EACH RECIPIENT OF SUCH FUNDS SHALL BE
REQUIRED TO DOCUMENT AND DEMONSTRATE THE EFFECTIVE USE OF FUNDS DISTRIB-
UTED HEREIN.
2. DATA PROVIDED BY VOLUNTARY FOSTER CARE AGENCIES SHALL BE COMPLIANT
WITH THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT, AND SHALL
BE TRANSMITTED SECURELY USING EMEDS OR OTHER MECHANISM TO BE DETERMINED
BY THE DEPARTMENT OF HEALTH. SUCH DATA MAY BE USED BY THE DEPARTMENT OF
HEALTH TO ESTABLISH RATES OF PAYMENT FOR MANAGED CARE ORGANIZATIONS FOR
SERVICES PROVIDED TO CHILDREN IN FOSTER CARE. IN ESTABLISHING SUCH RATES
S. 6914 136 A. 9205
THE COMMISSIONER OF HEALTH SHALL ALSO TAKE INTO ACCOUNT CARE COORDI-
NATION SERVICES THAT WILL CONTINUE TO BE PROVIDED BY THE VOLUNTARY
FOSTER CARE AGENCIES.
3. THE COMMISSIONER OF HEALTH SHALL ISSUE A REPORT TO BE MADE PUBLIC
ON THE DEPARTMENT OF HEALTH'S WEBSITE. SUCH REPORT SHALL CONFORM TO THE
REQUIREMENTS OF SUBDIVISION FIVE OF SECTION NINETY-TWO OF PART H OF
CHAPTER FIFTY-NINE OF THE LAWS OF TWO THOUSAND ELEVEN.
S 45. Subdivision 3 of section 365-n of the social services law, as
added by section 6 of part F of chapter 56 of the laws of 2012, is
amended to read as follows:
3. Notwithstanding sections sixty-one, sixty-three, seventy, seventy-
eight, seventy-nine, eighty-one and [eight-one-a] EIGHTY-ONE-A 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 the functions established in subdivision two of this section
as of the effective date of this section OR ANY SUCH APPOINTEES WHO MEET
THE OPEN COMPETITIVE QUALIFICATIONS FOR POSITIONS ESTABLISHED TO PERFORM
THESE FUNCTIONS will be eligible for voluntary transfer to appropriate
positions, in the department, that are classified to perform such func-
tions without further examination, qualification, or probationary peri-
od; and, upon such transfer, will have all the rights and privileges of
the jurisdictional classification to which such positions are allocated
in the classified service of the state.
S 46. Section 365-n of the social services law is amended by adding a
new subdivision 5-a to read as follows:
5-A. (A) THE COMMISSIONER MAY TAKE NECESSARY ACTION TO REVIEW THE
ACCURACY OF DETERMINATIONS OF INITIAL AND ONGOING ELIGIBILITY UNDER THE
MEDICAL ASSISTANCE PROGRAM, AND TO IDENTIFY AND ELIMINATE INAPPROPRIATE
INSTANCES OF CONCURRENT OR DUPLICATE BENEFITS AND AUTHORIZATIONS. THE
COMMISSIONER IS AUTHORIZED TO CONTRACT WITH ONE OR MORE ENTITIES TO
ASSIST THE STATE IN IMPLEMENTING THE PROVISIONS OF THIS SUBDIVISION.
(B) NOTWITHSTANDING THE PROVISIONS 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 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 PROCESS, PROVIDED, HOWEVER, THAT:
(I) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
OF NO LESS THAN THIRTY DAYS:
(1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
(3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
TION IS FIRST POSTED ON THE WEBSITE; AND
(4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER; AND
(III) THE COMMISSIONER SHALL SELECT SUCH CONTRACTOR OR CONTRACTORS
THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE PURPOSES OF
THIS SECTION; AND
(IV) NO CONTRACT ENTERED PURSUANT TO THIS PARAGRAPH SHALL HAVE A TERM
THAT ENDS LATER THAN MARCH THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
S. 6914 137 A. 9205
S 47. Subparagraph (iv) of paragraph (e-2) of subdivision 4 of
section 2807-c of the public health law is amended by adding a new
clause (E) to read as follows:
(E) FOR FACILITIES SUBJECT TO THE PROVISIONS OF THIS SUBPARAGRAPH, THE
DEPARTMENT SHALL EXAMINE THE FEASIBILITY OF REIMBURSING SUCH FACILITIES
FOR SERVICES PROVIDED TO CHILDREN ELIGIBLE FOR MEDICAL ASSISTANCE ON A
NON-FEE-FOR-SERVICE BASIS. FOR PURPOSES OF THIS CLAUSE,
"NON-FEE-FOR-SERVICE" SHALL BE DEFINED AS AN ALTERNATIVE PAYMENT METHOD
TO BUNDLE CERTAIN SERVICES RENDERED BY SUCH FACILITY, INCLUDING INPA-
TIENT, OUTPATIENT, SPECIALTY OUTPATIENT AND PHYSICIAN SERVICES, IN
AMOUNTS DETERMINED BY THE COMMISSIONER. THE DEPARTMENT SHALL EXAMINE:
(A) WHAT SERVICES COULD BE PROVIDED PURSUANT TO THE NON-FEE-FOR-SER-
VICE BASIS;
(B) HOW TO ENSURE, FOR CHILDREN ENROLLED IN MEDICAID MANAGED CARE,
THAT THEIR HEALTH PLANS CAN CONTINUE TO ASSIST IN THE COORDINATION OF
THEIR CARE, PARTICULARLY UPON DISCHARGE FROM INPATIENT, OUTPATIENT OR
SPECIALTY OUTPATIENT SERVICES; AND
(C) WHETHER INCENTIVES SHOULD BE INCORPORATED FOR MEETING QUALITY
BENCHMARKS OR ACHIEVING EFFICIENCIES IN THE DELIVERY AND COORDINATION OF
CARE OR WHETHER OTHER MEANS SHOULD BE CONSIDERED TO ACHIEVE THESE OBJEC-
TIVES.
THE DEPARTMENT SHALL PROVIDE A REPORT OF ITS FINDINGS AND RECOMMENDA-
TIONS TO THE GOVERNOR AND LEGISLATURE NO LATER THAN MARCH FIRST, TWO
THOUSAND FIFTEEN.
S 48. Notwithstanding sections 112 and 163 of the state finance law,
or any other contrary provision of law, the commissioner of health is
authorized to negotiate an extension of the terms of the contract
executed by the department of health for actuarial and consulting
services, on September 18, 2009, without a competitive bid or request
for proposal process; provided, however, such extension shall not extend
beyond December 31, 2016.
S 49. Section 364-j of the social services law is amended by adding a
new subdivision 29 to read as follows:
29. IN THE EVENT THAT THE DEPARTMENT RECEIVES APPROVAL FROM THE
CENTERS FOR MEDICARE AND MEDICAID SERVICES TO AMEND ITS 1115 WAIVER
KNOWN AS THE PARTNERSHIP PLAN OR RECEIVES APPROVAL FOR A NEW 1115 WAIVER
FOR THE PURPOSE OF REINVESTING SAVINGS RESULTING FROM THE REDESIGN OF
THE MEDICAL ASSISTANCE PROGRAM, THE COMMISSIONER IS AUTHORIZED TO ENTER
INTO CONTRACTS, AND/OR TO AMEND THE TERMS OF CONTRACTS AWARDED PRIOR TO
THE EFFECTIVE DATE OF THIS SUBDIVISION, FOR THE PURPOSE OF ASSISTING THE
DEPARTMENT OF HEALTH WITH IMPLEMENTING PROJECTS AUTHORIZED UNDER SUCH
WAIVER APPROVAL. NOTWITHSTANDING THE PROVISIONS 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 CONTRARY PROVISION OF LAW, CONTRACTS MAY BE ENTERED
OR CONTRACT AMENDMENTS MAY BE MADE PURSUANT TO THIS SUBDIVISION WITHOUT
A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS IF THE TERM OF ANY
SUCH CONTRACT OR CONTRACT AMENDMENT DOES NOT EXTEND BEYOND MARCH THIR-
TY-FIRST, TWO THOUSAND NINETEEN; PROVIDED, HOWEVER, IN THE CASE OF A
CONTRACT ENTERED INTO AFTER THE EFFECTIVE DATE OF THIS SUBDIVISION,
THAT:
(A) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
OF NO LESS THAN THIRTY DAYS:
(I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
S. 6914 138 A. 9205
(III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
(IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER OF HEALTH; AND
(C) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
PURPOSES OF THIS SECTION.
S 50. Subdivision 1 of section 366 of the social services law is
amended by adding a new paragraph (g) to read as follows:
(G) COVERAGE OF CERTAIN NONCITIZENS. (1) APPLICANTS AND RECIPIENTS WHO
ARE LAWFULLY ADMITTED FOR PERMANENT RESIDENCE, OR WHO ARE PERMANENTLY
RESIDING IN THE UNITED STATES UNDER COLOR OF LAW; WHO ARE MAGI ELIGIBLE
PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVISION; AND WHO WOULD BE INELIGI-
BLE FOR MEDICAL ASSISTANCE COVERAGE UNDER SUBDIVISIONS ONE AND TWO OF
SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE SOLELY DUE TO THEIR
IMMIGRATION STATUS IF THE PROVISIONS OF SECTION ONE HUNDRED TWENTY-TWO
OF THIS CHAPTER WERE APPLIED, SHALL ONLY BE ELIGIBLE FOR ASSISTANCE
UNDER THIS TITLE IF ENROLLED IN A STANDARD HEALTH PLAN OFFERED BY A
BASIC HEALTH PROGRAM ESTABLISHED PURSUANT TO SECTION THREE HUNDRED
SIXTY-NINE-GG OF THIS ARTICLE IF SUCH PROGRAM IS ESTABLISHED AND OPERAT-
ING.
(2) WITH RESPECT TO A PERSON DESCRIBED IN SUBPARAGRAPH ONE OF THIS
PARAGRAPH WHO IS ENROLLED IN A STANDARD HEALTH PLAN, MEDICAL ASSISTANCE
COVERAGE SHALL MEAN:
(I) PAYMENT OF REQUIRED PREMIUMS AND OTHER COST-SHARING OBLIGATIONS
UNDER THE STANDARD HEALTH PLAN THAT EXCEED THE PERSON'S CO-PAYMENT OBLI-
GATION UNDER SUBDIVISION SIX OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF
THIS TITLE; AND
(II) PAYMENT FOR SERVICES AND SUPPLIES DESCRIBED IN SUBDIVISION ONE OR
TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE, AS APPLICABLE,
BUT ONLY TO THE EXTENT THAT SUCH SERVICES AND SUPPLIES ARE NOT COVERED
BY THE STANDARD HEALTH PLAN.
(3) NOTHING IN THIS SUBDIVISION SHALL PREVENT A PERSON DESCRIBED IN
SUBPARAGRAPH ONE OF THIS PARAGRAPH FROM QUALIFYING FOR OR RECEIVING
MEDICAL ASSISTANCE WHILE HIS OR HER ENROLLMENT IN A STANDARD HEALTH PLAN
IS PENDING, IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THIS TITLE.
S 51. The social services law is amended by adding a new section 369-
gg to read as follows:
S 369-GG. BASIC HEALTH PROGRAM. 1. DEFINITIONS. FOR PURPOSES OF THIS
SECTION:
(A) "ELIGIBLE ORGANIZATION" MEANS AN INSURER LICENSED PURSUANT TO
ARTICLE THIRTY-TWO OR FORTY-TWO OF THE INSURANCE LAW, A CORPORATION OR
AN ORGANIZATION UNDER ARTICLE FORTY-THREE OF THE INSURANCE LAW, OR AN
ORGANIZATION CERTIFIED UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW, INCLUDING PROVIDERS CERTIFIED UNDER SECTION FORTY-FOUR HUNDRED
THREE-E OF THE PUBLIC HEALTH LAW;
(B) "APPROVED ORGANIZATION" MEANS AN ELIGIBLE ORGANIZATION APPROVED BY
THE COMMISSIONER TO UNDERWRITE A BASIC HEALTH INSURANCE PLAN PURSUANT TO
THIS TITLE;
(C) "HEALTH CARE SERVICES" MEANS THE SERVICES AND SUPPLIES AS DEFINED
BY THE COMMISSIONER IN CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL
SERVICES, AND SHALL BE CONSISTENT WITH AND SUBJECT TO THE ESSENTIAL
S. 6914 139 A. 9205
HEALTH BENEFITS AS DEFINED BY THE COMMISSIONER IN ACCORDANCE WITH THE
PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L. 111-
148) AND CONSISTENT WITH THE BENEFITS PROVIDED BY THE REFERENCE PLAN
SELECTED BY THE COMMISSIONER FOR THE PURPOSES OF DEFINING SUCH BENEFITS;
(D) "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT MEETS THE CRITE-
RIA FOR CERTIFICATION DESCRIBED IN S 1311(C) OF THE PATIENT PROTECTION
AND AFFORDABLE CARE ACT (P.L. 111-148), AND IS OFFERED TO INDIVIDUALS
THROUGH THE HEALTH INSURANCE EXCHANGE MARKETPLACE; AND
(E) "BASIC HEALTH INSURANCE PLAN" MEANS A STANDARD HEALTH PLAN, SEPA-
RATE AND APART FROM QUALIFIED HEALTH PLANS, THAT IS ISSUED BY AN
APPROVED ORGANIZATION AND CERTIFIED IN ACCORDANCE WITH THIS SECTION.
2. AUTHORIZATION. IF IT IS IN THE FINANCIAL INTEREST OF THE STATE TO
DO SO, THE COMMISSIONER OF HEALTH IS AUTHORIZED, WITH THE APPROVAL OF
THE DIRECTOR OF THE BUDGET, TO ESTABLISH A BASIC HEALTH PROGRAM. THE
COMMISSIONER'S AUTHORITY PURSUANT TO THIS SECTION IS CONTINGENT UPON
OBTAINING AND MAINTAINING ALL NECESSARY APPROVALS FROM THE SECRETARY OF
HEALTH AND HUMAN SERVICES TO OFFER A BASIC HEALTH PROGRAM IN ACCORDANCE
WITH 42 U.S.C. 18051. THE COMMISSIONER MAY TAKE ANY AND ALL ACTIONS
NECESSARY TO OBTAIN SUCH APPROVALS.
3. ELIGIBILITY. A PERSON IS ELIGIBLE TO RECEIVE COVERAGE FOR HEALTH
CARE SERVICES PURSUANT TO THIS TITLE IF HE OR SHE:
(A) RESIDES IN NEW YORK STATE AND IS UNDER SIXTY-FIVE YEARS OF AGE;
(B) IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE UNDER TITLE ELEVEN OF THIS
ARTICLE OR FOR THE CHILD HEALTH INSURANCE PLAN DESCRIBED IN TITLE ONE-A
OF ARTICLE TWENTY-FIVE OF THE PUBLIC HEALTH LAW;
(C) IS NOT ELIGIBLE FOR MINIMUM ESSENTIAL COVERAGE, AS DEFINED IN
SECTION 5000A(F) OF THE INTERNAL REVENUE SERVICE CODE OF 1986, OR IS
ELIGIBLE FOR AN EMPLOYER-SPONSORED PLAN THAT IS NOT AFFORDABLE, IN
ACCORDANCE WITH SECTION 5000A OF SUCH CODE; AND
(D) (I) HAS HOUSEHOLD INCOME AT OR BELOW TWO HUNDRED PERCENT OF THE
FEDERAL POVERTY LINE DEFINED AND ANNUALLY REVISED BY THE UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR A HOUSEHOLD OF THE SAME
SIZE; AND (II) HAS HOUSEHOLD INCOME THAT EXCEEDS ONE HUNDRED
THIRTY-THREE PERCENT OF THE FEDERAL POVERTY LINE DEFINED AND ANNUALLY
REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR
A HOUSEHOLD OF THE SAME SIZE; HOWEVER, MAGI ELIGIBLE ALIENS LAWFULLY
PRESENT IN THE UNITED STATES WITH HOUSEHOLD INCOMES AT OR BELOW ONE
HUNDRED THIRTY-THREE PERCENT OF THE FEDERAL POVERTY LINE SHALL BE ELIGI-
BLE TO RECEIVE COVERAGE FOR HEALTH CARE SERVICES PURSUANT TO THE
PROVISIONS OF THIS TITLE IF SUCH ALIEN WOULD BE INELIGIBLE FOR MEDICAL
ASSISTANCE UNDER TITLE ELEVEN OF THIS ARTICLE DUE TO HIS OR HER IMMI-
GRATION STATUS.
AN APPLICANT WHO FAILS TO MAKE AN APPLICABLE PREMIUM PAYMENT SHALL
LOSE ELIGIBILITY TO RECEIVE COVERAGE FOR HEALTH CARE SERVICES IN ACCORD-
ANCE WITH TIME FRAMES AND PROCEDURES DETERMINED BY THE COMMISSIONER.
4. ENROLLMENT. (A) SUBJECT TO FEDERAL APPROVAL, THE COMMISSIONER IS
AUTHORIZED TO ESTABLISH AN APPLICATION AND ENROLLMENT PROCEDURE FOR
PROSPECTIVE ENROLLEES. SUCH PROCEDURE SHALL INCLUDE A VERIFICATION
SYSTEM FOR APPLICANTS, WHICH SHALL BE CONSISTENT WITH 42 USC S 1320B-7.
(B) SUCH PROCEDURE SHALL ALLOW FOR CONTINUOUS ENROLLMENT FOR ENROLLEES
TO THE BASIC HEALTH PROGRAM WHERE AN INDIVIDUAL MAY APPLY AND ENROLL FOR
COVERAGE AT ANY POINT.
(C) UPON AN APPLICANT'S ENROLLMENT IN A BASIC HEALTH INSURANCE PLAN,
COVERAGE FOR HEALTH CARE SERVICES PURSUANT TO THE PROVISIONS OF THIS
TITLE SHALL BE PROSPECTIVE. COVERAGE SHALL BEGIN IN A MANNER CONSISTENT
WITH THE REQUIREMENTS FOR QUALIFIED HEALTH PLANS OFFERED THROUGH THE
S. 6914 140 A. 9205
HEALTH INSURANCE EXCHANGE MARKETPLACE, AS DELINEATED IN FEDERAL REGU-
LATION AT 42 CFR 155.420(B)(1) OR ANY SUCCESSOR REGULATION THEREOF.
(D) A PERSON WHO HAS ENROLLED FOR COVERAGE PURSUANT TO THIS TITLE, AND
WHO LOSES ELIGIBILITY TO ENROLL IN THE BASIC HEALTH PROGRAM FOR A REASON
OTHER THAN CITIZENSHIP STATUS, LACK OF STATE RESIDENCE, FAILURE TO
PROVIDE A VALID SOCIAL SECURITY NUMBER, PROVIDING INACCURATE INFORMATION
THAT WOULD AFFECT ELIGIBILITY WHEN REQUESTING OR RENEWING HEALTH COVER-
AGE PURSUANT TO THIS TITLE, OR FAILURE TO MAKE AN APPLICABLE PREMIUM
PAYMENT, BEFORE THE END OF A TWELVE MONTH PERIOD BEGINNING ON THE EFFEC-
TIVE DATE OF THE PERSON'S INITIAL ELIGIBILITY FOR COVERAGE, OR BEFORE
THE END OF A TWELVE MONTH PERIOD BEGINNING ON THE DATE OF ANY SUBSEQUENT
DETERMINATION OF ELIGIBILITY, SHALL HAVE HIS OR HER ELIGIBILITY FOR
COVERAGE CONTINUED UNTIL THE END OF SUCH TWELVE MONTH PERIOD, PROVIDED
THAT THE STATE RECEIVES FEDERAL APPROVAL FOR USING FUNDS FROM THE BASIC
HEALTH PROGRAM TRUST FUND, ESTABLISHED UNDER SECTION 97-OOOO OF THE
STATE FINANCE LAW, FOR THE COSTS ASSOCIATED WITH SUCH ASSISTANCE.
5. PREMIUMS AND COST SHARING. (A) SUBJECT TO FEDERAL APPROVAL, THE
COMMISSIONER SHALL ESTABLISH PREMIUM PAYMENTS ENROLLEES SHALL PAY TO
APPROVED ORGANIZATIONS FOR COVERAGE OF HEALTH CARE SERVICES PURSUANT TO
THIS TITLE. SUCH PREMIUM PAYMENTS SHALL BE ESTABLISHED IN THE FOLLOWING
MANNER:
(I) UP TO TWENTY DOLLARS MONTHLY FOR AN INDIVIDUAL WITH A HOUSEHOLD
INCOME ABOVE ONE HUNDRED AND FIFTY PERCENT OF THE FEDERAL POVERTY LINE
BUT AT OR BELOW TWO HUNDRED PERCENT OF THE FEDERAL POVERTY LINE DEFINED
AND ANNUALLY REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN
SERVICES FOR A HOUSEHOLD OF THE SAME SIZE; AND
(II) NO PAYMENT IS REQUIRED FOR INDIVIDUALS WITH A HOUSEHOLD INCOME AT
OR BELOW ONE HUNDRED AND FIFTY PERCENT OF THE FEDERAL POVERTY LINE
DEFINED AND ANNUALLY REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH
AND HUMAN SERVICES FOR A HOUSEHOLD OF THE SAME SIZE.
(B) THE COMMISSIONER SHALL ESTABLISH COST SHARING OBLIGATIONS FOR
ENROLLEES, SUBJECT TO FEDERAL APPROVAL.
6. ANY FUNDS TRANSFERRED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES
TO THE STATE PURSUANT TO 42 U.S.C. 18051(D) SHALL BE DEPOSITED IN TRUST.
FUNDS FROM THE TRUST SHALL BE USED FOR PROVIDING HEALTH BENEFITS THROUGH
AN APPROVED ORGANIZATION, WHICH, AT A MINIMUM, SHALL INCLUDE ESSENTIAL
HEALTH BENEFITS AS DEFINED IN 42 U.S.C. 18022(B); TO REDUCE THE PREMIUMS
AND COST SHARING OF PARTICIPANTS IN THE BASIC HEALTH PROGRAM; OR FOR
SUCH OTHER PURPOSES AS MAY BE ALLOWED BY THE SECRETARY OF HEALTH AND
HUMAN SERVICES. HEALTH BENEFITS AVAILABLE THROUGH THE BASIC HEALTH
PROGRAM SHALL BE PROVIDED BY ONE OR MORE APPROVED ORGANIZATIONS PURSUANT
TO AN AGREEMENT WITH THE DEPARTMENT OF HEALTH AND SHALL MEET THE
REQUIREMENTS OF APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS.
7. AN INDIVIDUAL WHO IS LAWFULLY ADMITTED FOR PERMANENT RESIDENCE OR
PERMANENTLY RESIDING IN THE UNITED STATES UNDER COLOR OF LAW, AND WHO
WOULD BE INELIGIBLE FOR MEDICAL ASSISTANCE UNDER TITLE ELEVEN OF THIS
ARTICLE DUE TO HIS OR HER IMMIGRATION STATUS IF THE PROVISIONS OF
SECTION ONE HUNDRED TWENTY-TWO OF THIS CHAPTER WERE APPLIED, SHALL BE
CONSIDERED TO BE INELIGIBLE FOR MEDICAL ASSISTANCE FOR PURPOSES OF PARA-
GRAPHS (B) AND (C) OF SUBDIVISION THREE OF THIS SECTION.
S 52. Subparagraph 2 of paragraph (e) of subdivision 3 of section
367-a of the social services law, as added by section 16 of part D of
chapter 56 of the laws of 2013, is amended to read as follows:
(2) Payment pursuant to this paragraph shall be for premium obli-
gations of the individual under the qualified health plan and shall
continue only if and for so long as the individual's MAGI household
S. 6914 141 A. 9205
income exceeds one hundred thirty-three percent, but does not exceed one
hundred fifty percent, of the federal poverty line for the applicable
family size, OR, IF EARLIER, UNTIL THE INDIVIDUAL IS ELIGIBLE FOR
ENROLLMENT IN A STANDARD HEALTH PLAN PURSUANT TO SECTION THREE HUNDRED
SIXTY-NINE-GG OF THIS ARTICLE.
S 53. The state finance law is amended by adding a new section 97-oooo
to read as follows:
S 97-OOOO. BASIC HEALTH PROGRAM TRUST FUND. 1. THERE IS HEREBY ESTAB-
LISHED IN THE JOINT CUSTODY OF THE COMPTROLLER AND THE COMMISSIONER OF
TAXATION AND FINANCE A FUND, TO BE KNOWN AS THE "BASIC HEALTH PROGRAM
TRUST FUND".
2. SUCH FUND SHALL CONSIST OF MONEYS TRANSFERRED FROM THE FEDERAL
GOVERNMENT PURSUANT TO 42 U.S.C. S 18051(D) FOR THE PURPOSE OF REDUCING
THE PREMIUMS AND COST-SHARING OF, OR PROVIDING BENEFITS FOR, ELIGIBLE
INDIVIDUALS ENROLLED IN THE BASIC HEALTH PROGRAM, ESTABLISHED PURSUANT
TO SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW.
