senate Bill S2606C

Signed By Governor
2013-2014 Legislative Session

Enacts into law major components of legislation necessary to implement the state health mental hygiene budget for the 2013-2014 state fiscal year

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Archive: Last Bill Status - Signed by Governor


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Mar 28, 2013 signed chap.56
delivered to governor
returned to senate
passed assembly
motion to amend lost
motion to amend lost
ordered to third reading rules cal.45
substituted for a3006d
Mar 27, 2013 referred to ways and means
Mar 26, 2013 delivered to assembly
passed senate
ordered to third reading cal.276
Mar 23, 2013 print number 2606d
amend (t) and recommit to finance
Mar 10, 2013 print number 2606c
amend (t) and recommit to finance
Feb 22, 2013 print number 2606b
amend (t) and recommit to finance
Feb 13, 2013 print number 2606a
amend and recommit to finance
Jan 22, 2013 referred to finance

Bill Amendments

Original
A
B
C
D (Active)
Original
A
B
C
D (Active)

S2606 - Bill Details

Law Section:
Budget Bills
Laws Affected:
Amd Various Laws, generally

S2606 - Bill Texts

view summary

Relates to the cap on local Medicaid expenditures; relates to the determination of rates of payments by certain state governmental agencies; relates to the medical assistance information and payment system; relates to managed care programs and managed long term care plans; relates to participation in the state health insurance exchange; relates to liability for certain acts under the false claims act; relates to civil actions pursuant to the false claims act; relates to the delay of certain administrative costs; relates to the preferred drug program; relates to antipsychotic therapeutic drugs; authorizes the commissioner of health to implement an incontinence supply utilization management program; relates to the funding of health home infrastructure development; relates to general hospital inpatient reimbursement; relates to managed care programs; relates to rates of payment for residential health care facilities and rates of reimbursement for inpatient detoxification and withdrawal services; relates to hospital inpatient base years; relates to the Medicaid managed care inpatient psychiatric care default rate; relates to the Medicaid managed care default rate; moves rate setting for child health plus to the department of health; requires the use of an enrollment broker for counties that are mandated Medicaid managed care and managed long term care; repeals the twentieth day of the month enrollment cut-off for managed long term care enrollees; relates to the nursing home financially disadvantaged program; eliminates the recruitment and retention attestation requirement for certain certified home health agencies; extends the office of the Medicaid inspector general's power to audit rebasing rates; relates to rebasing transition payments; relates to payment of claims; establishes the home and community-based care work group; relates to critical access hospitals; eliminates the bed hold requirement; relates to eligibility for Medicaid; relates to treatment of income and resources of institutionalized persons; relates to the people; repeals certain provisions of law relating to the pharmacy and therapeutics committee; relates to payments to hospital assessments; relates to the effectiveness of eligibility for medical assistance and the family health plus program; extends various plans and programs; relates to rates of payment by state governmental agencies; relates to reports on chronic illness demonstration projects and reports by the commissioner of health on health homes; relates to rates of payment for long term home health care programs; extends a demonstration program for physicians suffering from alcoholism, drug abuse or mental illness; relates to indigent care; relates to permitting online and telephone Medicaid applications; allows administrative renewals and self-attestation of residency; ends applications for family health plus; establishes a methodology for modified adjusted gross income; centralizes child health plus eligibility determinations; requires audit standards for eligibility; relates to residency and income attestation and verification for child health plus; eliminates temporary enrollment in child health plus; expands the child health plus social security number requirement to lawfully residing children; requires a status report on the health benefit exchange; relates to health benefit exchange navigators and clarifies the identity of persons to whom insurance licensing requirements apply; relates to coverage limitations requirements and student accident and health insurance; relates to standardization of individual enrollee direct payment contracts; ensures that group and individual insurance policy provisions conform to applicable requirements of federal law; relates to the general public health work program; consolidates the excess medical malpractice liability coverage pool; relates to the addition to the methadone registry of dosage and such other information as is necessary to facilitate disaster management; relates to state aid funding authorization of services funded by the office of alcoholism and substance abuse services; vests all authority to appoint and remove officers and employees of the office of mental health; creates mental health incident review panels; relates to psychiatric emergency programs; relates to foregoing a cost-of-living adjustment during the 2013-2014 state fiscal year; authorizes the actions necessary to manage the loss of federal revenue and create the mental hygiene stabilization fund; provides medical assistance to certain retirees of the New York city off-track betting corporation; and relates to funding to SUNY Downstate Medical Center and directing the restructuring of the hospital.

view sponsor memo
BILL NUMBER:S2606

TITLE OF BILL:
An act
to amend chapter 59 of the laws of 2011, amending the public health
law and other laws
relating to general hospital reimbursement for annual rates,
in relation to the cap
on local Medicaid expenditures;
to amend the public health law, in relation to
general hospital
inpatient reimbursement; to amend the social services law, in relation
to the medical
assistance information and payment system; to amend the social services
law, in relation to certain
contracts entered into
by the commissioner of health for the purpose of implementing the
Medicaid redesign
team initiatives;
to amend the public health law,
in relation to the
preferred drug program;
to amend
the public health law, in relation to antipsychotic therapeutic drugs;
to amend the social services law, in relation to reducing pharmacy
reimbursement for name brand drugs; to amend the public health law, in
relation to eliminating the summary posting requirement for the pharmacy
and therapeutic committee; to amend the social services law, in relation
to early refill of prescriptions; to amend the social services law, in
relation to authorizing the commissioner of health to implement an
incontinence supply utilization management program; to amend the social
services law, in relation to
certain individual psychotherapy services; to amend the social services
law, in relation to the funding of health home infrastructure
development; to amend the public health law, in relation to general
hospital inpatient reimbursement;
to amend the social services law, in relation to managed care programs;
to amend section 2 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 the effectiveness thereof;
to amend the public health law, in relation to rates of payment
for residential health care facilities and in relation to rates of
reimbursement for inpatient detoxification and withdrawal services; to
amend the public health law, in relation to hospital inpatient base
years; to amend the public health law, in relation to the Medicaid
managed care inpatient psychiatric care default rate; to amend the
public health law, in relation to the Medicaid managed care default
rate; to amend the public health law, in relation to moving rate
setting for child health plus to the department of health; 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 repealing the twentieth day of the
month enrollment cut-off for managed long term care enrollees; to amend
the public health law, in relation to the nursing home financially
disadvantaged program; to amend the public health law, in relation to


eliminating the recruitment and
retention attestation requirement for certain certified home health
agencies; to amend the public health law, in relation to extending the
office of the Medicaid inspector general's power to audit rebasing
rates; to amend the public health law, in relation to rebasing
transition payments; to amend the public health law, in relation to
capital cost reimbursement for nursing homes; to amend the public
health law, in relation to eliminating the bed hold requirement;
to amend the public health
law, in relation to authorizing upper payment limits for certain nursing
homes; to amend the public health law, in relation to rates for
specialty nursing homes; to amend the social services law, in relation
to eliminating spousal refusal of medical care; to amend the social
services law, in relation to eligibility for Medicaid;
to amend the social services law, in relation to treatment of income and
resources of institutionalized persons; to amend the
public health law, in
relation to certain payments for certain home care agencies and
services; to amend the social services law, in relation to Medicaid
eligibility;
to amend
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, in relation to the effectiveness
thereof;
to amend subdivision 1 of section 92 of part H of chapter 59
of the laws of 2011, amending the public health law and
other laws relating to known and projected department
of health state funds Medicaid expenditures, in relation to the
effectiveness thereof; in relation
to eliminating the 2013-2014 trend factor and thereafter;
to repeal
certain provisions
of the
social services law and the public health law
relating to managed care programs;
and to repeal certain provisions of the public health law and the
social
services law
relating to the pharmacy and therapeutics committee; providing
for the repeal of certain provisions upon expiration thereof
(Part A);
to amend the public health law, in relation to payments to
hospital assessments;
to amend part C of chapter 58 of the laws of 2009 amending the
public health law relating to payment by governmental agencies for
general hospital inpatient services, in relation to the
effectiveness of eligibility for medical assistance and the family
health plus program;
to amend chapter 474 of the laws of 1996, amending the
education law and
other laws relating to rates for residential healthcare facilities, in
relation to
reimbursements; to amend chapter 884 of the laws of 1990, amending the
public health
law relating to authorizing bad debt and charity care allowances for
certified home health


agencies, in relation to the effectiveness thereof;
to amend the long term care
integration and finance act of 1997,
in relation to extending the expiration of operating demonstrations
operating a managed long term care plan;
to amend chapter
81 of the laws of 1995,
amending the public health law and other laws relating to medical
reimbursement
and welfare reform, in relation to reimbursements and the
effectiveness thereof; to
amend the public health law, in relation to capital related inpatient
expenses;
to amend part C of chapter 58 of
the laws of 2007,
amending the social services law and other laws relating to enacting
the major
components of legislation necessary to implement the health and mental
hygiene
budget for the 2007-2008 state fiscal year, in relation to rates of
payment by state
governmental agencies and the effectiveness of certain provisions
of such chapter;
to amend the social services law, in relation to
reports on chronic illness demonstration projects;
to amend
chapter 451 of the
laws of 2007, amending the public health law, the social services law
and the insurance
law, relating to providing enhanced consumer and provider protections,
in relation to
extending the effectiveness of certain provisions thereof; to amend
the public health law,
in relation to rates of payment for long term home health care
programs; to amend
chapter 2 of the laws of 1998,
amending the public health law and other
laws
relating to expanding the child health insurance plan, in relation to
the effectiveness of
certain provisions thereof;
to amend chapter 426 of the laws of 1983, amending the public health law
relating to professional misconduct proceedings and chapter 582 of the
laws of 1984, amending the public health law relating to regulating
activities of physicians, in relation to
making such provisions permanent;
to amend the public health law, in relation to
extending a
demonstration program for physicians suffering from alcoholism, drug
abuse or mental illness;
to amend part X2 of chapter 62 of the laws of 2003 amending the public
health law relating to allowing the use of funds of the office of
professional medical conduct for activities of the patient health
information and quality improvement act of 2000, in relation to the
effectiveness of certain provisions thereof;
to repeal subdivision 8 of section 364-l of the social services
law relating thereto;


to repeal certain
provisions of chapter 81 of the laws of 1995 amending the public health
law and other laws relating to medical reimbursement and welfare
relating to the effectiveness thereof
(Part B);
to amend the public health law, in relation to indigent
care
(Part C);
to amend the social services law, in relation to eligibility conditions;
to amend the social services law, in relation to permitting online and
telephone Medicaid applications; to amend the social services law, in
relation to allowing administrative renewals and self-attestation of
residency; to amend the social services law, in relation to ending
applications for family health plus; to amend the social services law,
in relation to modified adjusted gross income and Medicaid eligibility
groups; to amend the public health law, in relation to establishing
methodology for modified adjusted gross income; to amend the public
health law, in relation to centralizing child health plus eligibility
determinations; to amend the public health law, in relation to requiring
audit standards for eligibility; to amend the public health law, in
relation to residency and income attestation and verification for child
health plus; to amend the public health law, in relation to eliminating
temporary enrollment in child health plus; to amend the public health
law, in relation to expanding the child health plus social security
number requirement to lawfully residing children; to amend the public
health law, in relation to modified adjusted gross income under child
health plus;
to amend the public health law, in relation to personal interviews under
child health plus;
to amend the social services law, in relation
to amendment of contracts awarded by the commissioner of health; to
amend the insurance law, in relation to clarifying the identity of
persons to whom insurance licensing requirements apply; to amend the
insurance law, in relation to coverage limitations requirements and
student accident and health insurance; to amend the insurance law, in
relation to standardization of individual enrollee direct payment
contracts; to amend the insurance law, in relation to ensuring that
group and individual insurance policy provisions conform to applicable
requirements of federal law and to make conforming changes; to repeal
sections 369-ee and 369-ff of the social services law, relating to the
family health plus program; to repeal certain other provisions of the
social services law relating thereto; to repeal certain provisions
of the insurance law relating thereto;
providing for the repeal of certain provisions upon expiration thereof
(Part D);
to amend the public health law and the insurance law, in relation to the
early intervention program for infants and toddlers with disabilities
and their families; to amend the public health law, in relation to the
general public health work program; to amend chapter 577 of the laws of
2008 amending the public health law, relating to expedited partner
therapy for persons infected with chlamydia trachomatis, in relation to
the effectiveness of such chapter; to amend the public health law, in
relation to outcome based contracting and outcome based health planning;
to amend the public health law, the mental hygiene law and the
executive law,
in relation to consolidating
the excess medical


malpractice liability coverage pool;
to amend the insurance law, in relation
to the appointment of
members of the board of the New York state health foundation and the
investment of funds;
to amend
the insurance law and the general municipal law, in relation to
malpractice
and professional misconduct;
to amend the administrative code of the city of New York,
in relation to the definition of a certified first responder; to amend
the workers' compensation law, in relation to an injury
incurred by an emergency medical technician;
to amend
the education law and the state finance
law, in relation to medical
malpractice reform;
and to repeal sections 3002, 3002-a, 3003-a,
3005-b, 3009, 3017 and articles 30-B and 30-C of the public
health law relating to emergency medical services;
to amend chapter 420 of the laws of 2002 amending
the education law relating to the profession of social work; chapter 676
of the laws of 2002 amending the education law relating to the practice
of psychology; and chapter 130
of the laws of 2010 amending the education
law and other laws relating to the registration of entities providing
certain professional services and the licensure of certain professions,
in relation to reporting requirements and expiration dates; and
to amend the public health law, in relation to consolidating
the excess medical
malpractice liability coverage pool; and to repeal section 18 of
chapter 266 of the laws of 1986,
amending the civil practice law and rules and other laws relating to
medical and dental
malpractice, relating thereto;
to repeal certain provisions of the
public health law relating to state aid for certain public health
programs and provisions relating to sexually transmitted
diseases
(Part E);
to amend the mental hygiene law, in relation to the addition to the
methadone registry of dosage and such other information as is necessary
to facilitate disaster management
(Part F);
to amend the mental hygiene law, in relation to state aid funding
authorization of services funded by the office of alcoholism and
substance abuse services; to repeal article 26 of such law relating
thereto
(Part G);
to amend the mental hygiene law and chapter 56 of the laws of 2012,
amending the mental hygiene law relating to the closure and the
reduction in size of certain facilities serving persons with mental
illness, in relation to references to certain former children's
psychiatric centers in the city of New York, and in relation to the
expiration and repeal of certain provisions thereof; to authorize the
office of mental health to close, consolidate, reduce, transfer and
otherwise redesign its programs;


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 subcommittees 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 H);
to amend the mental hygiene law, in relation to the recovery of exempt
income by the office of mental health for community residential programs
(Part I);
to amend the mental hygiene law, in relation to vesting all authority to
appoint and remove officers and employees of the office of mental health
(Part J);
to amend the mental hygiene law, in relation to an annual examination
and notice of rights provided to respondent sex offenders who are
confined in a secure treatment facility
(Part K);
to amend the mental hygiene law and the education law, in relation to
creating mental health incident review panels
(Part L);
to repeal certain provisions of the mental hygiene law and certain
provisions of chapter 723 of the laws of 1989, amending the mental
hygiene law and other laws relating to the establishment of
comprehensive psychiatric emergency programs, relating to eliminating
the annual reports on the
comprehensive
psychiatric emergency program;
family care; and the confinement, care and treatment of persons with
developmental disabilities
(Part M); and
to amend chapter 57 of the laws of 2006, relating to establishing a cost
of living adjustment for designated human services programs, in relation
to foregoing such adjustment during the 2013-2014 state fiscal year
(Part N)

PURPOSE: This bill contains provisions needed to
implement the Health
and Mental Hygiene portions of the 2013-14 Executive Budget.

This memorandum describes Parts A through N of the bill which are
described wholly within the parts listed below.

Part A Make statutory changes necessary to continue implementing
Medicaid Redesign Team recommendations.

Purpose:

This bill would make statutory changes necessary to continue
implementing Medicaid Redesign Team (MRT) recommendations.

Statement in Support, Summary of Provisions,
Existing Law, and Prior
Legislative History:


Section 1 of the bill would amend L. 2011, c. 59, Part H, § 90, to
extend the two percent across-the-board reduction of Medicaid
payments for two years through March 31, 2015.

Section 2 of the bill would amend L. 2011, c. 59, Part H, § 91, to
modify the Medicaid State funds cap calculation to allow for the
inclusion of the operational costs of the Office of Health Insurance
Programs under the Medicaid Spending Cap. These costs would not be
subject to annual consumer price index adjustments.

Section 3 of the bill would amend L. 2011, c. 59, Part H, § 92, to
extend the Medicaid Spending Cap for one year through March 31, 2015.

Sections 4 of the bill would amend Public Health Law (PHL) § 2807-c to
permanently continue the elimination of trend factor adjustments in
Medicaid provider reimbursement rates.

Section 5 of the bill would amend Social Services Law (SSL) § 367-b
to allow the Department of Health (DOH) to use one or more fiscal
intermediaries to pay claims and issue payments for services on an
emergency basis in the event that a fiscal intermediary or agent
cannot issue payments.

Sections 6 and 7 of the bill would amend SSL § 365-l and 368-d to
allow DOH to amend certain existing contracts that implement actions
recommended by the MRT without competitive bid for purpose of
implementing related MRT initiatives.

Sections 8 and 9 of the bill are intentionally omitted.

Sections 10 and 11 of the bill would repeal SSL § 364-j and amend PHL

§ 273 to eliminate "prescriber prevails" provisions related to prior
authorization requirements for prescription drugs.

Section 12 of the bill would amend SSL § 365-a to authorize DOH to
require prior authorization for the refill of a prescription drug
when the patient should still have more than a six-day supply of the
previously dispensed amount remaining based on normal use. In
addition, the section would allow DOH to deny prior authorization for
opioid prescriptions in excess of four prescriptions in a 30-day
period, upon determining that the prescription is not medically
necessary and after allowing the prescriber a reasonable opportunity
to justify the refill.

Section 13 of the bill would amend SSL § 367-a to reduce the
fee-for-service pharmacy brand reimbursement rate to the average
wholesale price less 17.6 percent.

Sections 14 through 20 of the bill would repeal PHL §§ 270 and amend
PHL §§ 272, 274, 277 and SSL § 369-bb to merge the Pharmacy and
Therapeutics Committee with the Drug Utilization Review Board (DUR)
and modify the membership of the DUR accordingly. These changes also
would permit the Commissioner of Health (Commissioner) to require
prior authorization of drugs eligible for reimbursement by State
public health plans unless the pharmaceutical manufacturers agreed to
provide minimum supplemental rebates.


Section 21 of the bill would amend SSL § 365-a to authorize the
Commissioner to implement an incontinence supply management program
to reduce costs without limiting access through the existing provider
network.

Section 22 of the bill would amend SSL § 365-a to authorize
reimbursement of individual psychotherapy services provided by
certified social workers for children and those requiring such
services as a result of pregnancy or childbirth.

Section 23 of the bill would amend SSL § 365-I to authorize the
Commissioner to invest up to $15 million in health home
infrastructure development.

Section 24 of the bill would amend SSL § 365-a to provide additional
funding to promote the delivery of integrated mental health,
substance abuse, and physical health services in a single location.

Section 25 of the bill would amend PHL § 2807-c(4)(1) to refer to the
DOH website for the current diagnostic related groups (DRGs) listing
for inpatient detox DRGs subject to separate reimbursement.

Section 26 of the bill would amend PHL § 2807-c(35) to provide for an
updated base year effective January 1, 2014, for inpatient hospital
services, to allow calculation on a calendar year basis rather than
starting December 1, 2013.

Sections 27 through 29 of the bill would amend PHL § 2807-c(4)(e-1)(i)
and (e-2)(vii) and add a new PHL § 2807-c(4)(1)(v) to authorize the
Commissioner to issue regulations providing for base year updates for
specialty hospitals.

Section 30 of the bill would amend PHL § 2807-c(4)(e-2)(iv) to allow
children's specialty hospital outpatient rates to be calculated by
the Commissioner pursuant to regulations.

Section 31 of the bill would add a new PHL § 2807-c(1)(a-2)(iii) to
authorize the Commissioner to issue regulations governing when the
new inpatient psychiatric reform rate methodology will apply to
Medicaid managed care default rates.

Section 32 would amend PHL § 2807-c(1)(a-2)(i) to exclude certain
capital adjustments from the calculation of managed care default
rates to avoid unnecessary retroactive impacts on Medicaid managed
care rates.

Section 33 of the bill would amend PHL § 2807-c(8) to authorize the to
establish capital reimbursement methodologies through regulations for
inpatient and outpatient services, including emergency services,
consistent with the transition to managed care.

Section 34 of the bill would amend SSL § 364-i to clarify that
Medicaid services shall not be authorized or provided prior to a
determination of eligibility.

Section 35 of the bill would require managed care contracts with
nursing homes to support standard rates of compensation which are


sufficient to ensure the retention of a qualified workforce capable
of providing high quality care.

Section 35-a of the bill would amend SSL § 364-j(1)(b)(i) to authorize
a special needs managed care plan or comprehensive HIV special needs
plan to provide for covered comprehensive health services on a full
capitation basis.

Section 36 of the bill would amend SSL § 364-j(1)(c), (m) and (p) to
include special needs managed care plans in the definition of
"managed care program" and define a "credentialed alcoholism and
substance abuse counselor" as an individual credentialed by the
Office of Alcoholism and Substance Abuse Services (OASAS).

Section 37 of the bill would amend SSL § 364-j(2)(c) to refer to
special needs managed care plans more broadly,_ rather than simply
mental health special needs plans, for flexibility in applying for
federal waivers to promote care management.

Section 38 of the bill would amend SSL § 364-j(3) to allow additional
services to be provided by Medicaid managed care plans, and for
additional populations to be required to enroll in Medicaid managed
care, upon the Commissioner establishing program features and
reimbursement rates.

Section 39 of the bill would amend SSL § 364-j(4) to require managed
care providers to allow enrollees to access appropriately certified
chemical dependence treatment services.

Section 40 of the bill would amend SSL § 364-1(5) to require the
managed care program to include comprehensive HIV special needs plans
and special needs managed care plans in the selection of qualified
managed care providers.

Section 41 of the bill would amend SSL § 364-j(6) to eliminate a
reference to "mental health special needs plan" or "comprehensive HIV
special needs plan provider" with respect to unallowable practices.

Section 42 of the bill would amend SSL § 364-1(17) to provide that the
furnishing of certain services shall be effective if, and as long as
applicable, federal financial participation is available.

Section 43 of the bill would amend SSL § 364- (20) to replace "mental
health special needs plan" with "special needs managed care plan."

Section 44 of the bill would amend SSL § 364-j(23) to require DOH to
consult with the Office of Mental Health (OMH) and OASAS when
necessary to appoint temporary management of a managed care provider.

Section 45 of the bill would amend SSL § 365-m to allow DOH, OMH and
OASAS to designate certain special needs managed care plans to manage
the behavioral and physical health of medical assistance enrollees
with significant behavioral health needs.

Section 46 of the bill would amend PHL § 4401 to eliminate the term
"specialized managed care plan" from those that are required to
obtain a certificate of authority to operate a managed care plan.


Section 47 of the bill would amend PHL § 4403-d to eliminate the term
"specialized managed care plans" from those that are a required to
obtain a certificate of authority to operate a managed care plan.

Section 48 of the bill would amend PHL § 4403-f to amend the list of
persons or groups that are not required to enter into a managed long
term care plan or other specialized care coordination model.

Section 48-a of the bill would authorize the transfer of funds by
OASAS to DOH for purposes of increasing Medicaid payments to managed
care organizations for the purpose of chemical dependency services.

Section 49 of the bill would amend L. 2010, c. 111, Part H, § 2, to
provide a sunset date of March 31, 2105, for previously enacted
statutory provisions allowing the transfer of
funds by OMH to DOH for purposes of increasing Medicaid payments to
managed care organizations for outpatient mental health services
provided by hospital-based and freestanding clinics.

Sections 50 and 51 of the bill would amend PHL § 2511 to provide for
the transition of rate setting for the Child Health Plus program from
the Department of Financial Services to DOH.

Sections 52 and 53 of the bill would amend SSL § 364-j(4)(e)(ii) and
PHL § 44034(7)(b) to authorize DOH to require counties which
implemented mandatory managed care to use the enrollment counseling
and enrollment services for which DOH has contracted.

Section 54 of the bill would amend PHL § 44034(7)(g) to allow DOH to
set the cutoff date for monthly enrollment in a managed long term
care plan.

Sections 55 through 57 of the bill would amend PHL § 3614 to eliminate
the attestation requirements for certain certified home health care
providers receiving worker recruitment and retention and recruitment,
training and retention payments, consistent with the transition to
managed long-term care.

Section 58 of the bill would amend PHL § 2808 to sunset payments for
financially disadvantaged nursing homes effective December 31, 2012,
so that such funding can be redirected to nursing homes through vital
access provider payments.

Section 59 of the bill would amend PHL § 2808(2-b)(d) to extend audit
authority for calendar year 2002 cost reports filed by nursing homes
through December 31, 2018.

Sections 60 and 61 of the bill would amend PHL § 2808(2-b)(a) and (b)
to eliminate the requirement that certain rate adjustments for
nursing homes be subject to reconciliation.

Section 62 of the bill would amend PHL § 2808 to authorize DOH to
establish capital reimbursement methodologies for nursing homes
through regulation.


Sections 63 and 64 of the bill would amend PHL § 2808(12) to provide
for additional flexibility in the calculation of upper payment limit
distributions for public nursing homes.

Section 65 of the bill would amend PHL § 4403-f(6) to eliminate the
cap on the maximum number of managed long-term care plans that can be
authorized.

Section 66 of the bill would amend PHL § 2808(2-c) to develop a
pricing reimbursement methodology for specialty nursing home
facilities.

Section 67 of the bill would amend SSL § 366(3) to require spousal
support for the costs of community-based long-term care.

Section 68 of the bill would amend SSL § 366-c(2) to apply spousal
protections to all managed long-term care enrollees.

Sections 69 and 70 of the bill would amend PHL § 3614(6) and SSL
461.1 to authorize capital debt reimbursement for certain adult homes
which convert to assisted living programs.

Section 71 of the bill would amend SSL § 366(14) to extend certain
income disregards related to costs for eligible adult home residents
who transition into managed long term care plans.

Section 72 of the bill would add a new SSL § 364-j(27) to allow the
Office for People with Developmental Disabilities (OPWDD) to perform
a Fully Integrated Duals Advantage program in order to provide
comprehensive health services to targeted populations of
Medicare/Medicaid dually eligible persons.

Section 73 through 80 of the bill would amend PHL § 4403, add a new
PHL § 4403-g and 4403(8) and amend SSL §§ 3641 and 365-a to establish
Developmental Disability Individual. Support and Care Coordination
Organizations and authorize managed care plans to provide services
operated, certified, funded, authorized or approved through OPWDD,
with certain protections in place to recognize the unique needs of
individuals with developmental disabilities.

Sections 81 through 84 of the bill set forth time frames of notice,
authority to promulgate emergency regulations, severability clause,
and effective dates.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget and the State's multi-year Financial Plan by keeping overall
Medicaid spending within DOH within capped levels, which are indexed
to the ten-year rolling average of the medical component of the CPI
as proscribed in current statute.

Effective Date:

This bill would take effect April 1, 2013, except that sections 10,
11, 12 and 13 would take effect July 1, 2013.


Part B - Extend provisions of the Public Health, Social Services and
Mental Hygiene Laws to preserve previously enacted Medicaid savings.

Purpose:
This bill would maintain Financial Plan savings by continuing various
Medicaid and health savings initiatives that were previously
authorized in statute.

Statement in Support, Summary of Provisions,
Existing Law, and Prior
Legislative History:

Section 1 of the bill would amend Chapter 58 of the Laws of 2009, Part
C, § 129(f), to extend authorization for Patient Centered Medical
Homes for three years, through April 1, 2016.

Section 2 of the bill would amend Chapter 474 of the Laws of 1996,
212(1)(a), to permanently extend authorization to make
"intergovernmental transfer" ("IGT") payments to non-New York City
public hospitals.

Section 3 of the bill would amend Chapter 884 of the Laws of 1990,
11, to extend authorization for bad debt and charity care costs as
reported by certified home health agencies and diagnostic and
treatment centers for five years, through June 30, 2018.

Section 4 of the bill would amend Chapter 81 of the Laws of 1995,
246(2), to permanently extend provisions relating to Medicaid
inpatient capital cost reimbursement, such as reducing capital
over-budgeting.

Section 5 of the bill would amend Public Health Law ("PHL")
2807-d(2)(b)(vi), to permanently extend the 6 percent nursing home
reimbursable cash assessment.

Section 6 of the bill would amend. Chapter 659 of the Laws of 1997,
88, to permanently extend authorization for the continued operation
of managed long term care ("MLTC") operating demonstrations known as
"Project Eldercare."

Section 7 of the bill would amend PHL § 2807-c(35)(b)(v) to extend
authorization to achieve savings associated with reducing potentially
preventable readmissions and potentially preventable negative
outcomes for one year.

Section 8 of the bill would amend Chapter 58 of the Laws of 2007, Part
C, § 93(2), to extend the Chronic Illness Demonstration Project for
one year, through March 31, 2014.

Section 8-a of the bill would repeal Social Services Law § 364-1(8) to
eliminate a reporting requirement for the Chronic Illness
Demonstration Project.

Section 9 of the bill would amend Chapter 474 of the Laws of 1996,
194, to permanently continue the exclusion of the 1996-97 trend
factor from nursing home and inpatient rates.


Section 10 of the bill would amend Chapter 58 of the Laws of 2007,
Part C, § 89-a(1), to permanently continue the 0.25 percent trend
factor reduction for hospitals and nursing homes.

Sections 11, 12, 13, 14 and 14-a of the bill would amend Chapter 81 of
the Laws of 1995, § 64(1)(f), (3)(b)(ii), (4)(b)(iii) and (5)(b), and
Chapter 474 of the Laws of 1996.,
228, to permanently extend the requirement that nursing homes,
hospitals, certified home health care and long term care home health
care providers maximize Medicare revenues.

Sections 15 and 16 of the bill would amend Chapter 81 of the Laws of
1995, §§ 64-b and 246(5-a), to remove a $1.5 million reconciliation
limit for the certified home health care agency administrative and
general cap for five years, through March 31, 2018.

Section 17 of the bill would amend Chapter 451 of the Laws of 2007,
20(1), to extend the requirement that parties to a contract between a
hospital and a managed care organization continue to abide by the
terms of the contract for two months from the effective date of
contract termination or non-renewal, unless certain circumstances are
met, through June 30, 2015.

Section 18 of the bill would amend PHL § 3614(7-a) to permanently
extend a limitation on the reimbursement of the long term care home
health program administrative and general costs to a statewide average.

Section 19 of the bill would amend Chapter 2 of the Laws of 1998,
47(3), (4) and (5), to permanently extend 1998 Child Health Plus
income and benefit expansions.

Section 20 of the bill would amend Chapter 58 of the Laws of 2007,
Part C, § 93(6-a), to extend authorization for spousal budgeting in
long term care waiver programs for five . years, through December 31,
2018.

Section 21 of the bill would repeal Chapter 81 of the Laws of 1995,
246(12), permanently continue the statutory requirement that
establishes limited licensed home care service agencies in adult
homes or enriched housing programs as providers of personal care and
limited medical services.

Section 22 of the bill would amend Chapter 426 of the Laws of 1983,
5, to permanently extend exemptions related to professional conduct
proceedings to provide immunity for physicians from medical conduct
reporting requirements, when information is received solely from
their participation on a committee related to physicians suffering
from addiction or mental illness.

Sections 22, 23 and 24 of the bill would amend Chapter 426 of the Laws
of 1983, § 5, Chapter 582 of the Laws of 1984, § 5, and PHL
230(11)(c)(ii) to permanently extend exemptions related to
professional conduct proceedings to provide immunity for physicians
from medical conduct reporting requirements, when information is
received solely from their participation on a committee related to
physicians suffering from addiction or mental illness.


Section 25 of the bill would amend Chapter 62 of the Laws of 2003,
Part X2, § 5, to extend for two years the authority to use Office of
Professional Medical Conduct funding for patient safety activities.

Sections 26 and 27 of the bill set forth provisions regarding time
frames for notice and severability.

Section 28 of the bill sets forth the effective date.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget because it maintains a balanced State Financial Plan and
preserves savings totaling $842.1 million annually.

Effective Date:

This bill would take effect April 1, 2013.

Part C - Revise the methodology for distributing Indigent Care Pool
("ICP") funds to general hospitals, including Federal
Disproportionate Share Hospital ("DSH") payments.

Purpose:

This bill would revise the methodology for distributing Indigent Care
Pool ("ICP") funds to general hospitals, including Federal
Disproportionate Share Hospital ("DSH") payments, to: (1) ensure that
the allocation of ICP funds is simplified, transparent and equitable;
(2) comply with Federal changes to the DSH program, mitigating the
potential reduction in funds to the State as a result of such changes
and protecting access to care by indigent persons; and (3) improve
compliance with Public Health Law ("PHL") § 2807-k (9-a), known as
the Financial Assistance Law ("FAL").

Statement in Support, Summary of Provisions,
Existing Law, and Prior
Legislative History:

Section 1 of the bill would add a new PHL § 2807-k(5-d) to require the
Department of Health ("DOH") to promulgate regulations establishing a
new ICP distribution methodology for periods on and after January 1,
2013, through December 31, 2015. For each of those years, the
methodology would require distribution of $139.4 million to major
public general hospitals and $994.9 million to private hospitals,
allocated according to the "uncompensated care need amount." It also
would establish a transition pool for the purpose of ensuring that no
facility has reduced 1CP payments greater than set percentages
specified in regulations, as compared to the average distribution
that each such facility received for the three prior calendar years.
These funds would be generated with an additional $25 million and by
redistributing funds over three years from those hospitals that
experience an increase in distributions from those that experience a
decrease.

This new subdivision would also provide that, effective January, 2014
one percent of the funds available for distribution would be reserved


and set aside in a "Financial Assistance Compliance Pool." Funds
would be released to individual hospitals based on their substantial
compliance with regulations implementing the FAL.

Section 2 of the bill would amend PHL § 2807-c(14-f) to conform the
indigent care adjustment distributions to the new methodology for the
"uncompensated care need amount."

Section 3 of the bill would amend PHL § 2807(2-a) to reduce Hospital
Outpatient Ambulatory Patient Group payments by an aggregate of $25
million annually to fund Indigent Care Transition Pool Payments.

Section 4 of the bill sets forth the effective date.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget, the State's multi-year Financial Plan, and to mitigate
potential losses in Federal DSH funding. The bill would shift $25
million in gross ($12.5 million General Fund) Medicaid spending to
HCRA Fund indigent care spending, but otherwise is fiscally neutral.

Effective Date:

This bill would take effect immediately upon enactment; provided,
however, that sections 1 and 2 would be deemed to have been in full
force and effect on January 1, 2013.

Part D - Amend State law to conform to the requirements of the federal
Affordable Care Act.

Purpose:

This bill would make amend State law to conform to the requirements of
the federal Patient Protection and Affordable Care Act, known as the
"Affordable Care Act" (ACA).

Statement in Support, Summary of Provisions, Existing Law,
and Prior
Legislative History:

Section 1 of the bill would repeal Social Services Law (SSL) § 366(1)
and replace it with a new § 366(1) that sets forth the Medicaid
eligibility categories that will exist as of January 1, 2014, when
the Medicaid requirements of the ACA take effect. The new subdivision
would identify the categories of individuals who will have their
financial eligibility determined based on their'modified adjusted
gross income ("MAGI"), in
accordance with the new federal requirements, and the categories of
individuals whose financial eligibility will be determined under the
current rules. The new subdivision also would specify which eligible
individuals will receive the current Medicaid benefit package, and
which will receive "benchmark coverage" under the new federal
requirements. Finally, the new subdivision would define terms such as
"benchmark coverage," "caretaker relative," "family size," "federal
poverty line," "household," "MAGI (Modified Adjusted Gross Income),"
"MAGI-based income," "MAGI household income," and "standard coverage."


Section 2 of the bill would repeal SSL § 366(4) and add a new § 366(4)
updating current Medicaid provisions related to transitional medical
assistance, pregnant women and children, continuous coverage for
adults, breast and cervical cancer treatment and colon and prostate
cancer treatment to conform to federal ACA requirements.

Sections 3, 4 and 5 of the bill would amend SSL § 364-1(4), (5) and
(6) to base presumptive Medicaid eligibility for pregnant women,
children, and persons in need of treatment for breast, cervical,
colon, or prostate cancer on MAGI household income.

Section 6 of the bill would amend SSL § 365-a(1) and (2) to define the
Medicaid benchmark benefit to include the current Medicaid benefit
package, with the exception of institutional long term care services,
plus any additional federally required benefits.

Section 7 of the bill would amend SSL § 366-a(1) to allow online and
phone Medicaid applications.

Sections 8 and 9 of the bill would amend SSL § 366-a(2) and (3) to
increase the extent to which Medicaid applications may be submitted
to and processed by the Department of Health (DOH) or its agent.

Section 10 of the bill would amend SSL § 366-a(5)(b) and (c) to
require DOH to recertify Medicaid eligibility, whenever possible,
based on reliable information possessed or available to DOH. However,
if DOH or its agent is unable to renew eligibility based on available
information, the recipient will be required to supply only such
information as is reasonably necessary to determine continued
eligibility for medical assistance.

Section 11 of the bill would repeal SSL § 366-a(5)(d) to eliminate
documentation requirements that are inconsistent with federal ACA
provisions requiring self-attestation of certain information used to
determine Medicaid eligibility.

Section 12 of the bill would amend SSL § 366-a(5)(e) to provide that
the Commissioner of Health (Commissioner) will only request
additional information from a Medicaid applicant or recipient when
information supplied by the applicant or recipient is not reasonably
compatible with information obtained by the Commissioner from other
sources.

Section 13 of the bill would repeal SSL § 364-j(11) to eliminate the
guarantee of Medicaid payment of six months of premiums to a Medicaid
managed care plan with respect to an individual who becomes
ineligible for Medicaid prior to the end of the first six months of
enrollment with the plan.

Section 14 of the bill would amend SSL § 369-ee(2)(a)(v)(d),
restricting applications to enroll in the Family Health Plus program
to those received through December 31, 2013.

Section 14-a of the bill would add new SSL § 369-ee(5)(d) to provide
that Family Health Plus coverage for individuals enrolled as of
January 1, 2014, will terminate once such individuals obtain coverage
through the New York Health Benefit Exchange (Exchange), on December


31, 2014, or on such date as federal financial participation is no
longer available for Family Health Plus, whichever is earliest.

Section 15 of the bill would repeal SSL § 369-ee and 369-ff to
eliminate the Family Health Plus program and the Family Health Plus
employer buy-in program, effective January 1, 2015.

Section 16 of the bill would add a new SSL § 367-a(3)(e) to provide
for the payment of premiums and cost-sharing obligations for
individuals who enroll in a qualified health plan (QHP) at the silver
level through the Exchange, if they were also enrolled in the Family
Health Plus program at its termination or at the time of enrollment
in the QHP and have MAGI household income in excess of 133 percent,
but less than 150 percent, of the federal poverty level.

Section 17 of the bill would add a new Public Health Law (PHL)
2510(13) to define household income for purposes of determining
eligibility for the Child Health Plus program.

Section 18 of the bill would add new PHL § 2510(14) and (15) to
clarify that the "State Enrollment Center" makes eligibility
determinations for all insurance affordability programs, including
the Child Health Plus program, as the centralized system.

Sections 19 and 20 of the bill would amend PHL § 2511(2) to allow the
State Enrollment Center to dis-enroll a child from Child Health Plus
if the child's household does not provide income documentation
required by request of the State Enrollment Center in a timely
manner, and clarify that the State Enrollment Center must maintain
confidentiality of records supplied.

Section 21 of the bill would amend PHL § 2511(4) to require households
to report to the State Enrollment Center within 30 days if there are
any changes in New York State residency or health care coverage that
may make a child ineligible for subsidy payments.

Section 22 of the bill would amend PHL § 2511(5-a) to require the
State Enrollment Center to review all information of Child Health
Plus program applicants for the purpose of making eligibility
determinations.

Section 23 of the bill would amend PHL § 2511(11) to discontinue the
need for plans to report enrollee demographic information once the
State Enrollment Center is implemented.

Sections 24 and 25 of the bill would amend PHL § 2511(12) and (12-a)
to discontinue the requirement for audits of plan eligibility
determinations.

Section 26 of the bill would amend PHL § 2511(2)(f) to define rules
for electronic verification of income and residency of an applicant
for the Child Health Plus program.

Section 27 would amend PHL § 2511(2)(g) to eliminate temporary
enrollment in the Child Health Plus program.


Section 28 of the bill would amend PHL § 2511(2-b) to require a
household whose members are lawfully residing in the country to
provide a social security number for children enrolled in the Child
Health Plus program.

Sections 29 through 32 of the bill would amend PHL §§ 2510(9) and
2511(2)(a), (2)(d) and (18) to modify Child Health Plus program
eligibility categories to conform to MAGI.

Section 33 of the bill would amend PHL § 2511(9) to remove the
necessity of personal interviews for recertification of the Child
Health Plus eligibility.

Section 33-a of the bill would amend SSL § 365-n(5) to include
amendment of existing contracts as necessary to comply with the
requirements of the ACA.

Sections 34 through 37 of the bill would amend Insurance Law (IL)
2101(a), (c) and (k) and 2102 (b)(4) to exempt navigators from the
definitions of "insurance agent," "insurance broker," "insurance
producers," and "insurance consultant."

Sections 38 through 40 of the bill would amend IL §§ 3216(i)(25)(B),
3221(l)(17)(B) and 4303(ee)(2) by replacing the existing $45,000
annual benefit limit for applied behavior analysis for individuals
diagnosed with autism spectrum disorder with an annual benefit limit
of 680 hours of treatment.

Section 41 of the bill would add a new IL § 3240 to define student
accident and health insurance, disallow pre-existing condition
exclusions, include essential health benefits, to specify appropriate
reasons for termination, to allow the Superintendent of Financial
Services (Superintendent) to promulgate regulations, to set the ratio
of benefits to
premiums at 82 percent, and to require insurers and corporations to
annually report claims experience and other data to the Superintendent.

Sections 42 through 46 would amend IL §§ 3216, 4304, 4321 and 4322 and
add a new IL § 4328 to provide that policies meeting the requirements
of the ACA shall be offered by all health maintenance organizations
(HMOs) rather than the standardized health insurance contracts
currently required. HMOs may choose to provide this coverage through
the Exchange, the market outside the Exchange, or both. HMOs that
satisfy this requirement through the Exchange must provide coverage
on a limited basis outside of the Exchange for those that are not
eligible to purchase coverage through the Exchange. Not-for-profit
corporations and commercial insurers offering coverage in the
individual market must also comply with the requirements of the ACA
on the same basis as HMOs.

Sections 47 through 52 would amend IL §§ 3221, 4304 and 4305 to bring
health insurance conversion policies into compliance with the ACA.

Sections 53 through 55 would amend IL §§ 3216, 3221 and 4303 to
provide that small group policies that are not "grandfathered health
plans" must provide essential health benefits required by the ACA and
that optional "make available" benefits do not need to be offered in


the health benefit exchange or outside of the health benefit exchange
if they are incorporated into the essential health benefits required
by the ACA.

Section 56 of the bill would amend IL § 4326 to eliminate the Healthy
NY program for qualified individuals and qualified small employers
who are sole proprietors. This section also would end all Healthy NY
contracts, including grandfathered contracts, for qualified small
employers and transitions qualified small employers to ACA compliant
plans that offer the essential health benefits package at a
permissible actuarial value. It also would require the Superintendent
to standardize the benefit package and cost sharing requirements for
such plans.

Section 57 of the bill would add a new IL § 4326-a to end Healthy NY
coverage for individual and sole proprietor enrollees on December 31,
2013, and require 180 days' notice of program discontinuance. This
section also would discontinue qualified small employer contracts
that do not offer coverage for essential health benefits and requires
enrollees to be transitioned to a plan that complies with ACA.

Section 58 of the bill would amend IL § 4327 to eliminate the
individual stop loss fund for the Healthy NY program.

Section 59 of the bill would amend IL § 4235(d)(1) to provide that the
current definition of employee does not apply to insurance plans that
offer group hospital, medical or other types of comprehensive expense
reimbursed health insurance.

Section 60 of the bill would add a new IL § 4235(d)(3) to define
"employee" in accordance with the definition found in the ACA, 42
U.S.C. § 300gg-91(d)(5) and to define "full time employee"-as an
employee who is employed on average for at least 30 hours of service
per week.

Sections 61 and 62 of the bill would amend IL §§ 3231 and 4308 to
amend the reporting date for medical loss ratios to make said date
consistent with federal reporting requirements.

Section 63 of the bill would add a new IL § 3233(d) to authorize the
Superintendent to suspend or terminate any risk-adjustment mechanism
under this section should a sufficient federal risk-adjustment
mechanism be implemented to avoid a duplicative mechanism.

Sections 64, 65, 67 and 68 of the bill would amend IL § 3221(p) and
4305(j) to establish an alternate process for insurers or
corporations which cease to offer group or blanket policies of
hospital, surgical, medical expense insurance and instead will be
offering a group or blanket policy of hospital, surgical, medical
expense insurance that complies with the ACA.

Section 66 of the bill would amend IL § 4304(c) to make technical
corrections to correct erroneous cross-references to other sections
of law.

Section 69 of the bill would amend IL § 3231 to align group size
requirements for small groups to conform with requirements under


federal law, correct language regarding preexisting condition
limitations, subject certain insurance products to enrollment periods
in conformance with federal law, amend language to conform with
pooling requirements. In addition, this section would specify new
requirements for premium rating tiers and relativities and require
standardized rating regions.

Section 70 of the bill would amend IL § 3231(g) to require that
non-employer based groups and Professional Employer Organizations
("PEOs"), must rate separately for individuals, individual
proprietors and small employer groups.

Section 71 of the bill would amend IL § 3231(i) to eliminate the
special community rating provision applicable to individual
proprietors starting on January 1, 2014.

Section 72 of the bill would amend IL § 4317 to align group size
requirements for small groups to conform with requirements under
federal law, correct language regarding preexisting condition
limitations, and subject certain insurance products to enrollment
periods in conformance with federal law, amend language to conform
with pooling requirements. In addition, this section would specify
new requirements for premium rating tiers and relativities and
require standardized rating regions. This section would also specify
new rating requirements for individual proprietors and certain
members of association groups to comply with federal law.

Sections 73 through 76 of the bill set forth time frames of notice,
authority for emergency rulemaking, and effective dates.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget and meet the requirements of the federal Patient Protection
-and Affordable Care Act, known as the Affordable Care Act or ACA.
These changes are critical to the Medicaid Financial Plan and
managing spending within the State funds cap. Conforming eligibility
levels in Medicaid and Child Health Plus with federal rules is
essential to meeting the requirements for certain enhanced federal
funding levels in Medicaid and Child Health Plus authorized by the
ACA. The elimination of Family Health Plus is expected to result in
State share savings of $39 million in SFY 2014-15. Additionally, this
bill would increase the number of insured New Yorkers who will pay
premiums, generating premium taxes and other health care assessments
and reducing the need for public support for uncompensated care.

Effective Date:

This bill would take effect immediately and would be deemed to be in
full force and effect on and after January 1, 2013, except that: (1)
§§ 38, 39, 40, 41, 47, 48, 49, 50, 51, 52, 53, 54, and 55 would take
effect January 1, 2014, and would apply to all policies and contracts
issued, renewed, modified, altered or amended on or after such date;
(2) §§ 42, 43, 44, 45 and 46 of the bill would apply to all policies
and contracts issued, renewed, modified, altered or amended on or
after October 1, 2013; (3) § 56 would take effect January 1, 2014;
(4) §§ 15 and 58 would take effect January 1, 2015; (5) §§ 59 and 60


would take effect January 1, 2016, and would apply to all policies
and contracts issued, renewed, modified, altered or amended on or
after such date; (6) §§ 14 and 14a would take effect immediately and
would be deemed to be in full force and effect on and after April 1,
2013; and (7) the amendments to PHL § 2511(2)(e) and (f) made by
19 and 26 of the bill would take effect January 1, 2014, or upon
implementation of the ACA, whichever is later.

Part E Improve the State's health care system by: reforming the Early
Intervention and the General Public Health Work programs;
establishing a new outcome-based contracting and planning initiative
for public health programs; streamlining and rationalizing the health
planning process; promoting primary care through scope of practice
changes; supporting innovative models of care and financing; and
rationalizing the State-funded excess medical malpractice insurance
pool.

Purpose:

This bill would: (1) reform the Early Intervention (El) program by
integrating covered El services into health insurance networks and,
in conformance with recent changes to federal regulations that allow
for greater flexibility in eligibility determinations, streamlining
the eligibility process to decrease costs and promote more timely
entry into the program for eligible children; (2) enhance the General
Public Health Work (GPHW)
program by promoting State health priorities, providing fiscal
incentives to improve outcomes and reducing burdens on the State and
local governments in administering this program; (3) institute a new
outcome-based contracting and planning initiative to permit the
Department of Health (DOH) to better administer and target funding to
produce improved outcomes and meet emergent needs; (4) streamline and
rationalize the health planning processes for health care services
and facilities and emergency medical services; (5) promote primary
care by enhancing the scope of practice for certain practitioners and
permitting operation of retail clinics; (6) support innovative models
of care and financing; and (7) rationalize the State-funded excess
medical malpractice insurance pool.

Statement in Support, Summary of Provisions, Existing Law,
and Prior
Legislative History:

Early Intervention

Section 1 of the bill would amend PHL § 2541(9) and (10) to revise the
definition of "evaluation" and "evaluator" and define the term
"partial evaluation."

Section 2 of the bill would add new PHL § 2541 (13-b) and (15-a) to
define the terms "multidisciplinary" and "screening."

Section 3 of the bill would amend PHL § 2542(3) to require persons who
refer children to the El program to inform parents that for children
with a diagnosed physical or mental condition with a high probability
of resulting in a developmental delay, eligibility for the El program


shall be established through a records review as set forth in PI-IL
2544(5), amended by § 4 of the bill.

Section 4 of the bill would renumber several provisions of the PHL and
amend PHL § 2544(1) to clarify that each child thought to be an
eligible child is entitled to an evaluation conducted in accordance
with the provisions set forth in the statute.

Section 4 also would amend PHL § 2544(2) to require initial service
coordinators to inform parents that for children with a diagnosed
physical or mental condition with a high probability of resulting in
a developmental delay, eligibility for the El program shall be
established through a medical records review as set forth in PHL
2544(5).

Section 4 also would amend PHL § 2544(3) to require screenings to be
conducted using standardized screening instruments approved by DOH,
unless the evaluator provides a written statement why such screening
instruments are not appropriate or available for the child. If, based
on such screening, a child is not suspected of having a disability,
then an evaluation would not be required, unless requested by the
parents. If the screening indicates that an evaluation is required or
the parents request an evaluation, the evaluation would be initiated.
The screening component, which is required in some states and used by
most, would not delay development or implementation of the IFSP.
Federal and state law requires that once a referral is made, the
eligibility process must be completed and the IFSP meeting held
within 45 days.

Section 4 also would amend PHL § 2544(4) to require that evaluations
be conducted using standardized evaluation instruments approved by
DOH, unless the evaluator provides a written statement why such
evaluation instruments are not appropriate or available for the
child. If the child is found to be eligible, the evaluation would
continue with an assessment of child's strengths and needs in each of
the developmental areas and services appropriate to meet those needs
and other relevant considerations.

Section 4 also would add a new PHL § 2544(5) to provide that for
children with a diagnosed physical or mental condition with a high
probability of resulting in a developmental delay, eligibility for
the El program shall be established using medical or other records.
Such record review process is consistent with recent revisions to
regulations issued under the federal Individuals with Disabilities
Education Act (IDEA). If a child is found eligible pursuant to such
review, he or she would receive the assessment set forth in PHL
2544(4).

Section 4 also would add a new PHL § 2544(6) to provide that if a
child who received an evaluation, was found ineligible, and was
referred again due to the same delay in a single developmental area
more than three and less than six months later, the child would
receive a partial evaluation to assess the same developmental delay
in lieu of a second full evaluation that looked at all the
developmental areas. However, if there is a new concern in that same
developmental area, or the delay is in more than one developmental
area, or there is a significant change in overall development before


six months has passed, the child would receive another full
evaluation. This is consistent with the practice in other states and
with federal regulations.

Section 5 of the bill would amend PHL § 2545(1) and (2) to allow a
representative of a covered child's third party payor, including a
Health Maintenance Organizations (HMO), Medicaid, and Child Health
Plus, to attend the Individualized Family Service Plan (IFSP)
meeting. It further provides that the meeting date and time will be
chosen by the El official and that the representative can participate
via a conference call or other means.

Section 6 of the bill would amend PHL § 2545(10) to ensure timely
implementation of the IFSP.

Section 7 of the bill would add a new PHL § 2545-a to require that for
a child with third party insurance, a provider approved by DOH and
within the insurer's network be assigned to render the services to
the child unless certain conditions are met. This would apply to new
children referred to the program on or after January 1, 2014. This
section also states that evaluators and providers must maintain
contracts or agreements with an adequate number of insurers.

Section 8 of the bill would amend PHL § 2557 to structure the payment
process for children without health insurance coverage.

Section 9 of the bill would amend PHL § 2559 related to payment for
the El program from health insurers. Rates paid by insurers would be
negotiated between the insurer and the provider unless the provider
is not part of the. network, in which case payment would be made in
accordance with the out of network coverage rate. The payment
negotiated would be payment in full and there would be no balance
billing.

Section 10 of the bill would amend PHL § 2510 to require coverage of
El services by Child Health Plus as defined by the Commissioner of
Health (Commissioner).

Section 11 of the bill would amend PHL § 4403 to require third party
payors to make available an adequate number of network providers
qualified to. perform El services consistent with the needs of the El
program enrollment.

Section 12 of the bill would add a new PHL § 4406(6) to prohibit third
party payors from denying valid insurance claims solely on the basis
that the service was provided under El. Additionally, covered El
services would not be counted toward an established maximum annual or
lifetime monetary limit, but would be subject to an insurer's policy
or visit limitations. Insurance providers would have to provide
municipalities and service coordinators with information on the
extent of benefits within 15 days, and must also provide
municipalities and service coordinators with a list,
updated quarterly, of its network providers who are also approved
under the El program.

Section 13 of the bill would amend Insurance Law § 3235-a to authorize
insurers to negotiate rates for payment to providers. Payments to out


of network providers would be required to be paid at the out of
network rate. Additionally, insurance providers would have to provide
municipalities and service coordinators with information on the
extent of benefits within 15 days and a list, updated quarterly, of
its network providers who are also approved under the El program.

General Public Health Work

Sections 14 through 19 and §§ 21 through 30 of the bill would
streamline the process by which counties apply for GPHW funding and
would update the core public health service requirements for which
funding are available. This would include redefining the core public
health services by making chronic disease prevention and emergency
preparedness and response independent core services, eliminating
health education as a core service, and integrating health education
into each of the core services.

Section 20 of the bill would amend PHL § 605 to increase the State
base grant amount, currently the greater of $550,000 or 55 cents per
capita, to the greater of $650,000 or 65 cents per capita.

Section 31 of the bill would add a new PHL § 619-a to establish a new
statewide incentive performance program for GPHW activities and
provide up to $1 million annually for this purpose.

Section 32 through 41 of the bill would update language throughout PHL
Article 23 to update provisions regarding sexually transmitted
diseases ("STDs") to conform to current clinical terminology and
public health practice, and to authorize counties to seek third party
coverage or indemnification for STD diagnosis and treatment services
rendered, where appropriate.

Outcome Based Health Planning

Section 42 of the bill would create a new PHL Article 12-A, entitled
"Outcome Based Contracting and Outcome Based Health Planning,"
consisting of several new sections described below.

PHL § 1202 would set forth legislative findings establishing that the
purpose of new Article 12-A is the consolidation of public health
programs to provide DOH with the flexibility to promote better health
outcomes, target resources effectively and promptly address existing
and new or emerging health issues.

PHL § 1203 would establish outcome based contracting and planning and
would authorize the Commissioner to make grants, awards and
disbursements on a competitive basis, pursuant to requests for
application or proposal processes covering each of six areas. In
addition, the Commissioner could continue existing contracts and
agreements if they meet the other requirements of Article 12-A.

PHL § 1204 would establish six outcome based areas and authorize DOH
to develop and support various approaches for the purpose of
promoting health in integrated care management settings. The six
programmatic areas are as follows:


* Chronic Disease Prevention and Treatment: to implement evidence and
best practice approaches with an emphasis on preventive care and
healthier environments.

* Environmental Health and Infectious Disease: to minimize risks to
population health posed by environmental factors and infectious
disease and implement evidence and best practice approaches with an
emphasis on prevention of exposure.

* Maternal and Child Health Outcomes: to prevent and address those
priority adverse maternal and child health and nutrition outcomes,
emphasizing the importance of preventive care.

* HIV, AIDS, Hepatitis C and STDs: to implement evidence and best
practice based approaches to HIV, AIDS, Hepatitis C and STD
prevention and care.

* Health Quality and Outcomes: to support core priority initiatives
that address improved population health outcomes, patient safety and
quality.

* Workforce Development: to better address the goals of improving
care, reducing costs and preparing for the increased demand for
services resulting from the implementation of the federal health care
reform law (Affordable Care Act).

Health Planning

Section 43 of the bill would amend PHL § 2802 to streamline the
Certificate of Need (CON) planning process for the establishment and
construction of health care services and facilities and rationalize
standards used by the Public Health and Health Planning Council
(PHHPC) provisions in considering prospective facility operators.

Sections 50 and 51 of the bill would add a new PHL § 2806-a and amend
Mental Hygiene Law § 32.20 to allow the Commissioner to establish a
temporary operator of an adult care facility, a general hospital, a
diagnostic and treatment center, or a chemical dependence treatment
program certified by the Office of Alcoholism and Substance Abuse
(OASAS) on a temporary basis to preserve the best interests of the
residents or patients and community served by the facility, when a
statement of deficiencies has been issued by DOH for that facility
and upon a determination by the Commissioner that significant
management failures exist in the facility.

Sections 52 through 86 of the bill would amend PHL Article 30 to
reform the overall planning process for emergency medical services
(EMS). in particular, the bill would consolidate into a single State
Emergency Medical Services Advisory Board (SEMSAB) the four existing
statewide bodes: (1) the State Emergency Medical Services Council
(SEMSCO); (2) the State Emergency Medical Advisory Committee (SEMAC),
established within SEMSCO; (3) the State Trauma Advisory Committee
(STAG); and (4) the Emergency Medical Services for Children Council
(EMS--C). This new board would be medically driven, assist in
reviewing review standards and quality improvement guidelines, and
making recommendations to the Commissioner. Further, SEMSAB would be
authorized to form technical advisory groups to address issued


currently under the purview of SEMAC, SAC and EMS-C. In addition, the
18 Regional Emergency Medical Services Councils (REMSCOs) would be
consolidated into 10 units.

Primary Care

Section 87 of the bill would amend Education Law § 6908(1)(a)(iv) to
authorize a demonstration program to allow home health aides, while
supervised by a professional nurse, to administer medication that is
routine and premeasured.

Section 88 of the bill would add new Education Law § 6908(1)(i) to
authorize a certified advanced home care aide to provide nursing
services when such services are provided to a self-directing
individual, and such aide is assigned by and such services are
performed while supervised by a registered professional nurse.

Section 89 of the bill would add new PHL § 3612 to authorize the
Commissioner to certify advanced home care aides and promulgate
regulations establishing the minimum training and qualifications of
such advanced home care aides.

Section 90 of the bill would amend Education Law § 6605-b(1) to
clarify that a registered dental hygienist may not administer or
monitor nitrous oxide analgesia or local infiltration anesthesia
except under certain specified conditions.

Section 91 of the bill would amend Education Law § 6606(1) to
authorize a registered dental hygienist working for a hospital to
practice pursuant to a collaborative arrangement with a licensed
dentist pursuant to regulations promulgated under PHL Article 28.

Section 92 of the bill would amend Education Law § 6608 to repeal
language providing that a registered dental hygienist may perform
dental supportive services only under a dentist's supervision in
conformance with the other changes made in the bill.

Section 93 of the bill would amend Education Law § 6611(7) and (10) to
clarify that a registered dental hygienist who x-rays the mouth or
teeth of a patient during the performance of dental services must
work under the direct supervision of a dentist. This section would
also require a registered dental hygienist who practices in
collaboration with a licensed dentist for a hospital to be certified
in cardiopulmonary resuscitation ("CPR").

Section 94 of the bill would amend Education Law § 903(2) to authorize
a registered dental hygienist to sign a dental health certificate,
thereby certifying the dental health of students in public schools.
This section would also add dental practices and registered dental
hygienists to the current list of dental services provided on a free
or reduced cost basis that schools must make available upon request.

Section 95 of the bill would amend Education Law § 6902(3) to
eliminate the requirements for written collaboration agreements and
written practice protocols between certified nurse practitioners and
licensed physicians for nurse practitioners providing only primary


care services, if they demonstrate that such agreements and protocols
are not feasible.

Section 96 of the bill would amend Education Law § 6542(3) and (5) to
revise the number of physician assistants that can be supervised by a
physician from two to four in the physician's private practice and
from supervising four to six assistants when such physician is
employed by or renders services to the Department of Corrections and
Community Supervision (DOCCS).

Section 97 of the bill would require radiologic technologists licensed
in New York who are either licensed or seeking licensure in another
state to immediately report to DOH any out-of-state criminal
convictions or disciplinary actions.

Sections 98 through 100 of the bill would amend L. 2002, c. 420 and
repeal L. 2002, c. 676, § 17-a(b), to make permanent the exemption
from social work and mental health licensure for individuals working
in programs that are regulated, operated, funded or approved by the
Office of Mental Health, DOH, the State Office for the Aging, the
Office of Children and Family Services, DOCCS, OASAS, and the Office
for People with Developmental Disabilities, and/or local governmental
units or social services districts.

Section 101 of the bill would add a new PHL § 2801-a(17) to establish
the authority to promulgate regulations for the oversight of
diagnostic or treatment centers established to provide health care
services within a retail business operation.

New Models of Care and Financing

Section 102 and 103 of the bill are intentionally omitted.

Section 104 of the bill would add a new PHL § 2801-a(18) authorizing
the Commissioner to establish a pilot program under which PHHPC would
approve one business corporation in Kings County and another
elsewhere in the State allowing increased capital investment in
health care facilities.

Section 105 of the bill is intentionally omitted.

Excess Medical Malpractice Pool

Section 106 through 108 of the bill would limit the number of excess
medical malpractice policies purchased for physicians using State
funds to the number of policies for which the payment of actuarially
sound rates can be supported by the amount appropriated in the
budget, granting priority to the highest risk specialties. Refocusing
the priority of the excess pool in the manner will allow for a
reduction in the overall appropriation from previous years.

Sections through 109 through 118 of the bill are intentionally omitted.

Sections 119 through 122 of the bill set forth time frames of notice,
authority to promulgate emergency regulations, severability clause,
and effective dates.


Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget to achieve total savings of $52.4 million in Fiscal Year (FY)
2014 and $57.3 million in FY 2015, as detailed below.

* $0.9 million savings in FY 2014 ($3.6 million in FY 2015) associated
with the El program from streamlining certain eligibility
determinations;

* $1.2 million in costs in FY 2014 ($2.5 million in FY 2015) associated
with integrating covered El program services into the managed care
delivery program;

* $3.5 million savings in FY 2015 associated with GPHW savings
associated with reducing reimbursement for certain services offset by
the cost of increasing the base grant to counties and providing an
annual performance incentive;

* $40.0 million in annual savings starting in FY 2014 associated with
consolidating various programs within the local assistance schedule
into six health programmatic areas; and

* $12.7 million in savings associated with the rationalization of
State-funded excess medical malpractice insurance coverage.
Further, this bill avoids a $325 million annual cost resulting from
new licensure requirements for the State and entities licensed and
regulated by the State.

Effective Date:

This bill would take effect April 1, 2013, with the following
exceptions: (1) PHL § 2544(2)(a), as amended by § 4 of the bill,
would take effect January 1, 2014; (2) PHL § 2545(10), as amended by
§ 6 of the bill, would take effect at the same time as Chapter 56 of
the Laws of 2012, Part A, § 2-a; (3) PHL § 2545-a(2), as added by § 7
of the bill, and PHL § 4006(6)(g), as added by § .12 of the bill,
would take effect October 1, 2013; (4) PHL § 4406(6)(b), as added by
§ 13 of the bill, and Insurance Law § 3235-a, as amended by § 13 of
the bill, would take effect April 1, 2013; (5) PHL § 4406(6)(f), as
added by § 12 of the bill; would take effect January 1, 2014; (6)
Insurance Law § 3235- a(f), as added by § 13 of the bill, would take
effect January 1, 2014; (7) §§ 5, 9, 10, 14, 15, 16, 17, 18, 19, 20,
21, 22, 23, 24, 26, 27, 28, 29 and 30 would take effect January 1;
2014; and (8) §§ 87, 88 and 89 would take effect April 1, 2014.

Part F Require that the Methadone Registry include client dosage
information to assist in facilitating disaster management.

Purpose:

To require that the Methadone Registry collect and maintain data
regarding dosage delivery for patients enrolled in opioid treatment
programs.


Statement in Support,
Summary of Provisions, Existing Law, and Prior
Legislative History:

This bill requires the Methadone Registry to incorporate client dosing
information on individual patients enrolled in opioid treatment
programs. This will ensure that treatment services to such patients
will not be adversely impacted in the event of an emergency or
program closure.

Budget Implications:

While there are no immediate fiscal implications to the State, this
bill is intended to facilitate more efficient and effective services,
while avoiding costs that could arise due to improper client dosing
during a temporary or permanent program closure.

Effective Date:

This bill would take effect on April 1, 2013.

Part G - Clarify that OASAS can continue to fund provider programs via
direct contracts or through the State Aid Funding Authorization
process.

Purpose:
This bill would clarify that the Office of Alcoholism and Substance
Abuse Services (OASAS) can continue its current method of funding
provider programs either through direct contracts or via the State
Aid Funding Authorization (SAFA) process, whereby funds are directly
allocated to counties.

Statement in Support,
Summary of Provisions, Existing Law, and Prior
Legislative History:

This bill will address OSC concerns by streamlining the Mental Hygiene
Law (MHL) in relation to the funding of all services regulated by
OASAS. Specifically, it amends Article 25 and repeals Article 26 to
codify in statute the current process of State Aid funding, and
relationships between local governments, voluntary agencies, and OASAS.

Section 1 of the bill repeals Article 26 of the MHL.

Section 2 amends the title of Article 25, consistent with the creation
of a single Article relating to funding of all OASAS services.

Section 3 amends MHL § 25.01 to update definitions consistent with the
current funding process and to conform to other statutory and policy
changes applicable to state aid funding of substance abuse services,
which have been implemented since 1992.

Section 4 updates process descriptions regarding financial support and
disbursement of funds and clarifies maintenance of effort obligations
of local governments.


Sections 5, 6, 7, 8, 10, 11 and 12 make corresponding Changes to
terminology and conform language.

Section 9 updates the process description of distribution of state aid
to local governments to clarify the relationship to state finance
law, and contractual or other relationships and obligations between
local governments, voluntary agencies and OASAS regarding
distribution of state aid.

Section 13 amends § 14.18 of the MHL to remove reference to Article 26,
which is repealed by this bill.

Section 14 of the bill provides for an effective date of April 1,
2013.

Budget Implications:

Absent this bill, OASAS would need to hire two additional State
contract staff, at an annual cost of $210,000, to meet the new county
contracting requirements imposed by OSC. Additionally, counties would
experience increased administrative costs related to contract
development and execution.

Effective Date:

This bill would take effect on April 1, 2013; provided, however, that
any rules or regulations necessary to implement the bill will have
been promulgated prior to such effective date.

Part H - Continue criteria and appropriate prior notice to ensure the
efficient operation of hospitals by the Office of Mental Health;
extend the community reinvestment program.

Purpose:

This bill would continue the criteria authorized in Chapter 56 of the
Laws of 2012 for the Commissioner of the Office of Mental Health
(OMH) to identify potential closures, consolidations, mergers,
reductions, transfers, or redesign of services of hospitals,
facilities, and programs operated by OMH, including the closure of
wards or the conversion of beds to transitional placement programs.
The legislation continues the requirement in Chapter 56 of the Laws
of 2012 that OMH provide 75 days prior notice for facility closures
and 45 days prior notice for ward closures or conversions, and makes
that notice standard permanent. This requirement facilitates timely
placement of individuals in the most integrated setting. This bill
extends Section 41.55 of the Mental
Hygiene Law (MHL). It also makes technical corrections to the language
authorizing the New York City Children's Center (NYCCC) in Chapter 56
of the Laws of 2012.

Statement in Support,
Summary of Provisions, Existing Law, and Prior
Legislative History:

This bill would continue the existing flexibility for the Commissioner
of OMH to reduce inpatient capacity, and to implement other


reductions and actions as necessary for the cost-effective and
efficient operation of hospitals, facilities and programs, consistent
with Federal Olmstead requirements and Executive Order 84. This
continued flexibility would help redirect funding to enhance
community-based mental health services.

Determinations regarding the closure of beds shall be made by the
Commissioner of OMH based on facility-specific criteria, including,
but not limited to: what services are provided; long term capital
needs; proximity to other facilities that can meet anticipated
service needs; and what community mental health services exist in the
catchment area.

OMH shall provide notice to the Legislature when implementing a
closure or consolidation (75 days for a closure and 45 days for a
ward closure or conversion) and post a notice on the OMH public
website.

The Community Mental Health Reinvestment program and the community
services boards authorized under Section 41.11 of the MHL would both
be reauthorized for one year.

This bill also makes technical amendments to Chapter 56 of the Laws of
2012 to change the provision in section one of Part 0 pertaining to
the NYCCC from consolidated to unconsolidated law.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget and provide the flexibility needed to meet the federal
Olmstead requirement to serve individuals in the most integrated
setting possible.

Effective Date:

This bill would take effect on April 1, 2013.

Part I - Authorize the Office of Mental Health (OMH) to continue to
recover Medicaid exempt income from providers of community residences.

Purpose:
This bill would continue and permanently clarify OMH's authority to
recover Medicaid exempt income from providers consistent with
legislation enacted in prior years and a recent court decision.

Statement in Support,
Summary of Provisions, Existing Law, and Prior
Legislative History:

This bill amends section 41.44 of the Mental Hygiene Law to continue
and permanently clarify the authority of the Commissioner of OMH to
recoup Medicaid exempt income from providers of community residences
licensed by OMH. Legislation enacted in prior years clarified OMH's
statutory authority to recoup exempt income for specific time periods.

This proposal allows OMH to recover an amount equal to fifty percent
of the Medicaid revenue received by providers that exceeds the fixed


amount of annual budgeted Medicaid revenue, as established by OMH.
This authority is consistent with contractual agreements between OMH
and residential providers. This legislation is necessary to continue
existing practice and avoid a loss of $3 million in annual exempt
income recoveries.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget and will avoid a potential loss of $3 million in recoveries on
an annual basis.

Effective Date:

This bill would take effect immediately upon enactment.

Part J - Streamline the organizational structure at the Office of
Mental Health (OMH) by vesting statewide appointing authority with
the Commissioner of OMH.

Purpose:

This bill would give the Commissioner of OMH statewide appointing
authority concerning the assignment and reassignment of staff as
needed to ensure the continuity of services provided to patients by
OMH.

Statement in Support, Summary of
Provisions, Existing Law, and Prior
Legislative History:

This bill would amend an antiquated system and ensure that the
appointing authority for all positions previously under the
jurisdiction of twenty-four separate facility directors will reside
with the OMH Commissioner. This is a new bill that is designed to
streamline decision-making and better align responsibility to best
serve individuals with mental illness. Similar appointing authority
was authorized for the Commissioner of the Office of People with
Developmental Disabilities (OPWDD) under Sections 2 and 3 of Part J
of Chapter 56 of the Laws of 2012, and is common with most well-run
organizations.

Section one of the bill would amend subdivision (a) of Section 7.19 of
the Mental Hygiene Law (MHL) to establish the Commissioner as the
appointing authority for all OMH employees.

Section two would amend subdivision (a) of Section 7.21 of the MHL to
transfer the authority of OMH facility directors to appoint and
remove facility employees to the OMH Commissioner.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget because it would provide the necessary flexibility to ensure
that OMH can adequately staff hospitals and state run programs, while
ensuring a consistent and holistic approach to meeting the needs of
the individuals it serves.


Effective Date:

This would bill take effect on April 1, 2013.

Part K - Clarify the date when annual examinations and notice of
rights are provided to sex offenders confined in a secure treatment
facility.

Purpose:

This bill would amend Mental Hygiene Law (MHL) § 10.09 to clarify that
annual reviews for sex offenders must be completed within one year of
the date on which the court last ordered or confirmed the need for
continued confinement.

Statement in Support,
Summary of Provisions, Existing Law, and Prior
Legislative History:

Changes made to MHL § 10.09 in the 2012 Enacted Budget directed annual
reviews for sex offenders no later than one year after the date on
which the supreme or county court judge last ordered or confirmed the
need for continued confinement. However,
other new language suggesting that the date for the annual examination
also could be calculated from the date when the respondent waived the
right to petition for discharge, "whichever is later," has resulted
in confusion and inconsistent determinations of the annual review
dates. Some courts have mistakenly set-annual review dates calculated
from the date of the MHL § 10.09(g) waiver, even if the courts order
or confirmation was made after that date.

This proposal would resolve this confusion in several ways. First, it
would amend MHL § 10.09(a) to provide that the Commissioner of the
Office of Mental Hygiene (OMH) must provide the annual notice of the
respondent's right to petition for discharge no later than 11 months
after the date of the last court order or confirmation of the need
for continued confinement. Second, it would amend MHL § 10.09(b) to
clarify that the required annual examination of the respondent's
mental condition would be calculated from the date on which the court
last ordered or confirmed the need for continued confinement. Third,
it would amend MHL § 10.09(c) to provide that the due date of the
Commissioner's annual notice and report to the court shall likewise
be calculated from the date of the last court order or confirmation.

OMH psychiatric examiners completed 145 annual reviews in 2011. It is
estimated that approximately 170 reviews were done in 2012. On
average, each annual review takes seven days to complete, including
preparation and delivery of court testimony: Eliminating premature
reviews will free up psychiatric examiners to provide services for
confined sex offenders. At the same time, staff will still retain the
option to review a respondent at any time, regardless of the timing
of the last review. Respondents also will retain the ability to file
a writ of habeas corpus to challenge their continued confinement.

Budget Implications:


Enactment of this bill is necessary to implement the 2013-14 Executive
Budget and to create operational efficiencies for OMH.

Effective Date:

This bill would take effect immediately and shall be deemed to have
been in full force and effect on and after April 1, 2013.

Part L - Improve the State and local response to violent incidents
involving persons with mental illness through the establishment of
mental health incident
review panels.

Purpose:

This bill would authorize the Commissioner of the Office of Mental
Health (OMH) to convene panels of State and local officials to review
violent incidents involving persons with mental illness who either
harm others or are themselves harmed. Such panels must include mental
health officials, but may also include members from local law
enforcement and social service agencies. To encourage candid
assessments of systemic or other problems that led to the incident
under review, the information obtained by the review panel will be
deemed confidential. Such panels also shall have access to all
information, records, documentation and reports otherwise made
confidential by the provisions of Section 2805-m of the Public Health
Law. The OMH Commissioner must make an annual report to the
Legislature and the Governor summarizing the findings and
recommendations made by the review panels.

Statement in Support, Summary of
Provisions, Existing Law, and Prior
Legislative History:

This bill adds a new Section 31.37 to the Mental Hygiene Law (MHL) to
authorize the Commissioner of OMH to include local and state
officials with varied backgrounds in review panels, which will permit
more effective and comprehensive evaluations of any gaps or failures
that may have contributed to a violent incident in the community
involving a person with a mental illness. These reviews will result
in policy recommendations to help prevent future occurrences and to
enhance public safety.

The bill would amend Section 33.13 of the MHL and Section 6527 of the
Education Law to extend quality assurance privileges to the review
panels. The assurance of confidentiality will promote objective and
comprehensive incident reviews, since panel members may frankly and
freely discuss and analyze any errors or shortcomings in the mental
health and/or criminal justice system that may have led to the
incident's occurrence, thus leading to both improved quality of care
for persons with mental illness and enhanced protection for the
public. Such confidentiality provisions are already authorized for
the inpatient incident reviews required under Section 29.29 of the
MHL, for child fatality reviews conducted pursuant to Section 422-h
of the Social Services Law and for the new domestic violent fatality
review teams established pursuant to Chapter 491 of the Laws of 2012.


Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget because it would improve OMH's current incident reporting
procedures within existing resources.

Effective Date:

This bill would take effect sixty days after enactment.

Part M - Eliminate redundant reports prepared by the Office of Mental
Health (OMH) and the Office for People with Developmental
Disabilities (OPWDD).

Purpose:

This bill would repeal the statutory requirements for the annual
comprehensive psychiatric emergency (CPEP) and family care reports
required to be submitted by the Office of Mental Health (OMH) and the
Office for People With Developmental Disabilities (OPWDD), as well as
the annual abuse and neglect of adults with developmental
disabilities report submitted by OPWDD and the Office of Children and
Family Services (OCES), to the Governor and the Legislature.

Statement in Support,
Summary of Provisions, Existing Law, and Prior
Legislative History:

This bill would repeal mandated reports for the Family Care and CPEP
programs, which were established in 1975 and 1989 respectively, and
the mandated report of abuse and neglect of adults with developmental
disabilities, which was established in 2005. There has been ample
time to evaluate the operation of these programs. Additionally,
information in these mandated reports is duplicative of that included
in other documents and presentations that OMH and OPWDD annually
provide to the Governor and the Legislature, such as the 5.07 Plan
Report. Reports of abuse and neglect to individuals with
developmental disabilities will be handled by the newly formed
Justice Center for the Protection of People with Special Needs.

Section one of this bill would repeal the requirement under Chapter
723 of the Laws of 1989 for the annual report to the Governor and the
Legislature on the CPEP.

Section two would repeal the requirement under subdivision (c) of
Section 7.15 of the Mental Hygiene Law for an annual report on the
activities of the family care homes and other community residences
provided by OMH.

Section three would repeal the requirement under subdivision (c) of
Section 13.15 of the Mental Hygiene Law for an annual report on the
activities of family care homes and other community residences
provided by OPWDD.

Section four would repeal the requirement under paragraph (3) of
subdivision (d) of Section 16.19 of the Mental Hygiene Law for an


annual report of any instances of abuse and neglect to adults with
developmental disabilities.

Budget Implications:

Enactment of this bill is necessary to implement the 2013-14 Executive
Budget and will result in annualized savings of $50,000 from the
production costs and support staff time associated with these reports.

Effective Date:

This bill would take effect on April 1, 2013.

Part N - Establish a one-year deferral of the Human Services
Cost-of-Living Adjustment.

Purpose:

This bill would defer the Human Services Cost-of-Living Adjustment
(COLA) for FY 2014 and extend the adjustment for an additional year,
through March 31, 2017.

Statement in Support, Summary of
Provisions, Existing Law, and Prior
Legislative History:

This bill would defer the FY 2014 COLA for designated Human Services
programs under the auspices of several State agencies, including the
Office for People with Developmental Disabilities, Office of Mental
Health, Office of Alcoholism and Substance Abuse Services, the
Department of Health, the State Office for the Aging, and the Office
of Children and Family Services.

Additionally, this bill seeks to honor the State's commitment to
support the COLA for three years by continuing the adjustment for one
additional year, through FY 2017.

Budget Implications:

Deferring the formula for the FY 2014 Human Services COLA will result
in State savings of $44 million in FY 2014.

Effective Date:

This bill would take effect on April 1, 2013.

The provisions of this act shall take effect immediately, provided,
however, that the applicable effective date of each part of this act
shall be as specifically set forth in the last section of such part.

