senate Bill S1436

2013-2014 Legislative Session

Provides for increasing the applicability of brand name and generic prescription drug and other medical services co-payments for medicaid recipients

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to health
Jan 09, 2013 referred to health

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S1436 - Bill Details

See Assembly Version of this Bill:
A2640
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd §367-a, Soc Serv L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S3221, A2339
2009-2010: S2990A, A6678

S1436 - Bill Texts

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Provides for increasing the applicability of brand name and generic prescription drug and other medical services, except diagnostic services, co-payments for medicaid recipients.

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BILL NUMBER:S1436

TITLE OF BILL:
An act
to amend the social services law, in relation to medicaid co-payments
for prescription drugs and other services

PURPOSE OF THE BILL:
This bill provides for increasing brand name and
generic prescription drug and other medical services co-payments for
Medicaid recipients and requires prepayment.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1 - Amends paragraph (b) of
subdivision 6 of § 367-a of the Social Services Law to redefine those
persons not subject to co-payments for services.

Section 2 - Amends the opening paragraph of paragraph (d) of
subdivision 6 of § 367-a of the Social Services Law to require that
co-payments shall apply to all services covered by the title, except
diagnostic services, and to require that co-payments must be pre-paid
at the time when services are rendered.

Section 3 - Authorizes the Commissioner of Health to promulgate or
adopt any rules or regulations necessary to implement the provisions
of this Act.

Section 4 - Effective date.

JUSTIFICATION:
The rising cost of the Medicaid program is threatening
the ability for the State and its counties to maintain the current
program. Just as private health insurance requires co-payments for
services in order to rein in costs of health care, New York State
should implement the same model to rein in costs and ensure that the
cost of the Medicaid program can be sustained. In an effort to
modernize the Medicaid program so that it is similar to private
health insurance, this legislation institutes co-payments for all
services, except diagnostic services. To ensure that co-payments to
the providers of the services are received, prepayment of the
co-payments must be made when the services are rendered. Currently,
the law does not allow for providers to withhold services if the
recipient states that he or she can not pay the copayment.
However, abuse of this provision has become increasingly apparent, and
therefore steps must be taken to ensure that providers receive their
payments for the services that they provide to the consumers.

PRIOR LEGISLATIVE HISTORY:
2005-2006 - S.3578-B/A.5466-C
2007-08 - S.3292/A.4676 -- HEALTH/Health

2009-10: - S.2990-A/A.6678 -- HEALTH/Health
2011-12 S.3221/A.2339 - HEALTH/Health

FISCAL IMPLICATIONS:
Yet to be determined. Cost savings to both
counties and the state are expected.

EFFECTIVE DATE:
This act shall take effect immediately.

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

                                  1436

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens.  RANZENHOFER,  GALLIVAN,  LARKIN -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health

AN ACT to amend the social services law, in relation to medicaid co-pay-
  ments for prescription drugs and other services

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

  Section 1. Paragraph (b) of subdivision 6  of  section  367-a  of  the
social services law, as added by chapter 41 of the laws of 1992, subpar-
agraph  (iii) as amended by chapter 843 of the laws of 1992 and subpara-
graph (iv) as amended by section 40 of part C of chapter 58 of the  laws
of 2005, is amended to read as follows:
  (b)  Co-payments  shall apply to all eligible persons for the services
defined in paragraph (d) of this subdivision with the exception of:
  (i) [individuals under twenty-one years of age;
  (ii) pregnant women;
  (iii)] individuals who are inpatients in a medical facility  who  have
been  required  to  spend  all  of their income for medical care, except
their personal needs allowance or residents of community based  residen-
tial facilities licensed by the office of mental health or the office of
mental retardation and developmental disabilities who have been required
to spend all of their income, except their personal needs allowance;
  [(iv)  individuals  enrolled  in  health  maintenance organizations or
other entities which provide comprehensive  health  services,  or  other
managed care programs for services covered by such programs, except that
such  persons,  other  than  persons otherwise exempted from co-payments
pursuant to subparagraphs (i), (ii), (iii) and (v)  of  this  paragraph,
and  other  than  those  persons  enrolled  in  a managed long term care
program, shall be subject to co-payments as  described  in  subparagraph
(v) of paragraph (d) of this subdivision;] and

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04848-01-3

S. 1436                             2

  [(v)]  (II)  any  other individuals required to be excluded by federal
law or regulations.
  S  2.  The  opening  paragraph  of  paragraph  (d) of subdivision 6 of
section 367-a of the social services law, as added by chapter 41 of  the
laws of 1992, is amended to read as follows:
  Co-payments  shall  apply  to  [the following] ALL services COVERED BY
THIS TITLE, EXCEPT DIAGNOSTIC SERVICES, AND SHALL  BE  PRE-PAID  AT  THE
TIME  WHEN  SUCH  SERVICES  ARE RENDERED, subject to such exceptions for
subcategories of these services as recognized  by  the  commissioner  OF
HEALTH in regulations, provided in accordance with section three hundred
sixty-five-a  of this [article] TITLE and the regulations of the depart-
ment, to the extent permitted by title XIX of the federal social securi-
ty act:
  S 3. The commissioner of health is authorized to promulgate  or  adopt
any  rules  or regulations necessary to implement the provisions of this
act and any co-payments, procedures, forms,  or  instructions  necessary
for such implementation may be adopted and issued on or after the effec-
tive date of this act. Notwithstanding any inconsistent provision of the
state  administrative  procedure act or any other provision of law, rule
or regulation, the commissioner of  health  and  the  superintendent  of
financial  services  and any appropriate council are 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.
  S 4. This act shall take effect immediately.

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