3. UPON FEDERAL APPROVAL, ALL MONIES IN SUCH FUND SHALL BE USED TO
IMPLEMENT AND OPERATE THE BASIC HEALTH PLAN, PURSUANT TO SECTION THREE
HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW, EXCEPT TO THE EXTENT
THAT THE PROVISIONS OF SUCH SECTION CONFLICT OR ARE INCONSISTENT WITH
FEDERAL LAW, IN WHICH CASE THE PROVISIONS OF SUCH FEDERAL LAW SHALL
SUPERSEDE SUCH STATE LAW PROVISIONS.
S 54. The state finance law is amended by adding a new section 97-xxxx
to read as follows:
S 97-XXXX. STATE HEALTH INNOVATION PLAN ACCOUNT. 1. THERE IS HEREBY
ESTABLISHED IN THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE
COMMISSIONER OF THE DEPARTMENT OF HEALTH AN ACCOUNT OF THE MISCELLANEOUS
SPECIAL REVENUE FUND TO BE KNOWN AS THE STATE HEALTH INNOVATION PLAN
ACCOUNT.
2. NOTWITHSTANDING ANY OTHER LAW, RULE OR REGULATION TO THE CONTRARY,
THE STATE COMPTROLLER IS HEREBY AUTHORIZED AND DIRECTED TO RECEIVE FOR
DEPOSIT TO THE CREDIT OF THE STATE HEALTH INNOVATION PLAN ACCOUNT,
MONIES RECEIVED PURSUANT TO THE STATE INNOVATION MODEL INITIATIVE FROM
THE CENTERS FOR MEDICARE AND MEDICAID INNOVATION.
3. MONEYS OF THIS ACCOUNT, FOLLOWING APPROPRIATION BY THE LEGISLATURE,
SHALL BE AVAILABLE TO THE DEPARTMENT OF HEALTH FOR SERVICES AND EXPENSES
OF THE STATE HEALTH INNOVATION PLAN.
S 55. Section 364-i of the social services law is amended by adding a
new subdivision 8 to read as follows:
8. (A) THE FOLLOWING INDIVIDUALS SHALL BE PRESUMED TO BE ELIGIBLE FOR
MEDICAL ASSISTANCE UNDER THIS TITLE BEGINNING ON THE DATE THAT A QUALI-
FIED HOSPITAL, AS DEFINED IN PARAGRAPH (B) OF THIS SUBDIVISION, DETER-
MINES, ON THE BASIS OF PRELIMINARY INFORMATION, THAT:
(1) A CHILD HAS MAGI HOUSEHOLD INCOME THAT DOES NOT EXCEED THE APPLI-
CABLE LEVEL FOR ELIGIBILITY AS PROVIDED FOR PURSUANT TO SUBPARAGRAPH TWO
OR THREE OF PARAGRAPH (B) OF SUBDIVISION ONE OF SECTION THREE HUNDRED
SIXTY-SIX OF THIS TITLE;
(2) A PREGNANT WOMAN HAS MAGI HOUSEHOLD INCOME THAT DOES NOT EXCEED
THE MAGI-EQUIVALENT OF TWO HUNDRED PERCENT OF THE FEDERAL POVERTY LINE
FOR THE APPLICABLE FAMILY SIZE;
(3) A PARENT OR CARETAKER RELATIVE HAS MAGI HOUSEHOLD INCOME THAT DOES
NOT EXCEED THE MAGI-EQUIVALENT OF ONE HUNDRED THIRTY PERCENT OF THE
HIGHEST AMOUNT THAT ORDINARILY WOULD HAVE BEEN PAID TO A PERSON WITHOUT
ANY INCOME OR RESOURCES UNDER THE FAMILY ASSISTANCE PROGRAM AS IT
EXISTED ON THE FIRST DAY OF NOVEMBER, NINETEEN HUNDRED NINETY-SEVEN, OR
HAS NET AVAILABLE INCOME, INCLUDING AVAILABLE SUPPORT FROM RESPONSIBLE
S. 6914 142 A. 9205
RELATIVES, THAT DOES NOT EXCEED THE AMOUNTS SET FORTH IN PARAGRAPH (A)
OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
(4) AN INDIVIDUAL IN NEED OF TREATMENT OF BREAST, CERVICAL, COLON, OR
PROSTATE CANCER MEETS THE REQUIREMENTS OF PARAGRAPH (D) OR (E) OF SUBDI-
VISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
(5) AN INDIVIDUAL AGE NINETEEN OR OLDER AND UNDER AGE SIXTY-FIVE MEETS
THE REQUIREMENTS OF SUBPARAGRAPH ONE OF PARAGRAPH (B) OF SUBDIVISION ONE
OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
(6) AN INDIVIDUAL UNDER TWENTY-SIX YEARS OF AGE MEETS THE REQUIREMENTS
OF SUBPARAGRAPH NINE OF PARAGRAPH (C) OF SUBDIVISION ONE OF SECTION
THREE HUNDRED SIXTY-SIX OF THIS TITLE; AND
(7) AN INDIVIDUAL HAS INCOME THAT DOES NOT EXCEED THE MAGI-EQUIVALENT
OF TWO HUNDRED PERCENT OF THE FEDERAL POVERTY LINE FOR THE APPLICABLE
FAMILY SIZE, AND THE INDIVIDUAL MEETS THE REQUIREMENTS OF SUBPARAGRAPH
SIX OF PARAGRAPH (B) OF SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-
SIX OF THIS TITLE; COVERAGE PURSUANT TO THIS SUBPARAGRAPH SHALL BE
LIMITED TO FAMILY PLANNING SERVICES REIMBURSED BY THE FEDERAL GOVERNMENT
AT A RATE OF NINETY PERCENT.
(B) FOR THE PURPOSES OF THIS SUBDIVISION, "QUALIFIED HOSPITAL" MEANS A
HOSPITAL THAT:
(1) IS LICENSED AS A GENERAL HOSPITAL UNDER ARTICLE TWENTY-EIGHT OF
THE PUBLIC HEALTH LAW;
(2) IS ENROLLED AS A PROVIDER IN THE PROGRAM OF MEDICAL ASSISTANCE
UNDER THIS TITLE;
(3) HAS NOTIFIED THE DEPARTMENT OF HEALTH OF ITS ELECTION TO MAKE
PRESUMPTIVE ELIGIBILITY DETERMINATIONS UNDER THIS SUBDIVISION, AND
AGREES TO MAKE SUCH DETERMINATIONS IN ACCORDANCE WITH POLICIES AND
PROCEDURES ESTABLISHED BY THE DEPARTMENT;
(4) HAS BEEN DESIGNATED BY THE DEPARTMENT OF HEALTH AS A CERTIFIED
APPLICATION COUNSELOR TO PROVIDE INFORMATION TO INDIVIDUALS CONCERNING
QUALIFIED HEALTH PLANS OFFERED THROUGH A HEALTH INSURANCE EXCHANGE AND
OTHER INSURANCE AFFORDABILITY PROGRAMS, ASSIST INDIVIDUALS TO APPLY FOR
COVERAGE THROUGH A QUALIFIED HEALTH PLAN OR INSURANCE AFFORDABILITY
PROGRAM, AND HELP FACILITATE THE ENROLLMENT OF ELIGIBLE INDIVIDUALS IN
SUCH PLANS OR PROGRAMS; AND
(5) HAS NOT BEEN DISQUALIFIED BY THE DEPARTMENT OF HEALTH PURSUANT TO
PARAGRAPH (C) OF THIS SUBDIVISION.
(C) THE DEPARTMENT OF HEALTH MAY DISQUALIFY A HOSPITAL AS A QUALIFIED
HOSPITAL IF THE DEPARTMENT DETERMINES THAT THE HOSPITAL IS NOT:
(1) MAKING, OR IS NOT CAPABLE OF MAKING, PRESUMPTIVE ELIGIBILITY
DETERMINATIONS IN ACCORDANCE WITH THE POLICIES AND PROCEDURES ESTAB-
LISHED BY THE DEPARTMENT; OR
(2) MEETING SUCH STANDARDS AS MAY BE ESTABLISHED BY THE DEPARTMENT
WITH RESPECT TO THE PROPORTION OF INDIVIDUALS DETERMINED PRESUMPTIVELY
ELIGIBLE BY THE HOSPITAL WHO ARE FOUND BY THE MEDICAL ASSISTANCE PROGRAM
TO BE ELIGIBLE FOR ONGOING MEDICAL ASSISTANCE AFTER THE END OF THE
PRESUMPTIVE ELIGIBILITY PERIOD.
(D) CARE, SERVICES AND SUPPLIES, AS SET FORTH IN SECTION THREE HUNDRED
SIXTY-FIVE-A OF THIS TITLE, THAT ARE FURNISHED TO AN INDIVIDUAL DURING A
PRESUMPTIVE ELIGIBILITY PERIOD UNDER THIS SUBDIVISION BY AN ENTITY THAT
IS ELIGIBLE FOR PAYMENTS UNDER THIS TITLE SHALL BE DEEMED TO BE MEDICAL
ASSISTANCE FOR PURPOSES OF PAYMENT AND STATE REIMBURSEMENT.
S 56. Subdivision 1 of section 366 of the social services law is
amended by adding a new paragraph (f) to read as follows:
(F) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS TITLE, FOR AN
INDIVIDUAL WHO HAS INCOME IN EXCESS OF AN APPLICABLE INCOME ELIGIBILITY
S. 6914 143 A. 9205
STANDARD AND IS ALLOWED TO ACHIEVE ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER THIS TITLE BY INCURRING MEDICAL EXPENSES EQUAL TO THE AMOUNT OF
SUCH EXCESS INCOME, THE AMOUNT OF EXCESS INCOME MAY BE CALCULATED BY
COMPARING THE INDIVIDUAL'S MAGI HOUSEHOLD INCOME TO THE MAGI-EQUIVALENT
OF THE APPLICABLE INCOME ELIGIBILITY STANDARD; PROVIDED, HOWEVER, THAT
MEDICAL ASSISTANCE SHALL BE FURNISHED PURSUANT TO THIS PARAGRAPH ONLY
IF, FOR SO LONG AS, AND TO THE EXTENT THAT FEDERAL FINANCIAL PARTIC-
IPATION IS AVAILABLE THEREFOR. THE COMMISSIONER OF HEALTH SHALL MAKE ANY
AMENDMENTS TO THE STATE PLAN FOR MEDICAL ASSISTANCE, OR APPLY FOR ANY
WAIVER OR APPROVAL UNDER THE FEDERAL SOCIAL SECURITY ACT THAT ARE NECES-
SARY TO CARRY OUT THE PROVISIONS OF THIS PARAGRAPH.
S 56-a. Section 364-j of the social services law is amended by adding
a new subdivision 30 to read as follows:
30. NOTWITHSTANDING THE PROVISIONS OF SECTION ONE HUNDRED SIXTY-THREE
OF THE STATE FINANCE LAW, OR SECTIONS ONE HUNDRED FORTY-TWO AND ONE
HUNDRED FORTY-THREE OF THE ECONOMIC DEVELOPMENT LAW, OR ANY CONTRARY
PROVISION OF LAW, IN THE EVENT THAT THE STATE RECEIVES PRIOR APPROVAL
AND ENHANCED FINANCIAL PARTICIPATION FROM THE CENTERS FOR MEDICAID AND
MEDICARE SERVICES, ADMINISTRATION FOR CHILDREN AND FAMILIES AND THE
FEDERAL FOOD AND NUTRITION SERVICES FOR REIMBURSEMENT PURSUANT TO AN
A-87 COST ALLOCATION WAIVER FOR ENHANCED FUNDING FOR INTEGRATED ELIGI-
BILITY SYSTEMS, THE STATE IS AUTHORIZED TO ENTER INTO CONTRACTS, AND/OR
TO AMEND THE TERMS OF CONTRACTS AWARDED PRIOR TO THE EFFECTIVE DATE OF
THIS SUBDIVISION, WITHOUT A COMPETITIVE BID OR REQUEST FOR PROPOSAL
PROCESS, CONSISTENT WITH FEDERAL REQUIREMENTS, FOR THE PURPOSE OF IMPLE-
MENTING PROJECTS AUTHORIZED UNDER SUCH WAIVER AMENDMENT; PROVIDED,
HOWEVER, IN THE CASE OF A CONTRACT ENTERED INTO AFTER THE EFFECTIVE DATE
OF THIS SUBDIVISION, THAT:
(A) THE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE AND THE OFFICE
OF GENERAL SERVICES, OR ANOTHER STATE AGENCY, SHALL POST ON ITS WEBSITE
AND CONCURRENTLY PROVIDE TO THE CHAIR OF THE SENATE HEALTH COMMITTEE AND
THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE, 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
SUBMIT AN OFFER, 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 SUBMIT AN OFFER,
WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
(B) ALL RESPONSIVE AND REASONABLE OFFERS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONER OF TEMPORARY AND DISABILITY ASSISTANCE OR OTHER STATE AGEN-
CY; AND
(C) THE COMMISSIONERS OF THE DEPARTMENT OF HEALTH, THE OFFICE OF
TEMPORARY AND DISABILITY ASSISTANCE AND THE OFFICE OF CHILDREN AND FAMI-
LY SERVICES, WORKING IN COOPERATION WITH THE STATE CHIEF INFORMATION
OFFICER AND THE OFFICE OF GENERAL SERVICES, SHALL AWARD SUCH CONTRACT TO
THE CONTRACTOR OR CONTRACTORS OFFER THAT PROVIDES THE BEST VALUE AS SUCH
TERM IS DEFINED IN SECTION ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE
LAW, TO THE STATE. AT NOTIFICATION THE COMMISSIONER OF HEALTH SHALL
PROVIDE THIS INFORMATION TO THE CHAIR OF THE SENATE STANDING HEALTH
COMMITTEE AND THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE.
S. 6914 144 A. 9205
(D) ALL DECISIONS MADE AND APPROACHES TAKEN PURSUANT TO THIS SUBDIVI-
SION SHALL BE DOCUMENTED IN A PROCUREMENT RECORD AS DEFINED IN SECTION
ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW.
(E) IN ACCORDANCE WITH ALL FEDERAL ADVANCE PLANNING DOCUMENT GUIDANCE
AND WITHIN THE PARAMETERS ESTABLISHED BY THE ENHANCED FINANCIAL PARTIC-
IPATION FROM THE CENTERS FOR MEDICAID AND MEDICARE SERVICES, ADMINIS-
TRATION FOR CHILDREN AND FAMILIES AND THE FEDERAL FOOD AND NUTRITION
SERVICES FOR REIMBURSEMENT TO AN A-87 COST ALLOCATION WAIVER FOR
ENHANCED FUNDING FOR INTEGRATED ELIGIBILITY SYSTEMS, PHASE 1 WILL
INCLUDE FOUNDATIONAL ALLOWABLE SHARED SERVICE COMPONENTS REQUIRED TO
SUCCESSFULLY MEET THE REQUIREMENTS FOR NON-MAGI MEDICAID SUCH AS A
COMMON CLIENT PORTAL, DOCUMENT MANAGEMENT, RULES ENGINES, WORKFLOW
MANAGEMENT TOOLS, CASE MANAGEMENT, NOTICES AND TRAINING.
(F) THE CONTRACT WILL REQUIRE TRAINING TO BE PROVIDED AT NO COST TO
THE SOCIAL SERVICES DISTRICTS.
(G) THE CONTRACT SHALL REQUIRE THE COMPLETION OF SHARED SERVICE COMPO-
NENTS BY THE TIMELINES NECESSARY TO RECEIVE THE ENHANCED FINANCIAL
PARTICIPATION FROM THE CENTERS FOR MEDICAID AND MEDICARE SERVICES,
ADMINISTRATION FOR CHILDREN AND FAMILIES AND THE FEDERAL FOOD AND NUTRI-
TION SERVICES FOR REIMBURSEMENT TO AN A-87 COST ALLOCATION WAIVER.
(H) THE COMMISSIONER SHALL PROVIDE, WITHIN THIRTY DAYS OF AWARD OF
SUCH CONTRACT OR CONTRACTS, THE CHAIR OF THE SENATE STANDING COMMITTEE
ON HEALTH AND THE CHAIR OF THE ASSEMBLY HEALTH COMMITTEE WITH A REPORT
OUTLINING THE PROCUREMENT AND AWARDS.
S 57. Subdivision 8 of section 2511 of the public health law is
amended by adding a new paragraph (h) to read as follows:
(H) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS TITLE, ARTICLES
THIRTY-TWO AND FORTY-THREE OF THE INSURANCE LAW AND SUBSECTION (E) OF
SECTION ELEVEN HUNDRED TWENTY OF THE INSURANCE LAW, FOR THE PERIOD APRIL
FIRST, TWO THOUSAND FOURTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
FIFTEEN, SUBSIDY PAYMENTS MADE TO APPROVED ORGANIZATIONS SHALL BE AT
AMOUNTS APPROVED PRIOR TO APRIL FIRST, TWO THOUSAND FOURTEEN.
S 58. Article 29-A of the public health law is amended by adding a new
title 1-A to read as follows:
TITLE 1-A
RURAL DENTISTRY PILOT PROGRAM
SECTION 2958-A. RURAL DENTISTRY PILOT PROGRAM.
S 2958-A. RURAL DENTISTRY PILOT PROGRAM. 1. THE COMMISSIONER SHALL,
WITHIN MONIES APPROPRIATED THEREFORE, ESTABLISH A RURAL DENTISTRY PILOT
PROGRAM IN CHAUTAUQUA, ALLEGANY, AND CATTARAUGUS COUNTIES. THE COMMIS-
SIONER SHALL, IN COORDINATION WITH THE UNIVERSITY OF BUFFALO SCHOOL OF
DENTISTRY STUDY COST SAVINGS ACHIEVED THROUGH THE PROVISION OF DENTAL
SERVICES IN GEOGRAPHICALLY ISOLATED AND UNDERSERVED AREAS. SUCH A STUDY
SHALL DETERMINE:
(I) THE QUALITY OF CARE PROVIDED THROUGH A MOBILE DENTAL SYSTEM,
INCLUDING MINIMIZING ANY ADVERSE EFFECTS ON DENTAL PRACTICES ALREADY
SERVING OR SEEKING TO ENTER RURAL OR UNDERSERVED COMMUNITIES, THE
INVOLVEMENT OF DENTAL PRACTICES SERVING RURAL OR UNDERSERVED COMMUNITIES
IN SUCH A MOBILE DENTAL SYSTEM, AND THE ESTABLISHMENT OF REFERRAL
SYSTEMS AND NETWORKS TO EXISTING DENTAL PRACTICES SERVING RURAL OR
UNDERSERVED COMMUNITIES FOR REGULAR ONGOING CARE OF PATIENTS;
(II) COST SAVINGS ACHIEVED THROUGH TARGETED ORAL HEALTH INITIATIVES IN
RURAL AREAS;
(III) COROLLARIES BETWEEN PREVENTATIVE DENTAL CARE AND IMPROVED
PATIENT OUTCOMES IN RURAL AREAS;
S. 6914 145 A. 9205
(IV) KNOWLEDGE, ATTITUDE, AND BEHAVIOR OUTCOMES AMONG DENTAL STUDENTS
AND RECOMMENDATIONS FOR RURAL DENTAL HEALTH EDUCATION CURRICULUM;
(V) A PROFILE OF THE PARTICIPANTS, THE NUMBER OF PERSONS SERVED, AND
HEALTH CARE DISPARITIES;
(VI) A DESCRIPTION OF THE ACTIVITIES OF THE PROGRAM;
(VII) GUIDANCE ON FACILITATED PARTICIPATION IN RURAL AREAS;
(VIII) PROVIDER SHORTAGES IN RURAL AREAS;
(IX) A DESCRIPTION OF THE IMPACT OF THE PROGRAMS ON THE COMMUNITY AND
RECOMMENDATIONS FOR REPLICATION/IMPROVEMENT IN OTHER RURAL AREAS; AND
(X) SUCH OTHER ACTIVITIES AS THE COMMISSIONER MAY DEEM NECESSARY AND
APPROPRIATE TO THIS SECTION.
2. TWELVE MONTHS AFTER THE APPROVAL OF THE RURAL DENTISTRY PILOT
PROGRAM, AND ANNUALLY THEREAFTER, THE PROGRAM SHALL REPORT TO THE
COMMISSIONER ON THE PROGRESS OF THE PROGRAM. THE COMMISSIONER SHALL
EVALUATE THE FINDINGS OF THE STUDY AND REPORT TO THE GOVERNOR, THE
TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE
CHAIR OF THE SENATE STANDING COMMITTEE ON HEALTH, THE CHAIR OF THE
ASSEMBLY HEALTH COMMITTEE AND THE CHAIR OF THE LEGISLATIVE COMMISSION ON
RURAL RESOURCES ON ITS FINDINGS.
3. ADDITIONALLY, TO THE EXTENT OF FUNDS APPROPRIATED THEREFORE,
MEDICAL ASSISTANCE FUNDS, INCLUDING ANY FUNDING OR SHARED SAVINGS AS MAY
BECOME AVAILABLE THROUGH FEDERAL WAIVERS OR OTHERWISE UNDER TITLES EIGH-
TEEN AND NINETEEN OF THE FEDERAL SOCIAL SECURITY ACT, MAY BE USED FOR
EXPENDITURES IN SUPPORT OF THE DEMONSTRATION PROGRAM.
4. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW TO THE CONTRARY,
THE COMMISSIONER IS AUTHORIZED TO WAIVE, MODIFY OR SUSPEND THE
PROVISIONS OF RULES AND REGULATIONS PROMULGATED PURSUANT TO ARTICLE
TWENTY-EIGHT OF THIS CHAPTER IF THE COMMISSIONER DETERMINES THAT SUCH
WAIVER, MODIFICATION OR SUSPENSION IS NECESSARY FOR THE SUCCESSFUL
IMPLEMENTING OF THE RURAL DENTISTRY PILOT PROGRAM AUTHORIZED PURSUANT TO
THIS SECTION AND PROVIDED THAT THE COMMISSIONER DETERMINES THAT THE
HEALTH, SAFETY AND GENERAL WELFARE OF PEOPLE RECEIVING HEALTH CARE UNDER
SUCH RURAL DENTISTRY PILOT PROGRAM WILL NOT BE IMPAIRED AS A RESULT OF
SUCH WAIVER, MODIFICATION, OR SUSPENSION.
S 59. Paragraph (d) of subdivision 2 of section 2511 of the public
health law is REPEALED.
S 60. Subparagraphs (iv) and (v) of paragraph (b) of subdivision 9 of
section 2511 of the public health law, subparagraph (iv) as amended by
section 33 of part D of chapter 56 of the laws of 2013 and subparagraph
(v) as amended by chapter 2 of the laws of 1998, are amended to read as
follows:
(iv) outstationing of persons who are authorized to provide assistance
to families in completing the enrollment application process under this
title and title eleven of article five of the social services law, in
locations, such as community settings, which are geographically accessi-
ble to large numbers of children who may be eligible for benefits under
such titles, and at times, including evenings and weekends, when large
numbers of children who may be eligible for benefits under such titles
are likely to be encountered. Persons outstationed in accordance with
this subparagraph shall be authorized to make determinations of presump-
tive eligibility in accordance with paragraph [(g)] (F) of subdivision
two of THIS section [two thousand five hundred and eleven of this
title]; and
(v) notice by local social services districts to medical assistance
applicants of the availability of benefits under paragraph [(g)] (F) of
S. 6914 146 A. 9205
subdivision two of THIS section [two thousand five hundred and eleven of
this title].