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

    S. 2606                                                  A. 3006

                      S E N A T E - A S S E M B L Y

                            January 22, 2013
                               ___________

IN  SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
  cle seven of the Constitution -- read twice and ordered  printed,  and
  when printed to be committed to the Committee on Finance

IN  ASSEMBLY  --  A  BUDGET  BILL, submitted by the Governor pursuant to
  article seven of the Constitution -- read once  and  referred  to  the
  Committee on Ways and Means

AN  ACT  to  amend  chapter  59 of the laws of 2011, amending the public
  health law and other laws relating to general  hospital  reimbursement
  for  annual  rates,  in relation to the cap on local Medicaid expendi-
  tures; to amend the public health law, in relation to general hospital
  inpatient reimbursement; to amend the social services law, in relation
  to the medical assistance information and payment system; to amend the
  social services law, in relation to certain contracts entered into  by
  the  commissioner  of health for the purpose of implementing the Medi-
  caid redesign team initiatives; to amend the  public  health  law,  in
  relation  to  the  preferred  drug program; to amend the public health
  law, in relation to antipsychotic  therapeutic  drugs;  to  amend  the
  social  services  law,  in relation to reducing pharmacy reimbursement
  for name brand drugs; to amend the public health law, in  relation  to
  eliminating the summary posting requirement for the pharmacy and ther-
  apeutic  committee;  to  amend the social services law, in relation to
  early refill of prescriptions; to amend the social  services  law,  in
  relation  to  authorizing  the  commissioner of health to implement an
  incontinence supply  utilization  management  program;  to  amend  the
  social  services  law, in relation to certain individual psychotherapy
  services; to amend the social services law, in relation to the funding
  of health home infrastructure development; to amend the public  health
  law, in relation to general hospital inpatient reimbursement; to amend
  the  social  services  law,  in  relation to managed care programs; to
  amend section 2 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 the  effectiveness  thereof;
  to  amend  the  public health law, in relation to rates of payment for
  residential health  care  facilities  and  in  relation  to  rates  of
  reimbursement for inpatient detoxification and withdrawal services; to

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD12571-01-3

S. 2606                             2                            A. 3006

  amend  the  public  health law, in relation to hospital inpatient base
  years; to amend the public health law, in  relation  to  the  Medicaid
  managed  care  inpatient  psychiatric  care default rate; to amend the
  public  health  law,  in relation to the Medicaid managed care default
  rate; to amend the public health  law,  in  relation  to  moving  rate
  setting  for  child  health plus to the department of health; 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 repealing the twentieth day of
  the month enrollment cut-off for managed long term care enrollees;  to
  amend  the  public  health law, in relation to the nursing home finan-
  cially disadvantaged program; to  amend  the  public  health  law,  in
  relation  to  eliminating  the  recruitment  and retention attestation
  requirement for certain certified home health agencies; to  amend  the
  public health law, in relation to extending the office of the Medicaid
  inspector general's power to audit rebasing rates; to amend the public
  health  law, in relation to rebasing transition payments; to amend the
  public health law, in relation to capital cost reimbursement for nurs-
  ing homes; to amend the public health law, in relation to  eliminating
  the  bed hold requirement; to amend the public health law, in relation
  to authorizing upper payment limits  for  certain  nursing  homes;  to
  amend  the public health law, in relation to rates for specialty nurs-
  ing homes; to amend the social services law, in relation to  eliminat-
  ing spousal refusal of medical care; to amend the social services law,
  in  relation to eligibility for Medicaid; to amend the social services
  law, in relation to treatment of income and resources of  institution-
  alized persons; to amend the public health law, in relation to certain
  payments  for  certain  home  care agencies and services; to amend the
  social services law, in relation to  Medicaid  eligibility;  to  amend
  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 gener-
  al hospital inpatient reimbursement, in relation to the  effectiveness
  thereof;  to amend subdivision 1 of section 92 of part H of chapter 59
  of the laws of 2011, amending the public health  law  and  other  laws
  relating to known and projected department of health state funds Medi-
  caid  expenditures,  in  relation  to  the  effectiveness  thereof; in
  relation to eliminating the 2013-2014 trend factor and thereafter;  to
  repeal  certain  provisions  of the social services law and the public
  health law relating to managed care programs; and  to  repeal  certain
  provisions of the public health law and the social services law relat-
  ing  to  the  pharmacy  and  therapeutics committee; providing for the
  repeal of certain provisions upon  expiration  thereof  (Part  A);  to
  amend  the  public  health  law,  in  relation to payments to hospital
  assessments; to amend part C of chapter 58 of the laws of 2009  amend-
  ing the public health law relating to payment by governmental agencies
  for general hospital inpatient services, in relation to the effective-
  ness  of eligibility for medical assistance and the family health plus
  program; to amend chapter 474 of the laws of 1996, amending the educa-
  tion law and other laws relating to rates for  residential  healthcare
  facilities, in relation to reimbursements; to amend chapter 884 of the
  laws  of  1990, amending the public health law relating to authorizing
  bad debt and charity care allowances for certified home  health  agen-
  cies, in relation to the effectiveness thereof; to amend the long term
  care integration and finance act of 1997, in relation to extending the
  expiration  of  operating demonstrations operating a managed long term

S. 2606                             3                            A. 3006

  care plan; to amend chapter 81 of  the  laws  of  1995,  amending  the
  public health law and other laws relating to medical reimbursement and
  welfare  reform,  in  relation to reimbursements and the effectiveness
  thereof;  to  amend  the  public  health  law,  in relation to capital
  related inpatient expenses; to amend part C of chapter 58 of the  laws
  of  2007,  amending the social services law and other laws relating to
  enacting the major components of legislation  necessary  to  implement
  the  health  and  mental hygiene budget for the 2007-2008 state fiscal
  year, in relation to rates of payment by state  governmental  agencies
  and  the effectiveness of certain provisions of such chapter; to amend
  the social services law, in relation to  reports  on  chronic  illness
  demonstration  projects;  to  amend  chapter  451 of the laws of 2007,
  amending the public health law, the social services law and the insur-
  ance  law,  relating  to  providing  enhanced  consumer  and  provider
  protections,  in  relation  to  extending the effectiveness of certain
  provisions thereof; to amend the public health  law,  in  relation  to
  rates  of  payment  for  long term home health care programs; to amend
  chapter 2 of the laws of 1998, amending  the  public  health  law  and
  other  laws  relating to expanding the child health insurance plan, in
  relation to the effectiveness of certain provisions thereof; to  amend
  chapter 426 of the laws of 1983, amending the public health law relat-
  ing to professional misconduct proceedings and chapter 582 of the laws
  of  1984, amending the public health law relating to regulating activ-
  ities of physicians, in relation to making such provisions  permanent;
  to  amend  the  public  health  law, in relation to extending a demon-
  stration program for physicians suffering from alcoholism, drug  abuse
  or  mental illness; to amend part X2 of chapter 62 of the laws of 2003
  amending the public health law relating to allowing the use  of  funds
  of  the  office  of professional medical conduct for activities of the
  patient health information and quality improvement  act  of  2000,  in
  relation to the effectiveness of certain provisions thereof; to repeal
  subdivision  8  of  section  364-l of the social services law relating
  thereto; to repeal certain provisions of chapter 81  of  the  laws  of
  1995 amending the public health law and other laws relating to medical
  reimbursement  and welfare relating to the effectiveness thereof (Part
  B); to amend the public health law, in relation to indigent care (Part
  C); to amend the social  services  law,  in  relation  to  eligibility
  conditions;  to  amend the social services law, in relation to permit-
  ting online and telephone Medicaid applications; to amend  the  social
  services  law,  in  relation  to  allowing administrative renewals and
  self-attestation of residency; to amend the social  services  law,  in
  relation  to  ending applications for family health plus; to amend the
  social services law, in relation to modified adjusted gross income and
  Medicaid eligibility groups;  to  amend  the  public  health  law,  in
  relation  to  establishing  methodology  for  modified  adjusted gross
  income; to amend the public health law, in  relation  to  centralizing
  child  health  plus  eligibility  determinations;  to amend the public
  health law, in relation to requiring audit standards for  eligibility;
  to  amend  the  public health law, in relation to residency and income
  attestation and verification for  child  health  plus;  to  amend  the
  public  health law, in relation to eliminating temporary enrollment in
  child health plus; to amend the public  health  law,  in  relation  to
  expanding  the child health plus social security number requirement to
  lawfully residing  children;  to  amend  the  public  health  law,  in
  relation to modified adjusted gross income under child health plus; to
  amend  the public health law, in relation to personal interviews under

S. 2606                             4                            A. 3006

  child health plus; to amend the social services law,  in  relation  to
  amendment of contracts awarded by the commissioner of health; to amend
  the  insurance  law, in relation to clarifying the identity of persons
  to whom insurance licensing requirements apply; to amend the insurance
  law,  in  relation  to  coverage  limitations requirements and student
  accident and health insurance; to amend the insurance law, in relation
  to standardization of individual enrollee direct payment contracts; to
  amend the insurance law, in relation to ensuring that group and  indi-
  vidual  insurance policy provisions conform to applicable requirements
  of federal law and to make  conforming  changes;  to  repeal  sections
  369-ee  and  369-ff of the social services law, relating to the family
  health plus program; to repeal certain other provisions of the  social
  services  law  relating  thereto;  to repeal certain provisions of the
  insurance law relating thereto; providing for the  repeal  of  certain
  provisions  upon  expiration  thereof  (Part  D);  to amend the public
  health law and the insurance law, in  relation  to  the  early  inter-
  vention  program  for infants and toddlers with disabilities and their
  families; to amend the public health law, in relation to  the  general
  public  health  work program; to amend chapter 577 of the laws of 2008
  amending the public health law, relating to expedited partner  therapy
  for  persons  infected  with chlamydia trachomatis, in relation to the
  effectiveness of such chapter; to amend  the  public  health  law,  in
  relation  to  outcome based contracting and outcome based health plan-
  ning; to amend the public health law, the mental hygiene law  and  the
  executive  law,  in relation to consolidating the excess medical malp-
  ractice liability coverage  pool;  to  amend  the  insurance  law,  in
  relation  to  the  appointment of members of the board of the New York
  state health foundation and the investment  of  funds;  to  amend  the
  insurance  law  and the general municipal law, in relation to malprac-
  tice and professional misconduct; to amend the administrative code  of
  the  city  of  New  York, in relation to the definition of a certified
  first responder; to amend the workers' compensation law,  in  relation
  to an injury incurred by an emergency medical technician; to amend the
  education  law and the state finance law, in relation to medical malp-
  ractice reform; and to repeal sections 3002, 3002-a,  3003-a,  3005-b,
  3009,  3017 and articles 30-B and 30-C of the public health law relat-
  ing to emergency medical services; to amend chapter 420 of the laws of
  2002 amending the education law relating to the profession  of  social
  work;  chapter  676  of  the  laws  of 2002 amending the education law
  relating to the practice of psychology; and chapter 130 of the laws of
  2010 amending the education law and other laws relating to the  regis-
  tration  of  entities  providing certain professional services and the
  licensure of certain professions, in relation  to  reporting  require-
  ments  and  expiration  dates;  and to amend the public health law, in
  relation to consolidating the  excess  medical  malpractice  liability
  coverage  pool; and to repeal section 18 of chapter 266 of the laws of
  1986, amending the civil practice law and rules and other laws  relat-
  ing  to  medical  and  dental malpractice, relating thereto; to repeal
  certain provisions of the public health law relating to state aid  for
  certain  public  health  programs  and provisions relating to sexually
  transmitted diseases (Part E); to amend the  mental  hygiene  law,  in
  relation  to the addition to the methadone registry of dosage and such
  other information as is necessary to  facilitate  disaster  management
  (Part  F);  to  amend the mental hygiene law, in relation to state aid
  funding authorization of services funded by the office  of  alcoholism
  and  substance abuse services; to repeal article 26 of such law relat-

S. 2606                             5                            A. 3006

  ing thereto (Part G); to amend the mental hygiene law and  chapter  56
  of  the  laws of 2012, amending the mental hygiene law relating to the
  closure and the  reduction  in  size  of  certain  facilities  serving
  persons  with  mental  illness,  in  relation to references to certain
  former children's psychiatric centers in the city of New York, and  in
  relation  to  the expiration and repeal of certain provisions thereof;
  to authorize the  office  of  mental  health  to  close,  consolidate,
  reduce, transfer and otherwise redesign its programs; 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  work-
  force reinvestment program, the membership of subcommittees for mental
  health  of community services boards and the duties of such subcommit-
  tees and creating the community mental health and workforce  reinvest-
  ment account, in relation to extending such provisions relating there-
  to  (Part  H);  to  amend  the  mental hygiene law, in relation to the
  recovery of exempt income by the office of mental health for community
  residential programs (Part I); to amend the  mental  hygiene  law,  in
  relation  to  vesting all authority to appoint and remove officers and
  employees of the office of mental health (Part J); to amend the mental
  hygiene law, in relation to an annual examination and notice of rights
  provided to respondent sex offenders who  are  confined  in  a  secure
  treatment  facility  (Part K); to amend the mental hygiene law and the
  education law, in relation to creating mental health  incident  review
  panels  (Part  L);  to repeal certain provisions of the mental hygiene
  law and certain provisions of chapter 723 of the laws of 1989,  amend-
  ing  the  mental hygiene law and other laws relating to the establish-
  ment of comprehensive  psychiatric  emergency  programs,  relating  to
  eliminating  the annual reports on the comprehensive psychiatric emer-
  gency program; family care; and the confinement, care and treatment of
  persons with developmental disabilities (Part M); and to amend chapter
  57 of the laws of 2006, relating to  establishing  a  cost  of  living
  adjustment  for  designated  human  services  programs, in relation to
  foregoing such adjustment during the 2013-2014 state fiscal year (Part
  N)

  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 2013-2014
state fiscal year. Each component is  wholly  contained  within  a  Part
identified  as Parts A through N. 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.  Subdivision  (a) of section 90 of part H of chapter 59 of
the laws of 2011, amending the public health law and other laws,  relat-

S. 2606                             6                            A. 3006

ing  to  general  hospital  inpatient reimbursement for annual rates, is
amended to read as follows:
  (a)  Notwithstanding  any  other provision of law to the contrary, for
the state fiscal years beginning April 1, 2011 and ending on  March  31,
[2013]  2015,  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 [year] YEARS 2012-13, 2013-14  AND
2014-15  except  as  hereinafter  provided, for services provided on and
after April 1, 2011 through March 31,  [2013]  2015.    Any  alternative
methods  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
implementation is expected to begin. Nothing in this  section  shall  be
deemed  to  prevent  all or part of such alternative reduction plan from
taking effect retroactively, to the  extent  permitted  by  the  federal
centers for medicare and medicaid services.
  S  2.  Subdivision 1 of section 91 of part H of chapter 59 of the laws
of 2011, amending the public health  law  and  other  laws  relating  to
general hospital reimbursement for annual rates, as amended by section 5
of  part  F  of  chapter  56  of the laws of 2012, is amended to read as
follows:
  1. Notwithstanding any inconsistent provision of state  law,  rule  or
regulation  to  the  contrary,  subject to federal approval, the year to
year rate of growth of department of health state funds Medicaid  spend-
ing  shall not exceed the ten year rolling average of the medical compo-
nent of the consumer price index  as  published  by  the  United  States
department  of  labor, bureau of labor statistics, for the preceding ten
years[.]; PROVIDED, HOWEVER, THAT FOR STATE FISCAL YEAR 2013-14 AND  FOR
EACH  FISCAL  YEAR  THEREAFTER, THE MAXIMUM ALLOWABLE ANNUAL INCREASE IN
THE AMOUNT OF DEPARTMENT OF HEALTH STATE FUNDS MEDICAID  SPENDING  SHALL
BE  CALCULATED BY MULTIPLYING THE DEPARTMENT OF HEALTH STATE FUNDS MEDI-
CAID SPENDING FOR THE PREVIOUS YEAR, MINUS THE AMOUNT OF ANY  DEPARTMENT
OF  HEALTH  STATE OPERATIONS SPENDING INCLUDED THEREIN, BY SUCH TEN YEAR
ROLLING AVERAGE.
  S 3.  Subdivision 1 of section 92 of part H of  chapter 59 of the laws
of 2011, amending the public health law and other laws relating to known
and projected department of health state funds Medicaid expenditures, as
amended by section 57 of part D of chapter 56 of the laws  of  2012,  is
amended to read as follows:
  1.  For  state  fiscal  years 2011-12 through [2013-14] 2014-2015, 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

S. 2606                             7                            A. 3006

health medicaid state funds disbursements in the enacted  budget  finan-
cial  plan  pursuant to subdivision 3 of section 23 of the state finance
law, the commissioner of health, in consultation with  the  director  of
the  budget,  shall  develop a medicaid savings allocation plan to limit
such spending to the aggregate limit  level  specified  in  the  enacted
budget  financial  plan,  provided,  however,  such  projections  may be
adjusted by the director of the budget to account for any changes in the
New York state federal medical assistance percentage amount  established
pursuant  to the federal social security act, changes in provider reven-
ues, reductions to local social  services  district  medical  assistance
administration, and beginning April 1, 2012 the operational costs of the
New York state medical indemnity fund.
  S  4.  Subdivision  10  of  section 2807-c of the public health law is
amended by adding a new paragraph (d) to read as follows:
  (D)(I) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS  SECTION  OR
ANY  OTHER  CONTRARY PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, EFFECTIVE FOR MEDICAID RATE PERIODS  ON
AND  AFTER  APRIL  FIRST, TWO THOUSAND THIRTEEN, NO TREND FACTOR ADJUST-
MENTS SHALL BE AVAILABLE WITH  REGARD  TO  REIMBURSEMENT  FOR  INPATIENT
SERVICES OTHERWISE SUBJECT TO THE PROVISIONS OF THIS SECTION.
  (II)  NOTWITHSTANDING  ANY  INCONSISTENT  PROVISION  OF  THIS SECTION,
SECTION TWENTY-ONE OF CHAPTER ONE OF THE LAWS OF NINETEEN HUNDRED  NINE-
TY-NINE,  OR  ANY  OTHER  CONTRARY  PROVISION  OF LAW AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, EFFECTIVE FOR  MEDICAID
RATE  PERIODS  ON AND AFTER APRIL FIRST, TWO THOUSAND THIRTEEN, NO TREND
FACTOR ADJUSTMENTS SHALL BE AVAILABLE WITH REGARD TO  REIMBURSEMENT  FOR
THE FOLLOWING:
  (A)  RESIDENTIAL HEALTH CARE FACILITY INPATIENT SERVICES AND ADULT DAY
HEALTH CARE OUTPATIENT SERVICES PROVIDED PURSUANT TO THIS ARTICLE;
  (B) HOSPITAL OUTPATIENT SERVICES AND DIAGNOSTIC AND  TREATMENT  CENTER
SERVICES PROVIDED PURSUANT TO THIS ARTICLE, EXCEPT AS REQUIRED BY FEDER-
AL  LAW WITH REGARD TO SERVICES REIMBURSED PURSUANT TO SUBDIVISION EIGHT
OF SECTION TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE;
  (C) CERTIFIED HOME HEALTH AGENCIES AND  LONG  TERM  HOME  HEALTH  CARE
PROGRAMS  PURSUANT  TO SECTION THIRTY-SIX HUNDRED FOURTEEN OF THIS CHAP-
TER;
  (D) PERSONAL CARE SERVICES PROVIDED PURSUANT TO SECTION THREE  HUNDRED
SIXTY-SEVEN-I OF THE SOCIAL SERVICES LAW;
  (E) ADULT DAY HEALTH CARE SERVICES PROVIDED TO PATIENTS DIAGNOSED WITH
AIDS AS DEFINED BY APPLICABLE REGULATIONS;
  (F)  PERSONAL  CARE  SERVICES  PROVIDED IN THOSE LOCAL SOCIAL SERVICES
DISTRICTS, INCLUDING NEW YORK CITY, WHOSE  RATES  OF  PAYMENT  FOR  SUCH
SERVICES  ARE ESTABLISHED BY SUCH LOCAL SOCIAL SERVICES DISTRICTS PURSU-
ANT TO A RATE-SETTING EXEMPTION ISSUED BY THE COMMISSIONER TO SUCH LOCAL
SOCIAL SERVICES DISTRICTS IN ACCORDANCE WITH APPLICABLE REGULATIONS;
  (G) ASSISTED LIVING PROGRAM SERVICES; AND
  (H) HOSPICE SERVICES.
  S 5. Paragraph (a) of subdivision 8 of section  367-b  of  the  social
services  law, as amended by chapter 109 of the laws of 2007, is amended
to read as follows:
  (a) For the purpose  of  orderly  and  timely  implementation  of  the
medical  assistance  information  and  payment system, the department is
hereby authorized to enter into agreements with fiscal intermediaries or
fiscal agents for the design,  development,  implementation,  operation,
processing,  auditing  and  making  of payments, subject to audits being
conducted by the state in accordance with the terms of such  agreements,

S. 2606                             8                            A. 3006

for medical assistance claims under the system described by this section
in  any  social  services  district.  Such agreements shall specifically
provide that the state shall have complete oversight responsibility  for
the  fiscal  intermediaries'  or fiscal agents' performance and shall be
solely responsible for establishing eligibility requirements for recipi-
ents,  provider  qualifications,  rates  of  payment,  investigation  of
suspected  fraud and abuse, issuance of identification cards, establish-
ing and maintaining recipient eligibility files, provider profiles,  and
conducting  state  audits  of  the  fiscal intermediaries' or agents' at
least once annually. The system described in this subdivision  shall  be
operated  by  [a]  ONE  OR  MORE fiscal [intermediary] INTERMEDIARIES or
fiscal [agent] AGENTS in accordance with  this  subdivision  unless  the
department  is  otherwise  authorized by a law enacted subsequent to the
effective date of this subdivision to  operate  the  system  in  another
manner.  In  no  event  shall  such intermediary or agent be a political
subdivision of the state or any other  governmental  agency  or  entity.
NOTWITHSTANDING  THE  FOREGOING,  THE  DEPARTMENT MAY MAKE PAYMENTS TO A
PROVIDER UPON THE COMMISSIONER'S  DETERMINATION  THAT  THE  PROVIDER  IS
TEMPORARILY  UNABLE  TO COMPLY WITH BILLING REQUIREMENTS. The department
shall consult with the office of Medicaid  inspector  general  regarding
any  activities undertaken by the fiscal intermediaries or fiscal agents
regarding investigation of suspected fraud and abuse.
  S 6. Section 365-l of the social services law is amended by  adding  a
new subdivision 9 to read as follows:
  9.  ANY  CONTRACT  OR  CONTRACTS  ENTERED  INTO BY THE COMMISSIONER OF
HEALTH PRIOR TO JANUARY FIRST, TWO THOUSAND THIRTEEN PURSUANT TO  SUBDI-
VISION 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 PURPOSE OF IMPLEMENTING MEDICAID REDESIGN  TEAM  INITI-
ATIVES, INCLUDING THOSE RELATED TO MANAGED CARE, MANAGED LONG TERM CARE,
MEDICAL  ASSISTANCE  WAIVERS, AND THE MEDICAL ASSISTANCE GLOBAL SPENDING
CAP.
  S 7. Section 368-d of the social services law is amended by  adding  a
new subdivision 7 to read as follows:
  7.  ANY  CONTRACT  OR  CONTRACTS  ENTERED  INTO BY THE COMMISSIONER OF
HEALTH PRIOR TO JANUARY FIRST, TWO THOUSAND THIRTEEN PURSUANT TO  SUBDI-
VISION FIVE OF THIS SECTION OR SUBDIVISION FOUR OF SECTION THREE HUNDRED
SIXTY-EIGHT-E  OF THIS TITLE 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 PURPOSE OF IMPLEMENTING MEDICAID REDESIGN TEAM INITI-
ATIVES, INCLUDING THOSE RELATED TO MANAGED CARE, MANAGED LONG TERM CARE,
MEDICAL ASSISTANCE WAIVERS, AND THE MEDICAL ASSISTANCE  GLOBAL  SPENDING
CAP.
  S 8. Intentionally Omitted
  S 9. Intentionally Omitted
  S  10.  Subdivision  25 of section 364-j of the social services law is
REPEALED.

S. 2606                             9                            A. 3006

  S 11. Paragraph (b) of subdivision 3 of  section  273  of  the  public
health  law,  as added by section 10 of part C of chapter 58 of the laws
of 2005, is amended to read as follows:
  (b)  In the event that the patient does not meet the criteria in para-
graph (a) of this subdivision, the  prescriber  may  provide  additional
information  to  the  program  to justify the use of a prescription drug
that is not on the preferred drug list.  The  program  shall  provide  a
reasonable opportunity for a prescriber to reasonably present his or her
justification  of  prior authorization. [If, after consultation with the
program, the prescriber, in his or her reasonable professional judgment,
determines that the use of a  prescription  drug  that  is  not  on  the
preferred  drug  list is warranted, the prescriber's determination shall
be final.]
  S 12. 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 SIX 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,  EXCEPT
THAT  PRIOR  AUTHORIZATION  MAY  BE  DENIED IF THE DEPARTMENT OF HEALTH,
AFTER GIVING THE PRESCRIBER A REASONABLE OPPORTUNITY TO PRESENT A JUSTI-
FICATION, DETERMINES THAT THE ADDITIONAL PRESCRIPTION IS  NOT  MEDICALLY
NECESSARY;  medical  assistance  shall  not include any drug provided on
other than an in-patient basis for which a recipient  is  charged  or  a
claim is made in the case of a prescription drug, in excess of the maxi-
mum  reimbursable amounts to be established by department regulations in
accordance with standards established by the  secretary  of  the  United
States  department  of  health  and human services, or, in the case of a
drug not requiring a prescription, in excess of the maximum reimbursable
amount established by the commissioner of health pursuant  to  paragraph
(a) of subdivision four of this section;
  S  13.  Subparagraph (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:
  (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

S. 2606                            10                            A. 3006

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
AND  SIX-TENTHS  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 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 whole-
sale 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, or the maximum acquisition
cost, if any, established pursuant to paragraph (e) of this subdivision.
  S 14. Section 271 of the public health law is REPEALED.
  S 15. Subdivision 3 of  section  270  of  the  public  health  law  is
REPEALED,  subdivision  2 is renumbered subdivision 3 and a new subdivi-
sion 2 is added to read as follows:
  2. "BOARD" SHALL MEAN THE DRUG UTILIZATION REVIEW BOARD.
  S 16. Section 272 of the public health law, as added by section 10  of
part  C  of  chapter 58 of the laws of 2005, subdivision 4 as amended by
section 30 of part A of chapter 58 of the laws of 2008, subdivision 8 as
amended by section 5 of part B of chapter 109 of the laws of 2010, para-
graph (d) of subdivision 10 as added by section 17 of part H of  chapter
59  of the laws of 2011, subdivision 11 as amended by section 36 of part
C of chapter 58 of the laws of 2009, paragraph (b) of subdivision 11  as
amended  by  section  9  of part H of chapter 59 of the laws of 2011, is
amended to read as follows:
  S 272. Preferred drug  program.  1.  There  is  hereby  established  a
preferred   drug  program  to  promote  access  to  the  most  effective
prescription drugs while reducing the cost  of  prescription  drugs  for
persons in state public health plans.
  2.  When  a  prescriber  prescribes a non-preferred drug, state public
health plan reimbursement shall be denied unless prior authorization  is
obtained, unless no prior authorization is required under this article.
  3.  The  commissioner  shall  establish  performance standards for the
program that, at a minimum, ensure that the preferred drug  program  and
the  clinical  drug  review program provide sufficient technical support
and timely responses to consumers, prescribers and pharmacists.
  4. Notwithstanding any other provision of  law  to  the  contrary,  no
preferred   drug   program   or   prior  authorization  requirement  for
prescription drugs, except as created by this article,  paragraph  (a-1)
or  (a-2)  of  subdivision four of section three hundred sixty-five-a of
the social services law, paragraph (g) of  subdivision  two  of  section
three  hundred  sixty-five-a of the social services law, subdivision one
of section two hundred forty-one of the elder law and shall apply to the
state public health plans.
  5. The [pharmacy and therapeutics committee] DRUG  UTILIZATION  REVIEW
BOARD  shall  consider  and make recommendations to the commissioner for
the adoption  of  a  preferred  drug  program.  (a)  In  developing  the
preferred drug program, the [committee] BOARD shall, without limitation:
(i)  identify  therapeutic  classes  or  drugs  to  be  included  in the
preferred drug program; (ii) identify preferred drugs  in  each  of  the
chosen  therapeutic  classes;  (iii) evaluate the clinical effectiveness
and safety of drugs considering the latest  peer-reviewed  research  and
may  consider  studies  submitted  to the federal food and drug adminis-

S. 2606                            11                            A. 3006

tration in connection with its drug approval system; (iv)  consider  the
potential  impact  on  patient care and the potential fiscal impact that
may result from making such a therapeutic class subject to prior author-
ization;  and  (v)  consider  the potential impact of the preferred drug
program on the health of  special  populations  such  as  children,  the
elderly,  the  chronically  ill,  persons with HIV/AIDS and persons with
mental health conditions.
  (b) In developing the preferred drug program,  the  [committee]  BOARD
may consider preferred drug programs or evidence based research operated
or  conducted by or for other state governments, the federal government,
or multi-state coalitions. Notwithstanding any inconsistent provision of
section one hundred twelve or article eleven of the state finance law or
section one hundred forty-two of the economic  development  law  or  any
other law, the department may enter into contractual agreements with the
Oregon  Health  and Science University Drug Effectiveness Review Project
to provide technical and clinical support to the [committee]  BOARD  and
the department in researching and recommending drugs to be placed on the
preferred drug list.
  (c) The [committee] BOARD shall from time to time review all therapeu-
tic  classes  included  in the preferred drug program, and may recommend
that the commissioner add or delete drugs or classes of drugs to or from
the preferred drug program, subject to this subdivision.
  (d) The [committee]  BOARD  shall  establish  procedures  to  promptly
review  prescription  drugs  newly approved by the federal food and drug
administration.
  6. The [committee] BOARD shall recommend a procedure and criteria  for
the  approval  of non-preferred drugs as part of the prior authorization
process. In developing  these  criteria,  the  [committee]  BOARD  shall
include consideration of the following:
  (a) the preferred drug has been tried by the patient and has failed to
produce the desired health outcomes;
  (b) the patient has tried the preferred drug and has experienced unac-
ceptable side effects;
  (c)  the patient has been stabilized on a non-preferred drug and tran-
sition to the preferred drug would be medically contraindicated; and
  (d) other clinical indications for the use of the non-preferred  drug,
which  shall include consideration of the medical needs of special popu-
lations, including children, the elderly, the chronically  ill,  persons
with mental health conditions, and persons affected by HIV/AIDS.
  7.  The  commissioner  shall  provide thirty days public notice on the
department's website prior to any meeting of the  [committee]  BOARD  to
develop  recommendations  concerning  the  preferred  drug program. Such
notice regarding meetings of  the  [committee]  BOARD  shall  include  a
description  of the proposed therapeutic class to be reviewed, a listing
of drug products in the therapeutic  class,  and  the  proposals  to  be
considered  by the [committee] BOARD.  The [committee] BOARD shall allow
interested parties a reasonable opportunity to make an oral presentation
to the [committee] BOARD related to the prior authorization of the ther-
apeutic class to be reviewed. The [committee] BOARD shall  consider  any
information provided by any interested party, including, but not limited
to,  prescribers,  dispensers,  patients, consumers and manufacturers of
the drug in developing their recommendations.
  8. The commissioner shall provide notice of any recommendations devel-
oped by the [committee] BOARD regarding the preferred drug  program,  at
least  five  days before any final determination by the commissioner, by
making such information available  on  the  department's  website.  Such

S. 2606                            12                            A. 3006

public notice [shall] MAY include: a summary of the deliberations of the
[committee]  BOARD;  a  summary  of the positions of those making public
comments at meetings of the  [committee]  BOARD;  the  response  of  the
[committee] BOARD to those comments, if any; and the findings and recom-
mendations  of  the [committee] BOARD.   ALTERNATIVELY, THE COMMISSIONER
MAY PROVIDE SUCH NOTICE OF THE BOARD'S RECOMMENDATIONS BY MAKING A VIDEO
OR AUDIO OF THE BOARD'S MEETINGS AVAILABLE ON THE  DEPARTMENT'S  WEBSITE
AT LEAST FIVE DAYS BEFORE ANY FINAL DETERMINATION BY THE COMMISSIONER.
  9.  Within  ten  days of a final determination regarding the preferred
drug program, the  commissioner  shall  provide  public  notice  on  the
department's  website  of  such determinations, including: the nature of
the determination; and analysis of  the  impact  of  the  commissioner's
determination on state public health plan populations and providers; and
the  projected fiscal impact to the state public health plan programs of
the commissioner's determination.
  10. The commissioner shall adopt a preferred drug program  and  amend-
ments  after  considering the recommendations from the [committee] BOARD
and  any  comments  received  from  prescribers,  dispensers,  patients,
consumers and manufacturers of the drug.
  (a)  The  preferred drug list in any therapeutic class included in the
preferred drug program shall be developed based initially on  an  evalu-
ation  of  the  clinical  effectiveness,  safety  and  patient outcomes,
followed by consideration of the cost-effectiveness of the drugs.
  (b) In each therapeutic class included in the preferred drug  program,
the [committee] BOARD shall determine whether there is one drug which is
significantly more clinically effective and safe, and that drug shall be
included  on  the preferred drug list without consideration of cost. If,
among two or more drugs in a therapeutic class, the difference in  clin-
ical  effectiveness  and safety is not clinically significant, then cost
effectiveness (including price and supplemental  rebates)  may  also  be
considered  in  determining which drug or drugs shall be included on the
preferred drug list.
  (c) In addition to drugs selected under paragraph (b) of this subdivi-
sion, any prescription drug in the therapeutic class, whose cost to  the
state public health plans (including net price and supplemental rebates)
is  equal  to  or  less than the cost of another drug in the therapeutic
class that is on the preferred drug list under  paragraph  (b)  of  this
subdivision,  may be selected to be on the preferred drug list, based on
clinical effectiveness, safety and cost-effectiveness.
  (d) Notwithstanding any provision of this section to the contrary, the
commissioner may  designate  therapeutic  classes  of  drugs,  including
classes  with  only  one drug, as all preferred prior to any review that
may be conducted by the [committee] BOARD pursuant to this section.
  11. (a) The commissioner shall provide an opportunity  for  pharmaceu-
tical  manufacturers to provide supplemental rebates to the state public
health plans for drugs within a  therapeutic  class;  such  supplemental
rebates  shall  be taken into consideration by the [committee] BOARD and
the commissioner in determining the cost-effectiveness of drugs within a
therapeutic class under the state public health plans.
  (A-1) THE COMMISSIONER MAY REQUIRE A  PHARMACEUTICAL  MANUFACTURER  TO
PROVIDE  A  MINIMUM  SUPPLEMENTAL REBATE FOR DRUGS THAT ARE ELIGIBLE FOR
STATE PUBLIC HEALTH PLAN REIMBURSEMENT,  INCLUDING  SUCH  DRUGS  AS  SET
FORTH  IN  PARAGRAPH  (G-1)  OF SUBDIVISION TWO OF SECTION THREE HUNDRED
SIXTY-FIVE-A OF THE SOCIAL SERVICES LAW. IF SUCH A MINIMUM  SUPPLEMENTAL
REBATE  IS  NOT PROVIDED BY THE MANUFACTURER, PRIOR AUTHORIZATION MAY BE
REQUIRED BY THE COMMISSIONER.

S. 2606                            13                            A. 3006

  (b) The commissioner may designate a  pharmaceutical  manufacturer  as
one  with  whom  the  commissioner  is  negotiating  or has negotiated a
manufacturer agreement, and all of the drugs it manufactures or  markets
shall  be  included  in the preferred drug program. The commissioner may
negotiate directly with a pharmaceutical manufacturer for rebates relat-
ing to any or all of the drugs it manufactures or markets. A manufactur-
er  agreement  shall  designate  any or all of the drugs manufactured or
marketed by the pharmaceutical manufacturer as being  preferred  or  non
preferred  drugs. When a pharmaceutical manufacturer has been designated
by the commissioner under this paragraph but the  commissioner  has  not
reached  a  manufacturer agreement with the pharmaceutical manufacturer,
then the commissioner may designate some or all of  the  drugs  manufac-
tured  or  marketed  by the pharmaceutical manufacturer as non preferred
drugs.  However,  notwithstanding  this  paragraph,  any  drug  that  is
selected  to be on the preferred drug list under paragraph (b) of subdi-
vision ten of this section on grounds  that  it  is  significantly  more
clinically effective and safer than other drugs in its therapeutic class
shall be a preferred drug.
  (c)  Supplemental  rebates under this subdivision shall be in addition
to those required by applicable federal law  and  subdivision  seven  of
section three hundred sixty-seven-a of the social services law. In order
to  be  considered  in  connection with the preferred drug program, such
supplemental rebates shall apply to the drug  products  dispensed  under
the Medicaid program and the EPIC program. The commissioner is prohibit-
ed   from  approving  alternative  rebate  demonstrations,  value  added
programs or guaranteed savings from other program benefits as a  substi-
tution for supplemental rebates.
  13.  The  commissioner may implement all or a portion of the preferred
drug program through contracts with  administrators  with  expertise  in
management of pharmacy services, subject to applicable laws.
  14.  For  a  period  of  eighteen  months, commencing with the date of
enactment of this article, and without  regard  to  the  preferred  drug
program  or  the clinical drug review program requirements of this arti-
cle, the commissioner is authorized to implement, or continue,  a  prior
authorization  requirement for a drug which may not be dispensed without
a prescription as required by section sixty-eight  hundred  ten  of  the
education  law, for which there is a non-prescription version within the
same drug class, or for which there  is  a  comparable  non-prescription
version of the same drug. Any such prior authorization requirement shall
be  implemented in a manner that is consistent with the process employed
by the commissioner for such authorizations as of one day prior  to  the
date  of  enactment  of  this article. At the conclusion of the eighteen
month period, any such drug or  drug  class  shall  be  subject  to  the
preferred  drug program requirements of this article; provided, however,
that the commissioner is authorized to immediately subject any such drug
to prior authorization without regard to the provisions of  subdivisions
five through eleven of this section.
  S 17. Subdivisions 4, 5 and 6 of section 274 of the public health law,
as  added by section 10 of part C of chapter 58 of the laws of 2005, are
amended to read as follows:
  4. The commissioner shall obtain an  evaluation  of  the  factors  set
forth  in  subdivision  three of this section and a recommendation as to
the establishment of a prior authorization requirement for a drug  under
the  clinical  drug  review  program from the [pharmacy and therapeutics
committee] DRUG UTILIZATION REVIEW BOARD. For this purpose, the  commis-

S. 2606                            14                            A. 3006

sioner  and  the [committee] BOARD, as applicable, shall comply with the
following meeting and notice processes established by this article:
  (a) the open meetings law and freedom of information law provisions of
subdivision six of section two hundred seventy-one of this article; and
  (b)  the public notice and interested party provisions of subdivisions
seven, eight and nine of section two hundred seventy-two of  this  arti-
cle.
  5.  The [committee] BOARD shall recommend a procedure and criteria for
the approval of drugs subject to prior authorization under the  clinical
drug  review  program. Such criteria shall include the specific approved
clinical indications for use of the drug.
  6. The commissioner shall identify a drug  for  which  prior  authori-
zation  is required, as well as the procedures and criteria for approval
of use of the drug, under the clinical drug review program after consid-
ering the recommendations from the [committee] BOARD  and  any  comments
received  from  prescribers,  dispensers, consumers and manufacturers of
the drug. In  no  event  shall  the  prior  authorization  criteria  for
approval  pursuant  to  this  subdivision  result in denial of the prior
authorization request based on the relative cost of the drug subject  to
prior authorization.
  S  18. Section 277 of the public health law, as added by section 10 of
part C of chapter 58 of the laws of 2005, is amended to read as follows:
  S 277. Review and reports. 1. The commissioner, in  consultation  with
the [pharmacy and therapeutics committee] DRUG UTILIZATION REVIEW BOARD,
shall  undertake  periodic  reviews, at least annually, of the preferred
drug program which shall include consideration of:
  (a) the volume of prior authorizations being handled,  including  data
on  the  number  and characteristics of prior authorization requests for
particular prescription drugs;
  (b) the quality of the program's responsiveness, including the quality
of the administrator's responsiveness;
  (c) complaints received from patients and providers;
  (d) the savings attributable to the state, and to each county and  the
city of New York, due to the provisions of this article;
  (e)  the  aggregate  amount  of  supplemental  rebates received in the
previous fiscal year and in the current fiscal year, to date;  and  such
amounts are to be broken out by fiscal year and by month;
  (f)  the  education  and  outreach  program established by section two
hundred seventy-six of this article.
  2. The commissioner and the [panel] BOARD shall, beginning March thir-
ty-first, two thousand six and annually thereafter, submit a  report  to
the governor and the legislature concerning each of the items subject to
periodic review under subdivision one of this section.
  3.  The  commissioner  and the [panel] BOARD shall, beginning with the
commencement of the  preferred  drug  program  and  monthly  thereafter,
submit  a  report  to  the  governor  and the legislature concerning the
amount of supplemental rebates received.
  S 19. Subdivision 5 of section 369-bb of the social  services  law  is
REPEALED and a new subdivision 5 is added to read as follows:
  5.  (A)  THE  FUNCTIONS,  POWERS AND DUTIES OF THE FORMER PHARMACY AND
THERAPEUTICS COMMITTEE AS ESTABLISHED IN ARTICLE  TWO-A  OF  THE  PUBLIC
HEALTH  LAW  SHALL  NOW BE CONSIDERED A FUNCTION OF THE DRUG UTILIZATION
REVIEW BOARD, INCLUDING BUT NOT LIMITED TO:
  (I) CONDUCTING AN EXECUTIVE SESSION FOR THE PURPOSE OF  RECEIVING  AND
EVALUATING  DRUG PRICING INFORMATION RELATED TO SUPPLEMENTAL REBATES, OR
RECEIVING AND EVALUATING TRADE SECRETS, OR OTHER INFORMATION  WHICH,  IF

S. 2606                            15                            A. 3006

DISCLOSED, WOULD CAUSE SUBSTANTIAL INJURY TO THE COMPETITIVE POSITION OF
THE MANUFACTURER; AND
  (II)  EVALUATING  AND PROVIDING RECOMMENDATIONS TO THE COMMISSIONER OF
HEALTH ON OTHER ISSUES RELATING TO PHARMACY SERVICES UNDER  MEDICAID  OR
EPIC,  INCLUDING,  BUT NOT LIMITED TO: THERAPEUTIC COMPARISONS; ENHANCED
USE OF GENERIC DRUG PRODUCTS; ENHANCED TARGETING OF PHYSICIAN  PRESCRIB-
ING PATTERNS; AND
  (III)  COLLABORATING  WITH  MANAGED CARE ORGANIZATIONS TO ADDRESS DRUG
UTILIZATION CONCERNS AND TO IMPLEMENT CONSISTENT  MANAGEMENT  STRATEGIES
ACROSS THE FEE-FOR-SERVICE AND MANAGED CARE PHARMACY BENEFITS.
  (B)  ANY BUSINESS OR OTHER MATTER UNDERTAKEN OR COMMENCED BY THE PHAR-
MACY AND THERAPEUTICS COMMITTEE PERTAINING  TO  OR  CONNECTED  WITH  THE
FUNCTIONS,  POWERS,  OBLIGATIONS  AND  DUTIES ARE HEREBY TRANSFERRED AND
ASSIGNED TO THE DRUG UTILIZATION REVIEW BOARD AND PENDING ON THE  EFFEC-
TIVE  DATE  OF  THIS  SUBDIVISION, MAY BE CONDUCTED AND COMPLETED BY THE
DRUG UTILIZATION REVIEW BOARD IN THE SAME  MANNER  AND  UNDER  THE  SAME
TERMS  AND  CONDITIONS  AND  WITH  THE  SAME  EFFECT AS IF CONDUCTED AND
COMPLETED BY THE PHARMACY AND THERAPEUTICS COMMITTEE. ALL BOOKS, PAPERS,
AND PROPERTY OF THE PHARMACY AND THERAPEUTICS COMMITTEE  SHALL  CONTINUE
TO BE MAINTAINED BY THE DRUG UTILIZATION REVIEW BOARD.
  (C)  ALL  RULES,  REGULATIONS, ACTS, ORDERS, DETERMINATIONS, AND DECI-
SIONS OF THE PHARMACY AND THERAPEUTICS COMMITTEE PERTAINING TO THE FUNC-
TIONS AND POWERS HEREIN TRANSFERRED AND ASSIGNED, IN FORCE AT  THE  TIME
OF SUCH TRANSFER AND ASSUMPTION, SHALL CONTINUE IN FULL FORCE AND EFFECT
AS RULES, REGULATIONS, ACTS, ORDERS, DETERMINATIONS AND DECISIONS OF THE
DRUG  UTILIZATION  REVIEW  BOARD UNTIL DULY MODIFIED OR ABROGATED BY THE
COMMISSIONER OF HEALTH.
  S 20. Subdivision 2 of section 369-bb of the social services  law,  as
added  by  chapter  632 of the laws of 1992, paragraph (a) as amended by
chapter 843 of the laws of 1992, is amended to read as follows:
  2. The members of the DUR board shall be appointed by the commissioner
and shall serve a three-year term.  Members may be reappointed upon  the
completion  of  other  terms.   The membership shall be comprised of the
following:
  (a) [Five] SIX persons licensed and actively engaged in  the  practice
of  medicine in the state, [at least one of whom shall have expertise in
the area of mental health, who shall be selected from a list of nominees
provided by the medical society of the  state  of  New  York  and  other
medical  associations]  WITH  EXPERTISE  IN  THE AREAS OF MENTAL HEALTH,
HIV/AIDS, GERIATRICS, PEDIATRICS OR INTERNAL MEDICINE  AND  WHO  MAY  BE
SELECTED  BASED  ON INPUT FROM PROFESSIONAL ASSOCIATIONS AND/OR ADVOCACY
GROUPS IN NEW YORK STATE.
  (b) [Five] SIX persons licensed and actively practicing in [community]
pharmacy in the state who [shall] MAY be selected [from a list of  nomi-
nees  provided  by  pharmaceutical  societies/associations  of] BASED ON
INPUT FROM PROFESSIONAL ASSOCIATIONS AND/OR ADVOCACY GROUPS IN New  York
state.
  (c)  Two  persons  with  expertise  in drug utilization review who are
[either] health care professionals licensed  under  Title  VIII  of  the
education  law  [or  who  are pharmacologists] AT LEAST ONE OF WHOM IS A
PHARMACOLOGIST.
  (d) [One person from the department of social  services  (commissioner
or  designee).]  TWO  PERSONS  THAT  ARE CONSUMERS OR CONSUMER REPRESEN-
TATIVES OF ORGANIZATIONS WITH A REGIONAL OR STATEWIDE  CONSTITUENCY  AND
WHO  HAVE  BEEN  INVOLVED  IN ACTIVITIES RELATED TO HEALTH CARE CONSUMER
ADVOCACY, INCLUDING ISSUES AFFECTING MEDICAID OR EPIC RECIPIENTS.

S. 2606                            16                            A. 3006

  (E) ONE PERSON LICENSED AND ACTIVELY PRACTICING AS A NURSE PRACTITION-
ER OR MIDWIFE.
  (F)  THE  COMMISSIONER SHALL DESIGNATE A PERSON FROM THE DEPARTMENT TO
SERVE AS CHAIRPERSON OF THE BOARD.
  S 21. Paragraph (g) of subdivision 2 of section 365-a  of  the  social
services  law,  as  amended  by section 7 of part D of chapter 56 of the
laws of 2012, is amended to read as follows:
  (g) sickroom supplies, eyeglasses, prosthetic  appliances  and  dental
prosthetic  appliances  furnished  in accordance with the regulations of
the department; provided further that: (i) the commissioner of health is
authorized to implement a preferred diabetic supply program wherein  the
department  of  health  will  receive  enhanced  rebates  from preferred
manufacturers of glucometers and test strips, and may  subject  non-pre-
ferred manufacturers' glucometers and test strips to prior authorization
under  section  two hundred seventy-three of the public health law; (ii)
enteral formula therapy  and  nutritional  supplements  are  limited  to
coverage only for nasogastric, jejunostomy, or gastrostomy tube feeding,
for  treatment of an inborn metabolic disorder, or to address growth and
development problems in children, or, subject to  standards  established
by the commissioner, for persons with a diagnosis of HIV infection, AIDS
or   HIV-related   illness  or  other  diseases  and  conditions;  (iii)
prescription footwear and inserts are limited to coverage only when used
as an integral part of a lower limb orthotic appliance,  as  part  of  a
diabetic  treatment  plan, or to address growth and development problems
in children; [and] (iv) compression and support stockings are limited to
coverage only for pregnancy or treatment of venous  stasis  ulcers;  AND
(V)  THE  COMMISSIONER  OF HEALTH IS AUTHORIZED TO IMPLEMENT AN INCONTI-
NENCE SUPPLY UTILIZATION MANAGEMENT  PROGRAM  TO  REDUCE  COSTS  WITHOUT
LIMITING ACCESS THROUGH THE EXISTING PROVIDER NETWORK, INCLUDING BUT NOT
LIMITED  TO SINGLE OR MULTIPLE SOURCE CONTRACTS OR, A PREFERRED INCONTI-
NENCE SUPPLY PROGRAM WHEREIN  THE  DEPARTMENT  OF  HEALTH  WILL  RECEIVE
ENHANCED  REBATES FROM PREFERRED MANUFACTURERS OF INCONTINENCE SUPPLIES,
AND MAY SUBJECT NON-PREFERRED MANUFACTURERS'  INCONTINENCE  SUPPLIES  TO
PRIOR  APPROVAL  PURSUANT TO REGULATIONS OF THE DEPARTMENT, PROVIDED ANY
NECESSARY APPROVALS UNDER FEDERAL LAW  HAVE  BEEN  OBTAINED  TO  RECEIVE
FEDERAL  FINANCIAL  PARTICIPATION  IN THE COSTS OF INCONTINENCE SUPPLIES
PROVIDED PURSUANT TO THIS SUBPARAGRAPH;
  S 22. Subdivision 2 of section 365-a of the  social  services  law  is
amended by adding a new paragraph (aa) to read as follows:
  (AA)  INDIVIDUAL  PSYCHOTHERAPY  SERVICES  PROVIDED BY LICENSED SOCIAL
WORKERS, IN ACCORDANCE WITH LICENSING CRITERIA SET FORTH  IN  APPLICABLE
REGULATIONS,  TO  PERSONS  UNDER  THE  AGE  OF TWENTY-ONE AND TO PERSONS
REQUIRING SUCH SERVICES AS A RESULT OF OR RELATED TO PREGNANCY OR GIVING
BIRTH, PROVIDED ANY NECESSARY APPROVALS  UNDER  FEDERAL  LAW  HAVE  BEEN
OBTAINED  TO  RECEIVE  FEDERAL  FINANCIAL  PARTICIPATION IN THE COSTS OF
SERVICES PROVIDED PURSUANT TO THIS  PARAGRAPH;  PROVIDED,  HOWEVER,  THE
COMMISSIONER  OF HEALTH IS AUTHORIZED TO ESTABLISH CRITERIA FOR SERVICES
PROVIDED PURSUANT TO THIS PARAGRAPH IN ACCORDANCE  WITH  ALL  APPLICABLE
REQUIREMENTS  OF  FEDERAL LAW OR REGULATION PERTAINING TO SUCH SERVICES;
PROVIDED FURTHER NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO  MODIFY
ANY  LICENSURE, CERTIFICATION OR SCOPE OF PRACTICE PROVISION UNDER TITLE
EIGHT OF THE EDUCATION LAW.
  S 23. Section 365-l of the social services law is amended by adding  a
new subdivision 2-a to read as follows:
  2-A.  UP  TO  FIFTEEN  MILLION DOLLARS IN STATE FUNDING MAY BE USED TO
FUND HEALTH HOME INFRASTRUCTURE DEVELOPMENT BY MARCH  THIRTY-FIRST,  TWO

S. 2606                            17                            A. 3006

THOUSAND  FOURTEEN.  SUCH FUNDS SHALL BE DISBURSED PURSUANT TO A FORMULA
ESTABLISHED BY THE COMMISSIONER. SUCH FORMULA MAY CONSIDER PRIOR  ACCESS
TO  SIMILAR  FUNDING  OPPORTUNITIES, GEOGRAPHIC AND DEMOGRAPHIC FACTORS,
INCLUDING  THE  POPULATION  SERVED,  AND PREVALENCE OF QUALIFYING CONDI-
TIONS, CONNECTIVITY TO PROVIDERS, AND OTHER CRITERIA AS  ESTABLISHED  BY
THE COMMISSIONER.
  S  24.  Paragraph  (c) of subdivision 2 of section 365-a of the social
services law, as amended by chapter 778 of the laws of 1977, 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 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  [the  mentally
retarded] PERSONS WITH DEVELOPMENTAL DISABILITIES;
  S 25. The opening paragraph of paragraph 1 of subdivision 4 of section
2807-c  of  the public health law, as amended by section 11 of part C of
chapter 58 of the laws of 2009, is amended to read as follows:
  Notwithstanding any inconsistent provision of this section and subject
to the availability of federal financial participation, rates of payment
by governmental agencies for general hospitals which  are  certified  by
the  office  of alcoholism and substance abuse services to provide inpa-
tient detoxification and withdrawal services and, with regard  to  inpa-
tient  services  provided  to  patients discharged on and after December
first, two thousand eight and who are determined to be in  diagnosis-re-
lated  groups  [numbered seven hundred forty-three, seven hundred forty-
four, seven hundred forty-five, seven hundred forty-six,  seven  hundred
forty-seven,  seven hundred forty-eight, seven hundred forty-nine, seven
hundred fifty, or seven hundred fifty-one] AS IDENTIFIED  AND  PUBLISHED
ON  THE  NEW YORK STATE DEPARTMENT OF HEALTH WEBSITE, shall be made on a
per diem basis in accordance with the following:
  S 26. Paragraph (c) of subdivision 35 of section 2807-c of the  public
health law, as added by section 2 of part C of chapter 58 of the laws of
2009, is amended 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
BEGIN ON JANUARY FIRST, TWO THOUSAND FOURTEEN.
  S  27. 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-

S. 2606                            18                            A. 3006

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
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 PERIODIC BASE YEAR  UPDATES,  AND  ADJUSTMENTS  TO  THE
UTILIZATION OF BASE YEAR COSTS AND STATISTICS.
  S  28.  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 THE PERIODIC UPDATING AND ADJUSTMENT OF
THE  BASE  YEAR  COSTS  AND  STATISTICS USED TO COMPUTE RATES OF PAYMENT
PURSUANT TO THIS PARAGRAPH.
  S 29. 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 THE PERIODIC UPDATING AND ADJUSTMENT OF THE
BASE YEAR COSTS AND STATISTICS USED TO COMPUTE RATES OF PAYMENT PURSUANT
TO THIS PARAGRAPH.
  S 30. 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 (D) to
read as follows:
  (D) NOTWITHSTANDING ANY OTHER PROVISIONS OF LAW TO  THE  CONTRARY  AND
SUBJECT  TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, FOR ALL
RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND FOURTEEN, THE  OPER-
ATING  COMPONENT  OF  OUTPATIENT SPECIALTY RATES OF HOSPITALS SUBJECT TO
THIS SUBPARAGRAPH SHALL BE DETERMINED BY THE  COMMISSIONER  PURSUANT  TO
REGULATIONS,  INCLUDING  EMERGENCY REGULATIONS, AND IN CONSULTATION WITH
SUCH SPECIALTY OUTPATIENT FACILITIES.
  S 31. Paragraph (a-2) of subdivision 1 of section 2807-c of the public
health law is amended by adding a new  subparagraph  (iii)  to  read  as
follows:
  (III)  NOTWITHSTANDING ANY CONTRARY PROVISION OF THIS PARAGRAPH OR ANY
OTHER CONTRARY PROVISION OF LAW, PAYMENTS MADE PURSUANT  TO  THIS  PARA-
GRAPH  SHALL  NOT  REFLECT THE IMPLEMENTATION OF THE PROVISIONS OF PARA-
GRAPH (E-1) OF SUBDIVISION  FOUR  OF  THIS  SECTION  OR  OF  REGULATIONS
PROMULGATED  THEREUNDER  FOR ANY SERVICES PROVIDED PRIOR TO A DATE TO BE
DETERMINED IN ACCORDANCE WITH  REGULATIONS,  INCLUDING  EMERGENCY  REGU-
LATIONS,  PROMULGATED BY THE COMMISSIONER, PROVIDED, HOWEVER, THAT UNTIL
SUCH REGULATIONS ARE PROMULGATED THE PAYMENTS REQUIRED TO BE PAID PURSU-
ANT TO THIS PARAGRAPH SHALL BE SUCH PAYMENTS AS ARE REQUIRED PURSUANT TO
THIS PARAGRAPH FOR SERVICES PROVIDED ON OCTOBER NINETEENTH, TWO THOUSAND
TEN.
  S 32. Subparagraph (i) of paragraph (a-2) of subdivision 1 of  section
2807-c  of  the public health law, as amended by section 6 of part OO of
chapter 57 of the laws of 2008, is amended to read as follows:
  (i) With the exception of those enrollees covered under a payment rate
methodology agreement negotiated with a general hospital,  payments  for
inpatient  hospital  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

S. 2606                            19                            A. 3006

provisions of article forty-four of this chapter or  by  health  mainte-
nance  organizations  organized and operating 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[,
(i)] AS determined pursuant to this section, excluding  (I)  adjustments
pursuant  to  subdivision fourteen-f of this section, and (ii) excluding
medical education costs that are  reimbursed  directly  to  the  general
hospital  in  accordance  with  paragraph (a-3) of this subdivision, AND
(III) EXCLUDING ADJUSTMENTS MADE PURSUANT TO PARAGRAPHS (C) AND  (E)  OF
SUBDIVISION EIGHT OF THIS SECTION.
  S  33.  Subdivision  8  of  section 2807-c of the public health law is
amended by adding a new paragraph (h) to read as follows:
  (H) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION, SUBDI-
VISION TWO OF SECTION TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE, OR ANY
OTHER CONTRARY PROVISION OF LAW  AND  SUBJECT  TO  THE  AVAILABILITY  OF
FEDERAL FINANCIAL PARTICIPATION, THE CAPITAL COST COMPONENTS OF RATES OF
PAYMENT  BY GOVERNMENTAL AGENCIES FOR INPATIENT AND OUTPATIENT SERVICES,
INCLUDING EMERGENCY SERVICES, PROVIDED BY GENERAL HOSPITALS ON AND AFTER
JANUARY FIRST, TWO THOUSAND FOURTEEN SHALL BE DETERMINED  IN  ACCORDANCE
WITH  REGULATIONS,  INCLUDING  EMERGENCY REGULATIONS, PROMULGATED BY THE
COMMISSIONER. SUCH REGULATIONS SHALL BE DEVELOPED IN  CONSULTATION  WITH
THE HOSPITAL INDUSTRY.
  S  34. Section 364-i of the social services law is amended by adding a
new subdivision 7 to read as follows:
  7. NOTWITHSTANDING THE PROVISIONS OF SECTION ONE HUNDRED  THIRTY-THREE
OF  THIS  CHAPTER  OR ANY LAW TO THE CONTRARY, NO MEDICAL ASSISTANCE, AS
DEFINED IN SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS  TITLE,  SHALL  BE
AUTHORIZED  OR  REQUIRED  TO  BE FURNISHED TO AN INDIVIDUAL PRIOR TO THE
DATE THE INDIVIDUAL IS DETERMINED ELIGIBLE  FOR  ASSISTANCE  UNDER  THIS
TITLE,  EXCEPT  AS PROVIDED FOR IN THIS SECTION OR PURSUANT TO THE REGU-
LATIONS OF THE DEPARTMENT.
  S 35. Section 4406-c of the public health law is amended by  adding  a
new subdivision 9 to read as follows:
  9.  (A)  NOTWITHSTANDING  ANY INCONSISTENT PROVISION OF LAW, CONTRACTS
WITH NURSING HOMES TO PROVIDE INPATIENT SERVICES SHALL ENSURE  THAT  THE
RESOURCES MADE AVAILABLE BY SUCH CONTRACTS WILL SUPPORT COMPENSATION FOR
PERSONS  PROVIDING  SUCH  INPATIENT  NURSING HOME SERVICES SUFFICIENT TO
ENSURE THE RETENTION OF A QUALIFIED WORKFORCE CAPABLE OF PROVIDING  HIGH
QUALITY CARE TO THE RESIDENTS OF SUCH NURSING HOMES.
  (B)  SUCH  CONTRACTS SHALL REQUIRE THAT STANDARD RATES OF COMPENSATION
BE PAID TO  EMPLOYEES  WHO  PROVIDE  INPATIENT  NURSING  HOME  SERVICES,
INCLUDING  NURSES, NURSING AIDES, ORDERLIES, ATTENDANTS, THERAPISTS AND,
IN ADDITION, TO ANY OTHER OCCUPATIONS DETERMINED BY THE COMMISSIONER, IN
CONSULTATION WITH THE COMMISSIONER OF LABOR, TO PROVIDE INPATIENT  NURS-
ING HOME SERVICES.
  (C)  SUCH  STANDARD RATES OF COMPENSATION SHALL INCLUDE A BASIC HOURLY
CASH RATE OF PAY AND A SUPPLEMENTAL BENEFIT RATE, WHICH MAY BE  PAID  OR
PROVIDED.    SUCH RATES SHALL BE ANNUALLY DETERMINED BY THE COMMISSIONER
OF LABOR, IN CONSULTATION WITH  THE  COMMISSIONER,  UTILIZING  WAGE  AND
FRINGE  BENEFIT DATA FROM VARIOUS SOURCES, INCLUDING BUT NOT LIMITED TO,
DATA AND DETERMINATIONS OF FEDERAL, STATE OR  OTHER  GOVERNMENTAL  AGEN-
CIES.
  (D) THE COMMISSIONER SHALL DISTRIBUTE NOTICE OF SUCH RATES TO ALL SUCH
NURSING  HOMES,  WHICH  SHALL BE DEEMED TO BE A TERM OF, AND INCLUDED AS
PART OF, ALL CONTRACTS SUBJECT TO THIS SECTION.

S. 2606                            20                            A. 3006

  (E) A FAILURE TO COMPLY WITH THESE PROVISIONS OF THIS  SUBDIVISION  OR
WITH  REGULATIONS  PROMULGATED  THEREUNDER  SHALL  SUBJECT NON-COMPLIANT
EMPLOYERS TO THE SANCTIONS AND ENFORCEMENT PROCESSES SET  FORTH  IN  THE
LABOR  LAW  AND  REGULATIONS  FOR  A  FAILURE  TO PAY WAGES OR TO PAY OR
PROVIDE  SUPPLEMENTS,  IN ADDITION TO ANY PENALTIES AVAILABLE UNDER THIS
TITLE.
  (F) IN THE EVENT THE COMMISSIONER DETERMINES, IN CONSULTATION WITH THE
COMMISSIONER OF LABOR, THAT A NURSING HOME IS MATERIALLY OUT OF  COMPLI-
ANCE  WITH  THE  PROVISIONS  OF  THIS SUBDIVISION THE COMMISSIONER SHALL
REQUIRE THAT SUCH NURSING HOME NOT ACCEPT NEW ADMISSIONS PENDING REMEDI-
ATION OF SUCH NON-COMPLIANCE, PROVIDED, HOWEVER, THAT  THE  COMMISSIONER
MAY  WAIVE  SUCH  ACTION  IF  THE COMMISSIONER DETERMINES THAT CONTINUED
ADMISSIONS TO SUCH NURSING  HOME  IS  REQUIRED  TO  MAINTAIN  SUFFICIENT
ACCESS TO NURSING HOME SERVICES IN THE RELEVANT GEOGRAPHIC AREA.
  (G)  THIS SUBDIVISION SHALL APPLY TO CONTRACTS WITH NURSING HOMES THAT
ARE SUBJECT TO REVIEW BY THE DEPARTMENT  UNDER  THIS  ARTICLE  THAT  ARE
ISSUED, RENEWED, MODIFIED, ALTERED OR AMENDED ON OR AFTER OCTOBER FIRST,
TWO THOUSAND THIRTEEN.
  (H) THE COMMISSIONER AND THE COMMISSIONER OF LABOR MAY EACH PROMULGATE
REGULATIONS,   IN   CONSULTATION  WITH  EACH  OTHER,  TO  IMPLEMENT  THE
PROVISIONS OF THIS SUBDIVISION.
  S 35-a. Subparagraph (i) of paragraph (b) of subdivision 1 of  section
364-j  of the social services law, as amended by chapter 433 of the laws
of 1997, is amended to read as follows:
  (i) is authorized to operate under article forty-four  of  the  public
health  law  or article forty-three of the insurance law and provides or
arranges, directly or indirectly (including  by  referral)  for  covered
comprehensive  health  services  on a full capitation basis, INCLUDING A
SPECIAL NEEDS MANAGED CARE PLAN OR COMPREHENSIVE HIV SPECIAL NEEDS PLAN;
or
  S 36. Paragraphs (c), (m) and (p) of subdivision 1 of section 364-j of
the social services law, paragraph (c) as amended by section 12 of  part
C of chapter 58 of the laws of 2004, paragraph (m) as amended by section
42-b  of  part H of chapter 59 of the laws of 2011, and paragraph (p) as
amended by chapter 649 of the laws of 1996, are amended and a new  para-
graph (z) is added to read as follows:
  (c)  "Managed  care  program".  A  statewide  program in which medical
assistance recipients enroll  on  a  voluntary  or  mandatory  basis  to
receive medical assistance services, including case management, directly
and  indirectly  (including  by  referral) from a managed care provider,
[and] INCLUDING as applicable, a  [mental  health  special  needs  plan]
SPECIAL  NEEDS  MANAGED  CARE  PLAN or a comprehensive HIV special needs
plan, under this section.
  (m) "Special needs managed care plan" [and "specialized  managed  care
plan"]  shall have the same meaning as in section forty-four hundred one
of the public health law.
  (p) "Grievance". Any complaint presented by a participant or a partic-
ipant's representative for resolution through the grievance process of a
managed care provider[, comprehensive HIV special needs plan or a mental
health special needs plan].
  (Z) "CREDENTIALED ALCOHOLISM AND SUBSTANCE ABUSE  COUNSELOR  (CASAC)".
AN  INDIVIDUAL  CREDENTIALED  BY  THE OFFICE OF ALCOHOLISM AND SUBSTANCE
ABUSE SERVICES IN ACCORDANCE WITH APPLICABLE REGULATIONS OF THE  COMMIS-
SIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.

S. 2606                            21                            A. 3006

  S  37.  Paragraph  (c) of subdivision 2 of section 364-j of the social
services law, as added by section 42-c of part H of chapter  59  of  the
laws of 2011, is amended to read as follows:
  (c)  The  commissioner  of  health,  jointly  with the commissioner of
mental health and the commissioner of  alcoholism  and  substance  abuse
services  shall  be  authorized  to establish special needs managed care
[and specialized managed  care]  plans,  under  the  medical  assistance
program,  in accordance with applicable federal law and regulations. The
commissioner of health,  in  cooperation  with  such  commissioners,  is
authorized,  subject  to the approval of the director of the division of
the budget, to apply for federal  waivers  when  such  action  would  be
necessary to assist in promoting the objectives of this section.
  S  37-a.   Paragraphs (b) and (c) of subdivision 3 of section 364-j of
the social services law are REPEALED.
  S 38.  Paragraphs (a), (d) and (e) of subdivision 3 of  section  364-j
of  the  social  services law, paragraph (a) as amended by section 13 of
part C of chapter 58 of the laws of 2004, paragraph (d) as relettered by
section 77 and paragraph (e) as amended by section 77-a  of  part  H  of
chapter  59 of the laws of 2011, and paragraph (d) as amended by chapter
648 of the laws of 1999, is amended to read as follows:
  (a) Every person eligible for or receiving  medical  assistance  under
this  article,  who  resides  in  a  social  services district providing
medical assistance, which  has  implemented  the  state's  managed  care
program  shall  participate  in  the program authorized by this section.
Provided, however, that participation in  a  comprehensive  HIV  special
needs  plan  also  shall be in accordance with article forty-four of the
public health law and participation in a [mental health  special  needs]
SPECIAL NEEDS MANAGED CARE plan shall also be in accordance with article
forty-four of the public health law and article thirty-one of the mental
hygiene law.
  (d)  [The] UNTIL SUCH TIME AS PROGRAM FEATURES AND REIMBURSEMENT RATES
ARE APPROVED BY THE COMMISSIONER OF HEALTH,  IN  CONSULTATION  WITH  THE
COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH, THE OFFICE FOR PEOPLE WITH
DEVELOPMENTAL  DISABILITIES, THE OFFICE OF CHILDREN AND FAMILY SERVICES,
AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, AS  APPROPRI-
ATE,  THE following services shall not be provided to medical assistance
recipients through managed care programs established  pursuant  to  this
section,  and  shall  continue  to  be  provided outside of managed care
programs and in accordance with applicable reimbursement methodologies:
  (i) day treatment services provided to individuals with  developmental
disabilities;
  (ii) comprehensive medicaid case management services provided to indi-
viduals with developmental disabilities;
  (iii) services provided pursuant to title two-A of article twenty-five
of the public health law;
  (iv)  services  provided pursuant to article eighty-nine of the educa-
tion law;
  (v) mental health services provided by  a  certified  voluntary  free-
standing  day  treatment  program  where  such  services are provided in
conjunction with educational services authorized  in  an  individualized
education program in accordance with regulations promulgated pursuant to
article eighty-nine of the education law;
  (vi)  long  term  services as determined by the commissioner of mental
retardation and developmental disabilities, provided to individuals with
developmental disabilities at facilities licensed  pursuant  to  article
sixteen  of  the  mental hygiene law or clinics serving individuals with

S. 2606                            22                            A. 3006

developmental disabilities at facilities licensed  pursuant  to  article
twenty-eight of the public health law;
  (vii) TB directly observed therapy;
  (viii) AIDS adult day health care;
  (ix) HIV COBRA case management; and
  (x) other services as determined by the commissioner of health.
  (e)  The following categories of individuals may be required to enroll
with a managed care program  when  program  features  and  reimbursement
rates  are  approved  by the commissioner of health and, as appropriate,
the commissioners of the  [department]  OFFICE  of  mental  health,  the
office  for [persons] PEOPLE with developmental disabilities, the office
of children and family services, and the office of [alcohol]  ALCOHOLISM
and substance abuse services:
  (i)  an individual dually eligible for medical assistance and benefits
under the federal Medicare program [and enrolled in a  Medicare  managed
care  plan  offered  by  an entity that is also a managed care provider;
provided that (notwithstanding paragraph (g) of subdivision four of this
section):]; PROVIDED, HOWEVER, NOTHING HEREIN SHALL REQUIRE AN  INDIVID-
UAL  ENROLLED  IN  A  MANAGED  LONG  TERM CARE PLAN, PURSUANT TO SECTION
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW, TO  DISENROLL  FROM
SUCH PROGRAM;
  [(a)  if  the individual changes his or her Medicare managed care plan
as authorized by title XVIII of the federal  social  security  act,  and
enrolls  in  another  Medicare  managed care plan that is also a managed
care provider, the individual shall be (if required by the  commissioner
under this paragraph) enrolled in that managed care provider;
  (b) if the individual changes his or her Medicare managed care plan as
authorized  by  title  XVIII  of  the  federal  social security act, but
enrolls in another Medicare managed care plan that is not also a managed
care provider, the individual shall be disenrolled from the managed care
provider in which he or she was enrolled and withdraw from  the  managed
care program;
  (c) if the individual disenrolls from his or her Medicare managed care
plan  as  authorized  by title XVIII of the federal social security act,
and does not enroll in another Medicare managed care plan, the  individ-
ual  shall  be disenrolled from the managed care provider in which he or
she was enrolled and withdraw from the managed care program;
  (d) nothing herein shall require an individual enrolled in  a  managed
long  term  care plan, pursuant to section forty-four hundred three-f of
the public health law, to disenroll from such program.]
  (ii) an individual eligible for supplemental security income;
  (iii) HIV positive individuals;
  (iv) persons with serious mental illness and children and  adolescents
with  serious  emotional  disturbances, as defined in section forty-four
hundred one of the public health law;
  (v) a person receiving services provided by a residential  alcohol  or
substance abuse program or facility for the [mentally retarded] DEVELOP-
MENTALLY DISABLED;
  (vi)  a  person  receiving  services  provided by an intermediate care
facility for the [mentally retarded] DEVELOPMENTALLY DISABLED or who has
characteristics and needs similar to such persons;
  (vii) a  person  with  a  developmental  or  physical  disability  who
receives  home  and  community-based  services  or care-at-home services
through existing waivers under section nineteen hundred fifteen  (c)  of
the  federal  social  security  act or who has characteristics and needs
similar to such persons;

S. 2606                            23                            A. 3006

  (viii) a person who is eligible for  medical  assistance  pursuant  to
subparagraph  twelve or subparagraph thirteen of paragraph (a) of subdi-
vision one of section three hundred sixty-six of this title;
  (ix)  a  person receiving services provided by a long term home health
care program, or a person receiving inpatient services in a  state-oper-
ated  psychiatric facility or a residential treatment facility for chil-
dren and youth;
  (x) certified blind or disabled children  living  or  expected  to  be
living separate and apart from the parent for thirty days or more;
  (xi) residents of nursing facilities;
  (xii)  a foster child in the placement of a voluntary agency or in the
direct care of the local social services district;
  (xiii) a person or family that is homeless; [and]
  (xiv) individuals for whom a managed care provider  is  not  geograph-
ically  accessible so as to reasonably provide services to the person. A
managed care provider is not geographically  accessible  if  the  person
cannot  access  the  provider's  services  in  a  timely  fashion due to
distance or travel time[.];
  (XV) A PERSON ELIGIBLE  FOR  MEDICARE  PARTICIPATING  IN  A  CAPITATED
DEMONSTRATION PROGRAM FOR LONG TERM CARE;
  (XVI) AN INFANT LIVING WITH AN INCARCERATED MOTHER IN A STATE OR LOCAL
CORRECTIONAL FACILITY AS DEFINED IN SECTION TWO OF THE CORRECTION LAW;
  (XVII)  A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE
FOR LESS THAN SIX MONTHS;
  (XVIII) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS  ONLY
WITH RESPECT TO TUBERCULOSIS-RELATED SERVICES;
  (XIX) INDIVIDUALS RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;
  (XX)  A  PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAIL-
ABLE FROM OR UNDER A  THIRD-PARTY  PAYOR  WHICH  MAY  BE  MAINTAINED  BY
PAYMENT,  OR  PART PAYMENT, OF THE PREMIUM OR COST SHARING AMOUNTS, WHEN
PAYMENT OF SUCH PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE,
AS DETERMINED BY THE LOCAL SOCIAL SERVICES DISTRICT;
  (XXI) A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
GRAPH ELEVEN OF PARAGRAPH  (A)  OF  SUBDIVISION  ONE  OF  SECTION  THREE
HUNDRED SIXTY-SIX OF THIS TITLE;
  (XXII)  A  PERSON  WHO  IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
PARAGRAPH (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX  OF
THIS TITLE;
  (XXIII)  A  PERSON WHO IS MEDICARE/MEDICAID DUALLY ELIGIBLE AND WHO IS
NOT ENROLLED IN A MEDICARE MANAGED CARE PLAN;
  (XXIV) INDIVIDUALS WITH A CHRONIC  MEDICAL  CONDITION  WHO  ARE  BEING
TREATED  BY A SPECIALIST PHYSICIAN THAT IS NOT ASSOCIATED WITH A MANAGED
CARE PROVIDER IN THE INDIVIDUAL'S SOCIAL SERVICES DISTRICT; AND
  (XXV) NATIVE AMERICANS.
  S 39. Subparagraphs (ii), (iv) and (vii) of  paragraph  (e),  subpara-
graphs  (i)  and (v) of paragraph (f) and paragraphs (g), (h), (i), (o),
(p), (q) and (r) of  subdivision  4  of  section  364-j  of  the  social
services  law,  subparagraphs  (ii),  (iv)  and  (vii) of paragraph (e),
subparagraph (v) of paragraph  (f)  and  paragraph  (g)  as  amended  by
section 14 of part C of chapter 58 of the laws of 2004, subparagraph (i)
of paragraph (f) as amended by section 79 of part H of chapter 59 of the
laws  of  2011,  paragraph  (h) as amended by chapter 433 of the laws of
1997, and paragraphs (i), (o), (p), (q) and (r) as  amended  by  chapter
649 of the laws of 1996, are amended and a new paragraph (v) is added to
read as follows:

S. 2606                            24                            A. 3006

  (ii) In any social services district which has implemented a mandatory
managed  care program pursuant to this section, the requirements of this
subparagraph shall apply to the extent consistent with federal  law  and
regulations.  The  department  of  health, may contract with one or more
independent  organizations  to provide enrollment counseling and enroll-
ment services, for participants  required  to  enroll  in  managed  care
programs,  for  each social services district requesting the services of
an enrollment broker. To select such organizations,  the  department  of
health  shall  issue  a  request  for  proposals  (RFP),  shall evaluate
proposals submitted in response to such RFP and, pursuant to  such  RFP,
shall award a contract to one or more qualified and responsive organiza-
tions. Such organizations shall not be owned, operated, or controlled by
any  governmental  agency,  managed  care  provider,  [comprehensive HIV
special needs plan,  mental  health  special  needs  plan,]  or  medical
services provider.
  (iv)  Local  social  services  districts  or  enrollment organizations
through their enrollment counselors shall provide participants with  the
opportunity  for face to face counseling including individual counseling
upon request of the participant.  Local  social  services  districts  or
enrollment  organizations through their enrollment counselors shall also
provide participants with information in a culturally and linguistically
appropriate and understandable manner, in  light  of  the  participant's
needs,  circumstances and language proficiency, sufficient to enable the
participant to make an informed selection of a  managed  care  provider.
Such  information  shall  include,  but  shall not be limited to: how to
access care within the program; a description of the medical  assistance
services  that can be obtained other than through a managed care provid-
er[, mental health special needs plan or comprehensive HIV special needs
plan]; the available managed  care  providers[,  mental  health  special
needs  plans and comprehensive HIV special needs plans] and the scope of
services covered by each; a listing of the  medical  services  providers
associated  with  each  managed  care provider; the participants' rights
within the managed care  program;  and  how  to  exercise  such  rights.
Enrollment  counselors  shall  inquire  into each participant's existing
relationships with medical services providers and  explain  whether  and
how  such  relationships  may  be  maintained  within  the  managed care
program. For enrollments made during face to  face  counseling,  if  the
participant  has a preference for particular medical services providers,
enrollment counselors shall verify with the medical  services  providers
that  such  medical  services  providers  whom  the  participant prefers
participate in the managed care provider's network and are available  to
serve the participant.
  (vii)  Any  marketing materials developed by a managed care provider[,
comprehensive HIV special needs plan  or  mental  health  special  needs
plan]  shall be approved by the department of health or the local social
services district, and the commissioner of mental health AND THE COMMIS-
SIONER OF ALCOHOLISM AND SUBSTANCE ABUSE  SERVICES,  where  appropriate,
within sixty days prior to distribution to recipients of medical assist-
ance.  All  marketing  materials  shall be reviewed within sixty days of
submission.
  (i) Participants shall choose a managed care provider at the  time  of
application  for  medical assistance; if the participant does not choose
such a provider the commissioner shall  assign  such  participant  to  a
managed care provider in accordance with subparagraphs (ii), (iii), (iv)
and  (v)  of  this paragraph. Participants already in receipt of medical
assistance shall have no less than thirty days from the date selected by

S. 2606                            25                            A. 3006

the district to enroll in the managed care program to select  a  managed
care provider[, and as appropriate, a mental health special needs plan,]
and shall be provided with information to make an informed choice. Where
a participant has not selected such a provider [or mental health special
needs plan,] the commissioner of health shall assign such participant to
a  managed  care provider[, and] WHICH, IF as appropriate, [to] MAY BE a
[mental health special needs plan]  SPECIAL  NEEDS  MANAGED  CARE  PLAN,
taking  into account capacity and geographic accessibility.  The commis-
sioner may after the period of time established in subparagraph (ii)  of
this  paragraph  assign  participants  to a managed care provider taking
into account quality performance criteria and cost.   Provided  however,
cost  criteria  shall  not  be of greater value than quality criteria in
assigning participants.
  (v) The commissioner  shall  assign  all  participants  not  otherwise
assigned  to  a  managed care plan pursuant to subparagraphs (ii), (iii)
and (iv) of this paragraph  equally  among  each  of  the  managed  care
providers that meet the criteria established in subparagraph (i) of this
paragraph;  PROVIDED,  HOWEVER, THAT THE COMMISSIONER SHALL ASSIGN INDI-
VIDUALS MEETING THE CRITERIA FOR ENROLLMENT IN A SPECIAL  NEEDS  MANAGED
CARE PLAN TO SUCH PLAN OR PLANS WHERE AVAILABLE.
  (g)  If  another  managed  care provider[, mental health special needs
plan or comprehensive HIV special needs plan] is available, participants
may change such provider or plan without cause  within  thirty  days  of
notification of enrollment or the effective date of enrollment, whichev-
er  is  later with a managed care provider[, mental health special needs
plan or comprehensive HIV special needs plan] by making a request of the
local social services district except that such period shall  be  forty-
five  days  for participants who have been assigned to a provider by the
commissioner of health. However, after such  thirty  or  forty-five  day
period,  whichever  is  applicable, a participant may be prohibited from
changing managed care providers more frequently than once  every  twelve
months,  as permitted by federal law except for good cause as determined
by the commissioner of health through regulations.
  (h) If another medical services provider is available,  a  participant
may  change  his  or her provider of medical services (including primary
care practitioners) without cause within  thirty  days  of  the  partic-
ipant's  first  appointment with a medical services provider by making a
request of the managed care provider[, mental health special needs  plan
or comprehensive HIV special needs plan]. However, after that thirty day
period,  no participant shall be permitted to change his or her provider
of medical services other than once every six  months  except  for  good
cause as determined by the commissioner through regulations.
  (i)  A  managed  care provider[, mental health special needs plan, and
comprehensive HIV special needs plan] requesting a  disenrollment  shall
not  disenroll  a  participant  without  the prior approval of the local
social services district in which the participant resides, provided that
disenrollment from a [mental health special needs  plan]  SPECIAL  NEEDS
MANAGED  CARE PLAN must comply with the standards of the commissioner of
health, THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, and
the commissioner of mental health.  A  managed  care  provider[,  mental
health special needs plan or comprehensive HIV special needs plan] shall
not  request  disenrollment  of  a  participant  based on any diagnosis,
condition, or perceived  diagnosis  or  condition,  or  a  participant's
efforts  to  exercise  his  or  her  rights  under  a grievance process,
provided however, that a managed  care  provider  may,  where  medically
appropriate,  request  permission  to  refer  participants  to a [mental

S. 2606                            26                            A. 3006

health special needs plan] MANAGED CARE PROVIDER THAT IS A SPECIAL NEEDS
MANAGED CARE PLAN or  a  comprehensive  HIV  special  needs  plan  after
consulting  with  such participant and upon obtaining his/her consent to
such  referral,  and[,]  provided  further that a [mental health special
needs plan] SPECIAL NEEDS MANAGED CARE PLAN may, where clinically appro-
priate, disenroll  individuals  who  no  longer  require  the  level  of
services  provided by a [mental health special needs plan] SPECIAL NEEDS
MANAGED CARE PLAN.
  (o) A managed care provider shall  provide  or  arrange,  directly  or
indirectly,  (including  by  referral)  for  the  full  range of covered
services to all participants, notwithstanding that such participants may
be eligible to be enrolled in a comprehensive HIV special needs plan  or
[mental health special needs plan] SPECIAL NEEDS MANAGED CARE PLAN.
  (p) A managed care provider[, comprehensive HIV special needs plan and
mental health special needs plan] shall implement procedures to communi-
cate  appropriately  with participants who have difficulty communicating
in English and to communicate appropriately with  visually-impaired  and
hearing-impaired participants.
  (q) A managed care provider[, comprehensive HIV special needs plan and
mental health special needs plan] shall comply with applicable state and
federal  law provisions prohibiting discrimination on the basis of disa-
bility.
  (r) A managed care provider[, comprehensive HIV special needs plan and
mental health special needs plan] shall provide services to participants
pursuant to an order of a  court  of  competent  jurisdiction,  provided
however,  that  such  services shall be within such provider's or plan's
benefit package and are reimbursable under  title  xix  of  the  federal
social security act.
  (V)  A  MANAGED  CARE PROVIDER MUST ALLOW ENROLLEES TO ACCESS CHEMICAL
DEPENDENCE TREATMENT SERVICES FROM FACILITIES CERTIFIED BY THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE  SERVICES,  EVEN  IF  SUCH  SERVICES  ARE
RENDERED  BY  A PRACTITIONER WHO WOULD NOT OTHERWISE BE SEPARATELY REIM-
BURSED, INCLUDING BUT NOT  LIMITED  TO  A  CREDENTIALED  ALCOHOLISM  AND
SUBSTANCE ABUSE COUNSELOR (CASAC).
  S  40.  Paragraph  (a) of subdivision 5 of section 364-j of the social
services law, as amended by section 15 of part C of chapter  58  of  the
laws of 2004, is amended to read as follows:
  (a) The managed care program shall provide for the selection of quali-
fied  managed  care  providers  by  the  commissioner of health [and, as
appropriate, mental health special needs  plans  and  comprehensive  HIV
special needs plans] to participate in the program, INCLUDING COMPREHEN-
SIVE  HIV  SPECIAL  NEEDS  PLANS AND SPECIAL NEEDS MANAGED CARE PLANS IN
ACCORDANCE WITH THE PROVISIONS OF SECTION THREE HUNDRED SIXTY-FIVE-M  OF
THIS  TITLE;  provided,  however,  that  the  commissioner of health may
contract directly with comprehensive HIV special needs plans  consistent
with standards set forth in this section, and assure that such providers
are  accessible  taking into account the needs of persons with disabili-
ties and the differences between rural, suburban,  and  urban  settings,
and in sufficient numbers to meet the health care needs of participants,
and  shall  consider  the  extent  to  which  major public hospitals are
included within such providers' networks.
  S 41. The opening paragraph of subdivision 6 of section 364-j  of  the
social  services  law,  as  added by chapter 649 of the laws of 1996, is
amended to read as follows:

S. 2606                            27                            A. 3006

  6. A managed care provider[,  mental  health  special  needs  plan  or
comprehensive  HIV  special needs plan provider] shall not engage in the
following practices:
  S  42.  Subdivision 17 of section 364-j of the social services law, as
amended by section 94 of part B of chapter 436 of the laws of  1997,  is
amended to read as follows:
  17.  (A)  The  provisions  of  this section regarding participation of
persons receiving family assistance and supplemental security income  in
managed  care  programs  shall  be effective if, and as long as, federal
financial participation  is  available  for  expenditures  for  services
provided pursuant to this section.
  (B)  THE PROVISIONS OF THIS SECTION REGARDING THE FURNISHING OF HEALTH
AND BEHAVIORAL HEALTH SERVICES THROUGH A SPECIAL NEEDS MANAGED CARE PLAN
SHALL BE EFFECTIVE IF, AND AS LONG AS, FEDERAL  FINANCIAL  PARTICIPATION
IS AVAILABLE FOR EXPENDITURES FOR SERVICES PROVIDED BY SUCH PLANS PURSU-
ANT TO THIS SECTION.
  S  43.  Subdivision 20 of section 364-j of the social services law, as
added by chapter 649 of the laws of 1996, is amended to read as follows:
  20. Upon a determination that a participant appears to be suitable for
admission to a comprehensive HIV special needs plan or a [mental  health
special  needs  plan]  SPECIAL  NEEDS  MANAGED CARE PLAN, a managed care
provider shall inform the participant of the availability of such plans,
where available and appropriate.
  S 44. Paragraph (a) of subdivision 23 of section 364-j of  the  social
services law, as added by section 65 of part A of chapter 57 of the laws
of 2006, is amended to read as follows:
  (a) As a means of protecting the health, safety and welfare of recipi-
ents,  in  addition  to  any  other  sanctions  that may be imposed, the
commissioner, IN CONSULTATION WITH THE COMMISSIONERS OF  THE  OFFICE  OF
MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES,
WHERE  APPROPRIATE, shall appoint temporary management of a managed care
provider upon determining that the managed care provider has  repeatedly
failed to meet the substantive requirements of sections 1903(m) and 1932
of  the federal Social Security Act and regulations. A hearing shall not
be required prior to the appointment of temporary management.
  S 45. The opening paragraph of subdivision 4 of section 365-m  of  the
social services law, as added by section 42-d of part H of chapter 59 of
the laws of 2011, is amended to read as follows:
  The  commissioners of the office of mental health, the office of alco-
holism and substance abuse services and the department of health,  shall
have  the  responsibility  for  jointly designating on a regional basis,
after consultation with the local social  services  district  and  local
governmental unit, as such term is defined in the mental hygiene law, of
a  city with a population of over one million persons, and after consul-
tation of other affected counties,  a  limited  number  of  [specialized
managed  care  plans  under  section  three hundred sixty-four-j of this
title,] special [need] NEEDS managed  care  plans  under  section  three
hundred  sixty-four-j  of  this  title[,  and/or integrated physical and
behavioral health provider systems certified under article twenty-nine-E
of the public health law] capable of managing the behavioral  and  phys-
ical  health  needs  of  medical  assistance  enrollees with significant
behavioral health needs. Initial designations of such plans [or provider
systems] should be made no later than April first, two  thousand  [thir-
teen] FOURTEEN, provided, however, such designations shall be contingent
upon a determination by such state commissioners that the entities to be
designated  have  the capacity and financial ability to provide services

S. 2606                            28                            A. 3006

in such plans [or provider systems], and that the region  has  a  suffi-
cient  population  and service base to support such plans [and systems].
Once designated, the commissioner of health shall make  arrangements  to
enroll such enrollees in such plans [or integrated provider systems] and
to pay such plans [or provider systems] on a capitated or other basis to
manage,  coordinate,  and pay for behavioral and physical health medical
assistance services for such enrollees. Notwithstanding any inconsistent
provision of section one hundred twelve and one hundred  sixty-three  of
the state finance law, and section one hundred forty-two of the economic
development  law,  or any other law to the contrary, the designations of
such plans [and provider systems], and any resulting contracts with such
plans[,] OR providers [or provider systems] are authorized to be entered
into by such state commissioners without a competitive  bid  or  request
for proposal process, provided however that:
  S 46. Subdivision 8 of section 4401 of the public health law, as added
by section 42 of part H of chapter 59 of the laws of 2011, is amended to
read as follows:
  8.  "Special  needs  managed  care plan" [or "specialized managed care
plan"] shall mean a combination of persons natural or corporate, or  any
groups  of  such  persons,  or  a  county or counties, who enter into an
arrangement, agreement or plan, or combination of  arrangements,  agree-
ments  or  plans,  to  provide  health and behavioral health services to
enrollees with significant behavioral health needs.
  S 47. Section 4403-d of the public health law,  as  added  by  section
42-a  of part H of chapter 59 of the laws of 2011, is amended to read as
follows:
  S 4403-d. Special needs managed care plans  [and  specialized  managed
care plans]. No person, group of persons, county or counties may operate
a  special  needs  managed  care plan [or specialized managed care plan]
without first obtaining a certificate of authority from the  commission-
er,  issued jointly with the commissioner of the office of mental health
and the commissioner of the office of  alcoholism  and  substance  abuse
services.
  S  47-a.  Subparagraphs (iii) and (iv) of paragraph (b) of subdivision
7 of section 4403-f of the public health law are REPEALED.
  S 48. Subparagraph (v) of paragraph (b) 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:
  (v)  The following medical assistance recipients shall not be eligible
to participate in a managed long term care program or other care coordi-
nation model  established  pursuant  to  this  paragraph  until  program
features  and  reimbursement rates are approved by the commissioner and,
as applicable, the commissioner of developmental disabilities:
  (1) a person enrolled in a managed care plan pursuant to section three
hundred sixty-four-j of the social services law;
  (2) a participant in the traumatic brain injury waiver program;
  (3) a participant in the nursing home transition and diversion  waiver
program;
  (4) a person enrolled in the assisted living program;
  (5)  a  person  enrolled  in  home and community based waiver programs
administered   by   the   office   for   people    with    developmental
disabilities[.];
  (6) A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE FOR
LESS  THAN SIX MONTHS, FOR A REASON OTHER THAN THAT THE PERSON IS ELIGI-
BLE FOR MEDICAL ASSISTANCE ONLY THROUGH THE APPLICATION OF EXCESS INCOME
TOWARD THE COST OF MEDICAL CARE AND SERVICES;

S. 2606                            29                            A. 3006

  (7) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS ONLY WITH
RESPECT TO TUBERCULOSIS-RELATED SERVICES;
  (8) A PERSON RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;
  (9) A PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAILABLE
FROM OR UNDER A THIRD-PARTY PAYOR WHICH MAY BE MAINTAINED BY PAYMENT, OR
PART  PAYMENT,  OF  THE PREMIUM OR COST SHARING AMOUNTS, WHEN PAYMENT OF
SUCH PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE, AS  DETER-
MINED BY THE SOCIAL SERVICES DISTRICT;
  (10)  A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
GRAPH ELEVEN OF PARAGRAPH  (A)  OF  SUBDIVISION  ONE  OF  SECTION  THREE
HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES LAW;
  (11) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO PARA-
GRAPH  (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX OF THE
SOCIAL SERVICES LAW; AND
  (12) NATIVE AMERICANS.
  S 48-a. Notwithstanding any contrary provision of law, the commission-
er of alcoholism and substance abuse services is 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  licensed  pursuant  to  article  28 of the public health law or
article 32 of the mental hygiene law for chemical  dependency  services,
as  determined  by  the commissioner of health, in consultation with the
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  estab-
lished  for such services under the ambulatory patient group (APG) rate-
setting methodology as utilized by the department of health  or  by  the
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 of alcoholism and substance abuse services, be greater
than the increased funds made available pursuant to  this  section.  The
commissioner  of  health  may,  in consultation with the commissioner of
alcoholism and substance abuse services, promulgate regulations, includ-
ing emergency regulations, as are necessary to implement the  provisions
of this section.
  S  49. 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, 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, 2015.
  S 50. Paragraph (e) of subdivision 8 of section  2511  of  the  public
health  law,  as  added  by section 21-a of part B of chapter 109 of the
laws of 2010, is amended and a new paragraph (h) is  added  to  read  as
follows:
  (e)  The commissioner shall adjust subsidy payments to approved organ-
izations made on and after April first, two thousand ten  THROUGH  MARCH
THIRTY-FIRST,  TWO  THOUSAND  THIRTEEN,  so that the amount of each such

S. 2606                            30                            A. 3006

payment, as  otherwise  calculated  pursuant  to  this  subdivision,  is
reduced  by  twenty-eight percent of the amount by which such calculated
payment exceeds the statewide average subsidy payment for  all  approved
organizations in effect on April first, two thousand ten. Such statewide
average  subsidy  payment  shall  be  calculated by the commissioner and
shall not reflect adjustments made pursuant to this paragraph.
  (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, EFFECTIVE APRIL
FIRST, TWO THOUSAND THIRTEEN:
  (I) THE COMMISSIONER SHALL, SUBJECT TO APPROVAL OF THE DIRECTOR OF THE
DIVISION OF THE BUDGET, DEVELOP REIMBURSEMENT METHODOLOGIES  FOR  DETER-
MINING THE AMOUNT OF SUBSIDY PAYMENTS MADE TO APPROVED ORGANIZATIONS FOR
THE  COST  OF COVERED HEALTH CARE SERVICES COVERAGE PROVIDED PURSUANT TO
THIS TITLE.
  (II) THE COMMISSIONER,  IN  CONSULTATION  WITH  ENTITIES  REPRESENTING
APPROVED  ORGANIZATIONS,  SHALL  SELECT AND CONTRACT WITH AN INDEPENDENT
ACTUARY TO REVIEW SUCH REIMBURSEMENT METHODOLOGIES;  PROVIDED,  HOWEVER,
NOTWITHSTANDING  SECTION  ONE  HUNDRED  SIXTY-THREE OF THE STATE FINANCE
LAW, THE COMMISSIONER MAY SELECT AND CONTRACT WITH THE INDEPENDENT ACTU-
ARY SELECTED PURSUANT TO SUBDIVISION EIGHTEEN OF SECTION  THREE  HUNDRED
SIXTY-FOUR-J  OF  THE  SOCIAL SERVICES LAW, WITHOUT A COMPETITIVE BID OR
REQUEST FOR PROPOSAL PROCESS. SUCH INDEPENDENT ACTUARY SHALL REVIEW  AND
MAKE  RECOMMENDATIONS CONCERNING APPROPRIATE ACTUARIAL ASSUMPTIONS RELE-
VANT TO THE ESTABLISHMENT OF REIMBURSEMENT METHODOLOGIES, INCLUDING  BUT
NOT  LIMITED  TO  THE ADEQUACY OF SUBSIDY PAYMENT AMOUNTS IN RELATION TO
THE POPULATION TO BE SERVED ADJUSTED FOR CASE MIX, THE SCOPE OF SERVICES
APPROVED ORGANIZATIONS MUST PROVIDE, THE UTILIZATION  OF  SUCH  SERVICES
AND THE NETWORK OF PROVIDERS REQUIRED TO MEET STATE STANDARDS.
  (III) FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH DECEM-
BER  THIRTY-FIRST,  TWO  THOUSAND  THIRTEEN,  SUBSIDY  PAYMENTS  MADE TO
APPROVED ORGANIZATIONS SHALL BE  AT  AMOUNTS  APPROVED  PRIOR  TO  APRIL
FIRST,  TWO  THOUSAND THIRTEEN. ON AND AFTER JANUARY FIRST, TWO THOUSAND
FOURTEEN, SUBSIDY PAYMENTS MADE TO APPROVED ORGANIZATIONS  SHALL  BE  AT
AMOUNTS  DETERMINED  BY  THE  COMMISSIONER IN ACCORDANCE WITH THIS PARA-
GRAPH.
  S 51. Paragraph (b) of subdivision 7 of section  2511  of  the  public
health law, as amended by chapter 923 of the laws of 1990, is amended to
read as follows:
  (b)  The  commissioner, in consultation with the superintendent, shall
make a determination whether to approve, disapprove or recommend modifi-
cation of the proposal. In order for a proposal to be  approved  by  the
commissioner,  the  proposal must also be approved by the superintendent
with respect to the provisions of subparagraphs (viii)  [through],  (IX)
AND (xii) of paragraph (a) of this subdivision.
  S  52.  Subparagraph (ii) of paragraph (e) of subdivision 4 of section
364-j of the social services law, as amended by section 14 of part C  of
chapter 58 of the laws of 2004, is amended to read as follows:
  (ii) In any social services district which has implemented a mandatory
managed  care program pursuant to this section, the requirements of this
subparagraph shall apply to the extent consistent with federal  law  and
regulations.  The  department  of  health, may contract with one or more
independent organizations to provide enrollment counseling  and  enroll-
ment  services,  for  participants  required  to  enroll in managed care
programs, for each social services district [requesting the services  of
an  enrollment  broker]  WHICH  HAS IMPLEMENTED A MANDATORY MANAGED CARE

S. 2606                            31                            A. 3006

PROGRAM.  To select such organizations, the department of  health  shall
issue  a request for proposals (RFP), shall evaluate proposals submitted
in response to such RFP  and,  pursuant  to  such  RFP,  shall  award  a
contract  to  one  or  more qualified and responsive organizations. Such
organizations shall not be owned, operated, or controlled by any govern-
mental agency, managed care provider, comprehensive  HIV  special  needs
plan, mental health special needs plan, or medical services provider.
  S  53. Subparagraph (vii) of paragraph (b) of subdivision 7 of section
4403-f of the public health law, as amended by section 40-a of part D of
chapter 56 of the laws of 2012, is amended to read as follows:
  (vii) Managed long term care provided and  plans  certified  or  other
care  coordination  model  established  pursuant to this paragraph shall
comply with the provisions of paragraphs (d),  (i),  (t),  and  (u)  and
subparagraph  (iii)  of  paragraph  (a) and [subparagraph] SUBPARAGRAPHS
(II) AND (iv) of paragraph (e) of  subdivision  four  of  section  three
hundred sixty-four-j of the social services law.
  S  54. Subparagraph (iii) of paragraph (g) 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:
  (iii) The enrollment application shall be  submitted  by  the  managed
long  term  care  plan  or demonstration to the entity designated by the
department prior to the commencement of services under the managed  long
term  care  plan or demonstration. [For purposes of reimbursement of the
managed long term care plan or demonstration, if the enrollment applica-
tion is submitted on or before the  twentieth  day  of  the  month,  the
enrollment  shall  commence  on the first day of the month following the
completion and submission and if the enrollment application is submitted
after the twentieth day of the month, the enrollment shall  commence  on
the  first  day  of  the second month following submission.] Enrollments
conducted by a plan or demonstration shall  be  subject  to  review  and
audit  by  the department or a contractor selected pursuant to paragraph
(d) of this subdivision.
  S 55. Paragraph (a) of subdivision 8 of section  3614  of  the  public
health  law,  as added by section 54 of part J of chapter 82 of the laws
of 2002, is amended to read as follows:
  (a) Notwithstanding any inconsistent provision of law, rule  or  regu-
lation  and  subject to the provisions of paragraph (b) of this subdivi-
sion and to the availability of  federal  financial  participation,  the
commissioner  shall  adjust  medical  assistance  rates  of  payment for
services provided by certified home health agencies  FOR  SUCH  SERVICES
PROVIDED  TO  CHILDREN  UNDER  EIGHTEEN  YEARS  OF  AGE AND FOR SERVICES
PROVIDED TO A SPECIAL NEEDS POPULATION OF MEDICALLY COMPLEX AND  FRAGILE
CHILDREN,  ADOLESCENTS  AND  YOUNG  DISABLED  ADULTS BY A CHHA OPERATING
UNDER A PILOT PROGRAM APPROVED BY THE DEPARTMENT, long term home  health
care  programs and AIDS home care programs in accordance with this para-
graph and paragraph (b) of this subdivision for  purposes  of  improving
recruitment  and retention of non-supervisory home care services workers
or any worker with direct patient care responsibility in  the  following
amounts  for services provided on and after December first, two thousand
two.
  (i) rates of payment  by  governmental  agencies  for  certified  home
health  agency  services  FOR  SUCH  SERVICES PROVIDED TO CHILDREN UNDER
EIGHTEEN YEARS OF AGE AND FOR SERVICES PROVIDED TO A SPECIAL NEEDS POPU-
LATION OF MEDICALLY COMPLEX AND FRAGILE CHILDREN, ADOLESCENTS AND  YOUNG
DISABLED  ADULTS  BY  A CHHA OPERATING UNDER A PILOT PROGRAM APPROVED BY
THE DEPARTMENT  (including  services  provided  through  contracts  with

S. 2606                            32                            A. 3006

licensed  home  care  services  agencies)  shall  be  increased by three
percent;
  (ii)  rates  of  payment  by  governmental agencies for long term home
health  care  program  services  (including  services  provided  through
contracts  with licensed home care services agencies) shall be increased
by three percent; and
  (iii) rates of payment by governmental agencies  for  AIDS  home  care
programs  (including  services  provided through contracts with licensed
home care services agencies) shall be increased by three percent.
  S 56. The opening paragraph of subdivision 9 of section  3614  of  the
public  health  law, as amended by section 5 of part C of chapter 109 of
the laws of 2006, is amended to read as follows:
  Notwithstanding any law  to  the  contrary,  the  commissioner  shall,
subject  to  the availability of federal financial participation, adjust
medical assistance rates of payment for certified home  health  agencies
FOR  SUCH  SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND
FOR SERVICES PROVIDED TO A SPECIAL NEEDS POPULATION OF MEDICALLY COMPLEX
AND FRAGILE CHILDREN, ADOLESCENTS AND YOUNG DISABLED ADULTS  BY  A  CHHA
OPERATING  UNDER  A  PILOT PROGRAM APPROVED BY THE DEPARTMENT, long term
home health care programs, AIDS home care programs established  pursuant
to  this  article,  hospice  programs established under article forty of
this chapter and for 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. Such adjustments shall be for purposes
of improving recruitment, training and retention of home health aides or
other personnel with direct patient care responsibility in the following
aggregate amounts for the following periods:
  S 57. Paragraph (a) of subdivision 10 of section 3614  of  the  public
health law, as amended by section 24 of part C of chapter 59 of the laws
of 2011, is amended to read as follows:
  (a)  Such  adjustments to rates of payments shall be allocated propor-
tionally based on each certified home  health  [agency's]  AGENCY,  long
term home health care program, AIDS home care and hospice program's home
health  aide or other direct care services total annual hours of service
provided to medicaid patients, as reported in each  such  agency's  most
recently available cost report as submitted to the department or for the
purpose of the managed long term care program a suitable proxy developed
by  the department in consultation with the interested parties. Payments
made pursuant to this section shall not be subject to subsequent adjust-
ment or reconciliation; PROVIDED  THAT  SUCH  ADJUSTMENTS  TO  RATES  OF
PAYMENTS  TO  CERTIFIED  HOME  HEALTH  AGENCIES  SHALL  ONLY BE FOR THAT
PORTION OF SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND
FOR SERVICES PROVIDED TO A SPECIAL NEEDS POPULATION OF MEDICALLY COMPLEX
AND FRAGILE CHILDREN, ADOLESCENTS AND YOUNG DISABLED ADULTS  BY  A  CHHA
OPERATING UNDER A PILOT PROGRAM APPROVED BY THE DEPARTMENT.
  S  58.  Paragraph  (h) of subdivision 21 of section 2808 of the public
health law, as amended by section 8 of part D of chapter 58 of the  laws
of 2009, is amended to read as follows:
  (h)  The  total  amount  of  funds  to be allocated and distributed as
medical assistance for financially disadvantaged residential health care
facility rate adjustments to eligible facilities for a  rate  period  in
accordance with this subdivision shall be thirty million dollars for the
period  October  first, two thousand four through December thirty-first,
two thousand four and thirty million dollars on an annualized basis  for
rate  periods  on  and  after  January  first, two thousand five through
December thirty-first, two thousand eight and thirty million dollars  on

S. 2606                            33                            A. 3006

an  annualized  basis  on  and  after  January  first, two thousand nine
THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE. The nonfederal share
of such rate adjustments shall be paid  by  the  state,  with  no  local
share,  from  allocations made pursuant to paragraph (hh) of subdivision
one of section twenty-eight hundred seven-v of this  article.    In  the
event  the  statewide  total  of  the annual rate adjustments determined
pursuant to paragraph (g) of this subdivision varies  from  the  amounts
set  forth in this paragraph, each qualifying facility's rate adjustment
shall be proportionately increased or decreased such that the  total  of
the  annual  rate adjustments made pursuant to this subdivision is equal
to the amounts set forth in this paragraph on a statewide basis.
  S 59. Paragraph (d) of subdivision 2-b of section 2808 of  the  public
health  law, as added by section 47 of part C of chapter 109 of the laws
of 2006, is amended to read as follows:
  (d) Cost reports submitted by residential health care  facilities  for
the  two  thousand two calendar year or any part thereof shall, notwith-
standing any contrary provision of law,  be  subject  to  audit  through
December  thirty-first,  two thousand [fourteen] EIGHTEEN and facilities
shall retain for the purpose of such audits all fiscal  and  statistical
records  relevant to such cost reports, provided, however, that any such
audit commenced on or before December thirty-first, two thousand  [four-
teen]  EIGHTEEN,  may be completed and used for the purpose of adjusting
any Medicaid rates which utilize such costs.
  S 60. Subparagraph (ii) of paragraph (a) of subdivision 2-b of section
2808 of the public health law, as added by section 47 of part C of chap-
ter 109 of the laws of 2006, is amended to read as follows:
  (ii) Rates for the periods two thousand seven and two  thousand  eight
shall  be further adjusted by a per diem add-on amount, as determined by
the commissioner, reflecting the proportional amount of each  facility's
projected  Medicaid  benefit to the total projected Medicaid benefit for
all facilities of the imputed use of the  rate-setting  methodology  set
forth  in paragraph (b) of this subdivision, provided, however, that for
those facilities that do not receive a per diem add-on adjustment pursu-
ant to this subparagraph, rates shall be further adjusted to include the
proportionate benefit, as determined by the commissioner, of the expira-
tion of the opening paragraph and paragraph (a) of  subdivision  sixteen
of  this  section  and  of paragraph (a) of subdivision fourteen of this
section, provided, further, however, that the  aggregate  total  of  the
rate adjustments made pursuant to this subparagraph shall not exceed one
hundred  thirty-seven  million five hundred thousand dollars for the two
thousand seven rate period and  one  hundred  sixty-seven  million  five
hundred  thousand  dollars  for  the  two thousand eight rate period AND
PROVIDED FURTHER, HOWEVER, THAT SUCH RATE ADJUSTMENTS AS  MADE  PURSUANT
TO  THIS  SUBPARAGRAPH PRIOR TO TWO THOUSAND TWELVE SHALL NOT BE SUBJECT
TO SUBSEQUENT ADJUSTMENT OR RECONCILIATION.
  S 61. Subparagraph (i) of paragraph (b) of subdivision 2-b of  section
2808  of  the  public  health law, as amended by section 94 of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
  (i) (A) Subject to the provisions of subparagraphs (ii) through  (xiv)
of  this  paragraph,  for periods on and after April first, two thousand
nine the operating cost component of  rates  of  payment  shall  reflect
allowable operating costs as reported in each facility's cost report for
the  two  thousand  two  calendar  year, as adjusted for inflation on an
annual basis in accordance with the methodology set forth  in  paragraph
(c)  of  subdivision ten of section twenty-eight hundred seven-c of this
article, provided, however, that for  those  facilities  which  [do  not

S. 2606                            34                            A. 3006

receive  a  per  diem add-on adjustment pursuant to subparagraph (ii) of
paragraph (a) of this subdivision] ARE DETERMINED BY THE COMMISSIONER TO
BE QUALIFYING FACILITIES IN ACCORDANCE WITH THE PROVISIONS OF CLAUSE (B)
OF  THIS  SUBPARAGRAPH,  rates  shall be further adjusted to include the
proportionate benefit, as determined by the commissioner, of the expira-
tion of the opening paragraph and paragraph (a) of  subdivision  sixteen
of  this  section  and  of paragraph (a) of subdivision fourteen of this
section, and provided further that the operating cost component of rates
of payment for those facilities  which  [did  not  receive  a  per  diem
adjustment in accordance with subparagraph (ii) of paragraph (a) of this
subdivision] ARE DETERMINED BY THE COMMISSIONER TO BE QUALIFYING FACILI-
TIES  IN  ACCORDANCE  WITH THE PROVISIONS OF CLAUSE (B) OF THIS SUBPARA-
GRAPH shall not be less than the  operating  component  such  facilities
received  in  the  two  thousand  eight  rate  period,  as  adjusted for
inflation on an annual basis in  accordance  with  the  methodology  set
forth  in  paragraph  (c)  of  subdivision  ten  of section twenty-eight
hundred seven-c of this article  and  further  provided,  however,  that
rates  for  facilities whose operating cost component reflects base year
costs subsequent to January first, two thousand  two  shall  have  rates
computed  in accordance with this paragraph, utilizing allowable operat-
ing costs as reported in such subsequent base year period,  and  trended
forward  to  the  rate  year  in  accordance  with  applicable inflation
factors.
  (B) FOR THE PURPOSES OF THIS SUBPARAGRAPH  QUALIFYING  FACILITIES  ARE
THOSE  FACILITIES  FOR  WHICH  THE  COMMISSIONER  DETERMINES  THAT THEIR
REPORTED TWO THOUSAND TWO BASE YEAR OPERATING COST COMPONENT, AS DEFINED
IN ACCORDANCE WITH THE REGULATIONS OF THE DEPARTMENT AS SET FORTH IN  10
NYCRR  86-2.10(A)(7);  IS LESS THAN THE OPERATING COMPONENT SUCH FACILI-
TIES RECEIVED IN THE TWO THOUSAND EIGHT  RATE  PERIOD,  AS  ADJUSTED  BY
APPLICABLE TREND FACTORS.
  S  62.  Subdivision  2-c  of  section 2808 of the public health law is
amended by adding a new paragraph (e) to read as follows:
  (E) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR  ANY
CONTRARY  PROVISION  OF  LAW  AND SUBJECT TO THE AVAILABILITY OF FEDERAL
FINANCIAL PARTICIPATION, THE CAPITAL COST COMPONENTS OF RATES OF PAYMENT
BY GOVERNMENTAL AGENCIES FOR INPATIENT SERVICES PROVIDED BY  RESIDENTIAL
HEALTH CARE FACILITIES ON AND AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN
SHALL  BE DETERMINED IN ACCORDANCE WITH REGULATIONS, INCLUDING EMERGENCY
REGULATIONS, PROMULGATED BY THE COMMISSIONER. SUCH REGULATIONS SHALL  BE
DEVELOPED IN CONSULTATION WITH THE NURSING HOME INDUSTRY.
  S  63. Paragraph (e-1) of subdivision 12 of section 2808 of the public
health law, as amended by section 1 of part D of chapter 59 of the  laws
of 2011, 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

S. 2606                            35                            A. 3006

thousand eight and of up to three hundred million dollars in such aggre-
gate  annual  additional  payments  for  the state fiscal year beginning
April first, two thousand nine, and for the state fiscal year  beginning
April  first,  two  thousand ten and for the state fiscal year beginning
April first, two thousand eleven, and for the state fiscal years  begin-
ning  April  first,  two  thousand  twelve and April first, two thousand
thirteen. The amount  allocated  to  each  eligible  public  residential
health  care  facility  for  this period shall be computed in accordance
with the provisions of paragraph  (f)  of  this  subdivision,  provided,
however,  that  patient  days  shall  be  utilized  for such computation
reflecting actual reported data for two thousand three and  each  repre-
sentative  succeeding year as applicable, AND PROVIDED FURTHER, HOWEVER,
THAT, IN CONSULTATION WITH IMPACTED PROVIDERS, OF  THE  FUNDS  ALLOCATED
FOR  DISTRIBUTION  IN  THE  STATE FISCAL YEAR BEGINNING APRIL FIRST, TWO
THOUSAND THIRTEEN, UP TO SIXTEEN MILLION DOLLARS  MAY  BE  ALLOCATED  IN
ACCORDANCE WITH PARAGRAPH (F-1) OF THIS SUBDIVISION.
  S  64.  Subdivision  12  of  section  2808 of the public health law is
amended by adding a new paragraph (f-1) to read as follows:
  (F-1) FUNDS ALLOCATED BY THE PROVISIONS OF  PARAGRAPH  (E-1)  OF  THIS
SUBDIVISION  FOR DISTRIBUTION PURSUANT TO THIS PARAGRAPH, SHALL BE ALLO-
CATED PROPORTIONALLY TO THOSE PUBLIC RESIDENTIAL HEALTH CARE  FACILITIES
WHICH  WERE  SUBJECT TO RETROACTIVE REDUCTIONS IN PAYMENTS MADE PURSUANT
TO THIS SUBDIVISION FOR STATE FISCAL YEAR PERIODS BEGINNING APRIL FIRST,
TWO THOUSAND SIX.
  S 65. Paragraph (a) of subdivision 6 of section 4403-f of  the  public
health  law,  as  amended by section 41-b of part H of chapter 59 of the
laws of 2011, is amended to read as follows:
  (a) An applicant shall be issued  a  certificate  of  authority  as  a
managed  long  term  care  plan upon a determination by the commissioner
that the applicant  complies  with  the  operating  requirements  for  a
managed  long term care plan under this section. [The commissioner shall
issue no more than seventy-five certificates  of  authority  to  managed
long term care plans pursuant to this section.]
  S  66.  Paragraph (c) 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:
  (c) The non-capital component of the rates for: (i) AIDS facilities or
discrete AIDS units within facilities; (ii) discrete units for residents
receiving care in a long-term inpatient rehabilitation program for trau-
matic  brain injured persons; (iii) discrete units providing specialized
programs for residents requiring behavioral interventions; (iv) discrete
units for long-term ventilator dependent residents; and  (v)  facilities
or  discrete  units  within  facilities  that provide extensive nursing,
medical, psychological and counseling support services solely  to  chil-
dren  shall  reflect  the rates in effect for such facilities on January
first, two thousand nine, as adjusted for inflation and rate appeals  in
accordance  with applicable statutes, provided, however, that such rates
for facilities described in subparagraph (i)  of  this  paragraph  shall
reflect the application of the provisions of section twelve of part D of
chapter  fifty-eight  of  the  laws  of  two thousand nine, and provided
further, however, that insofar as such rates reflect  trend  adjustments
for  trend  factors attributable to the two thousand eight and two thou-
sand nine calendar years the  aggregate  amount  of  such  trend  factor
adjustments  shall be subject to the provisions of section two of part D
of chapter fifty-eight of the laws of two thousand nine, as amended; AND
PROVIDED  FURTHER,  HOWEVER,  THAT  NOTWITHSTANDING   ANY   INCONSISTENT

S. 2606                            36                            A. 3006

PROVISIONS OF THIS SUBDIVISION AND SUBJECT TO THE AVAILABILITY OF FEDER-
AL  FINANCIAL  PARTICIPATION,  FOR  ALL  RATE PERIODS ON AND AFTER APRIL
FIRST, TWO THOUSAND FOURTEEN, RATES CONSISTENT WITH PARAGRAPHS  (A)  AND
(B)  OF  THIS  SUBDIVISION  FOR  FACILITIES DESCRIBED IN THIS PARAGRAPH,
INCLUDING A  PATIENT  ACUITY  ADJUSTMENT  FOR  FACILITIES  DESCRIBED  IN
SUBPARAGRAPH  (V) OF THIS PARAGRAPH, SHALL BE ESTABLISHED BY THE COMMIS-
SIONER BY REGULATION AS AUTHORIZED BY PARAGRAPH (D) OF THIS  SUBDIVISION
AND IN CONSULTATION WITH AFFECTED PROVIDERS.
  S  67.  Paragraph  (a)  of  subdivision 3 of section 366 of the social
services law, as amended by chapter 110 of the laws of 1971, is  amended
to read as follows:
  (a)  Medical  assistance  shall  be  furnished  to applicants in cases
where, although such applicant has a responsible  relative  with  suffi-
cient  income  and resources to provide medical assistance as determined
by the regulations of the department, the income and  resources  of  the
responsible  relative are not available to such applicant because of the
absence of such relative [or] AND the refusal or failure of such  ABSENT
relative  to  provide the necessary care and assistance.  In such cases,
however, the furnishing of  such  assistance  shall  create  an  implied
contract  with such relative, and the cost thereof may be recovered from
such relative in accordance with title six  of  article  three  OF  THIS
CHAPTER and other applicable provisions of law.
  S  68.  Paragraph  (a) of subdivision 2 of section 366-c of the social
services law, as added by chapter 558 of the laws of 1989, is amended to
read as follows:
  (a) For purposes of this section an "institutionalized  spouse"  is  a
person  (I) WHO IS in a medical institution or nursing facility [(i) who
is] AND expected to remain in such facility or institution for at  least
thirty  consecutive days[,]; or (II) WHO is receiving care, services and
supplies pursuant to a waiver pursuant  to  subsection  (c)  of  section
nineteen  hundred  fifteen  of  the  federal  social  security act OR IS
RECEIVING CARE, SERVICES AND SUPPLIES IN A MANAGED LONG-TERM  CARE  PLAN
PURSUANT  TO  SECTION ELEVEN HUNDRED FIFTEEN OF THE SOCIAL SECURITY ACT;
and [(ii)] (III) who is married to a person who  is  not  in  a  medical
institution  or  nursing  facility  or  is not receiving WAIVER services
[pursuant to a waiver pursuant to subsection  (c)  of  section  nineteen
hundred fifteen of the federal social security act] DESCRIBED IN SUBPAR-
AGRAPH  (II)  OF THIS PARAGRAPH; PROVIDED, HOWEVER, THAT MEDICAL ASSIST-
ANCE SHALL BE FURNISHED PURSUANT TO THIS PARAGRAPH ONLY IF, FOR SO  LONG
AS,  AND TO THE EXTENT THAT FEDERAL FINANCIAL PARTICIPATION 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 NECESSARY  TO  CARRY  OUT
THE PROVISIONS OF THIS PARAGRAPH.
  S  69.  Paragraph  (b)  of subdivision 6 of section 3614 of the public
health law, as added by chapter 645 of the laws of 2003, is  amended  to
read as follows:
  (b)   For   purposes   of  this  subdivision,  real  property  capital
construction costs shall only  be  included  in  rates  of  payment  for
assisted  living  programs  if: THE FACILITY HOUSES EXCLUSIVELY ASSISTED
LIVING PROGRAM BEDS AUTHORIZED PURSUANT TO PARAGRAPH (J) OF  SUBDIVISION
THREE  OF SECTION FOUR HUNDRED SIXTY-ONE-L OF THE SOCIAL SERVICES LAW OR
(i) the facility is operated by a not-for-profit corporation;  (ii)  the
facility  commenced operation after nineteen hundred ninety-eight and at
least ninety-five percent of the certified approved beds are provided to
residents who are subject to the assisted living program; and (iii)  the

S. 2606                            37                            A. 3006

assisted living program is in a county with a population of no less than
two  hundred eighty thousand persons.  The methodology used to calculate
the rate for such capital construction costs shall be the same methodol-
ogy  used  to  calculate  the  capital construction costs at residential
health care facilities for such costs, PROVIDED  THAT  THE  COMMISSIONER
MAY  ADOPT  RULES AND REGULATIONS WHICH ESTABLISH A CAP ON REAL PROPERTY
CAPITAL CONSTRUCTION COSTS FOR THOSE FACILITIES THAT  HOUSE  EXCLUSIVELY
ASSISTED  LIVING  PROGRAM  BEDS  AUTHORIZED PURSUANT TO PARAGRAPH (J) OF
SUBDIVISION THREE OF SECTION FOUR  HUNDRED  SIXTY-ONE-L  OF  THE  SOCIAL
SERVICES LAW.
  S  70.  Subdivision  3  of section 461-l of the social services law is
amended by adding a new paragraph (j) to read as follows:
  (J) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ADD UP TO  FOUR  THOU-
SAND  FIVE  HUNDRED  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 TWELVE.  APPLICANTS ELIGIBLE TO SUBMIT AN
APPLICATION UNDER THIS PARAGRAPH SHALL BE LIMITED  TO  ADULT  HOMES  (I)
ESTABLISHED PURSUANT TO SECTION FOUR HUNDRED SIXTY-ONE-B OF THIS ARTICLE
WITH,  AS  OF SEPTEMBER FIRST, TWO THOUSAND TWELVE, A CERTIFIED CAPACITY
OF EIGHTY BEDS OR MORE IN WHICH TWENTY-FIVE PERCENT OR MORE OF THE RESI-
DENT POPULATION ARE PERSONS WITH SERIOUS MENTAL ILLNESS  AS  DEFINED  IN
REGULATIONS  PROMULGATED  BY THE COMMISSIONER OF HEALTH AND (II) LOCATED
IN A CITY WITH A POPULATION OF OVER ONE MILLION PERSONS.    THE  COMMIS-
SIONER  OF HEALTH SHALL NOT BE REQUIRED TO REVIEW ON A COMPARATIVE BASIS
APPLICATIONS SUBMITTED FOR ASSISTED LIVING PROGRAM BEDS  MADE  AVAILABLE
UNDER THIS PARAGRAPH.
  S  71.  Subdivision  14  of section 366 of the social services law, as
added by section 74 of part H of chapter 59 of  the  laws  of  2011,  is
amended to read as follows:
  14.  The  commissioner  of health may make any available amendments to
the state plan for medical  assistance  submitted  pursuant  to  section
three  hundred  sixty-three-a  of this title, or, if an amendment is not
possible, develop and submit an application for any waiver  or  approval
under the federal social security act that may be necessary to disregard
or exempt an amount of income, for the purpose of assisting with housing
costs,  for  individuals receiving coverage of nursing facility services
under this title, OTHER THAN SHORT-TERM REHABILITATION SERVICES, AND FOR
INDIVIDUALS IN RECEIPT OF MEDICAL ASSISTANCE WHILE IN AN ADULT HOME,  AS
DEFINED  IN  SUBDIVISION TWENTY-FIVE OF SECTION TWO OF THIS CHAPTER, who
[are]: ARE (i) discharged [from the nursing facility] to the  community;
AND  (ii)  IF ELIGIBLE, enrolled in a plan certified pursuant to section
forty-four hundred three-f of the public health law; and (iii) [while so
enrolled, not] DO NOT MEET THE CRITERIA TO BE  considered  an  "institu-
tionalized  spouse" for purposes of section three hundred sixty-six-c of
this title.
  S 72. Section 364-j of the social services law is amended by adding  a
new subdivision 27 to read as follows:
  27. (A) THE CENTERS FOR MEDICARE AND MEDICAID SERVICES HAS ESTABLISHED
AN  INITIATIVE  TO  ALIGN  INCENTIVES BETWEEN MEDICARE AND MEDICAID. THE
GOAL OF THE INITIATIVE  IS  TO  INCREASE  ACCESS  TO  SEAMLESS,  QUALITY
PROGRAMS  THAT INTEGRATE SERVICES FOR THE DUALLY ELIGIBLE BENEFICIARY AS
WELL AS TO ACHIEVE BOTH STATE AND FEDERAL HEALTH CARE SAVINGS BY IMPROV-
ING HEALTH CARE DELIVERY AND ENCOURAGING HIGH-QUALITY,  EFFICIENT  CARE.
IN FURTHERANCE OF THIS GOAL, THE LEGISLATURE AUTHORIZES THE COMMISSIONER
OF  HEALTH  TO  ESTABLISH  A  FULLY  INTEGRATED  DUALS  ADVANTAGE (FIDA)
PROGRAM.

S. 2606                            38                            A. 3006

  (B)  THE  FIDA  PROGRAM  SHALL   PROVIDE   TARGETED   POPULATIONS   OF
MEDICARE/MEDICAID  DUALLY  ELIGIBLE  PERSONS  WITH  COMPREHENSIVE HEALTH
SERVICES THAT INCLUDE THE FULL RANGE OF MEDICARE  AND  MEDICAID  COVERED
SERVICES,   INCLUDING  BUT  NOT  LIMITED  TO  PRIMARY  AND  ACUTE  CARE,
PRESCRIPTION   DRUGS,  BEHAVIORAL  HEALTH  SERVICES,  CARE  COORDINATION
SERVICES,  AND  LONG-TERM  SUPPORTS  AND  SERVICES,  AS  WELL  AS  OTHER
SERVICES,  THROUGH MANAGED CARE PROVIDERS, AS DEFINED IN SUBDIVISION ONE
OF THIS SECTION, INCLUDING MANAGED LONG TERM CARE PLANS CERTIFIED PURSU-
ANT TO SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW.
  (C) UNDER THE FIDA PROGRAM ESTABLISHED PURSUANT TO  THIS  SUBDIVISION,
UP TO THREE MANAGED LONG TERM CARE PLANS MAY BE AUTHORIZED TO EXCLUSIVE-
LY  ENROLL  INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES, AS SUCH TERM IS
DEFINED IN SECTION 1.03 OF THE MENTAL HYGIENE LAW. THE  COMMISSIONER  OF
HEALTH  MAY WAIVE ANY OF THE DEPARTMENT'S REGULATIONS AS THE COMMISSION-
ER, IN CONSULTATION WITH THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES,
DEEMS NECESSARY TO ALLOW SUCH MANAGED LONG TERM CARE PLANS TO PROVIDE OR
ARRANGE FOR SERVICES FOR  INDIVIDUALS  WITH  DEVELOPMENTAL  DISABILITIES
THAT  ARE ADEQUATE AND APPROPRIATE TO MEET THE NEEDS OF SUCH INDIVIDUALS
AND THAT WILL ENSURE THEIR HEALTH AND SAFETY. THE COMMISSIONER OF DEVEL-
OPMENTAL DISABILITIES MAY WAIVE ANY OF THE OFFICE FOR PEOPLE WITH DEVEL-
OPMENTAL DISABILITIES' REGULATIONS AS SUCH COMMISSIONER, IN CONSULTATION
WITH THE COMMISSIONER OF HEALTH, DEEMS NECESSARY TO ALLOW  SUCH  MANAGED
LONG  TERM CARE PLANS TO PROVIDE OR ARRANGE FOR SERVICES FOR INDIVIDUALS
WITH DEVELOPMENTAL DISABILITIES THAT ARE  ADEQUATE  AND  APPROPRIATE  TO
MEET THE NEEDS OF SUCH INDIVIDUALS AND THAT WILL ENSURE THEIR HEALTH AND
SAFETY.
  (D)  THE  PROVISIONS  OF  THIS  SUBDIVISION SHALL NOT APPLY UNLESS ALL
NECESSARY APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN  OBTAINED
TO  RECEIVE  FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF HEALTH CARE
SERVICES PROVIDED PURSUANT TO THIS SUBDIVISION.
  (E) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO SUBMIT  AMENDMENTS  TO
THE STATE PLAN FOR MEDICAL ASSISTANCE AND/OR SUBMIT ONE OR MORE APPLICA-
TIONS FOR WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT AS MAY BE NECESSARY
TO OBTAIN THE FEDERAL APPROVALS NECESSARY TO IMPLEMENT THIS SUBDIVISION.
  (F)  THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE COMMISSIONER
OF DEVELOPMENTAL DISABILITIES, AS APPROPRIATE, MAY CONTRACT WITH MANAGED
CARE PLANS APPROVED TO PARTICIPATE IN THE FIDA PROGRAM 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.
  S 73. The public health law is amended by adding a new section  4403-g
to read as follows:
  S 4403-G. DEVELOPMENTAL DISABILITY INDIVIDUAL SUPPORT AND CARE COORDI-
NATION ORGANIZATIONS.  1. DEFINITIONS. AS USED IN THIS SECTION:
  (A) "DEVELOPMENTAL DISABILITY INDIVIDUAL SUPPORT AND CARE COORDINATION
ORGANIZATION" OR "DISCO" MEANS AN ENTITY THAT HAS RECEIVED A CERTIFICATE
OF AUTHORITY PURSUANT TO THIS SECTION TO PROVIDE, OR ARRANGE FOR, HEALTH
AND  LONG  TERM CARE SERVICES, AS DETERMINED BY THE COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES,  ON  A  CAPITATED  BASIS  IN
ACCORDANCE  WITH  THIS  SECTION,  FOR  A  POPULATION OF INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES, AS SUCH TERM IS DEFINED IN SECTION  1.03  OF
THE MENTAL HYGIENE LAW, WHICH THE ORGANIZATION IS AUTHORIZED TO ENROLL.
  (B)  "ELIGIBLE  APPLICANT"  MEANS  AN ENTITY CONTROLLED BY ONE OR MORE
NON-PROFIT ORGANIZATIONS WHICH HAVE A HISTORY OF PROVIDING OR COORDINAT-

S. 2606                            39                            A. 3006

ING HEALTH AND LONG TERM CARE SERVICES  TO  PERSONS  WITH  DEVELOPMENTAL
DISABILITIES.
  (C) "HEALTH AND LONG TERM CARE SERVICES" MEANS SERVICES INCLUDING, BUT
NOT LIMITED TO, HOME AND COMMUNITY-BASED AND INSTITUTION-BASED LONG TERM
CARE  AND  ANCILLARY  SERVICES  (THAT SHALL INCLUDE MEDICAL SUPPLIES AND
NUTRITIONAL SUPPLEMENTS) THAT ARE NECESSARY TO MEET THE NEEDS OF PERSONS
WHOM THE PLAN IS AUTHORIZED TO ENROLL, AND MAY INCLUDE PRIMARY CARE  AND
ACUTE  CARE  IF  THE  DISCO IS AUTHORIZED TO PROVIDE OR ARRANGE FOR SUCH
SERVICES.
  2. APPROVAL AUTHORITY.  AN APPLICANT SHALL BE ISSUED A CERTIFICATE  OF
AUTHORITY  AS  A  DISCO UPON A DETERMINATION BY THE COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES THAT THE  APPLICANT  COMPLIES
WITH THE OPERATING REQUIREMENTS FOR A DISCO UNDER THIS SECTION.
  3.  APPLICATION  FOR CERTIFICATE OF AUTHORITY; FORM.  THE COMMISSIONER
AND THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES SHALL JOINTLY DEVELOP
APPLICATION FORMS FOR A CERTIFICATE OF AUTHORITY TO OPERATE A DISCO.  AN
ELIGIBLE APPLICANT SHALL SUBMIT AN  APPLICATION  FOR  A  CERTIFICATE  OF
AUTHORITY  TO  OPERATE A DISCO UPON FORMS PRESCRIBED BY SUCH COMMISSION-
ERS. SUCH ELIGIBLE APPLICANT SHALL SUBMIT INFORMATION AND  DOCUMENTATION
TO THE COMMISSIONER WHICH SHALL INCLUDE, BUT NOT BE LIMITED TO:
  (A)  A  DESCRIPTION  OF  THE SERVICE AREA PROPOSED TO BE SERVED BY THE
DISCO WITH PROJECTIONS OF ENROLLMENT THAT  WILL  RESULT  IN  A  FISCALLY
SOUND PLAN;
  (B) A DESCRIPTION OF THE SERVICES TO BE COVERED BY SUCH DISCO;
  (C) A DESCRIPTION OF THE PROPOSED MARKETING PLAN;
  (D) THE NAMES OF THE PROVIDERS PROPOSED TO BE IN THE DISCO'S NETWORK;
  (E)  EVIDENCE  OF  THE  CHARACTER  AND  COMPETENCE  OF THE APPLICANT'S
PROPOSED OPERATORS;
  (F) ADEQUATE DOCUMENTATION OF THE APPROPRIATE LICENSES, CERTIFICATIONS
OR APPROVALS TO PROVIDE CARE AS PLANNED, INCLUDING AFFILIATE  AGREEMENTS
OR PROPOSED CONTRACTS WITH SUCH PROVIDERS AS MAY BE NECESSARY TO PROVIDE
THE  FULL  COMPLEMENT  OF  SERVICES  REQUIRED  TO BE PROVIDED UNDER THIS
SECTION;
  (G) A DESCRIPTION OF THE PROPOSED QUALITY-ASSURANCE MECHANISMS, GRIEV-
ANCE PROCEDURES, MECHANISMS TO PROTECT THE RIGHTS OF ENROLLEES AND  CARE
COORDINATION SERVICES TO ENSURE CONTINUITY, QUALITY, APPROPRIATENESS AND
COORDINATION OF CARE;
  (H)  A  DESCRIPTION OF THE PROPOSED QUALITY ASSESSMENT AND PERFORMANCE
IMPROVEMENT PROGRAM THAT INCLUDES PERFORMANCE AND OUTCOME BASED  QUALITY
STANDARDS   FOR  ENROLLEE  HEALTH  STATUS  AND  SATISFACTION,  AND  DATA
COLLECTION AND REPORTING FOR STANDARD PERFORMANCE MEASURES;
  (I) A DESCRIPTION OF THE MANAGEMENT SYSTEMS  AND  SYSTEMS  TO  PROCESS
PAYMENT FOR COVERED SERVICES;
  (J)  A  DESCRIPTION  OF THE MECHANISM TO MAXIMIZE REIMBURSEMENT OF AND
COORDINATE SERVICES REIMBURSED PURSUANT TO TITLE XVIII  OF  THE  FEDERAL
SOCIAL SECURITY ACT AND ALL OTHER APPLICABLE BENEFITS, WITH SUCH BENEFIT
COORDINATION  INCLUDING,  BUT  NOT LIMITED TO, MEASURES TO SUPPORT SOUND
CLINICAL DECISIONS, REDUCE ADMINISTRATIVE COMPLEXITY, COORDINATE  ACCESS
TO  SERVICES,  MAXIMIZE  BENEFITS  AVAILABLE  PURSUANT TO SUCH TITLE AND
ENSURE THAT NECESSARY CARE IS PROVIDED;
  (K) A DESCRIPTION OF THE SYSTEMS  FOR  SECURING  AND  INTEGRATING  ANY
POTENTIAL  SOURCES  OF  FUNDING  FOR SERVICES PROVIDED BY OR THROUGH THE
ORGANIZATION, INCLUDING, BUT NOT LIMITED  TO,  FUNDING  AVAILABLE  UNDER
TITLES XVI, XVIII, XIX AND XX OF THE FEDERAL SOCIAL SECURITY ACT AND ALL
OTHER AVAILABLE SOURCES OF FUNDING;

S. 2606                            40                            A. 3006

  (L) A DESCRIPTION OF THE PROPOSED CONTRACTUAL ARRANGEMENTS FOR PROVID-
ERS OF HEALTH AND LONG TERM CARE SERVICES IN THE BENEFIT PACKAGE; AND
  (M) INFORMATION RELATED TO THE FINANCIAL CONDITION OF THE APPLICANT.
  4.  CERTIFICATE  OF  AUTHORITY  APPROVAL.   THE COMMISSIONER SHALL NOT
APPROVE AN APPLICATION FOR A CERTIFICATE OF AUTHORITY UNLESS THE  APPLI-
CANT  DEMONSTRATES  TO  THE  SATISFACTION  OF  THE  COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES:
  (A) THAT IT WILL HAVE IN  PLACE  ACCEPTABLE  QUALITY  ASSURANCE  MECH-
ANISMS,  GRIEVANCE  PROCEDURES  AND  MECHANISMS TO PROTECT THE RIGHTS OF
ENROLLEES AND CARE COORDINATION SERVICES TO ENSURE CONTINUITY,  QUALITY,
APPROPRIATENESS AND COORDINATION OF CARE;
  (B)  THAT  IT  HAS  DEVELOPED  A  QUALITY  ASSESSMENT  AND PERFORMANCE
IMPROVEMENT PROGRAM THAT INCLUDES PERFORMANCE AND OUTCOME BASED  QUALITY
STANDARDS  FOR  ENROLLEE  HEALTH STATUS AND SATISFACTION, WHICH SHALL BE
REVIEWED BY THE COMMISSIONER AND THE COMMISSIONER OF DEVELOPMENTAL DISA-
BILITIES. THE PROGRAM SHALL INCLUDE DATA COLLECTION  AND  REPORTING  FOR
STANDARD  PERFORMANCE  MEASURES  AS REQUIRED BY THE COMMISSIONER AND THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES;
  (C) THAT AN OTHERWISE ELIGIBLE ENROLLEE  SHALL  NOT  BE  INVOLUNTARILY
DISENROLLED  WITHOUT  THE PRIOR APPROVAL OF THE COMMISSIONER OF DEVELOP-
MENTAL DISABILITIES;
  (D) THAT THE APPLICANT SHALL NOT USE DECEPTIVE OR  COERCIVE  MARKETING
METHODS TO ENCOURAGE PARTICIPANTS TO ENROLL AND THAT THE APPLICANT SHALL
NOT  DISTRIBUTE  MARKETING  MATERIALS TO POTENTIAL ENROLLEES BEFORE SUCH
MATERIALS HAVE BEEN APPROVED BY THE COMMISSIONER AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES;
  (E) SATISFACTORY EVIDENCE OF  THE  CHARACTER  AND  COMPETENCE  OF  THE
APPLICANT'S PROPOSED OPERATORS;
  (F)  REASONABLE ASSURANCE THAT THE APPLICANT WILL PROVIDE HIGH QUALITY
SERVICES TO AN ENROLLED POPULATION,  THAT  THE  APPLICANT'S  NETWORK  OF
PROVIDERS  IS  ADEQUATE AND THAT SUCH PROVIDERS HAVE DEMONSTRATED SUFFI-
CIENT COMPETENCY TO DELIVER HIGH QUALITY SERVICES TO THE ENROLLED  POPU-
LATION  AND THAT POLICIES AND PROCEDURES WILL BE IN PLACE TO ADDRESS THE
CULTURAL AND LINGUISTIC NEEDS OF THE ENROLLED POPULATION;
  (G) SUFFICIENT MANAGEMENT SYSTEMS CAPACITY TO MEET THE REQUIREMENTS OF
THIS SECTION AND THE ABILITY TO EFFICIENTLY PROCESS PAYMENT FOR  COVERED
SERVICES;
  (H)  READINESS AND CAPABILITY TO MAXIMIZE REIMBURSEMENT OF AND COORDI-
NATE SERVICES REIMBURSED PURSUANT TO TITLE XVIII OF THE  FEDERAL  SOCIAL
SECURITY  ACT AND ALL OTHER APPLICABLE BENEFITS, WITH SUCH BENEFIT COOR-
DINATION INCLUDING, BUT NOT LIMITED TO, MEASURES TO SUPPORT SOUND  CLIN-
ICAL  DECISIONS,  REDUCE ADMINISTRATIVE COMPLEXITY, COORDINATE ACCESS TO
SERVICES, MAXIMIZE BENEFITS AVAILABLE PURSUANT TO SUCH TITLE AND  ENSURE
THAT NECESSARY CARE IS PROVIDED;
  (I) READINESS AND CAPABILITY TO ARRANGE AND MANAGE COVERED SERVICES;
  (J) WILLINGNESS AND CAPABILITY OF TAKING, OR COOPERATING IN, ALL STEPS
NECESSARY  TO  SECURE AND INTEGRATE ANY POTENTIAL SOURCES OF FUNDING FOR
SERVICES PROVIDED BY OR THROUGH THE DISCO, INCLUDING,  BUT  NOT  LIMITED
TO, FUNDING AVAILABLE UNDER TITLES XVI, XVIII, XIX AND XX OF THE FEDERAL
SOCIAL SECURITY ACT AND ALL OTHER AVAILABLE SOURCES OF FUNDING;
  (K) THAT THE CONTRACTUAL ARRANGEMENTS FOR PROVIDERS OF HEALTH AND LONG
TERM  CARE  SERVICES IN THE BENEFIT PACKAGE ARE SUFFICIENT TO ENSURE THE
AVAILABILITY AND ACCESSIBILITY OF SUCH SERVICES TO THE PROPOSED ENROLLED
POPULATION CONSISTENT WITH GUIDELINES ESTABLISHED  BY  THE  COMMISSIONER
AND THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES; AND

S. 2606                            41                            A. 3006

  (L)  THAT  THE  APPLICANT  IS  FINANCIALLY  RESPONSIBLE  AND  SHALL BE
EXPECTED TO MEET ITS OBLIGATIONS TO ITS ENROLLED MEMBERS.
  5.  ENROLLMENT.   (A) ONLY PERSONS WITH DEVELOPMENTAL DISABILITIES, AS
DETERMINED BY THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES,
SHALL BE ELIGIBLE TO ENROLL IN DISCOS.
  (B)  THE  OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL DISABILITIES OR ITS
DESIGNEE SHALL ENROLL AN ELIGIBLE PERSON IN THE DISCO CHOSEN BY  HIM  OR
HER,  HIS  OR  HER GUARDIAN OR OTHER LEGAL REPRESENTATIVE, PROVIDED THAT
SUCH DISCO IS AUTHORIZED TO ENROLL SUCH PERSON.
  (C) NO PERSON WITH A DEVELOPMENTAL  DISABILITY  WHO  IS  RECEIVING  OR
APPLYING  FOR  MEDICAL  ASSISTANCE  AND WHO IS RECEIVING, OR ELIGIBLE TO
RECEIVE, SERVICES FUNDED,  CERTIFIED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR  PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL BE REQUIRED TO
ENROLL IN A DISCO IN  ORDER  TO  RECEIVE  SUCH  SERVICES  UNTIL  PROGRAM
FEATURES  AND  REIMBURSEMENT  RATES ARE APPROVED BY THE COMMISSIONER AND
THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES, AND UNTIL  SUCH  COMMIS-
SIONERS DETERMINE THAT THERE ARE A SUFFICIENT NUMBER OF PLANS AUTHORIZED
TO  COORDINATE  CARE  FOR  INDIVIDUALS  WITH  DEVELOPMENTAL DISABILITIES
PURSUANT TO THIS ARTICLE OPERATING IN THE PERSON'S COUNTY  OF  RESIDENCE
TO  MEET  THE NEEDS OF PERSONS WITH DEVELOPMENTAL DISABILITIES, AND THAT
SUCH DISCOS MEET THE STANDARDS OF THIS SECTION.
  (D) PERSONS REQUIRED TO ENROLL IN A DISCO  SHALL  HAVE  NO  LESS  THAN
THIRTY  DAYS  TO SELECT A DISCO, AND SUCH PERSONS AND THEIR GUARDIANS OR
OTHER LEGAL REPRESENTATIVES SHALL BE PROVIDED WITH INFORMATION  TO  MAKE
AN  INFORMED  CHOICE.  WHERE A PERSON, GUARDIAN OR OTHER LEGAL REPRESEN-
TATIVE HAS NOT SELECTED A DISCO, THE COMMISSIONER OF DEVELOPMENTAL DISA-
BILITIES OR ITS DESIGNEE SHALL ENROLL SUCH PERSON IN A DISCO  CHOSEN  BY
SUCH  COMMISSIONER, TAKING INTO ACCOUNT QUALITY, CAPACITY AND GEOGRAPHIC
ACCESSIBILITY. THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES  OR
ITS  DESIGNEE SHALL AUTOMATICALLY RE-ENROLL A PERSON WITH THE SAME DISCO
IF THERE IS A LOSS OF MEDICAID ELIGIBILITY OF TWO MONTHS OR LESS.
  (E) ENROLLED PERSONS MAY CHANGE THEIR ENROLLMENT AT ANY  TIME  WITHOUT
CAUSE, PROVIDED, HOWEVER, THAT A PERSON REQUIRED TO ENROLL IN A DISCO IN
ORDER  TO  RECEIVE  SERVICES FUNDED, LICENSED, AUTHORIZED OR APPROVED BY
THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES MAY ONLY DISENROLL
FROM A DISCO IF HE OR SHE ENROLLS IN ANOTHER DISCO AUTHORIZED TO  ENROLL
HIM  OR  HER.    SUCH DISENROLLMENT SHALL BE EFFECTIVE NO LATER THAN THE
FIRST DAY OF THE SECOND MONTH FOLLOWING THE REQUEST.
  (F) A DISCO MAY REQUEST THE INVOLUNTARY DISENROLLMENT OF  AN  ENROLLED
PERSON  IN WRITING TO THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILI-
TIES. SUCH DISENROLLMENT SHALL NOT BE EFFECTIVE  UNTIL  THE  REQUEST  IS
REVIEWED  AND APPROVED BY SUCH OFFICE. THE DEPARTMENT AND THE OFFICE FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL ADOPT RULES AND REGULATIONS
GOVERNING THIS PROCESS.
  6. ASSESSMENTS.  THE OFFICE FOR PEOPLE  WITH  DEVELOPMENTAL  DISABILI-
TIES,  OR  ITS  DESIGNEE, SHALL COMPLETE A COMPREHENSIVE ASSESSMENT THAT
SHALL INCLUDE, BUT NOT BE LIMITED TO,  AN  EVALUATION  OF  THE  MEDICAL,
SOCIAL  AND ENVIRONMENTAL NEEDS OF EACH PROSPECTIVE ENROLLEE IN A DISCO.
THIS ASSESSMENT SHALL ALSO SERVE AS THE BASIS FOR  THE  DEVELOPMENT  AND
PROVISION  OF  AN APPROPRIATE PLAN OF CARE FOR THE ENROLLEE. THE ASSESS-
MENT SHALL BE COMPLETED BY THE  OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL
DISABILITIES  OR  ITS  DESIGNEE  IN  CONSULTATION  WITH  THE PROSPECTIVE
ENROLLEE'S HEALTH CARE PRACTITIONER AS NECESSARY.  THE  COMMISSIONER  OF
DEVELOPMENTAL  DISABILITIES  SHALL  PRESCRIBE  THE  FORMS  ON  WHICH THE
ASSESSMENT SHALL BE MADE. THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISA-
BILITIES MAY DESIGNATE THE DISCO TO PERFORM SUCH ASSESSMENTS.

S. 2606                            42                            A. 3006

  7. PROGRAM OVERSIGHT AND ADMINISTRATION.  (A) THE COMMISSIONER AND THE
COMMISSIONER OF  DEVELOPMENTAL  DISABILITIES  SHALL  JOINTLY  PROMULGATE
REGULATIONS  TO  IMPLEMENT  THIS  SECTION,  TO  PROVIDE FOR OVERSIGHT OF
DISCOS, INCLUDING ON SITE REVIEWS, AND TO ENSURE THE QUALITY,  APPROPRI-
ATENESS AND COST-EFFECTIVENESS OF THE SERVICES PROVIDED BY DISCOS.
  (B)  THE  COMMISSIONER AND THE COMMISSIONER OF DEVELOPMENTAL DISABILI-
TIES MAY WAIVE RULES AND REGULATIONS OF THEIR RESPECTIVE  DEPARTMENT  OR
OFFICE,  INCLUDING  BUT  NOT LIMITED TO, THOSE PERTAINING TO DUPLICATIVE
REQUIREMENTS CONCERNING RECORD KEEPING, BOARDS  OF  DIRECTORS,  STAFFING
AND  REPORTING,  WHEN SUCH WAIVER WILL PROMOTE THE EFFICIENT DELIVERY OF
APPROPRIATE, QUALITY, COST-EFFECTIVE SERVICES AND WHEN THE HEALTH, SAFE-
TY AND GENERAL WELFARE OF DISCO ENROLLEES WILL  NOT  BE  IMPAIRED  AS  A
RESULT OF SUCH WAIVER. IN ORDER TO ACHIEVE DISCO SYSTEM EFFICIENCIES AND
COORDINATION  AND  TO PROMOTE THE OBJECTIVES OF HIGH QUALITY, INTEGRATED
AND COST EFFECTIVE CARE, THE COMMISSIONERS MAY ESTABLISH A SINGLE  COOR-
DINATED SURVEILLANCE PROCESS, ALLOW FOR A COMPREHENSIVE QUALITY IMPROVE-
MENT  AND  REVIEW  PROCESS  TO  MEET COMPONENT QUALITY REQUIREMENTS, AND
REQUIRE A UNIFORM COST REPORT.  THE COMMISSIONERS SHALL  REQUIRE  DISCOS
TO  UTILIZE QUALITY IMPROVEMENT MEASURES, BASED ON HEALTH OUTCOMES DATA,
FOR INTERNAL QUALITY ASSESSMENT PROCESSES AND MAY UTILIZE SUCH  MEASURES
AS PART OF THE SINGLE COORDINATED SURVEILLANCE PROCESS.
  (C)  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THE SOCIAL SERVICES
LAW TO THE CONTRARY, THE COMMISSIONER IN CONSULTATION WITH  THE  COMMIS-
SIONER  OF  DEVELOPMENTAL  DISABILITIES  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 ARE INCONSISTENT WITH THE FLEXIBILITY NECESSARY  FOR  THE  EFFICIENT
ADMINISTRATION  OF  DISCOS, AND SUCH REGULATIONS SHALL PROVIDE THAT SUCH
PROVISIONS SHALL NOT BE APPLICABLE TO ENROLLEES OF DISCOS, PROVIDED THAT
SUCH DETERMINATIONS ARE CONSISTENT WITH APPLICABLE FEDERAL LAW AND REGU-
LATION.
  (D) THE COMMISSIONER AND THE COMMISSIONER OF  DEVELOPMENTAL  DISABILI-
TIES SHALL ENSURE, THROUGH PERIODIC REVIEWS OF DISCOS, THAT ORGANIZATION
SERVICES  ARE  PROMPTLY  AVAILABLE  TO  ENROLLEES WHEN APPROPRIATE. SUCH
PERIODIC REVIEWS SHALL BE MADE ACCORDING TO STANDARDS AS  DETERMINED  BY
THE COMMISSIONERS IN REGULATIONS.
  (E)  THE  COMMISSIONER AND THE COMMISSIONER OF DEVELOPMENTAL DISABILI-
TIES SHALL HAVE THE AUTHORITY TO CONDUCT  BOTH  ON  SITE  AND  OFF  SITE
REVIEWS OF DISCOS.  SUCH REVIEWS MAY INCLUDE, BUT NOT BE LIMITED TO, THE
FOLLOWING   COMPONENTS:  GOVERNANCE;  FISCAL  AND  FINANCIAL  REPORTING;
RECORDKEEPING; INTERNAL CONTROLS;  MARKETING;  NETWORK  CONTRACTING  AND
ADEQUACY;  PROGRAM  INTEGRITY ASSURANCES; UTILIZATION CONTROL AND REVIEW
SYSTEMS; GRIEVANCE AND APPEALS SYSTEMS; QUALITY ASSESSMENT AND ASSURANCE
SYSTEMS;  CARE  MANAGEMENT;  ENROLLMENT  AND  DISENROLLMENT;  MANAGEMENT
INFORMATION SYSTEMS, AND OTHER OPERATIONAL AND MANAGEMENT COMPONENTS.
  8.  SOLVENCY.   (A) THE COMMISSIONER, IN CONSULTATION WITH THE COMMIS-
SIONER OF DEVELOPMENTAL DISABILITIES, SHALL BE RESPONSIBLE FOR  EVALUAT-
ING,  APPROVING  AND REGULATING ALL MATTERS RELATING TO FISCAL SOLVENCY,
INCLUDING RESERVES, SURPLUS AND  PROVIDER  CONTRACTS.  THE  COMMISSIONER
SHALL  PROMULGATE REGULATIONS TO IMPLEMENT THIS SECTION. THE COMMISSION-
ER, IN THE ADMINISTRATION OF THIS SUBDIVISION:
  (I) SHALL BE GUIDED BY THE STANDARDS THAT GOVERN THE  FISCAL  SOLVENCY
OF  A  HEALTH  MAINTENANCE  ORGANIZATION,  PROVIDED,  HOWEVER,  THAT THE
COMMISSIONER SHALL RECOGNIZE THE SPECIFIC  DELIVERY  COMPONENTS,  OPERA-

S. 2606                            43                            A. 3006

TIONAL CAPACITY AND FINANCIAL CAPABILITY OF THE ELIGIBLE APPLICANT FOR A
CERTIFICATE OF AUTHORITY;
  (II)  SHALL  NOT  APPLY FINANCIAL SOLVENCY STANDARDS THAT EXCEED THOSE
REQUIRED FOR A HEALTH MAINTENANCE ORGANIZATION; AND
  (III) SHALL ESTABLISH REASONABLE CAPITALIZATION AND CONTINGENT RESERVE
REQUIREMENTS.
  (B) STANDARDS  ESTABLISHED  PURSUANT  TO  THIS  SUBDIVISION  SHALL  BE
ADEQUATE TO PROTECT THE INTERESTS OF ENROLLEES IN THE DISCO. THE COMMIS-
SIONER  SHALL  BE  SATISFIED  THAT THE ELIGIBLE APPLICANT IS FINANCIALLY
SOUND, AND HAS MADE ADEQUATE PROVISIONS TO PAY FOR QUALITY SERVICES THAT
ARE COST EFFECTIVE AND APPROPRIATE TO NEEDS AND THE  PROTECTION  OF  THE
HEALTH, SAFETY, WELFARE AND SATISFACTION OF THOSE SERVED.
  9.  ROLE  OF THE SUPERINTENDENT OF FINANCIAL SERVICES.  (A) THE SUPER-
INTENDENT OF FINANCIAL SERVICES SHALL DETERMINE AND APPROVE PREMIUMS  IN
ACCORDANCE  WITH  THE INSURANCE LAW WHENEVER ANY POPULATION OF ENROLLEES
NOT ELIGIBLE UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT IS TO BE
COVERED. THE DETERMINATION AND APPROVAL OF THE SUPERINTENDENT OF  FINAN-
CIAL  SERVICES  SHALL  RELATE  TO PREMIUMS CHARGED TO SUCH ENROLLEES NOT
ELIGIBLE UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT.
  (B) THE  SUPERINTENDENT  OF  FINANCIAL  SERVICES  SHALL  EVALUATE  AND
APPROVE  ANY  ENROLLEE CONTRACTS WHENEVER SUCH ENROLLEE CONTRACTS ARE TO
COVER ANY POPULATION OF ENROLLEES NOT ELIGIBLE UNDER TITLE  XIX  OF  THE
FEDERAL SOCIAL SECURITY ACT.
  10. PAYMENT RATES FOR DISCO ENROLLEES ELIGIBLE FOR MEDICAL ASSISTANCE.
THE  COMMISSIONER SHALL ESTABLISH PAYMENT RATES FOR SERVICES PROVIDED TO
ENROLLEES ELIGIBLE UNDER TITLE XIX OF THE FEDERAL SOCIAL  SECURITY  ACT.
SUCH  PAYMENT  RATES SHALL BE SUBJECT TO APPROVAL BY THE DIRECTOR OF THE
DIVISION OF THE BUDGET. PAYMENT RATES SHALL  BE  RISK-ADJUSTED  TO  TAKE
INTO  ACCOUNT  THE  CHARACTERISTICS OF ENROLLEES, OR PROPOSED ENROLLEES,
INCLUDING, BUT NOT LIMITED TO:   FRAILTY, DISABILITY LEVEL,  HEALTH  AND
FUNCTIONAL  STATUS, AGE, GENDER, THE NATURE OF SERVICES PROVIDED TO SUCH
ENROLLEES, AND OTHER FACTORS AS DETERMINED BY THE COMMISSIONER  AND  THE
COMMISSIONER  OF  DEVELOPMENTAL DISABILITIES. THE RISK ADJUSTED PREMIUMS
MAY ALSO BE COMBINED WITH  DISINCENTIVES  OR  REQUIREMENTS  DESIGNED  TO
MITIGATE ANY INCENTIVES TO OBTAIN HIGHER PAYMENT CATEGORIES.
  11.  CONTINUATION  OF  CERTIFICATE  OF  AUTHORITY.   CONTINUATION OF A
CERTIFICATE OF AUTHORITY ISSUED UNDER THIS SECTION SHALL  BE  CONTINGENT
UPON  COMPLIANCE BY THE DISCO WITH APPLICABLE PROVISIONS OF THIS SECTION
AND RULES AND REGULATIONS PROMULGATED THEREUNDER; THE CONTINUING  FISCAL
SOLVENCY  OF  THE DISCO; AND FEDERAL FINANCIAL PARTICIPATION IN PAYMENTS
ON BEHALF OF ENROLLEES WHO ARE ELIGIBLE TO RECEIVE SERVICES UNDER  TITLE
XIX OF THE FEDERAL SOCIAL SECURITY ACT.
  12.  PROTECTION  OF  ENROLLEES.    THE COMMISSIONER MAY, IN HIS OR HER
DISCRETION AND WITH THE CONCURRENCE OF THE COMMISSIONER OF DEVELOPMENTAL
DISABILITIES, FOR THE PURPOSE OF THE  PROTECTION  OF  ENROLLEES,  IMPOSE
MEASURES INCLUDING, BUT NOT LIMITED TO BANS ON FURTHER ENROLLMENTS UNTIL
ANY  IDENTIFIED PROBLEMS ARE RESOLVED TO THE SATISFACTION OF THE COMMIS-
SIONER, OR FINES UPON A FINDING THAT THE DISCO HAS FAILED TO COMPLY WITH
THE PROVISIONS OF ANY APPLICABLE STATUTE, RULE OR REGULATION.
  13. INFORMATION SHARING.   THE COMMISSIONER AND  THE  COMMISSIONER  OF
DEVELOPMENTAL  DISABILITIES  SHALL,  AS  NECESSARY  AND  CONSISTENT WITH
FEDERAL REGULATIONS PROMULGATED PURSUANT TO THE HEALTH INSURANCE  PORTA-
BILITY  AND ACCOUNTABILITY ACT, SHARE WITH SUCH DISCO THE FOLLOWING DATA
IF IT IS AVAILABLE:
  (A) INFORMATION CONCERNING UTILIZATION OF SERVICES  AND  PROVIDERS  BY
EACH OF ITS ENROLLEES PRIOR TO AND DURING ENROLLMENT.

S. 2606                            44                            A. 3006

  (B)  AGGREGATE DATA CONCERNING UTILIZATION AND COSTS FOR ENROLLEES AND
FOR COMPARABLE  COHORTS  SERVED  THROUGH  THE  MEDICAID  FEE-FOR-SERVICE
PROGRAM.
  14.  CONTRACTS.    NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS
SECTION AND SECTIONS ONE HUNDRED TWELVE AND ONE HUNDRED  SIXTY-THREE  OF
THE  STATE  FINANCE  LAW,  THE  COMMISSIONER,  IN  CONSULTATION WITH THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES,  MAY  CONTRACT  WITH  DISCOS
APPROVED  UNDER  THIS  SECTION  WITHOUT A COMPETITIVE BID OR REQUEST FOR
PROPOSAL PROCESS, TO PROVIDE COVERAGE FOR  ENROLLEES  PURSUANT  TO  THIS
SECTION. NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS SECTION AND
SECTION  ONE  HUNDRED  FORTY-THREE  OF  THE ECONOMIC DEVELOPMENT LAW, NO
NOTICE IN THE PROCUREMENT OPPORTUNITIES NEWSLETTER SHALL BE REQUIRED FOR
CONTRACTS AWARDED BY THE COMMISSIONER TO QUALIFIED  DISCOS  PURSUANT  TO
THIS SECTION.
  15.  APPLICABILITY  OF  OTHER  LAWS.    DISCOS SHALL BE SUBJECT TO THE
PROVISIONS OF THE INSURANCE LAW AND  REGULATIONS  APPLICABLE  TO  HEALTH
MAINTENANCE  ORGANIZATIONS,  THIS  ARTICLE  AND  REGULATIONS PROMULGATED
THEREUNDER. TO THE EXTENT THAT THE PROVISIONS OF THIS SECTION ARE INCON-
SISTENT WITH THE PROVISIONS OF THIS CHAPTER OR  THE  PROVISIONS  OF  THE
INSURANCE LAW, THE PROVISIONS OF THIS SECTION SHALL PREVAIL.
  16. EFFECTIVENESS. THE PROVISIONS OF THIS SECTION SHALL ONLY BE EFFEC-
TIVE  IF,  FOR  SO  LONG  AS,  AND  TO THE EXTENT THAT FEDERAL FINANCIAL
PARTICIPATION IS AVAILABLE FOR THE COSTS OF  SERVICES  PROVIDED  BY  THE
DISCOS TO ENROLLEES WHO ARE RECIPIENTS OF MEDICAL ASSISTANCE PURSUANT TO
TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. THE COMMISSION-
ER  SHALL  MAKE  ANY  NECESSARY AMENDMENTS TO THE STATE PLAN FOR MEDICAL
ASSISTANCE SUBMITTED PURSUANT TO SECTION THREE HUNDRED SIXTY-THREE-A  OF
THE  SOCIAL  SERVICES  LAW,  IN  ORDER  TO ENSURE SUCH FEDERAL FINANCIAL
PARTICIPATION.
  S 74. Section 4403 of the public health law is amended by adding a new
subdivision 8 to read as follows:
  8. NOTWITHSTANDING ANY PROVISION OF LAW  TO  THE  CONTRARY,  A  HEALTH
MAINTENANCE  ORGANIZATION  MAY  EXPAND ITS COMPREHENSIVE HEALTH SERVICES
PLAN TO INCLUDE SERVICES  OPERATED,  CERTIFIED,  FUNDED,  AUTHORIZED  OR
APPROVED  BY  THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND
MAY OFFER SUCH EXPANDED PLAN TO A POPULATION OF  PERSONS  WITH  DEVELOP-
MENTAL  DISABILITIES, AS SUCH TERM IS DEFINED IN THE MENTAL HYGIENE LAW,
SUBJECT TO THE FOLLOWING:
  (A) SUCH ORGANIZATION MUST HAVE THE ABILITY TO PROVIDE  OR  COORDINATE
SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, AS DEMONSTRATED BY
CRITERIA  TO  BE  DETERMINED BY THE COMMISSIONER AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES;
  (B) THE PROVISION BY SUCH ORGANIZATION OF  SERVICES  OPERATED,  CERTI-
FIED,  FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE OFFICE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES SHALL BE SUBJECT TO THE JOINT  OVERSIGHT  AND
REVIEW  OF  BOTH  THE DEPARTMENT AND THE OFFICE FOR PEOPLE WITH DEVELOP-
MENTAL DISABILITIES;
  (C) SUCH ORGANIZATION SHALL NOT PROVIDE OR ARRANGE FOR SERVICES  OPER-
ATED, CERTIFIED, FUNDED, AUTHORIZED OR APPROVED BY THE OFFICE FOR PEOPLE
WITH  DEVELOPMENTAL DISABILITIES UNTIL THE COMMISSIONER AND COMMISSIONER
OF DEVELOPMENTAL DISABILITIES APPROVE PROGRAM FEATURES  AND  RATES  THAT
INCLUDE  SUCH  SERVICES,  AND DETERMINE THAT SUCH ORGANIZATION MEETS THE
REQUIREMENTS OF THIS PARAGRAPH;
  (D) AN OTHERWISE ELIGIBLE ENROLLEE RECEIVING SERVICES THROUGH THE PLAN
THAT ARE OPERATED, CERTIFIED, FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT BE INVOLUN-

S. 2606                            45                            A. 3006

TARILY DISENROLLED FROM SUCH PLAN WITHOUT  THE  PRIOR  APPROVAL  OF  THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES;
  (E) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL DETER-
MINE  THE ELIGIBILITY OF INDIVIDUALS RECEIVING SERVICES OPERATED, CERTI-
FIED, FUNDED, AUTHORIZED OR APPROVED BY SUCH OFFICE TO ENROLL IN SUCH  A
PLAN  AND  SHALL  ENROLL  INDIVIDUALS IT DETERMINES ELIGIBLE IN THE PLAN
CHOSEN BY SUCH INDIVIDUAL, GUARDIAN OR OTHER LEGAL REPRESENTATIVE;
  (F) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, OR IF IT SO
DESIGNATES, THE HEALTH MAINTENANCE ORGANIZATION OR OTHER DESIGNEE, SHALL
COMPLETE A COMPREHENSIVE ASSESSMENT FOR ENROLLEES THAT RECEIVE  SERVICES
OPERATED,  CERTIFIED,  FUNDED,  AUTHORIZED  OR  APPROVED BY SUCH OFFICE.
THIS ASSESSMENT SHALL INCLUDE, BUT NOT BE LIMITED TO, AN  EVALUATION  OF
THE  MEDICAL,  SOCIAL AND ENVIRONMENTAL NEEDS OF EACH PROSPECTIVE ENROL-
LEE. THIS ASSESSMENT SHALL ALSO SERVE AS THE BASIS FOR  THE  DEVELOPMENT
AND  PROVISION  OF  AN  APPROPRIATE  PLAN  OF CARE FOR THE ENROLLEE. THE
ASSESSMENT SHALL BE COMPLETED BY SUCH OFFICE OR ITS DESIGNEE, IN CONSUL-
TATION WITH THE  PROSPECTIVE  ENROLLEE'S  HEALTH  CARE  PRACTITIONER  AS
NECESSARY.   THE   COMMISSIONER   OF  DEVELOPMENTAL  DISABILITIES  SHALL
PRESCRIBE THE FORMS ON WHICH THE ASSESSMENT SHALL BE MADE.
  (G) NO PERSON WITH A DEVELOPMENTAL DISABILITY  SHALL  BE  REQUIRED  TO
ENROLL IN A COMPREHENSIVE HEALTH SERVICES PLAN AS A CONDITION OF RECEIV-
ING MEDICAL ASSISTANCE AND SERVICES OPERATED, CERTIFIED, FUNDED, AUTHOR-
IZED  OR  APPROVED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILI-
TIES UNTIL PROGRAM FEATURES AND REIMBURSEMENT RATES ARE APPROVED BY  THE
COMMISSIONER  AND  THE  COMMISSIONER  OF  DEVELOPMENTAL DISABILITIES AND
UNTIL SUCH COMMISSIONERS DETERMINE THAT THERE ARE A SUFFICIENT NUMBER OF
PLANS AUTHORIZED TO COORDINATE CARE FOR INDIVIDUALS  WITH  DEVELOPMENTAL
DISABILITIES  PURSUANT  TO THIS ARTICLE OPERATING IN THE PERSON'S COUNTY
OF RESIDENCE TO MEET THE NEEDS OF PERSONS WITH  DEVELOPMENTAL  DISABILI-
TIES, AND THAT SUCH PLANS MEET THE STANDARDS OF THIS SECTION.
  (H) THE PROVISIONS OF THIS SUBDIVISION SHALL ONLY BE EFFECTIVE IF, FOR
SO  LONG  AS,  AND TO THE EXTENT THAT FEDERAL FINANCIAL PARTICIPATION IS
AVAILABLE FOR THE COSTS OF SERVICES PROVIDED HEREUNDER TO RECIPIENTS  OF
MEDICAL  ASSISTANCE  PURSUANT  TO  TITLE  ELEVEN  OF ARTICLE FIVE OF THE
SOCIAL SERVICES LAW. THE COMMISSIONER SHALL MAKE  ANY  NECESSARY  AMEND-
MENTS  TO  THE  STATE  PLAN FOR MEDICAL ASSISTANCE SUBMITTED PURSUANT TO
SECTION THREE HUNDRED SIXTY-THREE-A OF THE SOCIAL SERVICES  LAW,  AND/OR
SUBMIT  ONE OR MORE APPLICATIONS FOR WAIVERS OF THE FEDERAL SOCIAL SECU-
RITY ACT, AS MAY BE NECESSARY TO ENSURE SUCH FEDERAL  FINANCIAL  PARTIC-
IPATION.  TO  THE  EXTENT  THAT  THE  PROVISIONS OF THIS SUBDIVISION ARE
INCONSISTENT  WITH  OTHER  PROVISIONS  OF  THIS  ARTICLE  OR  WITH   THE
PROVISIONS  OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES
LAW, THE PROVISIONS OF THIS SUBDIVISION SHALL PREVAIL.
  S 75. The opening paragraph of  paragraph  (h)  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:
  The commissioner AND, IN THE CASE OF A PLAN ARRANGING FOR OR PROVIDING
SERVICES OPERATED, CERTIFIED, FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR  PEOPLE WITH DEVELOPMENTAL DISABILITIES, THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES, shall, upon request by a managed  long  term
care  plan or operating demonstration, and consistent with federal regu-
lations promulgated pursuant to the  Health  Insurance  Portability  and
Accountability  Act, share with such plan or demonstration the following
data if it is available:
  S 76. Section 4403-f of the public health law  is  amended  by  adding
three new subdivisions 12, 13 and 14 to read as follows:

S. 2606                            46                            A. 3006

  12. NOTWITHSTANDING ANY PROVISION TO THE CONTRARY, A MANAGED LONG TERM
CARE PLAN MAY EXPAND THE SERVICES IT PROVIDES OR ARRANGES FOR TO INCLUDE
SERVICES  OPERATED,  CERTIFIED,  FUNDED,  AUTHORIZED  OR APPROVED BY THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES FOR  A  POPULATION  OF
PERSONS  WITH DEVELOPMENTAL DISABILITIES, AS SUCH TERM IS DEFINED IN THE
MENTAL HYGIENE LAW, SUBJECT TO THE FOLLOWING:
  (A) SUCH PLAN MUST HAVE THE ABILITY TO PROVIDE OR COORDINATE  SERVICES
FOR  PERSONS WITH DEVELOPMENTAL DISABILITIES AS DEMONSTRATED BY CRITERIA
TO BE DETERMINED BY THE COMMISSIONER AND THE  COMMISSIONER  OF  DEVELOP-
MENTAL DISABILITIES;
  (B)  THE PROVISION BY SUCH PLAN OF SERVICES OPERATED, CERTIFIED, FUND-
ED, AUTHORIZED OR APPROVED BY THE OFFICE FOR PEOPLE  WITH  DEVELOPMENTAL
DISABILITIES  SHALL BE SUBJECT TO THE JOINT OVERSIGHT AND REVIEW OF BOTH
THE DEPARTMENT AND THE OFFICE FOR PEOPLE  WITH  DEVELOPMENTAL  DISABILI-
TIES;
  (C)  SUCH  PLAN  SHALL  NOT  PROVIDE OR ARRANGE FOR SERVICES OPERATED,
CERTIFIED, FUNDED, AUTHORIZED OR APPROVED BY THE OFFICE FOR PEOPLE  WITH
DEVELOPMENTAL  DISABILITIES  UNTIL  THE COMMISSIONER AND COMMISSIONER OF
DEVELOPMENTAL DISABILITIES  APPROVE  PROGRAM  FEATURES  AND  RATES  THAT
INCLUDE  SUCH  SERVICES,  AND DETERMINE THAT SUCH ORGANIZATION MEETS THE
REQUIREMENTS OF THIS SUBDIVISION;
  (D) AN OTHERWISE ELIGIBLE ENROLLEE RECEIVING SERVICES THROUGH THE PLAN
THAT ARE OPERATED, CERTIFIED, FUNDED,  AUTHORIZED  OR  APPROVED  BY  THE
OFFICE  FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT BE INVOLUN-
TARILY DISENROLLED FROM SUCH PLAN WITHOUT  THE  PRIOR  APPROVAL  OF  THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES;
  (E) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL DETER-
MINE  THE ELIGIBILITY OF INDIVIDUALS RECEIVING SERVICES OPERATED, CERTI-
FIED, FUNDED, AUTHORIZED OR APPROVED BY SUCH OFFICE TO ENROLL IN SUCH  A
PLAN.  SUCH  OFFICE OR ITS DESIGNEE SHALL ENROLL ELIGIBLE INDIVIDUALS IT
DETERMINES ELIGIBLE IN A PLAN CHOSEN BY  SUCH  INDIVIDUAL,  GUARDIAN  OR
OTHER LEGAL REPRESENTATIVE;
  (F) THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, OR IF IT SO
DESIGNATES,  A  PLAN  OR  OTHER DESIGNEE, SHALL COMPLETE A COMPREHENSIVE
ASSESSMENT FOR ENROLLEES WHO RECEIVE SERVICES OPERATED, CERTIFIED, FUND-
ED, AUTHORIZED OR APPROVED  BY  SUCH  OFFICE.    THIS  ASSESSMENT  SHALL
INCLUDE, BUT NOT BE LIMITED TO, AN EVALUATION OF THE MEDICAL, SOCIAL AND
ENVIRONMENTAL  NEEDS OF EACH PROSPECTIVE ENROLLEE. THIS ASSESSMENT SHALL
ALSO SERVE AS THE BASIS FOR THE DEVELOPMENT AND PROVISION OF  AN  APPRO-
PRIATE  PLAN OF CARE FOR THE ENROLLEE. THE ASSESSMENT SHALL BE COMPLETED
BY THE OFFICE OR, IF DESIGNATED, THE  PLAN,  IN  CONSULTATION  WITH  THE
PROSPECTIVE  ENROLLEE'S  HEALTH  CARE  PRACTITIONER  AS  NECESSARY.  THE
COMMISSIONER OF DEVELOPMENTAL DISABILITIES SHALL PRESCRIBE THE FORMS  ON
WHICH THE ASSESSMENT SHALL BE MADE.
  (G)  NO  PERSON  WITH  A DEVELOPMENTAL DISABILITY SHALL BE REQUIRED TO
ENROLL IN A MANAGED LONG TERM CARE PLAN  AS  A  CONDITION  OF  RECEIVING
MEDICAL  ASSISTANCE AND SERVICES OPERATED, CERTIFIED, FUNDED, AUTHORIZED
OR APPROVED BY THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES
UNTIL  PROGRAM  FEATURES  AND  REIMBURSEMENT  RATES  ARE APPROVED BY THE
COMMISSIONER AND THE  COMMISSIONER  OF  DEVELOPMENTAL  DISABILITIES  AND
UNTIL SUCH COMMISSIONERS DETERMINE THAT THERE ARE A SUFFICIENT NUMBER OF
PLANS  AUTHORIZED  TO COORDINATE CARE FOR INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES PURSUANT TO THIS ARTICLE OPERATING IN THE  PERSON'S  COUNTY
OF  RESIDENCE  TO MEET THE NEEDS OF PERSONS WITH DEVELOPMENTAL DISABILI-
TIES, AND THAT SUCH PLANS MEET THE STANDARDS OF THIS SECTION.

S. 2606                            47                            A. 3006

  13. NOTWITHSTANDING ANY INCONSISTENT PROVISION TO  THE  CONTRARY,  THE
COMMISSIONER  MAY ISSUE A CERTIFICATE OF AUTHORITY TO NO MORE THAN THREE
ELIGIBLE APPLICANTS TO OPERATE MANAGED LONG TERM PLANS THAT ARE  AUTHOR-
IZED  TO EXCLUSIVELY ENROLL INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES,
AS  SUCH  TERM IS DEFINED IN SECTION 1.03 OF THE MENTAL HYGIENE LAW. THE
COMMISSIONER MAY ONLY ISSUE CERTIFICATES OF AUTHORITY PURSUANT  TO  THIS
SUBDIVISION  IF,  AND  TO  THE  EXTENT THAT, THE DEPARTMENT HAS RECEIVED
FEDERAL APPROVAL TO OPERATE A FULLY INTEGRATED DUALS  ADVANTAGE  PROGRAM
FOR  THE  INTEGRATION  OF  SERVICES FOR PERSONS ENROLLED IN MEDICARE AND
MEDICAID.   THE COMMISSIONER MAY WAIVE ANY  OF  THE  DEPARTMENT'S  REGU-
LATIONS  AS  THE  COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES, DEEMS NECESSARY TO ALLOW SUCH  MANAGED  LONG
TERM  PLANS  TO  PROVIDE  OR  ARRANGE  FOR SERVICES FOR INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES THAT ARE ADEQUATE AND APPROPRIATE TO MEET THE
NEEDS OF SUCH INDIVIDUALS AND THAT WILL ENSURE THEIR HEALTH AND SAFETY.
  14. THE PROVISIONS OF SUBDIVISIONS TWELVE AND THIRTEEN OF THIS SECTION
SHALL ONLY BE EFFECTIVE IF, FOR SO LONG  AS,  AND  TO  THE  EXTENT  THAT
FEDERAL  FINANCIAL  PARTICIPATION IS AVAILABLE FOR THE COSTS OF SERVICES
PROVIDED THEREUNDER TO RECIPIENTS  OF  MEDICAL  ASSISTANCE  PURSUANT  TO
TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. THE COMMISSION-
ER  SHALL  MAKE  ANY  NECESSARY AMENDMENTS TO THE STATE PLAN FOR MEDICAL
ASSISTANCE SUBMITTED PURSUANT TO SECTION THREE HUNDRED SIXTY-THREE-A  OF
THE  SOCIAL  SERVICES  LAW,  AND/OR  SUBMIT ONE OR MORE APPLICATIONS FOR
WAIVERS OF THE FEDERAL SOCIAL SECURITY  ACT,  AS  MAY  BE  NECESSARY  TO
ENSURE  SUCH  FEDERAL  FINANCIAL  PARTICIPATION.  TO THE EXTENT THAT THE
PROVISIONS OF SUBDIVISIONS TWELVE  AND  THIRTEEN  OF  THIS  SECTION  ARE
INCONSISTENT   WITH  OTHER  PROVISIONS  OF  THIS  ARTICLE  OR  WITH  THE
PROVISIONS OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL  SERVICES
LAW, THE PROVISIONS OF THIS SUBDIVISION SHALL PREVAIL.
  S  77.  Subparagraph (ii) of paragraph (b) of subdivision 1 of section
364-j of the social services law, as amended by chapter 433 of the  laws
of  1997,  is  amended  and a new subparagraph (iii) is added to read as
follows:
  (ii) is authorized  as  a  partially  capitated  program  pursuant  to
section  three  hundred sixty-four-f of this title or section forty-four
hundred three-e of the public health law or section 1915b of the  social
security act[.]; OR
  (III)  IS  AUTHORIZED  TO  OPERATE  UNDER  SECTION  FORTY-FOUR HUNDRED
THREE-G OF THE PUBLIC HEALTH LAW.
  S 78. Section 364-j of the social services law is amended by adding  a
new subdivision 28 to read as follows:
  28.  TO  THE EXTENT THAT ANY PROVISION OF THIS SECTION IS INCONSISTENT
WITH ANY PROVISION OF SECTION FORTY-FOUR HUNDRED THREE-G OF  THE  PUBLIC
HEALTH  LAW, SUCH PROVISION OF THIS SECTION SHALL NOT APPLY TO AN ENTITY
AUTHORIZED TO OPERATE PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-G  OF
THE PUBLIC HEALTH LAW.
  S  79.  Subdivision  2  of section 365-a of the social services law is
amended by adding a new paragraph (aa) to read as follows:
  (AA) CARE AND SERVICES FURNISHED BY A DEVELOPMENTAL  DISABILITY  INDI-
VIDUAL  SUPPORT  AND  CARE  COORDINATION  ORGANIZATION  (DISCO) THAT HAS
RECEIVED A CERTIFICATE  OF  AUTHORITY  PURSUANT  TO  SECTION  FORTY-FOUR
HUNDRED  THREE-G OF THE PUBLIC HEALTH LAW TO ELIGIBLE INDIVIDUALS RESID-
ING IN THE GEOGRAPHIC AREA SERVED BY SUCH ENTITY, WHEN SUCH SERVICES ARE
FURNISHED IN ACCORDANCE WITH AN AGREEMENT APPROVED BY THE DEPARTMENT  OF
HEALTH WHICH MEETS THE REQUIREMENTS OF FEDERAL LAW AND REGULATIONS.

S. 2606                            48                            A. 3006

  S  80.  The  commissioner  of  health  shall, to the extent necessary,
submit the appropriate waivers, including, but  not  limited  to,  those
authorized  pursuant  to  sections  eleven  hundred fifteen and nineteen
hundred fifteen  of  the  federal  social  security  act,  or  successor
provisions,  and  any other waivers necessary to achieve the purposes of
high quality, integrated and cost effective care and  integrated  finan-
cial eligibility policies under the medical assistance program or pursu-
ant  to  title  XVIII  of the federal social security act and to require
medical  assistance  recipients  with  developmental  disabilities   who
require  home  and community-based services, as specified by the commis-
sioner, to receive  such  services  through  an  available  organization
certified  pursuant  to  article  44 of the public health law. Copies of
such original  waiver  applications  and  amendments  thereto  shall  be
provided  to  the  chairs  of the senate finance committee, the assembly
ways and means committee and the senate and assembly  health  committees
simultaneously with their submission to the federal government.
  S 81. 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 82. 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 83. 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 84. This act shall take effect immediately and shall  be  deemed  to
have  been  in full force and effect on and after April 1, 2013 provided
that:
  1. the amendments to subdivision 10 of section 2807-c  of  the  public
health law, made by section four of this act, shall not affect the expi-
ration of such subdivision and shall be deemed repealed therewith;
  1-a.  sections ten, eleven, twelve and thirteen of this act shall take
effect July 1, 2013;
  2. any rules or regulations necessary to implement the  provisions  of
this  act  may be promulgated and any procedures, forms, or instructions
necessary for such implementation may be adopted and issued on or  after
the date this act shall have become a law;
  3. this act shall not be construed to alter, change, affect, impair or
defeat any rights, obligations, duties or interests accrued, incurred or
conferred prior to the effective date of this act;
  4.  the  commissioner  of  health  and the superintendent of financial
services and any appropriate council may take  any  steps  necessary  to
implement this act prior to its effective date;

S. 2606                            49                            A. 3006

  5. notwithstanding any inconsistent provision of the state administra-
tive  procedure  act  or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of financial  services
and  any  appropriate council is authorized to adopt or amend or promul-
gate  on  an  emergency  basis  any regulation he or she or such council
determines necessary to implement any  provision  of  this  act  on  its
effective date;
  6.  the  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;
  7. the amendments to subparagraph (ii) of paragraph (b) of subdivision
9 of section 367-a of the social services law made by  section  thirteen
of  this  act  shall  not  affect the expiration of such subdivision and
shall be deemed to expire therewith;
  8. the amendments to paragraph  (a-2)  of  subdivision  1  of  section
2807-c  of the public health law made by sections thirty-one and thirty-
two of this act shall not affect the expiration of  such  paragraph  and
shall be deemed to expire therewith;
  9.  the amendments to section 364-j of the social services law made by
sections thirty-five-a, thirty-six, thirty-seven, thirty-eight,  thirty-
nine,  forty,  forty-one, forty-two, forty-three, forty-four, fifty-two,
seventy-two, seventy-seven and  seventy-eight  of  this  act  shall  not
affect  the  repeal  of such section and shall be deemed repealed there-
with;
  10. section forty-eight-a of this  act  shall  expire  and  be  deemed
repealed March 31, 2015; and
  11.  the amendments to section 4403-f of the public health law made by
sections forty-eight, fifty-three, fifty-four, sixty-five,  seventy-five
and  seventy-six of this act shall not affect the repeal of such section
and shall be deemed repealed therewith.