S 61. Subdivisions 3, 4 and 5 of section 47 of chapter 2 of the laws
of 1998, amending the public health law and other laws relating to
expanding the child health insurance plan, as amended by section 19 of
part D of chapter 59 of the laws of 2011, are amended to read as
follows:
3. section six of this act shall take effect January 1, 1999;
provided, however, that subparagraph (iii) of paragraph (c) of subdivi-
sion 9 of section 2510 of the public health law, as added by this act,
shall expire on July 1, [2014] 2017;
4. sections two, three, four, seven, eight, nine, fourteen, fifteen,
sixteen, eighteen, eighteen-a, [twenty-three,] twenty-four, and twenty-
nine of this act shall take effect January 1, 1999 and SECTION EIGH-
TEEN-A shall expire on July 1, 2014; section twenty-five of this act
shall take effect on January 1, 1999 and shall expire on April 1, 2005;
5. section twelve of this act shall take effect January 1, 1999;
provided, however, paragraphs (g) and (h) of subdivision 2 of section
2511 of the public health law, as added by such section, shall expire on
July 1, [2014] 2017;
S 62. The opening paragraph of subparagraph (ii) of paragraph (a) of
subdivision 2 of section 369 of the social services law, as amended by
chapter 41 of the laws of 1992, is amended to read as follows:
with respect to the real property of an individual who is an inpatient
in a nursing facility, intermediate care facility for the mentally
retarded, or other medical institution, [and] who is not reasonably
expected to be discharged from the medical institution and to return
home, AND WHO IS REQUIRED, AS A CONDITION OF RECEIVING SERVICES IN SUCH
INSTITUTION UNDER THE STATE PLAN FOR MEDICAL ASSISTANCE, TO SPEND FOR
COSTS OF MEDICAL CARE ALL BUT A MINIMAL AMOUNT OF HIS OR HER INCOME
REQUIRED FOR PERSONAL NEEDS; provided, however, any such lien will
dissolve upon the individual's discharge from the medical institution
and return home; in addition, no such lien may be imposed on the indi-
vidual's home if one of the following persons is lawfully residing in
the home:
S 62-a. Subparagraph (i) of paragraph (b) of subdivision 2 of section
369 of the social services law, as amended by chapter 170 of the laws of
1994, is amended to read as follows:
(i) Notwithstanding any inconsistent provision of this chapter or
other law, no adjustment or recovery may be made against the property of
any individual on account of any medical assistance correctly paid to or
on behalf of an individual under this title, except that recoveries must
be pursued:
(A) upon the sale of the property subject to a lien imposed on account
of medical assistance paid to an individual described in clause (ii) of
paragraph (a) of this subdivision, or from the estate of such individ-
ual; and
(B) from the estate of an individual who was fifty-five years of age
or older when he or she received such assistance, PROVIDED THAT FOR
INDIVIDUALS WHOSE ELIGIBILITY FOR MEDICAL ASSISTANCE WAS BASED ON PARA-
GRAPH (B) OF SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-SIX OF THIS
TITLE, RECOVERY SHALL BE LIMITED TO MEDICAL ASSISTANCE CONSISTING OF
NURSING FACILITY SERVICES, HOME AND COMMUNITY-BASED SERVICES, AND
RELATED HOSPITAL AND PRESCRIPTION DRUG SERVICES.
S 63. Section 4 of chapter 779 of the laws of 1986, amending the
social services law relating to authorizing services for non-residents
S. 6914 147 A. 9205
in adult homes, residences for adults and enriched housing programs, as
amended by chapter 108 of the laws of 2011, is amended to read as
follows:
S 4. This act shall take effect on the one hundred twentieth day after
it shall have become a law and shall remain in full force and effect
until July 1, [2014] 2017, provided however, that effective immediately,
the addition, amendment and/or repeal of any rules or regulations neces-
sary for the implementation of the foregoing sections of this act on its
effective date are authorized and directed to be made and completed on
or before such effective date.
S 64. Subdivision (i-1) of section 79 of part C of chapter 58 of the
laws of 2008, amending the social services law and the public health law
relating to adjustments of rates, as amended by section 21 of part D of
chapter 59 of the laws of 2011, is amended to read as follows:
(i-1) section thirty-one-a of this act shall be deemed repealed July
1, [2014] 2017;
S 65. Section 4 of chapter 19 of the laws of 1998, amending the social
services law relating to limiting the method of payment for prescription
drugs under the medical assistance program, as amended by section 107 of
part H of chapter 59 of the laws of 2011, is amended to read as follows:
S 4. This act shall take effect 120 days after it shall have become a
law and shall expire and be deemed repealed March 31, [2014] 2017.
S 66. Paragraph (e-1) of subdivision 12 of section 2808 of the public
health law, as amended by section 63 of part A of chapter 56 of the laws
of 2013, is amended to read as follows:
(e-1) Notwithstanding any inconsistent provision of law or regulation,
the commissioner shall provide, in addition to payments established
pursuant to this article prior to application of this section, addi-
tional payments under the medical assistance program pursuant to title
eleven of article five of the social services law for non-state operated
public residential health care facilities, including public residential
health care facilities located in the county of Nassau, the county of
Westchester and the county of Erie, but excluding public residential
health care facilities operated by a town or city within a county, in
aggregate annual amounts of up to one hundred fifty million dollars in
additional payments for the state fiscal year beginning April first, two
thousand six and for the state fiscal year beginning April first, two
thousand seven and for the state fiscal year beginning April first, two
thousand eight and of up to three hundred million dollars in such aggre-
gate annual additional payments for the state fiscal year beginning
April first, two thousand nine, and for the state fiscal year beginning
April first, two thousand ten and for the state fiscal year beginning
April first, two thousand eleven, and for the state fiscal years begin-
ning April first, two thousand twelve and April first, two thousand
thirteen, AND OF UP TO FIVE HUNDRED MILLION DOLLARS IN SUCH AGGREGATE
ANNUAL ADDITIONAL PAYMENTS FOR THE STATE FISCAL YEARS BEGINNING APRIL
FIRST, TWO THOUSAND FOURTEEN, APRIL FIRST, TWO THOUSAND FIFTEEN AND
APRIL FIRST, TWO THOUSAND SIXTEEN. The amount allocated to each eligible
public residential health care facility for this period shall be
computed in accordance with the provisions of paragraph (f) of this
subdivision, provided, however, that patient days shall be utilized for
such computation reflecting actual reported data for two thousand three
and each representative succeeding year as applicable, and provided
further, however, that, in consultation with impacted providers, of the
funds allocated for distribution in the state fiscal year beginning
S. 6914 148 A. 9205
April first, two thousand thirteen, up to thirty-two million dollars may
be allocated in accordance with paragraph (f-1) of this subdivision.
S 67. Paragraph (i) of subdivision 3 of section 461-1 of the social
services law, as amended by section 4 of part D of chapter 56 of the
laws of 2012, is amended to read as follows:
(i) (A) The commissioner of health is authorized to add up to six
thousand assisted living program beds to the gross number of assisted
living program beds having been determined to be available as of April
first, two thousand nine. Nothing herein shall be interpreted as prohib-
iting any eligible applicant from submitting an application for any
assisted living program bed so added. The commissioner of health shall
not be required to review on a comparative basis applications submitted
for assisted living program beds made available under this paragraph.
The commissioner of health shall only authorize the addition of six
thousand beds pursuant to a [five] SEVEN year plan ENDING PRIOR TO JANU-
ARY FIRST, TWO THOUSAND SEVENTEEN.
(B) THE COMMISSIONER OF HEALTH SHALL PROVIDE AN ANNUAL WRITTEN REPORT
TO THE CHAIR OF THE SENATE STANDING COMMITTEE ON HEALTH AND THE CHAIR OF
THE ASSEMBLY HEALTH COMMITTEE NO LATER THAN JANUARY FIRST OF EACH YEAR.
SUCH REPORT SHALL INCLUDE, BUT NOT BE LIMITED TO, THE NUMBER OF ASSISTED
LIVING PROGRAM BEDS MADE AVAILABLE PURSUANT TO THIS SECTION BY COUNTY,
THE TOTAL NUMBER OF ASSISTED LIVING PROGRAM BEDS BY COUNTY, THE NUMBER
OF VACANT ASSISTED LIVING PROGRAM BEDS BY COUNTY, AND ANY OTHER INFORMA-
TION DEEMED NECESSARY AND APPROPRIATE.
S 67-a. Subparagraph (v) of paragraph (b) of subdivision 35 of section
2807-c of the public health law, as amended by section 7 of part B of
chapter 56 of the laws of 2013, is amended to read as follows:
(v) such regulations shall incorporate quality related measures,
including, but not limited to, potentially preventable re-admissions
(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 annual periods beginning
April first, two thousand eleven through March thirty-first, two thou-
sand [fourteen] FIFTEEN, provided further that such aggregate reductions
shall be offset by Medicaid payment reductions occurring as a result of
decreased PPRs during the period July first, two thousand ten through
March thirty-first, two thousand eleven and the period April first, two
thousand eleven through March thirty-first, two thousand [fourteen]
FIFTEEN and as a result of decreased PPNOs during the period April
first, two thousand eleven through March thirty-first, two thousand
[fourteen] FIFTEEN; and provided further that for the period July first,
two thousand ten through March thirty-first, two thousand [fourteen]
FIFTEEN, 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-
S. 6914 149 A. 9205
ologies and benchmarks set forth in regulations issued pursuant to this
subparagraph;
S 67-b. Paragraph (b) of subdivision 1 of section 76 of chapter 731 of
the laws of 1993, amending the public health law and other laws relating
to reimbursement, delivery and capital cost of ambulatory health care
services and inpatient hospital services, as amended by section 28 of
part A of chapter 59 of the laws of 2011, is amended to read as follows:
(b) sections fifteen through nineteen and subdivision 3 of section
2807-e of the public health law as added by section twenty of this act
shall expire on July 1, [2014] 2017, and section seventy-four of this
act shall expire on July 1, 2007;
S 67-c. Section 18 of chapter 904 the laws of 1984, amending the
public health law and the social services law relating to encouraging
comprehensive health services, as amended by section 21 of part C of
chapter 59 of the laws of 2011, is amended to read as follows:
S 18. This act shall take effect immediately, except that sections
six, nine, ten and eleven of this act shall take effect on the sixtieth
day after it shall have become a law, sections two, three, four and nine
of this act shall expire and be of no further force or effect on or
after March 31, [2014] 2017, section two of this act shall take effect
on April 1, 1985 or seventy-five days following the submission of the
report required by section one of this act, whichever is later, and
sections eleven and thirteen of this act shall expire and be of no
further force or effect on or after March 31, 1988.
S 68. 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 69. 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 70. 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 71. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2014 provided
that:
1. sections five, fifty-nine and sixty of this act shall take effect
July 1, 2014;
2. section twenty-six of this act shall take effect immediately and be
deemed to have been in full force and effect on and after March 1, 2014;
3. section nine of this act shall take effect May 1, 2014; provided,
however, that the amendments to subparagraph (iii) of paragraph (c) of
subdivision 6 of section 367-a of the social services law made by
S. 6914 150 A. 9205
section nine of this act shall not affect the repeal of such paragraph
and shall be deemed repealed therewith;
3-a. amendments made to section 365-h of the social services law made
by section seven of this act, shall not affect the repeal of such
section and shall be deemed repealed therewith.
3-b. section twenty-six-a of this act shall take effect October 1,
2014;
3-c. sections fifty, fifty-one, fifty-two and fifty-three shall take
effect April 1, 2015;
3-d. section fifty-five of this act shall take effect January 1, 2015;
4. the amendments to subdivision 9 of section 2511 of the public
health law made by section sixty of this act shall not affect the expi-
ration of such subdivision and shall expire therewith;
4-a. section twenty-two of this act shall take effect April 1, 2014,
and shall be deemed expired January 1, 2017;
4-b. the amendments to subdivisions (a) and (b) of section 364-jj of
the social services law made by section thirty-nine of this act shall
not affect the expiration of such section and shall be deemed to expire
therewith;
4-c. the amendments to section 364-j of the social services law made
by section forty-nine of this act shall not affect the repeal of such
section and shall be deemed to repeal therewith;
4-d. the amendments to section 48-a of part A of chapter 56 of the
laws of 2013 made by section thirteen of this act shall not affect the
expiration of such section and shall expire therewith;
4-e. the amendments to section 1 of part H of chapter 111 of the laws
of 2010 made by section fifteen of this act shall not affect the expira-
tion of such section and shall expire therewith;
5. 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;
6. 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;
7. the commissioner of health and the superintendent of the department
of financial services and any appropriate council may take any steps
necessary to implement this act prior to its effective date;
8. 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 the department of
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
9. the provisions of this act shall become effective notwithstanding
the failure of the commissioner of health or the superintendent of the
department of financial services or any council to adopt or amend or
promulgate regulations implementing this act.
PART D
Section 1. Section 6802 of the education law is amended by adding
three new subdivisions 24, 25 and 26 to read as follows:
24. "COMPOUNDING" MEANS THE COMBINING, ADMIXING, MIXING, DILUTING,
POOLING, RECONSTITUTING, OR OTHERWISE ALTERING OF A DRUG OR BULK DRUG
S. 6914 151 A. 9205
SUBSTANCE TO CREATE A DRUG WITH RESPECT TO AN OUTSOURCING FACILITY UNDER
SECTION 503B OF THE FEDERAL FOOD, DRUG AND COSMETIC ACT AND FURTHER
DEFINED IN THIS SECTION.
25. "OUTSOURCING FACILITY" MEANS A FACILITY THAT:
(A) IS ENGAGED IN THE COMPOUNDING OF STERILE DRUGS;
(B) IS CURRENTLY REGISTERED AS AN OUTSOURCING FACILITY WITH THE SECRE-
TARY OF HEALTH AND HUMAN SERVICES; AND
(C) COMPLIES WITH ALL APPLICABLE REQUIREMENTS OF FEDERAL AND STATE
LAW, INCLUDING THE FEDERAL FOOD, DRUG AND COSMETIC ACT.
26. "STERILE DRUG" MEANS A DRUG THAT IS INTENDED FOR PARENTERAL ADMIN-
ISTRATION, AN OPHTHALMIC OR ORAL INHALATION DRUG IN AQUEOUS FORMAT, OR A
DRUG THAT IS REQUIRED TO BE STERILE UNDER FEDERAL OR STATE LAW.
S 2. Subdivision 1 of section 6808 of the education law, as added by
chapter 987 of the laws of 1971, is amended to read as follows:
1. No person, firm, corporation or association shall possess drugs,
prescriptions or poisons for the purpose of compounding, dispensing,
retailing, wholesaling, or manufacturing, or shall offer drugs,
prescriptions or poisons for sale at retail or wholesale unless regis-
tered by the department as a pharmacy, [store,] wholesaler, [or]
manufacturer OR OUTSOURCING FACILITY.
S 3. Subdivisions 5, 6 and 7 of section 6808 of the education law are
renumbered subdivisions 6, 7 and 8 and a new subdivision 5 is added to
read as follows:
5. OUTSOURCING FACILITY'S REGISTRATION.
A. OBTAINING A REGISTRATION. AN OUTSOURCING FACILITY SHALL BE REGIS-
TERED AS FOLLOWS:
(1) AN APPLICATION FOR INITIAL REGISTRATION OR RENEWAL OF REGISTRATION
SHALL BE MADE ON A FORM PRESCRIBED BY THE DEPARTMENT.
(2) AN APPLICATION FOR INITIAL REGISTRATION SHALL BE ACCOMPANIED BY A
FEE OF EIGHT HUNDRED TWENTY-FIVE DOLLARS.
B. RENEWAL OF REGISTRATION. ALL OUTSOURCING FACILITIES' REGISTRATIONS
SHALL BE RENEWED ON A DATE SET BY THE DEPARTMENT. THE TRIENNIAL REGIS-
TRATION FEE SHALL BE FIVE HUNDRED TWENTY DOLLARS OR A PRO RATED PORTION
THEREOF AS DETERMINED BY THE DEPARTMENT.
C. DISPLAY OF REGISTRATION. THE REGISTRATION SHALL BE DISPLAYED
CONSPICUOUSLY IN THE PLACE OF BUSINESS.
D. CHANGE OF LOCATION. IN THE EVENT THAT THE LOCATION OF SUCH PLACE OF
BUSINESS SHALL BE CHANGED, THE OWNER SHALL APPLY TO THE DEPARTMENT FOR
INSPECTION OF THE NEW LOCATION AND ENDORSEMENT OF THE REGISTRATION FOR
THE NEW LOCATION. THE FEE FOR INSPECTION AND ENDORSEMENT SHALL BE ONE
HUNDRED SEVENTY-FIVE DOLLARS, UNLESS IT APPEARS TO THE SATISFACTION OF
THE DEPARTMENT THAT THE CHANGE IN LOCATION IS OF A TEMPORARY NATURE DUE
TO FIRE, FLOOD OR OTHER DISASTER.
E. REPORT. UPON INITIALLY REGISTERING AS AN OUTSOURCING FACILITY AND
EVERY SIX MONTHS THEREAFTER, EACH OUTSOURCING FACILITY SHALL SUBMIT TO
THE EXECUTIVE SECRETARY OF THE STATE BOARD OF PHARMACY A REPORT:
(1) IDENTIFYING THE DRUGS COMPOUNDED BY SUCH OUTSOURCING FACILITY
DURING THE PREVIOUS 6-MONTH PERIOD; AND
(2) WITH RESPECT TO EACH DRUG IDENTIFIED UNDER SUBPARAGRAPH ONE OF
THIS PARAGRAPH, PROVIDING THE ACTIVE INGREDIENT; THE SOURCE OF SUCH
ACTIVE INGREDIENT; THE NATIONAL DRUG CODE NUMBER OF THE SOURCE DRUG OR
BULK ACTIVE INGREDIENT, IF AVAILABLE; THE STRENGTH OF THE ACTIVE INGRE-
DIENT PER UNIT; THE DOSAGE FORM AND ROUTE OF ADMINISTRATION; THE PACKAGE
DESCRIPTION; THE NUMBER OF INDIVIDUAL UNITS PRODUCED; AND THE NATIONAL
DRUG CODE NUMBER OF THE FINAL PRODUCT, IF ASSIGNED.
S. 6914 152 A. 9205
F. CONDUCT OF OUTSOURCING FACILITY. EVERY OWNER OF AN OUTSOURCING
FACILITY IS RESPONSIBLE FOR THE STRENGTH, QUALITY, PURITY AND LABELING
THEREOF OF ALL COMPOUNDED DRUGS, SUBJECT TO THE GUARANTY PROVISIONS OF
THIS ARTICLE AND THE PUBLIC HEALTH LAW. EVERY OUTSOURCING FACILITY SHALL
BE UNDER THE IMMEDIATE SUPERVISION AND MANAGEMENT OF A PHARMACIST
LICENSED TO PRACTICE IN NEW YORK STATE.
G. APPLICANT FOR REGISTRATION. AN APPLICANT FOR REGISTRATION OF AN
OUTSOURCING FACILITY SHALL BE OF GOOD MORAL CHARACTER, AS DETERMINED BY
THE DEPARTMENT. IN THE CASE OF A CORPORATE APPLICANT, THE REQUIREMENT
SHALL EXTEND TO ALL OFFICERS AND DIRECTORS AND STAKEHOLDERS HAVING A TEN
PERCENT OR GREATER INTEREST IN THE CORPORATION.
S 4. Subdivisions 6 and 7 of section 6808 of the education law, as
added by chapter 987 of the laws of 1971, such subdivisions as renum-
bered by section three of this act, are amended to read as follows:
6. Inspection. The state board of pharmacy and the department of
education, and their employees designated by the commissioner, shall
have the right to enter any pharmacy, wholesaler, manufacturer, [or
registered store,] OUTSOURCING FACILITY or vehicle and to inspect, at
reasonable times, such factory, warehouse, establishment or vehicle and
all records required by this article, pertinent equipment, finished and
unfinished materials, containers, and labels.
7. [Revocation or suspension] PENALTIES. A pharmacy, [store,] whole-
saler [or], manufacturer [registration may be revoked or suspended by
the committee on professional conduct of the state board of pharmacy in
accordance with the provisions of article one hundred thirty] OR
OUTSOURCING FACILITY REGISTERED UNDER THIS SECTION SHALL BE UNDER THE
SUPERVISION OF THE BOARD OF REGENTS AND SHALL BE SUBJECT TO DISCIPLINARY
PROCEEDINGS AND PENALTIES IN ACCORDANCE WITH ARTICLE ONE HUNDRED THIRTY
OF THIS CHAPTER IN THE SAME MANNER AND TO THE SAME EXTENT AS INDIVIDUALS
AND PROFESSIONAL SERVICE CORPORATIONS WITH RESPECT TO THEIR LICENSES AND
REGISTRATIONS, PROVIDED THAT FAILURE TO COMPLY WITH THE REQUIREMENTS OF
THIS SECTION SHALL CONSTITUTE PROFESSIONAL MISCONDUCT.
S 5. Subdivision 1 of section 6808-b of the education law, as amended
by chapter 567 of the laws of 2002, is amended to read as follows:
1. Definition. The term "nonresident establishment" shall mean any
pharmacy, manufacturer [or], wholesaler, OR OUTSOURCING FACILITY located
outside of the state that ships, mails or delivers prescription drugs or
devices to other establishments, authorized prescribers and/or patients
residing in this state. Such establishments shall include, but not be
limited to, pharmacies that transact business through the use of the
internet.
S 6. Paragraph f of subdivision 4 of section 6808-b of the education
law, as amended by chapter 567 of the laws of 2002, is amended to read
as follows:
f. The application of establishments to be registered as a manufactur-
er [or], wholesaler OR OUTSOURCING FACILITY of drugs and/or devices
shall be accompanied by a fee as provided in section sixty-eight hundred
eight of this article; and
S 7. Section 6810 of the education law is amended by adding a new
subdivision 14 to read as follows:
14. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, NO
OUTSOURCING FACILITY MAY DISTRIBUTE OR DISPENSE ANY DRUG TO ANY PERSON
PURSUANT TO A PRESCRIPTION UNLESS IT IS ALSO REGISTERED AS A PHARMACY IN
THIS STATE AND MEETS ALL OTHER APPLICABLE REQUIREMENTS OF FEDERAL AND
STATE LAW.
S. 6914 153 A. 9205
S 8. Section 6811 of the education law is amended by adding a new
subdivision 26 to read as follows:
26. ANY OUTSOURCING FACILITY TO SELL OR OFFER TO SELL ANY DRUG THAT IS
NOT BOTH COMPOUNDED UNDER THE PERSONAL SUPERVISION OF A LICENSED PHARMA-
CIST AND LABELED WITH THE FULL NAME OF THE OUTSOURCING FACILITY.
S 9. Subdivisions 1 and 2 of section 6811-a of the education law, as
added by chapter 729 of the laws of 1981, are amended to read as
follows:
1. [No] EXCEPT AS OTHERWISE AUTHORIZED IN THE FEDERAL FOOD, DRUG AND
COSMETIC ACT, NO drug for which a prescription is required by the
provisions of the Federal Food, Drug and Cosmetic Act or by the commis-
sioner of health may be manufactured or commercially distributed within
this state in tablet or capsule form unless it has clearly marked or
imprinted on each such tablet or capsule in conformance with the appli-
cable plan required by subdivision three of this section:
(a) an individual symbol, number, company name, words, letters, mark-
ing or National Drug Code (hereinafter referred to as N. D. C.) number
identifying the manufacturer or distributor of the drug; and
(b) an N. D. C. number, symbol, number, letters, words or marking
identifying such drug or combination of drugs.
2. [No] EXCEPT AS OTHERWISE AUTHORIZED IN THE FEDERAL FOOD, DRUG AND
COSMETIC ACT, NO drug for which any prescription is required by the
provisions of the Federal Food, Drug and Cosmetic Act or by the commis-
sioner of health contained within a bottle, vial, carton or other
container, or in any way affixed or appended to or enclosed within a
package of any kind, and designed or intended for delivery in such
container or package to an ultimate consumer, shall be manufactured or
distributed within this state unless such container or package has
clearly and permanently marked or imprinted upon it in conformance with
the applicable plan required by subdivision three of this section:
(a) an individual symbol, N. D. C. number, company name, number,
letters, words or marking identifying the manufacturer or distributor of
the drug;
(b) an N. D. C. number, symbol, number, letters, words or marking
identifying such drug or combination of drugs; and
(c) whenever the distributor of the prescription drug product does not
also manufacture the product the names and places of business of both
shall appear on the label in words clearly distinguishing each.
S 10. Subdivision 1 of section 6812 of the education law, as added by
chapter 987 of the laws of 1971, is amended to read as follows:
1. Where any pharmacy, MANUFACTURER, WHOLESALER OR OUTSOURCING FACILI-
TY registered by the department is damaged by fire the board shall be
notified within a period of forty-eight hours, and the board shall have
power to impound all drugs for analysis and condemnation, if found unfit
for use. Where a pharmacy is discontinued, the owner of its
prescription records shall notify the department as to the disposition
of said prescription records, and in no case shall records be sold or
given away to a person who does not currently possess a registration to
operate a pharmacy.
S 11. Subdivision 1 of section 6817 of the education law, as added by
chapter 987 of the laws of 1971, is amended to read as follows:
1. [No] EXCEPT AS OTHERWISE PROVIDED IN THE FEDERAL FOOD, DRUG AND
COSMETIC ACT, NO person shall sell, deliver, offer for sale, hold for
sale, or give away any new drug, unless:
a. an application with respect thereto has become effective, or in the
case of an investigational drug the sponsor has complied with the appli-
S. 6914 154 A. 9205
cable requirements, under the [federal food, drug, and cosmetic act]
FEDERAL FOOD, DRUG, AND COSMETIC ACT, or
b. when not subject to such act, such drug has been tested and has not
been found to be unsafe or ineffective for use under the conditions
prescribed, recommended or suggested in the labeling thereof, and, prior
to selling or offering for sale such drug, there has been filed with the
department an application setting forth
(1) full reports of investigations which have been made to show wheth-
er or not such drug is safe and effective for use;
(2) a full list of the ingredients used as components of such drug;
(3) a full statement of the composition of such drug;
(4) a full description of the methods used in, and the facilities and
controls used for, the manufacture, processing and packing of such
drugs;
(5) such samples of such drug and of the ingredients used as compo-
nents thereof as the board or secretary may require; and
(6) specimens of the labeling proposed to be used for such drug.
S 12. The education law is amended by adding a new section 6831 to
read as follows:
S 6831. SPECIAL PROVISIONS RELATING TO OUTSOURCING FACILITIES. 1.
REGISTRATION. ANY OUTSOURCING FACILITY THAT IS ENGAGED IN THE COMPOUND-
ING OF STERILE DRUGS IN THIS STATE SHALL BE REGISTERED AS AN OUTSOURCING
FACILITY UNDER THE FEDERAL FOOD, DRUG AND COSMETIC ACT AND BE REGISTERED
AS AN OUTSOURCING FACILITY PURSUANT TO THIS ARTICLE.
2. NEW DRUGS. SECTIONS 502(F)(1), 505 AND 582 OF THE FEDERAL FOOD,
DRUG AND COSMETIC ACT SHALL NOT APPLY TO A DRUG COMPOUNDED IN AN
OUTSOURCING FACILITY REGISTERED UNDER THE FEDERAL FOOD, DRUG AND COSMET-
IC ACT.
3. PRESCRIPTIONS. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE
CONTRARY, NO OUTSOURCING FACILITY MAY DISTRIBUTE OR DISPENSE ANY DRUG TO
ANY PERSON PURSUANT TO A PRESCRIPTION UNLESS IT IS ALSO REGISTERED AS A
PHARMACY IN THIS STATE AND MEETS ALL OTHER APPLICABLE REQUIREMENTS OF
FEDERAL AND STATE LAW.
4. RESTRICTIONS. ANY DRUGS COMPOUNDED IN AN OUTSOURCING FACILITY
REGISTERED PURSUANT TO THIS ARTICLE SHALL BE COMPOUNDED IN ACCORDANCE
WITH ALL APPLICABLE FEDERAL AND STATE LAWS.
5. LABELING. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRA-
RY, THE LABEL OF ANY DRUG COMPOUNDED BY AN OUTSOURCING FACILITY SHALL
INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING:
(A) A STATEMENT THAT THE DRUG IS A COMPOUNDED DRUG OR A REASONABLE
COMPARABLE ALTERNATIVE STATEMENT THAT PROMINENTLY IDENTIFIES THE DRUG AS
A COMPOUNDED DRUG;
(B) THE NAME, ADDRESS, AND PHONE NUMBER OF THE APPLICABLE OUTSOURCING
FACILITY; AND
(C) WITH RESPECT TO THE DRUG:
(I) THE LOT OR BATCH NUMBER;
(II) THE ESTABLISHED NAME OF THE DRUG;
(III) THE DOSAGE FORM AND STRENGTH;
(IV) THE STATEMENT OF QUANTITY OR VOLUME, AS APPROPRIATE;
(V) THE DATE THAT THE DRUG WAS COMPOUNDED;
(VI) THE EXPIRATION DATE;
(VII) STORAGE AND HANDLING INSTRUCTIONS;
(VIII) THE NATIONAL DRUG CODE NUMBER, IF AVAILABLE;
(IX) THE STATEMENT THAT THE DRUG IS NOT FOR RESALE, AND THE STATEMENT
"OFFICE USE ONLY"; AND
S. 6914 155 A. 9205
(X) A LIST OF THE ACTIVE AND INACTIVE INGREDIENTS, IDENTIFIED BY
ESTABLISHED NAME, AND THE QUANTITY OR PROPORTION OF EACH INGREDIENT.
6. CONTAINER. THE CONTAINER FROM WHICH THE INDIVIDUAL UNITS OF THE
DRUG ARE REMOVED FOR DISPENSING OR FOR ADMINISTRATION (SUCH AS A PLASTIC
BAG CONTAINING INDIVIDUAL PRODUCT SYRINGES) SHALL INCLUDE:
(A) A LIST OF ACTIVE AND INACTIVE INGREDIENTS, IDENTIFIED BY ESTAB-
LISHED NAME, AND THE QUANTITY OR PROPORTION OF EACH INGREDIENT; AND
(B) ANY OTHER INFORMATION REQUIRED BY REGULATIONS PROMULGATED BY THE
COMMISSIONER TO FACILITATE ADVERSE EVENT REPORTING IN ACCORDANCE WITH
THE REQUIREMENTS ESTABLISHED IN SECTION 310.305 OF TITLE 21 OF THE CODE
OF FEDERAL REGULATIONS.
7. BULK DRUGS. A DRUG MAY ONLY BE COMPOUNDED IN AN OUTSOURCING FACILI-
TY THAT DOES NOT COMPOUND USING BULK DRUG SUBSTANCES AS DEFINED IN
SECTION 207.3(A)(4) OF TITLE 21 OF THE CODE OF FEDERAL REGULATIONS OR
ANY SUCCESSOR REGULATION UNLESS:
(A) THE BULK DRUG SUBSTANCE APPEARS ON A LIST ESTABLISHED BY THE
SECRETARY OF HEALTH AND HUMAN SERVICES IDENTIFYING BULK DRUG SUBSTANCES
FOR WHICH THERE IS A CLINICAL NEED;
(B) THE DRUG IS COMPOUNDED FROM A BULK DRUG SUBSTANCE THAT APPEARS ON
THE FEDERAL DRUG SHORTAGE LIST IN EFFECT AT THE TIME OF COMPOUNDING,
DISTRIBUTING, AND DISPENSING;
(C) IF AN APPLICABLE MONOGRAPH EXISTS UNDER THE UNITED STATES PHARMA-
COPEIA, THE NATIONAL FORMULARY, OR ANOTHER COMPENDIUM OR PHARMACOPEIA
RECOGNIZED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES AND THE BULK
DRUG SUBSTANCES EACH COMPLY WITH THE MONOGRAPH;
(D) THE BULK DRUG SUBSTANCES ARE EACH MANUFACTURED BY AN ESTABLISHMENT
THAT IS REGISTERED WITH THE FEDERAL GOVERNMENT.
8. INGREDIENTS. IF AN OUTSOURCING FACILITY USES INGREDIENTS, OTHER
THAN BULK DRUG SUBSTANCES, SUCH INGREDIENTS MUST COMPLY WITH THE STAND-
ARDS OF THE APPLICABLE UNITED STATES PHARMACOPEIA OR NATIONAL FORMULARY
MONOGRAPH, IF SUCH MONOGRAPH EXISTS, OR OF ANOTHER COMPENDIUM OR PHARMA-
COPEIA RECOGNIZED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES FOR
PURPOSES OF THIS SUBDIVISION, IF ANY.
9. UNSAFE OR INEFFECTIVE DRUGS. NO OUTSOURCING FACILITY MAY COMPOUND A
DRUG THAT APPEARS ON A LIST PUBLISHED BY THE SECRETARY OF HEALTH AND
HUMAN SERVICES THAT HAS BEEN WITHDRAWN OR REMOVED FROM THE MARKET
BECAUSE SUCH DRUGS OR COMPONENTS OF SUCH DRUGS HAVE BEEN FOUND TO BE
UNSAFE OR NOT EFFECTIVE.
10. PROHIBITION ON WHOLESALING. NO COMPOUNDED DRUG WILL BE SOLD OR
TRANSFERRED BY ANY ENTITY OTHER THAN THE OUTSOURCING FACILITY THAT
COMPOUNDED SUCH DRUG. THIS DOES NOT PROHIBIT THE ADMINISTRATION OF A
DRUG IN A HEALTH CARE SETTING OR DISPENSING A DRUG PURSUANT TO A PROPER-
LY EXECUTED PRESCRIPTION.
11. PROHIBITION AGAINST COPYING AN APPROVED DRUG. NO OUTSOURCING
FACILITY MAY COMPOUND A DRUG THAT IS ESSENTIALLY A COPY OF ONE OR MORE
APPROVED DRUGS.
12. PROHIBITION AGAINST COMPOUNDING DRUGS PRESENTING DEMONSTRABLE
DIFFICULTIES. NO OUTSOURCING FACILITY MAY COMPOUND A DRUG:
I. THAT IS IDENTIFIED, DIRECTLY OR AS PART OF A CATEGORY OF DRUGS, ON
A LIST PUBLISHED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES THAT
PRESENT DEMONSTRABLE DIFFICULTIES FOR COMPOUNDING THAT ARE REASONABLY
LIKELY TO LEAD TO AN ADVERSE EFFECT ON THE SAFETY OR EFFECTIVENESS OF
THE DRUG OR CATEGORY OF DRUGS, TAKING INTO ACCOUNT THE RISKS AND BENE-
FITS TO PATIENTS; OR
S. 6914 156 A. 9205
II. THAT IS COMPOUNDED IN ACCORDANCE WITH ALL APPLICABLE CONDITIONS
IDENTIFIED ON THE DRUG LIST AS CONDITIONS THAT ARE NECESSARY TO PREVENT
THE DRUG OR CATEGORY OF DRUGS FROM PRESENTING DEMONSTRABLE DIFFICULTIES.
13. ADVERSE EVENT REPORTS. OUTSOURCING FACILITIES SHALL SUBMIT A COPY
OF ALL ADVERSE EVENT REPORTS SUBMITTED TO THE SECRETARY OF HEALTH AND
HUMAN SERVICES IN ACCORDANCE WITH THE CONTENT AND FORMAT REQUIREMENTS
ESTABLISHED IN SECTION 310.305 OF TITLE 21 OF THE CODE OF FEDERAL REGU-
LATIONS, OR ANY SUCCESSOR REGULATION, TO THE EXECUTIVE SECRETARY FOR THE
STATE BOARD OF PHARMACY.
14. REPORTS. THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER
OF HEALTH, SHALL PREPARE AND SUBMIT A REPORT TO THE GOVERNOR AND THE
LEGISLATURE, DUE EIGHTEEN MONTHS FROM THE EFFECTIVE DATE OF THIS
SECTION, EVALUATING THE EFFECTIVENESS OF THE REGISTRATION AND OVERSIGHT
OF OUTSOURCING FACILITIES RELATED TO COMPOUNDING.
S 13. Section 3302 of the public health law is amended by adding two
new subdivisions 42 and 43 to read as follows:
42. "COMPOUNDING" MEANS THE COMBINING, ADMIXING, MIXING, DILUTING,
POOLING, RECONSTITUTING, OR OTHERWISE ALTERING OF A DRUG OR BULK DRUG
SUBSTANCE TO CREATE A DRUG WITH RESPECT TO AN OUTSOURCING FACILITY UNDER
SECTION 503B OF THE FEDERAL FOOD, DRUG AND COSMETIC ACT AND FURTHER
DEFINED IN THIS SECTION.
43. "OUTSOURCING FACILITY" MEANS A FACILITY THAT:
(A) IS ENGAGED IN THE COMPOUNDING OF STERILE DRUGS AS DEFINED IN
SECTION SIXTY-EIGHT HUNDRED TWO OF THE EDUCATION LAW;
(B) IS CURRENTLY REGISTERED AS AN OUTSOURCING FACILITY PURSUANT TO
ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW; AND
(C) COMPLIES WITH ALL APPLICABLE REQUIREMENTS OF FEDERAL AND STATE
LAW, INCLUDING THE FEDERAL FOOD, DRUG AND COSMETIC ACT.
NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, WHEN AN
OUTSOURCING FACILITY DISTRIBUTES OR DISPENSES ANY DRUG TO ANY PERSON
PURSUANT TO A PRESCRIPTION, SUCH OUTSOURCING FACILITY SHALL BE DEEMED TO
BE PROVIDING PHARMACY SERVICES AND SHALL BE SUBJECT TO ALL LAWS, RULES
AND REGULATIONS GOVERNING PHARMACIES AND PHARMACY SERVICES.
S 14. The opening paragraph of subdivision 2 of section 3318 of the
public health law, as added by chapter 878 of the laws of 1972, is
amended to read as follows:
No controlled substance contained within a bottle, vial, carton or
other container, or in any way affixed or appended to or enclosed within
a package of any kind, and designed or intended for delivery in such
container or package to an ultimate consumer, shall be manufactured,
DELIVERED or distributed within this state unless such container or
package has clearly and permanently marked or imprinted upon it:
S 15. Subdivision 1 of section 3320 of the public health law, as added
by chapter 878 of the laws of 1972, is amended to read as follows:
1. Controlled substances may be lawfully distributed within this state
only to licensed distributors or manufacturers, practitioners, pharma-
cists, pharmacies, institutional dispensers, REGISTERED OUTSOURCING
FACILITIES, and laboratory, research or instructional facilities author-
ized by law to possess the particular substance distributed.
S 16. Paragraph (a) of subdivision 1 of section 3321 of the public
health law, as added by chapter 878 of the laws of 1972, is amended to
read as follows:
(a) the return of controlled substances to a manufacturer, REGISTERED
OUTSOURCING FACILITY or distributor by a practitioner or pharmacy;
S. 6914 157 A. 9205
S 17. Section 3322 of the public health law, as added by chapter 878
of the laws of 1972, subdivision 2 as amended by chapter 108 of the laws
of 1975, is amended to read as follows:
S 3322. Reports and records. 1. Persons licensed under this title OR
OPERATING A REGISTERED OUTSOURCING FACILITY shall maintain records of
all controlled substances manufactured, COMPOUNDED, received, disposed
of, DELIVERED or distributed by them. The record shall show the date of
receipt or delivery, the name and address, and registration number of
the person from whom received or to whom DELIVERED OR distributed, the
kind and quantity of substance received and DELIVERED OR distributed,
the kind and quantity of substance produced or removed from the process
of manufacture and the date thereof.
2. Any person licensed under this title OR OPERATING A REGISTERED
OUTSOURCING FACILITY shall prepare and maintain a biennial report
setting forth the current inventory of controlled substances, the quan-
tities of controlled substances manufactured, COMPOUNDED, DELIVERED or
distributed within the state during the period covered by the report and
such other information as the commissioner shall [be] BY regulation
prescribe. Maintaining for inspection a biennial inventory of controlled
substances prepared and maintained in compliance with federal statutes
and regulations shall be deemed in compliance with this section.
3. Any person licensed under this title OR OPERATING A REGISTERED
OUTSOURCING FACILITY shall forthwith notify the department of any inci-
dent involving the theft, loss or possible diversion of controlled
substances manufactured, COMPOUNDED, DELIVERED or distributed by the
licensee OR OPERATOR.
4. The records and reports required by this section shall be prepared,
preserved, or filed in such manner and detail as the commissioner shall
by regulation prescribe.
S 18. Paragraph (c) of subdivision 1 of section 3397 of the public
health law, as amended by chapter 547 of the laws of 1981, is amended to
read as follows:
(c) falsely assume the title of, or represent himself to be a licensed
manufacturer, distributor, pharmacy, pharmacist, practitioner, research-
er, approved institutional dispenser, OWNER OR EMPLOYEE OF A REGISTERED
OUTSOURCING FACILITY or other authorized person, for the purpose of
obtaining a controlled substance;
S 19. This act shall take effect on the ninetieth day after it shall
have become a law.
PART E
Section 1. The mental hygiene law is amended by adding a new section
13.41 to read as follows:
S 13.41 INTEGRATED EMPLOYMENT PLAN.
(A) THE COMMISSIONER, IN CONSULTATION WITH THE DEVELOPMENTAL DISABILI-
TIES ADVISORY COUNCIL, SHALL ESTABLISH A PLAN TO INCREASE EMPLOYMENT
OPPORTUNITIES FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES. THE PLAN SHALL
INCLUDE, BUT NOT BE LIMITED TO:
(1) IDENTIFICATION OF STRATEGIES TO INCREASE COMPETITIVE EMPLOYMENT
OPPORTUNITIES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, INCLUDING
STUDENTS TRANSITIONING FROM EDUCATIONAL PROGRAMS;
(2) DATA CONCERNING JOB RETENTION AMONG INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES AND THE IDENTIFICATION OF STRATEGIES TO INCREASE JOB
RETENTION;
S. 6914 158 A. 9205
(3) IDENTIFICATION OF MODELS OF INTEGRATED EMPLOYMENT PROMOTING, TO
THE GREATEST EXTENT POSSIBLE, INDIVIDUALS WITH DEVELOPMENTAL DISABILI-
TIES WORKING ALONGSIDE INDIVIDUALS WITHOUT DISABILITIES, INCLUDING
CONSIDERATIONS OF ABILITY LEVELS, CRITICAL LIFE TRANSITIONS AND APPRO-
PRIATE OPTIONS;
(4) STRATEGIES FOR ASSISTING INDIVIDUALS IN TRANSITIONING FROM SHEL-
TERED WORKSHOP PROGRAMS TO COMPETITIVE EMPLOYMENT;
(5) PARTNERSHIPS WITH BUSINESS COMMUNITIES AND SENIOR SERVICES TO
ASSIST IN INCREASING THE AVAILABILITY OF COMPETITIVE EMPLOYMENT FOR
OLDER ADULTS;
(6) IDENTIFICATION OF MEANS TO ASSIST INDIVIDUALS WITH SIGNIFICANT
BEHAVIORAL OR MEDICAL NEEDS IN PREPARING FOR AND MOVING TOWARDS INTE-
GRATED EMPLOYMENT;
(7) TECHNICAL ASSISTANCE, COMPLIANCE AND TRANSITION ASSISTANCE PROCE-
DURES FOR EXISTING PROVIDERS WHO SEEK TO TRANSITION TO COMPETITIVE
AND/OR INTEGRATED EMPLOYMENT MODELS; AND
(8) ASSESSMENTS OF FUNDING AND NECESSARY SUPPORTS FOR INDIVIDUALS AND
PROVIDERS.
(B) THE COMMISSIONER, IN CONSULTATION WITH THE DEVELOPMENTAL DISABILI-
TIES ADVISORY COUNCIL, SHALL DEVELOP THE PLAN WITH INPUT FROM STAKEHOLD-
ERS, INCLUDING INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, PARENTS AND
GUARDIANS OF INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, ADVOCATES AND
PROVIDERS OF SERVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES.
(C) THE PLAN REQUIRED PURSUANT TO THIS SECTION SHALL BE DEVELOPED AND
SUBMITTED TO THE TEMPORARY PRESIDENT OF THE SENATE AND SPEAKER OF THE
ASSEMBLY AND POSTED ON THE WEBSITE OF THE OFFICE FOR PEOPLE WITH DEVEL-
OPMENTAL DISABILITIES WITHIN ONE HUNDRED EIGHTY DAYS OF THE CENTERS FOR
MEDICARE AND MEDICAID SERVICES' APPROVAL OF THE PLAN TO INCREASE COMPET-
ITIVE EMPLOYMENT OPPORTUNITIES FOR PEOPLE WITH DEVELOPMENTAL DISABILI-
TIES.
S 2. This act shall take effect immediately.
PART F
Section 1. No later than January 1, 2016, the office for people with
developmental disabilities shall issue a report to the governor, the
temporary president of the senate and the speaker of the assembly
setting forth recommendations for the establishment of a direct support
professional credentialing pilot program. Recommendations for the
program shall be based on a study to be conducted by the office for
people with developmental disabilities and shall include consideration
of: (1) national and international models of direct support credential-
ing; (2) career ladders for direct support professionals and supervi-
sors; (3) current direct support professional salaries and training
requirements; (4) classroom and on-the-job training requirements for
existing direct support credentialing programs and the impact of these
requirements on operations of providers of services; (5) ongoing and
continuing professional education requirements for credentialed direct
support of professionals; (6) the fiscal impact of a credentialing pilot
program; and (7) financial incentives for those who successfully
complete the credentialing program.
S 2. This act shall take effect immediately.
PART G
S. 6914 159 A. 9205
Section 1. Subdivision (e) of section 41.55 of the mental hygiene law,
as amended by section 3 of part C of chapter 111 of the laws of 2010, is
amended to read as follows:
(e) The amount of community mental health support and workforce rein-
vestment funds for the office of mental health shall be determined in
the annual budget and shall include the amount of actual state oper-
ations general fund appropriation reductions, including personal service
savings and other than personal service savings directly attributed to
each child and adult non-geriatric inpatient bed closure. For the
purposes of this section a bed shall be considered to be closed upon the
elimination of funding for such beds in the executive budget. The
appropriation reductions as a result of inpatient bed closures shall be
no less than [seventy] ONE HUNDRED TEN thousand dollars per bed on a
full annual basis, as annually recommended by the commissioner, subject
to the approval of the director of the budget, in the executive budget
request prior to the fiscal year for which the executive budget is being
submitted. The methodologies used to calculate the per bed closure
savings shall be developed by the commissioner and the director of the
budget. In no event shall the full annual value of community mental
health support and workforce reinvestment programs attributable to beds
closed as a result of net inpatient census decline exceed the twelve
month value of the office of mental health state operations general fund
reductions resulting from such census decline. Such reinvestment amount
shall be made available in the same proportion by which the office of
mental health's state operations general fund appropriations are reduced
each year as a result of child and adult non-geriatric inpatient bed
closures due to census decline.
S 2. Subdivision 2 of section 97-dddd of the state finance law, as
added by section 6 of part R2 of chapter 62 of the laws of 2003, is
amended to read as follows:
2. The commissioner of the office of mental health shall notify the
director of the budget when the number of children's psychiatric center
beds or adult, non-geriatric psychiatric center beds closed in any one
year exceeds the number of beds projected to be closed by the office of
mental health in the executive budget request submitted in the year
prior to the fiscal year for which the executive budget is being submit-
ted. Notwithstanding any other law, rule or regulation to the contrary
the director of the budget shall then transfer the amount of actual
state operations general fund appropriation reductions, including
personal service and nonpersonal service, directly attributed to the
closure of such beds, to the state comptroller who shall then credit
such appropriation reductions to the community mental health support and
workforce reinvestment account. The per bed appropriation reduction
shall be no less than [seventy] ONE HUNDRED TEN thousand dollars on a
full annual basis.
S 3. Section 7 of part R2 of chapter 62 of the laws of 2003, amending
the mental hygiene law and the state finance law relating to the commu-
nity mental health support and workforce reinvestment program, the
membership of subcommittees for mental health of community services
boards and the duties of such subcommittees and creating the community
mental health and workforce reinvestment account, as amended by section
3 of part H of chapter 56 of the laws of 2013, is amended to read as
follows:
S 7. This act shall take effect immediately and shall expire March 31,
[2015] 2018 when upon such date the provisions of this act shall be
deemed repealed.
S. 6914 160 A. 9205
S 4. This act shall take effect immediately; provided that:
1. the amendments to subdivision (e) of section 41.55 of the mental
hygiene law made by section one of this act shall not affect the repeal
of such section and shall be deemed repealed therewith; and
2. the amendments to subdivision 2 of section 97-dddd of the state
finance law made by section two of this act shall not affect the repeal
of such section and shall be deemed repealed therewith.