                                 PART B

  Section 1. Subdivision (f) of section 129 of part C of chapter  58  of
the  laws of 2009, amending the public health law relating to payment by
governmental  agencies  for  general  hospital  inpatient  services,  is
amended to read as follows:
  (f)  section  twenty-five  of  this  act  shall  expire  and be deemed
repealed April 1, [2013] 2016;
  S 2. Paragraph (a) of subdivision 1 of section 212 of chapter  474  of
the  laws of 1996, amending the education law and other laws relating to
rates for residential healthcare facilities, as amended by section 2  of
part D of chapter 59 of the laws of 2011, is amended to read as follows:
  (a) Notwithstanding any inconsistent provision of law or regulation to
the  contrary,  effective beginning August 1, 1996, for the period April
1, 1997 through March 31, 1998, April 1, 1998 for the  period  April  1,
1998  through  March  31,  1999, August 1, 1999, for the period April 1,
1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
through March 31, 2001, April 1, 2001, for  the  period  April  1,  2001
through  March  31,  2002,  April  1, 2002, for the period April 1, 2002
through March 31, 2003, and for the state fiscal year beginning April 1,
2005 through March 31, 2006, and for the  state  fiscal  year  beginning
April  1,  2006  through  March  31, 2007, and for the state fiscal year
beginning April 1, 2007 through March 31, 2008, and for the state fiscal
year beginning April 1, 2008 through March 31, 2009, and for  the  state

S. 2606                            50                            A. 3006

fiscal  year beginning April 1, 2009 through March 31, 2010, and for the
state fiscal year beginning April 1, 2010 through March  31,  2013,  AND
FOR  EACH  STATE  FISCAL  YEAR  THEREAFTER,  the department of health is
authorized to pay public general hospitals, as defined in subdivision 10
of  section  2801 of the public health law, operated by the state of New
York or by the state university of New York or by a county, which  shall
not  include  a city with a population of over one million, of the state
of New York, and those public general hospitals located in the county of
Westchester, the county of Erie or  the  county  of  Nassau,  additional
payments  for inpatient hospital services as medical assistance payments
pursuant to title 11 of  article  5  of  the  social  services  law  for
patients eligible for federal financial participation under title XIX of
the  federal  social  security act in medical assistance pursuant to the
federal laws and regulations governing disproportionate  share  payments
to  hospitals  up  to  one  hundred  percent of each such public general
hospital's medical assistance and uninsured  patient  losses  after  all
other  medical  assistance, including disproportionate share payments to
such public general hospital for  1996,  1997,  1998,  and  1999,  based
initially  for  1996  on reported 1994 reconciled data as further recon-
ciled to actual reported  1996  reconciled  data,  and  for  1997  based
initially  on  reported  1995  reconciled  data as further reconciled to
actual reported 1997  reconciled  data,  for  1998  based  initially  on
reported  1995  reconciled data as further reconciled to actual reported
1998 reconciled data, for 1999 based initially on reported  1995  recon-
ciled  data  as  further  reconciled  to actual reported 1999 reconciled
data, for 2000 based initially  on  reported  1995  reconciled  data  as
further reconciled to actual reported 2000 data, for 2001 based initial-
ly  on  reported  1995  reconciled  data as further reconciled to actual
reported 2001 data, for 2002 based initially on reported 2000 reconciled
data as further reconciled to actual reported 2002 data, and  for  state
fiscal  years  beginning  on  April 1, 2005, based initially on reported
2000 reconciled data as further reconciled to actual reported  data  for
2005,  and  for  state  fiscal  years  beginning on April 1, 2006, based
initially on reported 2000 reconciled  data  as  further  reconciled  to
actual  reported  data for 2006, for state fiscal years beginning on and
after April 1, 2007 through March 31, 2009, based initially on  reported
2000  reconciled  data as further reconciled to actual reported data for
2007 and 2008, respectively, for state fiscal  years  beginning  on  and
after  April  1, 2009, based initially on reported 2007 reconciled data,
adjusted for authorized Medicaid rate changes applicable  to  the  state
fiscal year, and as further reconciled to actual reported data for 2009,
for  state  fiscal  years  beginning  on  and after April 1, 2010, based
initially on reported reconciled data from the base year two years prior
to the payment year,  adjusted  for  authorized  Medicaid  rate  changes
applicable  to  the  state fiscal year, and further reconciled to actual
reported data from such payment year, and to actual  reported  data  for
each  respective succeeding year.  The payments may be added to rates of
payment or made as aggregate payments  to  an  eligible  public  general
hospital.
  S  3.  Section  11  of  chapter  884 of the laws of 1990, amending the
public health law relating to authorizing  bad  debt  and  charity  care
allowances  for  certified home health agencies, as amended by section 3
of part D of chapter 59 of the laws of  2011,  is  amended  to  read  as
follows:
  S 11. This act shall take effect immediately and:
  (a) sections one and three shall expire on December 31, 1996,

S. 2606                            51                            A. 3006

  (b)  sections  four  through ten shall expire on June 30, [2013] 2018,
and
  (c) provided that the amendment to section 2807-b of the public health
law  by  section two of this act shall not affect the expiration of such
section 2807-b as otherwise provided by  law  and  shall  be  deemed  to
expire therewith.
  S  4.  Subdivision 2 of section 246 of chapter 81 of the laws of 1995,
amending the public health  law  and  other  laws  relating  to  medical
reimbursement  and  welfare reform, as amended by section 4 of part D of
chapter 59 of the laws of 2011, is amended to read as follows:
  2. Sections five, seven through nine,  twelve  through  fourteen,  and
eighteen  of  this  act  shall  be deemed to have been in full force and
effect on and after April 1, 1995 through March  31,  1999  and  on  and
after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
through  March 31, 2003 and on and after April 1, 2003 through March 31,
2006 and on and after April 1, 2006 through March 31, 2007  and  on  and
after  April  1,  2007  through March 31, 2009 and on and after April 1,
2009 through March 31, 2011 and sections twelve, thirteen  and  fourteen
of  this act shall be deemed to be in full force and effect on and after
April 1, 2011 [through March 31, 2013];
  S 5. Subparagraph (vi) of paragraph (b) of subdivision  2  of  section
2807-d  of the public health law, as amended by section 102 of part H of
chapter 59 of the laws of 2011, is amended to read as follows:
  (vi) Notwithstanding any contrary provision of this paragraph  or  any
other  provision  of  law or regulation to the contrary, for residential
health care facilities the assessment shall be six percent of each resi-
dential health care facility's gross receipts received from all  patient
care  services and other operating income on a cash basis for the period
April first, two thousand two through March thirty-first,  two  thousand
three  for  hospital  or  health-related  services,  including adult day
services; provided, however, that residential  health  care  facilities'
gross receipts attributable to payments received pursuant to title XVIII
of the federal social security act (medicare) shall be excluded from the
assessment; provided, however, that for all such gross receipts received
on  or after April first, two thousand three through March thirty-first,
two thousand five, such assessment shall be five  percent,  and  further
provided  that  for  all  such gross receipts received on or after April
first, two thousand five through March thirty-first, two thousand  nine,
and  on  or  after  April first, two thousand nine through March thirty-
first, two thousand eleven such assessment shall  be  six  percent,  and
further  provided  that for all such gross receipts received on or after
April first, two thousand eleven [through March thirty-first, two  thou-
sand thirteen] such assessment shall be six percent.
  S  6.  Section 88 of chapter 659 of the laws of 1997, constituting the
long term care integration and finance act of 1997, as amended by  chap-
ter 446 of the laws of 2011, is amended to read as follows:
  S  88. Notwithstanding any provision of law to the contrary, all oper-
ating demonstrations, as such term is defined in paragraph (c) of subdi-
vision 1 of section 4403-f of the public health law as added by  section
eighty-two  of this act, due to expire prior to January 1, 2001 shall be
deemed to [expire on December 31, 2013] REMAIN IN FULL FORCE AND  EFFECT
SUBSEQUENT TO SUCH DATE.
  S  7.  Subparagraph  (v) of paragraph (b) of subdivision 35 of section
2807-c of the public health law, as amended by section 2 of  part  G  of
chapter 56 of the laws of 2012, is amended to read as follows:

S. 2606                            52                            A. 3006

  (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   [thirteen]   FOURTEEN,   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
[thirteen] FOURTEEN and as a result of decreased PPNOs during the period
April  first,  two thousand eleven through March thirty-first, two thou-
sand [thirteen] FOURTEEN; and provided further that for the period  July
first,  two thousand ten through March thirty-first, two thousand [thir-
teen] FOURTEEN, such rate adjustments or payment disallowances shall not
apply to behavioral health PPRs; or to readmissions  that  occur  on  or
after fifteen days following an initial admission. By no later than July
first,  two  thousand eleven the commissioner shall enter into consulta-
tions with representatives of the health care facilities subject to this
section regarding potential prospective revisions to applicable  method-
ologies  and benchmarks set forth in regulations issued pursuant to this
subparagraph;
  S 8.  Subdivision 2 of section 93 of part C of chapter 58 of the  laws
of  2007  amending  the  social  services law and other laws relating to
enacting the major components of legislation necessary to implement  the
health  and  mental  hygiene  budget  for  the 2007-2008 fiscal year, as
amended by section 10 of part B of chapter 58 of the laws  of  2009,  is
amended to read as follows:
  2.  section  two  of  this  act shall expire and be deemed repealed on
March 31, [2013] 2014;
  S 8-a. Subdivision 8 of section 364-l of the social  services  law  is
REPEALED.
  S  9.  Section  194  of  chapter 474 of the laws of 1996, amending the
education law and other laws relating to rates  for  residential  health
care  facilities, as amended by section 9 of part D of chapter 59 of the
laws of 2011, is amended to read as follows:
  S 194. 1. Notwithstanding any inconsistent provision of law  or  regu-
lation,  the  trend factors used to project reimbursable operating costs
to the rate period for purposes of determining rates of payment pursuant
to article 28 of the public  health  law  for  residential  health  care
facilities  for reimbursement of inpatient services provided to patients
eligible for payments made by state governmental agencies on  and  after
April  1, 1996 through March 31, 1999 and for payments made on and after
July 1, 1999 through March 31, 2000 and  on  and  after  April  1,  2000
through  March 31, 2003 and on and after April 1, 2003 through March 31,
2007 and on and after April 1, 2007 through March 31, 2009  and  on  and
after  April  1,  2009  through March 31, 2011 and on and after April 1,

S. 2606                            53                            A. 3006

2011 [through March 31, 2013] shall reflect no trend factor  projections
or adjustments for the period April 1, 1996, through March 31, 1997.
  2.  The  commissioner  of health shall adjust such rates of payment to
reflect the exclusion pursuant to this section of such  specified  trend
factor projections or adjustments.
  S  10.  Subdivision  1  of section 89-a of part C of chapter 58 of the
laws of 2007, amending the social services law and other  laws  relating
to  enacting  the major components of legislation necessary to implement
the health and mental hygiene budget  for  the  2007-2008  state  fiscal
year,  as  amended  by section 10 of part D of chapter 59 of the laws of
2011, is amended to read as follows:
  1. Notwithstanding paragraph (c) of subdivision 10 of  section  2807-c
of  the  public  health  law  and section 21 of chapter 1 of the laws of
1999, as amended, and any other inconsistent provision of law  or  regu-
lation  to  the  contrary,  in  determining  rates  of payments by state
governmental agencies effective for services provided beginning April 1,
2006, through March 31, 2009, and on and after  April  1,  2009  through
March  31, 2011, and on and after April 1, 2011 [through March 31, 2013]
for inpatient and outpatient services provided by general hospitals  and
for  inpatient  services  and  outpatient adult day health care services
provided by residential health care facilities pursuant to article 28 of
the public health law, the commissioner of health shall  apply  a  trend
factor projection of two and twenty-five hundredths percent attributable
to  the  period  January  1,  2006 through December 31, 2006, and on and
after January 1, 2007, provided, however, that on reconciliation of such
trend factor for the period January 1, 2006 through  December  31,  2006
pursuant  to  paragraph  (c)  of subdivision 10 of section 2807-c of the
public health law, such trend factor shall  be  the  final  US  Consumer
Price  Index  (CPI)  for  all  urban  consumers,  as published by the US
Department  of  Labor,  Bureau  of  Labor  Statistics  less  twenty-five
hundredths of a percentage point.
  S  11.  Paragraph  (f) of subdivision 1 of section 64 of chapter 81 of
the laws of 1995, amending the public health law and other laws relating
to medical reimbursement and welfare reform, as amended by section 11 of
part D of chapter 59 of the laws of 2011, is amended to read as follows:
  (f) Prior to [February 1, 2001, February 1, 2002,  February  1,  2003,
February  1, 2004, February 1, 2005, February 1, 2006, February 1, 2007,
February 1, 2008, February 1, 2009, February 1, 2010, February 1,  2011,
February  1, 2012, and February 1, 2013] FEBRUARY FIRST OF EACH YEAR the
commissioner of health shall calculate the result of the statewide total
of residential health care facility days of care provided  to  benefici-
aries  of  title  XVIII  of  the federal social security act (medicare),
divided by the sum of such days of care plus days of  care  provided  to
residents eligible for payments pursuant to title 11 of article 5 of the
social  services  law  minus  the  number  of days provided to residents
receiving hospice care,  expressed  as  a  percentage,  for  the  period
commencing January 1, through November 30, of the prior year respective-
ly,  based  on such data for such period. This value shall be called the
[2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011,
2012, and  2013]  statewide  target  percentage  [respectively]  OF  THE
RESPECTIVE YEAR FOR WHICH IT IS CALCULATED.
  S  12.  Subparagraph (ii) of paragraph (b) of subdivision 3 of section
64 of chapter 81 of the laws of 1995, amending the public health law and
other laws relating to medical  reimbursement  and  welfare  reform,  as
amended  by  section  12 of part D of chapter 59 of the laws of 2011, is
amended to read as follows:

S. 2606                            54                            A. 3006

  (ii) If the [1997, 1998, 2000, 2001, 2002,  2003,  2004,  2005,  2006,
2007,  2008, 2009, 2010, 2011, 2012, and 2013] statewide target percent-
ages are not for each year at least three percentage points higher  than
the  statewide  base percentage, the commissioner of health shall deter-
mine  the  percentage  by which the statewide target percentage for each
year is not at least three percentage points higher than  the  statewide
base  percentage.  The  percentage calculated pursuant to this paragraph
shall be called the [1997, 1998, 2000, 2001,  2002,  2003,  2004,  2005,
2006,  2007, 2008, 2009, 2010, 2011, 2012, and 2013] statewide reduction
percentage [respectively] OF THE RESPECTIVE YEAR FOR WHICH IT IS  CALCU-
LATED.  If  the  [1997,  1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
2007, 2008, 2009, 2010, 2011, 2012, and 2013] statewide target  percent-
age  for  the respective year is at least three percentage points higher
than the statewide base percentage, the statewide  reduction  percentage
for the respective year shall be zero.
  S 13.  Subparagraph (iii) of paragraph (b) of subdivision 4 of section
64 of chapter 81 of the laws of 1995, amending the public health law and
other  laws  relating  to  medical  reimbursement and welfare reform, as
amended by section 13 of part D of chapter 59 of the laws  of  2011,  is
amended to read as follows:
  (iii) The [1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,
2009,  2010,  2011, 2012, and 2013] statewide reduction percentage shall
be multiplied by one hundred two million dollars respectively to  deter-
mine  the  [1998,  2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,
2009, 2010, 2011, 2012, and 2013] RESPECTIVE YEAR'S statewide  aggregate
reduction  amount.  If  the  [1998 and the 2000, 2001, 2002, 2003, 2004,
2005, 2006, 2007, 2008, 2009, 2010,  2011,  2012,  and  2013]  statewide
reduction  percentage  shall  be  zero  respectively,  there shall be no
[1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010,
2011, 2012, and 2013] reduction amount.
  S 14. Paragraph (b) of subdivision 5 of section 64 of  chapter  81  of
the laws of 1995, amending the public health law and other laws relating
to medical reimbursement and welfare reform, as amended by section 14 of
part D of chapter 59 of the laws of 2011, is amended to read as follows:
  (b)  The  [1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
2006, 2007, 2008, 2009, 2010, 2011, 2012, and 2013] statewide  aggregate
reduction  amounts  shall for each year be allocated by the commissioner
of health among residential health care facilities that are eligible  to
provide  services  to beneficiaries of title XVIII of the federal social
security act (medicare) and residents eligible for payments pursuant  to
title  11  of  article  5 of the social services law on the basis of the
extent of each facility's failure to achieve  a  two  percentage  points
increase  in  the  1996  target  percentage,  a  three  percentage point
increase in the [1997, 1998, 2000, 2001, 2002, 2003, 2004,  2005,  2006,
2007,  2008,  2009, 2010, 2011, 2012, and 2013] target percentage THERE-
AFTER and a two and one-quarter percentage point increase  in  the  1999
target percentage for each year, compared to the base percentage, calcu-
lated  on  a  facility  specific basis for this purpose, compared to the
statewide total of the extent of each facility's failure  to  achieve  a
two  percentage points increase in the 1996 and a three percentage point
increase in the 1997 and a three percentage point increase in  the  1998
and  a  two and one-quarter percentage point increase in the 1999 target
percentage and a three percentage point increase  in  the  [2000,  2001,
2002,  2003,  2004,  2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, and
2013] target percentage compared to the base percentage.  These  amounts
shall  be  called  the  [1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003,

S. 2606                            55                            A. 3006

2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, and 2013] facility
specific reduction amounts [respectively] OF  THE  RESPECTIVE  YEAR  FOR
WHICH IT IS CALCULATED.
  S  14-a.  Section 228 of chapter 474 of the laws of 1996, amending the
education law and other laws relating to rates  for  residential  health
care  facilities,  as amended by section 14-a of part D of chapter 59 of
the laws of 2011, is amended to read as follows:
  S 228. 1. Definitions. (a) Regions,  for  purposes  of  this  section,
shall  mean  a downstate region to consist of Kings, New York, Richmond,
Queens, Bronx, Nassau and Suffolk counties  and  an  upstate  region  to
consist  of  all  other New York state counties. A certified home health
agency or long term home health care program shall  be  located  in  the
same county utilized by the commissioner of health for the establishment
of rates pursuant to article 36 of the public health law.
  (b)  Certified  home  health  agency  (CHHA)  shall  mean such term as
defined in section 3602 of the public health law.
  (c) Long term home health care program (LTHHCP) shall mean  such  term
as defined in subdivision 8 of section 3602 of the public health law.
  (d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
ly, located within a region.
  (e)  Medicaid  revenue percentage, for purposes of this section, shall
mean CHHA and LTHHCP  revenues  attributable  to  services  provided  to
persons  eligible  for payments pursuant to title 11 of article 5 of the
social services law divided by such revenues plus CHHA and LTHHCP reven-
ues attributable to services provided to beneficiaries of Title XVIII of
the federal social security act (medicare).
  (f) Base period, for purposes of this  section,  shall  mean  calendar
year 1995.
  (g) Target period. For purposes of this section, the 1996 target peri-
od  shall  mean  August  1, 1996 through March 31, 1997, the 1997 target
period shall mean January 1, 1997 through November 30,  1997,  the  1998
target  period shall mean January 1, 1998 through November 30, 1998, the
1999 target period shall mean January 1, 1999 through November 30, 1999,
the 2000 target period shall mean January 1, 2000 through  November  30,
2000, the 2001 target period shall mean January 1, 2001 through November
30,  2001,  the  2002  target  period shall mean January 1, 2002 through
November 30, 2002, the 2003 target period shall  mean  January  1,  2003
through  November 30, 2003, the 2004 target period shall mean January 1,
2004 through November 30, 2004, and the 2005 target  period  shall  mean
January  1, 2005 through November 30, 2005, the 2006 target period shall
mean January 1, 2006 through November 30,  2006,  and  the  2007  target
period shall mean January 1, 2007 through November 30, 2007 and the 2008
target  period shall mean January 1, 2008 through November 30, 2008, and
the 2009 target period shall mean January 1, 2009 through  November  30,
2009  and  the  2010  target  period  shall mean January 1, 2010 through
November 30, 2010 and the 2011 target period shall mean January 1,  2011
through  November 30, 2011 and the 2012 target period shall mean January
1, 2012 through November 30, 2012 and the 2013 target period shall  mean
January  1, 2013 through November 30, 2013, AND FOR EACH SUBSEQUENT YEAR
SUCH TARGET PERIOD SHALL BE THE FIRST OF JANUARY THROUGH  THE  THIRTIETH
OF NOVEMBER FOR THE RESPECTIVE YEAR.
  2.  (a) Prior to February 1, 1997, for each regional group the commis-
sioner of health shall calculate the 1996 medicaid  revenue  percentages
for the period commencing August 1, 1996 to the last date for which such
data is available and reasonably accurate.

S. 2606                            56                            A. 3006

  (b)  Prior  to  [February 1, 1998, prior to February 1, 1999, prior to
February 1, 2000, prior to February 1, 2001, prior to February 1,  2002,
prior  to February 1, 2003, prior to February 1, 2004, prior to February
1, 2005, prior to February 1, 2006, prior to February 1, 2007, prior  to
February  1, 2008, prior to February 1, 2009, prior to February 1, 2010,
prior to February 1, 2011, prior to February 1, 2012 and prior to Febru-
ary 1, 2013] THE FIRST OF FEBRUARY EACH YEAR for each regional group the
commissioner of health shall calculate the prior year's medicaid revenue
percentages for the period commencing January 1 through November  30  of
such prior year.
  3.  By September 15, 1996, for each regional group the commissioner of
health shall calculate the base period medicaid revenue percentage.
  4. (a) For each regional  group,  the  1996  target  medicaid  revenue
percentage  shall be calculated by subtracting the 1996 medicaid revenue
reduction percentages from the base period medicaid revenue percentages.
The 1996 medicaid revenue  reduction  percentage,  taking  into  account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
  (i)  one  and one-tenth percentage points for CHHAs located within the
downstate region;
  (ii) six-tenths of one percentage point for CHHAs located  within  the
upstate region;
  (iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
  (iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
  (b)  For  [1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
2008, 2009, 2010, 2011, 2012, and 2013 for]  each  regional  group,  the
target  medicaid  revenue  percentage  for  the respective year shall be
calculated  by  subtracting  the  respective  year's  medicaid   revenue
reduction  percentage  from the base period medicaid revenue percentage.
The medicaid revenue reduction percentages for [1997, 1998, 2000,  2001,
2002,  2003,  2004,  2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, and
2013] EACH RESPECTIVE YEAR, taking into  account  regional  and  program
differences  in  utilization  of medicaid and medicare services, for the
following regional groups shall be equal to for each such year:
  (i) one and one-tenth percentage points for CHHAs located  within  the
downstate region;
  (ii)  six-tenths  of one percentage point for CHHAs located within the
upstate region;
  (iii) one and eight-tenths percentage points for LTHHCPs located with-
in the downstate region; and
  (iv) one and seven-tenths percentage points for LTHHCPs located within
the upstate region.
  (c) For each regional group, the 1999 target medicaid revenue percent-
age shall  be  calculated  by  subtracting  the  1999  medicaid  revenue
reduction  percentage  from the base period medicaid revenue percentage.
The 1999 medicaid revenue reduction  percentages,  taking  into  account
regional and program differences in utilization of medicaid and medicare
services, for the following regional groups shall be equal to:
  (i)  eight  hundred  twenty-five  thousandths (.825) of one percentage
point for CHHAs located within the downstate region;
  (ii) forty-five hundredths (.45) of one  percentage  point  for  CHHAs
located within the upstate region;
  (iii)  one  and  thirty-five  hundredths  percentage points (1.35) for
LTHHCPs located within the downstate region; and

S. 2606                            57                            A. 3006

  (iv) one and two hundred seventy-five  thousandths  percentage  points
(1.275) for LTHHCPs located within the upstate region.
  5.  (a) For each regional group, if the 1996 medicaid revenue percent-
age is not equal to or  less  than  the  1996  target  medicaid  revenue
percentage,  the  commissioner of health shall compare the 1996 medicaid
revenue percentage to the 1996 target  medicaid  revenue  percentage  to
determine  the  amount  of the shortfall which, when divided by the 1996
medicaid  revenue  reduction  percentage,  shall  be  called  the   1996
reduction  factor.  These  amounts, expressed as a percentage, shall not
exceed one hundred percent. If the 1996 medicaid revenue  percentage  is
equal  to  or less than the 1996 target medicaid revenue percentage, the
1996 reduction factor shall be zero.
  (b) For [1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004,  2005,  2006,
2007,  2008,  2009, 2010, 2011, 2012, and 2013 for] each regional group,
if the medicaid revenue percentage for the respective year is not  equal
to  or less than the target medicaid revenue percentage for such respec-
tive year, the commissioner of  health  shall  compare  such  respective
year's  medicaid  revenue  percentage  to  such respective year's target
medicaid revenue percentage to determine the  amount  of  the  shortfall
which,  when divided by the respective year's medicaid revenue reduction
percentage, shall be called the reduction  factor  for  such  respective
year.  These  amounts,  expressed  as a percentage, shall not exceed one
hundred percent. If the medicaid revenue  percentage  for  a  particular
year is equal to or less than the target medicaid revenue percentage for
that year, the reduction factor for that year shall be zero.
  6.  (a)  For  each  regional group, the 1996 reduction factor shall be
multiplied by the following amounts to determine each  regional  group's
applicable 1996 state share reduction amount:
  (i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;
  (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
  (iii)  one  million  two hundred seventy thousand dollars ($1,270,000)
for LTHHCPs located within the downstate region; and
  (iv) five hundred  ninety  thousand  dollars  ($590,000)  for  LTHHCPs
located within the upstate region.
  For  each regional group reduction, if the 1996 reduction factor shall
be zero, there shall be no 1996 state share reduction amount.
  (b) For [1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005,  2006,  2007,
2008,  2009,  2010,  2011,  2012, and 2013 for] each regional group, the
reduction factor for the respective year  shall  be  multiplied  by  the
following  amounts  to  determine each regional group's applicable state
share reduction amount for such respective year:
  (i) two million three hundred ninety thousand dollars ($2,390,000) for
CHHAs located within the downstate region;
  (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
within the upstate region;
  (iii) one million two hundred seventy  thousand  dollars  ($1,270,000)
for LTHHCPs located within the downstate region; and
  (iv)  five  hundred  ninety  thousand  dollars  ($590,000) for LTHHCPs
located within the upstate region.
  For each regional group reduction,  if  the  reduction  factor  for  a
particular  year  shall be zero, there shall be no state share reduction
amount for such year.

S. 2606                            58                            A. 3006

  (c) For each regional group, the 1999 reduction factor shall be multi-
plied by the following amounts to determine each regional group's appli-
cable 1999 state share reduction amount:
  (i) one million seven hundred ninety-two thousand five hundred dollars
($1,792,500) for CHHAs located within the downstate region;
  (ii)  five  hundred sixty-two thousand five hundred dollars ($562,500)
for CHHAs located within the upstate region;
  (iii) nine hundred fifty-two thousand five hundred dollars  ($952,500)
for LTHHCPs located within the downstate region; and
  (iv)  four  hundred forty-two thousand five hundred dollars ($442,500)
for LTHHCPs located within the upstate region.
  For each regional group reduction, if the 1999 reduction factor  shall
be zero, there shall be no 1999 state share reduction amount.
  7.  (a) For each regional group, the 1996 state share reduction amount
shall be allocated by the commissioner of health among CHHAs and LTHHCPs
on the basis of the extent  of  each  CHHA's  and  LTHHCP's  failure  to
achieve  the  1996  target  medicaid revenue percentage, calculated on a
provider specific basis utilizing revenues for this  purpose,  expressed
as  a  proportion  of  the  total of each CHHA's and LTHHCP's failure to
achieve the 1996 target medicaid revenue percentage within the  applica-
ble  regional group. This proportion shall be multiplied by the applica-
ble 1996 state share reduction amount calculation pursuant to  paragraph
(a)  of  subdivision  6 of this section. This amount shall be called the
1996 provider specific state share reduction amount.
  (b) For [1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004,  2005,  2006,
2007,  2008,  2009, 2010, 2011, 2012, and 2013 for] each regional group,
the state share reduction amount for the respective year shall be  allo-
cated by the commissioner of health among CHHAs and LTHHCPs on the basis
of  the extent of each CHHA's and LTHHCP's failure to achieve the target
medicaid revenue percentage for the applicable  year,  calculated  on  a
provider  specific  basis utilizing revenues for this purpose, expressed
as a proportion of the total of each  CHHA's  and  LTHHCP's  failure  to
achieve  the  target medicaid revenue percentage for the applicable year
within the applicable regional group. This proportion  shall  be  multi-
plied  by the applicable year's state share reduction amount calculation
pursuant to paragraph (b) or (c) of subdivision 6 of this section.  This
amount  shall  be  called  the  provider  specific state share reduction
amount for the applicable year.
  8. (a) The 1996 provider specific state share reduction  amount  shall
be due to the state from each CHHA and LTHHCP and may be recouped by the
state  by  March  31, 1997 in a lump sum amount or amounts from payments
due to the CHHA and LTHHCP pursuant to title 11  of  article  5  of  the
social services law.
  (b)  The  provider  specific  state  share reduction amount for [1997,
1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,  2009,
2010,  2011,  2012, and 2013 respectively,] THE RESPECTIVE YEAR shall be
due to the state from each CHHA and LTHHCP and each year the amount  due
for  such year may be recouped by the state by March 31 of the following
year in a lump sum amount or amounts from payments due to the  CHHA  and
LTHHCP pursuant to title 11 of article 5 of the social services law.
  9.  CHHAs  and  LTHHCPs shall submit such data and information at such
times as the commissioner of health may require  for  purposes  of  this
section.  The  commissioner of health may use data available from third-
party payors.
  10. On or about June 1, 1997, for each regional group the commissioner
of health shall calculate for the period August 1,  1996  through  March

S. 2606                            59                            A. 3006

31,  1997  a  medicaid  revenue  percentage, a reduction factor, a state
share reduction amount, and a provider specific  state  share  reduction
amount  in  accordance with the methodology provided in paragraph (a) of
subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
sion  6 and paragraph (a) of subdivision 7 of this section. The provider
specific state share reduction amount calculated in accordance with this
subdivision shall be compared to the 1996 provider specific state  share
reduction amount calculated in accordance with paragraph (a) of subdivi-
sion 7 of this section. Any amount in excess of the amount determined in
accordance  with paragraph (a) of subdivision 7 of this section shall be
due to the state from each CHHA  and  LTHHCP  and  may  be  recouped  in
accordance  with  paragraph (a) of subdivision 8 of this section. If the
amount is less than the amount determined in accordance  with  paragraph
(a)  of  subdivision 7 of this section, the difference shall be refunded
to the CHHA and LTHHCP by the state no later than July 15,  1997.  CHHAs
and  LTHHCPs  shall  submit  data  for the period August 1, 1996 through
March 31, 1997 to the commissioner of health by April 15, 1997.
  11. If a CHHA or LTHHCP  fails  to  submit  data  and  information  as
required for purposes of this section:
  (a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
caid  revenue  percentage  between  the  applicable  base period and the
applicable target period for purposes of the  calculations  pursuant  to
this section; and
  (b)  the  commissioner of health shall reduce the current rate paid to
such CHHA and such LTHHCP by state  governmental  agencies  pursuant  to
article  36  of the public health law by one percent for a period begin-
ning on the first day of the calendar month following the applicable due
date as established by the commissioner of health and  continuing  until
the last day of the calendar month in which the required data and infor-
mation are submitted.
  12. The commissioner of health shall inform in writing the director of
the  budget  and the chair of the senate finance committee and the chair
of the assembly ways and means committee of the results  of  the  calcu-
lations pursuant to this section.
  S  15.  Subdivision  5-a  of  section 246 of chapter 81 of the laws of
1995, amending the public health law and other laws relating to  medical
reimbursement  and welfare reform, as amended by section 15 of part D of
chapter 59 of the laws of 2011, is amended to read as follows:
  5-a. Section sixty-four-a of this act shall be deemed to have been  in
full  force and effect on and after April 1, 1995 through March 31, 1999
and on and after July 1, 1999 through March 31, 2000 and  on  and  after
April  1,  2000  through  March  31, 2003 and on and after April 1, 2003
through March 31, 2007, and on and after April 1, 2007 through March 31,
2009, and on and after April 1, 2009 through March 31, 2011, and on  and
after  April  1,  2011 through March 31, 2013, AND ON AND AFTER APRIL 1,
2013 THROUGH MARCH 31, 2018;
  S 16. Section 64-b of chapter 81 of the laws  of  1995,  amending  the
public  health  law and other laws relating to medical reimbursement and
welfare reform, as amended by section 16 of part D of chapter 59 of  the
laws of 2011, is amended to read as follows:
  S  64-b.  Notwithstanding  any  inconsistent  provision  of  law,  the
provisions of subdivision 7 of section 3614 of the public health law, as
amended, shall remain and be in full force and effect on April  1,  1995
through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
and after April 1, 2000 through March 31, 2003 and on and after April 1,
2003  through  March  31,  2007,  and on and after April 1, 2007 through

S. 2606                            60                            A. 3006

March 31, 2009, and on and after April 1, 2009 through March  31,  2011,
and  on and after April 1, 2011 through March 31, 2013, AND ON AND AFTER
APRIL 1, 2013 THROUGH MARCH 31, 2018.
  S  17. Subdivision 1 of section 20 of chapter 451 of the laws of 2007,
amending the public health law, the social services law and  the  insur-
ance   law,   relating  to  providing  enhanced  consumer  and  provider
protections, as amended by section 17 of part D of  chapter  59  of  the
laws of 2011, is amended to read as follows:
  1.  sections  four, eleven and thirteen  of this act shall take effect
immediately and shall expire and be  deemed  repealed  June  30,  [2013]
2015;
  S  18. The opening paragraph of subdivision 7-a of section 3614 of the
public health law, as amended by section 18 of part D of chapter  59  of
the laws of 2011, is amended to read as follows:
  Notwithstanding  any  inconsistent provision of law or regulation, for
the purposes of establishing rates of payment by  governmental  agencies
for  long term home health care programs for the period April first, two
thousand five, through December thirty-first, two thousand five, and for
the period January first, two thousand six through  March  thirty-first,
two  thousand  seven,  and  on and after April first, two thousand seven
through March thirty-first, two thousand nine, and on  and  after  April
first,  two thousand nine through March thirty-first, two thousand elev-
en, and on and after April first,  two  thousand  eleven  through  March
thirty-first,  two  thousand  thirteen AND FOR EACH YEAR THEREAFTER, the
reimbursable base year administrative and general costs of a provider of
services shall not exceed the statewide average  of  total  reimbursable
base  year  administrative  and  general  costs  of  such  providers  of
services.
  S 19. Subdivisions 3, 4 and 5 of section 47 of chapter 2 of  the  laws
of  1998,  amending  the  public  health  law and other laws relating to
expanding the child health insurance plan, as amended by section  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;]
  4. sections two, three, four, seven, eight, nine,  fourteen,  fifteen,
sixteen,  eighteen, eighteen-a, [twenty-three,] twenty-four, and twenty-
nine of this act shall take effect January 1, 1999 [and shall expire  on
July  1,  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;]
  S 20.  Subdivision 6-a of section 93 of part C of chapter  58  of  the
laws  of 2007 amending the social services law and the public health law
relating to adjustments of rates, as amended by section 40 of part D  of
chapter 58 of the laws of 2009, is amended to read as follows:
  6-a.  section  fifty-seven  of  this  act  shall  expire and be deemed
repealed on December 31, [2013] 2018; provided that the amendments  made
by such section to subdivision 4 of section 366-c of the social services
law  shall  apply  with  respect  to  determining initial and continuing
eligibility for medical assistance, including the continued  eligibility
of recipients originally determined eligible prior to the effective date

S. 2606                            61                            A. 3006

of  this  act, and provided further that such amendments shall not apply
to any person or group of persons if it is  subsequently  determined  by
the  Centers  for Medicare and Medicaid services or by a court of compe-
tent jurisdiction that medical assistance with federal financial partic-
ipation  is  available for the costs of services provided to such person
or persons under the provisions of subdivision 4 of section 366-c of the
social services law in effect immediately prior to the effective date of
this act.
  S 21. Subdivision 12 of section 246 of chapter 81 of the laws of 1995,
amending the public health  law  and  other  laws  relating  to  medical
reimbursement and welfare reform, is REPEALED.
  S  22.  Section  5  of  chapter  426 of the laws of 1983, amending the
public health law relating to professional  misconduct  proceedings,  as
amended  by  chapter  36  of  the  laws  of  2008, is amended to read as
follows:
  S 5. This act shall take effect June 1, 1983 [and shall remain in full
force and effect until March 31, 2013].
  S 23. Section 5 of chapter 582 of  the  laws  of  1984,  amending  the
public  health  law  relating to regulating activities of physicians, as
amended by chapter 36 of the  laws  of  2008,  is  amended  to  read  as
follows:
  S  5.  This  act shall take effect immediately[, provided however that
the provisions of this act shall remain in full force and  effect  until
March  31, 2013 at which time the provisions of this act shall be deemed
to be repealed].
  S 24. Subparagraph (ii) of paragraph (c) of subdivision 11 of  section
230  of  the  public health law, as amended by chapter 36 of the laws of
2008, is amended to read as follows:
  (ii) Participation and membership during a  three  year  demonstration
period  in  a physician committee of the Medical Society of the State of
New York or the New York State Osteopathic Society whose purpose  is  to
confront and refer to treatment physicians who are thought to be suffer-
ing  from  alcoholism,  drug abuse or mental illness. Such demonstration
period shall commence on April first, nineteen hundred eighty and termi-
nate on May thirty-first, nineteen hundred eighty-three.  An  additional
demonstration  period  shall  commence  on  June first, nineteen hundred
eighty-three and  terminate  on  March  thirty-first,  nineteen  hundred
eighty-six.  An  additional demonstration period shall commence on April
first, nineteen hundred eighty-six and terminate on March  thirty-first,
nineteen  hundred  eighty-nine. An additional demonstration period shall
commence April first, nineteen hundred eighty-nine and  terminate  March
thirty-first,  nineteen  hundred ninety-two. An additional demonstration
period shall commence  April  first,  nineteen  hundred  ninety-two  and
terminate  March  thirty-first,  nineteen  hundred ninety-five. An addi-
tional demonstration period shall  commence  on  April  first,  nineteen
hundred  ninety-five  and  terminate  on  March  thirty-first,  nineteen
hundred ninety-eight. An additional demonstration period shall  commence
on  April  first,  nineteen  hundred ninety-eight and terminate on March
thirty-first, two thousand three.  An  additional  demonstration  period
shall  commence  on  April  first,  two thousand three [and terminate on
March thirty-first, two thousand thirteen]; provided, however, that  the
commissioner  may  prescribe  requirements  for the continuation of such
demonstration program, including periodic reviews of such  programs  and
submission  of  any  reports  and data necessary to permit such reviews.
During these additional periods, the  provisions  of  this  subparagraph
shall also apply to a physician committee of a county medical society.

S. 2606                            62                            A. 3006

  S 25. Section 4 of part X2 of chapter 62 of the laws of 2003, amending
the  public  health law relating to allowing for the use of funds of the
office of professional medical conduct for  activities  of  the  patient
health  information  and  quality improvement act of 2000, as amended by
section  27  of  part A of chapter 59 of the laws of 2011, is amended to
read as follows:
  S 4. This  act  shall  take  effect  immediately;  provided  that  the
provisions  of  section  one of this act shall be deemed to have been in
full force and effect on and after April 1, 2003, and shall expire March
31, [2013] 2015 when upon such date the provisions of such section shall
be deemed repealed.
  S 26. 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  27. Severability clause. If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair or invalidate the remainder thereof, but shall be confined in its
operation to the clause, sentence, paragraph,  subdivision,  section  or
part  thereof  directly involved in the controversy in which such judge-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  28.  This  act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2013.

                                 PART C

  Section 1. Section 2807-k of the  public  health  law  is  amended  by
adding a new subdivision 5-d to read as follows:
  5-D.  (A)  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION,
SECTION TWENTY-EIGHT HUNDRED  SEVEN-W  OF  THIS  ARTICLE  OR  ANY  OTHER
CONTRARY  PROVISION  OF  LAW, AND SUBJECT TO THE AVAILABILITY OF FEDERAL
FINANCIAL PARTICIPATION, FOR PERIODS ON AND  AFTER  JANUARY  FIRST,  TWO
THOUSAND  THIRTEEN, THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND FIFTEEN,
ALL FUNDS AVAILABLE  FOR  DISTRIBUTION  PURSUANT  TO  THIS  SECTION  AND
SECTION  TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE, SHALL BE RESERVED
AND SET ASIDE AND DISTRIBUTED IN ACCORDANCE WITH THE PROVISIONS OF  THIS
SUBDIVISION.
  (B)  THE COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE
EMERGENCY REGULATIONS, ESTABLISHING METHODOLOGIES FOR  THE  DISTRIBUTION
OF  FUNDS  AS  DESCRIBED  IN  PARAGRAPH (A) OF THIS SUBDIVISION AND SUCH
REGULATIONS SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING:
  (I) SUCH REGULATIONS SHALL  ESTABLISH  METHODOLOGIES  FOR  DETERMINING
EACH  FACILITY'S  RELATIVE UNCOMPENSATED CARE NEED AMOUNT BASED ON UNIN-
SURED INPATIENT AND OUTPATIENT UNITS OF SERVICE FROM THE COST  REPORTING
YEAR  TWO YEARS PRIOR TO THE DISTRIBUTION YEAR, MULTIPLIED BY THE APPLI-
CABLE MEDICAID RATES IN EFFECT JANUARY FIRST OF THE  DISTRIBUTION  YEAR,
AS SUMMED AND ADJUSTED BY A STATEWIDE COST ADJUSTMENT FACTOR AND REDUCED
BY  THE  SUM  OF  ALL  PAYMENT  AMOUNTS  COLLECTED  FROM  SUCH UNINSURED
PATIENTS, AND AS FURTHER ADJUSTED  BY  APPLICATION  OF  A  NOMINAL  NEED
COMPUTATION  THAT SHALL TAKE INTO ACCOUNT EACH FACILITY'S MEDICAID INPA-
TIENT SHARE.

S. 2606                            63                            A. 3006

  (II) ANNUAL DISTRIBUTIONS PURSUANT TO SUCH  REGULATIONS  FOR  THE  TWO
THOUSAND  THIRTEEN  THROUGH TWO THOUSAND FIFTEEN CALENDAR YEARS SHALL BE
IN ACCORD WITH THE FOLLOWING:
  (A)  ONE  HUNDRED  THIRTY-NINE  MILLION  FOUR HUNDRED THOUSAND DOLLARS
SHALL BE DISTRIBUTED AS MEDICAID DISPROPORTIONATE SHARE HOSPITAL ("DSH")
PAYMENTS TO MAJOR PUBLIC GENERAL HOSPITALS; AND
  (B) NINE HUNDRED NINETY-FOUR MILLION NINE HUNDRED THOUSAND DOLLARS  AS
MEDICAID  DSH  PAYMENTS  TO ELIGIBLE GENERAL HOSPITALS, OTHER THAN MAJOR
PUBLIC GENERAL HOSPITALS.
  (III)(A) SUCH REGULATIONS SHALL ESTABLISH  TRANSITION  ADJUSTMENTS  TO
THE  DISTRIBUTIONS  MADE PURSUANT TO CLAUSES (A) AND (B) OF SUBPARAGRAPH
(II) OF THIS PARAGRAPH SUCH THAT NO FACILITY EXPERIENCES A REDUCTION  IN
INDIGENT CARE POOL PAYMENTS PURSUANT TO THIS SUBDIVISION THAT IS GREATER
THAN  THE  PERCENTAGES, AS SPECIFIED IN SUCH REGULATIONS, AS COMPARED TO
THE AVERAGE DISTRIBUTION THAT EACH SUCH FACILITY RECEIVED FOR THE  THREE
CALENDAR  YEARS  PRIOR TO TWO THOUSAND THIRTEEN PURSUANT TO THIS SECTION
AND SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE.
  (B) SUCH REGULATIONS SHALL ALSO  ESTABLISH  ADJUSTMENTS  LIMITING  THE
INCREASES  IN  INDIGENT  CARE  POOL  PAYMENTS  EXPERIENCED BY FACILITIES
PURSUANT TO THIS SUBDIVISION BY AN AMOUNT THAT WILL BE, AS DETERMINED BY
THE COMMISSIONER AND IN CONJUNCTION WITH SUCH OTHER FUNDING  AS  MAY  BE
AVAILABLE  FOR  THIS  PURPOSE, SUFFICIENT TO ENSURE FULL FUNDING FOR THE
TRANSITION ADJUSTMENT PAYMENTS AUTHORIZED BY CLAUSE (A) OF THIS SUBPARA-
GRAPH.
  (IV) SUCH REGULATIONS SHALL RESERVE ONE PERCENT OF THE FUNDS AVAILABLE
FOR DISTRIBUTION IN THE TWO THOUSAND FOURTEEN AND TWO  THOUSAND  FIFTEEN
CALENDAR  YEARS  PURSUANT TO THIS SUBDIVISION, SUBDIVISION FOURTEEN-F OF
SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THIS ARTICLE, AND  SECTIONS  TWO
HUNDRED   ELEVEN   AND  TWO  HUNDRED  TWELVE  OF  CHAPTER  FOUR  HUNDRED
SEVENTY-FOUR OF THE LAWS OF NINETEEN HUNDRED NINETY-SIX, IN A "FINANCIAL
ASSISTANCE COMPLIANCE POOL" AND SHALL ESTABLISH  METHODOLOGIES  FOR  THE
DISTRIBUTION  OF  SUCH  POOL FUNDS TO FACILITIES BASED ON THEIR LEVEL OF
COMPLIANCE, AS DETERMINED BY THE COMMISSIONER, WITH  THE  PROVISIONS  OF
SUBDIVISION NINE-A OF THIS SECTION.
  S  2.  Subdivision 14-f of section 2807-c of the public health law, as
amended by chapter 1 of the laws of 1999, is amended to read as follows:
  14-f. Public general hospital indigent care adjustment.  Notwithstand-
ing any inconsistent provision of this section AND SUBJECT TO THE AVAIL-
ABILITY OF FEDERAL FINANCIAL PARTICIPATION, payment for inpatient hospi-
tal   services   for   persons  eligible  for  payments  made  by  state
governmental agencies for the period  January  first,  nineteen  hundred
ninety-seven through December thirty-first, nineteen hundred ninety-nine
and  periods  on  and  after  January  first, two thousand applicable to
patients eligible for federal financial participation under title XIX of
the federal social security act in medical assistance provided  pursuant
to title eleven of article five of the social services law determined in
accordance  with  this section shall include for eligible public general
hospitals a public general hospital indigent care  adjustment  equal  to
the aggregate amount of the adjustments provided for such public general
hospital  for  the  period  January  first,  nineteen hundred ninety-six
through December thirty-first, nineteen hundred ninety-six  pursuant  to
subdivisions  fourteen-a and fourteen-d of this section on an annualized
basis, [provided all federal approvals  necessary  by  federal  law  and
regulation  for  federal  financial  participation  in payments made for
beneficiaries eligible for medical assistance under  title  XIX  of  the
federal social security act based upon the adjustment provided herein as

S. 2606                            64                            A. 3006

a  component  of  such payments are granted] PROVIDED, HOWEVER, THAT FOR
PERIODS ON AND AFTER JANUARY FIRST,  TWO  THOUSAND  THIRTEEN  AN  ANNUAL
AMOUNT  OF  FOUR  HUNDRED  TWELVE  MILLION DOLLARS SHALL BE ALLOCATED TO
ELIGIBLE  MAJOR  PUBLIC HOSPITALS BASED ON EACH HOSPITAL'S PROPORTIONATE
SHARE OF MEDICAID AND UNINSURED LOSSES TO TOTAL MEDICAID  AND  UNINSURED
LOSSES  FOR  ALL  ELIGIBLE MAJOR PUBLIC HOSPITALS, NET OF ANY DISPROPOR-
TIONATE  SHARE  HOSPITAL  PAYMENTS   RECEIVED   PURSUANT   TO   SECTIONS
TWENTY-EIGHT  HUNDRED  SEVEN-K  AND TWENTY-EIGHT HUNDRED SEVEN-W OF THIS
ARTICLE. The adjustment may be made to rates of payment or as  aggregate
payments to an eligible hospital.
  S  3.  Paragraph  (i) of subdivision 2-a of section 2807 of the public
health law, as amended by section 16 of part C of chapter 58 of the laws
of 2009, is amended to read as follows:
  (i) Notwithstanding any provision of law to  the  contrary,  rates  of
payment   by  governmental  agencies  for  general  hospital  outpatient
services, general hospital emergency services  and  ambulatory  surgical
services  provided  by  a general hospital established pursuant to para-
graphs (a), (c) and (d) of this subdivision shall result in an aggregate
increase in such rates of payment of fifty-six million dollars  for  the
period  December  first,  two thousand eight through March thirty-first,
two thousand nine and one  hundred  seventy-eight  million  dollars  for
periods   after   April   first,   two   thousand  nine,  THROUGH  MARCH
THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND ONE HUNDRED FIFTY-THREE MILLION
DOLLARS FOR STATE FISCAL YEAR PERIODS ON  AND  AFTER  APRIL  FIRST,  TWO
THOUSAND  THIRTEEN,  provided,  however,  that  for periods on and after
April first, two thousand nine, such amounts may be adjusted to  reflect
projected  decreases in fee-for-service Medicaid utilization and changes
in case-mix with regard to such services from  the  two  thousand  seven
calendar  year to the applicable rate year, and provided further, howev-
er, that funds made available as a result of any such decreases  may  be
utilized  by the commissioner to increase capitation rates paid to Medi-
caid managed care plans and family health plus plans to cover  increased
payments  to  health  care providers for ambulatory care services and to
increase such other ambulatory care payment rates  as  the  commissioner
determines  necessary  to  facilitate  access to quality ambulatory care
services.
  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, 2013 provided
that:
  a. sections one and two of this act shall be deemed to  have  been  in
full force and effect on and after January 1, 2013; and
  b.  the amendments to subdivision 14-f of section 2807-c of the public
health law made by section two of this act shall not affect the  expira-
tion of such subdivision and shall be deemed to expire therewith.

                                 PART D

  Section  1. Subdivision 1 of section 366 of the social services law is
REPEALED and a new subdivision 1 is added to read as follows:
  1. (A) DEFINITIONS. FOR PURPOSES OF THIS SECTION:
  (1) "BENCHMARK COVERAGE" REFERS TO MEDICAL ASSISTANCE COVERAGE DEFINED
IN SUBDIVISION ONE OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE;
  (2) "CARETAKER RELATIVE" MEANS A RELATIVE  OF  A  DEPENDENT  CHILD  BY
BLOOD,  ADOPTION, OR MARRIAGE WITH WHOM THE CHILD IS LIVING, WHO ASSUMES
PRIMARY RESPONSIBILITY FOR THE CHILD'S  CARE  AND  WHO  IS  ONE  OF  THE
FOLLOWING:

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  (I)  THE  CHILD'S  FATHER,  MOTHER, GRANDFATHER, GRANDMOTHER, BROTHER,
SISTER, STEPFATHER, STEPMOTHER, STEPBROTHER,  STEPSISTER,  UNCLE,  AUNT,
FIRST COUSIN, NEPHEW, OR NIECE; OR
  (II) THE SPOUSE OF SUCH PARENT OR RELATIVE, EVEN AFTER THE MARRIAGE IS
TERMINATED BY DEATH OR DIVORCE;
  (3) "FAMILY SIZE" MEANS THE NUMBER OF PERSONS COUNTED AS MEMBERS OF AN
INDIVIDUAL'S  HOUSEHOLD;  WITH  RESPECT  TO  INDIVIDUALS  WHOSE  MEDICAL
ASSISTANCE ELIGIBILITY IS BASED ON MODIFIED ADJUSTED  GROSS  INCOME,  IN
DETERMINING THE FAMILY SIZE OF A PREGNANT WOMAN, OR OF OTHER INDIVIDUALS
WHO  HAVE  A  PREGNANT  WOMAN  IN THEIR HOUSEHOLD, THE PREGNANT WOMAN IS
COUNTED AS HERSELF PLUS THE NUMBER OF CHILDREN SHE IS EXPECTED TO DELIV-
ER;
  (4) "FEDERAL POVERTY LINE" MEANS THE POVERTY LINE DEFINED AND ANNUALLY
REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES;
  (5) "HOUSEHOLD," FOR PURPOSES OF DETERMINING THE FINANCIAL ELIGIBILITY
OF APPLICANTS AND RECIPIENTS OF BENEFITS  UNDER  THIS  TITLE,  SHALL  BE
DEFINED BY THE COMMISSIONER OF HEALTH, AND BE BASED ON ELIGIBILITY CATE-
GORY;  WITH  RESPECT TO INDIVIDUALS WHOSE MEDICAL ASSISTANCE ELIGIBILITY
IS BASED ON MODIFIED ADJUSTED GROSS INCOME,  SUCH  DEFINITION  SHALL  BE
CONSISTENT WITH THE REQUIREMENTS OF FEDERAL REGULATION AT 42 CFR 435.603
OR ANY SUCCESSOR REGULATION;
  (6) "MAGI" MEANS MODIFIED ADJUSTED GROSS INCOME;
  (7) "MAGI-BASED INCOME" MEANS INCOME CALCULATED USING THE SAME METHOD-
OLOGIES  USED TO DETERMINE MAGI UNDER SECTION 36B(D)(2)(B) OF THE INTER-
NAL REVENUE CODE, WITH THE   EXCEPTION OF  LUMP  SUM  PAYMENTS,  CERTAIN
EDUCATIONAL  SCHOLARSHIPS, AND CERTAIN AMERICAN INDIAN AND ALASKA NATIVE
INCOME, AS SPECIFIED BY  THE  COMMISSIONER  OF  HEALTH  CONSISTENT  WITH
FEDERAL REGULATION AT 42 CFR 435.603 OR ANY SUCCESSOR REGULATION;
  (8) "MAGI HOUSEHOLD INCOME" MEANS, WITH RESPECT TO AN INDIVIDUAL WHOSE
MEDICAL  ASSISTANCE  ELIGIBILITY  IS  BASED  ON  MODIFIED ADJUSTED GROSS
INCOME, THE SUM OF THE MAGI-BASED INCOME OF EVERY PERSON INCLUDED IN THE
INDIVIDUAL'S MAGI HOUSEHOLD, MINUS AN AMOUNT EQUIVALENT TO FIVE PERCENT-
AGE POINTS OF THE FEDERAL POVERTY LEVEL FOR THE APPLICABLE FAMILY  SIZE,
EXCEPT  THAT IT SHALL NOT INCLUDE THE MAGI-BASED INCOME OF THE FOLLOWING
PERSONS IF SUCH PERSONS ARE NOT EXPECTED TO BE REQUIRED TO  FILE  A  TAX
RETURN  IN  THE TAXABLE YEAR IN WHICH ELIGIBILITY FOR MEDICAL ASSISTANCE
IS BEING DETERMINED:
  (I) A BIOLOGICAL, ADOPTED, OR STEP CHILD WHO IS INCLUDED IN THE  INDI-
VIDUAL'S MAGI HOUSEHOLD; OR
  (II)  A  PERSON, OTHER THAN A SPOUSE OR A BIOLOGICAL, ADOPTED, OR STEP
CHILD, WHO IS EXPECTED TO BE CLAIMED AS A TAX DEPENDENT BY THE  INDIVID-
UAL;
  (9)  "STANDARD COVERAGE" REFERS TO MEDICAL ASSISTANCE COVERAGE DEFINED
IN SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE.
  (B) MAGI ELIGIBILITY GROUPS. INDIVIDUALS LISTED IN THIS PARAGRAPH  ARE
ELIGIBLE FOR MEDICAL ASSISTANCE BASED ON MODIFIED ADJUSTED GROSS INCOME.
  (1)  AN  INDIVIDUAL  IS  ELIGIBLE FOR BENCHMARK COVERAGE IF HIS OR HER
MAGI HOUSEHOLD INCOME DOES NOT EXCEED ONE HUNDRED  THIRTY-THREE  PERCENT
OF THE FEDERAL POVERTY LINE FOR THE APPLICABLE FAMILY SIZE AND HE OR SHE
IS:
  (I) AGE NINETEEN OR OLDER AND UNDER AGE SIXTY-FIVE; AND
  (II) NOT PREGNANT; AND
  (III)  NOT  ENTITLED TO OR ENROLLED FOR BENEFITS UNDER PARTS A OR B OF
TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT; AND
  (IV) NOT OTHERWISE ELIGIBLE FOR AND RECEIVING COVERAGE UNDER  SUBPARA-
GRAPHS TWO AND THREE OF THIS PARAGRAPH; AND

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  (V)  NOT  A  PARENT  OR  OTHER CARETAKER RELATIVE OF A DEPENDENT CHILD
UNDER TWENTY-ONE YEARS OF AGE AND LIVING WITH SUCH  CHILD,  UNLESS  SUCH
CHILD IS RECEIVING BENEFITS UNDER THIS TITLE OR UNDER TITLE 1-A OF ARTI-
CLE  TWENTY-FIVE  OF  THE PUBLIC HEALTH LAW, OR OTHERWISE IS ENROLLED IN
MINIMUM ESSENTIAL COVERAGE.
  (2)  A  PREGNANT  WOMAN  OR  AN INFANT YOUNGER THAN ONE YEAR OF AGE IS
ELIGIBLE FOR STANDARD COVERAGE IF HIS OR HER MAGI HOUSEHOLD INCOME  DOES
NOT  EXCEED  THE  MAGI-EQUIVALENT  OF TWO HUNDRED PERCENT OF THE FEDERAL
POVERTY LINE FOR THE APPLICABLE FAMILY SIZE, WHICH SHALL  BE  CALCULATED
IN ACCORDANCE WITH GUIDANCE ISSUED BY THE SECRETARY OF THE UNITED STATES
DEPARTMENT  OF  HEALTH AND HUMAN SERVICES, OR AN INFANT YOUNGER THAN ONE
YEAR OF AGE WHO MEETS THE PRESUMPTIVE ELIGIBILITY REQUIREMENTS OF SUBDI-
VISION FOUR OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (3) A CHILD WHO IS AT LEAST ONE YEAR OF AGE BUT YOUNGER THAN  NINETEEN
YEARS OF AGE IS ELIGIBLE FOR STANDARD COVERAGE IF HIS OR HER MAGI HOUSE-
HOLD   INCOME  DOES  NOT  EXCEED  THE  MAGI-EQUIVALENT  OF  ONE  HUNDRED
THIRTY-THREE PERCENT OF THE FEDERAL  POVERTY  LINE  FOR  THE  APPLICABLE
FAMILY  SIZE,  WHICH  SHALL  BE  CALCULATED  IN ACCORDANCE WITH GUIDANCE
ISSUED BY THE SECRETARY OF THE UNITED STATES DEPARTMENT  OF  HEALTH  AND
HUMAN  SERVICES,  OR A CHILD WHO IS AT LEAST ONE YEAR OF AGE BUT YOUNGER
THAN NINETEEN  YEARS  OF  AGE  WHO  MEETS  THE  PRESUMPTIVE  ELIGIBILITY
REQUIREMENTS  OF  SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-FOUR-I
OF THIS TITLE.
  (4) AN INDIVIDUAL WHO IS A PREGNANT WOMAN OR IS A MEMBER OF  A  FAMILY
THAT  CONTAINS A DEPENDENT CHILD LIVING WITH A PARENT OR OTHER CARETAKER
RELATIVE IS ELIGIBLE FOR STANDARD COVERAGE IF HIS OR HER MAGI  HOUSEHOLD
INCOME 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,
WHICH SHALL BE CALCULATED IN ACCORDANCE  WITH  GUIDANCE  ISSUED  BY  THE
SECRETARY  OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES;
FOR PURPOSES OF THIS SUBPARAGRAPH, THE  TERM  DEPENDENT  CHILD  MEANS  A
PERSON  WHO  IS UNDER EIGHTEEN YEARS OF AGE, OR IS EIGHTEEN YEARS OF AGE
AND A FULL-TIME STUDENT, WHO IS DEPRIVED OF PARENTAL SUPPORT OR CARE  BY
REASON OF THE DEATH, CONTINUED ABSENCE, OR PHYSICAL OR MENTAL INCAPACITY
OF  A PARENT, OR BY REASON OF THE UNEMPLOYMENT OF THE PARENT, AS DEFINED
BY THE DEPARTMENT OF HEALTH.
  (5) A CHILD WHO IS UNDER TWENTY-ONE YEARS OF AGE AND WHO WAS IN FOSTER
CARE UNDER THE RESPONSIBILITY OF THE STATE  ON  HIS  OR  HER  EIGHTEENTH
BIRTHDAY   IS   ELIGIBLE  FOR  STANDARD  COVERAGE;  NOTWITHSTANDING  ANY
PROVISION OF LAW TO THE CONTRARY, THE PROVISIONS  OF  THIS  SUBPARAGRAPH
SHALL  BE EFFECTIVE ONLY IF AND FOR SO LONG AS FEDERAL FINANCIAL PARTIC-
IPATION IS AVAILABLE IN THE COSTS OF MEDICAL ASSISTANCE FURNISHED  HERE-
UNDER.
  (6) AN INDIVIDUAL WHO IS NOT OTHERWISE ELIGIBLE FOR MEDICAL ASSISTANCE
UNDER  THIS SECTION IS ELIGIBLE FOR COVERAGE OF FAMILY PLANNING SERVICES
REIMBURSED BY THE FEDERAL GOVERNMENT AT A RATE OF  NINETY  PERCENT,  AND
FOR  COVERAGE OF THOSE SERVICES IDENTIFIED BY THE COMMISSIONER OF HEALTH
AS SERVICES GENERALLY PERFORMED AS PART  OF  OR  AS  A  FOLLOW-UP  TO  A
SERVICE ELIGIBLE FOR SUCH NINETY PERCENT REIMBURSEMENT, INCLUDING TREAT-
MENT  FOR  SEXUALLY  TRANSMITTED DISEASES, IF HIS OR HER INCOME DOES NOT
EXCEED THE MAGI-EQUIVALENT OF TWO HUNDRED PERCENT OF THE FEDERAL POVERTY
LINE FOR THE APPLICABLE  FAMILY  SIZE,  WHICH  SHALL  BE  CALCULATED  IN
ACCORDANCE  WITH  GUIDANCE  ISSUED BY THE SECRETARY OF THE UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES.

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  (C) NON-MAGI ELIGIBILITY GROUPS. INDIVIDUALS LISTED IN THIS  PARAGRAPH
ARE ELIGIBLE FOR STANDARD COVERAGE. WHERE A FINANCIAL ELIGIBILITY DETER-
MINATION  MUST BE MADE BY THE MEDICAL ASSISTANCE PROGRAM FOR INDIVIDUALS
IN THESE GROUPS,  SUCH  FINANCIAL  ELIGIBILITY  WILL  BE  DETERMINED  IN
ACCORDANCE WITH SUBDIVISION TWO OF THIS SECTION.
  (1)  AN  INDIVIDUAL  RECEIVING  OR ELIGIBLE TO RECEIVE FEDERAL SUPPLE-
MENTAL SECURITY INCOME PAYMENTS AND/OR ADDITIONAL STATE PAYMENTS  PURSU-
ANT  TO  TITLE  SIX  OF THIS ARTICLE; ANY INCONSISTENT PROVISION OF THIS
CHAPTER OR OTHER LAW NOTWITHSTANDING, THE DEPARTMENT MAY  DESIGNATE  THE
OFFICE  OF TEMPORARY AND DISABILITY ASSISTANCE AS ITS AGENT TO DISCHARGE
ITS RESPONSIBILITY, OR SO MUCH OF ITS RESPONSIBILITY AS IS PERMITTED  BY
FEDERAL  LAW,  FOR  DETERMINING  ELIGIBILITY FOR MEDICAL ASSISTANCE WITH
RESPECT TO PERSONS WHO ARE NOT ELIGIBLE TO RECEIVE FEDERAL  SUPPLEMENTAL
SECURITY  INCOME  PAYMENTS  BUT  WHO  ARE RECEIVING A STATE ADMINISTERED
SUPPLEMENTARY PAYMENT OR MANDATORY MINIMUM SUPPLEMENT IN ACCORDANCE WITH
THE PROVISIONS OF SUBDIVISION ONE OF SECTION TWO HUNDRED TWELVE OF  THIS
ARTICLE.
  (2)  AN  INDIVIDUAL  WHO,  ALTHOUGH NOT RECEIVING PUBLIC ASSISTANCE OR
CARE FOR HIS OR HER MAINTENANCE UNDER OTHER PROVISIONS OF THIS  CHAPTER,
HAS  INCOME  AND RESOURCES, INCLUDING AVAILABLE SUPPORT FROM RESPONSIBLE
RELATIVES, THAT DOES NOT EXCEED THE AMOUNTS SET FORTH IN  PARAGRAPH  (A)
OF  SUBDIVISION  TWO OF THIS SECTION, AND IS (I) SIXTY-FIVE YEARS OF AGE
OR OLDER, OR CERTIFIED BLIND OR CERTIFIED DISABLED OR (II)  FOR  REASONS
OTHER  THAN  INCOME  OR  RESOURCES, IS ELIGIBLE FOR FEDERAL SUPPLEMENTAL
SECURITY INCOME BENEFITS AND/OR ADDITIONAL STATE PAYMENTS.
  (3) AN INDIVIDUAL WHO, ALTHOUGH NOT  RECEIVING  PUBLIC  ASSISTANCE  OR
CARE  FOR HIS OR HER MAINTENANCE UNDER OTHER PROVISIONS OF THIS CHAPTER,
HAS INCOME, INCLUDING AVAILABLE SUPPORT FROM RESPONSIBLE RELATIVES, THAT
DOES NOT EXCEED THE AMOUNTS SET FORTH IN PARAGRAPH  (A)  OF  SUBDIVISION
TWO  OF  THIS  SECTION, AND IS (I) UNDER THE AGE OF TWENTY-ONE YEARS, OR
(II) A SPOUSE OF A CASH PUBLIC ASSISTANCE RECIPIENT LIVING WITH  HIM  OR
HER AND ESSENTIAL OR NECESSARY TO HIS OR HER WELFARE AND WHOSE NEEDS ARE
TAKEN INTO ACCOUNT IN DETERMINING THE AMOUNT OF HIS OR HER CASH PAYMENT,
OR  (III)  IS A SINGLE INDIVIDUAL OR A MEMBER OF A CHILDLESS COUPLE, AND
AGE NINETEEN OR OLDER AND UNDER AGE SIXTY-FIVE, AND  UNABLE  TO  RECEIVE
NECESSARY  MEDICAL  CARE UNDER OTHER PROVISIONS OF THIS SECTION, OR (IV)
FOR REASONS OTHER THAN INCOME, WOULD MEET THE  ELIGIBILITY  REQUIREMENTS
OF  THE AID TO DEPENDENT CHILDREN PROGRAM AS IT EXISTED ON THE SIXTEENTH
DAY OF JULY, NINETEEN HUNDRED NINETY-SIX.
  (4) A CHILD IN FOSTER CARE, OR  A  CHILD  DESCRIBED  IN  SECTION  FOUR
HUNDRED FIFTY-FOUR OR FOUR HUNDRED FIFTY-EIGHT-D OF THIS CHAPTER.
  (5) A DISABLED INDIVIDUAL AT LEAST SIXTEEN YEARS OF AGE, BUT UNDER THE
AGE  OF  SIXTY-FIVE,  WHO:    WOULD  BE  ELIGIBLE FOR BENEFITS UNDER THE
SUPPLEMENTAL SECURITY INCOME PROGRAM BUT FOR EARNINGS IN EXCESS  OF  THE
ALLOWABLE  LIMIT;  HAS  NET  AVAILABLE  INCOME  THAT DOES NOT EXCEED TWO
HUNDRED FIFTY PERCENT OF THE APPLICABLE FEDERAL INCOME OFFICIAL  POVERTY
LINE,  AS  DEFINED AND UPDATED BY THE UNITED STATES DEPARTMENT OF HEALTH
AND HUMAN SERVICES, FOR A ONE-PERSON OR TWO-PERSON HOUSEHOLD, AS DEFINED
BY THE COMMISSIONER IN REGULATION; HAS HOUSEHOLD RESOURCES,  AS  DEFINED
IN PARAGRAPH (E) OF SUBDIVISION TWO OF SECTION THREE HUNDRED SIXTY-SIX-C
OF THIS TITLE, OTHER THAN RETIREMENT ACCOUNTS, THAT DO NOT EXCEED TWENTY
THOUSAND  DOLLARS  FOR A ONE-PERSON HOUSEHOLD OR THIRTY THOUSAND DOLLARS
FOR A TWO-PERSON HOUSEHOLD, AS DEFINED  BY  THE  COMMISSIONER  IN  REGU-
LATION;  AND  CONTRIBUTES  TO  THE  COST  OF MEDICAL ASSISTANCE PROVIDED
PURSUANT TO THIS SUBPARAGRAPH IN ACCORDANCE WITH SUBDIVISION  TWELVE  OF
SECTION  THREE HUNDRED SIXTY-SEVEN-A OF THIS TITLE; FOR PURPOSES OF THIS

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SUBPARAGRAPH, DISABLED MEANS HAVING A MEDICALLY DETERMINABLE  IMPAIRMENT
OF  SUFFICIENT  SEVERITY  AND  DURATION  TO  QUALIFY  FOR BENEFITS UNDER
SECTION 1902(A)(10)(A)(II)(XV) OF THE SOCIAL SECURITY ACT.
  (6)  AN INDIVIDUAL AT LEAST SIXTEEN YEARS OF AGE, BUT UNDER THE AGE OF
SIXTY-FIVE, WHO: IS EMPLOYED; CEASES TO BE IN RECEIPT OF MEDICAL ASSIST-
ANCE UNDER SUBPARAGRAPH FIVE OF THIS PARAGRAPH BECAUSE  THE  PERSON,  BY
REASON  OF MEDICAL IMPROVEMENT, IS DETERMINED AT THE TIME OF A REGULARLY
SCHEDULED CONTINUING DISABILITY REVIEW TO  NO  LONGER  BE  ELIGIBLE  FOR
SUPPLEMENTAL  SECURITY  INCOME  PROGRAM BENEFITS OR DISABILITY INSURANCE
BENEFITS UNDER THE SOCIAL SECURITY  ACT;  CONTINUES  TO  HAVE  A  SEVERE
MEDICALLY  DETERMINABLE  IMPAIRMENT, TO BE DETERMINED IN ACCORDANCE WITH
APPLICABLE FEDERAL REGULATIONS; AND CONTRIBUTES TO THE COST  OF  MEDICAL
ASSISTANCE  PROVIDED  PURSUANT  TO  THIS SUBPARAGRAPH IN ACCORDANCE WITH
SUBDIVISION TWELVE OF SECTION THREE HUNDRED SIXTY-SEVEN-A OF THIS TITLE;
FOR PURPOSES OF THIS SUBPARAGRAPH, A PERSON IS CONSIDERED TO BE EMPLOYED
IF THE PERSON IS EARNING AT LEAST  THE  APPLICABLE  MINIMUM  WAGE  UNDER
SECTION SIX OF THE FEDERAL FAIR LABOR STANDARDS ACT AND WORKING AT LEAST
FORTY HOURS PER MONTH; OR
  (7)  AN  INDIVIDUAL  RECEIVING TREATMENT FOR BREAST OR CERVICAL CANCER
WHO MEETS THE ELIGIBILITY REQUIREMENTS OF PARAGRAPH (D)  OF  SUBDIVISION
FOUR  OF  THIS  SECTION  OR  THE PRESUMPTIVE ELIGIBILITY REQUIREMENTS OF
SUBDIVISION FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (8) AN INDIVIDUAL RECEIVING TREATMENT FOR COLON OR PROSTATE CANCER WHO
MEETS THE ELIGIBILITY REQUIREMENTS OF PARAGRAPH (E) OF SUBDIVISION  FOUR
OF  THIS SECTION OR THE PRESUMPTIVE ELIGIBILITY REQUIREMENTS OF SUBDIVI-
SION FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (9) AN INDIVIDUAL WHO:
  (I) IS UNDER TWENTY-SIX YEARS OF AGE; AND
  (II) WAS IN FOSTER CARE UNDER THE RESPONSIBILITY OF THE STATE  ON  HIS
OR HER EIGHTEENTH BIRTHDAY; AND
  (III)  WAS  IN RECEIPT OF MEDICAL ASSISTANCE UNDER THIS TITLE WHILE IN
FOSTER CARE; AND
  (IV) IS NOT OTHERWISE  ELIGIBLE  FOR  MEDICAL  ASSISTANCE  UNDER  THIS
TITLE.
  (10)  A  RESIDENT  OF  A HOME FOR ADULTS OPERATED BY A SOCIAL SERVICES
DISTRICT, OR A RESIDENTIAL CARE CENTER FOR ADULTS OR COMMUNITY RESIDENCE
OPERATED OR CERTIFIED BY THE OFFICE  OF  MENTAL  HEALTH,  AND  HAS  NOT,
ACCORDING TO CRITERIA PROMULGATED BY THE DEPARTMENT CONSISTENT WITH THIS
TITLE, SUFFICIENT INCOME, OR IN THE CASE OF A PERSON SIXTY-FIVE YEARS OF
AGE  OR OLDER, CERTIFIED BLIND, OR CERTIFIED DISABLED, SUFFICIENT INCOME
AND RESOURCES, INCLUDING AVAILABLE SUPPORT FROM  RESPONSIBLE  RELATIVES,
TO  MEET  ALL  THE COSTS OF REQUIRED MEDICAL CARE AND SERVICES AVAILABLE
UNDER THIS TITLE.
  (D) CONDITIONS OF ELIGIBILITY. A PERSON  SHALL  NOT  BE  ELIGIBLE  FOR
MEDICAL ASSISTANCE UNDER THIS TITLE UNLESS HE OR SHE:
  (1)  IS  A  RESIDENT OF THE STATE, OR, WHILE TEMPORARILY IN THE STATE,
REQUIRES IMMEDIATE  MEDICAL  CARE  WHICH  IS  NOT  OTHERWISE  AVAILABLE,
PROVIDED  THAT  SUCH  PERSON  DID NOT ENTER THE STATE FOR THE PURPOSE OF
OBTAINING SUCH MEDICAL CARE; AND
  (2) ASSIGNS TO THE APPROPRIATE SOCIAL  SERVICES  OFFICIAL  OR  TO  THE
DEPARTMENT,  IN ACCORDANCE WITH DEPARTMENT REGULATIONS: (I) ANY BENEFITS
WHICH ARE AVAILABLE TO HIM OR HER INDIVIDUALLY FROM ANY THIRD PARTY  FOR
CARE  OR OTHER MEDICAL BENEFITS AVAILABLE UNDER THIS TITLE AND WHICH ARE
OTHERWISE ASSIGNABLE PURSUANT TO A CONTRACT OR ANY AGREEMENT  WITH  SUCH
THIRD  PARTY;  OR  (II)  ANY  RIGHTS,  OF THE INDIVIDUAL OR OF ANY OTHER
PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS  TITLE  AND  ON

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WHOSE  BEHALF  THE  INDIVIDUAL  HAS  THE  LEGAL  AUTHORITY TO EXECUTE AN
ASSIGNMENT OF SUCH RIGHTS, TO  SUPPORT  SPECIFIED  AS  SUPPORT  FOR  THE
PURPOSE OF MEDICAL CARE BY A COURT OR ADMINISTRATIVE ORDER; AND
  (3)  COOPERATES  WITH  THE APPROPRIATE SOCIAL SERVICES OFFICIAL OR THE
DEPARTMENT IN ESTABLISHING PATERNITY OR IN ESTABLISHING,  MODIFYING,  OR
ENFORCING  A  SUPPORT  ORDER WITH RESPECT TO HIS OR HER CHILD; PROVIDED,
HOWEVER, THAT NOTHING HEREIN CONTAINED SHALL BE CONSTRUED TO  REQUIRE  A
PAYMENT  UNDER THIS TITLE FOR CARE OR SERVICES, THE COST OF WHICH MAY BE
MET IN WHOLE OR IN PART BY A THIRD PARTY; NOTWITHSTANDING THE FOREGOING,
A SOCIAL SERVICES OFFICIAL SHALL NOT REQUIRE  SUCH  COOPERATION  IF  THE
SOCIAL  SERVICES OFFICIAL OR THE DEPARTMENT DETERMINES THAT SUCH ACTIONS
WOULD BE DETRIMENTAL TO THE BEST INTEREST OF THE  CHILD,  APPLICANT,  OR
RECIPIENT, OR WITH RESPECT TO PREGNANT WOMEN DURING PREGNANCY AND DURING
THE  SIXTY-DAY PERIOD BEGINNING ON THE LAST DAY OF PREGNANCY, IN ACCORD-
ANCE WITH PROCEDURES AND CRITERIA  ESTABLISHED  BY  REGULATIONS  OF  THE
DEPARTMENT CONSISTENT WITH FEDERAL LAW; AND
  (4) APPLIES FOR AND UTILIZES GROUP HEALTH INSURANCE BENEFITS AVAILABLE
THROUGH  A  CURRENT  OR FORMER EMPLOYER, INCLUDING BENEFITS FOR A SPOUSE
AND DEPENDENT CHILDREN,  IN  ACCORDANCE  WITH  THE  REGULATIONS  OF  THE
DEPARTMENT.
  (E)  CONDITIONS OF COVERAGE. AN OTHERWISE ELIGIBLE PERSON SHALL NOT BE
ENTITLED TO MEDICAL ASSISTANCE COVERAGE OF CARE, SERVICES, AND  SUPPLIES
UNDER THIS TITLE WHILE HE OR SHE:
  (1)  IS  AN  INMATE  OR  PATIENT IN AN INSTITUTION OR FACILITY WHEREIN
MEDICAL ASSISTANCE MAY NOT BE PROVIDED  IN  ACCORDANCE  WITH  APPLICABLE
FEDERAL  OR STATE REQUIREMENTS, EXCEPT FOR PERSONS DESCRIBED IN SUBPARA-
GRAPH TEN OF PARAGRAPH (C) OF THIS SUBDIVISION OR SUBDIVISION  ONE-A  OR
SUBDIVISION ONE-B OF THIS SECTION; OR
  (2)  IS  A  PATIENT IN A PUBLIC INSTITUTION OPERATED PRIMARILY FOR THE
TREATMENT OF TUBERCULOSIS OR CARE OF THE  MENTALLY  DISABLED,  WITH  THE
EXCEPTION  OF:  (I)  A  PERSON  SIXTY-FIVE  YEARS  OF AGE OR OLDER AND A
PATIENT IN ANY SUCH INSTITUTION; (II) A PERSON UNDER TWENTY-ONE YEARS OF
AGE AND RECEIVING IN-PATIENT PSYCHIATRIC SERVICES IN A  PUBLIC  INSTITU-
TION  OPERATED  PRIMARILY FOR THE CARE OF THE MENTALLY DISABLED; (III) A
PATIENT IN A PUBLIC INSTITUTION OPERATED PRIMARILY FOR THE CARE  OF  THE
MENTALLY  RETARDED  WHO  IS  RECEIVING MEDICAL CARE OR TREATMENT IN THAT
PART OF SUCH INSTITUTION THAT HAS BEEN APPROVED PURSUANT  TO  LAW  AS  A
HOSPITAL  OR  NURSING HOME; (IV) A PATIENT IN AN INSTITUTION OPERATED BY
THE STATE DEPARTMENT OF MENTAL HYGIENE, WHILE UNDER CARE IN  A  HOSPITAL
ON  RELEASE  FROM  SUCH INSTITUTION FOR THE PURPOSE OF RECEIVING CARE IN
SUCH HOSPITAL; OR (V) IS A PERSON RESIDING IN A COMMUNITY RESIDENCE OR A
RESIDENTIAL CARE CENTER FOR ADULTS.
  S 2. Subdivision 4 of section  366  of  the  social  services  law  is
REPEALED and a new subdivision 4 is added to read as follows:
  4. SPECIAL ELIGIBILITY PROVISIONS.
  (A) TRANSITIONAL MEDICAL ASSISTANCE.
  (1)  NOTWITHSTANDING ANY OTHER PROVISION OF LAW, EACH FAMILY WHICH WAS
ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO SUBPARAGRAPH FOUR  OF  PARA-
GRAPH  (B) OF SUBDIVISION ONE OF THIS SECTION IN AT LEAST ONE OF THE SIX
MONTHS IMMEDIATELY PRECEDING THE MONTH IN WHICH SUCH FAMILY BECAME INEL-
IGIBLE FOR SUCH ASSISTANCE BECAUSE OF INCOME FROM THE EMPLOYMENT OF  THE
CARETAKER  RELATIVE SHALL, WHILE SUCH FAMILY INCLUDES A DEPENDENT CHILD,
REMAIN ELIGIBLE FOR MEDICAL ASSISTANCE FOR TWELVE CALENDAR MONTHS  IMME-
DIATELY  FOLLOWING  THE  MONTH  IN  WHICH SUCH FAMILY WOULD OTHERWISE BE
DETERMINED TO BE INELIGIBLE  FOR  MEDICAL  ASSISTANCE  PURSUANT  TO  THE
PROVISIONS OF THIS TITLE AND THE REGULATIONS OF THE DEPARTMENT GOVERNING

S. 2606                            70                            A. 3006

INCOME  AND  RESOURCE LIMITATIONS RELATING TO ELIGIBILITY DETERMINATIONS
FOR FAMILIES DESCRIBED IN SUBPARAGRAPH FOUR OF PARAGRAPH (B) OF SUBDIVI-
SION ONE OF THIS SECTION.
  (2)  (I)  UPON  GIVING  NOTICE  OF  TERMINATION  OF MEDICAL ASSISTANCE
PROVIDED PURSUANT TO SUBPARAGRAPH FOUR OF PARAGRAPH (B)  OF  SUBDIVISION
ONE OF THIS SECTION, THE DEPARTMENT SHALL NOTIFY EACH SUCH FAMILY OF ITS
RIGHTS TO EXTENDED BENEFITS UNDER SUBPARAGRAPH ONE OF THIS PARAGRAPH AND
DESCRIBE THE CONDITIONS UNDER WHICH SUCH EXTENSION MAY BE TERMINATED.
  (II)  THE  DEPARTMENT  SHALL  PROMULGATE  REGULATIONS IMPLEMENTING THE
REQUIREMENTS OF THIS SUBPARAGRAPH AND SUBPARAGRAPH ONE OF THIS PARAGRAPH
RELATING TO THE CONDITIONS UNDER WHICH EXTENDED COVERAGE  HEREUNDER  MAY
BE  TERMINATED,  THE  SCOPE  OF COVERAGE, AND THE CONDITIONS UNDER WHICH
COVERAGE MAY BE EXTENDED PENDING A REDETERMINATION OF ELIGIBILITY.  SUCH
REGULATIONS SHALL, AT A MINIMUM, PROVIDE FOR: TERMINATION OF SUCH COVER-
AGE  AT  THE  CLOSE  OF  THE  FIRST  MONTH IN WHICH THE FAMILY CEASES TO
INCLUDE A DEPENDENT CHILD; NOTICE OF TERMINATION PRIOR TO THE  EFFECTIVE
DATE  OF  ANY  TERMINATIONS;  COVERAGE  UNDER  EMPLOYEE HEALTH PLANS AND
HEALTH MAINTENANCE ORGANIZATIONS; AND DISQUALIFICATION  OF  PERSONS  FOR
EXTENDED COVERAGE BENEFITS UNDER THIS PARAGRAPH FOR FRAUD.
  (3)  NOTWITHSTANDING  ANY  INCONSISTENT  PROVISION OF LAW, EACH FAMILY
WHICH WAS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO SUBPARAGRAPH  FOUR
OF PARAGRAPH (B) OF SUBDIVISION ONE OF THIS SECTION IN AT LEAST THREE OF
THE  SIX  MONTHS  IMMEDIATELY  PRECEDING  THE MONTH IN WHICH SUCH FAMILY
BECAME INELIGIBLE FOR SUCH ASSISTANCE AS A RESULT, WHOLLY OR PARTLY,  OF
THE  COLLECTION  OR  INCREASED  COLLECTION  OF  CHILD OR SPOUSAL SUPPORT
PURSUANT TO PART D OF TITLE IV  OF  THE  FEDERAL  SOCIAL  SECURITY  ACT,
SHALL,  FOR PURPOSES OF MEDICAL ASSISTANCE ELIGIBILITY, BE CONSIDERED TO
BE ELIGIBLE FOR MEDICAL ASSISTANCE  PURSUANT  TO  SUBPARAGRAPH  FOUR  OF
PARAGRAPH  (B) OF SUBDIVISION ONE OF THIS SECTION FOR AN ADDITIONAL FOUR
CALENDAR MONTHS BEGINNING WITH THE MONTH INELIGIBILITY FOR SUCH  ASSIST-
ANCE BEGINS.
  (B) PREGNANT WOMEN AND CHILDREN.
  (1)  A  PREGNANT  WOMAN ELIGIBLE FOR MEDICAL ASSISTANCE UNDER SUBPARA-
GRAPH TWO OR FOUR OF PARAGRAPH (B) OF SUBDIVISION ONE OF THIS SECTION ON
ANY DAY OF HER PREGNANCY WILL CONTINUE TO BE ELIGIBLE FOR SUCH CARE  AND
SERVICES  THROUGH THE END OF THE MONTH IN WHICH THE SIXTIETH DAY FOLLOW-
ING THE END OF THE PREGNANCY OCCURS, WITHOUT REGARD TO ANY CHANGE IN THE
INCOME OF THE FAMILY THAT INCLUDES THE  PREGNANT  WOMAN,  EVEN  IF  SUCH
CHANGE  OTHERWISE WOULD HAVE RENDERED HER INELIGIBLE FOR MEDICAL ASSIST-
ANCE.
  (2) A CHILD BORN TO A WOMAN ELIGIBLE FOR AND RECEIVING MEDICAL ASSIST-
ANCE ON THE DATE OF THE CHILD'S BIRTH SHALL BE DEEMED  TO  HAVE  APPLIED
FOR  MEDICAL ASSISTANCE AND TO HAVE BEEN FOUND ELIGIBLE FOR SUCH ASSIST-
ANCE ON THE DATE OF SUCH BIRTH AND TO REMAIN ELIGIBLE FOR  SUCH  ASSIST-
ANCE  FOR  A PERIOD OF ONE YEAR, SO LONG AS THE CHILD IS A MEMBER OF THE
WOMAN'S HOUSEHOLD AND THE WOMAN REMAINS ELIGIBLE FOR SUCH ASSISTANCE  OR
WOULD REMAIN ELIGIBLE FOR SUCH ASSISTANCE IF SHE WERE PREGNANT.
  (3)  A  CHILD UNDER THE AGE OF NINETEEN WHO IS DETERMINED ELIGIBLE FOR
MEDICAL ASSISTANCE UNDER THE PROVISIONS OF THIS SECTION, SHALL, CONSIST-
ENT WITH APPLICABLE  FEDERAL  REQUIREMENTS,  REMAIN  ELIGIBLE  FOR  SUCH
ASSISTANCE UNTIL THE EARLIER OF:
  (I)  THE  LAST  DAY  OF THE MONTH WHICH IS TWELVE MONTHS FOLLOWING THE
DETERMINATION OR REDETERMINATION OF ELIGIBILITY FOR SUCH ASSISTANCE; OR
  (II) THE LAST DAY OF THE MONTH IN WHICH THE CHILD REACHES THE  AGE  OF
NINETEEN.

S. 2606                            71                            A. 3006

  (4) AN INFANT ELIGIBLE UNDER SUBPARAGRAPH TWO OR FOUR OF PARAGRAPH (B)
OF  SUBDIVISION ONE OF THIS SECTION WHO IS RECEIVING MEDICALLY NECESSARY
IN-PATIENT SERVICES FOR WHICH MEDICAL ASSISTANCE IS PROVIDED ON THE DATE
THE CHILD ATTAINS ONE YEAR OF AGE, AND WHO, BUT FOR ATTAINING SUCH  AGE,
WOULD  REMAIN  ELIGIBLE  FOR MEDICAL ASSISTANCE UNDER SUCH SUBPARAGRAPH,
SHALL CONTINUE TO REMAIN ELIGIBLE UNTIL THE END OF THE  STAY  FOR  WHICH
IN-PATIENT SERVICES ARE BEING FURNISHED.
  (5)  A  CHILD  ELIGIBLE  UNDER  SUBPARAGRAPH THREE OF PARAGRAPH (B) OF
SUBDIVISION ONE OF THIS SECTION WHO  IS  RECEIVING  MEDICALLY  NECESSARY
IN-PATIENT SERVICES FOR WHICH MEDICAL ASSISTANCE IS PROVIDED ON THE DATE
THE CHILD ATTAINS NINETEEN YEARS OF AGE, AND WHO, BUT FOR ATTAINING SUCH
AGE,  WOULD REMAIN ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS PARAGRAPH,
SHALL CONTINUE TO REMAIN ELIGIBLE UNTIL THE END OF THE  STAY  FOR  WHICH
IN-PATIENT SERVICES ARE BEING FURNISHED.
  (6)  A  WOMAN  WHO WAS PREGNANT WHILE IN RECEIPT OF MEDICAL ASSISTANCE
WHO SUBSEQUENTLY LOSES HER ELIGIBILITY FOR MEDICAL ASSISTANCE SHALL HAVE
HER ELIGIBILITY FOR MEDICAL ASSISTANCE CONTINUED FOR A PERIOD  OF  TWEN-
TY-FOUR  MONTHS  FROM  THE  END  OF  THE MONTH IN WHICH THE SIXTIETH DAY
FOLLOWING THE END OF HER PREGNANCY OCCURS, BUT ONLY FOR FEDERAL TITLE  X
SERVICES  WHICH ARE ELIGIBLE FOR REIMBURSEMENT BY THE FEDERAL GOVERNMENT
AT A RATE OF NINETY PERCENT; PROVIDED, HOWEVER, THAT SUCH NINETY PERCENT
LIMITATION SHALL NOT APPLY TO THOSE SERVICES IDENTIFIED BY  THE  COMMIS-
SIONER   AS  SERVICES,  INCLUDING  TREATMENT  FOR  SEXUALLY  TRANSMITTED
DISEASES, GENERALLY PERFORMED AS PART OF OR AS A FOLLOW-UP TO A  SERVICE
ELIGIBLE  FOR  SUCH  NINETY PERCENT REIMBURSEMENT; AND PROVIDED FURTHER,
HOWEVER, THAT NOTHING IN  THIS  PARAGRAPH  SHALL  BE  DEEMED  TO  AFFECT
PAYMENT  FOR SUCH TITLE X SERVICES IF FEDERAL FINANCIAL PARTICIPATION IS
NOT AVAILABLE FOR SUCH CARE, SERVICES AND SUPPLIES.
  (C)  CONTINUOUS  COVERAGE  FOR  ADULTS.  NOTWITHSTANDING   ANY   OTHER
PROVISION  OF  LAW, A PERSON WHOSE ELIGIBILITY FOR MEDICAL ASSISTANCE IS
BASED ON THE MODIFIED  ADJUSTED  GROSS  INCOME  OF  THE  PERSON  OR  THE
PERSON'S  HOUSEHOLD, AND WHO LOSES ELIGIBILITY FOR SUCH ASSISTANCE FOR A
REASON OTHER THAN CITIZENSHIP STATUS, LACK OF STATE RESIDENCE, OR  FAIL-
URE  TO  PROVIDE  A  VALID  SOCIAL  SECURITY NUMBER, BEFORE THE END OF A
TWELVE MONTH PERIOD BEGINNING ON THE  EFFECTIVE  DATE  OF  THE  PERSON'S
INITIAL  ELIGIBILITY  FOR SUCH ASSISTANCE, OR BEFORE THE END OF A TWELVE
MONTH PERIOD BEGINNING ON THE DATE OF ANY  SUBSEQUENT  DETERMINATION  OF
ELIGIBILITY  BASED  ON MODIFIED ADJUSTED GROSS INCOME, SHALL HAVE HIS OR
HER ELIGIBILITY FOR SUCH ASSISTANCE CONTINUED  UNTIL  THE  END  OF  SUCH
TWELVE  MONTH  PERIOD,  PROVIDED THAT FEDERAL FINANCIAL PARTICIPATION IN
THE COSTS OF SUCH ASSISTANCE IS AVAILABLE.
  (D) BREAST AND CERVICAL CANCER TREATMENT.
  (1) PERSONS WHO ARE NOT ELIGIBLE  FOR  MEDICAL  ASSISTANCE  UNDER  THE
TERMS  OF  SECTION  1902(A)(10)(A)(I) OF THE FEDERAL SOCIAL SECURITY ACT
ARE ELIGIBLE FOR MEDICAL ASSISTANCE COVERAGE  DURING  THE  TREATMENT  OF
BREAST OR CERVICAL CANCER, SUBJECT TO THE PROVISIONS OF THIS PARAGRAPH.
  (2)  (I)  MEDICAL  ASSISTANCE  IS  AVAILABLE  UNDER  THIS PARAGRAPH TO
PERSONS WHO ARE UNDER SIXTY-FIVE YEARS OF AGE, HAVE  BEEN  SCREENED  FOR
BREAST  AND/OR CERVICAL CANCER UNDER THE CENTERS FOR DISEASE CONTROL AND
PREVENTION BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM  AND  NEED
TREATMENT  FOR  BREAST OR CERVICAL CANCER, AND ARE NOT OTHERWISE COVERED
UNDER CREDITABLE COVERAGE  AS  DEFINED  IN  THE  FEDERAL  PUBLIC  HEALTH
SERVICE ACT; PROVIDED HOWEVER THAT MEDICAL ASSISTANCE SHALL BE FURNISHED
PURSUANT  TO THIS CLAUSE ONLY TO THE EXTENT PERMITTED UNDER FEDERAL LAW,
IF, FOR SO LONG AS, AND TO THE EXTENT  THAT  FEDERAL  FINANCIAL  PARTIC-
IPATION IS AVAILABLE THEREFOR.