PART H
Section 1. Paragraphs 11, 12, 13, 14, 16 and 17 of subsection (a) of
section 3217-a of the insurance law, as added by chapter 705 of the laws
of 1996, are amended and four new paragraphs 16-a, 18, 19 and 20 are
added to read as follows:
(11) where applicable, notice that an insured enrolled in a managed
care product OR IN A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF
PROVIDERS offered by the insurer may obtain a referral [to] OR PREAU-
THORIZATION FOR a health care provider outside of the insurer's network
or panel when the insurer does not have a health care provider [with]
WHO IS GEOGRAPHICALLY ACCESSIBLE TO THE INSURED AND WHO HAS THE appro-
priate training and experience in the network or panel to meet the
particular health care needs of the insured and the procedure by which
the insured can obtain such referral OR PREAUTHORIZATION;
(12) where applicable, notice that an insured enrolled in a managed
care product OR A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF
PROVIDERS offered by the insurer with a condition which requires ongoing
care from a specialist may request a standing referral to such a
specialist and the procedure for requesting and obtaining such a stand-
ing referral;
(13) where applicable, notice that an insured enrolled in a managed
care product OR A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF
PROVIDERS offered by the insurer with [(i)] (A) a life-threatening
condition or disease, or [(ii)] (B) a degenerative and disabling condi-
tion or disease, either of which requires specialized medical care over
a prolonged period of time may request a specialist responsible for
providing or coordinating the insured's medical care and the procedure
for requesting and obtaining such a specialist;
(14) where applicable, notice that an insured enrolled in a managed
care product OR A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF
PROVIDERS offered by the insurer with [(i)] (A) a life-threatening
condition or disease, or [(ii)] (B) a degenerative and disabling condi-
tion or disease, either of which requires specialized medical care over
a prolonged period of time, may request access to a specialty care
center and the procedure by which such access may be obtained;
(16) notice of all appropriate mailing addresses and telephone numbers
to be utilized by insureds seeking information or authorization; [and]
(16-A) WHERE APPLICABLE, NOTICE THAT AN INSURED SHALL HAVE DIRECT
ACCESS TO PRIMARY AND PREVENTIVE OBSTETRIC AND GYNECOLOGIC SERVICES,
INCLUDING ANNUAL EXAMINATIONS, CARE RESULTING FROM SUCH ANNUAL EXAMINA-
TIONS, AND TREATMENT OF ACUTE GYNECOLOGIC CONDITIONS, FROM A QUALIFIED
PROVIDER OF SUCH SERVICES OF HER CHOICE FROM WITHIN THE PLAN OR FOR ANY
CARE RELATED TO A PREGNANCY;
(17) where applicable, a listing by specialty, which may be in a sepa-
rate document that is updated annually, of the name, address, and tele-
phone number of all participating providers, including facilities, and
in addition, in the case of physicians, board certification[.],
S. 6914 161 A. 9205
LANGUAGES SPOKEN AND ANY AFFILIATIONS WITH PARTICIPATING HOSPITALS. THE
LISTING SHALL ALSO BE POSTED ON THE INSURER'S WEBSITE AND THE INSURER
SHALL UPDATE THE WEBSITE WITHIN FIFTEEN DAYS OF THE ADDITION OR TERMI-
NATION OF A PROVIDER FROM THE INSURER'S NETWORK OR A CHANGE IN A PHYSI-
CIAN'S HOSPITAL AFFILIATION;
(18) A DESCRIPTION OF THE METHOD BY WHICH AN INSURED MAY SUBMIT A
CLAIM FOR HEALTH CARE SERVICES;
(19) WITH RESPECT TO OUT-OF-NETWORK COVERAGE:
(A) A CLEAR DESCRIPTION OF THE METHODOLOGY USED BY THE INSURER TO
DETERMINE REIMBURSEMENT FOR OUT-OF-NETWORK HEALTH CARE SERVICES;
(B) THE AMOUNT THAT THE INSURER WILL REIMBURSE UNDER THE METHODOLOGY
FOR OUT-OF-NETWORK HEALTH CARE SERVICES SET FORTH AS A PERCENTAGE OF THE
USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH CARE SERVICES; AND
(C) EXAMPLES OF ANTICIPATED OUT-OF-POCKET COSTS FOR FREQUENTLY BILLED
OUT-OF-NETWORK HEALTH CARE SERVICES; AND
(20) INFORMATION IN WRITING AND THROUGH AN INTERNET WEBSITE THAT
REASONABLY PERMITS AN INSURED OR PROSPECTIVE INSURED TO ESTIMATE THE
ANTICIPATED OUT-OF-POCKET COST FOR OUT-OF-NETWORK HEALTH CARE SERVICES
IN A GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE BETWEEN
WHAT THE INSURER WILL REIMBURSE FOR OUT-OF-NETWORK HEALTH CARE SERVICES
AND THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH CARE
SERVICES.
S 2. Paragraphs 11 and 12 of subsection (b) of section 3217-a of the
insurance law, as added by chapter 705 of the laws of 1996, are amended
and two new paragraphs 13 and 14 are added to read as follows:
(11) where applicable, provide the written application procedures and
minimum qualification requirements for health care providers to be
considered by the insurer for participation in the insurer's network for
a managed care product; [and]
(12) disclose such other information as required by the superinten-
dent, provided that such requirements are promulgated pursuant to the
state administrative procedure act[.];
(13) DISCLOSE WHETHER A HEALTH CARE PROVIDER SCHEDULED TO PROVIDE A
HEALTH CARE SERVICE IS AN IN-NETWORK PROVIDER; AND
(14) WITH RESPECT TO OUT-OF-NETWORK COVERAGE, DISCLOSE THE APPROXIMATE
DOLLAR AMOUNT THAT THE INSURER WILL PAY FOR A SPECIFIC OUT-OF-NETWORK
HEALTH CARE SERVICE. THE INSURER SHALL ALSO INFORM THE INSURED THROUGH
SUCH DISCLOSURE THAT SUCH APPROXIMATION IS NOT BINDING ON THE INSURER
AND THAT THE APPROXIMATE DOLLAR AMOUNT THAT THE INSURER WILL PAY FOR A
SPECIFIC OUT-OF-NETWORK HEALTH CARE SERVICE MAY CHANGE.
S 3. Section 3217-a of the insurance law is amended by adding a new
subsection (f) to read as follows:
(F) FOR PURPOSES OF THIS SECTION, "USUAL AND CUSTOMARY COST" SHALL
MEAN THE EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR HEALTH
CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME OR SIMILAR SPECIALTY
AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE SUPER-
INTENDENT. THE NONPROFIT ORGANIZATION SHALL NOT BE AFFILIATED WITH AN
INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF THIS CHAPTER, A
MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE
FORTY-SEVEN OF THIS CHAPTER, OR A HEALTH MAINTENANCE ORGANIZATION CERTI-
FIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
S 4. Section 3217-d of the insurance law is amended by adding a new
subsection (d) to read as follows:
(D) AN INSURER THAT ISSUES A COMPREHENSIVE POLICY THAT UTILIZES A
NETWORK OF PROVIDERS AND IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT
S. 6914 162 A. 9205
AS DEFINED IN SUBSECTION (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE
OF THIS CHAPTER, SHALL PROVIDE ACCESS TO OUT-OF-NETWORK SERVICES
CONSISTENT WITH THE REQUIREMENTS OF SUBSECTION (A) OF SECTION FOUR THOU-
SAND EIGHT HUNDRED FOUR OF THIS CHAPTER, SUBSECTIONS (G-6) AND (G-7) OF
SECTION FOUR THOUSAND NINE HUNDRED OF THIS CHAPTER, SUBSECTIONS (A-1)
AND (A-2) OF SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER,
PARAGRAPHS THREE AND FOUR OF SUBSECTION (B) OF SECTION FOUR THOUSAND
NINE HUNDRED TEN OF THIS CHAPTER, AND SUBPARAGRAPHS (C) AND (D) OF PARA-
GRAPH FOUR OF SUBSECTION (B) OF SECTION FOUR THOUSAND NINE HUNDRED FOUR-
TEEN OF THIS CHAPTER.
S 5. Section 3224-a of the insurance law is amended by adding a new
subsection (j) to read as follows:
(J) AN INSURER OR AN ORGANIZATION OR CORPORATION LICENSED OR CERTIFIED
PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR A STUDENT HEALTH PLAN ESTAB-
LISHED OR MAINTAINED PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWEN-
TY-FOUR OF THIS CHAPTER SHALL ACCEPT CLAIMS SUBMITTED BY A POLICYHOLDER
OR COVERED PERSON, IN WRITING, INCLUDING THROUGH THE INTERNET, BY ELEC-
TRONIC MAIL OR BY FACSIMILE.
S 6. The insurance law is amended by adding a new section 3241 to read
as follows:
S 3241. NETWORK COVERAGE. (A) AN INSURER, A CORPORATION ORGANIZED
PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER, A MUNICIPAL COOPERATIVE
HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS
CHAPTER, OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT TO
SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER, THAT
ISSUES A HEALTH INSURANCE POLICY OR CONTRACT WITH A NETWORK OF HEALTH
CARE PROVIDERS SHALL ENSURE THAT THE NETWORK IS ADEQUATE TO MEET THE
HEALTH NEEDS OF INSUREDS AND PROVIDE AN APPROPRIATE CHOICE OF PROVIDERS
SUFFICIENT TO RENDER THE SERVICES COVERED UNDER THE POLICY OR CONTRACT.
THE SUPERINTENDENT SHALL REVIEW THE NETWORK OF HEALTH CARE PROVIDERS FOR
ADEQUACY AT THE TIME OF THE SUPERINTENDENT'S INITIAL APPROVAL OF A
HEALTH INSURANCE POLICY OR CONTRACT; AT LEAST EVERY THREE YEARS THERE-
AFTER; AND UPON APPLICATION FOR EXPANSION OF ANY SERVICE AREA ASSOCIATED
WITH THE POLICY OR CONTRACT IN CONFORMANCE WITH THE STANDARDS SET FORTH
IN SUBDIVISION FIVE OF SECTION FOUR THOUSAND FOUR HUNDRED THREE OF THE
PUBLIC HEALTH LAW. TO THE EXTENT THAT THE NETWORK HAS BEEN DETERMINED
BY THE COMMISSIONER OF HEALTH TO MEET THE STANDARDS SET FORTH IN SUBDI-
VISION FIVE OF SECTION FOUR THOUSAND FOUR HUNDRED THREE OF THE PUBLIC
HEALTH LAW, SUCH NETWORK SHALL BE DEEMED ADEQUATE BY THE SUPERINTENDENT.
(B)(1)(A) AN INSURER, A CORPORATION ORGANIZED PURSUANT TO ARTICLE
FORTY-THREE OF THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN
CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, A HEALTH
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED
PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAP-
TER, THAT ISSUES A COMPREHENSIVE GROUP OR GROUP REMITTANCE HEALTH INSUR-
ANCE POLICY OR CONTRACT THAT COVERS OUT-OF-NETWORK HEALTH CARE SERVICES
SHALL MAKE AVAILABLE AND, IF REQUESTED BY THE POLICYHOLDER OR CONTRACT-
HOLDER, PROVIDE AT LEAST ONE OPTION FOR COVERAGE FOR AT LEAST EIGHTY
PERCENT OF THE USUAL AND CUSTOMARY COST OF EACH OUT-OF-NETWORK HEALTH
CARE SERVICE AFTER IMPOSITION OF A DEDUCTIBLE OR ANY PERMISSIBLE BENEFIT
MAXIMUM.
(B) IF THERE IS NO COVERAGE AVAILABLE PURSUANT TO SUBPARAGRAPH (A) OF
THIS PARAGRAPH IN A RATING REGION, THEN THE SUPERINTENDENT MAY REQUIRE
AN INSURER, A CORPORATION ORGANIZED PURSUANT TO ARTICLE FORTY-THREE OF
S. 6914 163 A. 9205
THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED
PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, A HEALTH MAINTENANCE
ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC
HEALTH LAW, OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT
TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER ISSUING
A COMPREHENSIVE GROUP OR GROUP REMITTANCE HEALTH INSURANCE POLICY OR
CONTRACT IN THE RATING REGION, TO MAKE AVAILABLE AND, IF REQUESTED BY
THE POLICYHOLDER OR CONTRACTHOLDER, PROVIDE AT LEAST ONE OPTION FOR
COVERAGE OF EIGHTY PERCENT OF THE USUAL AND CUSTOMARY COST OF EACH OUT-
OF-NETWORK HEALTH CARE SERVICE AFTER IMPOSITION OF ANY PERMISSIBLE
DEDUCTIBLE OR BENEFIT MAXIMUM. THE SUPERINTENDENT MAY, AFTER GIVING
CONSIDERATION TO THE PUBLIC INTEREST, PERMIT AN INSURER, A CORPORATION,
OR A HEALTH MAINTENANCE ORGANIZATION TO SATISFY THE REQUIREMENTS OF THIS
PARAGRAPH ON BEHALF OF ANOTHER INSURER, CORPORATION, OR HEALTH MAINTE-
NANCE ORGANIZATION WITHIN THE SAME HOLDING COMPANY SYSTEM, AS DEFINED IN
ARTICLE FIFTEEN OF THIS CHAPTER, INCLUDING A HEALTH MAINTENANCE ORGAN-
IZATION OPERATED AS A LINE OF BUSINESS OF A HEALTH SERVICE CORPORATION
ORGANIZED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER. THE SUPER-
INTENDENT MAY, UPON WRITTEN REQUEST, WAIVE THE REQUIREMENT FOR COVERAGE
OF OUT-OF-NETWORK HEALTH CARE SERVICES TO BE MADE AVAILABLE PURSUANT TO
THIS SUBPARAGRAPH IF THE SUPERINTENDENT DETERMINES THAT IT WOULD POSE AN
UNDUE HARDSHIP UPON AN INSURER, A CORPORATION ORGANIZED PURSUANT TO
ARTICLE FORTY-THREE OF THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH
BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER,
A HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW, OR A STUDENT HEALTH PLAN ESTAB-
LISHED OR MAINTAINED PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWEN-
TY-FOUR OF THIS CHAPTER.
(2) FOR THE PURPOSES OF THIS SUBSECTION, "USUAL AND CUSTOMARY COST"
SHALL MEAN THE EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR
HEALTH CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME OR SIMILAR
SPECIALTY AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A
BENCHMARKING DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED
BY THE SUPERINTENDENT. THE NONPROFIT ORGANIZATION SHALL NOT BE AFFIL-
IATED WITH AN INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF
THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED
PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, A HEALTH MAINTENANCE
ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC
HEALTH LAW OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT
TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER.
(3) THIS SUBSECTION SHALL NOT APPLY TO EMERGENCY CARE SERVICES IN
HOSPITAL FACILITIES OR PREHOSPITAL EMERGENCY MEDICAL SERVICES AS DEFINED
IN CLAUSE (I) OF SUBPARAGRAPH (E) OF PARAGRAPH TWENTY-FOUR OF SUBSECTION
(I) OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN OF THIS ARTICLE, OR
CLAUSE (I) OF SUBPARAGRAPH (E) OF PARAGRAPH FIFTEEN OF SUBSECTION (L) OF
SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS CHAPTER, OR
SUBPARAGRAPH (A) OF PARAGRAPH FIVE OF SUBSECTION (AA) OF SECTION FOUR
THOUSAND THREE HUNDRED THREE OF THIS CHAPTER.
(4) NOTHING IN THIS SUBSECTION SHALL LIMIT THE SUPERINTENDENT'S
AUTHORITY PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED SEVENTEEN OF
THIS ARTICLE TO ESTABLISH MINIMUM STANDARDS FOR THE FORM, CONTENT AND
SALE OF ACCIDENT AND HEALTH INSURANCE POLICIES AND SUBSCRIBER CONTRACTS,
TO REQUIRE ADDITIONAL COVERAGE OPTIONS FOR OUT-OF-NETWORK SERVICES, OR
TO PROVIDE FOR STANDARDIZATION AND SIMPLIFICATION OF COVERAGE.
(C) WHEN AN INSURED OR ENROLLEE UNDER A CONTRACT OR POLICY THAT
PROVIDES COVERAGE FOR EMERGENCY SERVICES RECEIVES THE SERVICES FROM A
S. 6914 164 A. 9205
HEALTH CARE PROVIDER THAT DOES NOT PARTICIPATE IN THE PROVIDER NETWORK
OF AN INSURER, A CORPORATION ORGANIZED PURSUANT TO ARTICLE FORTY-THREE
OF THIS CHAPTER, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED
PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, A HEALTH MAINTENANCE
ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC
HEALTH LAW, OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT
TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER ("HEALTH
CARE PLAN"), THE HEALTH CARE PLAN SHALL ENSURE THAT THE INSURED OR
ENROLLEE SHALL INCUR NO GREATER OUT-OF-POCKET COSTS FOR THE EMERGENCY
SERVICES THAN THE INSURED OR ENROLLEE WOULD HAVE INCURRED WITH A HEALTH
CARE PROVIDER THAT PARTICIPATES IN THE HEALTH CARE PLAN'S PROVIDER
NETWORK. FOR THE PURPOSE OF THIS SECTION, "EMERGENCY SERVICES" SHALL
HAVE THE MEANING SET FORTH IN SUBPARAGRAPH (D) OF PARAGRAPH NINE OF
SUBSECTION (I) OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN OF THIS
ARTICLE, SUBPARAGRAPH (D) OF PARAGRAPH FOUR OF SUBSECTION (K) OF SECTION
THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS ARTICLE, AND SUBPARAGRAPH
(D) OF PARAGRAPH TWO OF SUBSECTION (A) OF SECTION FOUR THOUSAND THREE
HUNDRED THREE OF THIS CHAPTER.
S 7. Section 4306-c of the insurance law is amended by adding a new
subsection (d) to read as follows:
(D) A CORPORATION, INCLUDING A MUNICIPAL COOPERATIVE HEALTH BENEFIT
PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER AND A
STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT TO SECTION ONE
THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER, THAT ISSUES A COMPRE-
HENSIVE POLICY THAT UTILIZES A NETWORK OF PROVIDERS AND IS NOT A MANAGED
CARE HEALTH INSURANCE CONTRACT AS DEFINED IN SUBSECTION (C) OF SECTION
FOUR THOUSAND EIGHT HUNDRED ONE OF THIS CHAPTER, SHALL PROVIDE ACCESS TO
OUT-OF-NETWORK SERVICES CONSISTENT WITH THE REQUIREMENTS OF SUBSECTION
(A) OF SECTION FOUR THOUSAND EIGHT HUNDRED FOUR OF THIS CHAPTER,
SUBSECTIONS (G-6) AND (G-7) OF SECTION FOUR THOUSAND NINE HUNDRED OF
THIS CHAPTER, SUBSECTIONS (A-1) AND (A-2) OF SECTION FOUR THOUSAND NINE
HUNDRED FOUR OF THIS CHAPTER, PARAGRAPHS THREE AND FOUR OF SUBSECTION
(B) OF SECTION FOUR THOUSAND NINE HUNDRED TEN OF THIS CHAPTER, AND
SUBPARAGRAPHS (C) AND (D) OF PARAGRAPH FOUR OF SUBSECTION (B) OF SECTION
FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER.
S 8. Paragraphs 11, 12, 13, 14, 16-a, 17, and 18 of subsection (a) of
section 4324 of the insurance law, paragraphs 11, 12, 13, 14, 17 and 18
as added by chapter 705 of the laws of 1996, paragraph 16-a as added by
chapter 554 of the laws of 2002, are amended and three new paragraphs
19, 20 and 21 are added to read as follows:
(11) where applicable, notice that a subscriber enrolled in a managed
care product OR IN A COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF
PROVIDERS offered by the corporation may obtain a referral [to] OR
PREAUTHORIZATION FOR a health care provider outside of the corporation's
network or panel when the corporation does not have a health care
provider [with] WHO IS GEOGRAPHICALLY ACCESSIBLE TO THE INSURED AND WHO
HAS THE appropriate training and experience in the network or panel to
meet the particular health care needs of the subscriber and the proce-
dure by which the subscriber can obtain such referral OR PREAUTHORI-
ZATION;
(12) where applicable, notice that a subscriber enrolled in a managed
care product OR A COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF
PROVIDERS offered by the corporation with a condition which requires
ongoing care from a specialist may request a standing referral to such a
specialist and the procedure for requesting and obtaining such a stand-
ing referral;
S. 6914 165 A. 9205
(13) where applicable, notice that a subscriber enrolled in a managed
care product OR A COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF
PROVIDERS offered by the corporation with (i) a life-threatening condi-
tion or disease, or (ii) a degenerative and disabling condition or
disease, either of which requires specialized medical care over a
prolonged period of time may request a specialist responsible for
providing or coordinating the subscriber's medical care and the proce-
dure for requesting and obtaining such a specialist;
(14) where applicable, notice that a subscriber enrolled in a managed
care product OR A COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF
PROVIDERS offered by the corporation with [(i)] (A) a life-threatening
condition or disease, or [(ii)] (B) a degenerative and disabling condi-
tion or disease, either of which requires specialized medical care over
a prolonged period of time may request access to a specialty care center
and the procedure by which such access may be obtained;
(16-a) where applicable, notice that an enrollee shall have direct
access to primary and preventive obstetric and gynecologic services,
INCLUDING ANNUAL EXAMINATIONS, CARE RESULTING FROM SUCH ANNUAL EXAMINA-
TIONS, AND TREATMENT OF ACUTE GYNECOLOGIC CONDITIONS, from a qualified
provider of such services of her choice from within the plan [for no
fewer than two examinations annually for such services] or [to] FOR any
care related to A pregnancy [and that additionally, the enrollee shall
have direct access to primary and preventive obstetric and gynecologic
services required as a result of such annual examinations or as a result
of an acute gynecologic condition];
(17) where applicable, a listing by specialty, which may be in a sepa-
rate document that is updated annually, of the name, address, and tele-
phone number of all participating providers, including facilities, and
in addition, in the case of physicians, board certification[; and],
LANGUAGES SPOKEN AND ANY AFFILIATIONS WITH PARTICIPATING HOSPITALS. THE
LISTING SHALL ALSO BE POSTED ON THE CORPORATION'S WEBSITE AND THE CORPO-
RATION SHALL UPDATE THE WEBSITE WITHIN FIFTEEN DAYS OF THE ADDITION OR
TERMINATION OF A PROVIDER FROM THE CORPORATION'S NETWORK OR A CHANGE IN
A PHYSICIAN'S HOSPITAL AFFILIATION;
(18) a description of the mechanisms by which subscribers may partic-
ipate in the development of the policies of the corporation[.];
(19) THE METHOD BY WHICH A SUBSCRIBER MAY SUBMIT A CLAIM FOR HEALTH
CARE SERVICES;
(20) WITH RESPECT TO OUT-OF-NETWORK COVERAGE:
(A) A CLEAR DESCRIPTION OF THE METHODOLOGY USED BY THE CORPORATION TO
DETERMINE REIMBURSEMENT FOR OUT-OF-NETWORK HEALTH CARE SERVICES;
(B) A DESCRIPTION OF THE AMOUNT THAT THE CORPORATION WILL REIMBURSE
UNDER THE METHODOLOGY FOR OUT-OF-NETWORK HEALTH CARE SERVICES SET FORTH
AS A PERCENTAGE OF THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK
HEALTH CARE SERVICES; AND
(C) EXAMPLES OF ANTICIPATED OUT-OF-POCKET COSTS FOR FREQUENTLY BILLED
OUT-OF-NETWORK HEALTH CARE SERVICES; AND
(21) INFORMATION IN WRITING AND THROUGH AN INTERNET WEBSITE THAT
REASONABLY PERMITS A SUBSCRIBER OR PROSPECTIVE SUBSCRIBER TO ESTIMATE
THE ANTICIPATED OUT-OF-POCKET COST FOR OUT-OF-NETWORK HEALTH CARE
SERVICES IN A GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE
BETWEEN WHAT THE CORPORATION WILL REIMBURSE FOR OUT-OF-NETWORK HEALTH
CARE SERVICES AND THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH
CARE SERVICES.
S. 6914 166 A. 9205
S 9. Paragraphs 11 and 12 of subsection (b) of section 4324 of the
insurance law, as added by chapter 705 of the laws of 1996, are amended
and two new paragraphs 13 and 14 are added to read as follows:
(11) where applicable, provide the written application procedures and
minimum qualification requirements for health care providers to be
considered by the corporation for participation in the corporation's
network for a managed care product; [and]
(12) disclose such other information as required by the superinten-
dent, provided that such requirements are promulgated pursuant to the
state administrative procedure act[.];
(13) DISCLOSE WHETHER A HEALTH CARE PROVIDER SCHEDULED TO PROVIDE A
HEALTH CARE SERVICE IS AN IN-NETWORK PROVIDER; AND
(14) WITH RESPECT TO OUT-OF-NETWORK COVERAGE, DISCLOSE THE APPROXIMATE
DOLLAR AMOUNT THAT THE CORPORATION WILL PAY FOR A SPECIFIC OUT-OF-NET-
WORK HEALTH CARE SERVICE. THE CORPORATION SHALL ALSO INFORM THE INSURED
THROUGH SUCH DISCLOSURE THAT SUCH APPROXIMATION IS NOT BINDING ON THE
CORPORATION AND THAT THE APPROXIMATE DOLLAR AMOUNT THAT THE CORPORATION
WILL PAY FOR A SPECIFIC OUT-OF-NETWORK HEALTH CARE SERVICE MAY CHANGE.
S 10. Section 4324 of the insurance law is amended by adding a new
subsection (f) to read as follows:
(F) FOR PURPOSES OF THIS SECTION, "USUAL AND CUSTOMARY COST" SHALL
MEAN THE EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR HEALTH
CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME OR SIMILAR SPECIALTY
AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE SUPER-
INTENDENT. THE NONPROFIT ORGANIZATION SHALL NOT BE AFFILIATED WITH AN
INSURER, A CORPORATION SUBJECT TO THIS ARTICLE, A MUNICIPAL COOPERATIVE
HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS
CHAPTER, OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO
ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
S 11. Section 4900 of the insurance law is amended by adding a new
subsection (g-6-a) to read as follows:
(G-6-A) "OUT-OF-NETWORK REFERRAL DENIAL" MEANS A DENIAL UNDER A
MANAGED CARE PRODUCT AS DEFINED IN SUBSECTION (C) OF SECTION FOUR THOU-
SAND EIGHT HUNDRED ONE OF THIS CHAPTER OF A REQUEST FOR AN AUTHORIZATION
OR REFERRAL TO AN OUT-OF-NETWORK PROVIDER ON THE BASIS THAT THE HEALTH
CARE PLAN HAS A HEALTH CARE PROVIDER IN THE IN-NETWORK BENEFITS PORTION
OF ITS NETWORK WITH APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE
PARTICULAR HEALTH CARE NEEDS OF AN INSURED, AND WHO IS ABLE TO PROVIDE
THE REQUESTED HEALTH SERVICE. THE NOTICE OF AN OUT-OF-NETWORK REFERRAL
DENIAL PROVIDED TO AN INSURED SHALL INCLUDE INFORMATION EXPLAINING WHAT
INFORMATION THE INSURED MUST SUBMIT IN ORDER TO APPEAL THE OUT-OF-NET-
WORK REFERRAL DENIAL PURSUANT TO SUBSECTION (A-2) OF SECTION FOUR THOU-
SAND NINE HUNDRED FOUR OF THIS ARTICLE. AN OUT-OF-NETWORK REFERRAL
DENIAL UNDER THIS SUBSECTION DOES NOT CONSTITUTE AN ADVERSE DETERMI-
NATION AS DEFINED IN THIS ARTICLE. AN OUT-OF-NETWORK REFERRAL DENIAL
SHALL NOT BE CONSTRUED TO INCLUDE AN OUT-OF-NETWORK DENIAL AS DEFINED IN
SUBSECTION (G-6) OF THIS SECTION.