S. 2606                            72                            A. 3006

  (II)  MEDICAL  ASSISTANCE IS AVAILABLE UNDER THIS PARAGRAPH TO PERSONS
WHO MEET THE REQUIREMENTS OF CLAUSE (I) OF  THIS  SUBPARAGRAPH  BUT  FOR
THEIR AGE AND/OR GENDER, WHO HAVE BEEN SCREENED FOR BREAST AND/OR CERVI-
CAL  CANCER  UNDER THE PROGRAM DESCRIBED IN TITLE ONE-A OF ARTICLE TWEN-
TY-FOUR OF THE PUBLIC HEALTH LAW AND NEED TREATMENT FOR BREAST OR CERVI-
CAL  CANCER,  AND ARE NOT OTHERWISE COVERED UNDER CREDITABLE COVERAGE AS
DEFINED IN THE FEDERAL PUBLIC HEALTH SERVICE ACT; PROVIDED HOWEVER  THAT
MEDICAL  ASSISTANCE  SHALL  BE FURNISHED PURSUANT TO THIS CLAUSE ONLY IF
AND FOR SO LONG AS THE PROVISIONS OF CLAUSE (I) OF THIS SUBPARAGRAPH ARE
IN EFFECT.
  (3) MEDICAL ASSISTANCE PROVIDED TO A PERSON UNDER THIS PARAGRAPH SHALL
BE LIMITED TO THE PERIOD IN WHICH SUCH  PERSON  REQUIRES  TREATMENT  FOR
BREAST OR CERVICAL CANCER.
  (4)  (I)  THE COMMISSIONER OF HEALTH SHALL PROMULGATE SUCH REGULATIONS
AS MAY BE NECESSARY TO CARRY OUT THE PROVISIONS OF THIS PARAGRAPH.  SUCH
REGULATIONS  SHALL  INCLUDE, BUT NOT BE LIMITED TO: ELIGIBILITY REQUIRE-
MENTS; A DESCRIPTION OF THE MEDICAL SERVICES WHICH ARE  COVERED;  AND  A
PROCESS  FOR  PROVIDING PRESUMPTIVE ELIGIBILITY WHEN A QUALIFIED ENTITY,
AS DEFINED BY THE COMMISSIONER, DETERMINES ON THE BASIS  OF  PRELIMINARY
INFORMATION  THAT  A PERSON MEETS THE REQUIREMENTS FOR ELIGIBILITY UNDER
THIS PARAGRAPH.
  (II) FOR PURPOSES OF DETERMINING ELIGIBILITY  FOR  MEDICAL  ASSISTANCE
UNDER  THIS  PARAGRAPH, RESOURCES AVAILABLE TO SUCH INDIVIDUAL SHALL NOT
BE CONSIDERED NOR REQUIRED TO BE APPLIED  TOWARD  THE  PAYMENT  OR  PART
PAYMENT  OF  THE  COST  OF MEDICAL CARE, SERVICES AND SUPPLIES AVAILABLE
UNDER THIS PARAGRAPH.
  (III) AN INDIVIDUAL SHALL BE ELIGIBLE FOR PRESUMPTIVE ELIGIBILITY  FOR
MEDICAL  ASSISTANCE  UNDER THIS PARAGRAPH IN ACCORDANCE WITH SUBDIVISION
FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (5) THE COMMISSIONER OF HEALTH SHALL, CONSISTENT WITH THIS TITLE, MAKE
ANY NECESSARY AMENDMENTS  TO  THE  STATE  PLAN  FOR  MEDICAL  ASSISTANCE
SUBMITTED PURSUANT TO SECTION THREE HUNDRED SIXTY-THREE-A OF THIS TITLE,
IN ORDER TO ENSURE FEDERAL FINANCIAL PARTICIPATION IN EXPENDITURES UNDER
THIS  PARAGRAPH.  NOTWITHSTANDING  ANY PROVISION OF LAW TO THE CONTRARY,
THE PROVISIONS OF CLAUSE (I) OF SUBPARAGRAPH TWO OF THIS PARAGRAPH SHALL
BE EFFECTIVE ONLY IF AND FOR SO LONG AS FEDERAL FINANCIAL  PARTICIPATION
IS AVAILABLE IN THE COSTS OF MEDICAL ASSISTANCE FURNISHED THEREUNDER.
  (E) COLON AND PROSTATE CANCER TREATMENT.
  (1)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF LAW TO THE CONTRARY, A
PERSON WHO HAS BEEN SCREENED OR REFERRED  FOR  SCREENING  FOR  COLON  OR
PROSTATE  CANCER  BY  THE CANCER SERVICES SCREENING PROGRAM, AS ADMINIS-
TERED BY THE DEPARTMENT OF HEALTH, AND HAS BEEN DIAGNOSED WITH COLON  OR
PROSTATE  CANCER  IS ELIGIBLE FOR MEDICAL ASSISTANCE FOR THE DURATION OF
HIS OR HER TREATMENT FOR SUCH CANCER.
  (2) PERSONS ELIGIBLE FOR MEDICAL ASSISTANCE UNDER THIS PARAGRAPH SHALL
HAVE AN INCOME OF TWO HUNDRED FIFTY PERCENT OR LESS  OF  THE  COMPARABLE
FEDERAL  INCOME OFFICIAL POVERTY LINE AS DEFINED AND ANNUALLY REVISED BY
THE FEDERAL OFFICE OF MANAGEMENT AND BUDGET.
  (3) AN INDIVIDUAL SHALL BE ELIGIBLE FOR  PRESUMPTIVE  ELIGIBILITY  FOR
MEDICAL  ASSISTANCE  UNDER THIS PARAGRAPH IN ACCORDANCE WITH SUBDIVISION
FIVE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE.
  (4) MEDICAL ASSISTANCE IS AVAILABLE UNDER THIS  PARAGRAPH  TO  PERSONS
WHO  ARE  UNDER  SIXTY-FIVE  YEARS OF AGE, AND ARE NOT OTHERWISE COVERED
UNDER CREDITABLE COVERAGE  AS  DEFINED  IN  THE  FEDERAL  PUBLIC  HEALTH
SERVICE ACT.

S. 2606                            73                            A. 3006

  S  3.  Paragraph  (a)  of subdivision 4 of section 364-i of the social
services law, as added by section 29-a of part A of chapter  58  of  the
laws of 2007, is amended to read as follows:
  (a) Notwithstanding any inconsistent provision of law to the contrary,
a  child  shall  be presumed to be eligible for medical assistance under
this title beginning on the date that a qualified entity, as defined  in
paragraph  (c)  of this subdivision, determine, on the basis of prelimi-
nary information, that the [net] MAGI household income of the child does
not exceed the applicable level for eligibility as provided for pursuant
to SUBPARAGRAPH TWO OR THREE  OF  paragraph  [(u)]  (B)  of  subdivision
[four] ONE of section three hundred sixty-six of this title.
  S  4.  Paragraph  (a)  of subdivision 5 of section 364-i of the social
services law, as added by chapter 176 of the laws of 2006, is amended to
read as follows:
  (a) An individual shall be presumed to be eligible for medical assist-
ance under this title beginning on the date that a qualified entity,  as
defined  in  paragraph (c) of this subdivision, determines, on the basis
of preliminary information, that the individual meets  the  requirements
of  paragraph  [(v)  or (v-1)] (D) OR (E) of subdivision four of section
three hundred sixty-six of this title.
  S 5. Subdivision 6 of section 364-i of the  social  services  law,  as
added by chapter 484 of the laws of 2009 and paragraph (a-2) as added by
section  76  of  part H of chapter 59 of the laws of 2011, is amended to
read as follows:
  6. (a) A pregnant woman shall be presumed to be eligible for [coverage
of services described in paragraph  (c)  of  this  subdivision]  MEDICAL
ASSISTANCE  UNDER  THIS TITLE, EXCLUDING INPATIENT SERVICES AND INSTITU-
TIONAL LONG TERM CARE, beginning  on  the  date  that  a  prenatal  care
provider,  licensed  under article twenty-eight of the public health law
or other prenatal care provider approved by  the  department  of  health
determines,  on  the basis of preliminary information, that the pregnant
woman's [family has: (i) subject to the approval of the federal  Centers
for  Medicare  and  Medicaid Services, gross income that does not exceed
two hundred thirty percent of the federal poverty line (as  defined  and
annually  revised  by  the  United States department of health and human
services) for a family of the same size, or (ii) in the absence of  such
approval,  net  income  that  does not exceed two hundred percent of the
federal poverty line (as defined and  annually  revised  by  the  United
States department of health and human services) for a family of the same
size.]  MAGI HOUSEHOLD INCOME DOES NOT EXCEED THE MAGI-EQUIVALENT OF TWO
HUNDRED PERCENT OF THE FEDERAL POVERTY LINE FOR  THE  APPLICABLE  FAMILY
SIZE,  WHICH  SHALL  BE CALCULATED IN ACCORDANCE WITH GUIDANCE ISSUED BY
THE SECRETARY OF THE  UNITED  STATES  DEPARTMENT  OF  HEALTH  AND  HUMAN
SERVICES.
  (a-2)  At the time of application for presumptive eligibility pursuant
to this subdivision, a pregnant woman who resides in a  social  services
district  that has implemented the state's managed care program pursuant
to section three hundred  sixty-four-j  of  this  title  must  choose  a
managed  care  provider. If a managed care provider is not chosen at the
time of application, the pregnant woman will be assigned  to  a  managed
care provider in accordance with subparagraphs (ii), (iii), (iv) and (v)
of  paragraph  (f)  of  subdivision four of section three hundred sixty-
four-j of this title.
  (b) Such presumptive eligibility shall continue  through  the  earlier
of:   the day on which eligibility is determined pursuant to this title;
or the last day of the month following the month in which  the  provider

S. 2606                            74                            A. 3006

makes  preliminary  determination,  in  the case of a pregnant woman who
does not file an application for medical assistance on  or  before  such
day.
  (c)  [A presumptively eligible pregnant woman is eligible for coverage
of:
  (i) all medical care,  services,  and  supplies  available  under  the
medical  assistance  program,  excluding inpatient services and institu-
tional long term care, if the woman's family has:  (A)  subject  to  the
approval  of  the  federal  Centers  for Medicare and Medicaid Services,
gross income that does not exceed one  hundred  twenty  percent  of  the
federal  poverty  line  (as  defined  and annually revised by the United
States department of health and human services) for a family of the same
size, or (B) in the absence of such approval, net income that  does  not
exceed  one  hundred percent of the federal poverty line (as defined and
annually revised by the United States department  of  health  and  human
services) for a family of the same size; or
  (ii) prenatal care services as described in subparagraph four of para-
graph (o) of subdivision four of section three hundred sixty-six of this
title,  if  the  woman's  family has: (A) subject to the approval of the
federal Centers for Medicare and Medicaid Services,  gross  income  that
exceeds  one  hundred  twenty  percent  of  the federal poverty line (as
defined and annually revised by the United States department  of  health
and  human  services) for families of the same size, but does not exceed
two hundred thirty percent of such federal poverty line, or (B)  in  the
absence  of  such  approval, net income that exceeds one hundred percent
but does not exceed two hundred percent of the federal poverty line  (as
defined  and  annually revised by the United States department of health
and human services) for a family of the same size.
  (d)] The department of health shall provide  prenatal  care  providers
licensed  under  article twenty-eight of the public health law and other
approved prenatal care providers with such forms as are necessary for  a
pregnant  woman  to apply and information on how to assist such women in
completing and filing such forms. A qualified provider which  determines
that  a pregnant woman is presumptively eligible shall notify the social
services district in which the pregnant woman resides  of  the  determi-
nation  within  five  working days after the date on which such determi-
nation is made and shall inform the woman at the time the  determination
is  made that she is required to make application by the last day of the
month following the month in which the determination is made.
  [(e)] (D) Notwithstanding any other provision of  law,  care  that  is
furnished  to  a  pregnant  woman  pursuant to this subdivision during a
presumptive eligibility period shall be deemed as medical assistance for
purposes of payment and state reimbursement.
  [(f)] (E) Facilities licensed under article twenty-eight of the public
health law providing prenatal care services  shall  perform  presumptive
eligibility  determinations  and  assist women in submitting appropriate
documentation to the social services district as required by the commis-
sioner; provided, however, that a facility may apply to the commissioner
for exemption from this requirement on the basis of undue hardship.
  [(g)] (F) All prenatal care providers enrolled in the medicaid program
must provide prenatal  care  services  to  eligible  service  recipients
determined  presumptively  eligible  for  medical assistance but not yet
enrolled in the medical assistance program, and assist women in  submit-
ting  appropriate  documentation  to  the  social  services  district as
required by the commissioner.

S. 2606                            75                            A. 3006

  S 6. Subdivision 1 and the  opening  paragraph  of  subdivision  2  of
section  365-a  of  the social services law, subdivision 1 as amended by
chapter 110 of the laws of 1971 and the opening paragraph of subdivision
2 as amended by chapter 41 of the laws of 1992, are amended to  read  as
follows:
  [1.] The amount, nature and manner of providing medical assistance for
needy  persons  shall  be determined by the public welfare official with
the advice of a physician and in accordance with the local medical plan,
this title, and the regulations of the department.
  1. "BENCHMARK COVERAGE" SHALL MEAN PAYMENT OF PART OR ALL OF THE  COST
OF MEDICALLY NECESSARY MEDICAL, DENTAL, AND REMEDIAL CARE, SERVICES, AND
SUPPLIES DESCRIBED IN SUBDIVISION TWO OF THIS SECTION, AND TO THE EXTENT
NOT  INCLUDED  THEREIN,  ANY  ESSENTIAL BENEFITS AS DEFINED IN 42 U.S.C.
18022(B), WITH THE EXCEPTION OF INSTITUTIONAL LONG TERM  CARE  SERVICES;
SUCH  CARE,  SERVICES AND SUPPLIES SHALL BE PROVIDED THROUGH THE MANAGED
CARE PROGRAM DESCRIBED IN SECTION THREE  HUNDRED  SIXTY-FOUR-J  OF  THIS
TITLE.
  ["Medical  assistance"] "STANDARD COVERAGE" shall mean payment of part
or all of the cost of medically necessary medical, dental  and  remedial
care,  services  and  supplies, as authorized in this title or the regu-
lations of the department, which are  necessary  to  prevent,  diagnose,
correct  or  cure  conditions  in the person that cause acute suffering,
endanger life, result in  illness  or  infirmity,  interfere  with  such
person's  capacity  for  normal  activity,  or threaten some significant
handicap and which are furnished an eligible person in  accordance  with
this  title  and  the regulations of the department. Such care, services
and supplies shall include the  following  medical  care,  services  and
supplies,  together  with  such  medical  care,  services  and  supplies
provided for in subdivisions three, four and five of this  section,  and
such  medical care, services and supplies as are authorized in the regu-
lations of the department:
  S 7. Subdivision 1 of section 366-a of the  social  services  law,  as
amended  by  section  60 of part C of chapter 58 of the laws of 2009, is
amended to read as follows:
  1. Any person  requesting  medical  assistance  may  make  application
therefor  [in  person,  through another in his behalf or by mail] IN ANY
FORM OR MANNER PERMITTED BY THE DEPARTMENT OF HEALTH, WHICH MAY  INCLUDE
THE SUBMISSION OF: A WRITTEN APPLICATION to the social services official
of  the  county[, city or town, or to the service officer of the city or
town] in which the applicant resides or is found OR TO THE DEPARTMENT OF
HEALTH OR ITS AGENT; A PHONE APPLICATION;  OR  AN  ON-LINE  APPLICATION.
[In  addition, in the case of a person who is sixty-five years of age or
older and is a patient in a state hospital for tuberculosis or  for  the
mentally  disabled,  applications  may be made to the department or to a
social services official designated as the  agent  of  the  department.]
Notwithstanding  any  provision  of law to the contrary, [a personal] AN
IN-PERSON interview with the applicant  or  with  the  person  who  made
application  on  his  or  her  behalf shall not be required as part of a
determination of initial or  continuing  eligibility  pursuant  to  this
title.
  S  8.  Paragraph  (a)  of subdivision 2 of section 366-a of the social
services law, as amended by section 60 of part C of chapter  58  of  the
laws of 2009, is amended to read as follows:
  (a)  Upon receipt of such application, the appropriate social services
official, or the department of health or its agent [when  the  applicant
is a patient in a state hospital for the mentally disabled,] shall veri-

S. 2606                            76                            A. 3006

fy the eligibility of such applicant. In accordance with the regulations
of  the  department  of  health,  it  shall be the responsibility of the
applicant to provide information and  documentation  necessary  for  the
determination of initial and ongoing eligibility for medical assistance.
If  an  applicant or recipient is unable to provide necessary documenta-
tion, the [public welfare] SOCIAL SERVICES official OR THE DEPARTMENT OF
HEALTH OR ITS AGENT shall promptly cause an investigation  to  be  made.
Where  an  investigation is necessary, sources of information other than
public records will be consulted only with permission of  the  applicant
or  recipient.  In  the event that such permission is not granted by the
applicant or recipient, or necessary documentation cannot  be  obtained,
the  social  services  official or the department of health or its agent
may suspend or deny medical assistance until such  time  as  it  may  be
satisfied as to the applicant's or recipient's eligibility therefor.
  S  9.  The  opening paragraph of subdivision 3 of section 366-a of the
social services law, as added by chapter 256 of the  laws  of  1966,  is
amended to read as follows:
  Upon  the receipt of such application, and after the completion of any
investigation that shall be deemed necessary,  the  appropriate  [public
welfare]  SOCIAL SERVICES official[,] or the department OF HEALTH or its
agent [when the applicant is a patient in a state hospital for  tubercu-
losis or for the mentally disabled,] shall
  S  10. Paragraphs (b) and (c) of subdivision 5 of section 366-a of the
social services law, as added by section 52 of part A of  chapter  1  of
the laws of 2002, are amended to read as follows:
  (b)  [The  commissioner shall develop a simplified statewide recertif-
ication form for use in redetermining eligibility under this title.  The
form shall include requests only for such information that is:
  (i)  reasonably  necessary  to  determine  continued  eligibility  for
medical assistance under this title; and
  (ii) subject to change since  the  date  of  the  recipient's  initial
application.] THE REGULATIONS REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVI-
SION SHALL PROVIDE, AT A MINIMUM, THAT:
  (I)  THE REDETERMINATION OF ELIGIBILITY WILL BE MADE WITHOUT REQUIRING
INFORMATION FROM THE RECIPIENT, IF POSSIBLE, BASED ON RELIABLE  INFORMA-
TION  POSSESSED  OR  AVAILABLE TO THE DEPARTMENT OF HEALTH OR ITS AGENT,
INCLUDING INFORMATION ACCESSED FROM DATABASES  PURSUANT  TO  SUBDIVISION
EIGHT OF THIS SECTION;
  (II)  IF  THE  DEPARTMENT  OF  HEALTH  OR ITS AGENT IS UNABLE TO RENEW
ELIGIBILITY BASED  ON  AVAILABLE  INFORMATION,  THE  RECIPIENT  WILL  BE
REQUESTED  TO SUPPLY ONLY SUCH INFORMATION AS IS REASONABLY NECESSARY TO
DETERMINE CONTINUED ELIGIBILITY FOR MEDICAL ASSISTANCE UNDER THIS  TITLE
AND SUBJECT TO CHANGE SINCE THE DATE OF THE RECIPIENT'S INITIAL APPLICA-
TION;  IF  INCOME  INFORMATION IS REQUESTED, THE RECIPIENT MAY ATTEST TO
SUCH INFORMATION UNLESS THE RECIPIENT IS ELIGIBLE UNDER SUBPARAGRAPH TWO
OF PARAGRAPH (C) OF SUBDIVISION ONE OF SECTION THREE  HUNDRED  SIXTY-SIX
OF  THIS  TITLE  AND IS RECEIVING MEDICAL ASSISTANCE COVERAGE OF NURSING
FACILITY SERVICES;
  (III) FOR PERSONS WHOSE MEDICAL ASSISTANCE  ELIGIBILITY  IS  BASED  ON
MODIFIED  ADJUSTED  GROSS INCOME, ELIGIBILITY MUST BE RENEWED ONCE EVERY
TWELVE MONTHS, AND NO MORE FREQUENTLY THAN  ONCE  EVERY  TWELVE  MONTHS,
UNLESS  THE DEPARTMENT OF HEALTH OR ITS AGENT RECEIVES INFORMATION ABOUT
A CHANGE IN A RECIPIENT'S CIRCUMSTANCES THAT MAY AFFECT ELIGIBILITY; AND
  (IV) ESTABLISH PROCEDURES FOR RENEWING AND  REDETERMINING  ELIGIBILITY
THAT  COMPLY  WITH  THE  REQUIREMENTS  OF  FEDERAL  REGULATION AT 42 CFR
435.916 OR ANY SUCCESSOR REGULATION.

S. 2606                            77                            A. 3006

  (c) [A personal] AN IN-PERSON interview with the recipient  shall  not
be required as part of a redetermination of eligibility pursuant to this
subdivision.
  S  11.  Paragraph  (d) of subdivision 5 of section 366-a of the social
services law is REPEALED.
  S 12. Paragraph (e) of subdivision 5 of section 366-a  of  the  social
services  law, as added by section 1 of part C of chapter 58 of the laws
of 2007, is amended to read as follows:
  [(e)] (D) The commissioner of health shall verify the accuracy of  the
information  provided  by  [the]  AN APPLICANT OR recipient [pursuant to
paragraph (d) of this subdivision] by matching it against information to
which the commissioner of health has access, including under subdivision
eight of this section.  In the event [there is an inconsistency between]
the information reported  by  the  recipient  [and]  IS  NOT  REASONABLY
COMPATIBLE  WITH  any information obtained by the commissioner of health
from other sources and such [inconsistency] INCOMPATIBILITY is  material
to  medical  assistance  eligibility,  the  commissioner of health shall
request that the recipient provide adequate documentation to verify  his
or  her  place of residence or income, as applicable. In addition to the
documentation of residence and income authorized by this paragraph,  the
commissioner  of  health is authorized to periodically require a reason-
able sample of recipients to  provide  documentation  of  residence  and
income at recertification. The commissioner of health shall consult with
the  medicaid inspector general regarding income and residence verifica-
tion practices and procedures necessary to  maintain  program  integrity
and deter fraud and abuse.
  S  13.  Subdivision  11 of section 364-j of the social services law is
REPEALED.
  S 14. Clause (D) of subparagraph (v) of paragraph (a) of subdivision 2
of section 369-ee of the social services law, as amended by  section  67
of  part  C  of  chapter  58  of the laws of 2009, is amended, and a new
subparagraph (vi) is added to read as follows:
  (D) is not described in clause (A), (B) or (C)  of  this  subparagraph
and has gross family income equal to or less than two hundred percent of
the  federal income official poverty line (as defined and updated by the
United States Department of Health and Human Services) for a  family  of
the  same size; provided, however, that eligibility under this clause is
subject to sources of federal and non-federal funding for  such  purpose
described   in   section  sixty-seven-a  of  [the]  PART  C  OF  chapter
FIFTY-EIGHT of the laws of two thousand nine [that added this clause] or
as may be available under the waiver agreement  entered  into  with  the
federal  government  under section eleven hundred fifteen of the federal
social security act, as jointly determined by the commissioner  and  the
director  of the division of the budget. In no case shall state funds be
utilized to support the non-federal share of  expenditures  pursuant  to
this  subparagraph,  provided  however  that the commissioner may demon-
strate to the United States department of health and human services  the
existence of non-federally participating state expenditures as necessary
to secure federal funding under an eleven hundred fifteen waiver for the
purposes  herein. Eligibility under this clause may be provided to resi-
dents of all counties or, at the joint discretion  of  the  commissioner
and  the director of the division of the budget, a subset of counties of
the state[.]; AND
  (VI) MAKES APPLICATION FOR BENEFITS  PURSUANT  TO  THIS  TITLE  ON  OR
BEFORE DECEMBER THIRTY-FIRST, TWO THOUSAND THIRTEEN.

S. 2606                            78                            A. 3006

  S  14-a. Subdivision 5 of section 369-ee of the social services law is
amended by adding a new paragraph (d) to read as follows:
  (D)  NOTWITHSTANDING  THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
SION OR ANY OTHER PROVISION OF LAW, IN THE CASE OF  A  PERSON  RECEIVING
HEALTH  CARE SERVICES PURSUANT TO THIS TITLE ON JANUARY FIRST, TWO THOU-
SAND FOURTEEN, SUCH PERSON'S ELIGIBILITY SHALL BE RECERTIFIED AS SOON AS
PRACTICABLE THEREAFTER, AND SUCH  PERSON'S  COVERAGE  UNDER  THIS  TITLE
SHALL  END  ON THE EARLIEST OF: (I) THE DATE THE PERSON IS ENROLLED IN A
QUALIFIED HEALTH PLAN OFFERED THROUGH A HEALTH INSURANCE EXCHANGE ESTAB-
LISHED IN ACCORDANCE  WITH  THE  REQUIREMENTS  OF  THE  FEDERAL  PATIENT
PROTECTION  AND  AFFORDABLE  CARE  ACT (P.L. 111-148), AS AMENDED BY THE
FEDERAL HEALTH CARE AND EDUCATION  ACT  OF  2010  (P.L.  111-152);  (II)
DECEMBER THIRTY-FIRST, TWO THOUSAND FOURTEEN; OR (III) THE DATE ON WHICH
THE  DEPARTMENT  OF  HEALTH CEASES TO HAVE ALL NECESSARY APPROVALS UNDER
FEDERAL LAW AND REGULATION TO RECEIVE FEDERAL  FINANCIAL  PARTICIPATION,
UNDER  THE  PROGRAM  DESCRIBED  IN  TITLE ELEVEN OF THIS ARTICLE, IN THE
COSTS OF HEALTH SERVICES PROVIDED PURSUANT TO THIS SECTION.
  S 15. Sections 369-ee and  369-ff  of  the  social  services  law  are
REPEALED.
  S  16.  Subdivision  3  of section 367-a of the social services law is
amended by adding a new paragraph (e) to read as follows:
  (E) (1) PAYMENT OF PREMIUMS FOR  ENROLLING  INDIVIDUALS  IN  QUALIFIED
HEALTH  PLANS  OFFERED  THROUGH  A HEALTH INSURANCE EXCHANGE ESTABLISHED
PURSUANT TO THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L.
111-148), AS AMENDED BY THE FEDERAL HEALTH CARE AND EDUCATION  RECONCIL-
IATION ACT OF 2010 (P.L. 111-152), TOGETHER WITH THE COSTS OF APPLICABLE
CO-INSURANCE,  DEDUCTIBLE  AMOUNTS,  AND OTHER COST-SHARING OBLIGATIONS,
SHALL BE AVAILABLE TO INDIVIDUALS WHO:
  (I) IMMEDIATELY PRIOR TO BEING ENROLLED IN THE QUALIFIED HEALTH  PLAN,
OR  TO  THE EXPIRATION OR REPEAL OF THE FAMILY HEALTH PLUS PROGRAM, WERE
ELIGIBLE UNDER SUCH PROGRAM AND ENROLLED IN A  FAMILY  HEALTH  INSURANCE
PLAN  AS  A PARENT OR STEPPARENT OF A CHILD UNDER THE AGE OF TWENTY-ONE,
OR AS A CHILD NINETEEN OR TWENTY YEARS OF AGE LIVING  WITH  HIS  OR  HER
PARENT,  AND  WHOSE  MAGI  HOUSEHOLD  INCOME, AS DEFINED IN SUBPARAGRAPH
EIGHT OF PARAGRAPH (A) OF  SUBDIVISION  ONE  OF  SECTION  THREE  HUNDRED
SIXTY-SIX OF THIS TITLE, EXCEEDS ONE HUNDRED THIRTY-THREE PERCENT OF THE
FEDERAL POVERTY LINE FOR THE APPLICABLE FAMILY SIZE;
  (II)  ARE  NOT  OTHERWISE  ELIGIBLE  FOR MEDICAL ASSISTANCE UNDER THIS
TITLE; AND
  (III) ARE ENROLLED IN A QUALIFIED HEALTH PLAN IN THE SILVER LEVEL,  AS
DEFINED IN 42 U.S.C. 18022.
  (2) PAYMENT PURSUANT TO THIS PARAGRAPH SHALL BE FOR PREMIUMS, CO-INSU-
RANCE, DEDUCTIBLES, AND OTHER COST-SHARING OBLIGATIONS OF THE INDIVIDUAL
UNDER  THE  QUALIFIED  HEALTH  PLAN  TO  THE EXTENT THAT THEY EXCEED THE
AMOUNT THAT WOULD  HAVE  BEEN  THE  INDIVIDUAL'S  CO-PAYMENT  OBLIGATION
AMOUNT  UNDER THE FAMILY HEALTH PLUS PROGRAM, AND SHALL CONTINUE ONLY IF
AND FOR SO LONG AS THE INDIVIDUAL'S MAGI HOUSEHOLD  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.
  (3) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO SUBMIT  AMENDMENTS  TO
THE STATE PLAN FOR MEDICAL ASSISTANCE AND/OR SUBMIT ONE OR MORE APPLICA-
TIONS FOR WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT AS MAY BE NECESSARY
TO RECEIVE FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF PAYMENTS MADE
PURSUANT  TO  THIS PARAGRAPH; PROVIDED FURTHER, HOWEVER, THAT NOTHING IN
THIS SUBPARAGRAPH SHALL BE  DEEMED  TO  AFFECT  PAYMENTS  FOR  PREMIUMS,
CO-INSURANCE, DEDUCTIBLES, OR OTHER COST-SHARING OBLIGATIONS PURSUANT TO

S. 2606                            79                            A. 3006

THIS  PARAGRAPH  IF FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF SUCH
PAYMENTS IS NOT AVAILABLE.
  S 17. Section 2510 of the public health law is amended by adding a new
subdivision 13 to read as follows:
  13.  "HOUSEHOLD  INCOME"  MEANS THE SUM OF THE MODIFIED ADJUSTED GROSS
INCOME OF EVERY INDIVIDUAL INCLUDED IN A CHILD'S HOUSEHOLD CALCULATED IN
ACCORDANCE WITH APPLICABLE  FEDERAL  LAW  AND  REGULATIONS,  AS  MAY  BE
AMENDED.  THIS DEFINITION SHALL BE EFFECTIVE ON JANUARY FIRST, TWO THOU-
SAND FOURTEEN OR A LATER DATE  TO  BE  DETERMINED  BY  THE  COMMISSIONER
CONTINGENT  UPON THE REQUIREMENTS OF THE PATIENT PROTECTION AND AFFORDA-
BLE CARE ACT OF 2010  BEING  FULLY  IMPLEMENTED  BY  THE  STATE  AND  AS
APPROVED  BY  THE  SECRETARY  OF  THE  DEPARTMENT  OF  HEALTH  AND HUMAN
SERVICES.
  S 18. Section 2510 of the public health law is amended by  adding  two
new subdivisions 14 and 15 to read as follows:
  14.  "STATE ENROLLMENT CENTER" MEANS THE CENTRALIZED SYSTEM AND OPERA-
TION OF ELIGIBILITY DETERMINATIONS BY THE STATE OR  ITS  CONTRACTOR  FOR
ALL  INSURANCE AFFORDABILITY PROGRAMS, INCLUDING THE CHILD HEALTH INSUR-
ANCE PROGRAM ESTABLISHED PURSUANT TO THIS TITLE.
  15. "INSURANCE AFFORDABILITY PROGRAMS" MEANS THOSE PROGRAMS SET  FORTH
IN SECTION 435.4 OF TITLE 42 OF THE CODE OF FEDERAL REGULATIONS.
  S 19. Subparagraphs (iv) and (vi) of paragraph (f) of subdivision 2 of
section  2511  of  the  public health law, subparagraph (iv) as added by
section 44 of part A of chapter 1 of the laws of 2002  and  subparagraph
(vi)  as  added  by  section 45-b of part C of chapter 58 of the laws of
2008, are amended to read as follows:
  (iv) In the event a household does not  provide  income  documentation
required  by  subparagraph  (iii) of this paragraph within two months of
the approved organization's OR STATE ENROLLMENT CENTER'S request, WHICH-
EVER IS APPLICABLE, the approved organization OR STATE ENROLLMENT CENTER
shall disenroll the child at the end of such two month period. Except as
provided in  paragraph  (c)  of  subdivision  five-a  of  this  section,
approved  organizations shall not be obligated to repay subsidy payments
made by the state on behalf of children enrolled during this  two  month
period.
  (vi)  Any  income  verification response by the department of taxation
and finance pursuant to subparagraphs (i) and  (ii)  of  this  paragraph
shall  not  be  a public record and shall not be released by the commis-
sioner, the department of taxation and finance [or], an approved  organ-
ization,  OR  THE STATE ENROLLMENT CENTER, except pursuant to this para-
graph. Information disclosed pursuant to this paragraph shall be limited
to information necessary  for  verification.  Information  so  disclosed
shall be kept confidential by the party receiving such information. Such
information  shall be expunged within a reasonable time to be determined
by the commissioner and the department of taxation and finance.
  S 20. Paragraph (j) of subdivision 2 of section  2511  of  the  public
health law, as added by section 45 of part A of chapter 1 of the laws of
2002, is amended to read as follows:
  (j)  Where  an  application for recertification of coverage under this
title contains insufficient information for  a  final  determination  of
eligibility  for  continued coverage, a child shall be presumed eligible
for a period not to exceed the earlier of two months beyond the  preced-
ing  period  of eligibility or the date upon which a final determination
of eligibility is made based on the submission of  additional  data.  In
the event such additional information is not submitted within two months
of  the  approved  organization's  OR STATE ENROLLMENT CENTER'S request,

S. 2606                            80                            A. 3006

WHICHEVER IS APPLICABLE, the approved organization OR  STATE  ENROLLMENT
CENTER  shall  disenroll  the child following the expiration of such two
month period. Except as provided in paragraph (c) of subdivision  five-a
of  this section, approved organizations shall not be obligated to repay
subsidy payments received on behalf of children enrolled during this two
month period.
  S 21. Subdivision 4 of section 2511  of  the  public  health  law,  as
amended  by  section  70 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
  4. Households shall report  to  the  approved  organization  OR  STATE
ENROLLMENT  CENTER,  WHICHEVER  IS  APPLICABLE,  within thirty days, any
changes in New York state residency or health care coverage under insur-
ance that may make a child ineligible for subsidy payments  pursuant  to
this  section.  Any  individual who, with the intent to obtain benefits,
willfully misstates income or residence to establish eligibility  pursu-
ant  to  subdivision two of this section or willfully fails to notify an
approved organization OR STATE ENROLLMENT CENTER of a  change  in  resi-
dence  or  health care coverage pursuant to this subdivision shall repay
such subsidy to the commissioner. Individuals seeking to enroll children
for coverage shall be informed that such willful misstatement or failure
to notify shall result in such liability.
  S 22. The subdivision heading and paragraphs (a) and (b)  of  subdivi-
sion 5-a of section 2511 of the public health law, the subdivision head-
ing  and  paragraph  (a) as added by chapter 170 of the laws of 1994 and
paragraph (b) as amended by section 71 of part B of chapter  58  of  the
laws of 2005, are amended to read as follows:
  Obligations  of approved organizations OR THE STATE ENROLLMENT CENTER.
(a) An approved organization OR STATE ENROLLMENT  CENTER,  WHICHEVER  IS
APPLICABLE, shall have the obligation to review all information provided
pursuant  to  subdivision  two  of this section and shall not certify or
recertify a child as eligible for a subsidy  payment  unless  the  child
meets the eligibility criteria.
  (b)  An approved organization OR STATE ENROLLMENT CENTER, WHICHEVER IS
APPLICABLE, shall promptly review all information relating to  a  poten-
tial  change  in  eligibility  based on information provided pursuant to
subdivision four of this section. Within  at  least  thirty  days  after
receipt  of such information, the approved organization OR STATE ENROLL-
MENT CENTER shall make a determination whether the child is still eligi-
ble for a subsidy payment and shall notify the household and the commis-
sioner if it determines the child is not eligible for a subsidy payment.
  S 23. Paragraph (a) of subdivision 11 of section 2511  of  the  public
health law, as amended by section 37 of part A of chapter 58 of the laws
of 2007, is amended to read as follows:
  (a)  An approved organization shall submit required reports and infor-
mation to the commissioner in such form and at times, at least annually,
as may be required by the commissioner and specified  in  contracts  and
official department of health administrative guidance, in order to eval-
uate the operations and results of the program and quality of care being
provided  by  such  organizations.  Such  reports  and information shall
include, but not be limited to, enrollee demographics  (APPLICABLE  ONLY
UNTIL  THE  STATE ENROLLMENT CENTER IS IMPLEMENTED), program utilization
and expense, patient care outcomes and patient specific medical informa-
tion, including encounter data maintained by  an  approved  organization
for  purposes  of  quality assurance and oversight.   Any information or
data collected pursuant to this paragraph shall be kept confidential  in

S. 2606                            81                            A. 3006

accordance  with  Title  XXI  of  the federal social security act or any
other applicable state or federal law.
  S  24.  Subdivision  12  of  section 2511 of the public health law, as
amended by chapter 2 of the laws of 1998, is amended to read as follows:
  12. The commissioner shall, in consultation with  the  superintendent,
establish  procedures to coordinate the child health insurance plan with
the medical assistance program, including but not limited to, procedures
to maximize enrollment of eligible  children  under  those  programs  by
identification  and  transfer of children who are eligible or who become
eligible to receive medical  assistance  and  procedures  to  facilitate
changes  in enrollment status for children who are ineligible for subsi-
dies under this section and for children who are no longer eligible  for
medical  assistance  in  order  to  facilitate  and ensure continuity of
coverage. The commissioner shall review, on an annual basis, the  eligi-
bility verification and recertification procedures of approved organiza-
tions under this title to insure the appropriate enrollment of children.
Such  review shall include, but not be limited to, an audit of a statis-
tically representative sample of cases from among all approved organiza-
tions AND SHALL BE APPLICABLE TO ANY PERIOD  DURING  WHICH  AN  APPROVED
ORGANIZATION'S RESPONSIBILITIES INCLUDE DETERMINING ELIGIBILITY.  In the
event  such  review and audit reveals cases which do not meet the eligi-
bility criteria for coverage set forth in this section, that information
shall be forwarded to the approved organization and the commissioner for
appropriate action.
  S 25. Paragraph (e) of subdivision 12-a of section 2511 of the  public
health  law, as added by chapter 2 of the laws of 1998, is amended and a
new paragraph (f) is added to read as follows:
  (e) standards and procedures  for  the  imposition  of  penalties  for
substantial  noncompliance,  which  may  include, but not be limited to,
financial penalties in addition to penalties set forth in section twelve
of this chapter and consistent with  applicable  federal  standards,  as
specified in contracts, and contract termination[.]; PROVIDED HOWEVER
  (F)  AUDIT  STANDARDS  AND  PROCEDURES  ESTABLISHED  PURSUANT  TO THIS
SECTION, INCLUDING PENALTIES, SHALL BE APPLICABLE TO ELIGIBILITY  DETER-
MINATIONS  MADE  BY APPROVED ORGANIZATIONS ONLY FOR PERIODS DURING WHICH
AN APPROVED ORGANIZATION'S RESPONSIBILITIES INCLUDE MAKING  SUCH  ELIGI-
BILITY DETERMINATIONS.
  S  26.  Paragraph  (e)  and  subparagraphs (i), (ii), (iii) and (v) of
paragraph (f) of subdivision 2 of section 2511 of the public health law,
paragraph (e) as added by chapter 170 of the laws of 1994 and relettered
by chapter 2 of the laws of 1998, and  subparagraphs  (i)  and  (ii)  of
paragraph  (f)  as  amended  by section 6 of part B of chapter 58 of the
laws of 2010, subparagraph (iii) of paragraph (f) as amended by  chapter
535  of  the  laws  of  2010,  and  subparagraph (v) of paragraph (f) as
amended by section 7 of part J of chapter 82 of the laws  of  2002,  are
amended to read as follows:
  (e)  is  a resident of New York state. Such residency shall be [demon-
strated by] ATTESTED TO BY THE APPLICANT FOR INSURANCE, PROVIDED  HOWEV-
ER,  THE  COMMISSIONER MAY REQUIRE adequate proof[, as determined by the
commissioner,] of a New York state street  address  IN  LIMITED  CIRCUM-
STANCES  WHEN  THERE IS AN INCONSISTENCY WITH RESIDENCY INFORMATION FROM
OTHER DATA SOURCES. [If the child has no street address, such proof  may
include,  but  not  be limited to, school records or other documentation
determined by the commissioner.]
  (i) In order to establish income eligibility under this subdivision at
initial application, a household shall provide [such documentation spec-

S. 2606                            82                            A. 3006

ified in subparagraph (iii) of this paragraph, as necessary  and  suffi-
cient to determine a child's financial eligibility for a subsidy payment
under this title] THE SOCIAL SECURITY NUMBERS FOR EACH PARENT AND LEGAL-
LY  RESPONSIBLE  ADULT WHO IS A MEMBER OF THE HOUSEHOLD AND WHOSE INCOME
IS  AVAILABLE  TO  THE  CHILD,  SUBJECT  TO  SUBPARAGRAPH  (V)  OF  THIS
PARAGRAPH.  The  commissioner  [may  verify  the accuracy of such income
information provided by the household  by  matching  it  against]  SHALL
DETERMINE ELIGIBILITY BASED ON income information contained in databases
to which the commissioner has access, including the state's wage report-
ing  system pursuant to subdivision five of section one hundred seventy-
one-a of the tax law and by means of an  income  verification  performed
pursuant  to a cooperative agreement with the department of taxation and
finance  pursuant  to  subdivision   four   of   section   one   hundred
seventy-one-b  of the tax law.  THE COMMISSIONER MAY REQUIRE AN ATTESTA-
TION BY THE HOUSEHOLD THAT THE INCOME INFORMATION  OBTAINED  FROM  ELEC-
TRONIC  DATA  SOURCES  IS  ACCURATE.  SUCH ATTESTATION SHALL INCLUDE ANY
OTHER HOUSEHOLD INCOME INFORMATION NOT OBTAINED FROM AN ELECTRONIC  DATA
SOURCE  THAT  IS  NECESSARY TO DETERMINE A CHILD'S FINANCIAL ELIGIBILITY
FOR A SUBSIDY PAYMENT UNDER THIS TITLE. IF THE ATTESTATION IS REASONABLY
COMPATIBLE WITH INFORMATION OBTAINED FROM  AVAILABLE  DATA  SOURCES,  NO
FURTHER  INFORMATION OR DOCUMENTATION IS REQUIRED. IF THE ATTESTATION IS
NOT REASONABLY COMPATIBLE WITH INFORMATION OBTAINED FROM AVAILABLE  DATA
SOURCES  AND  A REASONABLE EXPLANATION IS NOT PROVIDED BY THE HOUSEHOLD,
DOCUMENTATION MAY BE REQUIRED AS SPECIFIED IN SUBPARAGRAPH (III) OF THIS
PARAGRAPH.
  (ii) In order to establish income eligibility under  this  subdivision
at recertification, [a household shall attest to all information regard-
ing the household's income that is necessary and sufficient to determine
a  child's  financial eligibility for a subsidy payment under this title
and shall provide the social security numbers for each parent and legal-
ly responsible adult who is a member of the household and  whose  income
is  available  to  the  child, subject to subparagraph (v) of this para-
graph.  The] THE commissioner [may verify the accuracy  of  such  income
information  provided  by  the  household by matching it against income]
SHALL MAKE A REDETERMINATION OF ELIGIBILITY WITHOUT  REQUIRING  INFORMA-
TION  FROM THE INDIVIDUAL IF ABLE TO DO SO BASED ON RELIABLE INFORMATION
CONTAINED IN THE INDIVIDUAL'S ENROLLMENT  FILE  OR  OTHER  MORE  CURRENT
information contained in databases to which the commissioner has access,
including  the  state's  wage reporting system and by means of an income
verification performed pursuant to  a  cooperative  agreement  with  the
department  of  taxation  and  finance  pursuant  to subdivision four of
section one hundred seventy-one-b of the tax law.  THE COMMISSIONER  MAY
REQUIRE  AN  ATTESTATION  BY  THE  HOUSEHOLD THAT THE INCOME INFORMATION
CONTAINED IN THE ENROLLMENT FILE OR OBTAINED FROM ELECTRONIC DATA SOURC-
ES IS ACCURATE. SUCH  ATTESTATION  SHALL  INCLUDE  ANY  OTHER  HOUSEHOLD
INCOME  INFORMATION  NOT OBTAINED FROM AN ELECTRONIC DATA SOURCE THAT IS
NECESSARY TO REDETERMINE A CHILD'S FINANCIAL ELIGIBILITY FOR  A  SUBSIDY
PAYMENT  UNDER  THIS  TITLE. In the event that there is an inconsistency
between the income information attested to  by  the  household  and  any
information  obtained by the commissioner from other sources pursuant to
this subparagraph, and such inconsistency is material to the household's
eligibility for a subsidy payment under  this  title,  the  commissioner
[shall]  MAY  require the [approved organization to obtain] HOUSEHOLD TO
PROVIDE income  documentation  [from  the  household]  as  specified  in
subparagraph (iii) of this paragraph.

S. 2606                            83                            A. 3006

  (iii) IF THE ATTESTATION OF HOUSEHOLD INCOME REQUIRED BY SUBPARAGRAPHS
(I)  AND (II) OF THIS PARAGRAPH IS NOT REASONABLY COMPATIBLE WITH INFOR-
MATION  OBTAINED  FROM  DATA  SOURCES,  FURTHER  INFORMATION,  INCLUDING
DOCUMENTATION,  MAY BE REQUIRED. Income documentation shall include, but
not  be  limited  to,  one  or more of the following for each parent and
legally responsible adult who is a member of  the  household  and  whose
income is available to the child;
  (A) current annual income tax returns;
  (B) paycheck stubs;
  (C) written documentation of income from all employers; or
  (D) written documentation of income eligibility of a child for free or
reduced  breakfast or lunch through the school meal program certified by
the child's school, provided that:
  (I) the commissioner  may  verify  the  accuracy  of  the  information
provided in the same manner and way as provided for in subparagraph (ii)
of this paragraph; and
  (II)  such  documentation  may  not be suitable proof of income in the
event of a material inconsistency in income after the  commissioner  has
performed  verification pursuant to subparagraph (ii) of this paragraph;
or
  (E) other documentation of income (earned or unearned)  as  determined
by  the  commissioner,  provided,  however, such documentation shall set
forth the source of such income.
  (v) In the event a household chooses not to provide the social securi-
ty numbers required by [subparagraph] SUBPARAGRAPHS (I) AND (ii) of this
paragraph, such household shall provide income  documentation  specified
in  subparagraph  (iii)  of this paragraph as a condition of the child's
enrollment. Nothing in this paragraph shall be construed as obligating a
household to provide social  security  numbers  of  parents  or  legally
responsible adults as a condition of a child's enrollment or eligibility
for a subsidy payment under this title.
  S  27.  Subparagraph (ii) of paragraph (g) of subdivision 2 of section
2511 of the public health law, as amended by section 29  of  part  A  of
chapter 58 of the laws of 2007, is amended to read as follows:
  (ii) Effective September first two thousand seven, THROUGH MARCH THIR-
TY-FIRST,  TWO THOUSAND FOURTEEN OR A LATER DATE TO BE DETERMINED BY THE
COMMISSIONER CONTINGENT UPON THE REQUIREMENTS OF THE PATIENT  PROTECTION
AND  AFFORDABLE CARE ACT OF 2010 BEING FULLY IMPLEMENTED BY THE DATE AND
AS APPROVED BY THE SECRETARY OF  THE  DEPARTMENT  OF  HEALTH  AND  HUMAN
SERVICES,  temporary  enrollment  pursuant  to  subparagraph (i) of this
paragraph shall be provided only to children  who  apply  for  recertif-
ication  of  coverage  under  this  title  who appear to be eligible for
medical assistance under title eleven of  article  five  of  the  social
services law.
  S  28.  Paragraph (a) of subdivision 2-b of section 2511 of the public
health law, as added by section 5 of part B of chapter 58 of the laws of
2010, is amended to read as follows:
  (a) Effective October first, two thousand ten, for purposes of  claim-
ing  federal  financial participation under paragraph nine of subsection
(c) of section twenty-one hundred five of the  federal  social  security
act[,]  for individuals declaring to be citizens at initial application,
AND, EFFECTIVE JANUARY FIRST, TWO THOUSAND FOURTEEN OR A LATER  DATE  TO
BE  DETERMINED  BY  THE COMMISSIONER CONTINGENT UPON THE REQUIREMENTS OF
THE PATIENT PROTECTION AND AFFORDABLE  CARE  ACT  OF  2010  BEING  FULLY
IMPLEMENTED BY THE STATE AND AS APPROVED BY THE SECRETARY OF THE DEPART-

S. 2606                            84                            A. 3006

MENT  OF  HEALTH  AND  HUMAN  SERVICES, FOR INDIVIDUALS WHO ARE LAWFULLY
RESIDING IN THE COUNTRY, a household shall provide:
  (i) the social security number for the applicant to be verified by the
commissioner  in  accordance  with  a  process established by the social
security administration pursuant to federal law, or
  (ii) documentation  of  citizenship  and  identity  of  the  applicant
consistent  with  requirements  under the medical assistance program, as
specified by the commissioner on the initial application.
  S 29. Paragraph (d) of subdivision 9 of section  2510  of  the  public
health law, as added by section 72-a of part C of chapter 58 of the laws
of 2009, is amended to read as follows:
  (d)  for periods on or after July first, two thousand nine, amounts as
follows:
  (i) no payments  are  required  for  eligible  children  whose  family
[gross]  household  income is less than one hundred sixty percent of the
non-farm federal poverty level and for eligible children who are  Ameri-
can  Indians  or  Alaskan  Natives, as defined by the U.S. Department of
Health and Human Services, whose family [gross] household income is less
than two hundred fifty-one  percent  of  the  non-farm  federal  poverty
level; and
  (ii)  nine  dollars  per  month  for  each eligible child whose family
[gross] household income is between one hundred sixty  percent  and  two
hundred twenty-two percent of the non-farm federal poverty level, but no
more than twenty-seven dollars per month per family; and
  (iii)  fifteen  dollars per month for each eligible child whose family
[gross] household income is between two hundred twenty-three percent and
two hundred fifty percent of the non-farm federal poverty level, but  no
more than forty-five dollars per month per family; and
  (iv)  thirty  dollars  per  month for each eligible child whose family
[gross] household income is between two hundred  fifty-one  percent  and
three hundred percent of the non-farm federal poverty level, but no more
than ninety dollars per month per family;
  (v)  forty-five dollars per month for each eligible child whose family
[gross] household income is between three hundred one percent and  three
hundred fifty percent of the non-farm federal poverty level, but no more
than one hundred thirty-five dollars per month per family; and
  (vi)  sixty  dollars  per  month  for each eligible child whose family
[gross] household income is between three hundred fifty-one percent  and
four  hundred percent of the non-farm federal poverty level, but no more
than one hundred eighty dollars per month per family.
  S 30. Subparagraph (iii) of paragraph (a) of subdivision 2 of  section
2511  of  the  public  health law, as amended by section 32 of part B of
chapter 58 of the laws of 2008, is amended to read as follows:
  (iii) effective September first, two  thousand  eight,  resides  in  a
household  having  a  [gross]  household income at or below four hundred
percent of the non-farm federal poverty level (as defined and updated by
the United States department of health and human services);
  S 31. Subparagraph (ii) of paragraph (d) of subdivision 2  of  section
2511  of  the  public  health law, as amended by section 33 of part A of
chapter 58 of the laws of 2007, clause (B) as amended by  section  3  of
part  OO  of  chapter  57  of  the  laws  of 2008, is amended to read as
follows:
  (ii) (A) The implementation of this paragraph for a child residing  in
a  household  having  a [gross] household income at or below two hundred
fifty percent of the non-farm federal  poverty  level  (as  defined  and
updated  by  the  United States department of health and human services)

S. 2606                            85                            A. 3006

shall take effect only upon the commissioner's  finding  that  insurance
provided  under  this  title  is  substituting  for coverage under group
health plans in excess of a percentage specified by the secretary of the
federal  department of health and human services. The commissioner shall
notify the legislature prior to implementation of this paragraph.
  (B) The implementation of clauses (A), (B), (C), (D),  (E),  (F),  (G)
and  (I) of subparagraph (i) of this paragraph for a child residing in a
household having a [gross] household income between two  hundred  fifty-
one  and  four hundred percent of the non-farm federal poverty level (as
defined and updated by the United States department of health and  human
services)  shall  take  effect  September  first,  two  thousand  eight;
provided however, the entirety of subparagraph  (i)  of  this  paragraph
shall  take  effect  and be applied to such children on the date federal
financial participation becomes available for such population in accord-
ance with the state's Title XXI  child  health  plan.  The  commissioner
shall  monitor  the  number  of  children who are subject to the waiting
period established pursuant to this clause.
  S 32. Clauses (A) and (B) of subparagraph  (i)  of  paragraph  (b)  of
subdivision  18  of  section  2511 of the public health law, as added by
section 31 of part A of chapter 58 of the laws of 2007, are  amended  to
read as follows:
  (A)  participation  in the program for a child who resides in a house-
hold having a [gross] household income at or  below  two  hundred  fifty
percent of the non-farm federal poverty level (as defined and updated by
the  United  States  department  of  health and human services) shall be
voluntary and an eligible child may disenroll from the  premium  assist-
ance  program  at  any time and enroll in individual coverage under this
title; and
  (B) participation in the program for a child who resides in  a  house-
hold having a [gross] household income between two hundred fifty-one and
four  hundred  percent of the non-farm federal poverty level (as defined
and updated  by  the  United  States  department  of  health  and  human
services)  and  meets certain eligibility criteria shall be mandatory. A
child in this income group who meets the criteria for enrollment in  the
premium assistance program shall not be eligible for individual coverage
under this title;
  S 33. Subparagraph (iv) of paragraph (b) and paragraph (d) of subdivi-
sion  9  of section 2511 of the public health law, as amended by section
18-a of 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,
[including the conduct of personal interviews pursuant to section  three
hundred  sixty-six-a  of the social services law and personal interviews
required upon recertification under such section of the social  services
law,] in locations, such as community settings, which are geographically
accessible 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
presumptive  eligibility in accordance with paragraph (g) of subdivision
two of section two thousand five hundred and eleven of this title; and
  (d) Subject to the availability of funds therefor, training  shall  be
provided  for  outstationed  persons and employees of approved organiza-
tions to enable them to  disseminate  information,  AND  facilitate  the

S. 2606                            86                            A. 3006

completion  of  the  application  process  under  this subdivision[, and
conduct  personal  interviews  required   by   section   three   hundred
sixty-six-a  of the social services law and personal interviews required
upon recertification under such section of the social services law].
  S  33-a. Subdivision 5 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:
  5.  Notwithstanding any inconsistent provision of sections one hundred
twelve and one hundred sixty-three of the state finance law, or sections
one hundred forty-two and one hundred forty-three of the economic devel-
opment law, or any other contrary provision of law, the commissioner  is
authorized  to  amend the terms of contracts awarded prior to the effec-
tive date of this section, including a contract entered into pursuant to
subdivision twenty-four of section two hundred six of the public  health
law, as added by section thirty-nine of part C of chapter fifty-eight of
the laws of two thousand eight, without a competitive bid or request for
proposal  process,  upon a determination that the existing contractor is
qualified to provide assistance with one or more  functions  established
in  subdivision  two  of  this  section, OR NECESSARY TO COMPLY WITH THE
PROVISIONS OF THE FEDERAL PATIENT PROTECTION  AND  AFFORDABLE  CARE  ACT
(P.L.    111-148),  AS  AMENDED BY THE FEDERAL HEALTH CARE AND EDUCATION
RECONCILIATION ACT OF 2010 (P.L.   111-152). Such  amendments  shall  be
limited to implementation of: (i) automation enhancements, including but
not  limited  to,  the  Medicare savings program and the family planning
benefit program; (ii) processes for verification of third  party  insur-
ance  and  processing  enrollment in medical assistance with third party
health insurance; (iii) procedures that will  increase  efficiencies  at
enrollment centers; (iv) an asset verification system; and (v) processes
to  comply with ANY HEALTH CARE RELATED PROVISIONS OF THE AFOREMENTIONED
federal [law] PUBLIC LAWS, including, but not limited  to,  the  use  of
modified adjusted gross income in eligibility determinations.
  S  34.  Paragraphs  9  and 10 of subsection (a) of section 2101 of the
insurance law, as added by chapter 687 of the laws of 2003, are  amended
and a new paragraph 11 is added to read as follows:
  (9)  a  person who is not a resident of this state who sells, solicits
or negotiates a contract of insurance for  commercial  property/casualty
risks  to  an  insured with risks located in more than one state insured
under that contract, provided that such person is otherwise licensed  as
an  insurance  producer  to sell, solicit or negotiate that insurance in
the state where the insured maintains its principal  place  of  business
and the contract of insurance insures risks located in that state; [or]
  (10)  any  salaried  full-time employee who counsels or advises his or
her employer relative to the insurance interests of the employer  or  of
the  subsidiaries  or  business affiliates of the employer provided that
the employee does not sell or solicit insurance  or  receive  a  commis-
sion[.]; OR
  (11)  ANY  PERSON WHO HAS RECEIVED A GRANT FROM AND HAS BEEN CERTIFIED
BY THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION  1311  OF
THE  AFFORDABLE  CARE  ACT, 42 U.S.C. S 18031, TO ACT AS A NAVIGATOR, AS
SUCH TERM IS USED IN 42 U.S.C. S 18031(I), PROVIDED THAT THE PERSON  HAS
COMPLETED THE TRAINING REQUIRED BY THE HEALTH BENEFIT EXCHANGE.
  S  35.  Paragraphs  8  and  9 of subsection (c) of section 2101 of the
insurance law, paragraph 8 as  amended  and  paragraph  9  as  added  by
section 5 of part I of chapter 61 of the laws of 2011, are amended and a
new paragraph 10 is added to read as follows:

S. 2606                            87                            A. 3006

  (8)  a  person who is not a resident of this state who sells, solicits
or negotiates a contract for commercial property/casualty  risks  to  an
insured  with  risks  located  in more than one state insured under that
contract, provided that such person is otherwise licensed as  an  insur-
ance  producer to sell, solicit or negotiate that insurance in the state
where the insured maintains its principal  place  of  business  and  the
contract of insurance insures risks located in that state; [or]
  (9)  a  person who is not a resident of this state who sells, solicits
or negotiates a contract of property/casualty insurance, as  defined  in
paragraph  six  of  subsection  (x)  of  this section, of an insurer not
authorized to  do  business  in  this  state,  provided  that:  (A)  the
insured's  home  state  is  a  state other than this state; and (B) such
person is otherwise licensed to sell, solicit or negotiate  excess  line
insurance in the insured's home state[.]; OR
  (10)  ANY  PERSON WHO HAS RECEIVED A GRANT FROM AND HAS BEEN CERTIFIED
BY THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION  1311  OF
THE  AFFORDABLE  CARE  ACT, 42 U.S.C. S 18031, TO ACT AS A NAVIGATOR, AS
SUCH TERM IS USED IN 42 U.S.C. S 18031(I), INCLUDING ANY PERSON EMPLOYED
BY A CERTIFIED NAVIGATOR, PROVIDED THAT THE  PERSON  HAS  COMPLETED  THE
TRAINING REQUIRED BY THE HEALTH BENEFIT EXCHANGE.
  S  36.  Paragraphs  10 and 11 of subsection (k) of section 2101 of the
insurance law, paragraph 10 as amended and  paragraph  11  as  added  by
section 6 of part I of chapter 61 of the laws of 2011, are amended and a
new paragraph 12 is added to read as follows:
  (10)  any  salaried  full-time employee who counsels or advises his or
her employer relative to the insurance interests of the employer  or  of
the  subsidiaries  or business affiliates of the employer, provided that
the employee does not sell or solicit insurance or receive a commission;
[or]
  (11) a person who is not a resident of this state who sells,  solicits
or  negotiates  a contract of property/casualty insurance, as defined in
paragraph six of subsection (x) of  this  section,  of  an  insurer  not
authorized  to  do  business  in  this  state,  provided  that:  (A) the
insured's home state is a state other than  this  state;  and  (B)  such
person  is  otherwise licensed to sell, solicit or negotiate excess line
insurance in the insured's home state[.]; OR
  (12) ANY PERSON WHO HAS RECEIVED A GRANT FROM AND HAS  BEEN  CERTIFIED
BY  THE  HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION 1311 OF
THE AFFORDABLE CARE ACT, 42 U.S.C. S 18031 TO ACT  AS  A  NAVIGATOR,  AS
SUCH TERM IS USED IN 42 U.S.C. S 18031(I), INCLUDING ANY PERSON EMPLOYED
BY  A  CERTIFIED  NAVIGATOR,  PROVIDED THAT THE PERSON HAS COMPLETED THE
TRAINING REQUIRED BY THE HEALTH BENEFIT EXCHANGE.
  S 37. Subparagraphs (B) and (C) of paragraph 4 of  subsection  (b)  of
section  2102  of  the insurance law, are amended and a new subparagraph
(D) is added to read as follows:
  (B) actuaries or certified public accountants who provide information,
recommendations, advice or services in their professional  capacity,  if
neither  they  nor  their  employer receive any compensation directly or
indirectly on  account  of  any  insurance,  bond,  annuity  or  pension
contract  that results in whole or part from such information, recommen-
dation, advice or services; [or]
  (C) regular salaried officers or employees of an  insurer  who  devote
substantially all of their services to activities other than the render-
ing  of consulting services to the insuring public while acting in their
capacity as such in discharging the duties of their employment[.]; OR

S. 2606                            88                            A. 3006

  (D) PERSONS WHO HAVE RECEIVED GRANTS FROM AND HAVE BEEN  CERTIFIED  BY
THE  HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION 1311 OF THE
AFFORDABLE CARE ACT, 42 U.S.C. S 18031, TO ACT AS  NAVIGATORS,  AS  SUCH
TERM  IS  USED  IN  42  U.S.C. S 18031(I), INCLUDING PERSONS EMPLOYED BY
CERTIFIED  NAVIGATORS,  PROVIDED  THAT  THE  PERSONS  HAVE COMPLETED THE
TRAINING REQUIRED BY THE HEALTH BENEFIT EXCHANGE.
  S 38. Subparagraph (B) of paragraph 25 of subsection  (i)  of  section
3216  of  the  insurance  law,  as amended by chapter 596 of the laws of
2011, is amended to read as follows:
  (B) Every policy [which] THAT provides  physician  services,  medical,
major  medical  or  similar  comprehensive-type  coverage  shall provide
coverage for the screening, diagnosis and treatment of  autism  spectrum
disorder  in accordance with this paragraph and shall not exclude cover-
age for the screening, diagnosis  or  treatment  of  medical  conditions
otherwise covered by the policy because the individual is diagnosed with
autism spectrum disorder. Such coverage may be subject to annual deduct-
ibles,  copayments  and  coinsurance as may be deemed appropriate by the
superintendent and shall be consistent with those imposed on other bene-
fits under the policy. Coverage for applied behavior analysis  shall  be
subject  to  a  maximum  benefit  of  [forty-five  thousand dollars] SIX
HUNDRED EIGHTY HOURS OF  TREATMENT  per  POLICY  OR  CALENDAR  year  per
covered individual [and such maximum annual benefit will increase by the
amount  calculated from the average ten year rolling average increase of
the medical component of the consumer price index]. This paragraph shall
not be construed as limiting the benefits that are  otherwise  available
to  an  individual  under  the policy, provided however that such policy
shall not contain any limitations on visits that are solely  applied  to
the  treatment  of  autism spectrum disorder. No insurer shall terminate
coverage or refuse to deliver, execute, issue, amend, adjust,  or  renew
coverage  to  an  individual  solely because the individual is diagnosed
with autism spectrum disorder or has received treatment for autism spec-
trum disorder. Coverage shall  be  subject  to  utilization  review  and
external  appeals of health care services pursuant to article forty-nine
of this chapter as well as, case  management,  and  other  managed  care
provisions.
  S  39.  Subparagraph  (B) of paragraph 17 of subsection (1) of section
3221 of the insurance law, as amended by chapter  596  of  the  laws  of
2011, is amended to read as follows:
  (B)  Every  group  or  blanket  policy [which] THAT provides physician
services, medical, major medical or similar comprehensive-type  coverage
shall  provide  coverage  for  the screening, diagnosis and treatment of
autism spectrum disorder in accordance with this paragraph and shall not
exclude coverage for the screening, diagnosis or  treatment  of  medical
conditions  otherwise  covered  by  the policy because the individual is
diagnosed with autism spectrum disorder. Such coverage may be subject to
annual deductibles, copayments and coinsurance as may be  deemed  appro-
priate  by the superintendent and shall be consistent with those imposed
on other benefits under  the  group  or  blanket  policy.  Coverage  for
applied  behavior  analysis  shall  be  subject  to a maximum benefit of
[forty-five thousand dollars] SIX HUNDRED EIGHTY HOURS OF TREATMENT  per
POLICY  OR CALENDAR year per covered individual [and such maximum annual
benefit will increase by the amount calculated from the average ten year
rolling average increase of the medical component of the consumer  price
index].  This  paragraph shall not be construed as limiting the benefits
that are otherwise available to an individual under the group or blanket
policy, provided however that such policy shall not contain any  limita-

S. 2606                            89                            A. 3006

tions on visits that are solely applied to the treatment of autism spec-
trum disorder. No insurer shall terminate coverage or refuse to deliver,
execute, issue, amend, adjust, or renew coverage to an individual solely
because the individual is diagnosed with autism spectrum disorder or has
received  treatment  for  autism  spectrum  disorder.  Coverage shall be
subject to utilization  review  and  external  appeals  of  health  care
services pursuant to article forty-nine of this chapter as well as, case
management, and other managed care provisions.
  S  40. Paragraph 2 of subsection (ee) of section 4303 of the insurance
law, as amended by chapter 596 of the laws of 2011, is amended  to  read
as follows:
  (2)  Every contract [which] THAT provides physician services, medical,
major medical  or  similar  comprehensive-type  coverage  shall  provide
coverage  for  the screening, diagnosis and treatment of autism spectrum
disorder in accordance with this [subsection] PARAGRAPH  and  shall  not
exclude  coverage  for  the screening, diagnosis or treatment of medical
conditions otherwise covered by the contract because the  individual  is
diagnosed with autism spectrum disorder. Such coverage may be subject to
annual  deductibles,  copayments and coinsurance as may be deemed appro-
priate by the superintendent and shall be consistent with those  imposed
on  other  benefits  under  the  contract. Coverage for applied behavior
analysis shall be subject to a maximum benefit of  [forty-five  thousand
dollars]  SIX HUNDRED EIGHTY HOURS OF TREATMENT per CONTRACT OR CALENDAR
year per covered  individual  [and  such  maximum  annual  benefit  will
increase  by  the  amount  calculated  from the average ten year rolling
average increase of the medical component of the consumer price  index].
This  paragraph shall not be construed as limiting the benefits that are
otherwise available to an individual under the contract, provided howev-
er that such contract shall not contain any limitations on  visits  that
are  solely  applied  to  the  treatment of autism spectrum disorder. No
insurer shall terminate coverage or refuse to deliver,  execute,  issue,
amend,  adjust,  or  renew  coverage to an individual solely because the
individual is diagnosed with autism spectrum disorder  or  has  received
treatment  for  autism  spectrum  disorder. Coverage shall be subject to
utilization review and external appeals of health care services pursuant
to article forty-nine of this chapter as well as, case  management,  and
other managed care provisions.
  S  41.  The  insurance  law is amended by adding a new section 3240 to
read as follows:
  S 3240. STUDENT ACCIDENT AND HEALTH INSURANCE.  (A) IN THIS SECTION:
  (1) "STUDENT ACCIDENT AND HEALTH INSURANCE" MEANS A POLICY OR CONTRACT
OF HOSPITAL, MEDICAL, OR SURGICAL EXPENSE INSURANCE DELIVERED OR  ISSUED
FOR  DELIVERY  IN  THIS  STATE  ON OR AFTER JANUARY FIRST, TWO  THOUSAND
FOURTEEN, BY AN INSURER OR A CORPORATION, TO AN  INSTITUTION  OF  HIGHER
EDUCATION   COVERING  STUDENTS  ENROLLED  IN  THE  INSTITUTION  AND  THE
STUDENTS' DEPENDENTS.
  (2) "INSTITUTION OF HIGHER EDUCATION" OR "INSTITUTION" SHALL HAVE  THE
MEANING SET FORTH IN THE HIGHER EDUCATION ACT OF 1965, 20 U.S.C. S 1001.
  (3)  "INSURER"  MEANS AN INSURER LICENSED TO WRITE ACCIDENT AND HEALTH
INSURANCE PURSUANT TO THIS CHAPTER.
  (4) "CORPORATION" MEANS A CORPORATION  ORGANIZED  IN  ACCORDANCE  WITH
ARTICLE FORTY-THREE OF THIS CHAPTER.
  (B) AN INSURER OR CORPORATION SHALL NOT IMPOSE ANY PRE-EXISTING CONDI-
TION  EXCLUSION  IN  A STUDENT   ACCIDENT AND HEALTH INSURANCE POLICY OR
CONTRACT.  AN INSURER OR CORPORATION SHALL NOT CONDITION    ELIGIBILITY,
INCLUDING  CONTINUED  ELIGIBILITY,  FOR  A  STUDENT  ACCIDENT AND HEALTH

S. 2606                            90                            A. 3006

INSURANCE POLICY  OR  CONTRACT  ON  HEALTH  STATUS,  MEDICAL  CONDITION,
INCLUDING BOTH PHYSICAL AND MENTAL ILLNESSES, CLAIMS EXPERIENCE, RECEIPT
OF HEALTH CARE, MEDICAL HISTORY, GENETIC INFORMATION, EVIDENCE OF INSUR-
ABILITY,  INCLUDING CONDITIONS ARISING OUT OF ACTS OF DOMESTIC VIOLENCE,
OR DISABILITY.
  (C) A STUDENT ACCIDENT AND HEALTH INSURANCE POLICY OR  CONTRACT  SHALL
PROVIDE  COVERAGE  FOR  ESSENTIAL  HEALTH BENEFITS AS DEFINED IN SECTION
1302(B) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(B).
  (D) AN INSURER OR CORPORATION SHALL NOT REFUSE TO RENEW  OR  OTHERWISE
TERMINATE  A  STUDENT  ACCIDENT  AND HEALTH INSURANCE POLICY OR CONTRACT
EXCEPT IF:
  (1) THE INDIVIDUAL COVERED  UNDER  THE  STUDENT  ACCIDENT  AND  HEALTH
INSURANCE  POLICY  OR CONTRACT CEASES TO BE ENROLLED AS A STUDENT IN THE
INSTITUTION OF HIGHER EDUCATION TO WHICH THE STUDENT ACCIDENT AND HEALTH
INSURANCE POLICY OR CONTRACT IS ISSUED, PROVIDED THE INSURER  OR  CORPO-
RATION TERMINATES THE POLICY OR CONTRACT UNIFORMLY WITHOUT REGARD TO ANY
HEALTH STATUS-RELATED FACTOR OF ANY COVERED PERSON;
  (2) THE INSURER TERMINATES THE POLICY FOR ANY OF THE REASONS SPECIFIED
IN  SUBPARAGRAPHS (A)  THROUGH (F) OF PARAGRAPH ONE OF SUBSECTION (G) OF
SECTION THREE THOUSAND TWO HUNDRED SIXTEEN OF THIS ARTICLE; OR
  (3) THE CORPORATION TERMINATES THE CONTRACT FOR  ANY  OF  THE  REASONS
SPECIFIED  IN  SUBPARAGRAPHS  (A) THROUGH (D) OR (F) OF PARAGRAPH TWO OF
SUBSECTION (C) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR OF THIS CHAP-
TER.
  (E) THIS SECTION SHALL NOT APPLY TO COVERAGE UNDER  A  STUDENT  HEALTH
PLAN  ISSUED PURSUANT TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF
THIS CHAPTER.
  (F) THE SUPERINTENDENT MAY PROMULGATE  REGULATIONS  REGARDING  STUDENT
ACCIDENT  AND  HEALTH INSURANCE, WHICH MAY INCLUDE MINIMUM STANDARDS FOR
THE FORM, CONTENT AND SALE OF THE POLICIES AND CONTRACTS  AND,  NOTWITH-
STANDING THE PROVISIONS OF SECTION THREE THOUSAND TWO HUNDRED THIRTY-ONE
AND FOUR THOUSAND THREE HUNDRED EIGHT OF THIS CHAPTER, THE ESTABLISHMENT
OF  RATING  METHODOLOGY  TO  BE  APPLIED  TO THE POLICIES AND CONTRACTS;
PROVIDED THAT ANY SUCH REGULATIONS SHALL BE NO LESS FAVORABLE  TO    THE
INSURED  THAN  THAT  WHICH  IS  PROVIDED UNDER FEDERAL LAW AND STATE LAW
APPLICABLE TO INDIVIDUAL INSURANCE.
  (G) THE  RATIO  OF  BENEFITS  TO  PREMIUMS  SHALL  BE  NOT  LESS  THAN
EIGHTY-TWO  PERCENT  AS  CALCULATED  IN A MANNER TO BE DETERMINED BY THE
SUPERINTENDENT.
  (H) EVERY INSURER OR CORPORATION SHALL REPORT  TO  THE  SUPERINTENDENT
ANNUALLY,  ON  A  DATE  SPECIFIED BY THE SUPERINTENDENT IN A REGULATION,
CLAIMS EXPERIENCE AND OTHER DATA IN A MANNER ACCEPTABLE  TO  THE  SUPER-
INTENDENT  THAT SHALL DEMONSTRATE THE INSURER'S OR CORPORATION'S COMPLI-
ANCE WITH THE APPLICABLE  RULES AND REGULATIONS.
  S 42. Subsection (1) of section 3216 of the insurance law is  REPEALED
and a new subsection (l) is added to read as follows:
  (L)  ON  AND  AFTER  OCTOBER  FIRST, TWO THOUSAND THIRTEEN, AN INSURER
SHALL NOT OFFER INDIVIDUAL HOSPITAL, MEDICAL OR SURGICAL EXPENSE  INSUR-
ANCE  POLICIES  UNLESS  THE POLICIES MEET THE REQUIREMENTS OF SUBSECTION
(B) OF SECTION FOUR THOUSAND THREE HUNDRED TWENTY-EIGHT OF THIS CHAPTER.
SUCH POLICIES THAT ARE OFFERED WITHIN THE HEALTH BENEFIT EXCHANGE ESTAB-
LISHED PURSUANT TO SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C.  S
18031,  OR  ANY  REGULATIONS PROMULGATED THEREUNDER, ALSO SHALL MEET ANY
REQUIREMENTS ESTABLISHED BY THE HEALTH BENEFIT EXCHANGE.
  S 43. Subsection (1) of section 4304 of the insurance law is  REPEALED
and a new subsection (1) is added to read as follows:

S. 2606                            91                            A. 3006

  (1)  ON  AND AFTER OCTOBER FIRST, TWO THOUSAND THIRTEEN, A CORPORATION
SHALL NOT OFFER INDIVIDUAL HOSPITAL, MEDICAL, OR SURGICAL EXPENSE INSUR-
ANCE CONTRACTS UNLESS THE CONTRACTS MEET THE REQUIREMENTS OF  SUBSECTION
(B) OF SECTION FOUR THOUSAND THREE HUNDRED TWENTY-EIGHT OF THIS ARTICLE.
SUCH  CONTRACTS  THAT  ARE  OFFERED  WITHIN  THE HEALTH BENEFIT EXCHANGE
ESTABLISHED PURSUANT TO SECTION 1311 OF  THE  AFFORDABLE  CARE  ACT,  42
U.S.C.  S  18031,  OR ANY REGULATIONS PROMULGATED THEREUNDER, ALSO SHALL
MEET ANY REQUIREMENTS ESTABLISHED BY THE HEALTH BENEFIT EXCHANGE. TO THE
EXTENT THAT A HOLDER OF  A  SPECIAL  PURPOSE  CERTIFICATE  OF  AUTHORITY
ISSUED  PURSUANT  TO  SECTION  FOUR THOUSAND FOUR HUNDRED THREE-A OF THE
PUBLIC HEALTH LAW  OFFERS  INDIVIDUAL  HOSPITAL,  MEDICAL,  OR  SURGICAL
EXPENSE  INSURANCE  CONTRACTS, THE CONTRACTS SHALL MEET THE REQUIREMENTS
OF SUBSECTION (B) OF SECTION FOUR THOUSAND THREE HUNDRED TWENTY-EIGHT OF
THIS ARTICLE.
  S 44. The section heading and subsection (a) of section  4321  of  the
insurance  law,  the section heading as added by chapter 504 of the laws
of 1995 and subsection (a) as amended by chapter  342  of  the  laws  of
2004, are amended to read as follows:
  Standardization   of  individual  enrollee  direct  payment  contracts
offered by health maintenance organizations PRIOR TO OCTOBER FIRST,  TWO
THOUSAND  THIRTEEN.  (a)  On  and  after January first, nineteen hundred
ninety-six, AND UNTIL SEPTEMBER THIRTIETH,  TWO  THOUSAND  THIRTEEN  all
health maintenance organizations issued a certificate of authority under
article forty-four of the public health law or licensed under this arti-
cle  shall  offer a standardized individual enrollee contract on an open
enrollment basis as prescribed by section forty-three hundred  seventeen
of  this article and section forty-four hundred six of the public health
law, and regulations promulgated  thereunder,  provided,  however,  that
such  requirements  shall not apply to a health maintenance organization
exclusively serving individuals enrolled pursuant  to  title  eleven  of
article  five of the social services law, title eleven-D of article five
of the social services law, title one-A of article  twenty-five  of  the
public health law or title eighteen of the federal Social Security Act[,
and,  further  provided, that such health maintenance organization shall
not discontinue a contract for an  individual  receiving  comprehensive-
type coverage in effect prior to January first, two thousand four who is
ineligible to purchase policies offered after such date pursuant to this
section  or section four thousand three hundred twenty-two of this arti-
cle due to the provision of 42 U.S.C. 1395ss in effect prior to  January
first,  two thousand four]. On and after January first, nineteen hundred
ninety-six, AND UNTIL SEPTEMBER THIRTIETH, TWO  THOUSAND  THIRTEEN,  the
enrollee  contracts  issued  pursuant  to  this section and section four
thousand three hundred twenty-two of this  article  shall  be  the  only
contracts  offered  by  health maintenance organizations to individuals.
The enrollee contracts issued by a health maintenance organization under
this section and section four thousand three hundred twenty-two of  this
article  shall  also  be the only contracts issued by health maintenance
organizations for purposes of conversion pursuant to sections four thou-
sand three hundred four and four thousand three  hundred  five  of  this
article.  However,  nothing  in  this section shall be deemed to require
health maintenance organizations to terminate individual direct  payment
contracts  issued prior to January first, nineteen hundred ninety-six or
prevent health maintenance  organizations  from  terminating  individual
direct payment contracts issued prior to January first, nineteen hundred
ninety-six.

S. 2606                            92                            A. 3006

  S  45.  The  section heading and subsection (a) of section 4322 of the
insurance law, the section heading as added by chapter 504 of  the  laws
of  1995  and  subsection  (a)  as amended by chapter 342 of the laws of
2004, are amended and a new subsection (i) is added to read as follows:
  Standardization   of  individual  enrollee  direct  payment  contracts
offered by health maintenance organizations  which  provide  out-of-plan
benefits PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN. (a) On and after
January  first, nineteen hundred ninety-six, AND UNTIL SEPTEMBER THIRTI-
ETH, TWO THOUSAND THIRTEEN, all health maintenance organizations  issued
a certificate of authority under article forty-four of the public health
law  or licensed under this article shall offer to individuals, in addi-
tion to the standardized contract  required  by  section  four  thousand
three  hundred  twenty-one  of  this  article, a standardized individual
enrollee  direct  payment  contract  on  an  open  enrollment  basis  as
prescribed  by  section  four  thousand  three hundred seventeen of this
article and section four thousand four hundred six of the public  health
law, and regulations promulgated thereunder, with an out-of-plan benefit
system,  provided,  however, that such requirements shall not apply to a
health maintenance organization exclusively serving individuals enrolled
pursuant to title eleven of article five of  the  social  services  law,
title  eleven-D  of article five of the social services law, title one-A
of article twenty-five of the public health law or title eighteen of the
federal Social Security Act[, and, further provided,  that  such  health
maintenance  organization  shall not discontinue a contract for an indi-
vidual receiving comprehensive-type coverage in effect prior to  January
first,  two thousand four who is ineligible to purchase policies offered
after such date pursuant to this section or section four thousand  three
hundred  twenty-two  of  this  article due to the provision of 42 U.S.C.
1395ss in effect prior to January first, two thousand four]. The out-of-
plan benefit system shall either be provided by the  health  maintenance
organization  pursuant  to subdivision two of section four thousand four
hundred six of the public health law or through an  accompanying  insur-
ance contract providing out-of-plan benefits offered by a company appro-
priately  licensed pursuant to this chapter. On and after January first,
nineteen hundred ninety-six, AND UNTIL SEPTEMBER THIRTIETH, TWO THOUSAND
THIRTEEN, the contracts issued pursuant to this section and section four
thousand three hundred twenty-one of this  article  shall  be  the  only
contracts  offered  by  health maintenance organizations to individuals.
The enrollee contracts issued by a health maintenance organization under
this section and section four thousand three hundred twenty-one of  this
article  shall  also  be the only contracts issued by the health mainte-
nance organization for purposes of conversion pursuant to sections  four
thousand three hundred four and four thousand three hundred five of this
article.  However,  nothing  in  this section shall be deemed to require
health maintenance organizations to terminate individual direct  payment
contracts  issued prior to January first, nineteen hundred ninety-six or
prohibit health maintenance organizations  from  terminating  individual
direct payment contracts issued prior to January first, nineteen hundred
ninety-six.
  (I)  ON  AND AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, EACH CONTRACT
THAT IS NOT A GRANDFATHERED HEALTH PLAN SHALL PROVIDE COVERAGE  FOR  THE
ESSENTIAL HEALTH BENEFIT PACKAGE. FOR PURPOSES OF THIS SUBSECTION:
  (1)  "ESSENTIAL  HEALTH  BENEFITS  PACKAGE" SHALL HAVE THE MEANING SET
FORTH IN SECTION 1302(A)  OF  THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S
18022(A); AND

S. 2606                            93                            A. 3006

  (2)  "GRANDFATHERED  HEALTH  PLAN" MEANS COVERAGE PROVIDED BY A CORPO-
RATION IN WHICH AN INDIVIDUAL WAS ENROLLED ON  MARCH  TWENTY-THIRD,  TWO
THOUSAND  TEN FOR AS LONG AS THE COVERAGE MAINTAINS GRANDFATHERED STATUS
IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C.
S 18011(E).
  S  46.  The  insurance  law is amended by adding a new section 4328 to
read as follows:
  S 4328. INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACTS OFFERED BY HEALTH
MAINTENANCE ORGANIZATIONS ON AND AFTER OCTOBER FIRST, TWO THOUSAND THIR-
TEEN.  (A) ON AND AFTER OCTOBER FIRST, TWO THOUSAND THIRTEEN, ALL HEALTH
MAINTENANCE ORGANIZATIONS ISSUED A CERTIFICATE OF AUTHORITY UNDER  ARTI-
CLE  FORTY-FOUR  OF THE PUBLIC HEALTH LAW OR LICENSED UNDER THIS ARTICLE
SHALL OFFER AN INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT IN ACCORDANCE
WITH THE REQUIREMENTS OF THIS  SECTION,  PROVIDED,  HOWEVER,  THAT  THIS
REQUIREMENT SHALL NOT APPLY TO A HOLDER OF A SPECIAL PURPOSE CERTIFICATE
OF  AUTHORITY  ISSUED  PURSUANT  TO  SECTION  FOUR THOUSAND FOUR HUNDRED
THREE-A OF THE PUBLIC HEALTH LAW OR EXCEPT AS OTHERWISE  REQUIRED  UNDER
SUBSECTION (L) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR OF THIS ARTI-
CLE,  A  HEALTH MAINTENANCE ORGANIZATION EXCLUSIVELY SERVING INDIVIDUALS
ENROLLED PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
LAW, TITLE ELEVEN-D OF ARTICLE FIVE OF THE SOCIAL  SERVICES  LAW,  TITLE
ONE-A  OF ARTICLE TWENTY-FIVE OF THE PUBLIC HEALTH LAW OR TITLE EIGHTEEN
OF THE FEDERAL SOCIAL SECURITY ACT. THE ENROLLEE CONTRACTS ISSUED  BY  A
HEALTH  MAINTENANCE  ORGANIZATION  UNDER  THIS SECTION ALSO SHALL BE THE
ONLY  CONTRACTS  ISSUED  BY  THE  HEALTH  MAINTENANCE  ORGANIZATION  FOR
PURPOSES  OF CONVERSION PURSUANT TO SECTIONS FOUR THOUSAND THREE HUNDRED
FOUR AND FOUR THOUSAND THREE HUNDRED FIVE OF THIS ARTICLE.
  (B) (1) THE INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT OFFERED PURSU-
ANT TO THIS SECTION SHALL PROVIDE  COVERAGE  FOR  THE  ESSENTIAL  HEALTH
BENEFIT  PACKAGE  AS  REQUIRED  IN  SECTION 2707(A) OF THE PUBLIC HEALTH
SERVICE ACT, 42 U.S.C. S 300GG-6(A). FOR  PURPOSES  OF  THIS  PARAGRAPH,
"ESSENTIAL  HEALTH BENEFITS PACKAGE" SHALL HAVE THE MEANING SET FORTH IN
SECTION 1302(A) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(A).
  (2) A HEALTH MAINTENANCE ORGANIZATION SHALL OFFER AT LEAST  ONE  INDI-
VIDUAL  ENROLLEE  DIRECT  PAYMENT  CONTRACT AT EACH LEVEL OF COVERAGE AS
DEFINED IN SECTION 1302(D) OF THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S
18022(D).  A HEALTH MAINTENANCE ORGANIZATION ALSO SHALL OFFER ONE CHILD-
ONLY PLAN AT EACH LEVEL OF COVERAGE AS REQUIRED IN  SECTION  2707(C)  OF
THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-6(C).
  (3) WITHIN THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO SECTION
1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18031, A HEALTH MAINTENANCE
ORGANIZATION  MAY  OFFER  AN INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT
THAT IS A CATASTROPHIC HEALTH PLAN AS DEFINED IN SECTION 1302(E) OF  THE
AFFORDABLE CARE ACT, 42 U.S.C. S 18022(E), OR ANY REGULATIONS PROMULGAT-
ED THEREUNDER.
  (4)  THE  INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT OFFERED PURSUANT
TO THIS SECTION  SHALL  HAVE  THE  SAME  ENROLLMENT  PERIODS,  INCLUDING
SPECIAL  ENROLLMENT  PERIODS,  AS  REQUIRED  FOR  AN  INDIVIDUAL  DIRECT
PAYMENT CONTRACT OFFERED WITHIN THE HEALTH BENEFIT EXCHANGE  ESTABLISHED
PURSUANT  TO SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18031,
OR ANY REGULATIONS PROMULGATED THEREUNDER.
  (5) THE INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT  OFFERED  PURSUANT
TO THIS SECTION SHALL BE ISSUED WITHOUT REGARD TO EVIDENCE OF INSURABIL-
ITY AND WITHOUT AN EXCLUSION FOR PRE-EXISTING CONDITIONS.
  (6)  A HEALTH MAINTENANCE ORGANIZATION OFFERING AN INDIVIDUAL ENROLLEE
DIRECT PAYMENT CONTRACT PURSUANT TO THIS  SECTION  SHALL  NOT  ESTABLISH

S. 2606                            94                            A. 3006

RULES  FOR ELIGIBILITY, INCLUDING CONTINUED ELIGIBILITY, OF ANY INDIVID-
UAL OR DEPENDENT OF THE INDIVIDUAL TO ENROLL UNDER THE CONTRACT BASED ON
ANY OF THE FOLLOWING HEALTH STATUS-RELATED FACTORS:
  (A) HEALTH STATUS;
  (B) MEDICAL CONDITION, INCLUDING BOTH PHYSICAL AND MENTAL ILLNESSES;
  (C) CLAIMS EXPERIENCE;
  (D) RECEIPT OF HEALTH CARE;
  (E) MEDICAL HISTORY;
  (F) GENETIC INFORMATION;
  (G) EVIDENCE OF INSURABILITY, INCLUDING CONDITIONS ARISING OUT OF ACTS
OF DOMESTIC VIOLENCE; OR
  (H) DISABILITY.
  (7)  THE  INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACT OFFERED PURSUANT
TO THIS SECTION SHALL BE COMMUNITY RATED. FOR  PURPOSES  OF  THIS  PARA-
GRAPH, "COMMUNITY RATED" MEANS A RATING METHODOLOGY IN WHICH THE PREMIUM
FOR  ALL  PERSONS  COVERED  BY A CONTRACT FORM IS THE SAME, BASED ON THE
EXPERIENCE OF THE ENTIRE POOL OF RISKS,  WITHOUT  REGARD  TO  AGE,  SEX,
HEALTH STATUS, TOBACCO USAGE, OR OCCUPATION.
  (C)  IN  ADDITION  TO  OR  IN  LIEU  OF THE INDIVIDUAL ENROLLEE DIRECT
PAYMENT CONTRACTS REQUIRED UNDER THIS SECTION,  ALL  HEALTH  MAINTENANCE
ORGANIZATIONS ISSUED A CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR
OF  THE PUBLIC HEALTH LAW OR LICENSED UNDER THIS ARTICLE MAY OFFER INDI-
VIDUAL ENROLLEE DIRECT  PAYMENT  CONTRACTS  WITHIN  THE  HEALTH  BENEFIT
EXCHANGE  ESTABLISHED  PURSUANT  TO  SECTION 1311 OF THE AFFORDABLE CARE
ACT, 42 U.S.C. S 18031, OR ANY REGULATIONS PROMULGATED  THEREUNDER,  AND
ANY REQUIREMENTS ESTABLISHED BY THE HEALTH BENEFIT EXCHANGE. IF A HEALTH
MAINTENANCE ORGANIZATION SATISFIES THE REQUIREMENTS OF SUBSECTION (A) OF
THIS  SECTION  BY  OFFERING INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACTS
WITHIN  THE  HEALTH     BENEFIT   EXCHANGE,   THE   HEALTH   MAINTENANCE
ORGANIZATION, NOT INCLUDING A HOLDER OF A SPECIAL PURPOSE CERTIFICATE OF
AUTHORITY  ISSUED PURSUANT TO SECTION FOUR THOUSAND FOUR HUNDRED THREE-A
OF THE PUBLIC HEALTH LAW, SHALL AT A MINIMUM OFFER THE  SAME  INDIVIDUAL
ENROLLEE DIRECT PAYMENT CONTRACTS OUTSIDE THE HEALTH BENEFIT EXCHANGE TO
INDIVIDUALS   NOT  ELIGIBLE  FOR  COVERAGE  WITHIN  THE  HEALTH  BENEFIT
EXCHANGE.
  (D)(1) NOTHING IN THIS SECTION SHALL BE DEEMED TO REQUIRE HEALTH MAIN-
TENANCE ORGANIZATIONS TO DISCONTINUE INDIVIDUAL DIRECT PAYMENT CONTRACTS
ISSUED PRIOR TO JANUARY FIRST, TWO THOUSAND FOURTEEN OR  PREVENT  HEALTH
MAINTENANCE  ORGANIZATIONS  FROM DISCONTINUING INDIVIDUAL DIRECT PAYMENT
CONTRACTS ISSUED PRIOR TO JANUARY FIRST, TWO THOUSAND FOURTEEN.    IF  A
HEALTH  MAINTENANCE  ORGANIZATION DISCONTINUES INDIVIDUAL DIRECT PAYMENT
CONTRACTS ISSUED PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN,  REGARD-
LESS OF WHETHER IT IS A GRANDFATHERED HEALTH PLAN, THEN THE HEALTH MAIN-
TENANCE  ORGANIZATION  SHALL COMPLY WITH  THE REQUIREMENTS OF SUBSECTION
(C) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR OF THIS ARTICLE.
  (2) FOR PURPOSES OF THIS SUBSECTION, "GRANDFATHERED HEALTH PLAN" MEANS
COVERAGE PROVIDED BY A CORPORATION IN WHICH AN INDIVIDUAL  WAS  ENROLLED
ON  MARCH  TWENTY-THIRD,  TWO  THOUSAND  TEN FOR AS LONG AS THE COVERAGE
MAINTAINS GRANDFATHERED STATUS IN ACCORDANCE WITH SECTION 1251(E) OF THE
AFFORDABLE CARE ACT, 42 U.S.C. S 18011(E).
  (E) THE SUPERINTENDENT MAY  PROMULGATE  REGULATIONS  IMPLEMENTING  THE
REQUIREMENTS  OF THIS  SECTION, INCLUDING REGULATIONS THAT MODIFY OR ADD
ADDITIONAL STANDARDIZED INDIVIDUAL ENROLLEE DIRECT PAYMENT CONTRACTS  IF
THE SUPERINTENDENT DETERMINES ADDITIONAL CONTRACTS WITH DIFFERENT LEVELS
OF BENEFITS ARE NECESSARY TO MEET THE NEEDS OF THE PUBLIC.