S 12. Subsection (b) of section 4903 of the insurance law, as amended
by chapter 514 of the laws of 2013, is amended to read as follows:
(b) A utilization review agent shall make a utilization review deter-
mination involving health care services which require pre-authorization
and provide notice of a determination to the insured or insured's desig-
nee and the insured's health care provider by telephone and in writing
within three business days of receipt of the necessary information. To
the extent practicable, such written notification to the enrollee's
S. 6914 167 A. 9205
health care provider shall be transmitted electronically, in a manner
and in a form agreed upon by the parties. THE NOTIFICATION SHALL IDEN-
TIFY: (1) WHETHER THE SERVICES ARE CONSIDERED IN-NETWORK OR OUT-OF-NET-
WORK; (2) WHETHER THE INSURED WILL BE HELD HARMLESS FOR THE SERVICES AND
NOT BE RESPONSIBLE FOR ANY PAYMENT, OTHER THAN ANY APPLICABLE CO-PAY-
MENT, CO-INSURANCE OR DEDUCTIBLE; (3) AS APPLICABLE, THE DOLLAR AMOUNT
THE HEALTH CARE PLAN WILL PAY IF THE SERVICE IS OUT-OF-NETWORK; AND (4)
AS APPLICABLE, INFORMATION EXPLAINING HOW AN INSURED MAY DETERMINE THE
ANTICIPATED OUT-OF-POCKET COST FOR OUT-OF-NETWORK HEALTH CARE SERVICES
IN A GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE BETWEEN
WHAT THE HEALTH CARE PLAN WILL REIMBURSE FOR OUT-OF-NETWORK HEALTH CARE
SERVICES AND THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK HEALTH CARE
SERVICES.
S 13. Section 4904 of the insurance law is amended by adding a new
subsection (a-2) to read as follows:
(A-2) AN INSURED OR THE INSURED'S DESIGNEE MAY APPEAL AN OUT-OF-NET-
WORK REFERRAL DENIAL BY A HEALTH CARE PLAN BY SUBMITTING A WRITTEN
STATEMENT FROM THE INSURED'S ATTENDING PHYSICIAN, WHO MUST BE A
LICENSED, BOARD CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRAC-
TICE IN THE SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT THE INSURED
FOR THE HEALTH SERVICE SOUGHT, PROVIDED THAT: (1) THE IN-NETWORK HEALTH
CARE PROVIDER OR PROVIDERS RECOMMENDED BY THE HEALTH CARE PLAN DO NOT
HAVE THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR
HEALTH CARE NEEDS OF THE INSURED FOR THE HEALTH SERVICE; AND (2) RECOM-
MENDS AN OUT-OF-NETWORK PROVIDER WITH THE APPROPRIATE TRAINING AND EXPE-
RIENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF THE INSURED, AND WHO
IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE.
S 14. Subsection (b) of section 4910 of the insurance law is amended
by adding a new paragraph 4 to read as follows:
(4)(A) THE INSURED HAS HAD AN OUT-OF-NETWORK REFERRAL DENIED ON THE
GROUNDS THAT THE HEALTH CARE PLAN HAS A HEALTH CARE PROVIDER IN THE
IN-NETWORK BENEFITS PORTION OF ITS NETWORK WITH APPROPRIATE TRAINING AND
EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED, AND
WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE.
(B) THE INSURED'S ATTENDING PHYSICIAN, WHO SHALL BE A LICENSED, BOARD
CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRACTICE IN THE
SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT THE INSURED FOR THE
HEALTH SERVICE SOUGHT, CERTIFIES THAT THE IN-NETWORK HEALTH CARE PROVID-
ER OR PROVIDERS RECOMMENDED BY THE HEALTH CARE PLAN DO NOT HAVE THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE
NEEDS OF AN INSURED, AND RECOMMENDS AN OUT-OF-NETWORK PROVIDER WITH THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE
NEEDS OF AN INSURED, AND WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH
SERVICE.
S 15. Paragraph 4 of subsection (b) of section 4914 of the insurance
law is amended by adding a new subparagraph (D) to read as follows:
(D) FOR EXTERNAL APPEALS REQUESTED PURSUANT TO PARAGRAPH FOUR OF
SUBSECTION (B) OF SECTION FOUR THOUSAND NINE HUNDRED TEN OF THIS TITLE
RELATING TO AN OUT-OF-NETWORK REFERRAL DENIAL, THE EXTERNAL APPEAL AGENT
SHALL REVIEW THE UTILIZATION REVIEW AGENT'S FINAL ADVERSE DETERMINATION
AND, IN ACCORDANCE WITH THE PROVISIONS OF THIS TITLE, SHALL MAKE A
DETERMINATION AS TO WHETHER THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED
BY THE HEALTH PLAN; PROVIDED THAT SUCH DETERMINATION SHALL:
(I) BE CONDUCTED ONLY BY ONE OR A GREATER ODD NUMBER OF CLINICAL PEER
REVIEWERS;
(II) BE ACCOMPANIED BY A WRITTEN STATEMENT:
S. 6914 168 A. 9205
(I) THAT THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED BY THE HEALTH
CARE PLAN EITHER WHEN THE REVIEWER OR A MAJORITY OF THE PANEL OF REVIEW-
ERS DETERMINES, UPON REVIEW OF THE TRAINING AND EXPERIENCE OF THE
IN-NETWORK HEALTH CARE PROVIDER OR PROVIDERS PROPOSED BY THE PLAN, THE
TRAINING AND EXPERIENCE OF THE REQUESTED OUT-OF-NETWORK PROVIDER, THE
CLINICAL STANDARDS OF THE PLAN, THE INFORMATION PROVIDED CONCERNING THE
INSURED, THE ATTENDING PHYSICIAN'S RECOMMENDATION, THE INSURED'S MEDICAL
RECORD, AND ANY OTHER PERTINENT INFORMATION, THAT THE HEALTH PLAN DOES
NOT HAVE A PROVIDER WITH THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET
THE PARTICULAR HEALTH CARE NEEDS OF AN INSURED WHO IS ABLE TO PROVIDE
THE REQUESTED HEALTH SERVICE, AND THAT THE OUT-OF-NETWORK PROVIDER HAS
THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR HEALTH
CARE NEEDS OF AN INSURED, IS ABLE TO PROVIDE THE REQUESTED HEALTH
SERVICE, AND IS LIKELY TO PRODUCE A MORE CLINICALLY BENEFICIAL OUTCOME;
OR
(II) UPHOLDING THE HEALTH PLAN'S DENIAL OF COVERAGE;
(III) BE SUBJECT TO THE TERMS AND CONDITIONS GENERALLY APPLICABLE TO
BENEFITS UNDER THE EVIDENCE OF COVERAGE UNDER THE HEALTH CARE PLAN;
(IV) BE BINDING ON THE PLAN AND THE INSURED; AND
(V) BE ADMISSIBLE IN ANY COURT PROCEEDING.
S 16. The public health law is amended by adding a new section 23 to
read as follows:
S 23. CLAIM FORMS. A NON-PARTICIPATING PHYSICIAN SHALL INCLUDE A
CLAIM FORM FOR A THIRD-PARTY PAYOR WITH A PATIENT BILL FOR HEALTH CARE
SERVICES, OTHER THAN A BILL FOR THE PATIENT'S CO-PAYMENT, COINSURANCE OR
DEDUCTIBLE.
S 17. The public health law is amended by adding a new section 24 to
read as follows:
S 24. DISCLOSURE. 1. A HEALTH CARE PROFESSIONAL, OR A GROUP PRACTICE
OF HEALTH CARE PROFESSIONALS, A DIAGNOSTIC AND TREATMENT CENTER OR A
HEALTH CENTER DEFINED UNDER 42 U.S.C. S 254B ON BEHALF OF HEALTH CARE
PROFESSIONALS RENDERING SERVICES AT THE GROUP PRACTICE, DIAGNOSTIC AND
TREATMENT CENTER OR HEALTH CENTER, SHALL DISCLOSE TO PATIENTS OR
PROSPECTIVE PATIENTS IN WRITING OR THROUGH AN INTERNET WEBSITE THE
HEALTH CARE PLANS IN WHICH THE HEALTH CARE PROFESSIONAL, GROUP PRACTICE,
DIAGNOSTIC AND TREATMENT CENTER OR HEALTH CENTER, IS A PARTICIPATING
PROVIDER AND THE HOSPITALS WITH WHICH THE HEALTH CARE PROFESSIONAL IS
AFFILIATED PRIOR TO THE PROVISION OF NON-EMERGENCY SERVICES AND VERBALLY
AT THE TIME AN APPOINTMENT IS SCHEDULED.
2. IF A HEALTH CARE PROFESSIONAL, OR A GROUP PRACTICE OF HEALTH CARE
PROFESSIONALS, A DIAGNOSTIC AND TREATMENT CENTER OR A HEALTH CENTER
DEFINED UNDER 42 U.S.C. S 254B ON BEHALF OF HEALTH CARE PROFESSIONALS
RENDERING SERVICES AT THE GROUP PRACTICE, DIAGNOSTIC AND TREATMENT
CENTER OR HEALTH CENTER, DOES NOT PARTICIPATE IN THE NETWORK OF A
PATIENT'S OR PROSPECTIVE PATIENT'S HEALTH CARE PLAN, THE HEALTH CARE
PROFESSIONAL, GROUP PRACTICE, DIAGNOSTIC AND TREATMENT CENTER OR HEALTH
CENTER, SHALL: (A) PRIOR TO THE PROVISION OF NON-EMERGENCY SERVICES,
INFORM A PATIENT OR PROSPECTIVE PATIENT THAT THE AMOUNT OR ESTIMATED
AMOUNT THE HEALTH CARE PROFESSIONAL WILL BILL THE PATIENT FOR HEALTH
CARE SERVICES IS AVAILABLE UPON REQUEST; AND (B) UPON RECEIPT OF A
REQUEST FROM A PATIENT OR PROSPECTIVE PATIENT, DISCLOSE TO THE PATIENT
OR PROSPECTIVE PATIENT IN WRITING THE AMOUNT OR ESTIMATED AMOUNT OR,
WITH RESPECT TO A HEALTH CENTER, A SCHEDULE OF FEES PROVIDED UNDER 42
U.S.C. S 254B(K)(3)(G)(I), THAT THE HEALTH CARE PROFESSIONAL, GROUP
PRACTICE, DIAGNOSTIC AND TREATMENT CENTER OR HEALTH CENTER, WILL BILL
THE PATIENT OR PROSPECTIVE PATIENT FOR HEALTH CARE SERVICES PROVIDED OR
S. 6914 169 A. 9205
ANTICIPATED TO BE PROVIDED TO THE PATIENT OR PROSPECTIVE PATIENT ABSENT
UNFORESEEN MEDICAL CIRCUMSTANCES THAT MAY ARISE WHEN THE HEALTH CARE
SERVICES ARE PROVIDED.
3. A HEALTH CARE PROFESSIONAL WHO IS A PHYSICIAN SHALL PROVIDE A
PATIENT OR PROSPECTIVE PATIENT WITH THE NAME, PRACTICE NAME, MAILING
ADDRESS, AND TELEPHONE NUMBER OF ANY HEALTH CARE PROVIDER SCHEDULED TO
PERFORM ANESTHESIOLOGY, LABORATORY, PATHOLOGY, RADIOLOGY OR ASSISTANT
SURGEON SERVICES IN CONNECTION WITH CARE TO BE PROVIDED IN THE PHYSI-
CIAN'S OFFICE FOR THE PATIENT OR COORDINATED OR REFERRED BY THE PHYSI-
CIAN FOR THE PATIENT AT THE TIME OF REFERRAL TO OR COORDINATION OF
SERVICES WITH SUCH PROVIDER.
4. A HEALTH CARE PROFESSIONAL WHO IS A PHYSICIAN SHALL, FOR A
PATIENT'S SCHEDULED HOSPITAL ADMISSION OR SCHEDULED OUTPATIENT HOSPITAL
SERVICES, PROVIDE A PATIENT AND THE HOSPITAL WITH THE NAME, PRACTICE
NAME, MAILING ADDRESS AND TELEPHONE NUMBER OF ANY OTHER PHYSICIAN WHOSE
SERVICES WILL BE ARRANGED BY THE PHYSICIAN AND ARE SCHEDULED AT THE TIME
OF THE PRE-ADMISSION TESTING, REGISTRATION OR ADMISSION AT THE TIME
NON-EMERGENCY SERVICES ARE SCHEDULED; AND INFORMATION AS TO HOW TO
DETERMINE THE HEALTHCARE PLANS IN WHICH THE PHYSICIAN PARTICIPATES.
5. A HOSPITAL SHALL ESTABLISH, UPDATE AND MAKE PUBLIC THROUGH POSTING
ON THE HOSPITAL'S WEBSITE, TO THE EXTENT REQUIRED BY FEDERAL GUIDELINES,
A LIST OF THE HOSPITAL'S STANDARD CHARGES FOR ITEMS AND SERVICES
PROVIDED BY THE HOSPITAL, INCLUDING FOR DIAGNOSIS-RELATED GROUPS ESTAB-
LISHED UNDER SECTION 1886(D)(4) OF THE FEDERAL SOCIAL SECURITY ACT.
6. A HOSPITAL SHALL POST ON THE HOSPITAL'S WEBSITE: (A) THE HEALTH
CARE PLANS IN WHICH THE HOSPITAL IS A PARTICIPATING PROVIDER; (B) A
STATEMENT THAT (I) PHYSICIAN SERVICES PROVIDED IN THE HOSPITAL ARE NOT
INCLUDED IN THE HOSPITAL'S CHARGES; (II) PHYSICIANS WHO PROVIDE SERVICES
IN THE HOSPITAL MAY OR MAY NOT PARTICIPATE WITH THE SAME HEALTH CARE
PLANS AS THE HOSPITAL, AND; (III) THE PROSPECTIVE PATIENT SHOULD CHECK
WITH THE PHYSICIAN ARRANGING FOR THE HOSPITAL SERVICES TO DETERMINE THE
HEALTH CARE PLANS IN WHICH THE PHYSICIAN PARTICIPATES; (C) AS APPLICA-
BLE, THE NAME, MAILING ADDRESS AND TELEPHONE NUMBER OF THE PHYSICIAN
GROUPS THAT THE HOSPITAL HAS CONTRACTED WITH TO PROVIDE SERVICES INCLUD-
ING ANESTHESIOLOGY, PATHOLOGY OR RADIOLOGY, AND INSTRUCTIONS HOW TO
CONTACT THESE GROUPS TO DETERMINE THE HEALTH CARE PLAN PARTICIPATION OF
THE PHYSICIANS IN THESE GROUPS; AND (D) AS APPLICABLE, THE NAME, MAILING
ADDRESS, AND TELEPHONE NUMBER OF PHYSICIANS EMPLOYED BY THE HOSPITAL AND
WHOSE SERVICES MAY BE PROVIDED AT THE HOSPITAL, AND THE HEALTH CARE
PLANS IN WHICH THEY PARTICIPATE.
7. IN REGISTRATION OR ADMISSION MATERIALS PROVIDED IN ADVANCE OF NON-
EMERGENCY HOSPITAL SERVICES, A HOSPITAL SHALL: (A) ADVISE THE PATIENT OR
PROSPECTIVE PATIENT TO CHECK WITH THE PHYSICIAN ARRANGING THE HOSPITAL
SERVICES TO DETERMINE: (I) THE NAME, PRACTICE NAME, MAILING ADDRESS AND
TELEPHONE NUMBER OF ANY OTHER PHYSICIAN WHOSE SERVICES WILL BE ARRANGED
BY THE PHYSICIAN; AND (II) WHETHER THE SERVICES OF PHYSICIANS WHO ARE
EMPLOYED OR CONTRACTED BY THE HOSPITAL TO PROVIDE SERVICES INCLUDING
ANESTHESIOLOGY, PATHOLOGY AND/OR RADIOLOGY ARE REASONABLY ANTICIPATED TO
BE PROVIDED TO THE PATIENT; AND (B) PROVIDE PATIENTS OR PROSPECTIVE
PATIENTS WITH INFORMATION AS TO HOW TO TIMELY DETERMINE THE HEALTH CARE
PLANS PARTICIPATED IN BY PHYSICIANS WHO ARE REASONABLY ANTICIPATED TO
PROVIDE SERVICES TO THE PATIENT AT THE HOSPITAL, AS DETERMINED BY THE
PHYSICIAN ARRANGING THE PATIENT'S HOSPITAL SERVICES, AND WHO ARE EMPLOY-
EES OF THE HOSPITAL OR CONTRACTED BY THE HOSPITAL TO PROVIDE SERVICES
INCLUDING ANESTHESIOLOGY, RADIOLOGY AND/OR PATHOLOGY.
8. FOR PURPOSES OF THIS SECTION:
S. 6914 170 A. 9205
(A) "HEALTH CARE PLAN" MEANS A HEALTH INSURER INCLUDING AN INSURER
LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE SUBJECT TO ARTICLE THIR-
TY-TWO OF THE INSURANCE LAW; A CORPORATION ORGANIZED PURSUANT TO ARTICLE
FORTY-THREE OF THE INSURANCE LAW; A MUNICIPAL COOPERATIVE HEALTH BENEFIT
PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE LAW; A
HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR
OF THIS CHAPTER; A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSU-
ANT TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THE INSURANCE LAW
OR A SELF-FUNDED EMPLOYEE WELFARE BENEFIT PLAN.
(B) "HEALTH CARE PROFESSIONAL" MEANS AN APPROPRIATELY LICENSED, REGIS-
TERED OR CERTIFIED HEALTH CARE PROFESSIONAL PURSUANT TO TITLE EIGHT OF
THE EDUCATION LAW.
(C) "HOSPITAL" MEANS A GENERAL HOSPITAL AS DEFINED IN SUBDIVISION TEN
OF SECTION TWO THOUSAND EIGHT HUNDRED ONE OF THIS CHAPTER.
S 18. Paragraphs (k), (p-1), (q) and (r) of subdivision 1 of section
4408 of the public health law, paragraphs (k), (q) and (r) as added by
chapter 705 of the laws of 1996, and paragraph (p-1) as added by chapter
554 of the laws of 2002, are amended and three new paragraphs (s), (t)
and (u) are added to read as follows:
(k) notice that an enrollee may obtain a referral to a health care
provider outside of the health maintenance organization's network or
panel when the health maintenance organization does not have a health
care provider [with] WHO IS GEOGRAPHICALLY ACCESSIBLE TO THE ENROLLEE
AND WHO HAS appropriate training and experience in the network or panel
to meet the particular health care needs of the enrollee and the proce-
dure by which the enrollee can obtain such referral;
(p-1) notice that an enrollee shall have direct access to primary and
preventive obstetric and gynecologic services, INCLUDING ANNUAL EXAMINA-
TIONS, CARE RESULTING FROM SUCH ANNUAL EXAMINATIONS, AND TREATMENT OF
ACUTE GYNECOLOGIC CONDITIONS, from a qualified provider of such services
of her choice from within the plan [for no fewer than two examinations
annually for such services] or [to] FOR any care related to A pregnancy
[and that additionally, the enrollee shall have direct access to primary
and preventive obstetric and gynecologic services required as a result
of such annual examinations or as a result of an acute gynecologic
condition];
(q) notice of all appropriate mailing addresses and telephone numbers
to be utilized by enrollees seeking information or authorization; [and]
(r) a listing by specialty, which may be in a separate document that
is updated annually, of the name, address and telephone number of all
participating providers, including facilities, and, in addition, in the
case of physicians, board certification[.], LANGUAGES SPOKEN AND ANY
AFFILIATIONS WITH PARTICIPATING HOSPITALS. THE LISTING SHALL ALSO BE
POSTED ON THE HEALTH MAINTENANCE ORGANIZATION'S WEBSITE AND THE HEALTH
MAINTENANCE ORGANIZATION SHALL UPDATE THE WEBSITE WITHIN FIFTEEN DAYS OF
THE ADDITION OR TERMINATION OF A PROVIDER FROM THE HEALTH MAINTENANCE
ORGANIZATION'S NETWORK OR A CHANGE IN A PHYSICIAN'S HOSPITAL AFFIL-
IATION;
(S) WHERE APPLICABLE, A DESCRIPTION OF THE METHOD BY WHICH AN ENROLLEE
MAY SUBMIT A CLAIM FOR HEALTH CARE SERVICES;
(T) WITH RESPECT TO OUT-OF-NETWORK COVERAGE:
(I) A CLEAR DESCRIPTION OF THE METHODOLOGY USED BY THE HEALTH MAINTE-
NANCE ORGANIZATION TO DETERMINE REIMBURSEMENT FOR OUT-OF-NETWORK HEALTH
CARE SERVICES;
(II) THE AMOUNT THAT THE HEALTH MAINTENANCE ORGANIZATION WILL REIM-
BURSE UNDER THE METHODOLOGY FOR OUT-OF-NETWORK HEALTH CARE SERVICES SET
S. 6914 171 A. 9205
FORTH AS A PERCENTAGE OF THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK
HEALTH CARE SERVICES;
(III) EXAMPLES OF ANTICIPATED OUT-OF-POCKET COSTS FOR FREQUENTLY
BILLED OUT-OF-NETWORK HEALTH CARE SERVICES; AND
(U) INFORMATION IN WRITING AND THROUGH AN INTERNET WEBSITE THAT
REASONABLY PERMITS AN ENROLLEE OR PROSPECTIVE ENROLLEE TO ESTIMATE THE
ANTICIPATED OUT-OF-POCKET COST FOR OUT-OF-NETWORK HEALTH CARE SERVICES
IN A GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE BETWEEN
WHAT THE HEALTH MAINTENANCE ORGANIZATION WILL REIMBURSE FOR OUT-OF-NET-
WORK HEALTH CARE SERVICES AND THE USUAL AND CUSTOMARY COST FOR
OUT-OF-NETWORK HEALTH CARE SERVICES.
S 19. Paragraphs (k) and (l) of subdivision 2 of section 4408 of the
public health law, as added by chapter 705 of the laws of 1996, are
amended and two new paragraphs (m) and (n) are added to read as follows:
(k) provide the written application procedures and minimum qualifica-
tion requirements for health care providers to be considered by the
health maintenance organization; [and]
(1) disclose other information as required by the commissioner,
provided that such requirements are promulgated pursuant to the state
administrative procedure act[.];
(M) DISCLOSE WHETHER A HEALTH CARE PROVIDER SCHEDULED TO PROVIDE A
HEALTH CARE SERVICE IS AN IN-NETWORK PROVIDER; AND
(N) WITH RESPECT TO OUT-OF-NETWORK COVERAGE, DISCLOSE THE APPROXIMATE
DOLLAR AMOUNT THAT THE HEALTH MAINTENANCE ORGANIZATION WILL PAY FOR A
SPECIFIC OUT-OF-NETWORK HEALTH CARE SERVICE. THE HEALTH MAINTENANCE
ORGANIZATION SHALL ALSO INFORM AN ENROLLEE THROUGH SUCH DISCLOSURE THAT
SUCH APPROXIMATION IS NOT BINDING ON THE HEALTH MAINTENANCE ORGANIZATION
AND THAT THE APPROXIMATE DOLLAR AMOUNT THAT THE HEALTH MAINTENANCE
ORGANIZATION WILL PAY FOR A SPECIFIC OUT-OF-NETWORK HEALTH CARE SERVICE
MAY CHANGE.
S 20. Section 4408 of the public health law is amended by adding a new
subdivision 7 to read as follows:
7. FOR PURPOSES OF THIS SECTION, "USUAL AND CUSTOMARY COST" SHALL
MEAN THE EIGHTIETH PERCENTILE OF ALL CHARGES FOR THE PARTICULAR HEALTH
CARE SERVICE PERFORMED BY A PROVIDER IN THE SAME OR SIMILAR SPECIALTY
AND PROVIDED IN THE SAME GEOGRAPHICAL AREA AS REPORTED IN A BENCHMARKING
DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE SUPER-
INTENDENT OF FINANCIAL SERVICES. THE NONPROFIT ORGANIZATION SHALL NOT BE
AFFILIATED WITH AN INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE
OF THE INSURANCE LAW, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTI-
FIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE LAW, OR A HEALTH
MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO THIS ARTICLE.
S 21. Section 4900 of the public health law is amended by adding a new
subdivision 7-f-1 to read as follows:
7-F-1. "OUT-OF-NETWORK REFERRAL DENIAL" MEANS A DENIAL OF A REQUEST
FOR AN AUTHORIZATION OR REFERRAL TO AN OUT-OF-NETWORK PROVIDER ON THE
BASIS THAT THE HEALTH CARE PLAN HAS A HEALTH CARE PROVIDER IN THE
IN-NETWORK BENEFITS PORTION OF ITS NETWORK WITH APPROPRIATE TRAINING AND
EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN ENROLLEE, AND
WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE. THE NOTICE OF AN
OUT-OF-NETWORK REFERRAL DENIAL PROVIDED TO AN ENROLLEE SHALL INCLUDE
INFORMATION EXPLAINING WHAT INFORMATION THE ENROLLEE MUST SUBMIT IN
ORDER TO APPEAL THE OUT-OF-NETWORK REFERRAL DENIAL PURSUANT TO SUBDIVI-
SION ONE-B OF SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS ARTICLE.
AN OUT-OF-NETWORK REFERRAL DENIAL UNDER THIS SUBDIVISION DOES NOT
CONSTITUTE AN ADVERSE DETERMINATION AS DEFINED IN THIS ARTICLE. AN OUT-
S. 6914 172 A. 9205
OF-NETWORK REFERRAL DENIAL SHALL NOT BE CONSTRUED TO INCLUDE AN OUT-OF-
NETWORK DENIAL AS DEFINED IN SUBDIVISION SEVEN-F OF THIS SECTION.
S 22. Subdivision 2 of section 4903 of the public health law, as
amended by chapter 514 of the laws of 2013, is amended to read as
follows:
2. A utilization review agent shall make a utilization review determi-
nation involving health care services which require pre-authorization
and provide notice of a determination to the enrollee or enrollee's
designee and the enrollee's health care provider by telephone and in
writing within three business days of receipt of the necessary informa-
tion. To the extent practicable, such written notification to the
enrollee's health care provider shall be transmitted electronically, in
a manner and in a form agreed upon by the parties. THE NOTIFICATION
SHALL IDENTIFY; (A) WHETHER THE SERVICES ARE CONSIDERED IN-NETWORK OR
OUT-OF-NETWORK; (B) AND WHETHER THE ENROLLEE WILL BE HELD HARMLESS FOR
THE SERVICES AND NOT BE RESPONSIBLE FOR ANY PAYMENT, OTHER THAN ANY
APPLICABLE CO-PAYMENT OR CO-INSURANCE; (C) AS APPLICABLE, THE DOLLAR
AMOUNT THE HEALTH CARE PLAN WILL PAY IF THE SERVICE IS OUT-OF-NETWORK;
AND (D) AS APPLICABLE, INFORMATION EXPLAINING HOW AN ENROLLEE MAY DETER-
MINE THE ANTICIPATED OUT-OF-POCKET COST FOR OUT-OF-NETWORK HEALTH CARE
SERVICES IN A GEOGRAPHICAL AREA OR ZIP CODE BASED UPON THE DIFFERENCE
BETWEEN WHAT THE HEALTH CARE PLAN WILL REIMBURSE FOR OUT-OF-NETWORK
HEALTH CARE SERVICES AND THE USUAL AND CUSTOMARY COST FOR OUT-OF-NETWORK
HEALTH CARE SERVICES.
S 23. Section 4904 of the public health law is amended by adding a new
subdivision 1-b to read as follows:
1-B. AN ENROLLEE OR THE ENROLLEE'S DESIGNEE MAY APPEAL A DENIAL OF AN
OUT-OF-NETWORK REFERRAL BY A HEALTH CARE PLAN BY SUBMITTING A WRITTEN
STATEMENT FROM THE ENROLLEE'S ATTENDING PHYSICIAN, WHO MUST BE A
LICENSED, BOARD CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRAC-
TICE IN THE SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT THE ENROLLEE
FOR THE HEALTH SERVICE SOUGHT, PROVIDED THAT: (A) THE IN-NETWORK HEALTH
CARE PROVIDER OR PROVIDERS RECOMMENDED BY THE HEALTH CARE PLAN DO NOT
HAVE THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR
HEALTH CARE NEEDS OF THE ENROLLEE FOR THE HEALTH SERVICE; AND (B) RECOM-
MENDS AN OUT-OF-NETWORK PROVIDER WITH THE APPROPRIATE TRAINING AND EXPE-
RIENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF THE ENROLLEE, AND WHO
IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE.
S 24. Subdivision 2 of section 4910 of the public health law is
amended by adding a new paragraph (d) to read as follows:
(D)(I) THE ENROLLEE HAS HAD AN OUT-OF-NETWORK REFERRAL DENIED ON THE
GROUNDS THAT THE HEALTH CARE PLAN HAS A HEALTH CARE PROVIDER IN THE
IN-NETWORK BENEFITS PORTION OF ITS NETWORK WITH APPROPRIATE TRAINING AND
EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN ENROLLEE, AND
WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH SERVICE.
(II) THE ENROLLEE'S ATTENDING PHYSICIAN, WHO SHALL BE A LICENSED,
BOARD CERTIFIED OR BOARD ELIGIBLE PHYSICIAN QUALIFIED TO PRACTICE IN THE
SPECIALTY AREA OF PRACTICE APPROPRIATE TO TREAT THE ENROLLEE FOR THE
HEALTH SERVICE SOUGHT, CERTIFIES THAT THE IN-NETWORK HEALTH CARE PROVID-
ER OR PROVIDERS RECOMMENDED BY THE HEALTH CARE PLAN DO NOT HAVE THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE
NEEDS OF AN ENROLLEE, AND RECOMMENDS AN OUT-OF-NETWORK PROVIDER WITH THE
APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTICULAR HEALTH CARE
NEEDS OF AN ENROLLEE, AND WHO IS ABLE TO PROVIDE THE REQUESTED HEALTH
SERVICE.
S. 6914 173 A. 9205
S 25. Paragraph (d) of subdivision 2 of section 4914 of the public
health law is amended by adding a new subparagraph (D) to read as
follows:
(D) FOR EXTERNAL APPEALS REQUESTED PURSUANT TO PARAGRAPH (D) OF SUBDI-
VISION TWO OF SECTION FOUR THOUSAND NINE HUNDRED TEN OF THIS TITLE
RELATING TO AN OUT-OF-NETWORK REFERRAL DENIAL, THE EXTERNAL APPEAL AGENT
SHALL REVIEW THE UTILIZATION REVIEW AGENT'S FINAL ADVERSE DETERMINATION
AND, IN ACCORDANCE WITH THE PROVISIONS OF THIS TITLE, SHALL MAKE A
DETERMINATION AS TO WHETHER THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED
BY THE HEALTH PLAN; PROVIDED THAT SUCH DETERMINATION SHALL:
(I) BE CONDUCTED ONLY BY ONE OR A GREATER ODD NUMBER OF CLINICAL PEER
REVIEWERS;
(II) BE ACCOMPANIED BY A WRITTEN STATEMENT:
(1) THAT THE OUT-OF-NETWORK REFERRAL SHALL BE COVERED BY THE HEALTH
CARE PLAN EITHER WHEN THE REVIEWER OR A MAJORITY OF THE PANEL OF REVIEW-
ERS DETERMINES, UPON REVIEW OF THE TRAINING AND EXPERIENCE OF THE
IN-NETWORK HEALTH CARE PROVIDER OR PROVIDERS PROPOSED BY THE PLAN, THE
TRAINING AND EXPERIENCE OF THE REQUESTED OUT-OF-NETWORK PROVIDER, THE
CLINICAL STANDARDS OF THE PLAN, THE INFORMATION PROVIDED CONCERNING THE
ENROLLEE, THE ATTENDING PHYSICIAN'S RECOMMENDATION, THE ENROLLEE'S
MEDICAL RECORD, AND ANY OTHER PERTINENT INFORMATION, THAT THE HEALTH
PLAN DOES NOT HAVE A PROVIDER WITH THE APPROPRIATE TRAINING AND EXPERI-
ENCE TO MEET THE PARTICULAR HEALTH CARE NEEDS OF AN ENROLLEE WHO IS ABLE
TO PROVIDE THE REQUESTED HEALTH SERVICE, AND THAT THE OUT-OF-NETWORK
PROVIDER HAS THE APPROPRIATE TRAINING AND EXPERIENCE TO MEET THE PARTIC-
ULAR HEALTH CARE NEEDS OF AN ENROLLEE, IS ABLE TO PROVIDE THE REQUESTED
HEALTH SERVICE, AND IS LIKELY TO PRODUCE A MORE CLINICALLY BENEFICIAL
OUTCOME; OR
(2) UPHOLDING THE HEALTH PLAN'S DENIAL OF COVERAGE;
(III) BE SUBJECT TO THE TERMS AND CONDITIONS GENERALLY APPLICABLE TO
BENEFITS UNDER THE EVIDENCE OF COVERAGE UNDER THE HEALTH CARE PLAN;
(IV) BE BINDING ON THE PLAN AND THE ENROLLEE; AND
(V) BE ADMISSIBLE IN ANY COURT PROCEEDING.
S 26. The financial services law is amended by adding a new article 6
to read as follows:
ARTICLE 6
EMERGENCY MEDICAL SERVICES AND SURPRISE BILLS
SECTION 601. DISPUTE RESOLUTION PROCESS ESTABLISHED.
602. APPLICABILITY.
603. DEFINITIONS.
604. CRITERIA FOR DETERMINING A REASONABLE FEE.
605. DISPUTE RESOLUTION FOR EMERGENCY SERVICES.
606. HOLD HARMLESS AND ASSIGNMENT OF BENEFITS FOR SURPRISE BILLS
FOR INSUREDS.
607. DISPUTE RESOLUTION FOR SURPRISE BILLS.
608. PAYMENT FOR INDEPENDENT DISPUTE RESOLUTION ENTITY.
S 601. DISPUTE RESOLUTION PROCESS ESTABLISHED. THE SUPERINTENDENT
SHALL ESTABLISH A DISPUTE RESOLUTION PROCESS BY WHICH A DISPUTE FOR A
BILL FOR EMERGENCY SERVICES OR A SURPRISE BILL MAY BE RESOLVED. THE
SUPERINTENDENT SHALL HAVE THE POWER TO GRANT AND REVOKE CERTIFICATIONS
OF INDEPENDENT DISPUTE RESOLUTION ENTITIES TO CONDUCT THE DISPUTE RESOL-
UTION PROCESS. THE SUPERINTENDENT SHALL PROMULGATE REGULATIONS ESTAB-
LISHING STANDARDS FOR THE DISPUTE RESOLUTION PROCESS, INCLUDING A PROC-
ESS FOR CERTIFYING AND SELECTING INDEPENDENT DISPUTE RESOLUTION
ENTITIES. AN INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL USE LICENSED
PHYSICIANS IN ACTIVE PRACTICE IN THE SAME OR SIMILAR SPECIALTY AS THE
S. 6914 174 A. 9205
PHYSICIAN PROVIDING THE SERVICE THAT IS SUBJECT TO THE DISPUTE RESOL-
UTION PROCESS OF THIS ARTICLE. TO THE EXTENT PRACTICABLE, THE PHYSICIAN
SHALL BE LICENSED IN THIS STATE.
S 602. APPLICABILITY. (A) THIS ARTICLE SHALL NOT APPLY TO HEALTH CARE
SERVICES, INCLUDING EMERGENCY SERVICES, WHERE PHYSICIAN FEES ARE SUBJECT
TO SCHEDULES OR OTHER MONETARY LIMITATIONS UNDER ANY OTHER LAW, INCLUD-
ING THE WORKERS' COMPENSATION LAW AND ARTICLE FIFTY-ONE OF THE INSURANCE
LAW, AND SHALL NOT PREEMPT ANY SUCH LAW.
(B)(1) WITH REGARD TO EMERGENCY SERVICES BILLED UNDER AMERICAN MEDICAL
ASSOCIATION CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES 99281 THROUGH
99285, 99288, 99291 THROUGH 99292, 99217 THROUGH 99220, 99224 THROUGH
99226, AND 99234 THROUGH 99236, THE DISPUTE RESOLUTION PROCESS ESTAB-
LISHED IN THIS ARTICLE SHALL NOT APPLY WHEN:
(A) THE AMOUNT BILLED FOR ANY SUCH CPT CODE MEETS THE REQUIREMENTS SET
FORTH IN PARAGRAPH THREE OF THIS SUBSECTION, AFTER ANY APPLICABLE CO-IN-
SURANCE, CO-PAYMENT AND DEDUCTIBLE; AND
(B) THE AMOUNT BILLED FOR ANY SUCH CPT CODE DOES NOT EXCEED ONE
HUNDRED TWENTY PERCENT OF THE USUAL AND CUSTOMARY COST FOR SUCH CPT
CODE.
(2) THE HEALTH CARE PLAN SHALL ENSURE THAT AN INSURED SHALL NOT INCUR
ANY GREATER OUT-OF-POCKET COSTS FOR EMERGENCY SERVICES BILLED UNDER A
CPT CODE AS SET FORTH IN THIS SUBSECTION THAN THE INSURED WOULD HAVE
INCURRED IF SUCH EMERGENCY SERVICES WERE PROVIDED BY A PARTICIPATING
PHYSICIAN.
(3) BEGINNING JANUARY FIRST, TWO THOUSAND FIFTEEN AND EACH JANUARY
FIRST THEREAFTER, THE SUPERINTENDENT SHALL PUBLISH ON A WEBSITE MAIN-
TAINED BY THE DEPARTMENT OF FINANCIAL SERVICES, AND PROVIDE IN WRITING
TO EACH HEALTH CARE PLAN, A DOLLAR AMOUNT FOR WHICH BILLS FOR THE PROCE-
DURE CODES IDENTIFIED IN THIS SUBSECTION SHALL BE EXEMPT FROM THE
DISPUTE RESOLUTION PROCESS ESTABLISHED IN THIS ARTICLE. SUCH AMOUNT
SHALL EQUAL THE AMOUNT FROM THE PRIOR YEAR, BEGINNING WITH SIX HUNDRED
DOLLARS IN TWO THOUSAND FOURTEEN, ADJUSTED BY THE AVERAGE OF THE ANNUAL
AVERAGE INFLATION RATES FOR THE MEDICAL CARE COMMODITIES AND MEDICAL
CARE SERVICES COMPONENTS OF THE CONSUMER PRICE INDEX. IN NO EVENT SHALL
AN AMOUNT EXCEEDING ONE THOUSAND TWO HUNDRED DOLLARS FOR A SPECIFIC CPT
CODE BILLED BE EXEMPT FROM THE DISPUTE RESOLUTION PROCESS ESTABLISHED IN
THIS ARTICLE.
S 603. DEFINITIONS. FOR THE PURPOSES OF THIS ARTICLE:
(A) "EMERGENCY CONDITION" MEANS A MEDICAL OR BEHAVIORAL CONDITION THAT
MANIFESTS ITSELF BY ACUTE SYMPTOMS OF SUFFICIENT SEVERITY, INCLUDING
SEVERE PAIN, SUCH THAT A PRUDENT LAYPERSON, POSSESSING AN AVERAGE KNOW-
LEDGE OF MEDICINE AND HEALTH, COULD REASONABLY EXPECT THE ABSENCE OF
IMMEDIATE MEDICAL ATTENTION TO RESULT IN : (1) PLACING THE HEALTH OF THE
PERSON AFFLICTED WITH SUCH CONDITION IN SERIOUS JEOPARDY, OR IN THE CASE
OF A BEHAVIORAL CONDITION PLACING THE HEALTH OF SUCH PERSON OR OTHERS IN
SERIOUS JEOPARDY; (2) SERIOUS IMPAIRMENT TO SUCH PERSON'S BODILY FUNC-
TIONS; (3) SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART OF SUCH
PERSON; (4) SERIOUS DISFIGUREMENT OF SUCH PERSON; OR (5) A CONDITION
DESCRIBED IN CLAUSE (I), (II) OR (III) OF SECTION 1867(E)(1)(A) OF THE
SOCIAL SECURITY ACT 42 U.S.C. S 1395DD.
(B) "EMERGENCY SERVICES" MEANS, WITH RESPECT TO AN EMERGENCY CONDI-
TION: (1) A MEDICAL SCREENING EXAMINATION AS REQUIRED UNDER SECTION 1867
OF THE SOCIAL SECURITY ACT, 42 U.S.C. S 1395DD, WHICH IS WITHIN THE
CAPABILITY OF THE EMERGENCY DEPARTMENT OF A HOSPITAL, INCLUDING ANCIL-
LARY SERVICES ROUTINELY AVAILABLE TO THE EMERGENCY DEPARTMENT TO EVALU-
ATE SUCH EMERGENCY MEDICAL CONDITION; AND (2) WITHIN THE CAPABILITIES OF
S. 6914 175 A. 9205
THE STAFF AND FACILITIES AVAILABLE AT THE HOSPITAL, SUCH FURTHER MEDICAL
EXAMINATION AND TREATMENT AS ARE REQUIRED UNDER SECTION 1867 OF THE
SOCIAL SECURITY ACT, 42 U.S.C. S 1395DD, TO STABILIZE THE PATIENT.
(C) "HEALTH CARE PLAN" MEANS AN INSURER LICENSED TO WRITE ACCIDENT AND
HEALTH INSURANCE PURSUANT TO ARTICLE THIRTY-TWO OF THE INSURANCE LAW; A
CORPORATION ORGANIZED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE
LAW; A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO
ARTICLE FORTY-SEVEN OF THE INSURANCE LAW; A HEALTH MAINTENANCE ORGANIZA-
TION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW;
OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT TO SECTION
ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THE INSURANCE LAW.
(D) "INSURED" MEANS A PATIENT COVERED UNDER A HEALTH CARE PLAN'S POLI-
CY OR CONTRACT.
(E) "NON-PARTICIPATING" MEANS NOT HAVING A CONTRACT WITH A HEALTH CARE
PLAN TO PROVIDE HEALTH CARE SERVICES TO AN INSURED.
(F) "PARTICIPATING" MEANS HAVING A CONTRACT WITH A HEALTH CARE PLAN TO
PROVIDE HEALTH CARE SERVICES TO AN INSURED.
(G) "PATIENT" MEANS A PERSON WHO RECEIVES HEALTH CARE SERVICES,
INCLUDING EMERGENCY SERVICES, IN THIS STATE.
(H) "SURPRISE BILL" MEANS A BILL FOR HEALTH CARE SERVICES, OTHER THAN
EMERGENCY SERVICES, RECEIVED BY:
(1) AN INSURED FOR SERVICES RENDERED BY A NON-PARTICIPATING PHYSICIAN
AT A PARTICIPATING HOSPITAL OR AMBULATORY SURGICAL CENTER, WHERE A
PARTICIPATING PHYSICIAN IS UNAVAILABLE OR A NON-PARTICIPATING PHYSICIAN
RENDERS SERVICES WITHOUT THE INSURED'S KNOWLEDGE, OR UNFORESEEN MEDICAL
SERVICES ARISE AT THE TIME THE HEALTH CARE SERVICES ARE RENDERED;
PROVIDED, HOWEVER, THAT A SURPRISE BILL SHALL NOT MEAN A BILL RECEIVED
FOR HEALTH CARE SERVICES WHEN A PARTICIPATING PHYSICIAN IS AVAILABLE AND
THE INSURED HAS ELECTED TO OBTAIN SERVICES FROM A NON-PARTICIPATING
PHYSICIAN;
(2) AN INSURED FOR SERVICES RENDERED BY A NON-PARTICIPATING PROVIDER,
WHERE THE SERVICES WERE REFERRED BY A PARTICIPATING PHYSICIAN TO A NON-
PARTICIPATING PROVIDER WITHOUT EXPLICIT WRITTEN CONSENT OF THE INSURED
ACKNOWLEDGING THAT THE PARTICIPATING PHYSICIAN IS REFERRING THE INSURED
TO A NON-PARTICIPATING PROVIDER AND THAT THE REFERRAL MAY RESULT IN
COSTS NOT COVERED BY THE HEALTH CARE PLAN; OR
(3) A PATIENT WHO IS NOT AN INSURED FOR SERVICES RENDERED BY A PHYSI-
CIAN AT A HOSPITAL OR AMBULATORY SURGICAL CENTER, WHERE THE PATIENT HAS
NOT TIMELY RECEIVED ALL OF THE DISCLOSURES REQUIRED PURSUANT TO SECTION
TWENTY-FOUR OF THE PUBLIC HEALTH LAW.
(I) "USUAL AND CUSTOMARY COST" MEANS THE EIGHTIETH PERCENTILE OF ALL
CHARGES FOR THE PARTICULAR HEALTH CARE SERVICE PERFORMED BY A PROVIDER
IN THE SAME OR SIMILAR SPECIALTY AND PROVIDED IN THE SAME GEOGRAPHICAL
AREA AS REPORTED IN A BENCHMARKING DATABASE MAINTAINED BY A NONPROFIT
ORGANIZATION SPECIFIED BY THE SUPERINTENDENT. THE NONPROFIT ORGANIZATION
SHALL NOT BE AFFILIATED WITH AN INSURER, A CORPORATION SUBJECT TO ARTI-
CLE FORTY-THREE OF THE INSURANCE LAW, A MUNICIPAL COOPERATIVE HEALTH
BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE
LAW, OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW.
S 604. CRITERIA FOR DETERMINING A REASONABLE FEE. IN DETERMINING THE
APPROPRIATE AMOUNT TO PAY FOR A HEALTH CARE SERVICE, AN INDEPENDENT
DISPUTE RESOLUTION ENTITY SHALL CONSIDER ALL RELEVANT FACTORS, INCLUD-
ING:
(A) WHETHER THERE IS A GROSS DISPARITY BETWEEN THE FEE CHARGED BY THE
PHYSICIAN FOR SERVICES RENDERED AS COMPARED TO:
S. 6914 176 A. 9205
(1) FEES PAID TO THE INVOLVED PHYSICIAN FOR THE SAME SERVICES RENDERED
BY THE PHYSICIAN TO OTHER PATIENTS IN HEALTH CARE PLANS IN WHICH THE
PHYSICIAN IS NOT PARTICIPATING, AND
(2) IN THE CASE OF A DISPUTE INVOLVING A HEALTH CARE PLAN, FEES PAID
BY THE HEALTH CARE PLAN TO REIMBURSE SIMILARLY QUALIFIED PHYSICIANS FOR
THE SAME SERVICES IN THE SAME REGION WHO ARE NOT PARTICIPATING WITH THE
HEALTH CARE PLAN;
(B) THE LEVEL OF TRAINING, EDUCATION AND EXPERIENCE OF THE PHYSICIAN;
(C) THE PHYSICIAN'S USUAL CHARGE FOR COMPARABLE SERVICES WITH REGARD
TO PATIENTS IN HEALTH CARE PLANS IN WHICH THE PHYSICIAN IS NOT PARTIC-
IPATING;
(D) THE CIRCUMSTANCES AND COMPLEXITY OF THE PARTICULAR CASE, INCLUDING
TIME AND PLACE OF THE SERVICE;
(E) INDIVIDUAL PATIENT CHARACTERISTICS; AND
(F) THE USUAL AND CUSTOMARY COST OF THE SERVICE.
S 605. DISPUTE RESOLUTION FOR EMERGENCY SERVICES. (A) EMERGENCY
SERVICES FOR AN INSURED. (1) WHEN A HEALTH CARE PLAN RECEIVES A BILL FOR
EMERGENCY SERVICES FROM A NON-PARTICIPATING PHYSICIAN, THE HEALTH CARE
PLAN SHALL PAY AN AMOUNT THAT IT DETERMINES IS REASONABLE FOR THE EMER-
GENCY SERVICES RENDERED BY THE NON-PARTICIPATING PHYSICIAN, IN ACCORD-
ANCE WITH SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THE INSUR-
ANCE LAW, EXCEPT FOR THE INSURED'S CO-PAYMENT, COINSURANCE OR
DEDUCTIBLE, IF ANY, AND SHALL ENSURE THAT THE INSURED SHALL INCUR NO
GREATER OUT-OF-POCKET COSTS FOR THE EMERGENCY SERVICES THAN THE INSURED
WOULD HAVE INCURRED WITH A PARTICIPATING PHYSICIAN PURSUANT TO
SUBSECTION (C) OF SECTION THREE THOUSAND TWO HUNDRED FORTY-ONE OF THE
INSURANCE LAW.