S. 2606                            95                            A. 3006

  S  47.  Paragraphs 4, 6, 9 and 10 of subsection (e) of section 3221 of
the insurance law are REPEALED, paragraphs 5, 7, 8, 11 and 12 are renum-
bered paragraphs 4, 5, 6, 7 and 8 and paragraph 1, as amended by chapter
306 of the laws of 1987, is amended to read as follows:
  (1)  A  group  policy  providing hospital, MEDICAL or surgical expense
insurance for other than  specific  diseases  or  accident  only,  shall
provide that if the insurance on an employee or member insured under the
group policy ceases because of termination of [(I)] (A) employment or of
membership in the class or classes eligible for coverage under the poli-
cy or [(II)] (B) the policy, for any reason whatsoever, unless the poli-
cyholder  has  replaced  the  group  policy  with similar and continuous
coverage for the  same  group  whether  insured  or  self-insured,  such
employee  or  member who has been insured under the group policy [for at
least three months] shall be  entitled  to  have  issued  to  [him]  THE
INSURED by the insurer without evidence of insurability upon application
made  to  the insurer within forty-five days after such termination, and
payment of the quarterly, or, at the option of the employee or member, a
less frequent premium applicable to the [class  of  risk  to  which  the
person  belongs,  the  age  of  such person, and the] form and amount of
insurance, an individual policy of insurance. The insurer  may,  at  its
option  elect  to provide the insurance coverage under a group insurance
policy, delivered in this state, in lieu of the issuance of a  converted
individual policy of insurance. Such individual policy, or group policy,
as the case may be is hereafter referred to as the converted policy. The
benefits  provided under the converted policy shall be those required by
subsection (f)[,] AND (g)[, (h) or (i) hereof] OF THIS SECTION,  [which-
ever  is  applicable  and,] in the event of termination of the converted
group policy of insurance, each insured thereunder shall have a right of
conversion to a converted individual policy of insurance.
  S 48. Paragraph 3 of subsection (e) of section 3221 of  the  insurance
law,  as separately amended by chapters 370 and 869 of the laws of 1984,
is amended to read as follows:
  (3) The converted policy shall, at  the  option  of  the  employee  or
member,  provide  identical coverage for the dependents of such employee
or member who were covered under the group  policy.  Provided,  however,
that  if the employee or member chooses the option of dependent coverage
then dependents acquired after the permitted time to convert  stated  in
paragraph  one of this subsection shall be added to the converted family
policy in accordance with the provisions of subsection  (c)  of  section
thirty-two  hundred  sixteen of this article and any regulations promul-
gated or guidelines issued by the superintendent. [The converted  policy
need  not  provide benefits in excess of those provided for such persons
under the group policy from which conversion is made and may contain any
exclusion or benefit limitation contained in the group policy or custom-
arily used in individual policies.] The effective date of  the  individ-
ual's  coverage  under  the  converted  policy  shall be the date of the
termination of the individual's insurance under the group policy  as  to
those persons covered under the group policy.
  S 49. Subsections (f) and (g) of section 3221 of the insurance law are
REPEALED  and  two  new  subsections  (f)  and  (g) are added to read as
follows:
  (F) IF THE GROUP INSURANCE POLICY INSURES THE EMPLOYEE OR  MEMBER  FOR
HOSPITAL,  MEDICAL OR SURGICAL EXPENSE INSURANCE, OR IF THE GROUP INSUR-
ANCE POLICY INSURES THE EMPLOYEE OR MEMBER FOR MAJOR MEDICAL OR  SIMILAR
COMPREHENSIVE-TYPE COVERAGE, THEN THE CONVERSION PRIVILEGE SHALL ENTITLE
THE  EMPLOYEE  OR  MEMBER  TO  OBTAIN  COVERAGE UNDER A CONVERTED POLICY

S. 2606                            96                            A. 3006

PROVIDING, AT THE INSURED'S OPTION, COVERAGE UNDER ANY ONE OF THE  PLANS
DESCRIBED  IN  SUBSECTION  (G)  OF  THIS  SECTION ON AN EXPENSE INCURRED
BASIS.
  (G) FOR CONVERSION PURPOSES, AN INSURER SHALL OFFER TO THE EMPLOYEE OR
MEMBER  A POLICY AT EACH LEVEL OF COVERAGE AS DEFINED IN SECTION 1302(D)
OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(D) THAT CONTAINS THE BENE-
FITS DESCRIBED IN PARAGRAPH ONE OF SUBSECTION (B) OF SECTION FOUR  THOU-
SAND THREE HUNDRED TWENTY-EIGHT OF THIS CHAPTER.
  S  50.  Subparagraph  (D)  of paragraph 4 of subsection (l) of section
3221 of the insurance law, as amended by chapter  230  of  the  laws  of
2004, is amended to read as follows:
  (D)  In addition to the requirements of subparagraph (A) of this para-
graph, every insurer issuing a group policy for delivery in  this  state
[which]  WHERE THE policy provides reimbursement to insureds for psychi-
atric or psychological services or for the diagnosis  and  treatment  of
mental,  nervous or emotional disorders and ailments, however defined in
such policy, by physicians, psychiatrists or psychologists, [must] SHALL
provide the same coverage to insureds for such services  when  performed
by  a licensed clinical social worker, within the lawful scope of his or
her practice, who is licensed pursuant to  subdivision  two  of  section
seven  thousand  seven hundred four of the education law and in addition
shall have either: (i) three or  more  additional  years  experience  in
psychotherapy,  which  for  the purposes of this subparagraph shall mean
the use of verbal methods in interpersonal relationships with the intent
of assisting a person  or  persons  to  modify  attitudes  and  behavior
[which]  THAT  are  intellectually, socially or emotionally maladaptive,
under supervision, satisfactory to the state board for social work, in a
facility,  licensed  or  incorporated  by  an  appropriate  governmental
department,  providing  services  for  diagnosis or treatment of mental,
nervous or emotional disorders or ailments[, or];  (ii)  three  or  more
additional  years  experience  in  psychotherapy  under the supervision,
satisfactory to the state board for social work, of  a  psychiatrist,  a
licensed and registered psychologist or a licensed clinical social work-
er  qualified for reimbursement pursuant to subsection [(h)] (E) of this
section, or (iii) a combination of the experience specified in items (i)
and (ii) OF THIS SUBPARAGRAPH totaling three years, satisfactory to  the
state board for social work.
  (E)  The  state  board  for  social  work shall maintain a list of all
licensed clinical  social  workers  qualified  for  reimbursement  under
[this] subparagraph (D) OF THIS PARAGRAPH.
  S  51.  Paragraph 1 of subsection (e) of section 4304 of the insurance
law, as amended by chapter 661 of  the  laws  of  1997  and  as  further
amended  by  section 104 of part A of chapter 62 of the laws of 2011, is
amended to read as follows:
  (1) If  any  such  contract  is  terminated  in  accordance  with  the
provisions  of paragraph one of subsection (c) [hereof] OF THIS SECTION,
or any such contract is terminated because of a default by the remitting
agent in the payment of premiums not cured within the grace  period  and
the  remitting  agent  has  not  replaced  the contract with similar and
continuous coverage for the same group whether insured or  self-insured,
or  any such contract is terminated in accordance with the provisions of
subparagraph (E) of paragraph two of subsection  (c)  [hereof]  OF  THIS
SECTION, or if an individual other than the contract holder is no longer
covered  under  a  "family  contract"  because [he] THE INDIVIDUAL is no
longer within the definition set forth in the contract, or a  spouse  is
no  longer  covered  under  the  contract  because  of  divorce from the

S. 2606                            97                            A. 3006

contract holder or annulment of the marriage, or any  such  contract  is
terminated  because of the death of the contract holder, then such indi-
vidual, former spouse, or in the case of the death of the contract hold-
er  the  surviving  spouse  or other dependents of the deceased contract
holder covered under the contract, as the case may be, shall be entitled
to convert, without evidence of insurability, upon application  therefor
and  the  making  of the first payment thereunder within thirty-one days
after the date of termination of such contract, to a contract [of a type
which provides coverage most nearly comparable to the type  of  coverage
under  the  contract from which the individual converted, which coverage
shall be no less than the minimum standards for  basic  hospital,  basic
medical,  or  major  medical  as provided for in department of financial
services regulation; provided, however, that if the corporation does not
issue such a major medical contract, then to a comprehensive or compara-
ble type of coverage which is most commonly being sold to  group  remit-
ting  agents.  Notwithstanding  the previous sentence, a corporation may
elect to issue a standardized individual enrollee contract  pursuant  to
section  four  thousand three hundred twenty-two of this article in lieu
of a major medical contract, comprehensive or comparable type of  cover-
age  required  to be offered upon conversion from an indemnity contract]
THAT CONTAINS THE BENEFITS DESCRIBED IN PARAGRAPH ONE OF SUBSECTION  (B)
OF SECTION FOUR THOUSAND THREE HUNDRED TWENTY-EIGHT OF THIS CHAPTER. THE
CORPORATION  SHALL  OFFER  ONE  CONTRACT  AT  EACH  LEVEL OF COVERAGE AS
DEFINED IN SECTION 1302(D) OF THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S
18022(D).  THE  INDIVIDUAL  MAY  CHOOSE ANY SUCH CONTRACT OFFERED BY THE
CORPORATION.   The effective  date  of  the  coverage  provided  by  the
converted  direct  payment contract shall be the date of the termination
of coverage under the contract from which conversion was made.
  S 52. Paragraph 1 of subsection (d) of section 4305 of  the  insurance
law,  as  amended  by  chapter  504  of  the laws of 1995 and as further
amended by section 104 of part A of chapter 62 of the laws of  2011,  is
amended to read as follows:
  (1) (A) A group contract issued pursuant to this section shall contain
a  provision  to  the  effect  that in case of a termination of coverage
under such contract of any member of the  group  because  of  [(I)]  (I)
termination  for  any reason whatsoever of [his] THE MEMBER'S employment
or membership, [if he has been covered under the group contract  for  at
least three months,] or [(II)] (II) termination for any reason whatsoev-
er  of  the  group  contract itself unless the group contract holder has
replaced the group contract with similar and continuous coverage for the
same group whether insured or self-insured, [he]  THE  MEMBER  shall  be
entitled  to have issued to [him] THE MEMBER by the corporation, without
evidence of insurability, upon application therefor and payment  of  the
first  premium  made  to  the  corporation  within forty-five days after
termination of the coverage,  an  individual  direct  payment  contract,
covering such member and [his] THE MEMBER'S eligible dependents who were
covered  by  the  group  contract,  which provides coverage [most nearly
comparable to the type of  coverage  under  the  group  contract,  which
coverage shall be no less than the minimum standards for basic hospital,
basic  medical, or major medical as provided for in department of finan-
cial services regulation; provided, however,  that  if  the  corporation
does not issue such a major medical contract, then to a comprehensive or
comparable  type  of coverage which is most commonly being sold to group
remitting agents. Notwithstanding the previous sentence,  a  corporation
may  elect to issue a standardized individual enrollee contract pursuant
to section four thousand three hundred twenty two  of  this  article  in

S. 2606                            98                            A. 3006

lieu  of  a  major medical contract, comprehensive or comparable type of
coverage required to  be  offered  upon  conversion  from  an  indemnity
contract]  THAT  CONTAINS  THE  BENEFITS  DESCRIBED  IN PARAGRAPH ONE OF
SUBSECTION  (B)  OF  SECTION FOUR THOUSAND THREE HUNDRED TWENTY-EIGHT OF
THIS CHAPTER. THE CORPORATION SHALL OFFER ONE CONTRACT AT EACH LEVEL  OF
COVERAGE  AS  DEFINED  IN SECTION 1302(D) OF THE AFFORDABLE CARE ACT, 42
U.S.C. S 18022(D). THE MEMBER MAY CHOOSE ANY SUCH  CONTRACT  OFFERED  BY
THE CORPORATION.
  (B) The conversion privilege afforded [herein] IN THIS PARAGRAPH shall
also  be  available:  [(A)]  (I)  upon  the  divorce or annulment of the
marriage of a member, to the divorced spouse or former  spouse  of  such
member[,  (B)];  (II)  upon  the  death  of the member, to the surviving
spouse and other dependents covered under  the  contract[,];  and  [(C)]
(III) to a dependent if no longer within the definition in the contract.
  S  53.  Section  3216  of the insurance law is amended by adding a new
subsection (m) to read as follows:
  (M) AN INSURER SHALL NOT BE REQUIRED TO  OFFER  THE  POLICYHOLDER  ANY
BENEFITS  THAT  MUST  BE  MADE AVAILABLE PURSUANT TO THIS SECTION IF THE
BENEFITS MUST BE COVERED AS ESSENTIAL HEALTH BENEFITS.  FOR  ANY  POLICY
ISSUED  WITHIN  THE  HEALTH  BENEFIT  EXCHANGE  ESTABLISHED  PURSUANT TO
SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18031,  AN  INSURER
SHALL  NOT  BE REQUIRED TO OFFER THE POLICYHOLDER ANY BENEFITS THAT MUST
BE MADE AVAILABLE  PURSUANT  TO  THIS  SECTION.  FOR  PURPOSES  OF  THIS
SUBSECTION, "ESSENTIAL HEALTH BENEFITS" SHALL HAVE THE MEANING SET FORTH
IN SECTION 1302(B) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(B).
  S 54. Subsections (h) and (i) of section 3221 of the insurance law are
REPEALED  and  two  new  subsections  (h)  and  (i) are added to read as
follows:
  (H) EVERY SMALL GROUP POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS
STATE  THAT PROVIDES  COVERAGE FOR HOSPITAL, MEDICAL OR SURGICAL EXPENSE
INSURANCE AND IS NOT A GRANDFATHERED HEALTH PLAN SHALL PROVIDE  COVERAGE
FOR  THE ESSENTIAL HEALTH BENEFIT PACKAGE AS REQUIRED IN SECTION 2707(A)
OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-6(A).  FOR  PURPOSES
OF THIS SUBSECTION:
  (1)  "ESSENTIAL  HEALTH  BENEFITS  PACKAGE" SHALL HAVE THE MEANING SET
FORTH IN SECTION 1302(A)  OF  THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S
18022(A);
  (2)  "GRANDFATHERED HEALTH PLAN" MEANS COVERAGE PROVIDED BY AN INSURER
IN WHICH AN INDIVIDUAL  WAS ENROLLED ON MARCH TWENTY-THIRD, TWO THOUSAND
TEN FOR AS LONG  AS  THE  COVERAGE  MAINTAINS  GRANDFATHERED  STATUS  IN
ACCORDANCE  WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S
18011(E); AND
  (3) "SMALL GROUP" MEANS A GROUP OF FIFTY OR FEWER EMPLOYEES OR MEMBERS
EXCLUSIVE OF SPOUSES  AND DEPENDENTS; PROVIDED, HOWEVER, THAT  BEGINNING
JANUARY  FIRST, TWO THOUSAND SIXTEEN, "SMALL GROUP" MEANS A GROUP OF ONE
HUNDRED OR FEWER EMPLOYEES OR MEMBERS EXCLUSIVE OF  SPOUSES  AND  DEPEN-
DENTS.
  (I)  AN  INSURER  SHALL  NOT BE REQUIRED TO OFFER THE POLICYHOLDER ANY
BENEFITS THAT MUST BE MADE AVAILABLE PURSUANT TO  THIS  SECTION  IF  THE
BENEFITS MUST BE COVERED PURSUANT TO SUBSECTION (H) OF THIS SECTION. FOR
ANY  POLICY ISSUED WITHIN THE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSU-
ANT TO SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C.  S  18031,  AN
INSURER  SHALL  NOT  BE  REQUIRED TO OFFER THE POLICYHOLDER ANY BENEFITS
THAT MUST BE MADE AVAILABLE PURSUANT TO THIS SECTION.

S. 2606                            99                            A. 3006

  S 55. Subsection (gg) of section 4303 of the insurance law,  as  added
by  chapter 536 of the laws of 2010, is relettered to be subsection (jj)
and two new subsections (kk) and (ll) are added to read as follows:
  (KK)  EVERY  SMALL  GROUP CONTRACT DELIVERED OR ISSUED FOR DELIVERY IN
THIS STATE THAT PROVIDES COVERAGE  FOR  HOSPITAL,  MEDICAL  OR  SURGICAL
EXPENSE  INSURANCE  AND IS NOT A GRANDFATHERED HEALTH PLAN SHALL PROVIDE
COVERAGE FOR THE ESSENTIAL HEALTH BENEFIT PACKAGE AS REQUIRED IN SECTION
2707(A) OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C.  S  300GG-6(A).  FOR
PURPOSES OF THIS SUBSECTION:
  (1)  "ESSENTIAL  HEALTH  BENEFITS  PACKAGE" SHALL HAVE THE MEANING SET
FORTH IN SECTION 1302(A)  OF  THE  AFFORDABLE  CARE  ACT,  42  U.S.C.  S
18022(A);
  (2)  "GRANDFATHERED  HEALTH  PLAN" MEANS COVERAGE PROVIDED BY A CORPO-
RATION IN WHICH AN  INDIVIDUAL WAS ENROLLED ON MARCH  TWENTY-THIRD,  TWO
THOUSAND TEN FOR AS LONG AS THE COVERAGE MAINTAINS  GRANDFATHERED STATUS
IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C.
S 18011(E); AND
  (3) "SMALL GROUP" MEANS A GROUP OF FIFTY OR FEWER EMPLOYEES OR MEMBERS
EXCLUSIVE OF SPOUSES  AND DEPENDENTS. BEGINNING JANUARY FIRST, TWO THOU-
SAND  SIXTEEN,  "SMALL  GROUP"  MEANS  A GROUP OF ONE   HUNDRED OR FEWER
EMPLOYEES OR MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS.
  (LL) A CORPORATION SHALL NOT BE REQUIRED TO OFFER THE CONTRACT  HOLDER
ANY  BENEFITS  THAT  MUST  BE MADE AVAILABLE PURSUANT TO THIS SECTION IF
SUCH BENEFITS MUST BE  COVERED  PURSUANT  TO  SUBSECTION  (KK)  OF  THIS
SECTION.  FOR  ANY  CONTRACT  ISSUED  WITHIN THE HEALTH BENEFIT EXCHANGE
ESTABLISHED PURSUANT TO SECTION 1311 OF  THE  AFFORDABLE  CARE  ACT,  42
U.S.C.  S  18031,  A  CORPORATION  SHALL  NOT  BE  REQUIRED TO OFFER THE
CONTRACT HOLDER ANY BENEFITS THAT MUST BE  MADE  AVAILABLE  PURSUANT  TO
THIS SECTION.
  S  56. Section 4326 of the insurance law, as added by chapter 1 of the
laws of 1999, subsection (b) as amended by chapter 342 of  the  laws  of
2004,  subparagraph (A) of paragraph 1 and subparagraph (C) of paragraph
3 of subsection (c) as amended by chapter 419 of the laws of 2000, para-
graphs 13 and 14 of subsection (d), paragraphs 6 and 7 of subsection (e)
and subsection (k) as amended and paragraph  15  of  subsection  (d)  as
added  by  chapter  219 of the laws of 2011 and subsections (d-1), (d-2)
and (d-3) as added by chapter 645 of the laws of  2005,  is  amended  to
read as follows:
  S  4326.  Standardized health insurance contracts for qualifying small
employers and individuals. (a) A program is hereby established  for  the
purpose  of  making standardized health insurance contracts available to
qualifying small employers [and qualifying individuals]  as  defined  in
this  section.  Such program is designed to encourage small employers to
offer health insurance coverage to their employees  [and  to  also  make
coverage available to uninsured employees whose employers do not provide
group health insurance].
  (b)  Participation  in  the  program  established  by this section and
section four thousand three hundred  twenty-seven  of  this  article  is
limited  to  corporations  or  insurers organized or licensed under this
article or article forty-two of  this  chapter  and  health  maintenance
organizations issued a certificate of authority under article forty-four
of  the  public health law or licensed under this article. Participation
by all health maintenance organizations is mandatory, provided, however,
that such requirements shall not apply to a HOLDER OF A SPECIAL  PURPOSE
CERTIFICATE  OF  AUTHORITY ISSUED PURSUANT TO SECTION FOUR THOUSAND FOUR
HUNDRED THREE-A OF THE PUBLIC HEALTH LAW OR A health maintenance  organ-

S. 2606                            100                           A. 3006

ization exclusively serving individuals enrolled pursuant to title elev-
en of article five of the social services law, title eleven-D of article
five  of  the social services law, title one-A of article twenty-five of
the  public  health law or title eighteen of the federal Social Security
Act[, and, further provided, that such health  maintenance  organization
shall  not discontinue a contract for an individual receiving comprehen-
sive-type coverage in effect prior to January first, two  thousand  four
who  is ineligible to purchase policies offered after such date pursuant
to this section or section four thousand  three  hundred  twenty-two  of
this article due to the provision of 42 U.S.C. 1395ss in effect prior to
January first, two thousand four]. On and after January first, two thou-
sand  one,  all  health maintenance organizations shall offer qualifying
group health  insurance  contracts  [and  qualifying  individual  health
insurance  contracts]  as  defined  in this section. For the purposes of
this section and section four thousand  three  hundred  twenty-seven  of
this  article,  article  forty-three  corporations  or article forty-two
insurers which voluntarily participate in compliance with  the  require-
ments  of this program shall be eligible for reimbursement from the stop
loss funds created pursuant to section four thousand three hundred twen-
ty-seven of this article under the same terms and conditions  as  health
maintenance organizations.
  (c)  The  following  definitions  shall be applicable to the insurance
contracts offered under the program established by this section:
  (1) (A) A qualifying small employer is [an employer that is either:
  (A) An individual proprietor who is the only employee of the business:
  (i) without health insurance which provides  benefits  on  an  expense
reimbursed  or  prepaid  basis  in effect during the twelve month period
prior to application for a qualifying group  health  insurance  contract
under the program established by this section; and
  (ii)  resides in a household having a net household income at or below
two hundred eight percent of the  non-farm  federal  poverty  level  (as
defined  and  updated  by  the  federal  department  of health and human
services) or the gross equivalent of such net income;
  (iii) except that the requirements set  forth  in  item  (i)  of  this
subparagraph  shall not be applicable where an individual proprietor had
health insurance coverage during the previous  twelve  months  and  such
coverage  terminated  due  to  one of the reasons set forth in items (i)
through (viii) of subparagraph (C) of paragraph three of subsection  (c)
of this section; or
  (B) An] AN employer with:
  (i) not more than fifty [eligible] employees;
  (ii)  no  group  health insurance [which] THAT provides benefits on an
expense reimbursed or prepaid basis covering employees in effect  during
the  twelve  month  period  prior  to application for a qualifying group
health insurance contract under the program established by this section;
and
  (iii) at least thirty percent of its  [eligible]  employees  receiving
annual  wages  from the employer at a level equal to or less than thirty
thousand dollars. The thirty thousand dollar figure  shall  be  adjusted
periodically pursuant to subparagraph [(F)] (D) of this paragraph.
  [(C)  The  requirements  set  forth in item (i) of subparagraph (A) of
this paragraph and in item (ii) of subparagraph (B)  of  this  paragraph
shall  not  be  applicable where an individual proprietor or employer is
transferring from a health insurance contract issued pursuant to the New
York state small business health insurance  partnership  program  estab-
lished  by  section  nine hundred twenty-two of the public health law or

S. 2606                            101                           A. 3006

from health care coverage issued pursuant to a  regional  pilot  project
for  the uninsured established by section one thousand one hundred eigh-
teen of this chapter.
  (D)]  (B)  The  twelve month period set forth [in item (i) of subpara-
graph (A) of this paragraph and] in item (ii) of subparagraph [(B)]  (A)
of  this  paragraph  may  be  adjusted by the superintendent from twelve
months to eighteen months if he determines that the twelve month  period
is  insufficient  to prevent inappropriate substitution of [other health
insurance contracts for] qualifying group health insurance contracts FOR
OTHER HEALTH INSURANCE CONTRACTS.
  [(E)] (C) An [individual proprietor or] employer shall cease to  be  a
qualifying  small employer if any health insurance [which] THAT provides
benefits on an expense reimbursed or prepaid basis covering  [the  indi-
vidual  proprietor  or]  an  employer's employees, other than qualifying
group health insurance purchased pursuant to this section, is  purchased
or  otherwise  takes  effect  subsequent to purchase of qualifying group
health insurance under the program established by this section.
  [(F)] (D) The wage levels utilized in subparagraph [(B)] (A)  of  this
paragraph shall be adjusted annually, beginning in two thousand two. The
adjustment shall take effect on July first of each year. For July first,
two  thousand  two,  the  adjustment shall be a percentage of the annual
wage figure specified in subparagraph [(B)] (A) of this  paragraph.  For
subsequent  years,  the  adjustment  shall be a percentage of the annual
wage figure [which] THAT took effect on July first of  the  prior  year.
The  percentage  adjustment  shall  be  the same percentage by which the
current year's non-farm federal poverty level, as defined and updated by
the federal department of health and human services, for a  family  unit
of  four  persons  for the forty-eight contiguous states and Washington,
D.C., changed from the same level established for the prior year.
  (2) A qualifying group health insurance contract is a  group  contract
purchased from a health maintenance organization, corporation or insurer
by  a  qualifying  small employer [which] THAT provides the benefits set
forth in subsection (d) of this section. The contract  must  insure  not
less than fifty percent of the employees [eligible for coverage].
  [(3)(A) A qualifying individual is an employed person:
  (i)  who  does not have and has not had health insurance with benefits
on an expense reimbursed or prepaid basis during the twelve month period
prior to the individual's application for  health  insurance  under  the
program established by this section;
  (ii)  whose  employer  does not provide group health insurance and has
not provided group health insurance with benefits on  an  expense  reim-
bursed  or  prepaid basis covering employees in effect during the twelve
month period prior to the individual's application for health  insurance
under the program established by this section;
  (iii) resides in a household having a net household income at or below
two  hundred  eight  percent  of  the non-farm federal poverty level (as
defined and updated by  the  federal  department  of  health  and  human
services) or the gross equivalent of such net income; and
  (iv) is ineligible for Medicare.
  (B)  The  requirements set forth in items (i) and (ii) of subparagraph
(A) of this paragraph shall not be applicable  where  an  individual  is
transferring  from  a  health  insurance contract issued pursuant to the
voucher insurance  program  established  by  section  one  thousand  one
hundred  twenty-one  of this chapter, a health insurance contract issued
pursuant to the New York state small business health insurance  partner-
ship  program  established  by  section  nine  hundred twenty-two of the

S. 2606                            102                           A. 3006

public health law or health care coverage issued pursuant to a  regional
pilot  project for the uninsured established by section one thousand one
hundred eighteen of this chapter.
  (C)  The  requirements set forth in items (i) and (ii) of subparagraph
(A) of this paragraph shall not be applicable where  an  individual  had
health  insurance  coverage  during  the previous twelve months and such
coverage terminated due to:
  (i) loss of employment due to factors other than voluntary separation;
  (ii) death of a family member which results in termination of coverage
under a health insurance contract under which the individual is covered;
  (iii) change to a new employer that  does  not  provide  group  health
insurance with benefits on an expense reimbursed or prepaid basis;
  (iv)  change  of  residence so that no employer-based health insurance
with benefits on an expense reimbursed or prepaid basis is available;
  (v) discontinuation of a group health insurance contract with benefits
on an expense reimbursed or prepaid basis covering the qualifying  indi-
vidual as an employee or dependent;
  (vi)  expiration  of the coverage periods established by the continua-
tion provisions of the  Employee  Retirement  Income  Security  Act,  29
U.S.C.    section  1161  et  seq.  and the Public Health Service Act, 42
U.S.C.  section 300bb-1 et seq. established by the Consolidated  Omnibus
Budget  Reconciliation  Act  of  1985,  as  amended, or the continuation
provisions of subsection (m) of section three thousand two hundred twen-
ty-one, subsection (k) of section four thousand three hundred  four  and
subsection (e) of section four thousand three hundred five of this chap-
ter;
  (vii)  legal  separation, divorce or annulment which results in termi-
nation of coverage under a health insurance  contract  under  which  the
individual is covered; or
  (viii) loss of eligibility under a group health plan.
  (D) The twelve month period set forth in items (i) and (ii) of subpar-
agraph  (A) of this paragraph may be adjusted by the superintendent from
twelve months to eighteen months if he determines that the twelve  month
period  is  insufficient  to prevent inappropriate substitution of other
health insurance contracts for qualifying  individual  health  insurance
contracts.
  (4) A qualifying individual health insurance contract is an individual
contract  issued  directly to a qualifying individual and which provides
the benefits set forth in subsection (d) of this section. At the  option
of  the  qualifying  individual,  such contract may include coverage for
dependents of the qualifying individual.]
  (d) [The contracts issued pursuant to this section by  health  mainte-
nance organizations, corporations or insurers and approved by the super-
intendent shall only provide in-plan benefits, except for emergency care
or  where  services  are not available through a plan provider.  Covered
services shall include only the following:
  (1) inpatient hospital services consisting of daily  room  and  board,
general  nursing care, special diets and miscellaneous hospital services
and supplies;
  (2) outpatient hospital services consisting of diagnostic  and  treat-
ment services;
  (3)   physician   services  consisting  of  diagnostic  and  treatment
services, consultant and referral services, surgical services (including
breast reconstruction surgery after a mastectomy), anesthesia  services,
second surgical opinion, and a second opinion for cancer treatment;

S. 2606                            103                           A. 3006

  (4) outpatient surgical facility charges related to a covered surgical
procedure;
  (5) preadmission testing;
  (6) maternity care;
  (7) adult preventive health services consisting of mammography screen-
ing; cervical cytology screening; periodic physical examinations no more
than once every three years; and adult immunizations;
  (8) preventive and primary health care services for dependent children
including routine well-child visits and necessary immunizations;
  (9)  equipment,  supplies and self-management education for the treat-
ment of diabetes;
  (10) diagnostic x-ray and laboratory services;
  (11) emergency services;
  (12) therapeutic services consisting of radiologic services,  chemoth-
erapy and hemodialysis;
  (13)  blood and blood products furnished in connection with surgery or
inpatient hospital services;
  (14) prescription drugs obtained at a participating pharmacy. In addi-
tion to providing coverage at a participating pharmacy,  health  mainte-
nance  organizations may utilize a mail order prescription drug program.
Health maintenance organizations may provide prescription drugs pursuant
to a drug formulary;  however,  health  maintenance  organizations  must
implement   an   appeals  process  so  that  the  use  of  non-formulary
prescription drugs may be requested by a physician; and
  (15) for a contract that is  not  a  grandfathered  health  plan,  the
following additional preventive health services:
  (A)  evidence-based  items or services that have in effect a rating of
'A' or 'B' in the current recommendations of the United  States  preven-
tive services task force;
  (B)  immunizations that have in effect a recommendation from the advi-
sory committee on immunization practices  of  the  centers  for  disease
control and prevention with respect to the individual involved;
  (C)  with  respect  to  children,  including  infants and adolescents,
evidence-informed preventive care and screenings  provided  for  in  the
comprehensive  guidelines supported by the health resources and services
administration; and
  (D) with respect to women, such additional preventive care and screen-
ings not described in subparagraph (A) of this paragraph as provided for
in comprehensive  guidelines  supported  by  the  health  resources  and
services administration.
  (E)  For purposes of this paragraph, "grandfathered health plan" means
coverage provided by a corporation in which an individual  was  enrolled
on  March  twenty-third,  two  thousand  ten for as long as the coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e)]  A  QUALIFYING  GROUP  HEALTH
INSURANCE CONTRACT SHALL PROVIDE COVERAGE FOR THE ESSENTIAL HEALTH BENE-
FIT  PACKAGE AS REQUIRED IN SECTION 2707(A) OF THE PUBLIC HEALTH SERVICE
ACT, 42 U.S.C. S 300GG-6(A). FOR PURPOSES OF THIS SUBSECTION  "ESSENTIAL
HEALTH  BENEFITS  PACKAGE"  SHALL  HAVE THE MEANING SET FORTH IN SECTION
1302(A) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(A).
  (d-1)  Covered  services  shall  not  include  drugs,  procedures  and
supplies  for the treatment of erectile dysfunction when provided to, or
prescribed for use by, a person who is required to  register  as  a  sex
offender pursuant to article six-C of the correction law, provided that:
(1) any denial of coverage pursuant to this subsection shall provide the
enrollee  with  the means of obtaining additional information concerning

S. 2606                            104                           A. 3006

both the denial and the means of challenging such denial; (2) all drugs,
procedures and supplies for the treatment of erectile dysfunction may be
subject to prior authorization by corporations, insurers or health main-
tenance  organizations for the purposes of implementing this subsection;
and (3) the superintendent shall promulgate regulations to implement the
denial of coverage pursuant to this subsection giving health maintenance
organizations, corporations and insurers at least sixty  days  following
promulgation  of  the  regulations  to implement their denial procedures
pursuant to this subsection.
  (d-2) No person or entity authorized to provide  coverage  under  this
section  shall be subject to any civil or criminal liability for damages
for any decision or action pursuant to subsection (d-1) of this section,
made in the ordinary course of business if  that  authorized  person  or
entity  acted reasonably and in good faith with respect to such informa-
tion.
  (d-3) Notwithstanding any other provision of law, if the  commissioner
of  health  makes  a  finding  pursuant  to  subdivision twenty-three of
section two hundred six of the public health law, the superintendent  is
authorized  to  remove  a  drug,  procedure  or supply from the services
covered by the standardized health  insurance  contract  established  by
this  section  for  those  persons required to register as sex offenders
pursuant to article six-C of the correction law.
  (e) [The benefits provided in the contracts  described  in  subsection
(d)  of  this  section shall be subject to the following deductibles and
copayments:
  (1) in-patient hospital services shall  have  a  five  hundred  dollar
copayment for each continuous hospital confinement;
  (2) surgical services shall be subject to a copayment of the lesser of
twenty  percent  of the cost of such services or two hundred dollars per
occurrence;
  (3) outpatient surgical facility charges shall be subject to a facili-
ty copayment charge of seventy-five dollars per occurrence;
  (4) emergency services shall have a fifty dollar copayment which  must
be waived if hospital admission results from the emergency room visit;
  (5)  prescription  drugs shall have a one hundred dollar calendar year
deductible per individual. After the deductible is satisfied, each thir-
ty-four day supply of a prescription drug will be subject  to  a  copay-
ment.  The  copayment  will  be  ten dollars if the drug is generic. The
copayment for a brand name drug will be twenty dollars plus the  differ-
ence  in  cost  between  the  brand name drug and the equivalent generic
drug. If a mail order drug program is utilized, a twenty  dollar  copay-
ment  shall  be  imposed  on a ninety day supply of generic prescription
drugs. A forty dollar copayment plus the difference in cost between  the
brand  name  drug  and the equivalent generic drug shall be imposed on a
ninety day supply of brand name prescription drugs. In  no  event  shall
the copayment exceed the cost of the prescribed drug;
  (6)  (A)  the maximum coverage for prescription drugs in an individual
contract that is a grandfathered health plan  shall  be  three  thousand
dollars per individual in a calendar year; and
  (B) the maximum dollar amount on coverage for prescription drugs in an
individual  contract  that  is not a grandfathered health plan or in any
group contract shall be consistent  with  section  2711  of  the  Public
Health Service Act, 42 U.S.C. S 300gg-11 or any regulations thereunder.
  (C)  For purposes of this paragraph, "grandfathered health plan" means
coverage provided by a corporation in which an individual  was  enrolled
on  March  twenty-third,  two  thousand  ten for as long as the coverage

S. 2606                            105                           A. 3006

maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e); and
  (7)  all  other services shall have a twenty dollar copayment with the
exception of prenatal care which shall have a ten  dollar  copayment  or
preventive  health  services  provided  pursuant to paragraph fifteen of
subsection (d) of this section, for which no copayment  shall  apply]  A
QUALIFYING  GROUP HEALTH INSURANCE CONTRACT ISSUED TO A QUALIFYING SMALL
EMPLOYER PRIOR TO JANUARY FIRST, TWO THOUSAND  FOURTEEN  THAT  DOES  NOT
INCLUDE  ALL  ESSENTIAL  HEALTH  BENEFITS  REQUIRED  PURSUANT TO SECTION
2707(A) OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-6(A),  SHALL
BE  DISCONTINUED, INCLUDING GRANDFATHERED HEALTH PLANS. FOR THE PURPOSES
OF THIS PARAGRAPH, "GRANDFATHERED HEALTH PLANS" MEANS COVERAGE  PROVIDED
BY A CORPORATION TO INDIVIDUALS WHO WERE ENROLLED ON MARCH TWENTY-THIRD,
TWO  THOUSAND  TEN  FOR  AS LONG AS THE COVERAGE MAINTAINS GRANDFATHERED
STATUS IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42
U.S.C. S 18011(E). A QUALIFYING SMALL EMPLOYER SHALL BE TRANSITIONED  TO
A  PLAN  THAT  PROVIDES:  (1)  A  LEVEL  OF COVERAGE THAT IS DESIGNED TO
PROVIDE BENEFITS THAT ARE ACTUARIALLY EQUIVALENT TO  EIGHTY  PERCENT  OF
THE  FULL  ACTUARIAL  VALUE OF THE BENEFITS PROVIDED UNDER THE PLAN; AND
(2) COVERAGE FOR THE ESSENTIAL HEALTH BENEFIT  PACKAGE  AS  REQUIRED  IN
SECTION   2707(A)  OF  THE  PUBLIC  HEALTH  SERVICE  ACT,  42  U.S.C.  S
300GG-6(A). THE SUPERINTENDENT SHALL STANDARDIZE THE BENEFIT PACKAGE AND
COST SHARING REQUIREMENTS OF QUALIFIED GROUP HEALTH INSURANCE  CONTRACTS
CONSISTENT  WITH  COVERAGE  OFFERED  THROUGH THE HEALTH BENEFIT EXCHANGE
ESTABLISHED PURSUANT TO SECTION 1311 OF  THE  AFFORDABLE  CARE  ACT,  42
U.S.C. S 18031.
  (f)  [Except as included in the list of covered services in subsection
(d) of this section, the] THE mandated and make-available  benefits  set
forth  in  sections [three thousand two hundred sixteen,] three thousand
two hundred twenty-one of this chapter and four thousand  three  hundred
three  of  this  article shall not be applicable to the contracts issued
pursuant to this section. [Mandated benefits included in such  contracts
shall  be  subject  to  the  deductibles  and  copayments  set  forth in
subsection (e) of this section.]
  (g) [The superintendent shall be authorized to modify, by  regulation,
the  copayment  and  deductible amounts described in this section if the
superintendent determines such amendments are  necessary  to  facilitate
implementation  of this section. On or after January first, two thousand
two, the superintendent shall be authorized to establish, by regulation,
one or more additional standardized health insurance benefit packages if
the superintendent determines additional benefit packages with different
levels of benefits are necessary to meet the needs of the public.
  (h)] A health maintenance organization, corporation  or  insurer  must
offer the benefit package without change or additional benefits. [Quali-
fying] A QUALIFYING small [employers] EMPLOYER shall be issued the bene-
fit package in a qualifying group health insurance contract. [Qualifying
individuals shall be issued the benefit package in a qualifying individ-
ual health insurance contract.
  (i)]  (H)  A  health  maintenance organization, corporation or insurer
shall obtain from the employer [or individual] written certification  at
the  time  of  initial  application  and annually thereafter ninety days
prior to the contract renewal date that such  employer  [or  individual]
meets  the  requirements of a qualifying small employer [or a qualifying
individual] pursuant to this section. A health maintenance organization,
corporation  or  insurer  may  require  the  submission  of  appropriate
documentation in support of the certification.

S. 2606                            106                           A. 3006

  [(j)] (I) Applications for qualifying group health insurance contracts
[and  qualifying individual health insurance contracts] must be accepted
from [any qualifying individual and] any qualifying  small  employer  at
all  times  throughout  the year. The superintendent, by regulation, may
require  health  maintenance  organizations, corporations or insurers to
give preference to qualifying small employers whose [eligible] employees
have the lowest average salaries.
  [(k) (1) All  coverage  under  a  qualifying  group  health  insurance
contract  or  a  qualifying individual health insurance contract must be
subject to a pre-existing condition limitation provision as set forth in
sections three thousand two hundred thirty-two of this chapter and  four
thousand three hundred eighteen of this article, including the crediting
requirements  thereunder.  The  underwriting  of  such contracts may not
involve more than the imposition of a pre-existing condition limitation.
However, as provided in sections three thousand two  hundred  thirty-two
of  this  chapter and four thousand three hundred eighteen of this arti-
cle, a corporation shall not impose a pre-existing condition  limitation
provision  on  any  person  under age nineteen, except may impose such a
limitation on those persons covered by a  qualifying  individual  health
insurance contract that is a grandfathered health plan.
  (2)]  (J)  Beginning January first, two thousand fourteen, pursuant to
section 2704 of the Public Health Service Act, 42 U.S.C.  S  300gg-3,  a
corporation  shall not impose any pre-existing condition limitation in a
qualifying group health insurance contract [or a  qualifying  individual
health insurance contract except may impose such a limitation in a qual-
ifying  individual  health  insurance  contract  that is a grandfathered
health plan].
  [(3) For purposes of  paragraphs  one  and  two  of  this  subsection,
"grandfathered  health plan" means coverage provided by a corporation in
which an individual was enrolled on March twenty-third, two thousand ten
for as long as the coverage maintains grandfathered status in accordance
with section 1251(e) of the Affordable Care Act, 42 U.S.C. S 18011(e).
  (l)] (K) A qualifying small  employer  shall  elect  whether  to  make
coverage  under the qualifying group health insurance contract available
to dependents of employees. Any employee or dependent who is enrolled in
Medicare is ineligible for coverage, unless  required  by  federal  law.
Dependents  of  an employee who is enrolled in Medicare will be eligible
for dependent coverage provided the dependent is not  also  enrolled  in
Medicare.
  [(m)]  (L) A qualifying small employer must pay at least fifty percent
of the premium for employees covered under  a  qualifying  group  health
insurance  contract  and  must offer coverage to all employees receiving
annual wages at a level of thirty thousand dollars or less, and at least
one such employee shall accept such coverage. The thirty thousand dollar
wage level shall be adjusted periodically in  accordance  with  subpara-
graph  (F)  of  paragraph  one  of  subsection  (c) of this section. The
employer premium contribution  must  be  the  same  percentage  for  all
covered employees.
  [(n)] (M) Premium rate calculations for qualifying group health insur-
ance  contracts  [and  qualifying individual health insurance contracts]
shall be subject to the following:
  (1) coverage must be community rated and [include rate tiers for indi-
viduals, two adult families and at least one other family tier. The rate
differences must be based upon the cost differences  for  the  different
family units and the rate tiers must be uniformly applied. The rate tier
structure  used  by  a  health  maintenance organization, corporation or

S. 2606                            107                           A. 3006

insurer for the contracts issued to qualifying small  employers  and  to
qualifying  individuals  must  be the same] THE SUPERINTENDENT SHALL SET
STANDARD RATING TIERS FOR FAMILY UNITS AND STANDARD RATING  RELATIVITIES
BETWEEN TIERS APPLICABLE TO ALL CONTRACTS SUBJECT TO THIS SECTION; AND
  (2)  [if  geographic  rating areas are utilized, such geographic areas
must be reasonable and in a given case may include a single county.  The
geographic  areas  utilized must be the same for the contracts issued to
qualifying small employers and to  qualifying  individuals.  The  super-
intendent  shall  not  require  the inclusion of any specific geographic
region within the proposed community rated region selected by the health
maintenance organization, corporation or insurer so long as  the  health
maintenance  organization,  corporation or insurer's proposed regions do
not contain configurations designed to  avoid  or  segregate  particular
areas  within  a  county covered by the health maintenance organization,
corporation or insurer's community rates.] BEGINNING JANUARY FIRST,  TWO
THOUSAND FOURTEEN, EVERY POLICY SUBJECT TO THIS SECTION SHALL USE STAND-
ARDIZED REGIONS ESTABLISHED BY THE SUPERINTENDENT; AND
  (3)  claims  experience  under  contracts  issued  to qualifying small
employers [and to qualifying individuals] must be pooled WITH THE HEALTH
MAINTENANCE ORGANIZATION, CORPORATION OR INSURER'S SMALL GROUP  BUSINESS
for  rate  setting  purposes.  [The  premium  rates for qualifying group
health insurance contracts and qualifying  individual  health  insurance
contracts must be the same.
  (o)]  (N)  A  health  maintenance organization, corporation or insurer
shall submit reports to the superintendent in such form and at times  as
may  be  reasonably  required  in  order  to evaluate the operations and
results of the standardized health insurance program established by this
section.
  [(p) Notwithstanding any other provision of law, all  individuals  and
small  businesses  that  are  participating  in  or covered by insurance
contracts or policies issued pursuant to the New York state small  busi-
ness  health  insurance  partnership program established by section nine
hundred twenty-two of the  public  health  law,  the  voucher  insurance
program  established  by  section one thousand one hundred twenty-one of
this chapter, or uninsured pilot programs established pursuant to  chap-
ter  seven  hundred  three  of the laws of nineteen hundred eighty-eight
shall be eligible for participation in the standardized health insurance
contracts established by this section, regardless of any of  the  eligi-
bility  requirements  established  pursuant  to  subsection  (c) of this
section.]
  S 57. The insurance law is amended by adding a new section  4326-a  to
read as follows:
  S  4326-A.  TRANSITION  OF HEALTHY NEW YORK ENROLLEES. (A) ON DECEMBER
THIRTY-FIRST, TWO THOUSAND THIRTEEN, COVERAGE ISSUED TO QUALIFYING INDI-
VIDUALS AND QUALIFYING SMALL  EMPLOYERS  WHO  ARE  SOLE  PROPRIETORS  AS
DEFINED IN SECTION FOUR THOUSAND THREE HUNDRED TWENTY-SIX SHALL END.
  (B)  A  HEALTH MAINTENANCE ORGANIZATION, CORPORATION, OR INSURER SHALL
PROVIDE WRITTEN NOTICE OF THE PROGRAM DISCONTINUANCE  TO  EACH  ENROLLED
INDIVIDUAL  AND  INDIVIDUAL  PROPRIETOR  AT LEAST ONE HUNDRED AND EIGHTY
DAYS PRIOR TO THE  DATE  OF  PROGRAM  DISCONTINUANCE.  EVERY  NOTICE  OF
PROGRAM  DISCONTINUANCE  SHALL BE IN SUCH FORM AND CONTAIN SUCH INFORMA-
TION AS THE SUPERINTENDENT REQUIRES. IN ADDITION TO ANY  OTHER  INFORMA-
TION  REQUIRED BY THE SUPERINTENDENT, THE WRITTEN NOTICE SHALL INCLUDE A
CONSPICUOUS EXPLANATION, IN PLAIN LANGUAGE, OF AVAILABLE  HEALTH  INSUR-
ANCE  OPTIONS,  INCLUDING  COVERAGE  THROUGH THE HEALTH BENEFIT EXCHANGE

S. 2606                            108                           A. 3006

ESTABLISHED PURSUANT TO SECTION 1311 OF  THE  AFFORDABLE  CARE  ACT,  42
U.S.C. S 18031, UPON SUCH DISCONTINUANCE.
  (C)  QUALIFYING  GROUP HEALTH INSURANCE CONTRACTS ISSUED TO QUALIFYING
SMALL EMPLOYERS PRIOR TO JANUARY FIRST, TWO THOUSAND  FOURTEEN  THAT  DO
NOT  INCLUDE  ALL ESSENTIAL HEALTH BENEFITS REQUIRED PURSUANT TO SECTION
2707(A) OF THE PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-6(A);  SHALL
BE  DISCONTINUED, INCLUDING GRANDFATHERED HEALTH PLANS. FOR THE PURPOSES
OF THIS PARAGRAPH, "GRANDFATHERED HEALTH PLANS" MEANS COVERAGE  PROVIDED
BY A CORPORATION TO INDIVIDUALS WHO WERE ENROLLED ON MARCH TWENTY-THIRD,
TWO  THOUSAND  TEN  FOR  AS LONG AS THE COVERAGE MAINTAINS GRANDFATHERED
STATUS IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42
U.S.C. S 18011(E). QUALIFYING SMALL EMPLOYERS THAT ARE IMPACTED  BY  THE
DISCONTINUANCE  SHALL  BE TRANSITIONED TO A PLAN THAT MEETS THE REQUIRE-
MENTS  OF  SUBSECTION  (E)  OF  SECTION  FOUR  THOUSAND  THREE   HUNDRED
TWENTY-SIX  OF  THIS  CHAPTER. A HEALTH MAINTENANCE ORGANIZATION, CORPO-
RATION, OR INSURER SHALL PROVIDE WRITTEN NOTICE OF THE  PROGRAM  DISCON-
TINUANCE TO EACH ENROLLED QUALIFYING SMALL EMPLOYER AT LEAST ONE HUNDRED
EIGHTY DAYS PRIOR TO THE DATE OF PROGRAM DISCONTINUANCE. EVERY NOTICE OF
PROGRAM  DISCONTINUANCE  SHALL BE IN SUCH FORM AND CONTAIN SUCH INFORMA-
TION AS REQUIRED BY THE SUPERINTENDENT. IN ADDITION TO ANY OTHER  INFOR-
MATION  THE SUPERINTENDENT MAY REQUIRE, THE WRITTEN NOTICE SHALL INCLUDE
A CONSPICUOUS EXPLANATION, IN PLAIN LANGUAGE, OF THE ABILITY TO  TRANSI-
TION  TO  A NEW QUALIFYING SMALL GROUP HEALTH INSURANCE CONTRACT OFFERED
PURSUANT TO SECTION FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS ARTI-
CLE.
  S 58. Section 4327 of the insurance law, as added by chapter 1 of  the
laws  of  1999,  subsection (h) as amended by chapter 419 of the laws of
2000, subsection (m-1) as added by section 12 of part B of chapter 58 of
the laws of 2010, subsection (s) as amended and subsection (t) as  added
by chapter 441 of the laws of 2006, is amended to read as follows:
  S  4327.  Stop  loss funds for standardized health insurance contracts
issued to qualifying small employers and qualifying individuals. (a) The
superintendent shall establish a  fund  from  which  health  maintenance
organizations,  corporations  or  insurers may receive reimbursement, to
the extent of funds available therefor, for claims paid by  such  health
maintenance  organizations, corporations or insurers for members covered
under qualifying group health insurance  contracts  issued  pursuant  to
section  four  thousand  three  hundred twenty-six of this article. This
fund shall be known as the "small employer stop loss fund". [The  super-
intendent shall establish a separate and distinct fund from which health
maintenance   organizations,   corporations   or  insurers  may  receive
reimbursement, to the extent of funds  available  therefor,  for  claims
paid  by such health maintenance organizations, corporations or insurers
for  members  covered  under  qualifying  individual  health   insurance
contracts  issued  pursuant to section four thousand three hundred twen-
ty-six of this article. This fund shall  be  known  as  the  "qualifying
individual stop loss fund".]
  (b)  [Commencing  on  January  first, two thousand one, health] HEALTH
maintenance organizations, corporations or insurers shall be eligible to
receive reimbursement for ninety percent of claims paid between [thirty]
FIVE thousand and [one  hundred]  SEVENTY-FIVE  thousand  dollars  in  a
calendar  year  for  any  member  covered  under a standardized contract
issued pursuant to section four thousand  three  hundred  twenty-six  of
this  article.  Claims  paid  for members covered under qualifying group
health insurance contracts shall be reimbursable from the small employer
stop loss fund. [Claims paid for members covered under qualifying  indi-

S. 2606                            109                           A. 3006

vidual  health insurance contracts shall be reimbursable from the quali-
fying individual stop loss fund.] For  the  purposes  of  this  section,
claims  shall  include  health  care claims paid by a health maintenance
organization on behalf of a covered member pursuant to such standardized
contracts.
  (c)  The  superintendent  shall  promulgate regulations that set forth
procedures for the operation of the small employer stop loss  fund  [and
the  qualifying  individual  stop  loss fund] and distribution of monies
therefrom.
  (d) [The small employer stop loss fund shall operate  separately  from
the  qualifying  individual  stop  loss  fund.  Except  as  specified in
subsection (b) of this section with respect to calendar year  two  thou-
sand  one,  the  level  of  stop  loss coverage for the qualifying group
health insurance contracts and the qualifying individual  health  insur-
ance contracts need not be the same. The two stop loss funds need not be
structured  or  operated in the same manner, except as specified in this
section. The monies available for distribution from the stop loss  funds
may  be  reallocated  between  the small employer stop loss fund and the
qualifying individual stop loss fund if  the  superintendent  determines
that  such  reallocation  is  warranted  due  to enrollment trends.] THE
SUPERINTENDENT MAY ADJUST THE LEVEL OF STOP LOSS COVERAGE  SPECIFIED  IN
SUBSECTION (B) OF THIS SECTION.
  (e)  Claims  shall be reported and funds shall be distributed from the
small employer stop loss fund [and from the qualifying  individual  stop
loss  fund]  on  a  calendar  year  basis.  Claims shall be eligible for
reimbursement only for the calendar year in which the claims  are  paid.
Once  claims  paid  on  behalf  of  a covered member reach or exceed one
hundred thousand dollars in a given calendar  year,  no  further  claims
paid  on  behalf  of such member in that calendar year shall be eligible
for reimbursement.
  (f) Each health maintenance organization, corporation or insurer shall
submit a request for reimbursement from [each of] the stop loss  [funds]
FUND  on  forms  prescribed  by  the superintendent.   [Each of the] THE
requests for reimbursement shall be submitted no later than April  first
following  the  end  of  the  calendar  year for which the reimbursement
requests are being made. The superintendent may require  health  mainte-
nance organizations, corporations or insurers to submit such claims data
in  connection  with the reimbursement requests as he deems necessary to
enable him to distribute monies and oversee the operation of  the  small
employer [and qualifying individual] stop loss [funds] FUND.  The super-
intendent  may  require  that  such  data  be submitted on a per member,
aggregate and/or categorical basis. [Data shall be  reported  separately
for  qualifying group health insurance contracts and qualifying individ-
ual health insurance contracts issued pursuant to section four  thousand
three hundred twenty-six of this article.]
  (g)  For [each] THE stop loss fund, the superintendent shall calculate
the total claims reimbursement amount for all health maintenance  organ-
izations,  corporations  or  insurers  for  the  calendar year for which
claims are being reported.
  (1) In the event that the total amount requested for reimbursement for
a calendar year exceeds funds available for distribution for claims paid
during that same calendar year, the superintendent shall provide for the
pro-rata distribution of the available funds.  Each  health  maintenance
organization,  corporation  or insurer shall be eligible to receive only
such proportionate amount of  the  available  funds  as  the  individual
health  maintenance  organization's,  corporation's  or  insurer's total

S. 2606                            110                           A. 3006

eligible claims paid bears to the total  eligible  claims  paid  by  all
health maintenance organizations, corporations or insurers.
  (2) In the event that funds available for distribution for claims paid
by all health maintenance organizations, corporations or insurers during
a  calendar year exceeds the total amount requested for reimbursement by
all health maintenance organizations, corporations  or  insurers  during
that  same  calendar year, any excess funds shall be carried forward and
made available for distribution in the next calendar year.  Such  excess
funds  shall be in addition to the monies appropriated for the stop loss
fund in the next calendar year.
  (h) Upon the request of the superintendent,  each  health  maintenance
organization  shall  be required to furnish such data as the superinten-
dent deems necessary to oversee the operation of the small employer [and
qualifying individual] stop  loss  [funds]  FUND.  Such  data  shall  be
furnished  in a form prescribed by the superintendent. Each health main-
tenance organization, corporation or insurer shall  provide  the  super-
intendent  with monthly reports of the total enrollment under the quali-
fying group health insurance contracts [and  the  qualifying  individual
health  insurance  contracts]  issued  pursuant to section four thousand
three hundred twenty-six of this article. The reports shall be in a form
prescribed by the superintendent.
  (i) The superintendent shall separately estimate the per member annual
cost of total claims reimbursement from each stop loss fund for  [quali-
fying  individual  health  insurance contracts and for] qualifying group
health insurance contracts based upon  available  data  and  appropriate
actuarial  assumptions.  Upon request, each health maintenance organiza-
tion, corporation or insurer shall furnish to the superintendent  claims
experience data for use in such estimations.
  (j) The superintendent shall determine total eligible enrollment under
qualifying  group  health insurance contracts [and qualifying individual
health insurance contracts].  [For  qualifying  group  health  insurance
contracts,  the]  THE  total  eligible enrollment shall be determined by
dividing the total funds  available  for  distribution  from  the  small
employer stop loss fund by the estimated per member annual cost of total
claims reimbursement from the small employer stop loss fund. [For quali-
fying  individual health insurance contracts, the total eligible enroll-
ment shall be determined by  dividing  the  total  funds  available  for
distribution  from the qualifying individual stop loss fund by the esti-
mated per member annual cost of  total  claims  reimbursement  from  the
qualifying individual stop loss fund.]
  (k)  The  superintendent shall suspend the enrollment of new employers
under qualifying group health insurance contracts  if  [he]  THE  SUPER-
INTENDENT  determines  that  the total enrollment reported by all health
maintenance organizations, corporations or insurers under such contracts
exceeds the total eligible enrollment, thereby resulting in  anticipated
annual  expenditures from the small employer stop loss fund in excess of
the total funds available for distribution from  such  stop  loss  fund.
[The  superintendent  shall  suspend  the  enrollment of new individuals
under qualifying individual health insurance contracts if he  determines
that  the  total enrollment reported by all health maintenance organiza-
tions, corporations or insurers under such contracts exceeds  the  total
eligible  enrollment,  thereby  resulting in anticipated annual expendi-
tures from the qualifying individual stop loss fund  in  excess  of  the
total funds available for distribution from such stop loss fund.]
  (l)  The superintendent shall provide the health maintenance organiza-
tions, corporations or insurers  with  notification  of  any  enrollment

S. 2606                            111                           A. 3006

suspensions as soon as practicable after receipt of all enrollment data.
[The superintendent's determination and notification shall be made sepa-
rately  for  the qualifying group health insurance contracts and for the
qualifying individual health insurance contracts.]
  (m)  If at any point during a suspension of enrollment of new qualify-
ing small employers [and/or qualifying individuals], the  superintendent
determines  that funds are sufficient to provide for the addition of new
enrollments, the superintendent shall be authorized  to  reactivate  new
enrollments  and  to notify all health maintenance organizations, corpo-
rations or insurers that enrollment of new  employers  [and/or  individ-
uals]  may  again  commence.  [The  superintendent's  determination  and
notification shall be made separately for the  qualifying  group  health
insurance  contracts  and for the qualifying individual health insurance
contracts.]
  (m-1) In the event that the superintendent suspends the enrollment  of
new  individuals  for  qualifying  group  health insurance contracts [or
qualifying individual health insurance  contracts],  the  superintendent
shall  ensure  that  small  employers  [or  sole proprietors] seeking to
enroll in a qualified group [or individual]  health  insurance  contract
pursuant  to  section forty-three hundred twenty-six of this article are
provided information on and directed to [the family health plus employer
partnership program under section three  hundred  sixty-nine-ff  of  the
social services law] COVERAGE OPTIONS AVAILABLE THROUGH THE HEALTH BENE-
FIT EXCHANGE ESTABLISHED PURSUANT TO SECTION 1311 OF THE AFFORDABLE CARE
ACT, 42 U.S.C. S 18031.
  (n)  The  suspension  of issuance of qualifying group health insurance
contracts to new qualifying small employers shall not preclude the addi-
tion of new employees of  an  employer  already  covered  under  such  a
contract  or  new  dependents  of  employees  already covered under such
contracts.
  (o) [The suspension of issuance of qualifying individual health insur-
ance contracts to new qualifying  individuals  shall  not  preclude  the
addition  of  new dependents to an existing qualifying individual health
insurance contract.
  (p)] The premiums for qualifying group health insurance contracts must
factor in the availability of reimbursement from the small employer stop
loss fund. [The premiums  for  qualifying  individual  health  insurance
contracts  must  factor  in  the  availability of reimbursement from the
qualifying individual stop loss funds.
  (q)] (P) The superintendent may obtain the services of an organization
to administer the stop loss funds established by this section.  [If  the
superintendent  deems  it  appropriate, he or she may utilize a separate
organization for administration of the small employer stop loss fund and
the qualifying individual stop  loss  fund.]  The  superintendent  shall
establish  guidelines  for  the submission of proposals by organizations
for the purposes of administering the funds.  The  superintendent  shall
make a determination whether to approve, disapprove or recommend modifi-
cation  to  the  proposal  of  an  applicant to administer the funds. An
organization approved to administer the funds shall  submit  reports  to
the  superintendent  in such form and at times as may be required by the
superintendent in order to  facilitate  evaluation  and  ensure  orderly
operation  of  the  funds,  including[,  but  not limited to,] an annual
report of the affairs and operations of the  fund,  such  report  to  be
delivered  to the superintendent and to the chairs of the senate finance
committee and the assembly ways and  means  committee.  An  organization
approved  to  administer  the  funds  shall  maintain  records in a form

S. 2606                            112                           A. 3006

prescribed by the  superintendent  and  which  shall  be  available  for
inspection  by  or at the request of the superintendent. The superinten-
dent shall determine the amount of compensation to be  allocated  to  an
approved  organization  as payment for fund administration. Compensation
shall be payable from the stop  loss  coverage  funds.  An  organization
approved  to  administer  the funds may be removed by the superintendent
and must cooperate in the orderly  transition  of  services  to  another
approved organization or to the superintendent.
  [(r)]  (Q)  If  the superintendent deems it appropriate for the proper
administration of the small employer stop loss fund [and/or the qualify-
ing individual stop loss fund], the administrator of the fund, on behalf
of and with the prior approval of the superintendent, shall  be  author-
ized  to  purchase stop loss insurance and/or reinsurance from an insur-
ance company licensed to write such type of  insurance  in  this  state.
Such  stop  loss  insurance  and/or  reinsurance may be purchased to the
extent of funds available therefor within such funds which are available
for purposes of the stop loss funds established by this section.
  [(s)] (R) The superintendent may access funding from the small employ-
er stop loss fund [and/or the qualifying individual stop loss fund]  for
the  purposes  of developing and implementing public education, outreach
and facilitated enrollment strategies targeted to small  employers  [and
working   adults]  without  health  insurance.  The  superintendent  may
contract with marketing organizations to perform or  provide  assistance
with  such  education,  outreach,  and enrollment strategies. The super-
intendent shall determine  the  amount  of  funding  available  for  the
purposes of this subsection which in no event shall exceed eight percent
of the annual funding amounts for the small employer stop loss fund [and
the qualifying individual stop loss fund].
  [(t)]  (S) Brooklyn healthworks pilot program [and upstate healthworks
pilot program]. Commencing on July first, two thousand six,  the  super-
intendent  shall  access  funding from the small employer stop loss fund
[and the qualifying individual  stop  loss  fund]  for  the  purpose  of
support and expansion of the existing pilot program Brooklyn healthworks
approved  by the superintendent [and for the establishment and operation
of a pilot program to be located in upstate New York]. For  the  purpose
of  this  subsection,  in no event shall the amount of funding available
exceed [two] ONE percent of the annual funding [amounts] AMOUNT for  the
small  employer  stop loss fund [and the qualifying individual stop loss
fund].
  S 59. Paragraph 1 of subsection (d) of section 4235 of  the  insurance
law is amended to read as follows:
  (1) In this section, for the purpose of insurance OTHER THAN FOR GROUP
HOSPITAL,  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPES OF
EXPENSE REIMBURSED INSURANCE hereunder:  "employees" includes the  offi-
cers,  managers,  employees and retired employees of the employer and of
subsidiary or affiliated corporations of a corporate employer,  and  the
individual  proprietors,  partners,  employees  and retired employees of
affiliated individuals and firms  controlled  by  the  insured  employer
through  stock  ownership,  contract  or  otherwise;  "employees" may be
deemed to include the individual proprietor or partners if the  employer
is an individual proprietor or a partnership; and "employees" as used in
subparagraph  (A)  of  paragraph  one  of subsection (c) hereof may also
include the directors of the employer and of  subsidiary  or  affiliated
corporations of a corporate employer.
  S  60.  Subsection (d) of section 4235 of the insurance law is amended
by adding a new paragraph 3 to read as follows:

S. 2606                            113                           A. 3006

  (3) IN THIS SECTION, FOR THE PURPOSE OF GROUP HOSPITAL, MEDICAL, MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPES OF EXPENSE  REIMBURSED  INSURANCE
HEREUNDER:
  (A) "EMPLOYEE" SHALL HAVE THE MEANING SET FORTH IN SECTION 2791 OF THE
PUBLIC HEALTH SERVICE ACT, 42 U.S.C. S 300GG-91(D)(5) OR ANY REGULATIONS
PROMULGATED THEREUNDER; AND
  (B)  "FULL-TIME EMPLOYEE" MEANS WITH RESPECT TO ANY MONTH, AN EMPLOYEE
WHO IS EMPLOYED ON AVERAGE FOR AT LEAST THIRTY HOURS OF SERVICE PER WEEK
AS SET FORTH IN SECTION 4980H(C)(4) OF THE  INTERNAL  REVENUE  CODE,  26
U.S.C. S 4980H(C)(4), OR ANY REGULATIONS PROMULGATED THEREUNDER.
  S  61.  Subparagraph  (B)  of paragraph 1 of subsection (e) of section
3231 of the insurance law, as amended by chapter  107  of  the  laws  of
2010, is amended to read as follows:
  (B)  The expected minimum loss ratio for a policy form subject to this
section, for which a rate filing or application is made pursuant to this
paragraph, other than a medicare supplemental insurance policy, or, with
the approval of the superintendent, an aggregation of policy forms  that
are  combined  into  one  community  rating  experience  pool  and rated
consistent with community rating requirements, shall not  be  less  than
eighty-two  percent.  In  reviewing  a  rate  filing or application, the
superintendent may modify the eighty-two percent expected  minimum  loss
ratio  requirement  if the superintendent determines the modification to
be in the interests of the people of this state or if the superintendent
determines that a modification is necessary to maintain insurer  solven-
cy.  No  later  than  [June thirtieth] AUGUST THIRTY-FIRST of each year,
every insurer subject to this subparagraph  shall  annually  report  the
actual  loss ratio for the previous calendar year in a format acceptable
to the superintendent. If an expected loss ratio is not met, the  super-
intendent  may  direct  the insurer to take corrective action, which may
include the submission of a rate filing to reduce future premiums, or to
issue dividends, premium refunds  or  credits,  or  any  combination  of
these.
  S  62.  Subparagraph  (A)  of paragraph 3 of subsection (c) of section
4308 of the insurance law, as added by chapter 107 of the laws of  2010,
is amended to read as follows:
  (A)  The  expected  minimum  loss ratio for a contract form subject to
this subsection for which a rate filing or application is made  pursuant
to   this  paragraph,  other  than  a  medicare  supplemental  insurance
contract, or, with the approval of the superintendent, an aggregation of
contract forms that are combined into one  community  rating  experience
pool  and rated consistent with community rating requirements, shall not
be less than eighty-two percent. In reviewing a rate filing or  applica-
tion,  the  superintendent  may  modify  the eighty-two percent expected
minimum loss ratio requirement  if  the  superintendent  determines  the
modification  to  be  in the interests of the people of this state or if
the superintendent determines that a modification is necessary to  main-
tain   insurer   solvency.   No   later  than  [June  thirtieth]  AUGUST
THIRTY-FIRST of each year, every corporation subject  to  this  subpara-
graph  shall  annually  report  the  actual  loss ratio for the previous
calendar year in a  format  acceptable  to  the  superintendent.  If  an
expected loss ratio is not met, the superintendent may direct the corpo-
ration  to take corrective action, which may include the submission of a
rate filing to reduce future premiums, or to  issue  dividends,  premium
refunds or credits, or any combination of these.
  S  63.  Section  3233  of the insurance law is amended by adding a new
subsection (d) to read as follows:

S. 2606                            114                           A. 3006

  (D) NOTWITHSTANDING ANY PROVISION OF THIS CHAPTER OR ANY  OTHER  CHAP-
TER,  THE  SUPERINTENDENT  MAY  SUSPEND OR TERMINATE, BY REGULATION, THE
OPERATION, IN WHOLE OR IN PART, OF ANY MECHANISM ESTABLISHED AND OPERAT-
ING PURSUANT TO THE AUTHORITY OF THIS SECTION PROVIDED THAT  THE  SUPER-
INTENDENT  DETERMINES  THAT  THE  OBJECTIVES STATED IN SUBSECTION (A) OF
THIS SECTION ARE MET BY THE  OPERATION  OF  A  MECHANISM  OR  MECHANISMS
ESTABLISHED  BY  THE  FEDERAL GOVERNMENT PURSUANT TO SECTION 1343 OF THE
AFFORDABLE CARE ACT, 42 U.S.C. S 18063. NOTWITHSTANDING  SUBSECTION  (B)
OF  THIS SECTION, THE SUPERINTENDENT MAY EXERCISE THIS AUTHORITY WITHOUT
CONVENING A TECHNICAL ADVISORY COMMITTEE.
  S 64. Subparagraph (D) of paragraph 2 of  subsection  (p)  of  section
3221  of the insurance law, as added by chapter 661 of the laws of 1997,
is amended to read as follows:
  (D) The insurer is ceasing to offer group or  blanket  policies  in  a
market in accordance with paragraph three OR SEVEN of this subsection.
  S  65.  Subsection (p) of section 3221 of the insurance law is amended
by adding a new paragraph 7 to read as follows:
  (7) AN INSURER MAY DISCONTINUE OFFERING A PARTICULAR CLASS OF GROUP OR
BLANKET POLICY  OF  HOSPITAL,  SURGICAL  OR  MEDICAL  EXPENSE  INSURANCE
OFFERED IN THE SMALL OR LARGE GROUP MARKET, AND INSTEAD OFFER A GROUP OR
BLANKET  POLICY  OF HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE THAT
COMPLIES WITH THE REQUIREMENTS OF SECTION  2707  OF  THE  PUBLIC  HEALTH
SERVICE  ACT,  S 42 U.S.C. 300GG-6 THAT BECOME APPLICABLE TO SUCH POLICY
AS OF JANUARY FIRST, TWO THOUSAND FOURTEEN, PROVIDED THAT THE INSURER:
  (A) DISCONTINUES THE EXISTING CLASS OF POLICY IN  SUCH  MARKET  AS  OF
EITHER  DECEMBER  THIRTY-FIRST,  TWO  THOUSAND  THIRTEEN  OR  THE POLICY
RENEWAL DATE OCCURRING IN TWO THOUSAND FOURTEEN IN ACCORDANCE WITH  THIS
CHAPTER;
  (B)  PROVIDES WRITTEN NOTICE TO EACH POLICYHOLDER PROVIDED COVERAGE OF
THE CLASS IN THE MARKET  (AND  TO  ALL  EMPLOYEES  AND  MEMBER  INSUREDS
COVERED  UNDER SUCH COVERAGE) OF THE DISCONTINUANCE AT LEAST NINETY DAYS
PRIOR TO THE DATE OF DISCONTINUANCE OF SUCH COVERAGE. THE WRITTEN NOTICE
SHALL BE IN A FORM SATISFACTORY TO THE SUPERINTENDENT;
  (C) OFFERS TO EACH POLICYHOLDER PROVIDED COVERAGE OF THE CLASS IN  THE
MARKET,  THE  OPTION TO PURCHASE ALL (OR, IN THE CASE OF THE LARGE GROUP
MARKET, ANY) OTHER HOSPITAL, SURGICAL AND MEDICAL EXPENSE COVERAGE  THAT
COMPLIES  WITH  THE  REQUIREMENTS  OF  SECTION 2707 OF THE PUBLIC HEALTH
SERVICE ACT, 42 U.S.C. S 300GG-6 THAT BECOME APPLICABLE TO SUCH COVERAGE
AS OF JANUARY FIRST, TWO THOUSAND FOURTEEN, CURRENTLY BEING  OFFERED  BY
THE INSURER TO A GROUP IN THAT MARKET;
  (D)  IN EXERCISING THE OPTION TO DISCONTINUE COVERAGE OF THE CLASS AND
IN OFFERING THE OPTION OF COVERAGE UNDER SUBPARAGRAPH (C) OF THIS  PARA-
GRAPH,  ACTS  UNIFORMLY WITHOUT REGARD TO THE CLAIMS EXPERIENCE OF THOSE
POLICYHOLDERS OR  ANY  HEALTH  STATUS-RELATED  FACTOR  RELATING  TO  ANY
PARTICULAR  COVERED EMPLOYEE, MEMBER INSURED OR DEPENDENT, OR PARTICULAR
NEW EMPLOYEE, MEMBER INSURED, OR DEPENDENT WHO MAY BECOME  ELIGIBLE  FOR
SUCH  COVERAGE,  AND DOES NOT DISCONTINUE THE COVERAGE OF THE CLASS WITH
THE INTENT OR AS A PRETEXT TO DISCONTINUING THE  COVERAGE  OF  ANY  SUCH
EMPLOYEE, MEMBER INSURED, OR DEPENDENT; AND
  (E)  AT LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE DATE OF THE DISCON-
TINUANCE OF SUCH COVERAGE, PROVIDES WRITTEN NOTICE TO THE SUPERINTENDENT
OF THE DISCONTINUANCE, INCLUDING CERTIFICATION BY AN OFFICER OR DIRECTOR
OF THE INSURER THAT: (I) THE REASON FOR THE DISCONTINUANCE IS TO REPLACE
THE COVERAGE WITH NEW COVERAGE THAT COMPLIES WITH  THE  REQUIREMENTS  OF
SECTION  2707 OF THE PUBLIC HEALTH SERVICE ACT, S 42 U.S.C. 300GG-6 THAT
BECOME EFFECTIVE JANUARY FIRST, TWO  THOUSAND  FOURTEEN;  AND  (II)  THE

S. 2606                            115                           A. 3006

REPLACEMENT COVERAGE OFFERED IN ACCORDANCE WITH SUBPARAGRAPH (C) OF THIS
PARAGRAPH  WILL  NOT  RESULT  IN A LOSS OF ANY BENEFIT COVERED UNDER THE
DISCONTINUED POLICY. FOR PURPOSES OF THIS SUBPARAGRAPH, A CHANGE IN COST
SHARING  SHALL  NOT  CONSTITUTE  A LOSS OF A BENEFIT. THE WRITTEN NOTICE
SHALL BE IN SUCH FORM AND CONTAIN SUCH  INFORMATION  THE  SUPERINTENDENT
REQUIRES.
  S  66. Item (iii) of subparagraph (C) of paragraph 2 of subsection (c)
of section 4304 of the insurance law, as amended by chapter 661  of  the
laws of 1997, is amended to read as follows:
  (iii)  Discontinuance  of all individual hospital, surgical or medical
expense insurance contracts for which the premiums are paid by a  remit-
ting  agent  of  a  group, in the small group market, or the large group
market, or both markets, in this state, in conjunction with a withdrawal
from the small group market, or the large group market, or both markets,
in this state. Withdrawal from the small  group  market,  or  the  large
group  market, or both markets, shall be governed by the requirements of
subparagraphs [(B)] (E) and [(C)] (F) of paragraph three  of  subsection
(j)  of  section  four  thousand three hundred five of this article. For
purposes of this item, "withdrawal" from a market means that no coverage
is offered or maintained in such market under contracts issued  pursuant
to  this  section  or contracts issued pursuant to section four thousand
three hundred five of this article.
  S 67. Subparagraph (D) of paragraph 2 of  subsection  (j)  of  section
4305  of the insurance law, as added by chapter 661 of the laws of 1997,
is amended to read as follows:
  (D) The corporation is ceasing to offer group or blanket contracts  in
a  market  in  accordance  with paragraph three OR PARAGRAPH SIX of this
subsection.
  S 68. Subsection (j) of section 4305 of the insurance law  is  amended
by adding a new paragraph 6 to read as follows:
  (6) A CORPORATION MAY DISCONTINUE OFFERING A PARTICULAR CLASS OF GROUP
OR  BLANKET  CONTRACT OF HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE
OFFERED IN THE SMALL OR LARGE GROUP MARKET, AND INSTEAD OFFER A GROUP OR
BLANKET CONTRACT OF HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE THAT
COMPLIES WITH THE REQUIREMENTS OF SECTION  2707  OF  THE  PUBLIC  HEALTH
SERVICE ACT, 42 U.S.C. S 300GG-6 THAT BECOME APPLICABLE TO SUCH CONTRACT
AS  OF  JANUARY  FIRST,  TWO THOUSAND FOURTEEN, PROVIDED THAT THE CORPO-
RATION:
  (A) DISCONTINUES THE EXISTING CLASS OF CONTRACT IN SUCH MARKET  AS  OF
EITHER  DECEMBER  THIRTY-FIRST,  TWO  THOUSAND  THIRTEEN OR THE CONTRACT
RENEWAL DATE OCCURRING IN TWO THOUSAND FOURTEEN IN ACCORDANCE WITH  THIS
CHAPTER;
  (B)  PROVIDES WRITTEN NOTICE TO EACH CONTRACT HOLDER PROVIDED COVERAGE
OF THE CLASS IN THE MARKET (AND TO ALL  EMPLOYEES  AND  MEMBER  INSUREDS
COVERED  UNDER SUCH COVERAGE) OF THE DISCONTINUANCE AT LEAST NINETY DAYS
PRIOR TO THE DATE OF DISCONTINUANCE OF SUCH COVERAGE. THE WRITTEN NOTICE
SHALL BE IN A FORM SATISFACTORY TO THE SUPERINTENDENT;
  (C) OFFERS TO EACH CONTRACT HOLDER PROVIDED COVERAGE OF THE  CLASS  IN
THE  MARKET,  THE  OPTION  TO PURCHASE ALL (OR, IN THE CASE OF THE LARGE
GROUP MARKET, ANY) OTHER HOSPITAL, SURGICAL AND MEDICAL EXPENSE COVERAGE
THAT COMPLIES WITH THE REQUIREMENTS OF SECTION 2707 OF THE PUBLIC HEALTH
SERVICE ACT, 42 U.S.C. S 300GG-6 THAT BECOME APPLICABLE TO SUCH COVERAGE
AS OF JANUARY FIRST, TWO THOUSAND FOURTEEN, CURRENTLY BEING  OFFERED  BY
THE CORPORATION TO A GROUP IN THAT MARKET;
  (D)  IN EXERCISING THE OPTION TO DISCONTINUE COVERAGE OF THE CLASS AND
IN OFFERING THE OPTION OF COVERAGE UNDER SUBPARAGRAPH (C) OF THIS  PARA-

S. 2606                            116                           A. 3006

GRAPH,  ACTS UNIFORMLY WITHOUT REGARD TO THE CLAIMS  EXPERIENCE OF THOSE
CONTRACT HOLDERS OR ANY HEALTH STATUS-RELATED  FACTOR  RELATING  TO  ANY
PARTICULAR  COVERED EMPLOYEE, MEMBER INSURED OR DEPENDENT, OR PARTICULAR
NEW  EMPLOYEE,  MEMBER INSURED, OR DEPENDENT WHO MAY BECOME ELIGIBLE FOR
SUCH COVERAGE, AND DOES NOT DISCONTINUE THE COVERAGE OF THE  CLASS  WITH
THE  INTENT  OR  AS  A PRETEXT TO DISCONTINUING THE COVERAGE OF ANY SUCH
EMPLOYEE, MEMBER INSURED, OR DEPENDENT; AND
  (E) AT LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE DATE OF THE  DISCON-
TINUANCE OF SUCH COVERAGE, PROVIDES WRITTEN NOTICE TO THE SUPERINTENDENT
OF THE DISCONTINUANCE, INCLUDING CERTIFICATION BY AN OFFICER OR DIRECTOR
OF  THE  CORPORATION  THAT:  (I) THE REASON FOR THE DISCONTINUANCE IS TO
REPLACE THE COVERAGE WITH NEW COVERAGE THAT COMPLIES WITH  THE  REQUIRE-
MENTS  OF  SECTION  2707  OF THE PUBLIC HEALTH SERVICE ACT, 42  U.S.C. S
300GG-6 THAT BECOME EFFECTIVE JANUARY FIRST, TWO THOUSAND FOURTEEN;  AND
(II)  THE  REPLACEMENT  COVERAGE OFFERED IN ACCORDANCE WITH SUBPARAGRAPH
(C) OF THIS PARAGRAPH WILL NOT RESULT IN A LOSS OF ANY  BENEFIT  COVERED
UNDER  THE  DISCONTINUED  CONTRACT. FOR PURPOSES OF THIS SUBPARAGRAPH, A
CHANGE IN COST SHARING SHALL NOT CONSTITUTE A LOSS  OF  A  BENEFIT.  THE
WRITTEN  NOTICE  SHALL  BE IN SUCH FORM AND CONTAIN SUCH INFORMATION THE
SUPERINTENDENT REQUIRES.
  S 69. Subsections (a), (b) and (c) of section 3231  of  the  insurance
law,  subsection  (a)  as  amended  by  chapter 661 of the laws of 1997,
subsection (b) as amended by chapter 557 of the laws of 2002, subsection
(c) as added by chapter 501 of the laws of 1992, are amended to read  as
follows:
  (a)  (1)  No  individual  health  insurance policy and no group health
insurance policy covering between  [two]  ONE  and  fifty  employees  or
members of the group OR BETWEEN ONE AND ONE HUNDRED EMPLOYEES OR MEMBERS
OF  THE  GROUP FOR POLICIES ISSUED OR RENEWED ON OR AFTER JANUARY FIRST,
TWO THOUSAND SIXTEEN exclusive of spouses  and  dependents,  hereinafter
referred  to  as  a small group, providing hospital and/or medical bene-
fits, including medicare supplemental insurance, shall be issued in this
state unless such policy is community  rated  and,  notwithstanding  any
other  provisions  of  law,  the underwriting of such policy involves no
more than the imposition of a pre-existing condition limitation [as]  IF
OTHERWISE  permitted by this article. (2) Any individual, and dependents
of such individual, and any small  group,  including  all  employees  or
group members and dependents of employees or members, applying for indi-
vidual health insurance coverage, including medicare supplemental cover-
age,  [or  small  group  health  insurance  coverage, including medicare
supplemental insurance,]  OR  SMALL  GROUP  HEALTH  INSURANCE  COVERAGE,
INCLUDING  MEDICARE  SUPPLEMENTAL  INSURANCE, BUT NOT INCLUDING COVERAGE
SPECIFIED IN SUBSECTION  (L)  OF  SECTION  THREE  THOUSAND  TWO  HUNDRED
SIXTEEN,  SUBSECTION  (1)  OF  SECTION FOUR THOUSAND THREE HUNDRED FOUR,
SECTION FOUR THOUSAND THREE HUNDRED TWENTY-ONE,  SECTION  FOUR  THOUSAND
THREE  HUNDRED  TWENTY-TWO AND SECTION FOUR THOUSAND THREE HUNDRED TWEN-
TY-EIGHT OF THIS CHAPTER must be accepted at all  times  throughout  the
year  for any hospital and/or medical coverage offered by the insurer to
individuals or small groups in this state. (3) Once accepted for  cover-
age,  an  individual  or small group cannot be terminated by the insurer
due to claims experience. Termination of an individual  or  small  group
shall  be  based  only  on  one  or  more  of  the  reasons set forth in
subsection  (g)  of  section  three  thousand  two  hundred  sixteen  or
subsection  (p) of section three thousand two hundred twenty-one of this
article. Group hospital  and/or  medical  coverage,  including  medicare
supplemental  insurance, obtained through an out-of-state trust covering