(2) A NON-PARTICIPATING PHYSICIAN OR A HEALTH CARE PLAN MAY SUBMIT A
DISPUTE REGARDING A FEE OR PAYMENT FOR EMERGENCY SERVICES FOR REVIEW TO
AN INDEPENDENT DISPUTE RESOLUTION ENTITY.
(3) THE INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL MAKE A DETERMI-
NATION WITHIN THIRTY DAYS OF RECEIPT OF THE DISPUTE FOR REVIEW.
(4) IN DETERMINING A REASONABLE FEE FOR THE SERVICES RENDERED, AN
INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL SELECT EITHER THE HEALTH
CARE PLAN'S PAYMENT OR THE NON-PARTICIPATING PHYSICIAN'S FEE. THE INDE-
PENDENT DISPUTE RESOLUTION ENTITY SHALL DETERMINE WHICH AMOUNT TO SELECT
BASED UPON THE CONDITIONS AND FACTORS SET FORTH IN SECTION SIX HUNDRED
FOUR OF THIS ARTICLE. IF AN INDEPENDENT DISPUTE RESOLUTION ENTITY
DETERMINES, BASED ON THE HEALTH CARE PLAN'S PAYMENT AND THE NON-PARTICI-
PATING PHYSICIAN'S FEE, THAT A SETTLEMENT BETWEEN THE HEALTH CARE PLAN
AND NON-PARTICIPATING PHYSICIAN IS REASONABLY LIKELY, OR THAT BOTH THE
HEALTH CARE PLAN'S PAYMENT AND THE NON-PARTICIPATING PHYSICIAN'S FEE
REPRESENT UNREASONABLE EXTREMES, THEN THE INDEPENDENT DISPUTE RESOLUTION
ENTITY MAY DIRECT BOTH PARTIES TO ATTEMPT A GOOD FAITH NEGOTIATION FOR
SETTLEMENT. THE HEALTH CARE PLAN AND NON-PARTICIPATING PHYSICIAN MAY BE
GRANTED UP TO TEN BUSINESS DAYS FOR THIS NEGOTIATION, WHICH SHALL RUN
CONCURRENTLY WITH THE THIRTY DAY PERIOD FOR DISPUTE RESOLUTION.
(B) EMERGENCY SERVICES FOR A PATIENT THAT IS NOT AN INSURED. (1) A
PATIENT THAT IS NOT AN INSURED OR THE PATIENT'S PHYSICIAN MAY SUBMIT A
DISPUTE REGARDING A FEE FOR EMERGENCY SERVICES FOR REVIEW TO AN INDE-
PENDENT DISPUTE RESOLUTION ENTITY UPON APPROVAL OF THE SUPERINTENDENT.
(2) AN INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL DETERMINE A REASON-
ABLE FEE FOR THE SERVICES BASED UPON THE SAME CONDITIONS AND FACTORS SET
FORTH IN SECTION SIX HUNDRED FOUR OF THIS ARTICLE.
S. 6914 177 A. 9205
(3) A PATIENT THAT IS NOT AN INSURED SHALL NOT BE REQUIRED TO PAY THE
PHYSICIAN'S FEE IN ORDER TO BE ELIGIBLE TO SUBMIT THE DISPUTE FOR REVIEW
TO AN INDEPENDENT DISPUTE RESOLUTION ENTITY.
(C) THE DETERMINATION OF AN INDEPENDENT DISPUTE RESOLUTION ENTITY
SHALL BE BINDING ON THE HEALTH CARE PLAN, PHYSICIAN AND PATIENT, AND
SHALL BE ADMISSIBLE IN ANY COURT PROCEEDING BETWEEN THE HEALTH CARE
PLAN, PHYSICIAN OR PATIENT, OR IN ANY ADMINISTRATIVE PROCEEDING BETWEEN
THIS STATE AND THE PHYSICIAN.
S 606. HOLD HARMLESS AND ASSIGNMENT OF BENEFITS FOR SURPRISE BILLS FOR
INSUREDS. WHEN AN INSURED ASSIGNS BENEFITS FOR A SURPRISE BILL IN WRIT-
ING TO A NON-PARTICIPATING PHYSICIAN THAT KNOWS THE INSURED IS INSURED
UNDER A HEALTH CARE PLAN, THE NON-PARTICIPATING PHYSICIAN SHALL NOT BILL
THE INSURED EXCEPT FOR ANY APPLICABLE COPAYMENT, COINSURANCE OR DEDUCT-
IBLE THAT WOULD BE OWED IF THE INSURED UTILIZED A PARTICIPATING PHYSI-
CIAN.
S 607. DISPUTE RESOLUTION FOR SURPRISE BILLS. (A) SURPRISE BILL
RECEIVED BY AN INSURED WHO ASSIGNS BENEFITS. (1) IF AN INSURED ASSIGNS
BENEFITS TO A NON-PARTICIPATING PHYSICIAN, THE HEALTH CARE PLAN SHALL
PAY THE NON-PARTICIPATING PHYSICIAN IN ACCORDANCE WITH PARAGRAPHS TWO
AND THREE OF THIS SUBSECTION.
(2) THE NON-PARTICIPATING PHYSICIAN MAY BILL THE HEALTH CARE PLAN FOR
THE HEALTH CARE SERVICES RENDERED, AND THE HEALTH CARE PLAN SHALL PAY
THE NON-PARTICIPATING PHYSICIAN THE BILLED AMOUNT OR ATTEMPT TO NEGOTI-
ATE REIMBURSEMENT WITH THE NON-PARTICIPATING PHYSICIAN.
(3) IF THE HEALTH CARE PLAN'S ATTEMPTS TO NEGOTIATE REIMBURSEMENT FOR
HEALTH CARE SERVICES PROVIDED BY A NON-PARTICIPATING PHYSICIAN DOES NOT
RESULT IN A RESOLUTION OF THE PAYMENT DISPUTE BETWEEN THE NON-PARTICI-
PATING PHYSICIAN AND THE HEALTH CARE PLAN, THE HEALTH CARE PLAN SHALL
PAY THE NON-PARTICIPATING PHYSICIAN AN AMOUNT THE HEALTH CARE PLAN
DETERMINES IS REASONABLE FOR THE HEALTH CARE SERVICES RENDERED, EXCEPT
FOR THE INSURED'S COPAYMENT, COINSURANCE OR DEDUCTIBLE, IN ACCORDANCE
WITH SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THE INSURANCE
LAW.
(4) EITHER THE HEALTH CARE PLAN OR THE NON-PARTICIPATING PHYSICIAN MAY
SUBMIT THE DISPUTE REGARDING THE SURPRISE BILL FOR REVIEW TO AN INDE-
PENDENT DISPUTE RESOLUTION ENTITY, PROVIDED HOWEVER, THE HEALTH CARE
PLAN MAY NOT SUBMIT THE DISPUTE UNLESS IT HAS COMPLIED WITH THE REQUIRE-
MENTS OF PARAGRAPHS ONE, TWO AND THREE OF THIS SUBSECTION.
(5) THE INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL MAKE A DETERMI-
NATION WITHIN THIRTY DAYS OF RECEIPT OF THE DISPUTE FOR REVIEW.
(6) WHEN DETERMINING A REASONABLE FEE FOR THE SERVICES RENDERED, THE
INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL SELECT EITHER THE HEALTH
CARE PLAN'S PAYMENT OR THE NON-PARTICIPATING PHYSICIAN'S FEE. AN INDE-
PENDENT DISPUTE RESOLUTION ENTITY SHALL DETERMINE WHICH AMOUNT TO SELECT
BASED UPON THE CONDITIONS AND FACTORS SET FORTH IN SECTION SIX HUNDRED
FOUR OF THIS ARTICLE. IF AN INDEPENDENT DISPUTE RESOLUTION ENTITY
DETERMINES, BASED ON THE HEALTH CARE PLAN'S PAYMENT AND THE NON-PARTICI-
PATING PHYSICIAN'S FEE, THAT A SETTLEMENT BETWEEN THE HEALTH CARE PLAN
AND NON-PARTICIPATING PHYSICIAN IS REASONABLY LIKELY, OR THAT BOTH THE
HEALTH CARE PLAN'S PAYMENT AND THE NON-PARTICIPATING PHYSICIAN'S FEE
REPRESENT UNREASONABLE EXTREMES, THEN THE INDEPENDENT DISPUTE RESOLUTION
ENTITY MAY DIRECT BOTH PARTIES TO ATTEMPT A GOOD FAITH NEGOTIATION FOR
SETTLEMENT. THE HEALTH CARE PLAN AND NON-PARTICIPATING PHYSICIAN MAY BE
GRANTED UP TO TEN BUSINESS DAYS FOR THIS NEGOTIATION, WHICH SHALL RUN
CONCURRENTLY WITH THE THIRTY DAY PERIOD FOR DISPUTE RESOLUTION.
S. 6914 178 A. 9205
(B) SURPRISE BILL RECEIVED BY AN INSURED WHO DOES NOT ASSIGN BENEFITS
OR BY A PATIENT WHO IS NOT AN INSURED. (1) AN INSURED WHO DOES NOT
ASSIGN BENEFITS IN ACCORDANCE WITH SUBSECTION (A) OF THIS SECTION OR A
PATIENT WHO IS NOT AN INSURED AND WHO RECEIVES A SURPRISE BILL MAY
SUBMIT A DISPUTE REGARDING THE SURPRISE BILL FOR REVIEW TO AN INDEPEND-
ENT DISPUTE RESOLUTION ENTITY.
(2) THE INDEPENDENT DISPUTE RESOLUTION ENTITY SHALL DETERMINE A
REASONABLE FEE FOR THE SERVICES RENDERED BASED UPON THE CONDITIONS AND
FACTORS SET FORTH IN SECTION SIX HUNDRED FOUR OF THIS ARTICLE.
(3) A PATIENT OR INSURED WHO DOES NOT ASSIGN BENEFITS IN ACCORDANCE
WITH SUBSECTION (A) OF THIS SECTION SHALL NOT BE REQUIRED TO PAY THE
PHYSICIAN'S FEE TO BE ELIGIBLE TO SUBMIT THE DISPUTE FOR REVIEW TO THE
INDEPENDENT DISPUTE ENTITY.
(C) THE DETERMINATION OF AN INDEPENDENT DISPUTE RESOLUTION ENTITY
SHALL BE BINDING ON THE PATIENT, PHYSICIAN AND HEALTH CARE PLAN, AND
SHALL BE ADMISSIBLE IN ANY COURT PROCEEDING BETWEEN THE PATIENT OR
INSURED, PHYSICIAN OR HEALTH CARE PLAN, OR IN ANY ADMINISTRATIVE
PROCEEDING BETWEEN THIS STATE AND THE PHYSICIAN.
S 608. PAYMENT FOR INDEPENDENT DISPUTE RESOLUTION ENTITY. (A) FOR
DISPUTES INVOLVING AN INSURED, WHEN THE INDEPENDENT DISPUTE RESOLUTION
ENTITY DETERMINES THE HEALTH CARE PLAN'S PAYMENT IS REASONABLE, PAYMENT
FOR THE DISPUTE RESOLUTION PROCESS SHALL BE THE RESPONSIBILITY OF THE
NON-PARTICIPATING PHYSICIAN. WHEN THE INDEPENDENT DISPUTE RESOLUTION
ENTITY DETERMINES THE NON-PARTICIPATING PHYSICIAN'S FEE IS REASONABLE,
PAYMENT FOR THE DISPUTE RESOLUTION PROCESS SHALL BE THE RESPONSIBILITY
OF THE HEALTH CARE PLAN. WHEN A GOOD FAITH NEGOTIATION DIRECTED BY THE
INDEPENDENT DISPUTE RESOLUTION ENTITY PURSUANT TO PARAGRAPH FOUR OF
SUBSECTION (A) OF SECTION SIX HUNDRED FIVE OF THIS ARTICLE, OR PARAGRAPH
SIX OF SUBSECTION (A) OF SECTION SIX HUNDRED SEVEN OF THIS ARTICLE
RESULTS IN A SETTLEMENT BETWEEN THE HEALTH CARE PLAN AND NON-PARTICIPAT-
ING PHYSICIAN, THE HEALTH CARE PLAN AND THE NON-PARTICIPATING PHYSICIAN
SHALL EVENLY DIVIDE AND SHARE THE PRORATED COST FOR DISPUTE RESOLUTION.
(B) FOR DISPUTES INVOLVING A PATIENT THAT IS NOT AN INSURED, WHEN THE
INDEPENDENT DISPUTE RESOLUTION ENTITY DETERMINES THE PHYSICIAN'S FEE IS
REASONABLE, PAYMENT FOR THE DISPUTE RESOLUTION PROCESS SHALL BE THE
RESPONSIBILITY OF THE PATIENT UNLESS PAYMENT FOR THE DISPUTE RESOLUTION
PROCESS WOULD POSE A HARDSHIP TO THE PATIENT. THE SUPERINTENDENT SHALL
PROMULGATE A REGULATION TO DETERMINE PAYMENT FOR THE DISPUTE RESOLUTION
PROCESS IN CASES OF HARDSHIP. WHEN THE INDEPENDENT DISPUTE RESOLUTION
ENTITY DETERMINES THE PHYSICIAN'S FEE IS UNREASONABLE, PAYMENT FOR THE
DISPUTE RESOLUTION PROCESS SHALL BE THE RESPONSIBILITY OF THE PHYSICIAN.
S 27. Paragraphs 5 and 6 of subsection (a) of section 2601 of the
insurance law, paragraph 5 as amended by chapter 547 of the laws of 1997
and paragraph 6 as amended by chapter 388 of the laws of 2008, are
amended and a new paragraph 7 is added to read as follows:
(5) compelling policyholders to institute suits to recover amounts due
under its policies by offering substantially less than the amounts ulti-
mately recovered in suits brought by them; [or]
(6) failing to promptly disclose coverage pursuant to subsection (d)
or subparagraph (A) of paragraph two of subsection (f) of section three
thousand four hundred twenty of this chapter[.]; OR
(7) SUBMITTING REASONABLY RENDERED CLAIMS TO THE INDEPENDENT DISPUTE
RESOLUTION PROCESS ESTABLISHED UNDER ARTICLE SIX OF THE FINANCIAL
SERVICES LAW.
S 28. 1. An out-of-network reimbursement rate workgroup shall be
convened and shall consist of 9 members appointed by the governor. Two
S. 6914 179 A. 9205
members shall be appointed on the recommendation of the speaker of the
assembly and two members shall be appointed on the recommendation of the
temporary president of the senate and shall consist of two physicians,
two representatives of health plans, and three consumers and shall be
co-chaired by the superintendent of the department of financial services
and the commissioner of the department of health. Such representatives
of the workgroup must represent different regions of the state. The
members shall receive no compensation for their services, but shall be
allowed their actual and necessary expenses incurred in the performance
of their duties.
2. The workgroup shall review the current out-of-network reimbursement
rates used by health insurers licensed under the insurance law and
health maintenance organizations certified under the public health law
and the rate methodology as required under the laws of 2014 and make
recommendations regarding an alternative rate methodology taking into
consideration the following factors:
a. current physician charges for out-of-network services;
b. trends in medical care and the actual costs of medical care;
c. regional differences regarding medical costs and trends;
d. the current methodologies and levels of reimbursement for out-of-
network services currently paid by health plans, including insurers,
HMOs, Medicare, and Medicaid;
e. the current in-network rates paid by health plans, including insur-
ers, HMOs, Medicare and Medicaid for the same service and by the same
provider;
f. the impact different rate methodologies would have on out-of-pocket
costs for consumers who access out-of-network services;
g. the impact different rate methodologies would have on premium costs
in different regions of the state;
h. reimbursement data from all health plans both public and private as
well as charge data from medical professionals and hospitals available
through the All Payer Database as developed and maintained by the
department of health including data provided in the annual report
published pursuant to section 2816 of the public health law; and
i. other issues deemed appropriate by either the superintendent of the
department of financial services or the commissioner of the department
of health.
3. The workgroup shall review out-of-network coverage in the individ-
ual and small group markets and make recommendations regarding the
availability and adequacy of the coverage, taking into consideration the
following factors:
a. the extent to which out-of-network coverage is available in each
rating region in this state;
b. the extent to which a significant level of out-of-network benefits
is available in every rating region in this state, including the preva-
lence of coverage based on the usual and customary cost as well as
coverage based on other set reimbursement methodologies, such as Medi-
care; and
c. other issues deemed appropriate by either the superintendent of the
department of financial services or the commissioner of the department
of health.
4. The workgroup shall report its findings and make recommendations
for legislation and regulations to the governor, the speaker of the
assembly, the senate majority leader, the chairs of the insurance and
health committees in both the assembly and the senate, and the super-
S. 6914 180 A. 9205
intendent of the department of financial services no later than January
1, 2016.
S 29. This act shall take effect one year after it shall have become a
law, provided, however, that:
1. if the amendments by chapter 514 of the laws of 2013 made to
subsection (b) of section 4903 of the insurance law and subdivision 2 of
section 4903 of the public health law, as amended by sections twelve and
twenty-two of this act, respectively, take effect after such date, then
sections twelve and twenty-two of this act shall take effect on the same
date as chapter 514 of the laws of 2013 takes effect;
2. for policies renewed on and after such date this act shall take
effect on the renewal date;
3. sections twelve, sixteen, seventeen, twenty-two and twenty-six of
this act shall apply to health care services provided on and after such
date;
4. sections eleven, thirteen, fourteen, fifteen, twenty-one, twenty-
three, twenty-four and twenty-five of this act shall apply to denials
issued on and after such date; and
5. effective immediately, the superintendent of financial services may
promulgate any regulations necessary for the implementation of the
provisions of this act on its effective date, and may certify one or
more independent dispute resolution entities.
PART I
Section 1. Subdivisions 3-b and 3-c of section 1 and 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 1 of part N of chapter 56 of the laws of 2013, are amended to
read as follows:
3-b. Notwithstanding any inconsistent provision of law, beginning
April 1, 2009 and ending March 31, [2014] 2016, the commissioners shall
not include a COLA for the purpose of establishing rates of payments,
contracts or any other form of reimbursement.
3-c. Notwithstanding any inconsistent provision of law, beginning
April 1, [2014] 2016 and ending March 31, [2017] 2019, the commissioners
shall develop the COLA under this section using the actual U.S. consumer
price index for all urban consumers (CPI-U) published by the United
States department of labor, bureau of labor statistics for the twelve
month period ending in July of the budget year prior to such state
fiscal year, for the purpose of establishing rates of payments,
contracts or any other form of reimbursement.
S 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,
[2017] 2019; provided, further, that sections two and three of this act
shall expire and be deemed repealed December 31, 2009.
S 2. Section 1 of part C of chapter 57 of the laws of 2006, relating
to establishing a cost of living adjustment for designated human
services programs, is amended by adding a new subdivision 3-d to read as
follows:
3-D. (I) NOTWITHSTANDING THE PROVISIONS OF SUBDIVISION 3-B OF THIS
SECTION, AS AMENDED BY SECTION ONE OF A CHAPTER OF THE LAWS OF 2014
WHICH ADDED THIS SUBDIVISION, OR ANY OTHER INCONSISTENT PROVISION OF
LAW, AND SUBJECT TO THE AVAILABILITY OF THE APPROPRIATION THEREFOR, FOR
THE PROGRAMS LISTED IN PARAGRAPHS (I), (II), (III), (IV), (V) AND (VI)
S. 6914 181 A. 9205
OF SUBDIVISION 4 OF THIS SECTION, THE COMMISSIONERS SHALL PROVIDE FUND-
ING TO SUPPORT (1) A TWO PERCENT (2%) INCREASE IN ANNUAL SALARY AND
SALARY-RELATED FRINGE BENEFITS FOR DIRECT CARE STAFF AND DIRECT SUPPORT
PROFESSIONALS, AND IN PAYMENT TO FOSTER PARENTS AND ADOPTIVE PARENTS, AS
DEFINED BY THE COMMISSIONER OF THE APPLICABLE STATE AGENCY SUBJECT TO
THE APPROVAL OF THE DIRECTOR OF THE BUDGET BEGINNING JANUARY 1, 2015,
AND (2) A TWO PERCENT (2%) INCREASE IN ANNUAL SALARY AND SALARY-RELATED
FRINGE BENEFITS FOR DIRECT CARE STAFF, DIRECT SUPPORT PROFESSIONALS AND
CLINICAL STAFF, AND IN PAYMENT TO FOSTER PARENTS AND ADOPTIVE PARENTS,
AS DEFINED BY THE COMMISSIONER OF THE APPLICABLE STATE AGENCY SUBJECT TO
THE APPROVAL OF THE DIRECTOR OF THE BUDGET BEGINNING APRIL 1, 2015. SUCH
COMMISSIONERS SHALL USE THE CONSOLIDATED FISCAL REPORTING MANUAL AS A
REFERENCE, TO THE EXTENT THAT APPLICABLE JOB TITLES ARE LISTED THEREIN.
WHERE APPLICABLE, THE FUNDING PROVIDED UNDER THIS SUBDIVISION SHALL BE
APPLIED TO REIMBURSABLE COSTS OR CONTRACT AMOUNTS TO SUPPORT SALARY
INCREASES AND SALARY-RELATED FRINGE BENEFITS OF ELIGIBLE PERSONS, THAT
TOOK EFFECT ON OR AFTER JANUARY 1, 2014. THE COMMISSIONERS SHALL PROVIDE
FUNDING FOR SUCH SALARY AND ASSOCIATED FRINGE BENEFIT INCREASES IN A
MANNER WHICH WILL RESULT IN A CONSISTENT METHODOLOGY AMONG PROGRAMS AND
PROVIDER TYPES.
(II) THE COMMISSIONERS SHALL DEVELOP STANDARDS, INCLUDING BUT NOT
LIMITED TO, REQUIRING THAT A LOCAL GOVERNMENT UNIT OR PROVIDER AGENCY
DEVELOP A PLAN OF IMPLEMENTATION TO ENSURE THAT SUCH FUNDING INCREASES
SHALL BE DIRECTED TO DIRECT CARE STAFF, DIRECT SUPPORT PROFESSIONALS,
CLINICAL STAFF, FOSTER PARENTS AND ADOPTIVE PARENTS, AS APPROPRIATE,
PURSUANT TO PARAGRAPH (I) OF THIS SUBDIVISION. EACH LOCAL GOVERNMENT
UNIT OR DIRECT CONTRACT PROVIDER RECEIVING SUCH FUNDING SHALL SUBMIT A
WRITTEN CERTIFICATION, IN SUCH FORM AND AT SUCH TIME AS EACH COMMISSION-
ER SHALL PRESCRIBE, ATTESTING TO HOW SUCH FUNDING WILL BE OR WAS USED
FOR PURPOSES ELIGIBLE UNDER THIS SECTION. FURTHER, PROVIDERS SHALL
SUBMIT A RESOLUTION FROM THEIR GOVERNING BODY TO THE APPROPRIATE COMMIS-
SIONER, ATTESTING THAT THE FUNDING RECEIVED WILL BE USED SOLELY TO
SUPPORT SALARY AND SALARY-RELATED FRINGE BENEFIT INCREASES FOR DIRECT
CARE STAFF, DIRECT SUPPORT PROFESSIONALS, CLINICAL STAFF, FOSTER PARENTS
AND ADOPTIVE PARENTS, PURSUANT TO PARAGRAPH (I) OF THIS SUBDIVISION AND
THE APPLICABLE STANDARDS ISSUED BY THE APPROPRIATE COMMISSIONER PURSUANT
TO THIS PARAGRAPH. SUCH COMMISSIONERS SHALL BE AUTHORIZED TO RECOUP ANY
FUNDS AS APPROPRIATED HEREIN DETERMINED TO HAVE BEEN USED IN A MANNER
INCONSISTENT WITH SUCH STANDARDS OR INCONSISTENT WITH THE PROVISIONS OF
THIS SUBDIVISION, AND SUCH COMMISSIONERS SHALL BE AUTHORIZED TO EMPLOY
ANY LEGAL MECHANISM TO RECOUP SUCH FUNDS, INCLUDING AN OFFSET OF OTHER
FUNDS THAT ARE OWED TO SUCH LOCAL GOVERNMENTAL UNIT OR PROVIDER.
(III) WHERE APPROPRIATE, TRANSFERS TO THE DEPARTMENT OF HEALTH SHALL
BE MADE AS REIMBURSEMENT FOR THE STATE SHARE OF MEDICAL ASSISTANCE.
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, 2014; provided,
however, that the amendments to subdivisions 3-b and 3-c of section 1 of
part C of chapter 57 of the laws of 2006, relating to establishing a
cost of living adjustment for designated human services programs made by
section one of this act shall not affect the repeal of such subdivisions
and shall be deemed repealed therewith.
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
S. 6914 182 A. 9205
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 I of this act shall be
as specifically set forth in the last section of such Parts.