S. 2606                            117                           A. 3006

a group of fifty or fewer employees or  participating  persons  who  are
residents  of this state must be community rated regardless of the situs
of delivery of the policy. Notwithstanding any other provisions of  law,
the  underwriting of such policy may involve no more than the imposition
of a pre-existing condition limitation as permitted by this article, and
once accepted for coverage, an  individual  or  small  group  cannot  be
terminated  due  to  claims  experience. Termination of an individual or
small group shall be based only on one or more of the reasons set  forth
in  subsection  (p)  of section three thousand two hundred twenty-one of
this article.  (4) For the purposes of this section,  "community  rated"
means  a rating methodology in which the premium for all persons covered
by a policy [or contract] form is the same based on  the  experience  of
the  entire  pool  of risks [covered by that policy or contract form] OF
ALL INDIVIDUALS OR SMALL GROUPS COVERED BY THE INSURER without regard to
age, sex, health status, TOBACCO USAGE or  occupation,  EXCLUDING  THOSE
COVERED  BY  MEDICARE SUPPLEMENTAL INSURANCE. CATASTROPHIC HEALTH INSUR-
ANCE POLICIES ISSUED PURSUANT TO SECTION 1302(E) OF THE AFFORDABLE  CARE
ACT,  42  U.S.C. S 18022(E), SHALL BE CLASSIFIED IN A DISTINCT COMMUNITY
RATING POOL.
  (b) [Nothing herein shall prohibit the use of premium rate  structures
to establish different premium rates for individuals as opposed to fami-
ly units or] (1) THE SUPERINTENDENT SHALL SET STANDARD PREMIUM TIERS AND
STANDARD  RATING  RELATIVITIES  BETWEEN TIERS APPLICABLE TO ALL POLICIES
SUBJECT TO THIS SECTION. THE SUPERINTENDENT SHALL SET A  STANDARD  RELA-
TIVITY  APPLICABLE  TO  CHILD-ONLY  POLICIES  ISSUED PURSUANT TO SECTION
1302(F) OF THE AFFORDABLE CARE ACT, 42 U.S.C.  S 18022(F). THE RELATIVI-
TY FOR CHILD-ONLY POLICIES SHALL BE ACTUARIALLY  JUSTIFIABLE  USING  THE
AGGREGATE  EXPERIENCE OF INSURERS TO PREVENT THE CHARGING OF UNJUSTIFIED
PREMIUMS. THE SUPERINTENDENT MAY ADJUST SUCH PREMIUM TIERS AND RELATIVI-
TIES PERIODICALLY BASED UPON THE AGGREGATE EXPERIENCE OF INSURERS  ISSU-
ING POLICY FORMS SUBJECT TO THIS SECTION. (2) AN INSURER SHALL ESTABLISH
separate community rates for individuals as opposed to small groups. (3)
If  an  insurer  is  required to issue a [contract] POLICY to individual
proprietors pursuant to subsection (i)  of  this  section,  such  policy
shall be subject to subsection (a) of this section.
  (c)  (1) The superintendent shall permit the use of separate community
rates for reasonable geographic regions, which may,  in  a  given  case,
include  a  single  county.  The regions shall be approved by the super-
intendent as part of the  rate  filing.  The  superintendent  shall  not
require  the  inclusion  of  any  specific geographic regions within the
proposed community rated regions selected by the  insurer  in  its  rate
filing  so long as the insurer's proposed regions do not contain config-
urations designed to avoid or segregate particular areas within a county
covered by the insurer's community rates.    (2)  BEGINNING  ON  JANUARY
FIRST,  TWO  THOUSAND FOURTEEN, FOR EVERY POLICY SUBJECT TO THIS SECTION
THAT PROVIDES PHYSICIAN SERVICES,  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
COMPREHENSIVE-TYPE  COVERAGE,  EXCEPT  FOR  MEDICARE  SUPPLEMENT  PLANS,
INSURERS SHALL USE STANDARDIZED REGIONS ESTABLISHED BY  THE  SUPERINTEN-
DENT.
  S 70. Subsection (g) of section 3231 of the insurance law, as added by
chapter 501 of the laws of 1992, is amended to read as follows:
  (g)  (1)  This  section shall also apply to policies issued to a group
defined in subsection (c) of section four thousand two  hundred  thirty-
five, including but not limited to an association or trust of employers,
if  the  group  includes  one  or  more member employers or other member
groups which have fifty or  fewer  employees  or  members  exclusive  of

S. 2606                            118                           A. 3006

spouses  and  dependents.    FOR  POLICIES ISSUED OR RENEWED ON OR AFTER
JANUARY FIRST, TWO THOUSAND FOURTEEN, IF THE GROUP INCLUDES ONE OR  MORE
MEMBER EMPLOYERS OR OTHER MEMBER GROUPS ELIGIBLE FOR COVERAGE SUBJECT TO
THIS  SECTION,  THEN  SUCH  MEMBER  GROUPS  SHALL BE CLASSIFIED AS SMALL
GROUPS FOR RATING PURPOSES AND THE  REMAINING  MEMBERS  SHALL  BE  RATED
CONSISTENT  WITH  THE  RATING RULES APPLICABLE TO SUCH REMAINING MEMBERS
PURSUANT TO THIS SECTION.
  (2) IF A POLICY IS ISSUED TO A GROUP  DEFINED  IN  SUBSECTION  (C)  OF
SECTION FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER, INCLUDING
AN ASSOCIATION GROUP, THAT INCLUDES ONE OR MORE INDIVIDUAL OR INDIVIDUAL
PROPRIETOR  MEMBERS,  FOR RATING PURPOSES THE INSURER SHALL INCLUDE SUCH
MEMBERS IN ITS INDIVIDUAL POOL OF RISKS IN  ESTABLISHING  PREMIUM  RATES
FOR SUCH MEMBERS.
  (3)   NOTWITHSTANDING   SUBDIVISION   FIVE  OF  SECTION  NINE  HUNDRED
TWENTY-TWO OF THE LABOR LAW, IF A POLICY ISSUED TO A  GROUP  THAT  IS  A
PROFESSIONAL  EMPLOYER  ORGANIZATION  AS DEFINED IN SECTION NINE HUNDRED
SIXTEEN OF THE LABOR LAW, INCLUDES  ONE  OR  MORE  SMALL  GROUP  MEMBERS
ELIGIBLE FOR COVERAGE SUBJECT TO THIS SECTION, THE INSURER SHALL INCLUDE
SUCH  EMPLOYER  MEMBERS IN ITS SMALL GROUP POOL OF RISKS IN ESTABLISHING
PREMIUM RATES FOR SUCH MEMBERS.
  S 71. Paragraph 2 of subsection (i) of section 3231 of  the  insurance
law,  as  amended by chapter 183 of the laws of 2011, is amended to read
as follows:
  (2) For coverage purchased pursuant to this subsection, THROUGH DECEM-
BER THIRTY-FIRST, TWO THOUSAND THIRTEEN, individual proprietors shall be
classified in their own community rating category, provided however,  up
to   and   including  December  thirty-first,  two  thousand  [fourteen]
THIRTEEN,  the  premium  rate  established  for  individual  proprietors
purchased  pursuant  to  paragraph  one  of this subsection shall not be
greater than one hundred fifteen percent of the rate established for the
same coverage issued to groups.  COVERAGE PURCHASED OR IN EFFECT  PURSU-
ANT  TO THIS SUBSECTION ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN
SHALL BE CLASSIFIED IN THE INDIVIDUAL RATING CATEGORY.
  S 72. Section 4317 of the insurance law, as added by  chapter  501  of
the  laws  of 1992, subsection (a) as amended by chapter 661 of the laws
of 1997, subsection (b) as amended and subsection (f) as added by  chap-
ter  557  of the laws of 2002, subsection (d) as amended by section 2 of
part A of chapter 494 of the laws of 2009, paragraph 2 of subsection (f)
as amended by chapter 183 of the laws of 2011, is  amended  to  read  as
follows:
  S  4317.  Rating  of  individual  and  small  group  health  insurance
contracts.  (a) (1) No individual health insurance contract and no group
health insurance contract covering between [two] ONE and fifty employees
or members of the group, OR BETWEEN ONE AND  ONE  HUNDRED  EMPLOYEES  OR
MEMBERS  OF THE GROUP FOR POLICIES ISSUED OR RENEWED ON OR AFTER JANUARY
FIRST, TWO THOUSAND SIXTEEN exclusive of spouses and dependents, includ-
ing contracts for which the premiums are paid by a remitting agent for a
group, hereinafter referred to as  a  small  group,  providing  hospital
and/or  medical  benefits,  including  Medicare  supplemental insurance,
shall be issued in this state unless such contract  is  community  rated
and,  notwithstanding  any  other provisions of law, the underwriting of
such contract involves no more than the  imposition  of  a  pre-existing
condition  limitation  [as]  IF OTHERWISE permitted by this article. (2)
Any individual, and dependents of such individual, and any small  group,
including  all employees or group members and dependents of employees or
members, applying for individual or small group health insurance  cover-

S. 2606                            119                           A. 3006

age OR SMALL GROUP HEALTH INSURANCE COVERAGE, INCLUDING MEDICARE SUPPLE-
MENTAL INSURANCE, BUT NOT INCLUDING COVERAGE SPECIFIED IN SUBSECTION (1)
OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, SUBSECTION (L) OF SECTION
FOUR  THOUSAND  THREE  HUNDRED FOUR, SECTION FOUR THOUSAND THREE HUNDRED
TWENTY-ONE, SECTION FOUR THOUSAND THREE HUNDRED TWENTY-TWO  AND  SECTION
FOUR  THOUSAND THREE HUNDRED TWENTY-EIGHT OF THIS CHAPTER, AND INCLUDING
COVERAGE THAT IS OFFERED WITHIN THE HEALTH BENEFIT EXCHANGE  ESTABLISHED
PURSUANT  TO  SECTION 1311 OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18031
AND ANY REGULATIONS PROMULGATED THEREUNDER,  must  be  accepted  at  all
times  throughout  the  year  for any hospital and/or medical coverage[,
including Medicare supplemental insurance,] offered by  the  corporation
to  individuals  or  small  groups in this state.  (3) Once accepted for
coverage, an individual or small  group  cannot  be  terminated  by  the
insurer  due  to claims experience. Termination of coverage for individ-
uals or small groups may be based only on one or more of the reasons set
forth in subsection (c) of section four thousand three hundred  four  or
subsection (j) of section four thousand three hundred five of this arti-
cle.  (4)  For  the  purposes of this section, "community rated" means a
rating methodology in which the premium for all  persons  covered  by  a
policy  or  contract  form  is  the same, based on the experience of the
entire pool of risks [covered by that policy or contract  form]  OF  ALL
INDIVIDUALS OR SMALL GROUPS COVERED BY THE CORPORATION without regard to
age,  sex,  health  status,  TOBACCO USAGE or occupation EXCLUDING THOSE
INDIVIDUALS COVERED BY  MEDICARE  SUPPLEMENTAL  INSURANCE.  CATASTROPHIC
HEALTH  INSURANCE  CONTRACTS  ISSUED  PURSUANT TO SECTION 1302(E) OF THE
AFFORDABLE CARE ACT, 42 U.S.C. S 18022(E),  SHALL  BE  CLASSIFIED  IN  A
DISTINCT COMMUNITY RATING POOL.
  (b)  [Nothing herein shall prohibit the use of premium rate structures
to establish different premium rates for individuals as opposed to fami-
ly units or] (1) THE SUPERINTENDENT SHALL SET STANDARD PREMIUM TIERS AND
STANDARD RATING RELATIVITIES BETWEEN TIERS APPLICABLE TO  ALL  CONTRACTS
SUBJECT  TO  THIS  SECTION. THE SUPERINTENDENT SHALL ALSO SET A STANDARD
RELATIVITY APPLICABLE TO CHILD-ONLY CONTRACTS ISSUED PURSUANT TO SECTION
1302(F) OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(F).  THE RELATIVI-
TY FOR CHILD-ONLY CONTRACTS MUST BE ACTUARIALLY  JUSTIFIABLE  USING  THE
AGGREGATE EXPERIENCE OF CORPORATIONS TO PREVENT THE CHARGING OF UNJUSTI-
FIED  PREMIUMS.    THE  SUPERINTENDENT MAY ADJUST SUCH PREMIUM TIERS AND
RELATIVITIES PERIODICALLY BASED UPON THE AGGREGATE EXPERIENCE OF  CORPO-
RATIONS  ISSUING  CONTRACT  FORMS SUBJECT TO THIS SECTION.  (2) A CORPO-
RATION SHALL ESTABLISH  separate  community  rates  for  individuals  as
opposed  to  small  groups.  (3) If a corporation is required to issue a
contract to individual proprietors pursuant to subsection  (f)  of  this
section,   such  contract  shall  be  subject  to  the  requirements  of
subsection (a) of this section.
  (c) (1) The superintendent shall permit the use of separate  community
rates  for  reasonable  geographic  regions, which may, in a given case,
include a single county. The regions shall be  approved  by  the  super-
intendent  as  part  of  the  rate  filing. The superintendent shall not
require the inclusion of any  specific  geographic  regions  within  the
proposed community rated regions selected by the corporation in its rate
filing  so  long  as  the  corporation's proposed regions do not contain
configurations designed to avoid or segregate particular areas within  a
county  covered  by the corporation's community rates.  (2) BEGINNING ON
JANUARY FIRST, TWO THOUSAND FOURTEEN, FOR EVERY CONTRACT SUBJECT TO THIS
SECTION THAT PROVIDES PHYSICIAN  SERVICES,  MEDICAL,  MAJOR  MEDICAL  OR
SIMILAR  COMPREHENSIVE-TYPE  COVERAGE,  EXCEPT FOR MEDICARE SUPPLEMENTAL

S. 2606                            120                           A. 3006

INSURANCE, CORPORATIONS SHALL USE STANDARDIZED  REGIONS  ESTABLISHED  BY
THE SUPERINTENDENT.
  (d) (1) [This] FOR POLICIES ISSUED ON OR BEFORE DECEMBER THIRTY-FIRST,
TWO  THOUSAND  THIRTEEN,  THIS section shall also apply to [contracts] A
CONTRACT issued to a group defined in subsection  (c)  of  section  four
thousand  two  hundred  thirty-five  of this chapter, including [but not
limited] to an association or trust of employers, if the group  includes
one or more member employers or other member groups [which have fifty or
fewer  employees  or  members exclusive of spouses and dependents.] THAT
WOULD BE SUBJECT TO THIS SUBSECTION. FOR CONTRACTS ISSUED OR RENEWED  ON
OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, IF THE GROUP INCLUDES ONE
OR MORE MEMBER EMPLOYERS OR OTHER MEMBER GROUPS THAT HAVE FIFTY OR FEWER
EMPLOYEES  OR  MEMBERS  EXCLUSIVE  OF  SPOUSES AND DEPENDENTS, THEN SUCH
MEMBER GROUPS SHALL BE CLASSIFIED AS SMALL GROUPS  FOR  RATING  PURPOSES
AND  THE  REMAINING  MEMBERS  SHALL  BE RATED CONSISTENT WITH THE RATING
RULES APPLICABLE TO SUCH REMAINING MEMBERS PURSUANT TO THIS SECTION.
  (2) IF A CONTRACT IS ISSUED TO A GROUP DEFINED IN  SUBSECTION  (C)  OF
SECTION  FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER INCLUDING
ASSOCIATION GROUPS, THAT INCLUDES ONE OR MORE INDIVIDUAL  OR  INDIVIDUAL
PROPRIETOR  MEMBERS,  THEN  FOR  RATING  PURPOSES  THE CORPORATION SHALL
INCLUDE SUCH MEMBERS IN ITS INDIVIDUAL POOL  OF  RISKS  IN  ESTABLISHING
PREMIUM RATES FOR SUCH MEMBERS.
  (3)   NOTWITHSTANDING   SUBDIVISION   FIVE  OF  SECTION  NINE  HUNDRED
TWENTY-TWO OF THE LABOR LAW, IF A CONTRACT IS ISSUED TO A GROUP THAT  IS
A  PROFESSIONAL EMPLOYER ORGANIZATION AS DEFINED IN SECTION NINE HUNDRED
SIXTEEN OF THE LABOR LAW, AND INCLUDES ONE OR  MORE  EMPLOYERS  ELIGIBLE
FOR COVERAGE SUBJECT TO THIS SECTION, THEN THE CORPORATION SHALL INCLUDE
SUCH  EMPLOYER  MEMBERS IN ITS SMALL GROUP POOL OF RISKS IN ESTABLISHING
PREMIUM RATES FOR SUCH MEMBERS.
  [(2)] (4) A corporation shall provide specific claims experience to  a
municipal  corporation,  as  defined  in  subsection (f) of section four
thousand seven hundred two of this chapter, covered by  the  corporation
under a community rated contract when the municipal corporation requests
its  claims  experience  for  purposes of forming or joining a municipal
cooperative health benefit plan certified pursuant to article forty-sev-
en of this chapter. Notwithstanding the foregoing provisions, no  corpo-
ration  shall be required to provide more than three years' claims expe-
rience to a municipal corporation making this request.
  (e) (1) Notwithstanding any other provision of this chapter, no insur-
er, subsidiary of an insurer, or controlled person of a holding  company
system may act as an administrator or claims paying agent, as opposed to
an  insurer,  on  behalf of small groups which, if they purchased insur-
ance, would be subject to this section. No  insurer,  subsidiary  of  an
insurer,  or  controlled  person  of  a holding company may provide stop
loss, catastrophic or reinsurance coverage to  small  groups  which,  if
they purchased insurance, would be subject to this section.
  (2)  This  subsection  shall  not  apply  to  coverage insuring a plan
[which] THAT was in effect on or before December thirty-first,  nineteen
hundred  ninety-one  and  was  issued  to  a group [which] THAT includes
member small employers or other member small groups, including  but  not
limited  to  association  groups,  provided that (A) acceptance of addi-
tional small member employers (or other member groups comprised of fifty
or fewer employees or members, exclusive of spouses and dependents) into
the group on or after June first, nineteen hundred ninety-two and before
April first, nineteen hundred ninety-four  does  not  exceed  an  amount
equal  to  ten  percent  per year of the total number of persons covered

S. 2606                            121                           A. 3006

under the group as of June first, nineteen hundred ninety-two, but noth-
ing in this subparagraph shall  limit  the  addition  of  larger  member
employers;  (B) (i) after April first, nineteen hundred ninety-four, the
group  thereafter accepts member small employers and member small groups
without underwriting by any more than the imposition of  a  pre-existing
condition  limitation  as  permitted  by  this  article and the cost for
participation in the group for all persons covered  shall  be  the  same
based  on  the  experience of the entire pool of risks covered under the
entire group, without regard to age, sex, health status  or  occupation;
and;  (ii)  once  accepted  for  coverage,  an individual or small group
cannot be terminated due to claims experience; (C) the [insurer]  CORPO-
RATION  has  registered  the  names  of such groups, including the total
number of persons covered as of June first, nineteen hundred ninety-two,
with the superintendent, in a form prescribed by the superintendent,  on
or  before  April  first, nineteen hundred ninety-three and shall report
annually thereafter until such groups  comply  with  the  provisions  of
subparagraph  (B)  of this paragraph; and (D) the types or categories of
employers or groups eligible to join the association are not altered  or
expanded after June first, nineteen hundred ninety-two.
  (3)  A corporation may apply to the superintendent for an extension or
extensions of time beyond April first, nineteen hundred  ninety-four  in
which  to  implement the provisions of this subsection as they relate to
groups registered with the superintendent pursuant to  subparagraph  (C)
of  paragraph  two  of this subsection; any such extension or extensions
may not exceed two years in aggregate duration, and the ten percent  per
year  limitation of subparagraph (A) of paragraph two of this subsection
shall be reduced to five percent per year during the period of any  such
extension  or  extensions. Any application for an extension shall demon-
strate that a significant financial hardship to such group would  result
from such implementation.
  (f)(1)  If the [insurer] CORPORATION issues coverage to an association
group (including chambers of commerce), as defined in  subparagraph  (K)
of  paragraph one of subsection (c) of section four thousand two hundred
thirty-five of this chapter, THEN the [insurer must]  CORPORATION  SHALL
issue  the  same coverage to individual proprietors [which] WHO purchase
coverage through the association  group  as  the  [insurer]  CORPORATION
issues  to groups [which] THAT purchase coverage through the association
group; provided, however, that [an insurer which] A CORPORATION THAT, on
the effective date of this subsection, is issuing coverage to individual
proprietors not connected with an association  group,  may  continue  to
issue  such  coverage provided that the coverage is otherwise in accord-
ance with this subsection and all other applicable provisions of law.
  (2) For coverage purchased pursuant to this subsection THROUGH  DECEM-
BER THIRTY-FIRST, TWO THOUSAND THIRTEEN, individual proprietors shall be
classified  in their own community rating category, provided however, up
to  and  including  December  thirty-first,  two   thousand   [fourteen]
THIRTEEN,  the  premium  rate  established  for  individual  proprietors
purchased pursuant to paragraph one of  this  subsection  shall  not  be
greater than one hundred fifteen percent of the rate established for the
same  coverage issued to groups.  COVERAGE PURCHASED OR IN EFFECT PURSU-
ANT TO THIS SUBSECTION ON OR AFTER JANUARY FIRST, TWO THOUSAND  FOURTEEN
SHALL BE CLASSIFIED IN THE INDIVIDUAL RATING CATEGORY.
  (3)  The  [insurer] CORPORATION may require members of the association
purchasing health insurance to verify that all employees electing health
insurance are legitimate employees of the employers,  as  documented  on
New  York  state  tax form NYS-45-ATT-MN or comparable documentation. In

S. 2606                            122                           A. 3006

order to be eligible to  purchase  health  insurance  pursuant  to  this
subsection  and  obtain the same group insurance products as are offered
to groups, a sole employee of a corporation or a sole proprietor  of  an
unincorporated  business  or  entity must (A) work at least twenty hours
per week, (B) if purchasing the coverage through an  association  group,
be  a  member  of  the  association for at least sixty days prior to the
effective date of the insurance [policy] CONTRACT,  and  (C)  present  a
copy  of  the  following  documentation  to the [insurer] CORPORATION or
health plan administrator on an annual basis:
  (i) NYS tax form 45-ATT, or comparable documentation of active employ-
ee status;
  (ii) for an unincorporated business, the prior year's  federal  income
tax Schedule C for an incorporated business subject to Subchapter S with
a  sole  employee,  federal income tax Schedule E for other incorporated
businesses with a sole employee, a W-2 annual wage statement, or federal
tax form 1099 with federal income tax Schedule F; or
  (iii) for a business in business for less than one year,  a  cancelled
business  check,  a  certificate  of  doing business, or appropriate tax
documentation; and
  (iv) such other documentation as may be  reasonably  required  by  the
insurer  as  approved  by the superintendent to verify eligibility of an
individual to purchase health insurance pursuant to this subsection.
  (4) Notwithstanding the provisions  of  item  (I)  of  clause  (i)  of
subparagraph  (K)  of  paragraph  one  of subsection (c) of section four
thousand two hundred thirty-five of this chapter, for purposes  of  this
section,  an  association  group shall include chambers of commerce with
less than two hundred members and which are  501C3  or  501C6  organiza-
tions.
  S 73. 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 74. 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 75. 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 76. This act shall take effect immediately and shall  be  deemed  to
have  been  in  full  force  and  effect  on  and after January 1, 2013;
provided that:
  a. sections thirty-eight, thirty-nine, forty, forty-one,  forty-seven,
forty-eight,   forty-nine,  fifty,  fifty-one,  fifty-two,  fifty-three,
fifty-four and fifty-five of this act shall take effect January 1, 2014,

S. 2606                            123                           A. 3006

and shall apply to all policies and contracts issued, renewed, modified,
altered or amended on or after such date.
  b.  sections forty-two, forty-three, forty-four, forty-five and forty-
six of this act shall  apply  to  all  policies  and  contracts  issued,
renewed, modified, altered or amended on or after October 1, 2013;
  c. section fifty-six of this act shall take effect January 1, 2014;
  d. section fifty-seven of this act shall be deemed repealed January 1,
2014;
  e.  sections  fifteen  and  fifty-eight  of this act shall take effect
January 1, 2015;
  f. sections fifty-nine and sixty of this act shall take effect January
1, 2016 and shall apply to all policies and contracts  issued,  renewed,
modified, altered, or amended on or after such date;
  g.  sections  fourteen  and  fourteen-a  of this act shall take effect
immediately and shall be deemed to have been in full force and effect on
and after April 1, 2013;
  h. the amendments to paragraphs  (e)  and  (f)  of  subdivision  2  of
section  2511  of  the  public  health law made by sections nineteen and
twenty-six of this act shall take effect January 1, 2014 or a later date
to be determined by the  commissioner  of  health  contingent  upon  the
requirements  of  the Patient Protection and Affordable Care Act of 2010
being fully implemented by the state and as approved by the secretary of
the department of health and human services; provided that  the  commis-
sioner  of  health shall notify the legislative bill drafting commission
upon the occurrence of the enactment of the legislation provided for  in
sections  nineteen  and twenty-six of this act in order that the commis-
sion may maintain an accurate and timely  effective  data  base  of  the
official  text  of  the  laws of the state of New York in furtherance of
effectuating the provisions of section 44 of  the  legislative  law  and
section 70-b of the public officers law;
  h-1.  provided  however,  the amendments to subparagraph (ii) of para-
graph (f) of subdivision 2 of section 2511 of the public health law made
by section twenty-six of this act shall take effect April 1, 2014;
  i. the amendments to subdivision 4  of  section  2511  of  the  public
health  law  made by section twenty-one of this act shall not affect the
expiration and reversion of such subdivision  and  shall  be  deemed  to
expire therewith;
  j. the amendments to subparagraph (ii) of paragraph (g) of subdivision
2  of section 2511 of the public health law made by section twenty-seven
of this act shall not affect the expiration of such paragraph and  shall
be deemed to expire therewith;
  j-1. the amendments to subparagraph (iii) of paragraph (a) of subdivi-
sion  2  of section 2511 of the public health law made by section thirty
of this act shall not affect the expiration of such paragraph and  shall
be deemed to expire therewith;
  j-2.  the  amendments  to subparagraph (iv) of paragraph (b) and para-
graph (d) of subdivision 9 of section 2511 of the public health law made
by section thirty-three of this act shall not affect the  expiration  of
such subdivision and shall be deemed to expire therewith;
  j-3.  the  amendments  to subdivision 5 of section 365-n of the social
services law made by section thirty-three-a of this act shall not affect
the repeal of such subdivision and shall be deemed repealed therewith;
  k. any rules or regulations necessary to implement the  provisions  of
this  act  may be promulgated and any procedures, forms, or instructions
necessary for implementation may be adopted and issued on or  after  the
date this act shall have become a law;

S. 2606                            124                           A. 3006

  l. 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;
  m.  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;
  n. notwithstanding any inconsistent provision of the state administra-
tive  procedure  act  or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of financial  services
and  any  appropriate council is authorized to adopt or amend or promul-
gate on an emergency basis any regulation he  or  she  or  such  council
determines  necessary  to  implement  any  provision  of this act on its
effective date; and
  o. the provisions of this act shall become  effective  notwithstanding
the  failure  of  the  commissioner  of  health or the superintendent of
financial services or any council to adopt or amend or promulgate  regu-
lations implementing this act.

                                 PART E

  Section  1. Subdivisions 9 and 10 of section 2541 of the public health
law, as added by chapter 428 of the laws of 1992, are amended to read as
follows:
  9. "Evaluation"  means  a  multidisciplinary  professional,  objective
[assessment]  EXAMINATION conducted by [appropriately] qualified person-
nel and conducted pursuant to section twenty-five hundred forty-four  of
this title to determine a child's eligibility under this title.
  A  "PARTIAL  EVALUATION"  SHALL  MEAN AN EXAMINATION OF THE CHILD IN A
SINGLE DEVELOPMENTAL AREA FOR PURPOSES OF DETERMINING  ELIGIBILITY,  AND
MAY  ALSO  MEAN  AN EXAMINATION OF THE CHILD TO DETERMINE THE NEED FOR A
MODIFICATION TO THE CHILD'S INDIVIDUALIZED FAMILY SERVICE PLAN.
  10. "Evaluator" means [a team of two or  more  professionals  approved
pursuant  to  section  twenty-five  hundred  fifty-one  of this title] A
PROVIDER APPROVED BY THE DEPARTMENT to  conduct  screenings  and  evalu-
ations.
  S  2.  Section  2541 of the public health law is amended by adding two
new subdivisions 13-b and 15-a to read as follows:
  13-B. "MULTIDISCIPLINARY" MEANS THE INVOLVEMENT OF TWO OR  MORE  SEPA-
RATE DISCIPLINES OR PROFESSIONS, WHICH MAY MEAN ONE INDIVIDUAL WHO MEETS
THE  DEFINITION  OF  QUALIFIED  PERSONNEL  AS  SET  FORTH IN SUBDIVISION
FIFTEEN OF THIS SECTION AND WHO IS QUALIFIED IN  ACCORDANCE  WITH  STATE
LICENSURE, CERTIFICATION, OR OTHER COMPARABLE STANDARDS, TO EVALUATE ALL
FIVE DEVELOPMENTAL AREAS.
  15-A.    "SCREENING" MEANS THE PROCEDURES USED BY QUALIFIED PERSONNEL,
AS DEFINED IN SUBDIVISION FIFTEEN OF THIS SECTION, TO DETERMINE  WHETHER
A  CHILD IS SUSPECTED OF HAVING A DISABILITY AND IN NEED OF EARLY INTER-
VENTION SERVICES, AND SHALL INCLUDE THE ADMINISTRATION OF A STANDARDIZED
SCREENING INSTRUMENT OR INSTRUMENTS APPROVED BY  THE  DEPARTMENT,  WHERE
AVAILABLE  AND APPROPRIATE FOR THE CHILD, IN ACCORDANCE WITH SUBDIVISION
THREE OF SECTION TWENTY-FIVE HUNDRED FORTY-FOUR OF THIS TITLE.
  S 3. Subdivision 3 of section  2542  of  the  public  health  law,  as
amended  by  chapter  231  of  the  laws  of 1993, is amended to read as
follows:
  3. [The] (A) UNLESS AN INFANT OR TODDLER HAS ALREADY BEEN REFERRED  TO
THE  EARLY  INTERVENTION  OFFICIAL  OR  THE HEALTH OFFICER OF THE PUBLIC
HEALTH DISTRICT IN WHICH THE INFANT OR TODDLER RESIDES, AS DESIGNATED BY

S. 2606                            125                           A. 3006

THE MUNICIPALITY, THE following persons and entities, within two working
days of identifying an infant or toddler suspected of having a disabili-
ty or at risk of having a disability, shall refer such infant or toddler
to  the early intervention official or the health officer [of the public
health district in which the infant or toddler resides, as designated by
the municipality,] AS APPLICABLE but in no event over the  objection  of
the parent made in accordance with procedures established by the depart-
ment  for  use  by  such primary referral sources[, unless the child has
already been referred]:   hospitals, child health  care  providers,  day
care  programs,  local school districts, public health facilities, early
childhood direction centers and such other  social  service  and  health
care  agencies  and providers as the commissioner shall specify in regu-
lation; provided, however, that the department  shall  establish  proce-
dures,  including regulations if required, to ensure that primary refer-
ral sources adequately inform the parent or  guardian  about  the  early
intervention  program, including through brochures and written materials
created or approved by the department.
  (B) THE PRIMARY REFERRAL SOURCES IDENTIFIED IN PARAGRAPH (A)  OF  THIS
SUBDIVISION  SHALL, WITH PARENT OR GUARDIAN CONSENT, COMPLETE AND TRANS-
MIT AT THE TIME OF REFERRAL, A REFERRAL FORM DEVELOPED  BY  THE  DEPART-
MENT,  WHICH  CONTAINS  INFORMATION  SUFFICIENT  TO DOCUMENT THE PRIMARY
REFERRAL SOURCE'S CONCERN OR BASIS FOR SUSPECTING THE CHILD HAS A  DISA-
BILITY OR IS AT RISK OF HAVING A DISABILITY, AND WHERE APPLICABLE, SPEC-
IFIES  THE  CHILD'S  DIAGNOSED  CONDITION  THAT  ESTABLISHES THE CHILD'S
ELIGIBILITY FOR THE EARLY INTERVENTION  PROGRAM.  THE  PRIMARY  REFERRAL
SOURCE  SHALL  ALSO, WITH PARENT OR GUARDIAN CONSENT, PROVIDE SUCH OTHER
RECORDS OR REPORTS PERTINENT TO  THE  CHILD'S  DEVELOPMENTAL  STATUS  OR
DISABILITY.  THE PRIMARY REFERRAL SOURCE SHALL FURTHER INFORM THE PARENT
OR GUARDIAN OF A CHILD WITH A DIAGNOSED CONDITION THAT HAS A HIGH PROBA-
BILITY  OF  RESULTING  IN  DEVELOPMENTAL DELAY, THAT ELIGIBILITY FOR THE
PROGRAM MAY BE ESTABLISHED BY MEDICAL  OR  OTHER  RECORDS,  AND  OF  THE
IMPORTANCE OF PROVIDING CONSENT FOR THE PRIMARY REFERRAL SOURCE TO TRAN-
SMIT  RECORDS  OR  REPORTS  NECESSARY  TO SUPPORT THE DIAGNOSIS, OR, FOR
PARENTS OR GUARDIANS OF CHILDREN WHO DO NOT HAVE A DIAGNOSED  CONDITION,
RECORDS  OR REPORTS THAT WOULD ASSIST IN DETERMINING ELIGIBILITY FOR THE
PROGRAM.
  S 4. Section 2544 of the public health law, as added by chapter 428 of
the laws of 1992, paragraph (c) of subdivision 2 as added by  section  1
of part A of chapter 56 of the laws of 2012, and subdivision 11 as added
by section 3 of part B3 of chapter 62 of the laws of 2003, is amended to
read as follows:
  S  2544.  Screening  and  evaluations.  1. Each child thought to be an
eligible child  is  entitled  to  [a  multidisciplinary]  AN  evaluation
CONDUCTED  IN  ACCORDANCE  WITH THIS SECTION, and the early intervention
official shall ensure such evaluation, with parental consent.
  2. (a) [The] SUBJECT TO THE PROVISIONS OF SECTION TWENTY-FIVE  HUNDRED
FORTY-FIVE-A  OF THIS TITLE, THE parent may select an evaluator from the
list of approved evaluators as described in section twenty-five  hundred
forty-two  of  this  title to conduct the SCREENING AND/OR evaluation AS
APPLICABLE AND IN ACCORDANCE WITH THIS SECTION.  The parent or evaluator
shall  immediately  notify  the  early  intervention  official  of  such
selection.  THE EVALUATOR SHALL REVIEW THE INFORMATION AND DOCUMENTATION
PROVIDED  WITH  THE  REFERRAL  TO DETERMINE THE APPROPRIATE SCREENING OR
EVALUATION PROCESS TO FOLLOW IN ACCORDANCE WITH THIS SECTION. The evalu-
ator may begin the SCREENING OR evaluation no sooner than  four  working

S. 2606                            126                           A. 3006

days  after  such notification, unless otherwise approved by the initial
service coordinator.
  (b)  [the  evaluator  shall  designate  an individual as the principal
contact for the multidisciplinary  team]  INITIAL  SERVICE  COORDINATORS
SHALL  INFORM PARENTS OF THE SCREENING OR EVALUATION PROCEDURES THAT MAY
BE PERFORMED, AS APPLICABLE. FOR A CHILD REFERRED TO  THE  EARLY  INTER-
VENTION  OFFICIAL  WHO HAS A DIAGNOSED PHYSICAL OR MENTAL CONDITION THAT
HAS A HIGH PROBABILITY OF RESULTING IN DEVELOPMENTAL DELAY, THE  INITIAL
SERVICE  COORDINATOR  SHALL INFORM THE PARENT THAT THE EVALUATION OF THE
CHILD SHALL BE CONDUCTED IN ACCORDANCE WITH THE PROCEDURES SET FORTH  IN
SUBDIVISION FIVE OF THIS SECTION.
  (c)  If,  in  consultation with the evaluator, the service coordinator
identifies a child that is potentially eligible for programs or services
offered by or under the auspices of the office for people with  develop-
mental disabilities, the service coordinator shall, with parent consent,
notify  the  office for people with developmental disabilities' regional
developmental disabilities services office of the potential  eligibility
of such child for said programs or services.
  3.  [(a)  To  determine eligibility, an evaluator shall, with parental
consent, either (i) screen a child to determine what type of evaluation,
if any, is warranted, or (ii) provide a multidisciplinary evaluation. In
making the determination whether to provide an evaluation, the evaluator
may rely on a recommendation from a physician or other qualified  person
as  designated  by the commissioner] SCREENINGS FOR CHILDREN REFERRED TO
THE EARLY INTERVENTION PROGRAM TO DETERMINE WHETHER THEY  ARE  SUSPECTED
OF  HAVING  A DISABILITY.   (A) FOR A CHILD REFERRED TO THE EARLY INTER-
VENTION PROGRAM, THE EVALUATOR SHALL FIRST PERFORM A  SCREENING  OF  THE
CHILD,  WITH  PARENTAL  CONSENT,  TO  DETERMINE  WHETHER  THE  CHILD  IS
SUSPECTED OF HAVING A DISABILITY.
  (B) THE EVALUATOR SHALL UTILIZE A STANDARDIZED SCREENING INSTRUMENT OR
INSTRUMENTS APPROVED BY THE DEPARTMENT TO CONDUCT THE SCREENING. IF  THE
EVALUATOR  DOES  NOT  UTILIZE  A  STANDARDIZED  SCREENING  INSTRUMENT OR
INSTRUMENTS APPROVED BY THE DEPARTMENT FOR THE SCREENING, THE  EVALUATOR
SHALL  DOCUMENT IN WRITING WHY THE SAME ARE UNAVAILABLE OR INAPPROPRIATE
FOR THE CHILD.
  (C) THE EVALUATOR SHALL EXPLAIN THE RESULTS OF THE  SCREENING  TO  THE
PARENT, AND SHALL FULLY DOCUMENT THE RESULTS IN WRITING.
  [(b)]  (D)  If,  based  upon the screening, a child is [believed to be
eligible, or if otherwise elected by the parent] SUSPECTED OF  HAVING  A
DISABILITY, the [child shall] EVALUATOR SHALL PROCEED, with [the consent
of  a parent] PARENTAL CONSENT, [receive a multidisciplinary] TO CONDUCT
AN evaluation[. All evaluations shall be conducted in  accordance  with]
OF  THE CHILD IN ACCORDANCE WITH THE PROCEDURES SET FORTH IN SUBDIVISION
FOUR OF THIS SECTION, the  coordinated  standards  and  procedures,  and
[with] regulations promulgated by the commissioner.
  (E) IF, BASED UPON THE SCREENING, A CHILD IS NOT SUSPECTED OF HAVING A
DISABILITY, AN EVALUATION SHALL NOT BE PROVIDED, UNLESS REQUESTED BY THE
PARENT.    THE EARLY INTERVENTION OFFICIAL SHALL PROVIDE THE PARENT WITH
WRITTEN NOTICE OF THE SCREENING RESULTS, WHICH SHALL INCLUDE INFORMATION
ON THE PARENT'S RIGHT TO REQUEST AN EVALUATION.
  (F) A SCREENING SHALL NOT BE PROVIDED TO CHILDREN WHO ARE REFERRED  TO
THE  EARLY  INTERVENTION PROGRAM WHO HAVE A DIAGNOSED PHYSICAL OR MENTAL
CONDITION WITH A HIGH PROBABILITY OF RESULTING  IN  DEVELOPMENTAL  DELAY
THAT  ESTABLISHES  ELIGIBILITY FOR THE PROGRAM, OR FOR CHILDREN WHO HAVE
PREVIOUSLY RECEIVED AN EVALUATION UNDER THE EARLY  INTERVENTION  PROGRAM

S. 2606                            127                           A. 3006

AND  HAVE  BEEN REFERRED AGAIN TO THE EARLY INTERVENTION OFFICIAL WITHIN
SIX MONTHS OF THE PREVIOUS EVALUATION.
  4. The evaluation of [each] A child shall:
  (a) INCLUDE THE ADMINISTRATION OF AN EVALUATION INSTRUMENT APPROVED BY
THE  DEPARTMENT. IF THE EVALUATOR DOES NOT UTILIZE AN EVALUATION INSTRU-
MENT APPROVED BY THE DEPARTMENT AS PART OF THE EVALUATION OF THE  CHILD,
THE  EVALUATOR  SHALL DOCUMENT IN WRITING WHY SUCH INSTRUMENT OR INSTRU-
MENTS ARE NOT APPROPRIATE OR AVAILABLE FOR THE CHILD;
  (B) be conducted by personnel trained to utilize  appropriate  methods
and procedures;
  [(b)] (C) be based on informed clinical opinion;
  [(c)]  (D)  be  made without regard to the availability of services in
the municipality or who might provide such services; [and
  (d)] (E) with parental consent, include the following:
  (i) a review of pertinent  records  related  to  the  child's  current
health status and medical history;
  (ii)  an evaluation of the child's level of functioning in each of the
developmental areas set forth in paragraph (c) of subdivision  seven  of
section  twenty-five  hundred  forty-one  of  this title[;] TO DETERMINE
WHETHER THE CHILD HAS A DISABILITY AS DEFINED IN THIS TITLE THAT  ESTAB-
LISHES THE CHILD'S ELIGIBILITY FOR THE PROGRAM; AND
  (F)  IF  THE CHILD HAS BEEN DETERMINED ELIGIBLE BY THE EVALUATOR AFTER
CONDUCTING THE PROCEDURES SET FORTH IN PARAGRAPHS  (A)  THROUGH  (E)  OF
THIS SUBDIVISION, THE EVALUATION SHALL ALSO INCLUDE:
  [(iii)]  (I) an assessment [of the unique needs of] FOR THE PURPOSE OF
IDENTIFYING the [child] CHILD'S UNIQUE STRENGTHS AND NEEDS in [terms of]
each of the developmental areas [set forth in paragraph (c) of  subdivi-
sion  seven  of  section  twenty-five  hundred  forty-one of this title,
including the identification of] AND  THE  EARLY  INTERVENTION  services
appropriate to meet those needs;
  (II)  A  FAMILY-DIRECTED ASSESSMENT, IF CONSENTED TO BY THE FAMILY, IN
ORDER TO IDENTIFY THE FAMILY'S RESOURCES, PRIORITIES  AND  CONCERNS  AND
THE  SUPPORTS  NECESSARY  TO  ENHANCE  THE FAMILY'S CAPACITY TO MEET THE
DEVELOPMENTAL NEEDS OF THE CHILD. THE FAMILY ASSESSMENT SHALL BE  VOLUN-
TARY ON THE PART OF EACH FAMILY MEMBER PARTICIPATING IN THE ASSESSMENT;
  [(iv)] (III) an [evaluation] ASSESSMENT of the transportation needs of
the child, if any; and
  [(v)]  (IV)  such  other  matters as the commissioner may prescribe in
regulation.
  5. EVALUATIONS FOR CHILDREN WHO ARE REFERRED TO THE EARLY INTERVENTION
OFFICIAL WITH DIAGNOSED PHYSICAL OR MENTAL CONDITIONS THAT HAVE  A  HIGH
PROBABILITY  OF  RESULTING IN DEVELOPMENTAL DELAY.  (A) IF A CHILD HAS A
DIAGNOSED PHYSICAL OR MENTAL CONDITION THAT HAS A  HIGH  PROBABILITY  OF
RESULTING  IN  DEVELOPMENTAL DELAY, THE CHILD'S MEDICAL OR OTHER RECORDS
SHALL BE USED, WHEN AVAILABLE TO ESTABLISH THE CHILD'S  ELIGIBILITY  FOR
THE PROGRAM.
  (B)  THE EVALUATOR SHALL, UPON REVIEW OF THE REFERRAL FORM PROVIDED IN
ACCORDANCE WITH SECTION TWENTY-FIVE HUNDRED FORTY-TWO OF THIS  TITLE  OR
ANY  OTHER  RECORDS,  OR AT THE TIME OF INITIAL CONTACT WITH THE CHILD'S
FAMILY, DETERMINE WHETHER THE  CHILD  HAS  A  DIAGNOSED  CONDITION  THAT
ESTABLISHES  THE  CHILD'S  ELIGIBILITY FOR THE PROGRAM. IF THE EVALUATOR
HAS REASON TO BELIEVE, AFTER SPEAKING WITH THE CHILD'S FAMILY, THAT  THE
CHILD MAY HAVE A DIAGNOSED CONDITION THAT ESTABLISHES THE CHILD'S ELIGI-
BILITY  BUT  THE  EVALUATOR  HAS NOT BEEN PROVIDED WITH MEDICAL OR OTHER
DOCUMENTATION OF SUCH DIAGNOSIS,  THE  EVALUATOR  SHALL,  WITH  PARENTAL

S. 2606                            128                           A. 3006

CONSENT,  OBTAIN SUCH DOCUMENTATION, WHEN AVAILABLE, PRIOR TO PROCEEDING
WITH THE EVALUATION OF THE CHILD.
  (C)  THE  EVALUATOR SHALL REVIEW ALL RECORDS RECEIVED TO DOCUMENT THAT
THE CHILD'S DIAGNOSIS AS SET  FORTH  IN  SUCH  RECORDS  ESTABLISHES  THE
CHILD'S ELIGIBILITY FOR THE EARLY INTERVENTION PROGRAM.
  (D)  NOTWITHSTANDING  SUBDIVISION FOUR OF THIS SECTION, IF THE CHILD'S
ELIGIBILITY FOR THE EARLY INTERVENTION PROGRAM IS ESTABLISHED IN ACCORD-
ANCE WITH THIS SUBDIVISION, THE EVALUATION OF THE CHILD SHALL CONSIST OF
(I) A REVIEW OF THE RESULTS OF THE MEDICAL OR OTHER RECORDS THAT  ESTAB-
LISHED  THE  CHILD'S ELIGIBILITY, AND ANY OTHER PERTINENT EVALUATIONS OR
RECORDS AVAILABLE AND (II) THE PROCEDURES SET FORTH IN PARAGRAPH (F)  OF
SUBDIVISION FOUR OF THIS SECTION. THE EVALUATION PROCEDURES SET FORTH IN
PARAGRAPHS (A) THROUGH (E) OF SUBDIVISION FOUR OF THIS SECTION SHALL NOT
BE REQUIRED OR CONDUCTED.
  6.  EVALUATIONS  FOR CHILDREN REFERRED TO THE EARLY INTERVENTION OFFI-
CIAL AFTER A PREVIOUS EARLY INTERVENTION EVALUATION FOUND THEM  INELIGI-
BLE  FOR  THE  PROGRAM.    (A)  NOTWITHSTANDING SUBDIVISION FOUR OF THIS
SECTION, A PARTIAL EVALUATION SHALL BE CONDUCTED FOR A  CHILD  THAT  WAS
PREVIOUSLY  REFERRED TO THE EARLY INTERVENTION OFFICIAL AND FOUND INELI-
GIBLE AFTER AN EVALUATION IF:
  (I) THE CHILD'S PRIOR EVALUATION WAS COMPLETED BETWEEN THREE  AND  SIX
MONTHS OF THE DATE OF THE CHILD'S SUBSEQUENT REFERRAL;
  (II) THE CHILD'S SUBSEQUENT REFERRAL IS BASED ON A SPECIFIC CONCERN IN
A SINGLE DEVELOPMENTAL AREA; AND
  (III) NO OTHER NEW MEDICAL, HEALTH OR DEVELOPMENTAL CONCERNS ARE INDI-
CATED.
  (B)  IF THE PARTIAL EVALUATION ESTABLISHES THE CHILD'S ELIGIBILITY FOR
THE EARLY INTERVENTION PROGRAM, THE EVALUATION OF THE CHILD  SHALL  ALSO
INCLUDE THE PROCEDURES SET FORTH IN PARAGRAPH (F) OF SUBDIVISION FOUR OF
THIS  SECTION.  THE  EVALUATION  PROCEDURES  SET FORTH IN PARAGRAPHS (A)
THROUGH (E) OF SUBDIVISION FOUR OF THIS SECTION SHALL NOT BE  CONDUCTED,
UNLESS REQUESTED BY THE PARENT.
  (C)  AN  EVALUATION  CONDUCTED  IN ACCORDANCE WITH SUBDIVISION FOUR OF
THIS SECTION SHALL BE PROVIDED TO A CHILD THAT WAS  PREVIOUSLY  REFERRED
TO  THE EARLY INTERVENTION OFFICIAL AND FOUND INELIGIBLE AFTER AN EVALU-
ATION IF THE CHILD'S PARENT OR PRIMARY REFERRAL SOURCE INDICATES SPECIF-
IC NEW CONCERNS IN MORE THAN ONE DEVELOPMENTAL AREA, OR  IF  RECORDS  OR
OTHER REPORTS INDICATE A SIGNIFICANT CHANGE IN OVERALL DEVELOPMENT.
  (D) FOR EVALUATIONS SUBJECT TO THE PROVISIONS OF THIS SUBDIVISION, THE
EVALUATOR  WHO  CONDUCTED  THE  PRIOR  EVALUATION  OF THE CHILD SHALL BE
ASSIGNED TO CONDUCT THE PARTIAL EVALUATION OR EVALUATION, AS APPLICABLE,
UNLESS THE EVALUATOR IS UNAVAILABLE OR THE PARENT OBJECTS TO THE ASSIGN-
MENT. THE EVALUATOR SHALL REVIEW THE PRIOR EVALUATION CONDUCTED  ON  THE
CHILD AND ANY OTHER PERTINENT RECORDS, WITH PARENTAL CONSENT.
  (E)  NOTWITHSTANDING  ANY  CONTRARY  PROVISION  OF LAW, A CHILD WHO IS
REFERRED TO THE EARLY INTERVENTION OFFICIAL WITHIN THREE MONTHS  OF  THE
COMPLETION  OF  A  PRIOR  EVALUATION  SHALL NOT BE ENTITLED TO A PARTIAL
EVALUATION OR EVALUATION, AS  APPLICABLE,  UNLESS  SIGNIFICANT  MEDICAL,
HEALTH OR DEVELOPMENTAL CHANGES ARE INDICATED.
  7. An evaluation shall not include a reference to any specific provid-
er of early intervention services.
  [6.]  8.  Nothing  in  this  section  shall restrict an evaluator from
utilizing, in addition to findings from his or her personal examination,
other examinations, evaluations or assessments conducted for such child,
including those conducted prior to the evaluation under this section, if

S. 2606                            129                           A. 3006

such examinations, evaluations or assessments are  consistent  with  the
coordinated standards and procedures.
  [7.]  9.  Following  completion of the evaluation, the evaluator shall
provide the parent and service coordinator with a copy of a  summary  of
the  full  evaluation.  To  the extent practicable, the summary shall be
provided in the native language of  the  parent.  Upon  request  of  the
parent,  early  intervention official or service coordinator, the evalu-
ator shall provide a copy of the full evaluation to such  parent,  early
intervention official or service coordinator.
  [8.]  10. A parent who disagrees with the results of an evaluation may
obtain an additional evaluation or partial evaluation at public  expense
to the extent authorized by federal law or regulation.
  [9.] 11. Upon receipt of the results of an evaluation, a service coor-
dinator may, with parental consent, require additional diagnostic infor-
mation  regarding  the  condition  of the child, provided, however, that
such evaluation or assessment is not unnecessarily duplicative or  inva-
sive to the child, and provided further, that:
  (a) where the evaluation has established the child's eligibility, such
additional  diagnostic information shall be used solely to provide addi-
tional information to the parent and service coordinator  regarding  the
child's  need  for services and cannot be a basis for refuting eligibil-
ity;
  (b) the service coordinator provides the parent with a written  expla-
nation of the basis for requiring additional diagnostic information;
  (c)  the  additional  diagnostic  procedures  are at no expense to the
parent; and
  (d) the evaluation is completed and a meeting to develop  an  IFSP  is
held  within  the  time prescribed in subdivision one of section twenty-
five hundred forty-five of this title.
  [10.] 12. (a) If the screening indicates that the infant or toddler is
not an eligible child and the parent elects not to have  an  evaluation,
or  if  the  evaluation  indicates  that the infant or toddler is not an
eligible child, the service coordinator shall inform the parent of other
programs or services that may benefit such child, and the child's family
and, with parental  consent,  refer  such  child  to  such  programs  or
services.
  (b)  A  parent  may  appeal a determination that a child is ineligible
pursuant to the provisions of section twenty-five hundred forty-nine  of
this  title,  provided,  however,  that  a  parent may not initiate such
appeal until all evaluations are completed.   IN ADDITION, FOR  A  CHILD
REFERRED TO THE EARLY INTERVENTION OFFICIAL WHO HAS A DIAGNOSED PHYSICAL
OR  MENTAL  CONDITION  THAT  ESTABLISHES THE CHILD'S ELIGIBILITY FOR THE
PROGRAM IN ACCORDANCE WITH SUBDIVISION FIVE OF THIS SECTION, THE  PARENT
MAY  APPEAL  THE  DENIAL  OF A REQUEST TO HAVE THE EVALUATOR CONDUCT THE
EVALUATION PROCEDURES SET FORTH IN PARAGRAPHS (A) THROUGH (E) OF  SUBDI-
VISION  FOUR OF THIS SECTION, PROVIDED, HOWEVER, THAT THE PARENT MAY NOT
INITIATE THE APPEAL UNTIL THE EVALUATION CONDUCTED  IN  ACCORDANCE  WITH
SUBDIVISION FIVE OF THIS SECTION IS COMPLETED.
  [11.]  13. Notwithstanding any other provision of law to the contrary,
where a request has been made to review an IFSP prior to  the  six-month
interval  provided  in  subdivision seven of section twenty-five hundred
forty-five of this title for purposes of increasing frequency  or  dura-
tion  of  an approved service, including service coordination, the early
intervention official may require an additional  evaluation  or  partial
evaluation  at  public  expense  by an approved evaluator other than the
current provider of service, with parent consent.

S. 2606                            130                           A. 3006

  S 5. Subdivision 1, the opening paragraph of subdivision 2 and  subdi-
vision  7  of section 2545 of the public health law, as added by chapter
428 of the laws of 1992, are amended to read as follows:
  1. If the evaluator determines that the infant or toddler is an eligi-
ble child, the early intervention official shall convene a meeting, at a
time  and place convenient to the parent, consisting of the parent, such
official, the evaluator, A REPRESENTATIVE FROM THE CHILD'S HEALTH INSUR-
ER OR HEALTH MAINTENANCE ORGANIZATION, WHICH SHALL INCLUDE  THE  MEDICAL
ASSISTANCE  PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTABLISHED IN
TITLE ONE-A OF THIS ARTICLE,  OR  ANY  OTHER  GOVERNMENTAL  THIRD  PARTY
PAYOR,  IF  THE  CHILD  HAS  HEALTH  INSURANCE COVERAGE THROUGH A HEALTH
INSURER OR HEALTH MAINTENANCE ORGANIZATION  AND  THE  REPRESENTATIVE  IS
AVAILABLE TO ATTEND THE MEETING ON THE DATE AND TIME CHOSEN BY THE EARLY
INTERVENTION  OFFICIAL,  the  initial  service coordinator and any other
persons who the parent or the  initial  service  coordinator,  with  the
parent's  consent,  invite,  provided that such meeting shall be held no
later than forty-five days from the date  that  the  early  intervention
official  was  first  contacted regarding the child, except under excep-
tional circumstances prescribed by the commissioner.  The  early  inter-
vention  official,  at  or  prior to the time of scheduling the meeting,
shall inform the parent of the right to invite any person to  the  meet-
ing.    IF  THE REPRESENTATIVE FROM THE CHILD'S HEALTH INSURER OR HEALTH
MAINTENANCE ORGANIZATION IS NOT  AVAILABLE  TO  ATTEND  THE  MEETING  IN
PERSON  ON  THE DATE AND TIME CHOSEN BY THE EARLY INTERVENTION OFFICIAL,
ARRANGEMENTS MAY BE MADE FOR THE  REPRESENTATIVE'S  INVOLVEMENT  IN  THE
MEETING  BY  PARTICIPATION  IN  A  TELEPHONE CONFERENCE CALL OR BY OTHER
MEANS.
  The early intervention official, A  REPRESENTATIVE  FROM  THE  CHILD'S
HEALTH  INSURER  OR HEALTH MAINTENANCE ORGANIZATION, WHICH SHALL INCLUDE
THE MEDICAL ASSISTANCE PROGRAM OR THE  CHILD  HEALTH  INSURANCE  PROGRAM
ESTABLISHED  IN  TITLE  ONE-A OF THIS ARTICLE, OR ANY OTHER GOVERNMENTAL
THIRD PARTY PAYOR, IF THE CHILD HAS HEALTH INSURANCE COVERAGE THROUGH  A
HEALTH INSURER OR HEALTH MAINTENANCE ORGANIZATION AND THE REPRESENTATIVE
IS  AVAILABLE  TO  ATTEND  OR PARTICIPATE IN THE MEETING ON THE DATE AND
TIME CHOSEN BY THE EARLY INTERVENTION OFFICIAL, initial service  coordi-
nator,  parent and evaluator shall develop an IFSP for an eligible child
whose parents request services. The IFSP shall be in writing  and  shall
include, but not be limited to:
  7.  The  IFSP  shall  be  reviewed at six month intervals and shall be
evaluated annually by the early intervention official, A  REPRESENTATIVE
FROM  THE  CHILD'S  HEALTH  INSURER  OR HEALTH MAINTENANCE ORGANIZATION,
WHICH SHALL INCLUDE THE MEDICAL ASSISTANCE PROGRAM OR THE  CHILD  HEALTH
INSURANCE  PROGRAM  ESTABLISHED  IN  TITLE ONE-A OF THIS ARTICLE, OR ANY
OTHER GOVERNMENTAL THIRD PARTY PAYOR, IF THE CHILD HAS HEALTH  INSURANCE
COVERAGE THROUGH A HEALTH INSURER OR HEALTH MAINTENANCE ORGANIZATION AND
THE  REPRESENTATIVE  IS AVAILABLE TO PARTICIPATE IN THE REVIEW OR ATTEND
THE ANNUAL MEETING TO EVALUATE THE IFSP ON THE DATE AND TIME  CHOSEN  BY
THE EARLY INTERVENTION OFFICIAL, THE service coordinator, the parent and
providers  of services to the eligible child.  Upon request of a parent,
the plan may be reviewed by such persons at more frequent intervals.  IF
THE REPRESENTATIVE FROM THE CHILD'S HEALTH INSURER OR HEALTH MAINTENANCE
ORGANIZATION IS NOT AVAILABLE TO PARTICIPATE IN THE REVIEW OR ATTEND THE
MEETING TO EVALUATE THE IFSP IN PERSON ON THE DATE AND  TIME  CHOSEN  BY
THE EARLY INTERVENTION OFFICIAL, ARRANGEMENTS MAY BE MADE FOR THE REPRE-
SENTATIVE'S  INVOLVEMENT BY PARTICIPATION IN A TELEPHONE CONFERENCE CALL
OR BY OTHER MEANS.

S. 2606                            131                           A. 3006

  S 6. Subdivision 10 of section 2545 of the public health law, as added
by section 2-a of part A of chapter 56 of the laws of 2012,  is  amended
to read as follows:
  10.  The service coordinator shall ensure that the IFSP, including any
amendments thereto, is implemented [in a timely manner but  not]  WITHIN
THIRTY  DAYS FROM THE DATE THE PARENT SIGNS THE IFSP AND CONSENTS TO THE
SERVICES, OR, IF THE PROJECTED DATE FOR INITIATION  OF  SERVICE  AS  SET
FORTH  IN  THE  IFSP  IS  MORE THAN THIRTY DAYS FROM THE DATE THE PARENT
SIGNS THE IFSP AND CONSENTS TO SUCH  SERVICE,  THE  SERVICE  COORDINATOR
SHALL  ENSURE  THAT  THE  IFSP  IS IMPLEMENTED NO later than thirty days
after the projected [dates] DATE for initiation of the [services as  set
forth in the plan] SERVICE.
  S  7.  The public health law is amended by adding a new section 2545-a
to read as follows:
  S 2545-A. USE OF NETWORK PROVIDERS. 1.  FOR CHILDREN REFERRED  TO  THE
EARLY INTERVENTION PROGRAM ON OR AFTER JANUARY FIRST, TWO THOUSAND FOUR-
TEEN,  IF A CHILD HAS HEALTH INSURANCE COVERAGE UNDER A HEALTH INSURANCE
POLICY, PLAN OR CONTRACT, INCLUDING COVERAGE AVAILABLE UNDER THE MEDICAL
ASSISTANCE PROGRAM OR THE CHILD HEALTH INSURANCE PROGRAM ESTABLISHED  IN
TITLE  ONE-A OF THIS ARTICLE OR UNDER ANY OTHER GOVERNMENTAL THIRD PARTY
PAYOR, AND THE HEALTH INSURANCE POLICY, PLAN OR CONTRACT PROVIDES COVER-
AGE FOR HEALTH, DIAGNOSTIC OR DEVELOPMENTAL  SCREENINGS  OR  EVALUATIONS
OR,  SERVICES  THAT  MAY BE RENDERED TO THE CHILD UNDER THE EARLY INTER-
VENTION PROGRAM, THE SERVICE COORDINATOR, OR, IN ACCORDANCE WITH SECTION
TWENTY-FIVE HUNDRED FORTY-FOUR OF THIS TITLE, THE PARENT,  WITH  RESPECT
TO  SCREENINGS  OR  EVALUATIONS, SHALL SELECT A PROVIDER APPROVED BY THE
DEPARTMENT AND WITHIN THE HEALTH INSURER'S OR HEALTH MAINTENANCE  ORGAN-
IZATION'S  NETWORK,  IF APPLICABLE, FOR THE PROVISION OF SUCH SCREENING,
EVALUATION OR SERVICES, PROVIDED HOWEVER THAT THIS SUBDIVISION SHALL NOT
APPLY UNDER THE FOLLOWING CONDITIONS:
  (A) SPECIAL CIRCUMSTANCES EXIST RELATED TO A PROVIDER'S QUALIFICATIONS
OR AVAILABILITY AND THE PROVIDER IS NOT WITHIN THE HEALTH  INSURER'S  OR
HEALTH MAINTENANCE ORGANIZATION'S NETWORK;
  (B)  HEALTH  INSURANCE  POLICY,  PLAN  OR  CONTRACT BENEFITS HAVE BEEN
EXHAUSTED; OR
  (C) OTHER EXTRAORDINARY CIRCUMSTANCES EXIST IN WHICH THERE IS A  CLEAR
SHOWING  THAT  THE  CHILD  HAS A DEMONSTRATED NEED, AS DETERMINED BY THE
HEALTH INSURER OR HEALTH MAINTENANCE ORGANIZATION, IF APPLICABLE, FOR  A
SCREENING,  EVALUATION  OR  SERVICE  RENDERED  BY A PROVIDER WHO HAS NOT
ENTERED INTO A PARTICIPATION AGREEMENT WITH THE CHILD'S  HEALTH  INSURER
OR  HEALTH MAINTENANCE ORGANIZATION FOR THE PROVISION OF SUCH SCREENING,
EVALUATION OR SERVICE.
  2.  ALL  APPROVED  EVALUATORS  AND  PROVIDERS  OF  EARLY  INTERVENTION
SERVICES, EXCEPT SERVICE COORDINATION SERVICES, HEREINAFTER COLLECTIVELY
REFERRED  TO  AS "PROVIDER" OR "PROVIDERS" FOR PURPOSES OF THIS SECTION,
SHALL ESTABLISH AND MAINTAIN CONTRACTS OR AGREEMENTS WITH  A  SUFFICIENT
NUMBER OF HEALTH INSURERS OR HEALTH MAINTENANCE ORGANIZATIONS, INCLUDING
THE  MEDICAL  ASSISTANCE  PROGRAM  OR THE CHILD HEALTH INSURANCE PROGRAM
ESTABLISHED UNDER TITLE ONE-A OF THIS ARTICLE, AS  DETERMINED  NECESSARY
BY  THE COMMISSIONER TO MEET HEALTH INSURER OR HEALTH MAINTENANCE ORGAN-
IZATION NETWORK ADEQUACY; PROVIDED, HOWEVER, THAT THE DEPARTMENT MAY, IN
ITS DISCRETION, APPROVE A PROVIDER WHO  DOES  NOT  HAVE  A  CONTRACT  OR
AGREEMENT  WITH ONE OR MORE HEALTH INSURERS OR HEALTH MAINTENANCE ORGAN-
IZATIONS IF THE PROVIDER RENDERS A SERVICE THAT MEETS A UNIQUE NEED  FOR
SUCH  SERVICE  UNDER  THE EARLY INTERVENTION PROGRAM. APPROVED PROVIDERS
SHALL SUBMIT TO THE DEPARTMENT  INFORMATION  AND  DOCUMENTATION  OF  THE

S. 2606                            132                           A. 3006

HEALTH  INSURERS  AND  HEALTH  MAINTENANCE  ORGANIZATIONS WITH WHICH THE
PROVIDER HOLDS AN AGREEMENT OR CONTRACT.  A PROVIDER'S APPROVAL WITH THE
DEPARTMENT TO DELIVER EVALUATIONS OR EARLY INTERVENTION  SERVICES  SHALL
TERMINATE  IF THE PROVIDER FAILS TO PROVIDE SUCH INFORMATION OR DOCUMEN-
TATION ACCEPTABLE TO THE DEPARTMENT OF ITS CONTRACTS OR AGREEMENTS  WITH
HEALTH  INSURERS OR HEALTH MAINTENANCE ORGANIZATIONS AS REQUESTED BY THE
DEPARTMENT.
  S 8. Subdivision 1 of section  2557  of  the  public  health  law,  as
amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
amended to read as follows:
  1. The approved costs, OTHER THAN  THOSE  REIMBURSABLE  IN  ACCORDANCE
WITH  SECTION  TWENTY-FIVE  HUNDRED  FIFTY-NINE  OF  THIS TITLE, for [an
eligible] A child who receives [an] A SCREENING,  evaluation  and  early
intervention  services pursuant to this title shall be a charge upon the
municipality wherein the eligible child resides or, where  the  services
are  covered by the medical assistance program, upon the social services
district of fiscal responsibility with respect to those  eligible  chil-
dren  who  are  also eligible for medical assistance. All approved costs
shall be paid in the first instance and at least quarterly by the appro-
priate governing body or  officer  of  the  municipality  upon  vouchers
presented  and  audited  in  the same manner as the case of other claims
against the municipality. Notwithstanding the  insurance  law  or  regu-
lations thereunder relating to the permissible exclusion of payments for
services under governmental programs, no such exclusion shall apply with
respect  to  payments  made  pursuant to this title. Notwithstanding the
insurance law or any other law or agreement to  the  contrary,  benefits
under this title shall be considered secondary to any [plan of insurance
or  state  government  benefit program] HEALTH INSURANCE POLICY, PLAN OR
CONTRACT under which an eligible  child  may  have  coverage,  INCLUDING
COVERAGE  AVAILABLE  UNDER  THE  MEDICAL ASSISTANCE PROGRAM OR THE CHILD
HEALTH INSURANCE PROGRAM ESTABLISHED IN TITLE ONE-A OF THIS ARTICLE,  OR
UNDER ANY OTHER GOVERNMENTAL THIRD PARTY PAYOR.  Nothing in this section
shall  increase  or  enhance coverages provided for within [an insurance
contract] A HEALTH INSURANCE POLICY, PLAN OR  CONTRACT  subject  to  the
provisions of this title.
  S  9.  Paragraph  (c)  of  subdivision 3 of section 2559 of the public
health law, as amended by section 11 of part A of chapter 56 of the laws
of 2012, is amended, paragraphs (b) and  (d)  of  such  subdivision  are
relettered  (d)  and (f) and two new paragraphs (b) and (c) are added to
read as follows:
  (B) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE  OR  REGU-
LATION, PAYMENTS MADE BY ANY HEALTH INSURER OR HEALTH MAINTENANCE ORGAN-
IZATION  FOR  SCREENINGS,  EVALUATIONS  AND  SERVICES PROVIDED UNDER THE
EARLY INTERVENTION PROGRAM SHALL BE MADE  AT  RATES  NEGOTIATED  BY  THE
HEALTH  INSURER  OR  HEALTH  MAINTENANCE  ORGANIZATION  AND PROVIDER, IF
APPLICABLE, PROVIDED, HOWEVER, THAT IF  THE  HEALTH  INSURER  OR  HEALTH
MAINTENANCE  ORGANIZATION  MAINTAINS A NETWORK OF PROVIDERS AND EXTRAOR-
DINARY CIRCUMSTANCES EXIST IN WHICH THERE IS  A  CLEAR  SHOWING  THAT  A
CHILD  HAS  A  DEMONSTRATED NEED, AS DETERMINED BY THE HEALTH INSURER OR
HEALTH MAINTENANCE ORGANIZATION, IF APPLICABLE, FOR A SCREENING,  EVALU-
ATION  OR  SERVICE  RENDERED  BY A PROVIDER WHO IS NOT WITHIN THE HEALTH
INSURER'S OR HEALTH MAINTENANCE ORGANIZATION'S NETWORK, PAYMENT TO  SUCH
OUT  OF  NETWORK  PROVIDER  SHALL  BE MADE IN ACCORDANCE WITH THE OUT OF
NETWORK COVERAGE, IF ANY, THAT IS AVAILABLE UNDER THE  HEALTH  INSURANCE
POLICY, PLAN OR CONTRACT.  PAYMENTS MADE BY ANY HEALTH INSURER OR HEALTH
MAINTENANCE  ORGANIZATION  SHALL BE CONSIDERED PAYMENTS IN FULL FOR SUCH

S. 2606                            133                           A. 3006

SERVICES AND THE PROVIDER SHALL NOT SEEK  ADDITIONAL  PAYMENT  FROM  THE
MUNICIPALITY,  CHILD, OR HIS OR HER PARENTS FOR ANY PORTION OF THE COSTS
OF SAID SERVICES. NOTHING HEREIN SHALL  PROHIBIT  A  HEALTH  INSURER  OR
HEALTH  MAINTENANCE  ORGANIZATION FROM APPLYING A COPAYMENT, COINSURANCE
OR DEDUCTIBLE AS SET FORTH IN  THE  HEALTH  INSURANCE  POLICY,  PLAN  OR
CONTRACT.   PAYMENTS FOR COPAYMENTS, COINSURANCE OR DEDUCTIBLES SHALL BE
MADE IN ACCORDANCE WITH PARAGRAPH (D) OF THIS SUBDIVISION.
  (C) WHEN PAYMENT UNDER A HEALTH INSURANCE POLICY, PLAN OR CONTRACT  IS
NOT  AVAILABLE  OR  BENEFITS  HAVE  BEEN EXHAUSTED, PROVIDERS SHALL SEEK
PAYMENT FOR SERVICES IN  ACCORDANCE  WITH  SECTION  TWENTY-FIVE  HUNDRED
FIFTY-SEVEN  OF  THIS  TITLE;  PROVIDED,  HOWEVER,  THAT  IF THE SERVICE
PROVIDED IS A COVERED BENEFIT UNDER THE HEALTH INSURANCE POLICY, PLAN OR
CONTRACT AND PAYMENT HAS BEEN DENIED ON GROUNDS OTHER THAN THAT BENEFITS
HAVE BEEN EXHAUSTED, THE PROVIDER SHALL  EXHAUST  ALL  APPEALS  OF  SAID
DENIAL  PRIOR TO CLAIMING PAYMENT TO THE MUNICIPALITY FOR THE SERVICE IN
ACCORDANCE WITH SECTION TWENTY-FIVE HUNDRED FIFTY-SEVEN OF  THIS  TITLE.
PROVIDERS  SHALL  NOT DISCONTINUE OR DELAY SERVICES TO ELIGIBLE CHILDREN
PENDING PAYMENT OF THE CLAIM OR DETERMINATIONS OF ANY APPEAL DENIALS.
  [(c)] (E) Payments made for early intervention services under  [an]  A
HEALTH insurance policy [or health benefit], plan OR CONTRACT, including
payments  made  by  the  medical  assistance program OR THE CHILD HEALTH
INSURANCE PROGRAM ESTABLISHED UNDER TITLE ONE-A OF THIS ARTICLE or other
governmental third party payor, which are provided as part  of  an  IFSP
pursuant  to  section twenty-five hundred forty-five of this title shall
not be applied by the insurer or plan administrator against any  maximum
lifetime  or  annual  limits  specified in the policy or health benefits
plan,  pursuant  to  section  eleven  of  [the]  chapter  FOUR   HUNDRED
TWENTY-EIGHT of the laws of nineteen hundred ninety-two which added this
title.
  S  10.  Subdivision  7  of  section  2510 of the public health law, as
amended by section 21 of part B of chapter 109 of the laws of  2010,  is
amended to read as follows:
  7.  "Covered  health care services" means: the services of physicians,
optometrists, nurses, nurse practitioners, midwives  and  other  related
professional  personnel  which  are  provided  on  an  outpatient basis,
including routine well-child visits; diagnosis and treatment of  illness
and injury; inpatient health care services; laboratory tests; diagnostic
x-rays;  prescription  and  non-prescription  drugs  and durable medical
equipment; radiation therapy; chemotherapy; hemodialysis; emergency room
services; hospice services; emergency,  preventive  and  routine  dental
care,  including  medically necessary orthodontia but excluding cosmetic
surgery;  emergency,  preventive  and  routine  vision  care,  including
eyeglasses;  speech  and hearing services; and, inpatient and outpatient
mental health, alcohol and substance abuse services as  defined  by  the
commissioner  in  consultation with the superintendent.  "COVERED HEALTH
CARE SERVICES" SHALL ALSO INCLUDE EARLY INTERVENTION  SERVICES  PROVIDED
PURSUANT  TO  TITLE  TWO-A  OF THIS ARTICLE UP TO THE SCOPE AND LEVEL OF
COVERAGE FOR THE SAME SERVICES PROVIDED PURSUANT TO THIS SUBDIVISION, AS
DEFINED BY THE COMMISSIONER. "Covered health care  services"  shall  not
include  drugs,  procedures  and  supplies for the treatment of erectile
dysfunction when provided to, or prescribed for use by, a person who  is
required  to register as a sex offender pursuant to article six-C of the
correction law, provided that any denial  of  coverage  of  such  drugs,
procedures  or  supplies  shall  provide  the  patient with the means of
obtaining additional information concerning  both  the  denial  and  the
means of challenging such denial.

S. 2606                            134                           A. 3006

  S  11.  Paragraph  (b)  of subdivision 5 of section 4403 of the public
health law is relettered paragraph (c) and a new paragraph (b) is  added
to read as follows:
  (B) UPON THE EFFECTIVE DATE OF THIS PARAGRAPH AND AT THE TIME OF EVERY
THREE  YEAR  REVIEW BY THE COMMISSIONER AS SET FORTH IN PARAGRAPH (A) OF
THIS SUBDIVISION, AND UPON APPLICATION FOR EXPANSION  OF  SERVICE  AREA,
THE  HEALTH MAINTENANCE ORGANIZATION SHALL DEMONSTRATE THAT IT MAINTAINS
AN ADEQUATE NETWORK OF PROVIDERS WHO ARE APPROVED TO DELIVER EVALUATIONS
AND EARLY INTERVENTION PROGRAM SERVICES IN ACCORDANCE WITH  TITLE  TWO-A
OF  ARTICLE  TWENTY-FIVE OF THIS CHAPTER, BY SHOWING TO THE SATISFACTION
OF THE COMMISSIONER  THAT:    (1)  THERE  ARE  A  SUFFICIENT  NUMBER  OF
GEOGRAPHICALLY  ACCESSIBLE  PARTICIPATING  PROVIDERS,  AND (2) THERE ARE
SUFFICIENT PROVIDERS IN EACH AREA OF SPECIALTY OF PRACTICE TO  MEET  THE
NEEDS OF THE ENROLLMENT POPULATION.
  S 12. Section 4406 of the public health law is amended by adding a new
subdivision 6 to read as follows:
  6.  (A) NO SUBSCRIBER CONTRACT OR BENEFIT PACKAGE SHALL EXCLUDE COVER-
AGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE BASIS THAT THE SERVICES
CONSTITUTE EARLY INTERVENTION PROGRAM  SERVICES  UNDER  TITLE  TWO-A  OF
ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  (B)  WHERE  A SUBSCRIBER CONTRACT OR BENEFIT PACKAGE PROVIDES COVERAGE
FOR A HEALTH, DIAGNOSTIC OR DEVELOPMENTAL SCREENING OR EVALUATION, OR  A
SERVICE  THAT  IS  PROVIDED  UNDER THE EARLY INTERVENTION PROGRAM AND IS
OTHERWISE COVERED UNDER THE SUBSCRIBER CONTRACT OR BENEFIT PACKAGE, SUCH
COVERAGE SHALL NOT BE APPLIED AGAINST ANY  MAXIMUM  ANNUAL  OR  LIFETIME
MONETARY  LIMITS  SET FORTH IN SUCH SUBSCRIBER CONTRACT OR BENEFIT PACK-
AGE. VISIT LIMITATIONS AND OTHER TERMS AND CONDITIONS OF THE  SUBSCRIBER
CONTRACT OR BENEFIT PACKAGE WILL CONTINUE TO APPLY TO EARLY INTERVENTION
SERVICES.  HOWEVER,  ANY  VISITS  USED  FOR  EARLY  INTERVENTION PROGRAM
SERVICES SHALL NOT REDUCE THE NUMBER OF VISITS  OTHERWISE  AVAILABLE  TO
THE  ENROLLEE  AND  THE  ENROLLEE'S  PARENTS  AND FAMILY MEMBERS WHO ARE
COVERED UNDER THE  SUBSCRIBER  CONTRACT  OR  BENEFIT  PACKAGE  FOR  SUCH
SERVICES THAT ARE NOT PROVIDED UNDER THE EARLY INTERVENTION PROGRAM.
  (C) THE HEALTH MAINTENANCE ORGANIZATION SHALL PROVIDE THE MUNICIPALITY
AND  SERVICE  COORDINATOR  WITH  INFORMATION  ON  THE EXTENT OF BENEFITS
AVAILABLE TO AN ENROLLEE UNDER SUCH SUBSCRIBER CONTRACT OR BENEFIT PACK-
AGE WITHIN FIFTEEN DAYS OF THE HEALTH MAINTENANCE ORGANIZATION'S RECEIPT
OF WRITTEN REQUEST AND NOTICE  AUTHORIZING  SUCH  RELEASE.  THE  SERVICE
COORDINATOR  SHALL  PROVIDE  SUCH  INFORMATION TO THE RENDERING PROVIDER
ASSIGNED TO PROVIDE SERVICES TO THE ENROLLEE.   THE  HEALTH  MAINTENANCE
ORGANIZATION  SHALL FURTHER PROVIDE THE MUNICIPALITY AND SERVICE COORDI-
NATOR WITH A LIST, UPDATED QUARTERLY,  OF  THE  NAMES  OF  PARTICIPATING
PROVIDERS  IN  THE  HEALTH  MAINTENANCE  ORGANIZATION'S  NETWORK WHO ARE
APPROVED TO DELIVER EVALUATIONS AND EARLY INTERVENTION PROGRAM  SERVICES
IN ACCORDANCE WITH TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  (D)  NO  HEALTH  MAINTENANCE  ORGANIZATION  SHALL  REFUSE  TO  ISSUE A
SUBSCRIBER CONTRACT OR BENEFIT PACKAGE OR REFUSE TO RENEW  A  SUBSCRIBER
CONTRACT  OR BENEFIT PACKAGE SOLELY BECAUSE THE APPLICANT OR ENROLLEE IS
RECEIVING SERVICES UNDER THE EARLY INTERVENTION PROGRAM.
  (E) HEALTH MAINTENANCE ORGANIZATIONS SHALL ACCEPT CLAIMS SUBMITTED FOR
PAYMENT UNDER THE CONTRACT OR BENEFIT PACKAGE FROM  A  PROVIDER  THROUGH
THE  DEPARTMENT'S FISCAL AGENT AND DATA SYSTEM FOR SUCH CLAIMING. HEALTH
MAINTENANCE ORGANIZATIONS SHALL, IN A MANNER AND FORMAT AS  REQUIRED  BY
THE  DEPARTMENT,  PROVIDE  THE  DEPARTMENT  WITH  INFORMATION  ON CLAIMS
SUBMITTED FOR SCREENINGS, EVALUATIONS AND  EARLY  INTERVENTION  SERVICES

S. 2606                            135                           A. 3006

PROVIDED  TO ENROLLEES UNDER THE EARLY INTERVENTION PROGRAM AND DISPOSI-
TION OF SUCH CLAIMS.
  (F)  WHERE  A SUBSCRIBER CONTRACT OR BENEFIT PACKAGE PROVIDES COVERAGE
FOR A SCREENING, EVALUATION OR SERVICE PROVIDED UNDER THE  EARLY  INTER-
VENTION PROGRAM, PAYMENT SHALL BE MADE AT RATES NEGOTIATED BY THE HEALTH
MAINTENANCE   ORGANIZATION  AND  PROVIDER  PROVIDED,  HOWEVER,  THAT  IF
EXTRAORDINARY CIRCUMSTANCES EXIST IN WHICH THERE IS A CLEAR SHOWING THAT
AN ENROLLEE HAS A DEMONSTRATED NEED, AS DETERMINED BY THE HEALTH MAINTE-
NANCE ORGANIZATION, FOR A SCREENING, EVALUATION OR SERVICE RENDERED BY A
PROVIDER  WHO  IS  NOT  WITHIN  THE  HEALTH  MAINTENANCE  ORGANIZATION'S
NETWORK,  PAYMENT  TO  SUCH  OUT  OF  NETWORK  PROVIDER SHALL BE MADE IN
ACCORDANCE WITH THE OUT OF NETWORK COVERAGE, IF ANY, THAT  IS  AVAILABLE
UNDER THE SUBSCRIBER CONTACT OR BENEFIT PACKAGE.
  (G)  HEALTH  MAINTENANCE ORGANIZATIONS SHALL, FOR SERVICES RENDERED TO
ENROLLEES UNDER THE EARLY INTERVENTION PROGRAM, AUTHORIZE SUCH PROVISION
OF SERVICES IN SETTINGS THAT ARE NATURAL  OR  TYPICAL  FOR  A  SAME-AGED
INFANT  OR  TODDLER  WITHOUT A DISABILITY, WHICH SHALL INCLUDE THE HOME.
THE  DETERMINATION  OF  THE  APPROPRIATE  LOCATION  OR  SETTING  WHEREIN
SERVICES  ARE  TO BE RENDERED SHALL BE MADE BY THE INDIVIDUALIZED FAMILY
SERVICE PLAN PARTICIPANTS IN ACCORDANCE WITH SECTION TWENTY-FIVE HUNDRED
FORTY-FIVE OF THIS CHAPTER.
  S 13. Subsections (b) and (c) of section 3235-a of the insurance  law,
subsection  (b) as added by section 3 of part C of chapter 1 of the laws
of 2002, subsection (c) as amended by section 17 of part A of chapter 56
of the laws of 2012, are amended and five new subsections (e), (f), (g),
(h) and (i) are added to read as follows:
  (b) Where a policy of  accident  and  health  insurance,  including  a
contract   issued   pursuant   to  [article]  ARTICLES  forty-three  AND
FORTY-SEVEN of this chapter, provides coverage for [an] A HEALTH,  DIAG-
NOSTIC  OR  DEVELOPMENTAL  SCREENING  OR EVALUATION OR A SERVICE THAT IS
PROVIDED UNDER THE early intervention program [service] AND IS OTHERWISE
COVERED UNDER THE POLICY OR CONTRACT, such coverage shall not be applied
against any maximum annual or lifetime monetary limits set forth in such
policy or contract. Visit limitations and other terms and conditions  of
the policy will continue to apply to early intervention services. Howev-
er,  any  visits  used for early intervention program services shall not
reduce the number of visits otherwise available TO  THE  COVERED  PERSON
AND  THE  COVERED  PERSON'S  PARENTS  AND FAMILY MEMBERS WHO ARE COVERED
under the policy or contract for such services  THAT  ARE  NOT  PROVIDED
UNDER THE EARLY INTERVENTION PROGRAM.
  (c)  Any  right  of  subrogation  to  benefits which a municipality or
provider is entitled in accordance with  paragraph  (d)  of  subdivision
three of section twenty-five hundred fifty-nine of the public health law
shall  be  valid  and  enforceable  to the extent benefits are available
under any accident and health insurance policy. The right of subrogation
does not attach to insurance benefits paid or provided under  any  acci-
dent  and  health  insurance  policy  prior to receipt by the insurer of
written notice from the municipality or  provider,  as  applicable.  The
insurer  shall  provide  the  municipality  and service coordinator with
information on the extent of benefits available to  the  covered  person
under  such policy within fifteen days of the insurer's receipt of writ-
ten request and notice authorizing such release. The service coordinator
shall provide such information to the  rendering  provider  assigned  to
provide  services  to  the  [child]  COVERED PERSON.   THE INSURER SHALL
FURTHER PROVIDE THE MUNICIPALITY AND SERVICE COORDINATOR  WITH  A  LIST,
UPDATED  QUARTERLY,  OF THE NAMES OF PROVIDERS IN THE INSURER'S NETWORK,

S. 2606                            136                           A. 3006

IF APPLICABLE, WHO ARE APPROVED BY THE COMMISSIONER OF HEALTH TO DELIVER
EVALUATIONS AND EARLY INTERVENTION PROGRAM SERVICES IN  ACCORDANCE  WITH
TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THE PUBLIC HEALTH LAW.
  (E)  WHERE  A  POLICY  OF  ACCIDENT  AND HEALTH INSURANCE, INCLUDING A
CONTRACT ISSUED PURSUANT TO ARTICLES FORTY-THREE AND FORTY-SEVEN OF THIS
CHAPTER, UTILIZES A NETWORK OF PROVIDERS, THE INSURER SHALL  DEMONSTRATE
TO  THE SUPERINTENDENT, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH,
THAT IT MAINTAINS AN ADEQUATE NETWORK OF PROVIDERS WHO ARE  APPROVED  TO
DELIVER  EVALUATIONS  AND EARLY INTERVENTION PROGRAM SERVICES IN ACCORD-
ANCE WITH TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THE PUBLIC HEALTH LAW BY
DOCUMENTING THAT: (1) THERE ARE A SUFFICIENT  NUMBER  OF  GEOGRAPHICALLY
ACCESSIBLE PARTICIPATING PROVIDERS; AND (2) THERE ARE SUFFICIENT PROVID-
ERS  IN  EACH  AREA  OF  SPECIALTY  OF PRACTICE TO MEET THE NEEDS OF THE
ENROLLMENT POPULATION.
  (F) WHERE A POLICY OF  ACCIDENT  AND  HEALTH  INSURANCE,  INCLUDING  A
CONTRACT ISSUED PURSUANT TO ARTICLES FORTY-THREE AND FORTY-SEVEN OF THIS
CHAPTER,  PROVIDES  COVERAGE  FOR  A HEALTH, DIAGNOSTIC OR DEVELOPMENTAL
SCREENING OR EVALUATION, OR SERVICE  PROVIDED  UNDER  THE  EARLY  INTER-
VENTION PROGRAM, PAYMENT SHALL BE MADE AT RATES NEGOTIATED BY THE INSUR-
ER AND PROVIDER, IF APPLICABLE, PROVIDED, HOWEVER, THAT IF EXTRAORDINARY
CIRCUMSTANCES  EXIST  IN  WHICH  THERE IS A CLEAR SHOWING THAT A COVERED
PERSON HAS A DEMONSTRATED NEED FOR A SCREENING,  EVALUATION  OR  SERVICE
RENDERED  BY  A PROVIDER WHO IS NOT WITHIN THE HEALTH INSURER'S NETWORK,
PAYMENT TO SUCH PROVIDER SHALL BE MADE IN ACCORDANCE  WITH  THE  OUT  OF
NETWORK  COVERAGE,  IF  ANY,  THAT  IS  AVAILABLE  UNDER  THE  POLICY OR
CONTRACT.
  (G) INSURERS SHALL ACCEPT CLAIMS SUBMITTED FOR PAYMENT UNDER THE POLI-
CY OR CONTRACT FROM A PROVIDER THROUGH THE DEPARTMENT OF HEALTH'S FISCAL
AGENT AND DATA SYSTEM FOR SUCH CLAIMING.   INSURERS SHALL, IN  A  MANNER
AND  FORMAT AS REQUIRED BY THE DEPARTMENT OF HEALTH, PROVIDE THE DEPART-
MENT OF HEALTH WITH INFORMATION  ON  CLAIMS  SUBMITTED  FOR  SCREENINGS,
EVALUATIONS  AND EARLY INTERVENTION SERVICES PROVIDED TO COVERED PERSONS
UNDER THE EARLY INTERVENTION PROGRAM AND THE DISPOSITION OF SUCH CLAIMS.
  (H) INSURERS SHALL, FOR SERVICES RENDERED TO COVERED PERSONS UNDER THE
EARLY INTERVENTION PROGRAM, AUTHORIZE  SUCH  PROVISION  OF  SERVICES  IN
SETTINGS  THAT  ARE NATURAL OR TYPICAL FOR A SAME-AGED INFANT OR TODDLER
WITHOUT A DISABILITY, WHICH SHALL INCLUDE THE HOME.   THE  DETERMINATION
OF  THE  APPROPRIATE  LOCATION  OR  SETTING  WHEREIN  SERVICES ARE TO BE
RENDERED SHALL BE MADE BY THE INDIVIDUALIZED FAMILY SERVICE PLAN PARTIC-
IPANTS IN ACCORDANCE WITH SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF  THE
PUBLIC HEALTH LAW.
  (I)  NOTHING  IN THIS SECTION SHALL BE DEEMED TO LIMIT THE SUPERINTEN-
DENT'S AUTHORITY TO IMPOSE NETWORK ADEQUACY REQUIREMENTS ON INSURERS  IN
GENERAL.
  S 14. Section 600 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  600.  State  aid; general requirements. In order to be eligible for
state aid under this title, a municipality shall be required to  do  the
following in accordance with the provisions of this article:
  1.  submit  an  application  to  the department for state aid WHICH IS
APPROVED BY THE COMMISSIONER IN ACCORDANCE WITH SECTION SIX HUNDRED  ONE
OF THIS TITLE;
  [2.  submit  a municipal public health services plan to the department
for approval;
  3. implement and adhere to the municipal public health services  plan,
as approved;

S. 2606                            137                           A. 3006

  4.  submit  a detailed report to the department of all expenditures on
services funded by this title for the immediately preceding fiscal  year
of such municipality;
  5.  employ  a  person  to  supervise  the  provision  of public health
services in accordance with the provisions of section six  hundred  four
of this chapter; and
  6.]  2. PROVIDE ALL CORE PUBLIC HEALTH SERVICES, AS DEFINED IN SECTION
SIX HUNDRED TWO OF THIS TITLE;
  3. SUBMIT A COMMUNITY HEALTH ASSESSMENT IN ACCORDANCE WITH SECTION SIX
HUNDRED TWO-A OF THIS TITLE;
  4. ESTABLISH,  COLLECT  AND  REPORT  FEES  AND  REVENUE  FOR  SERVICES
PROVIDED BY THE MUNICIPALITY, IN ACCORDANCE WITH SECTION SIX HUNDRED SIX
OF THIS TITLE; AND
  5.  appropriate  or  otherwise  make  funds  available  to  finance  a
prescribed share of the cost of public health services.
  S 15. Section 601 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S 601. Application for state aid. 1. The governing body of each  muni-
cipality  desiring  to  make  application for state aid under this title
shall annually, on such dates as  may  be  fixed  by  the  commissioner,
submit an application for such aid.
  2.  The  application  shall  be in such form as the commissioner shall
prescribe, and shall include, but not be limited to:
  (a) an organizational chart of the  municipal  health  agency,  AND  A
STATEMENT  PROVIDING  THE NUMBER OF EMPLOYEES, BY JOB TITLE, PROPOSED TO
PROVIDE PUBLIC HEALTH SERVICES FUNDED BY THIS TITLE;
  (b) a [detailed] budget of proposed expenditures for  services  funded
by this title;
  [(c)  a description of proposed program activities for services funded
by this title;
  (d) a copy of the municipal public health services plan  prepared  and
submitted pursuant to section six hundred two of this title;
  (e)  a  certification  by  the  chief executive officer of the munici-
pality, or in those municipalities with no chief executive  officer  the
chairman  of  the county legislature, that the proposed expenditures and
program activities are consistent with the public health services  plan;
and
  (f)]  (C)  A  DESCRIPTION  OF HOW THE MUNICIPALITY WILL PROVIDE PUBLIC
HEALTH SERVICES;
  (D) AN ATTESTATION BY THE CHIEF EXECUTIVE OFFICER OF THE  MUNICIPALITY
THAT  SUFFICIENT  FUNDS  HAVE  BEEN  APPROPRIATED  TO PROVIDE THE PUBLIC
HEALTH SERVICES FOR WHICH THE MUNICIPALITY IS SEEKING STATE AID;
  (E) AN ATTESTATION BY THE MUNICIPAL OFFICER IN CHARGE OF ADMINISTERING
PUBLIC HEALTH THAT THE MUNICIPALITY HAS DILIGENTLY  REVIEWED  ITS  STATE
AID APPLICATION AND THAT THE APPLICATION SEEKS STATE AID ONLY FOR ELIGI-
BLE PUBLIC HEALTH SERVICES;
  (F) A LIST OF PUBLIC HEALTH SERVICES PROVIDED BY THE MUNICIPALITY THAT
ARE NOT ELIGIBLE FOR STATE AID, AND THE COST OF EACH SERVICE;
  (G) A PROJECTION OF FEES AND REVENUE TO BE COLLECTED FOR PUBLIC HEALTH
SERVICES  ELIGIBLE FOR STATE AID, IN ACCORDANCE WITH SECTION SIX HUNDRED
SIX OF THIS TITLE; AND
  (H) such other information as the commissioner may require.
  3. THE COMMISSIONER SHALL APPROVE THE STATE  AID  APPLICATION  TO  THE
EXTENT  THAT IT IS CONSISTENT WITH THIS SECTION AND ANY OTHER CONDITIONS
OR LIMITATIONS ESTABLISHED IN, OR REGULATIONS PROMULGATED  PURSUANT  TO,
THIS ARTICLE.

S. 2606                            138                           A. 3006

  4.  A  MUNICIPALITY  MAY  AMEND  ITS  STATE  AID  APPLICATION WITH THE
APPROVAL OF THE COMMISSIONER, AND SUBJECT TO ANY RULES  AND  REGULATIONS
THAT THE COMMISSIONER MAY ADOPT.
  S  16.  Section  602  of  the  public health law is REPEALED and a new
section 602 is added to read as follows:
  S 602. CORE PUBLIC HEALTH SERVICES.  1. TO BE ELIGIBLE FOR STATE  AID,
A MUNICIPALITY MUST PROVIDE THE FOLLOWING CORE PUBLIC HEALTH SERVICES:
  (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 PREVENTATIVE CLINICAL HEALTH CARE SERVICES SHALL  NOT  BE
ELIGIBLE FOR STATE AID, SUBJECT TO SUCH EXCEPTIONS FOR PERSONS UNDER THE
AGE OF TWENTY-ONE AS THE COMMISSIONER MAY DEEM APPROPRIATE.
  (B)  COMMUNICABLE  DISEASE  CONTROL, WHICH SHALL INCLUDE ACTIVITIES TO
CONTROL AND MITIGATE THE EXTENT OF INFECTIOUS DISEASES. SUCH  ACTIVITIES
SHALL  INCLUDE,  BUT NOT BE LIMITED TO, SURVEILLANCE AND EPIDEMIOLOGICAL
PROGRAMS, PROGRAMS TO DETECT DISEASES IN THEIR EARLY  STAGES,  IMMUNIZA-
TIONS   AGAINST  INFECTIOUS  DISEASES,  INVESTIGATION  OF  DISEASES  AND
PREVENTION OF TRANSMISSION, PREVENTION AND TREATMENT OF  SEXUALLY  TRAN-
SMISSIBLE DISEASES, AND ARTHROPOD VECTOR-BORNE DISEASE PREVENTION.
  (C)  CHRONIC  DISEASES SERVICES, WHICH SHALL INCLUDE PROMOTING PUBLIC,
HEALTH CARE PROVIDER AND OTHER  COMMUNITY  SERVICE  PROVIDER  ACTIVITIES
THAT  ENCOURAGE  CHRONIC DISEASE PREVENTION, EARLY DETECTION AND QUALITY
CARE DELIVERY. SUCH ACTIVITIES INCLUDE, BUT ARE NOT  LIMITED  TO,  THOSE
THAT PROMOTE HEALTHY COMMUNITIES AND REDUCE RISK FACTORS SUCH AS TOBACCO
USE,  POOR  NUTRITION  AND  PHYSICAL  INACTIVITY.  PROVISION OF CLINICAL
SERVICES SHALL NOT BE ELIGIBLE FOR STATE AID, SUBJECT TO SUCH EXCEPTIONS
AS THE COMMISSIONER MAY DEEM APPROPRIATE.
  (D) COMMUNITY HEALTH ASSESSMENT, AS DESCRIBED IN SECTION  SIX  HUNDRED
TWO-A OF THIS ARTICLE.
  (E)  ENVIRONMENTAL HEALTH, WHICH SHALL INCLUDE ACTIVITIES THAT PROMOTE
HEALTH AND PREVENT ILLNESS AND INJURY BY ASSURING THAT SAFE AND SANITARY
CONDITIONS ARE  MAINTAINED  AT  PUBLIC  DRINKING  WATER  SUPPLIES,  FOOD
SERVICE  ESTABLISHMENTS,  AND  OTHER REGULATED FACILITIES; INVESTIGATING
PUBLIC HEALTH NUISANCES TO  ASSURE  ABATEMENT  BY  RESPONSIBLE  PARTIES;
PROTECTING THE PUBLIC FROM UNNECESSARY EXPOSURE TO RADIATION, CHEMICALS,
AND  OTHER  HARMFUL CONTAMINANTS; AND CONDUCTING INVESTIGATIONS OF INCI-
DENTS THAT RESULT IN ILLNESS, INJURY OR DEATH IN ORDER TO  IDENTIFY  AND
MITIGATE  THE  ENVIRONMENTAL  CAUSES TO PREVENT ADDITIONAL MORBIDITY AND
MORTALITY.
  (F) PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE, INCLUDING PLAN-
NING, TRAINING, AND MAINTAINING READINESS FOR PUBLIC HEALTH EMERGENCIES.
  2. THE MUNICIPALITY MUST INCORPORATE  INTO  EACH  CORE  PUBLIC  HEALTH
SERVICE THE FOLLOWING GENERAL ACTIVITIES:
  (A) ONGOING ASSESSMENT OF COMMUNITY HEALTH NEEDS;
  (B) EDUCATION ON PUBLIC HEALTH ISSUES;
  (C) DEVELOPMENT OF POLICIES AND PLANS TO ADDRESS HEALTH NEEDS; AND

S. 2606                            139                           A. 3006

  (D)  ACTIONS  TO ASSURE THAT SERVICES NECESSARY TO ACHIEVE AGREED UPON
GOALS ARE PROVIDED.
  3.  A  MUNICIPALITY MAY PROVIDE FEWER SERVICES THAN THOSE SET FORTH IN
SUBDIVISION ONE OF THIS SECTION, IF THE COMMISSIONER  DETERMINES  WITHIN
HIS  DISCRETION  THAT ANOTHER ENTITY IS WILLING AND ABLE TO PROVIDE SUCH
SERVICES.
  S 17. The public health law is amended by adding a new  section  602-a
to read as follows:
  S 602-A. COMMUNITY HEALTH ASSESSMENT.  1. EVERY MUNICIPALITY SHALL, ON
SUCH DATES AS MAY BE FIXED BY THE COMMISSIONER, SUBMIT TO THE DEPARTMENT
A COMMUNITY HEALTH ASSESSMENT.
  2.  THE  COMMUNITY  HEALTH  ASSESSMENT  SHALL  BE  IN SUCH FORM AS THE
COMMISSIONER SHALL PRESCRIBE, AND SHALL INCLUDE, BUT NOT BE LIMITED TO:
  (A) AN ESTIMATE AND DESCRIPTION OF THE HEALTH STATUS OF THE POPULATION
AND FACTORS THAT CONTRIBUTE TO HEALTH ISSUES;
  (B) IDENTIFICATION  OF  PRIORITY  AREAS  FOR  HEALTH  IMPROVEMENT,  IN
CONJUNCTION WITH THE STATE HEALTH IMPROVEMENT PLAN;
  (C)  IDENTIFICATION  OF PUBLIC HEALTH SERVICES IN THE MUNICIPALITY AND
IN THE COMMUNITY AND OTHER RESOURCES THAT CAN BE  MOBILIZED  TO  IMPROVE
POPULATION  HEALTH,  PARTICULARLY  IN THOSE PRIORITY AREAS IDENTIFIED IN
PARAGRAPH (B) OF THIS SUBDIVISION; AND
  (D) A COMMUNITY HEALTH IMPROVEMENT PLAN CONSISTING OF  ACTIONS,  POLI-
CIES,  STRATEGIES  AND  MEASURABLE  OBJECTIVES THROUGH WHICH THE MUNICI-
PALITY AND ITS COMMUNITY PARTNERS WILL ADDRESS AREAS FOR HEALTH IMPROVE-
MENT AND TRACK PROGRESS TOWARD IMPROVEMENT OF PUBLIC HEALTH OUTCOMES.
  S 18. Section 603 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S 603. [Municipal public health  services  plan]  CORE  PUBLIC  HEALTH
SERVICES; implementation. 1. In order to be eligible for state aid under
this  title,  each  municipality shall administer its CORE public health
[programs] SERVICES in accordance with [its  approved  municipal  public
health  services  plan  and] THE standards of performance established by
the commissioner through rules and regulations [and] PURSUANT TO SECTION
SIX HUNDRED NINETEEN  OF  THIS  ARTICLE.  EACH  MUNICIPALITY  shall,  in
particular,  ensure that public health services are provided in an effi-
cient and effective manner to all persons in the municipality.
  2. The commissioner may withhold state aid  reimbursement  under  this
title  for  the appropriate services if, on ANY audit [and], review OF A
STATE AID APPLICATION OR PERIODIC CLAIM FOR STATE AID, OR OTHER INFORMA-
TION AVAILABLE TO THE  DEPARTMENT,  the  commissioner  finds  that  such
services are not furnished or rendered in conformance with the rules and
regulations  established  by the commissioner, INCLUDING BUT NOT LIMITED
TO THE STANDARDS OF PERFORMANCE  ESTABLISHED  PURSUANT  TO  SECTION  SIX
HUNDRED  NINETEEN  OF  THIS  ARTICLE,  or that the expenditures were not
[made according to the approved public health services plan required by]
FOR AN ACTIVITY SET FORTH IN section six hundred two of this  title.  In
such  cases, the commissioner, in order to ensure that the public health
is promoted as defined  in  [paragraph  (b)  of  subdivision  three  of]
section  six  hundred two of this title, may use any proportionate share
of a municipality's per  capita  or  base  grant  that  is  withheld  to
contract  with  agencies,  associations,  or  organizations.  The health
department may use any such withheld  share  to  provide  services  upon
approval  of  the director of the division of the budget. Copies of such
transactions shall be filed with the fiscal committees of  the  legisla-
ture.

S. 2606                            140                           A. 3006

  3.  CONSISTENT  WITH  PARAGRAPH  (H) OF SUBDIVISION TWO OF SECTION SIX
HUNDRED ONE OF THIS TITLE, WHEN DETERMINING WHETHER TO APPROVE  A  STATE
AID  APPLICATION OR PERIODIC CLAIM FOR STATE AID, THE COMMISSIONER SHALL
HAVE AUTHORITY TO REQUEST ANY AND  ALL  FINANCIAL  AND  OTHER  DOCUMENTS
NECESSARY OR RELEVANT TO VERIFY THAT THE CLAIMED EXPENDITURES ARE ELIGI-
BLE FOR STATE AID UNDER THIS ARTICLE.
  S 19. Section 604 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  604. Supervision of public health programs. In order to be eligible
for state aid, under this title, each municipality shall employ a  full-
time local commissioner of health or public health director to supervise
the  provision  of public health services [and to implement the approved
public health services plan]  for  that  municipality,  SUBJECT  TO  THE
FOLLOWING EXCEPTIONS:
  1.  SUCH  PERSON  MAY SERVE AS THE HEAD OF A MERGED AGENCY OR MULTIPLE
AGENCIES, IF THE APPROVAL OF THE COMMISSIONER IS OBTAINED; AND
  2. SUCH PERSON MAY SERVE AS THE LOCAL COMMISSIONER OF HEALTH OR PUBLIC
HEALTH DIRECTOR OF ADDITIONAL  COUNTIES,  WHEN  AUTHORIZED  PURSUANT  TO
SECTION THREE HUNDRED FIFTY-ONE OF THIS CHAPTER.
  S 20. Section 605 of the public health law, as added by chapter 901 of
the  laws  of  1986,  subdivision 1 as amended by section 6 of part B of
chapter 57 of the laws of 2006, subdivision 2 as amended by  section  13
of  part  A  of  chapter  59  of the laws of 2011, is amended to read as
follows:
  S 605. State aid; amount of reimbursement. 1. A state aid  base  grant
shall  be reimbursed to municipalities for the [base] CORE public health
services identified in [paragraph (b) of subdivision three  of]  section
six  hundred  two  of this title, in an amount of the greater of [fifty-
five] SIXTY-FIVE cents per capita, for each person in the  municipality,
or  [five]  SIX hundred fifty thousand dollars provided that the munici-
pality expends at least [five] SIX hundred fifty  thousand  dollars  for
such [base] CORE public health services. A municipality must provide all
the  [basic] CORE public health services identified in [paragraph (b) of
subdivision three of] section six hundred two of this title  to  qualify
for  such  base  grant  unless  the municipality has the approval of the
commissioner to expend the base grant on a portion of such  [base]  CORE
public  health services. If any services in such [paragraph (b)] SECTION
are not [approved in the plan or  if  no  plan  is  submitted  for  such
services]  PROVIDED,  the  commissioner may limit the municipality's per
capita or base grant to [that proportionate share which will fund  those
services that are submitted in a plan and subsequently approved] REFLECT
THE SCOPE OF THE REDUCED SERVICES. The commissioner may use the [propor-
tionate  share]  AMOUNT  that  is not granted to contract with agencies,
associations, or organizations to provide such services; or  the  health
department may use such proportionate share to provide the services upon
approval of the director of the division of the budget.
  2.  State  aid  reimbursement for public health services provided by a
municipality under this title, shall be  made  if  the  municipality  is
providing some or all of the [basic] CORE public health services identi-
fied  in [paragraph (b) of subdivision three of] section six hundred two
of this title, pursuant to an approved [plan] APPLICATION FOR STATE AID,
at a rate of no less  than  thirty-six  per  centum  of  the  difference
between  the  amount  of  moneys expended by the municipality for public
health services required by [paragraph  (b)  of  subdivision  three  of]
section  six  hundred  two  of this title during the fiscal year and the
base grant provided pursuant to subdivision one of this section. No such

S. 2606                            141                           A. 3006

reimbursement shall be provided for services [if they are  not  approved
in  a  plan  or  if no plan is submitted for such services] THAT ARE NOT
ELIGIBLE FOR STATE AID PURSUANT TO THIS ARTICLE.
  3.  Municipalities  shall  make  every  reasonable  effort  to collect
payments for public health services provided. All such revenues shall be
reported to the commissioner PURSUANT TO SECTION SIX HUNDRED SIX OF THIS
TITLE and will be deducted from expenditures identified  under  subdivi-
sion two of this section to produce a net cost eligible for state aid.
  S 21. Section 606 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  606.  Assessment  of fees; THIRD-PARTY COVERAGE OR INDEMNIFICATION.
1. Assessment of fees  by  municipalities.    [Each  municipality  shall
assess  fees  for  services  provided by such municipality in accordance
with a fee and revenue plan which shall include a schedule of fees  that
the  municipality  proposes to charge for each service identified by the
commissioner and each additional service identified by the  municipality
for  which  a fee is to be charged. In accordance with the provisions of
subdivision four of section six hundred two of this chapter, the commis-
sioner shall review each fee and revenue plan submitted to him  and,  on
the  basis  of  such  review, issue a notice of intent to disapprove the
plan or approve the plan, with or without conditions, within ninety days
of his receipt of the plan. In determining whether to approve or  disap-
prove  a  plan,  the commissioner shall consider the extent to which the
plan, once implemented, will satisfy standards  which  the  commissioner
has  promulgated through rules and regulations after consulting with the
public health council and county health commissioners, boards and public
health directors. Such standards shall include a list of those  environ-
mental,  personal  health  and  other  services  for which fees shall be
charged, the calculation of cost by each municipality and the  relation-
ship  of  cost to fees, and provisions for prohibiting the assessment of
fees which would impede the delivery of services deemed essential to the
protection of the health of the public.] EACH MUNICIPALITY SHALL  ESTAB-
LISH A SCHEDULE OF FEES FOR PUBLIC HEALTH SERVICES PROVIDED BY THE MUNI-
CIPALITY  AND  SHALL  MAKE EVERY REASONABLE EFFORT TO COLLECT SUCH FEES.
Fees for personal health services shall be reflective of an individual's
ability to pay and shall not  be  inconsistent  with  the  reimbursement
guidelines  of  articles twenty-eight and thirty-six of this chapter and
applicable federal laws and regulations. To the extent possible revenues
generated shall be used to enhance or expand public health services.  IN
ITS STATE AID APPLICATION, EACH MUNICIPALITY SHALL PROVIDE  THE  DEPART-
MENT  WITH  A  PROJECTION  OF  FEES AND REVENUE TO BE COLLECTED FOR THAT
YEAR. EACH MUNICIPALITY SHALL PERIODICALLY REPORT TO THE DEPARTMENT FEES
AND REVENUE ACTUALLY COLLECTED.
  2. Assessment of fees by the commissioner. In each  municipality,  the
commissioner  shall  establish  a  fee  and  revenue  plan  for services
provided by the department in a manner consistent with the standards and
regulations established pursuant to subdivision one of this section.
  3. THIRD PARTY COVERAGE OR  INDEMNIFICATION.  FOR  ANY  PUBLIC  HEALTH
SERVICE  FOR  WHICH  COVERAGE  OR  INDEMNIFICATION FROM A THIRD PARTY IS
AVAILABLE, THE MUNICIPALITY MUST SEEK SUCH COVERAGE  OR  INDEMNIFICATION
AND  REPORT  ANY  ASSOCIATED  REVENUE TO THE DEPARTMENT IN ITS STATE AID
APPLICATION.
  S 22. Subdivisions 1 and 2 of section 609 of the public health law, as
amended by chapter 474 of the laws of  1996,  are  amended  to  read  as
follows:

S. 2606                            142                           A. 3006

  1.  Where  a  laboratory  shall  have been or is hereafter established
pursuant to article five of this chapter, the state, through the  legis-
lature and within the limits to be prescribed by the commissioner, shall
provide  aid  at  a  per  centum,  determined  in  accordance  with  the
provisions  of [paragraph (b) of] subdivision two of section six hundred
five of this article, of the  actual  cost  of  [installation,]  REPAIR,
RELOCATION,  equipment and maintenance of the laboratory or laboratories
FOR SERVICES ASSOCIATED WITH A CORE PUBLIC HEALTH SERVICE, AS  DESCRIBED
IN  SECTION  SIX  HUNDRED  TWO  OF  THIS TITLE.   Such cost shall be the
excess, if any, of such expenditures  over  available  revenues  of  all
types, including adequate and reasonable fees, derived from or attribut-
able to the performance of laboratory services.
  2.  Where a county or city provides or shall have provided for labora-
tory service by contracting with an established laboratory FOR  SERVICES
ASSOCIATED  WITH  A CORE PUBLIC HEALTH SERVICE, AS DESCRIBED IN SUBDIVI-
SION THREE OF SECTION SIX HUNDRED TWO OF THIS TITLE, with  the  approval
of  the commissioner, it shall be entitled to state aid at a per centum,
determined in accordance with  the  provisions  of  [paragraph  (b)  of]
subdivision two of section six hundred five of this article, of the cost
of the contracts. [State aid shall be available for a district laborato-
ry  supply  station  maintained  and operated in accordance with article
five of this chapter in the same manner and to the same  extent  as  for
laboratory services.]
  S 23. Sections 610 and 612 of the public health law are REPEALED.
  S  24.  Paragraphs  (a)  and (c) of subdivision 1 and subdivision 4 of
section 613 of the public health law, paragraphs (a) and (c) of subdivi-
sion 1 as amended by chapter 36 of the laws of 2010,  subdivision  4  as
amended  by  chapter  207  of  the  laws of 2004, are amended to read as
follows:
  (a) The commissioner shall develop and supervise the  execution  of  a
program of immunization, surveillance and testing, to raise to the high-
est  reasonable  level the immunity of the children of the state against
communicable diseases including, but not limited to, influenza,  poliom-
yelitis,  measles,  mumps, rubella, haemophilus influenzae type b (Hib),
diphtheria, pertussis, tetanus,  varicella,  hepatitis  B,  pneumococcal
disease,  and the immunity of adults of the state against diseases iden-
tified by the commissioner, including  but  not  limited  to  influenza,
smallpox,  [and]  hepatitis  AND SUCH OTHER DISEASES AS THE COMMISSIONER
MAY DESIGNATE THROUGH REGULATION.  [The commissioner shall encourage the
municipalities] MUNICIPALITIES in  the  state  [to  develop  and]  shall
[assist  them  in  the  development  and the execution of] DEVELOP local
programs of [inoculation] IMMUNIZATION to  raise  the  immunity  of  the
children  and  adults  of  each  municipality  to the highest reasonable
level. Such programs shall include ASSURANCE OF  provision  of  vaccine,
[surveillance  of  vaccine  effectiveness by means of laboratory tests,]
serological testing of individuals and  educational  efforts  to  inform
health  care  providers and target populations or their parents, if they
are minors, of the facts relative to these  diseases  and  [inoculation]
IMMUNIZATIONS to prevent their occurrence.
  (c)  The commissioner shall invite and encourage the active assistance
and cooperation in such education activities of: the medical  societies,
organizations  of  other  licensed  health  personnel, hospitals, corpo-
rations subject to article  forty-three  of  the  insurance  law,  trade
unions, trade associations, parents and teachers and their associations,
organizations of child care resource and referral agencies, the media of
mass communication, and such other voluntary groups and organizations of

S. 2606                            143                           A. 3006

citizens  as  he  or  she  shall deem appropriate. The public health AND
HEALTH PLANNING council, the department of education, the department  of
family  assistance,  and  the department of mental hygiene shall provide
the  commissioner with such assistance in carrying out the program as he
or she shall request.  All other state agencies shall also  render  such
assistance  as the commissioner may reasonably require for this program.
Nothing in this subdivision shall authorize  mandatory  immunization  of
adults  or  children,  except as provided in sections twenty-one hundred
sixty-four and twenty-one hundred sixty-five of this chapter.
  4. The commissioner shall expend such funds as the  legislature  shall
make available for the purchase of the vaccines described in subdivision
one  of  this  section.  [All  immunization vaccines purchased with such
funds shall be purchased by sealed competitive state  bids  through  the
office  of  general  services.  Immunization vaccine] VACCINES purchased
with funds made available under this section  shall  be  made  available
without  charge  to  licensed private physicians, hospitals, clinics and
such others as the commissioner  shall  determine  [in  accordance  with
regulations  to be promulgated by the commissioner], and no charge shall
be made to any patient for such vaccines.
  S 25. Subdivisions 5, 6 and 7 of section 613 of the public health  law
are REPEALED.
  S  26. Subdivision 2 of section 614 of the public health law, as added
by chapter 901 of the laws of 1986, is amended to read as follows:
  2. "City", each city of the state having a population of [fifty  thou-
sand]  ONE  MILLION  or  more,  according  to the last preceding federal
census[, but does not include any such city which is included as a  part
of a county health district pursuant to this chapter].
  S 27. Section 616 of the public health law, as added by chapter 901 of
the  laws of 1986 and subdivision 1 as amended by section 9 of part B of
chapter 57 of the laws of 2006, is amended to read as follows:
  S 616. Limitations on state aid. 1. The  total  amount  of  state  aid
provided  pursuant to this article shall be limited to the amount of the
annual appropriation made by the  legislature.  In  no  event,  however,
shall  such  state  aid  be less than an amount to provide the full base
grant and, as otherwise provided by paragraph (a) of subdivision two  of
section six hundred five of this article, at least thirty-six per centum
of  the  difference between the amount of moneys expended by the munici-
pality for ELIGIBLE public health services [required by paragraph (b) of
subdivision three of section six hundred two of this  article]  PURSUANT
TO  AN APPROVED APPLICATION FOR STATE AID during the fiscal year and the
base grant provided pursuant to subdivision one of section  six  hundred
five  of  this article. [A municipality shall also receive not less than
thirty-six per centum of the moneys expended  for  other  public  health
services  pursuant  to  paragraph  (b) of subdivision two of section six
hundred five of this article,  and,  at  least  the  minimum  amount  so
required for the services identified in title two of this article.]
  2.  No payments shall be made from moneys appropriated for the purpose
of this article to a municipality OR CONTRACTORS OF THE MUNICIPALITY for
contributions by the municipality for indirect costs  and  fringe  bene-
fits,  including  but  not limited to, employee retirement funds, health
insurance and federal old age and survivors insurance.
  S 28. Section 617 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S 617. Maintenance of effort. Such amount of state aid  provided  will
be  used to support and to the extent practicable, to increase the level
of funds that would otherwise be made available for  such  purposes  and

S. 2606                            144                           A. 3006

not  to  supplant  the amount to be provided by the municipalities. If a
municipality that is provided state aid pursuant to title  one  of  this
article reduces its expenditures beneath the amount expended in its base
year,  which  is  [the  greater  of  its expenditures in its fiscal year
ending in either nineteen hundred eighty-five or] the most recent fiscal
year for which the municipality has filed [an  annual]  ALL  expenditure
[report]  REPORTS  to  the  department, state aid reimbursement provided
pursuant to subdivision one of section six hundred five of this  article
will  be  reduced  by  the  [difference  between  the reduction in local
expenditures between its base year and its current fiscal year  and  the
reduction in state aid between the base year and the current fiscal year
pursuant  to  paragraphs  (a)  and (b) of subdivision two of section six
hundred five of  this  article.  A  municipality  may  include  revenue,
excluding  third  party  reimbursement,  raised  by  the municipality in
calculating its maintenance of effort] PERCENTAGE REDUCTION IN  EXPENDI-
TURES BETWEEN ITS BASE YEAR AND ITS CURRENT FISCAL YEAR. FOR PURPOSES OF
THIS  SECTION,  REDUCTIONS  IN  EXPENDITURES  SHALL  BE ADJUSTED FOR: AN
ABSENCE OF EXTRAORDINARY EXPENDITURES OF A  TEMPORARY  NATURE,  SUCH  AS
DISASTER  RELIEF; UNAVOIDABLE OR JUSTIFIABLE PROGRAM REDUCTIONS, SUCH AS
A PROGRAM BEING SUBSUMED BY ANOTHER AGENCY; OR  IN  CIRCUMSTANCES  WHERE
THE MUNICIPALITY CAN DEMONSTRATE, TO THE DEPARTMENT'S SATISFACTION, THAT
THE NEED FOR THE EXPENDITURE NO LONGER EXISTS.
  S 29. Section 618 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S  618. Performance and accountability.  The commissioner shall estab-
lish,  in  consultation  with  the  municipalities,  uniform   statewide
performance  standards for the services funded pursuant to this article;
provided, however, the commissioner may modify a specific standard for a
municipality if such municipality demonstrates  adequate  justification.
The  commissioner  shall recognize the particular needs and capabilities
of the  various  municipalities.  The  commissioner  shall  monitor  the
PERFORMANCE  AND  expenditures  of each municipality to ensure that each
one satisfies the performance standards.  Any  municipality  failing  to
satisfy its standards may be subject to a reduction or loss of aid until
such  municipality  can  demonstrate that it has the capacity to satisfy
such standards. [The commissioner shall establish a  uniform  accounting
system for monitoring the expenditures for services of each municipality
to  which aid is granted, and for determining the appropriateness of the
costs of such services. The commissioner shall also establish a  uniform
reporting  system  to  determine  the  appropriateness of the amount and
types of services provided, and the  number  of  people  receiving  such
services.    Such reporting system shall also require information on the
amount of public health moneys received from the federal government, the
private sector, grants, and fees. Each such  municipality  shall  comply
with  the  regulations  of  such  accounting  and reporting systems. The
commissioner shall determine the extent to which the services maintained
and improved the health status of a municipality's residents  and  main-
tained   and  improved  the  accessibility  and  quality  of  care,  and
controlled costs of the health care system.]
  S 30. Section 619 of the public health law, as added by chapter 901 of
the laws of 1986, is amended to read as follows:
  S 619. Commissioner; regulatory powers. The commissioner  [shall]  MAY
adopt  regulations  to  effectuate  the  provisions and purposes of this
article, including, but not limited to:
  1. setting standards of performance [and  reasonable  costs]  for  the
provision  of  [basic]  CORE  public health services which shall include

S. 2606                            145                           A. 3006

performance criteria to ensure that  reimbursable  health  services  are
delivered in an efficient and effective manner by a municipality; and
  2. monitoring, COLLECTING DATA and evaluating the provision of [basic]
CORE  public  health  services  by  the  municipalities  and the amounts
expended by the municipalities for such services.
  S 31. The public health law is amended by adding a new  section  619-a
to read as follows:
  S  619-A.  INCENTIVE STANDARDS OF PERFORMANCE. 1. THE COMMISSIONER MAY
ESTABLISH STATEWIDE INCENTIVE PERFORMANCE STANDARDS FOR THE DELIVERY  OF
CORE PUBLIC HEALTH SERVICES.
  2.  WITHIN  AMOUNTS  APPROPRIATED,  AND SUBJECT TO THE APPROVAL OF THE
DIRECTOR OF THE BUDGET, THE COMMISSIONER MAY INCREASE STATE AID  TO  ANY
MUNICIPALITY THAT MEETS OR EXCEEDS STATEWIDE INCENTIVE PERFORMANCE STAN-
DARDS  ESTABLISHED  UNDER  THIS SECTION, PROVIDED THAT THE TOTAL OF SUCH
PAYMENTS TO ALL MUNICIPALITIES MAY NOT EXCEED ONE MILLION DOLLARS  ANNU-
ALLY.
  S  32.  The article heading of article 23 of the public health law, as
amended by chapter 878 of the laws  of  1980,  is  amended  to  read  as
follows:
        CONTROL OF SEXUALLY [TRANSMISSIBLE] TRANSMITTED DISEASES
  S  33. Sections 2300, 2301, 2302 and 2303 of the public health law are
REPEALED.
  S 34. The section heading and subdivisions 1 and 2 of section 2304  of
the  public  health  law, as amended by chapter 878 of the laws of 1980,
are amended and two new subdivisions 4  and  5  are  added  to  read  as
follows:
  Sexually  [transmissible]  TRANSMITTED diseases; treatment facilities;
administration. 1. It shall be  the  responsibility  of  each  board  of
health  of  a  health  district  to  provide adequate facilities for the
[free] diagnosis and treatment of persons living within its jurisdiction
who are suspected of being infected or  are  infected  with  a  sexually
[transmissible] TRANSMITTED disease.
  2.  The  health officer of said health district shall administer these
facilities DIRECTLY OR THROUGH CONTRACT and shall  promptly  examine  or
arrange  for the examination of persons suspected of being infected with
a sexually  [transmissible]  TRANSMITTED  disease,  and  shall  promptly
institute  treatment  or  arrange  for  the  treatment of those found or
otherwise known to be infected with a sexually [transmissible] TRANSMIT-
TED disease, provided that any person may, at his option, be treated  at
his  own  expense  by a [licensed physician] HEALTH CARE PRACTITIONER of
his choice.
  4. EACH BOARD OF HEALTH AND LOCAL HEALTH  OFFICER  SHALL  ENSURE  THAT
DIAGNOSIS  AND  TREATMENT  SERVICES  ARE  AVAILABLE AND, TO THE GREATEST
EXTENT PRACTICABLE, SEEK THIRD PARTY  COVERAGE  OR  INDEMNIFICATION  FOR
SUCH  SERVICES; PROVIDED, HOWEVER, THAT NO BOARD OF HEALTH, LOCAL HEALTH
OFFICER, OR OTHER MUNICIPAL OFFICER OR ENTITY SHALL REQUEST  OR  REQUIRE
THAT  SUCH  COVERAGE  OR  INDEMNIFICATION  BE UTILIZED AS A CONDITION OF
PROVIDING DIAGNOSIS OR TREATMENT SERVICES.
  5. THE TERM "HEALTH OFFICER" AS USED IN  THIS  ARTICLE  SHALL  MEAN  A
COUNTY  HEALTH  OFFICER, A CITY HEALTH OFFICER, A TOWN HEALTH OFFICER, A
VILLAGE HEALTH OFFICER, THE HEALTH  OFFICER  OF  A  CONSOLIDATED  HEALTH
DISTRICT OR A STATE DISTRICT HEALTH OFFICER.
  S 35. Section 2305 of the public health law, as amended by chapter 878
of the laws of 1980, is amended to read as follows:
  S  2305.  Sexually [transmissible] TRANSMITTED diseases; [treatment by
licensed physician or staff  physician  of  a  hospital;  prescriptions]

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TREATMENT  OF  MINORS.   [1. No person, other than a licensed physician,
or, in a hospital, a staff physician, shall diagnose, treat or prescribe
for a person who is infected with a sexually transmissible  disease,  or
who has been exposed to infection with a sexually transmissible disease,
or dispense or sell a drug, medicine or remedy for the treatment of such
person except on prescription of a duly licensed physician.
  2.  A  licensed  physician,  or  in  a hospital, a staff physician,] A
HEALTH CARE PRACTITIONER WHO IS AUTHORIZED  UNDER  TITLE  EIGHT  OF  THE
EDUCATION  LAW  TO DIAGNOSE AND PRESCRIBE DRUGS FOR SEXUALLY TRANSMITTED
INFECTIONS, ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE, may diag-
nose, treat or prescribe for a person  under  the  age  of  [twenty-one]
EIGHTEEN years without the consent or knowledge of the parents or guard-
ian of said person[, where such person is infected with a sexually tran-
smissible  disease,  or  has  been  exposed to infection with a sexually
transmissible disease].
  [3. For the purposes of this section, the term "hospital" shall mean a
hospital as defined in article twenty-eight of this chapter.]
  S 36. Section 2306 of the public health law, as amended by chapter  41
of the laws of 2010, is amended to read as follows:
  S  2306.  Sexually  [transmissible]  TRANSMITTED diseases; reports and
information, confidential. All reports or information secured by a board
of health or health officer under the provisions of this  article  shall
be  confidential  except  in  so  far  as  is necessary to carry out the
purposes of this article. Such report or information may be disclosed by
court order in a criminal proceeding in which it is otherwise admissible
or in a proceeding pursuant to article ten of the family  court  act  in
which it is otherwise admissible, to the prosecution and to the defense,
or  in  a  proceeding pursuant to article ten of the family court act in
which it is otherwise admissible,  to  the  petitioner,  respondent  and
attorney  for  the  child,  provided  that  the subject of the report or
information has waived the confidentiality provided for by this  section
EXCEPT  INSOFAR  AS IS NECESSARY TO CARRY OUT THE PURPOSES OF THIS ARTI-
CLE. INFORMATION MAY BE DISCLOSED TO THIRD PARTY  REIMBURSERS  OR  THEIR
AGENTS  TO  THE  EXTENT NECESSARY TO REIMBURSE HEALTH CARE PROVIDERS FOR
HEALTH SERVICES; PROVIDED THAT, WHEN NECESSARY, AN OTHERWISE APPROPRIATE
AUTHORIZATION FOR SUCH DISCLOSURE HAS BEEN SECURED BY  THE  PROVIDER.  A
person  waives  the confidentiality provided for by this section if such
person voluntarily discloses or consents to disclosure of such report or
information or a portion thereof. If such person lacks the  capacity  to
consent to such a waiver, his or her parent, guardian or attorney may so
consent.  An  order  directing disclosure pursuant to this section shall
specify that no report or information shall  be  disclosed  pursuant  to
such  order  which  identifies  or  relates to any person other than the
subject of the report or information. REPORTS  AND  INFORMATION  MAY  BE
USED  IN  THE AGGREGATE IN PROGRAMS APPROVED BY THE COMMISSIONER FOR THE
IMPROVEMENT OF THE QUALITY OF MEDICAL  CARE  PROVIDED  TO  PERSONS  WITH
SEXUALLY  TRANSMITTED  DISEASES;  OR  WITH PATIENT IDENTIFIERS 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  IDENTIFIERS  SHALL  NOT  BE
DISCLOSED OUTSIDE THE STATE OR LOCAL HEALTH DEPARTMENT.
  S  37. The section heading and subdivisions 1 and 2 of section 2308 of
the public health law are amended to read as follows:
  [Venereal] SEXUALLY TRANSMITTED disease; pregnant  women;  blood  test
for  syphilis.    1. Every physician, OR HEALTH CARE PRACTITIONER ACTING
WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE, attending pregnant women  in

S. 2606                            147                           A. 3006

the  state shall in the case of every woman so attended take or cause to
be taken a sample of blood of such woman at the time of  first  examina-
tion,  and  submit  such sample to an approved laboratory for a standard
serological test for syphilis.
  2.  Every  other person permitted by law to attend upon pregnant women
in the state but not permitted by law to take blood tests, shall cause a
sample of the blood of such pregnant woman to be  taken  promptly  by  a
duly licensed physician, OR OTHER HEALTH CARE PRACTITIONER ACTING WITHIN
HIS  OR HER LAWFUL SCOPE OF PRACTICE, and submitted to an approved labo-
ratory for a standard serological test for syphilis.
  S 38. Section 2308-a of the public health law, as amended  by  chapter
878 of the laws of 1980, is amended to read as follows:
  S  2308-a.  Sexually  [transmissible]  TRANSMITTED diseases; tests for
sexually [transmissible] TRANSMITTED diseases.   1.  The  administrative
officer  or other person in charge of a clinic or other facility provid-
ing gynecological, obstetrical, genito-urological, contraceptive, steri-
lization or termination of pregnancy services or treatment shall require
the staff of such clinic or facility to offer  to  administer  to  every
resident  of the state of New York coming to such clinic or facility for
such services or treatment, appropriate examinations or  tests  for  the
detection of sexually [transmissible] TRANSMITTED diseases.
  2. Each physician providing gynecological, obstetrical, genito-urolog-
ical, contraceptive, sterilization, or termination of pregnancy services
or treatment shall offer to administer to every resident of the state of
New York coming to such physician for such services or treatment, appro-
priate  examinations or tests for the detection of sexually [transmissi-
ble] TRANSMITTED diseases.
  S 39. Sections 2309 and 2310 of the public health law are REPEALED.
  S 40. Section 2311 of the public health law, as added by  chapter  878
of the laws of 1980, is amended to read as follows:
  S 2311. Sexually [transmissible] TRANSMITTED disease list. The commis-
sioner  shall  promulgate a list of sexually [transmissible] TRANSMITTED
diseases, such as gonorrhea and syphilis, for the purposes of this arti-
cle. The commissioner, in determining the diseases  to  be  included  in
such  list,  shall  consider those conditions principally transmitted by
sexual contact, OTHER SECTIONS OF THIS CHAPTER  ADDRESSING  COMMUNICABLE
DISEASES  and  the impact of particular diseases on individual morbidity
and the health of newborns.
  S 41. Section 2 of chapter 577 of  the  laws  of  2008,  amending  the
public  health  law  relating  to  expedited partner therapy for persons
infected with chlamydia trachomatis, is amended to read as follows:
  S 2. This act shall take effect on the one hundred twentieth day after
it shall have become a law [and shall  expire  and  be  deemed  repealed
January 1, 2014].
  S 42. The public health law is amended by adding a new article 12-A to
read as follows:
                              ARTICLE 12-A
                      OUTCOME BASED CONTRACTING AND
                      OUTCOME BASED HEALTH PLANNING
SECTION 1202. LEGISLATIVE FINDINGS.
        1203. OUTCOME  BASED  CONTRACTING AND OUTCOME BASED HEALTH PLAN-
                NING.
        1204. OUTCOME BASED AREAS.
  S 1202. LEGISLATIVE FINDINGS.  1.  THE  LEGISLATURE  DECLARES  THAT  A
COMPREHENSIVE,  INTEGRATED  APPROACH  TO  PUBLIC  HEALTH AND HEALTH CARE
REQUIRES THAT THE DEPARTMENT HAVE  THE  FLEXIBILITY  TO  PROMOTE  BETTER

S. 2606                            148                           A. 3006

HEALTH  OUTCOMES,  TARGET RESOURCES EFFECTIVELY AND ADDRESS EXISTING AND
NEW OR EMERGING HEALTH ISSUES.
  2.  TO  ENSURE THAT RESOURCES ARE USED EFFICIENTLY AND EFFECTIVELY, IT
IS IMPORTANT THAT CONTRACTORS, TO THE EXTENT  DEEMED  NECESSARY  BY  THE
COMMISSIONER,  CARRY  OUT THE PURPOSES OF THIS ARTICLE AND BE SUBJECT TO
OUTCOME-BASED PERFORMANCE MEASURES.
  S 1203. OUTCOME BASED CONTRACTING AND OUTCOME BASED  HEALTH  PLANNING.
1.  WITHIN AMOUNTS APPROPRIATED THEREFOR, THE COMMISSIONER IS AUTHORIZED
TO MAKE GRANTS, AWARDS, DISBURSEMENTS, AND OTHER PAYMENTS AND TRANSFERS,
AND  MAY  ENTER  INTO  OR CONTINUE EXISTING CONTRACTS AND AGREEMENTS AND
OTHERWISE DISBURSE FUNDS TO GOVERNMENTAL, PUBLIC, NON-PROFIT OR  PRIVATE
ENTITIES  AS  NECESSARY  TO  ACCOMPLISH THE PURPOSES OF THIS ARTICLE, IN
EACH OF THE AREAS SET FORTH IN SECTION TWELVE HUNDRED FOUR OF THIS ARTI-
CLE.
  2. FUNDING SHALL BE AWARDED UNDER THIS ARTICLE IN THE NUMBER,  AMOUNTS
AND  MANNER DETERMINED BY THE COMMISSIONER ON A COMPETITIVE BASIS, WHEN-
EVER   PRACTICABLE,   PURSUANT   TO   ONE   OR   MORE    REQUESTS    FOR
APPLICATION/PROPOSAL PROCESSES COVERING EACH OR MULTIPLE AREAS SET FORTH
IN  SECTION  TWELVE  HUNDRED  FOUR  OF  THIS  ARTICLE OR OTHER ALLOWABLE
OPTIONS IN THE STATE FINANCE LAW. THE COMMISSIONER  SHALL  POST  ON  THE
DEPARTMENT'S  WEBSITE NOTICES OF FUNDING AVAILABILITY AND INCLUDE STATE-
MENTS TO ENCOURAGE EXISTING AND NEW PROVIDERS TO PARTICIPATE.
  3. PAYMENTS PURSUANT TO GRANT AWARDS AND OTHER DISBURSEMENTS OR TRANS-
FERS MADE UNDER THIS ARTICLE SHALL BE BASED ON THE INTENDED  ACHIEVEMENT
OF OUTCOMES AS SPECIFIED BY THE COMMISSIONER.
  4. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW WITHIN THIS CHAP-
TER,  THE  COMMISSIONER  SHALL NOT AWARD GRANTS, ENTER INTO CONTRACTS OR
CONTINUE CONTRACTS OR MAKE DISBURSEMENTS OR CONDUCT  PROGRAM  ACTIVITIES
WITH  RESPECT TO ANY PROGRAM OR ACTIVITY AUTHORIZED IN THIS CHAPTER THAT
THE COMMISSIONER DEEMS TO FALL WITHIN THE AREAS  SET  FORTH  IN  SECTION
TWELVE  HUNDRED  FOUR OF THIS ARTICLE, UNLESS THE COMMISSIONER EVALUATES
THE PROGRAM OR PROGRAM ACTIVITY AND DETERMINES  THAT  IT  IS  CONSISTENT
WITH THE OBJECTIVES AND STANDARDS OF THIS ARTICLE.
  S  1204.  OUTCOME  BASED AREAS. GRANT AWARDS, AND OTHER DISBURSEMENTS,
PAYMENTS OR TRANSFERS AND PROGRAM  ACTIVITIES  IN  THE  FOLLOWING  AREAS
SHALL BE SUBJECT TO THIS ARTICLE:
  1. WITHIN AMOUNTS APPROPRIATED, THE AREA OF CHRONIC DISEASE PREVENTION
AND  TREATMENT,  WHICH  SHALL BE DESIGNED TO IMPLEMENT EVIDENCE AND BEST
PRACTICE BASED APPROACHES TO CHRONIC DISEASE THAT EMPHASIZE  THE  IMPOR-
TANCE OF PREVENTIVE CARE AND HEALTHIER ENVIRONMENTS.  SUCH GRANTS SHOULD
ALSO,  TO THE EXTENT FEASIBLE, COMPLEMENT THE STATE'S EFFORTS TO PROMOTE
INTEGRATED CARE MANAGEMENT STRATEGIES IN THE PROVISION  OF  HEALTH  CARE
AND  LONG  TERM  CARE  SUPPORT.  THE  DEPARTMENT  SHALL IDENTIFY CHRONIC
DISEASES THAT ARE PUBLIC HEALTH PRIORITIES. TO THAT END AND  SUBJECT  TO
THE PROVISIONS OF THIS ARTICLE THE DEPARTMENT IS AUTHORIZED TO:
  (A)  DEVELOP AND/OR SUPPORT IMPLEMENTATION OF ENVIRONMENTAL APPROACHES
THAT PROMOTE HEALTH AND PREVENT DISEASE AND SUPPORT AND REINFORCE  HEAL-
THY BEHAVIORS IN VARIOUS SECTORS;
  (B)  DEVELOP  AND/OR  SUPPORT  PROGRAMS OF PUBLIC HEALTH MARKETING AND
COMMUNICATION, INCLUDING DEVELOPING, ADAPTING, PROMOTING AND DISSEMINAT-
ING PUBLIC  EDUCATION  MATERIALS  AND  CAMPAIGNS  TO  REDUCE  MORBIDITY,
MORTALITY AND HEALTH DISPARITIES;
  (C)  DEVELOP  AND/OR SUPPORT ACTIVITIES TO PROMOTE EARLY DETECTION AND
QUALITY CARE DELIVERY BY HEALTHCARE AND OTHER COMMUNITY SERVICE  PROVID-
ERS;

S. 2606                            149                           A. 3006

  (D)  CONDUCT  AND/OR  SUPPORT EPIDEMIOLOGY AND SURVEILLANCE TO GATHER,
ANALYZE, AND DISSEMINATE DATA AND INFORMATION AND CONDUCT EVALUATIONS TO
INFORM, PRIORITIZE, DELIVER AND MONITOR PROGRAM ACTIVITIES  AND  POPULA-
TION-LEVEL RISK FACTORS, DISEASES AND HEALTH; AND
  (E) ANY OTHER FUNCTIONS DEEMED NECESSARY BY THE COMMISSIONER TO IMPLE-
MENT THE PURPOSES OF THIS ARTICLE.
  2.  WITHIN  AMOUNTS  APPROPRIATED, IN THE AREA OF ENVIRONMENTAL HEALTH
AND INFECTIOUS DISEASE, WHICH SHALL BE  DESIGNED  TO  MINIMIZE  RISK  TO
POPULATION  HEALTH POSED BY ENVIRONMENTAL FACTORS AND INFECTIOUS DISEASE
AND IMPLEMENT EVIDENCE AND BEST PRACTICE BASED APPROACHES THAT EMPHASIZE
THE IMPORTANCE OF PREVENTION OF EXPOSURES. THE DEPARTMENT SHALL IDENTIFY
ENVIRONMENTAL CONDITIONS AND RELATED DISEASES AND EXPOSURES THAT  IMPACT
HUMAN  HEALTH  AND  IDENTIFY  PRIORITY  COMMUNICABLE  DISEASES AND SHALL
DEVELOP PROGRAMS TO PREVENT AND  ADDRESS  THOSE  PRIORITY  ENVIRONMENTAL
CONDITIONS AND COMMUNICABLE DISEASES, THEIR RISK FACTORS, MODES OF TRAN-
SMISSION  AND  PREVENTION.  TO THAT END AND SUBJECT TO THE PROVISIONS OF
THIS ARTICLE THE DEPARTMENT IS AUTHORIZED TO:
  (A) DEVELOP AND/OR SUPPORT  PROGRAMS  FOR  IDENTIFICATION,  SCREENING,
INSPECTION,  INVESTIGATION, ASSESSMENT, SURVEILLANCE, PREVENTION, TREAT-
MENT AND OUTREACH;
  (B) DEVELOP AND/OR SUPPORT PROGRAMS FOR POPULATION  BASED  PREVENTION,
PUBLIC EDUCATION AND OUTREACH;
  (C)  DEVELOP  AND/OR  SUPPORT  PROGRAMS FOR PROFESSIONAL EDUCATION AND
TRAINING IN OUTREACH, PREVENTION, DETECTION AND TREATMENT; AND
  (D) ANY OTHER FUNCTIONS DEEMED NECESSARY BY THE COMMISSIONER TO IMPLE-
MENT THE PURPOSES OF THIS ARTICLE.
  3. WITHIN AMOUNTS APPROPRIATED, IN THE  AREA  OF  MATERNAL  AND  CHILD
HEALTH  AND NUTRITION, WHICH SHALL BE DESIGNED TO IMPLEMENT EVIDENCE AND
BEST PRACTICE BASED APPROACHES TO MATERNAL AND CHILD HEALTH  AND  NUTRI-
TION  THAT  EMPHASIZE  THE IMPORTANCE OF PREVENTIVE CARE. THE DEPARTMENT
SHALL IDENTIFY ADVERSE MATERNAL AND CHILD HEALTH OUTCOMES AND  NUTRITION
RISKS  THAT  ARE  PRIORITIES,  AND SHALL DEVELOP PROGRAMS TO PREVENT AND
ADDRESS THOSE PRIORITY ADVERSE MATERNAL AND CHILD  HEALTH  OUTCOMES  AND
NUTRITION RISKS AND THEIR CAUSES, AND REDUCE HEALTH DISPARITIES. TO THAT
END  AND  SUBJECT  TO  THE  PROVISION  OF THIS ARTICLE THE DEPARTMENT IS
AUTHORIZED TO:
  (A) DEVELOP AND/OR SUPPORT  PROGRAMS  FOR  IDENTIFICATION,  SCREENING,
INVESTIGATION,  PREVENTION, TREATMENT AND OUTREACH, SURVEILLANCE, EVALU-
ATION AND SERVICE PROVISION;
  (B) DEVELOP AND/OR SUPPORT PROGRAMS  FOR  PROFESSIONAL  EDUCATION  AND
TRAINING  IN  OUTREACH,  PREVENTION,  DETECTION  TREATMENT  AND  SERVICE
PROVISION; AND
  (C) ANY OTHER FUNCTIONS DEEMED NECESSARY BY THE COMMISSIONER TO IMPLE-
MENT THE PURPOSES OF THIS ARTICLE.
  4. WITHIN THE AMOUNTS APPROPRIATED, IN THE AREAS OF HIV, AIDS, HEPATI-
TIS C AND SEXUALLY TRANSMITTED DISEASES,  WHICH  SHALL  BE  DESIGNED  TO
IMPLEMENT  EVIDENCE  AND  BEST  PRACTICE  BASED APPROACHES TO HIV, AIDS,
HEPATITIS C AND SEXUALLY TRANSMITTED DISEASE PREVENTION  AND  CARE.  THE
DEPARTMENT  SHALL IDENTIFY HIV AND AIDS, STD AND HEPATITIS C PREVENTION,
IDENTIFICATION AND TREATMENT PRIORITIES AND SHALL  DEVELOP  PROGRAMS  TO
PREVENT  AND  ADDRESS HIV AND AIDS, STD AND HEPATITIS C. TO THAT END AND
SUBJECT TO THE PROVISION OF THIS ARTICLE THE  DEPARTMENT  IS  AUTHORIZED
TO:
  (A)  DEVELOP  AND/OR  SUPPORT  PROGRAMS FOR IDENTIFICATION, SCREENING,
INVESTIGATION, SURVEILLANCE, PREVENTION,  TREATMENT,  SUPPORT,  OUTREACH
AND SERVICE PROVISION;

S. 2606                            150                           A. 3006

  (B)  DEVELOP  AND/OR  SUPPORT  PROGRAMS FOR PROFESSIONAL EDUCATION AND
TRAINING IN OUTREACH,  PREVENTION,  DETECTION,  SUPPORT,  TREATMENT  AND
SERVICE PROVISION;
  (C)  DEVELOP  AND/OR  SUPPORT PROGRAMS THAT ENSURE THE APPROPRIATENESS
AND QUALITY OF HIV/AIDS, STD, AND HEPATITIS C SERVICES; AND
  (D) ANY OTHER FUNCTIONS DEEMED NECESSARY BY THE COMMISSIONER TO IMPLE-
MENT THE PURPOSES OF THIS ARTICLE.
  5. WITHIN AMOUNTS APPROPRIATED, IN THE  AREA  OF  HEALTH  QUALITY  AND
OUTCOMES,  WHICH  SHALL BE DESIGNED TO SUPPORT CORE PRIORITY INITIATIVES
THAT ADDRESS IMPROVED POPULATION HEALTH  OUTCOMES,  PATIENT  SAFETY  AND
QUALITY.  TO  THAT END AND SUBJECT TO THE PROVISIONS OF THIS ARTICLE THE
DEPARTMENT IS AUTHORIZED TO:
  (A) CARRY OUT PATIENT SAFETY AND OUTCOMES RESEARCH;
  (B) USE EVIDENCE AND POPULATION HEALTH PRINCIPLES AND  BEST  PRACTICES
TO DRIVE IMPROVEMENT IN HEALTHCARE QUALITY AND PATIENT SAFETY;
  (C)  DEVELOP  OR  SUPPORT PROGRAMS TO ASSESS, EVALUATE AND COMMUNICATE
FINDINGS RELATED TO HEALTH CARE QUALITY AND SAFETY; AND
  (D) ANY OTHER FUNCTIONS DEEMED NECESSARY BY THE COMMISSIONER TO IMPLE-
MENT THE PURPOSES OF THIS ARTICLE.
  6. WITHIN AMOUNTS APPROPRIATED, IN THE AREA OF WORKFORCE  DEVELOPMENT,
WHICH  SHALL  BE DESIGNED TO BETTER ADDRESS THE GOALS OF IMPROVING CARE,
IMPROVING HEALTH, AND REDUCING COSTS, AND PREPARING  FOR  THE  INCREASED
DEMAND  FOR SERVICES RESULTING FROM THE IMPLEMENTATION OF FEDERAL HEALTH
CARE REFORM. TO THAT END AND SUBJECT TO THE PROVISIONS OF  THIS  ARTICLE
THE DEPARTMENT IS AUTHORIZED TO:
  (A) TRAIN ADDITIONAL HEALTH CARE WORKERS;
  (B) FOCUS ON TRAINING NEW HEALTH CARE WORKERS AND RE-TRAINING EXISTING
HEALTH  CARE EMPLOYEES IN EMERGING MODELS OF COLLABORATIVE CARE, WORK IN
CULTURALLY COMPETENT, PATIENT-CENTERED INTERDISCIPLINARY TEAMS, MAXIMIZ-
ING UTILIZATION OF  HEALTH  INFORMATION  TECHNOLOGY,  AND  TO  OTHERWISE
ADDRESS CHANGES IN THE HEALTH CARE DELIVERY SYSTEM;
  (C)  TRAIN  HEALTH  CARE  WORKERS TO CARE FOR HIGH NEED AND VULNERABLE
POPULATIONS WITH COMPLEX MEDICAL, BEHAVIORAL, AND LONG-TERM CARE NEEDS;
  (D) PROVIDE SERVICES  IN  COMMUNITIES  THAT  EXPERIENCE  SHORTAGES  OF
PHYSICIANS AND OTHER HEALTH CARE WORKERS;
  (E)  PROVIDE  TRAINING  OF PHYSICIANS IN CLINICAL RESEARCH IN ORDER TO
IMPROVE THE HEALTH STATUS OF THE POPULATION THROUGH ADVANCES IN BIOMEDI-
CAL RESEARCH; AND
  (F) ANY OTHER FUNCTIONS DEEMED NECESSARY BY THE COMMISSIONER TO IMPLE-
MENT THE PURPOSES OF THIS ARTICLE.
  S 43. Subdivisions 1, 2, 2-a, 2-b and 3 of section 2802 of the  public
health law, subdivisions 1, 2 and 2-b as amended by section 58 of part A
of  chapter  58  of the laws of 2010, subdivision 2-a as added and para-
graph (e) of subdivision 3 as amended by chapter  731  of  the  laws  of
1993,  subdivision  3 as amended by chapter 609 of the laws of 1982, are
amended to read as follows:
  1. An application for  such  construction  shall  be  filed  with  the
department,  together  with such other forms and information as shall be
prescribed by, or acceptable to, the department. Thereafter the  depart-
ment  shall forward a copy of the application and accompanying documents
to the public health and health planning council, and the health systems
agency, if any, having geographical jurisdiction of the area  where  the
hospital is located.
  2. The commissioner shall not act upon an application for construction
of  a  hospital  until the public health and health planning council and
the health systems agency have had a reasonable  time  to  submit  their

S. 2606                            151                           A. 3006

recommendations, and unless (a) the applicant has obtained all approvals
and  consents  required  by  law  for its incorporation or establishment
(including the approval of the public health and health planning council
pursuant  to the provisions of this article) provided, however, that the
commissioner may act upon an application for construction by  an  appli-
cant possessing a valid operating certificate when the application qual-
ifies  for  review without the recommendation of the council pursuant to
regulations adopted by the council and approved by the commissioner; and
(b) the commissioner  is  satisfied  as  to  the  public  need  for  the
construction,  at  the  time  and  place  and  under  the  circumstances
proposed, provided however that[,] in the case of an application by: (I)
a hospital established or operated by an organization defined in  subdi-
vision  one  of section four hundred eighty-two-b of the social services
law, the needs of the members of the religious  denomination  concerned,
for  care  or  treatment  in  accordance with their religious or ethical
convictions, shall be deemed to be public need[.]; (II) A GENERAL HOSPI-
TAL OR DIAGNOSTIC AND TREATMENT CENTER, ESTABLISHED UNDER THIS  ARTICLE,
TO  CONSTRUCT A FACILITY TO PROVIDE PRIMARY CARE SERVICES, AS DEFINED IN
REGULATION, THE CONSTRUCTION MAY BE APPROVED WITHOUT REGARD  FOR  PUBLIC
NEED;  OR (III) A GENERAL HOSPITAL OR A DIAGNOSTIC AND TREATMENT CENTER,
ESTABLISHED UNDER THIS ARTICLE, TO UNDERTAKE CONSTRUCTION THAT DOES  NOT
INVOLVE  A  CHANGE  IN  CAPACITY,  THE TYPES OF SERVICES PROVIDED, MAJOR
MEDICAL EQUIPMENT, FACILITY REPLACEMENT, OR THE GEOGRAPHIC  LOCATION  OF
SERVICES,  THE  CONSTRUCTION  MAY  BE APPROVED WITHOUT REGARD FOR PUBLIC
NEED.
  2-a. The council shall afford the applicant an opportunity to  present
information  in  person  concerning an application to a committee desig-
nated by the council.
  2-b. Beginning on January first,  nineteen  hundred  ninety-four,  and
each  year  thereafter,  a complete application received between January
first and June thirtieth of each year shall be reviewed by the appropri-
ate health systems agency and the department and presented to the public
health and health planning council for its consideration prior  to  June
thirtieth  of  the  following  year  and a complete application received
between July first and December  thirty-first  of  each  year  shall  be
reviewed by the appropriate health systems agency and the department and
presented to the public health and health planning council for consider-
ation prior to December thirty-first of the following year.
  3.  Subject to the provisions of paragraph (b) of subdivision two, the
commissioner in approving the construction of a hospital shall take into
consideration and be empowered to request information and advice  as  to
(a)  the  availability  of  facilities or services such as preadmission,
ambulatory or home care services which  may  serve  as  alternatives  or
substitutes  for  the  whole  or  any  part  of  the  proposed  hospital
construction;
  (b) the need for special equipment in view of existing utilization  of
comparable  equipment  at the time and place and under the circumstances
proposed;
  (c) the possible economies and improvements in service  to  be  antic-
ipated  from  the operation of joint central services including, but not
limited  to  laboratory,  research,  radiology,  pharmacy,  laundry  and
purchasing;
  (d) the adequacy of financial resources and sources of future revenue,
PROVIDED THAT THE COMMISSIONER MAY, BUT IS NOT REQUIRED TO, CONSIDER THE
ADEQUACY  OF  FINANCIAL  RESOURCES  AND  SOURCES  OF  FUTURE  REVENUE IN

S. 2606                            152                           A. 3006

RELATION TO APPLICATIONS UNDER SUBPARAGRAPHS (II) AND (III) OF PARAGRAPH
(B) OF SUBDIVISION TWO OF THIS SECTION; and
  (e)  whether  the facility is currently in substantial compliance with
all applicable codes, rules and regulations, provided, however, that the
commissioner shall not disapprove an application  solely  on  the  basis
that  the  facility  is  not currently in substantial compliance, if the
application is specifically:
  (i) to correct life safety code or patient care deficiencies;
  (ii) to correct deficiencies which are necessary to protect the  life,
health, safety and welfare of facility patients, residents or staff;
  (iii)  for replacement of equipment that no longer meets the generally
accepted operational standards existing for such equipment at  the  time
it was acquired; and
  (iv) for decertification of beds and services.
  S  44.  Subdivisions 1, 2 and 3 of section 2807-z of the public health
law, as amended by chapter 400 of the laws of 2012, are amended to  read
as follows:
  1. Notwithstanding any provision of this chapter or regulations or any
other  state  law  or  regulation,  for  any eligible capital project as
defined in subdivision six of this section, the  department  shall  have
thirty days of receipt of the certificate of need OR CONSTRUCTION appli-
cation,  PURSUANT  TO  SECTION TWENTY-EIGHT HUNDRED TWO OF THIS ARTICLE,
for  a  limited  or  administrative  review  to  deem  such  application
complete.  If the department determines the application is incomplete or
that more information is  required,  the  department  shall  notify  the
applicant in writing within thirty days of the date of the application's
submission, and the applicant shall have twenty business days to provide
additional information or otherwise correct the deficiency in the appli-
cation.
  2.  For an eligible capital project requiring a limited or administra-
tive review, within ninety days of the department deeming  the  applica-
tion complete, the department shall make a decision to approve or disap-
prove  the  certificate  of  need  OR  CONSTRUCTION application for such
project. If the department determines to  disapprove  the  project,  the
basis for such disapproval shall be provided in writing; however, disap-
proval  shall  not be based on the incompleteness of the application. If
the department fails to take action to approve or disapprove the  appli-
cation  within  ninety days of the certificate of need application being
deemed complete, the application will be deemed approved.
  3. For an eligible capital project requiring full review by the  coun-
cil, the certificate of need OR CONSTRUCTION application shall be placed
on the next council agenda following the department deeming the applica-
tion complete.
  S 45. Intentionally omitted.
  S  46.  Section 2801-a of the public health law is amended by adding a
new subdivision 3-b to read as follows:
  3-B. NOTWITHSTANDING ANY OTHER  PROVISIONS  OF  THIS  CHAPTER  TO  THE
CONTRARY,  THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL MAY APPROVE THE
ESTABLISHMENT OF DIAGNOSTIC OR TREATMENT CENTERS TO BE ISSUED  OPERATING
CERTIFICATES  FOR  THE  PURPOSE OF PROVIDING PRIMARY CARE, AS DEFINED BY
THE COMMISSIONER IN REGULATIONS, WITHOUT REGARD TO THE  REQUIREMENTS  OF
PUBLIC NEED AND FINANCIAL RESOURCES AS SET FORTH IN SUBDIVISION THREE OF
THIS SECTION.
  S  47.  Subdivision  3  of section 2801-a of the public health law, as
amended by section 57 of part A of chapter 58 of the laws  of  2010,  is
amended to read as follows:

S. 2606                            153                           A. 3006

  3.  The  public health and health planning council shall not approve a
certificate of incorporation, articles of  organization  or  application
for  establishment  unless it is satisfied, insofar as applicable, as to
(a) the public need for the existence of the institution at the time and
place  and  under the circumstances proposed, provided, however, that in
the case of an institution proposed to be established or operated by  an
organization  defined in subdivision one of section one hundred seventy-
two-a of the executive law, the needs of the members  of  the  religious
denomination  concerned,  for care or treatment in accordance with their
religious or ethical convictions, shall be deemed to be public need; (b)
the character,  competence,  and  standing  in  the  community,  of  the
proposed  incorporators,  directors,  sponsors, stockholders, members or
operators; with respect to any proposed incorporator, director, sponsor,
stockholder, member or operator who is already or within the past  [ten]
SEVEN years has been an incorporator, director, sponsor, member, princi-
pal  stockholder, principal member, or operator of any hospital, private
proprietary home for adults, residence for adults,  or  non-profit  home
for  the aged or blind which has been issued an operating certificate by
the state department of social services, or a halfway house,  hostel  or
other  residential  facility  or  institution  for  the care, custody or
treatment of the mentally disabled which is subject to approval  by  the
department  of  mental  hygiene, no approval shall be granted unless the
public health and health planning council, having afforded  an  adequate
opportunity  to  members  of  health  systems  agencies,  if any, having
geographical jurisdiction of the area where the  institution  is  to  be
located to be heard, shall affirmatively find by substantial evidence as
to  each  such incorporator, director, sponsor, MEMBER, principal stock-
holder, PRINCIPAL MEMBER, or operator that  a  substantially  consistent
high level of care is being or was being rendered in each such hospital,
home, residence, halfway house, hostel, or other residential facility or
institution  with  which  such  person  is  or  was  affiliated; for the
purposes of this paragraph, the public health and health planning  coun-
cil  shall  adopt  rules and regulations, subject to the approval of the
commissioner, to establish the criteria to be used to determine  whether
a  substantially  consistent  high  level  of  care  has  been rendered,
provided, however, that there shall not be a finding that a substantial-
ly consistent high level of care has been rendered where there have been
violations of the state hospital code, or  other  applicable  rules  and
regulations,  that  (i) threatened to directly affect the health, safety
or welfare of any patient or resident, and (ii) were recurrent  or  were
not  promptly  corrected,  UNLESS  THE  PROPOSED INCORPORATOR, DIRECTOR,
SPONSOR, STOCKHOLDER, MEMBER OR OPERATOR DEMONSTRATES,  AND  THE  PUBLIC
HEALTH  AND HEALTH PLANNING COUNCIL FINDS, THAT THE VIOLATIONS CANNOT BE
ATTRIBUTED TO THE ACTION OR  INACTION  OF  SUCH  PROPOSED  INCORPORATOR,
DIRECTOR,  SPONSOR,  STOCKHOLDER,  MEMBER OR OPERATOR DUE TO THE TIMING,
EXTENT OR MANNER OF THE AFFILIATION; (c) the financial resources of  the
proposed  institution  and  its sources of future revenues; and (d) such
other matters as it shall deem pertinent.
  S 48. Subdivision 4 of section 2801-a of the  public  health  law,  as
amended  by  section  57 of part A of chapter 58 of the laws of 2010, is
amended to read as follows:
  4. (a) Any change in the person who is  the  operator  of  a  hospital
shall  be  approved  by the public health and health planning council in
accordance with the provisions of subdivisions two  and  three  of  this
section.  Notwithstanding  any inconsistent provision of this paragraph,
any change by a natural person who is the operator of a hospital seeking

S. 2606                            154                           A. 3006

to transfer part of his or her interest  in  such  hospital  to  another
person  or  persons  so  as to create a partnership shall be approved in
accordance with the provisions of paragraph (b) of this subdivision.
  (b) [(i)] Any transfer, assignment or other disposition of ten percent
or more of [an] DIRECT OR INDIRECT interest or voting rights in [a part-
nership  or  limited  liability  company, which is the] AN operator of a
hospital to a new STOCKHOLDER,  partner  or  member,  OR  ANY  TRANSFER,
ASSIGNMENT  OR  OTHER  DISPOSITION  OF  A DIRECT OR INDIRECT INTEREST OR
VOTING RIGHTS OF SUCH AN OPERATOR WHICH  RESULTS  IN  THE  OWNERSHIP  OR
CONTROL  OF  MORE  THAN  TEN PERCENT OF THE INTEREST OR VOTING RIGHTS OF
SUCH OPERATOR BY ANY PERSON NOT PREVIOUSLY APPROVED BY THE PUBLIC HEALTH
AND HEALTH PLANNING COUNCIL, OR ITS PREDECESSOR, FOR THAT OPERATOR shall
be approved by the public health and health planning council, in accord-
ance with the provisions of subdivisions two and three of this  section,
except that: (A) any such change shall be subject to the approval by the
public  health  and health planning council in accordance with paragraph
(b) of subdivision three of this section only with respect  to  the  new
STOCKHOLDER, partner or member, and any remaining STOCKHOLDERS, partners
or  members  who  have not been previously approved for that facility in
accordance with such paragraph, and (B) such change shall not be subject
to paragraph (a) of subdivision three of this section. IN THE ABSENCE OF
SUCH APPROVAL, THE OPERATING  CERTIFICATE  OF  SUCH  HOSPITAL  SHALL  BE
SUBJECT TO REVOCATION OR SUSPENSION.
  [(ii)]  (C)  (I) With respect to a transfer, assignment or disposition
involving less than ten percent of [an] A DIRECT OR INDIRECT interest or
voting rights in [such partnership  or  limited  liability  company]  AN
OPERATOR OF A HOSPITAL to a new STOCKHOLDER, partner or member, no prior
approval  of  the  public  health  and  health planning council shall be
required. However, no such transaction  shall  be  effective  unless  at
least  ninety  days  prior  to  the intended effective date thereof, the
[partnership or limited liability company] OPERATOR fully completes  and
files  with  the  public  health and health planning council notice on a
form, to be developed by the public health and health planning  council,
which shall disclose such information as may reasonably be necessary for
the  public  health  and health planning council to determine whether it
should bar the transaction for any of the reasons set forth in item (A),
(B), (C) or (D) below. Within ninety days from the date  of  receipt  of
such  notice,  the public health and health planning council may bar any
transaction under this subparagraph: (A) if the equity position  of  the
[partnership  or  limited  liability  company,]  OPERATOR, determined in
accordance with  generally  accepted  accounting  principles,  would  be
reduced  as  a result of the transfer, assignment or disposition; (B) if
the transaction would result in  the  ownership  of  a  [partnership  or
membership]  DIRECT OR INDIRECT interest OR VOTING RIGHTS by any persons
who have been convicted of a felony described  in  subdivision  five  of
section  twenty-eight  hundred  six  of  this  article; (C) if there are
reasonable grounds to believe that the  proposed  transaction  does  not
satisfy  the  character and competence criteria set forth in subdivision
three of this section; or (D) UPON THE RECOMMENDATION OF THE DEPARTMENT,
if the transaction, together with all transactions under  this  subpara-
graph for the [partnership] OPERATOR, or successor, during any five year
period  would,  in the aggregate, involve twenty-five percent or more of
the interest in the [partnership] OPERATOR. The public health and health
planning council shall state specific reasons  for  barring  any  trans-
action  under  this  subparagraph  and shall so notify each party to the
proposed transaction.

S. 2606                            155                           A. 3006

  [(iii) With respect to a transfer, assignment  or  disposition  of  an
interest  or  voting  rights  in  such  partnership or limited liability
company to any remaining partner or member, which  transaction  involves
the withdrawal of the transferor from the partnership or limited liabil-
ity  company, no prior approval of the public health and health planning
council shall be required. However, no such transaction shall be  effec-
tive  unless  at  least ninety days prior to the intended effective date
thereof, the partnership or limited liability  company  fully  completes
and files with the public health and health planning council notice on a
form,  to be developed by the public health and health planning council,
which shall disclose such information as may reasonably be necessary for
the public health and health planning council to  determine  whether  it
should bar the transaction for the reason set forth below. Within ninety
days  from  the  date  of  receipt of such notice, the public health and
health planning council may bar any transaction under this  subparagraph
if  the equity position of the partnership 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  public  health  and  health  planning  council shall state specific
reasons for barring any transaction under this subparagraph and shall so
notify each party to the proposed transaction.
  (c) Any transfer, assignment or other disposition of  ten  percent  or
more  of the stock or voting rights thereunder of a corporation which is
the operator of a hospital or which is a member of a  limited  liability
company which is the operator of a hospital to a new stockholder, or any
transfer,  assignment or other disposition of the stock or voting rights
thereunder of such a corporation  which  results  in  the  ownership  or
control  of  more  than ten percent of the stock or voting rights there-
under of such corporation by any person not previously approved  by  the
public  health and health planning council, or its predecessor, for that
corporation shall be subject to approval by the public health and health
planning council, in accordance with the provisions of subdivisions  two
and  three  of  this section and rules and regulations pursuant thereto;
except that: any such transaction shall be subject to  the  approval  by
the  public  health and health planning council in accordance with para-
graph (b) of subdivision three of this section only with  respect  to  a
new stockholder or a new principal stockholder; and shall not be subject
to paragraph (a) of subdivision three of this section. In the absence of
such  approval,  the  operating  certificate  of  such hospital shall be
subject to revocation or suspension.] (II)  No  prior  approval  of  the
public health and health planning council shall be required with respect
to  a transfer, assignment or disposition of ten percent or more of [the
stock] A DIRECT OR INDIRECT INTEREST or voting rights [thereunder  of  a
corporation  which  is  the] IN AN operator of a hospital [or which is a
member of a limited liability company which is the owner of a  hospital]
to  any person previously approved by the public health and health plan-
ning council, or  its  predecessor,  for  that  [corporation]  OPERATOR.
However,  no  such transaction shall be effective unless at least ninety
days prior to the intended effective  date  thereof,  the  [stockholder]
OPERATOR  FULLY  completes  and  files with the public health and health
planning council notice on forms to be developed by  the  public  health
and  health  planning  council, which shall disclose such information as
may reasonably be necessary for the public health  and  health  planning
council  to determine whether it should bar the transaction. Such trans-
action will be final as of the intended  effective  date  unless,  prior
thereto,  the  public  health  and  health  planning council shall state

S. 2606                            156                           A. 3006

specific reasons for barring such transactions under this paragraph  and
shall  notify  each  party  to the proposed transaction. Nothing in this
paragraph shall be construed  as  permitting  a  person  not  previously
approved  by  the  public  health  and  health planning council for that
[corporation] OPERATOR to become the owner of ten percent or more of the
[stock of a corporation which is] INTEREST OR VOTING RIGHTS, DIRECTLY OR
INDIRECTLY, IN the operator of a hospital [or which is  a  member  of  a
limited  liability  company  which  is  the owner of a hospital] without
first obtaining the approval of the public health  and  health  planning
council.
  (d)  No  hospital  shall  be approved for establishment which would be
operated by a limited partnership,  or  by  a  partnership  any  of  the
members of which are not natural persons.
  (e)  No  hospital  shall  be approved for establishment which would be
operated by a corporation any of the stock of which is owned by  another
corporation  or  a  limited  liability  company  if any of its corporate
members' stock is owned by another corporation.
  (f) No corporation shall be a member of a  limited  liability  company
authorized  to  operate  a  hospital  unless its proposed incorporators,
directors,  stockholders  or  principal  stockholders  shall  have  been
approved  in accordance with the provisions of subdivision three of this
section applicable to the approval of the proposed incorporators, direc-
tors or stockholders of any other  corporation  requiring  approval  for
establishment.
  (g)  A  natural person appointed as trustee of an express testamentary
trust, created by a deceased sole proprietor, partner or shareholder  in
the  operation  of  a  hospital for the benefit of a person of less than
twenty-five years of age, may, as the trustee, apply pursuant to  subdi-
vision two of this section for approval to operate or participate in the
operation  of  a  facility  or interest therein which is included in the
corpus of such trust until such time as all beneficiaries attain the age
of twenty-five, unless the trust instrument provides for earlier  termi-
nation,  or  such  beneficiaries receive establishment approval in their
own right, or until a transfer of the trust corpus is  approved  by  the
public  health  and  health  planning  council,  in accordance with this
subdivision and subdivisions two and three of  this  section,  whichever
first  occurs.  The  public health and health planning council shall not
approve any such application unless it is satisfied as to:
  (i) the character, competence and standing in the  community  of  each
proposed trustee operator pursuant to the provisions of paragraph (b) of
subdivision three of this section; and
  (ii)  the  ability of the trustee under the terms of the trust instru-
ment to operate or participate in the operation of  the  hospital  in  a
manner consistent with this chapter and regulations promulgated pursuant
thereto.
  (h)  A natural person appointed conservator pursuant to article eight-
y-one of the mental hygiene law, or a natural person appointed committee
of the property of an incompetent pursuant to article eighty-one of  the
mental  hygiene  law  or  a sole proprietor, partner or shareholder of a
hospital, may apply pursuant to subdivision  two  of  this  section  for
approval  to  operate a hospital owned by the conservatee or incompetent
for a period not exceeding two years or until a transfer of the hospital
is approved by the public health and health planning council in  accord-
ance  with  subdivisions two and three of this section, whichever occurs
first. The public health and health planning council shall  not  approve
any such application unless it is satisfied as to:

S. 2606                            157                           A. 3006

  (i)  the  character,  competence  and standing in the community of the
proposed conservator operator or  committee  operator  pursuant  to  the
provisions of paragraph (b) of subdivision three of this section; and
  (ii)  the  ability  of the conservator or committee under the terms of
the court order to operate the hospital in a manner consistent with this
chapter and regulations promulgated pursuant thereto.
  S 49. Section 3611-a of the public health law, as amended  by  section
92  of part C of chapter 58 of the laws of 2009, subdivisions 1 and 2 as
amended by section 67 of part A of chapter 58 of the laws  of  2010,  is
amended to read as follows:
  S  3611-a.  Change  in  the  operator or owner.   1. Any change in the
person who, or any transfer, assignment,  or  other  disposition  of  an
interest  or  voting  rights  of  ten  percent or more, or any transfer,
assignment or other  disposition  which  results  in  the  ownership  or
control  of  an  interest  or voting rights of ten percent or more, in a
limited liability company or a partnership which is the  operator  of  a
licensed  home  care  services  agency or a certified home health agency
shall be approved by the public health and health planning  council,  in
accordance with the provisions of subdivision four of section thirty-six
hundred five of this article relative to licensure or subdivision two of
section  thirty-six  hundred six of this article relative to certificate
of approval, except that:
  (a) Public health  and  health  planning  council  approval  shall  be
required  only with respect to the person, or the member or partner that
is acquiring the interest or voting rights; and
  (b) With respect to certified home health agencies, such change  shall
not  be subject to the public need assessment described in paragraph (a)
of subdivision two of section thirty-six hundred six of this article.
  (c) IN THE ABSENCE OF SUCH APPROVAL, THE  LICENSE  OR  CERTIFICATE  OF
APPROVAL SHALL BE SUBJECT TO REVOCATION OR SUSPENSION.
  (D)  (I)  No  prior  approval of the public health and health planning
council shall be required with respect  to  a  transfer,  assignment  or
disposition of:
  [(i)]  (A)  an  interest  or  voting  rights  to any person previously
approved by the public health and health planning council, or its prede-
cessor, for that operator; or
  [(ii)] (B) an interest or voting rights of less than  ten  percent  in
the operator. [However, no]
  (II)  NO  such  transaction  UNDER  SUBPARAGRAPH (I) OF THIS PARAGRAPH
shall be effective unless at least ninety days  prior  to  the  intended
effective  date  thereof, the [partner or member] OPERATOR completes and
files with the public health and health planning council notice on forms
to be developed by the public health council, which shall disclose  such
information  as  may  reasonably  be necessary for the public health and
health planning council to determine whether it should  bar  the  trans-
action. Such transaction will be final as of the intended effective date
unless,  prior  thereto,  the  public health and health planning council
shall state specific reasons for barring such  transactions  under  this
paragraph and shall notify each party to the proposed transaction.
  2.  Any  transfer,  assignment  or other disposition of ten percent or
more of the stock or voting rights thereunder of a corporation which  is
the operator of a licensed home care services agency or a certified home
health  agency,  or any transfer, assignment or other disposition of the
stock or voting rights thereunder of such a corporation which results in
the ownership or control of more than ten percent of the stock or voting
rights thereunder of such corporation by any person shall be subject  to

S. 2606                            158                           A. 3006

approval  by the public health and health planning council in accordance
with the provisions of subdivision four of  section  thirty-six  hundred
five of this article relative to licensure or subdivision two of section
thirty-six  hundred  six  of  this  article  relative  to certificate of
approval, except that:
  (a) Public health  and  health  planning  council  approval  shall  be
required  only with respect to the person or entity acquiring such stock
or voting rights; and
  (b) With respect to certified home health agencies, such change  shall
not  be subject to the public need assessment described in paragraph (a)
of subdivision two of section thirty-six hundred six of this article. In
the absence of such approval, the license  or  certificate  of  approval
shall be subject to revocation or suspension.
  (c) No prior approval of the public health and health planning council
shall  be required with respect to a transfer, assignment or disposition
of an interest or voting rights to any person previously approved by the
public health and health planning council, or its predecessor, for  that
operator.  However,  no  such  transaction  shall be effective unless at
least one hundred twenty days prior to the intended effective date ther-
eof, the partner or member completes and files with  the  public  health
and  health  planning  council  notice  on  forms to be developed by the
public health and health planning council,  which  shall  disclose  such
information  as  may  reasonably  be necessary for the public health and
health planning council to determine whether it should  bar  the  trans-
action. Such transaction will be final as of the intended effective date
unless,  prior  thereto,  the  public health and health planning council
shall state specific reasons for barring such  transactions  under  this
paragraph and shall notify each party to the proposed transaction.
  3.  (a)  The  commissioner  shall charge to applicants for a change in
operator or owner of a licensed home care services agency or a certified
home health agency an application fee in  the  amount  of  two  thousand
dollars.
  (b)  The  fees paid by certified home health agencies pursuant to this
subdivision for any application approved in accordance with this section
shall be deemed allowable costs in the  determination  of  reimbursement
rates  established  pursuant  to this article. All fees pursuant to this
section shall be payable to the department of health  for  deposit  into
the  special revenue funds - other, miscellaneous special revenue fund -
339, certificate of need account.
  S 50. The public health law is amended by adding a new section  2806-a
to read as follows:
  S 2806-A. TEMPORARY OPERATOR. 1. FOR THE PURPOSES OF THIS SECTION:
  (A) "ADULT CARE FACILITY" SHALL MEAN AN ADULT HOME OR ENRICHED HOUSING
PROGRAM LICENSED PURSUANT TO ARTICLE SEVEN OF THE SOCIAL SERVICES LAW OR
AN ASSISTED LIVING RESIDENCE LICENSED PURSUANT TO ARTICLE FORTY-SIX-B OF
THIS CHAPTER;
  (B)  "ESTABLISHED  OPERATOR"  SHALL MEAN THE OPERATOR OF AN ADULT CARE
FACILITY, A GENERAL HOSPITAL OR A DIAGNOSTIC AND TREATMENT  CENTER  THAT
HAS  BEEN ESTABLISHED AND ISSUED AN OPERATING CERTIFICATE AS SUCH PURSU-
ANT TO THIS ARTICLE;
  (C) "FACILITY" SHALL MEAN (I) A GENERAL HOSPITAL OR A  DIAGNOSTIC  AND
TREATMENT  CENTER  THAT HAS BEEN ISSUED AN OPERATING CERTIFICATE AS SUCH
PURSUANT TO THIS ARTICLE; OR (II) AN ADULT CARE FACILITY;
  (D) "TEMPORARY OPERATOR" SHALL MEAN ANY PERSON OR ENTITY THAT:

S. 2606                            159                           A. 3006

  (I) AGREES TO OPERATE A FACILITY ON A  TEMPORARY  BASIS  IN  THE  BEST
INTERESTS  OF  ITS RESIDENTS OR PATIENTS AND THE COMMUNITY SERVED BY THE
FACILITY; AND
  (II) HAS DEMONSTRATED THAT HE OR SHE HAS THE CHARACTER, COMPETENCE AND
FINANCIAL  ABILITY TO OPERATE THE FACILITY IN COMPLIANCE WITH APPLICABLE
STANDARDS;
  (E) "SERIOUS FINANCIAL INSTABILITY" SHALL INCLUDE BUT NOT  BE  LIMITED
TO  DEFAULTING  OR  VIOLATING KEY COVENANTS OF LOANS, OR MISSED MORTGAGE
PAYMENTS, OR GENERAL UNTIMELY PAYMENT OF OBLIGATIONS, INCLUDING BUT  NOT
LIMITED  TO  EMPLOYEE  BENEFIT  FUND, PAYROLL TAX, AND INSURANCE PREMIUM
OBLIGATIONS, OR FAILURE  TO  MAINTAIN  REQUIRED  DEBT  SERVICE  COVERAGE
RATIOS OR, AS APPLICABLE, FACTORS THAT HAVE TRIGGERED A WRITTEN EVENT OF
DEFAULT NOTICE TO THE DEPARTMENT BY THE DORMITORY AUTHORITY OF THE STATE
OF NEW YORK; AND
  (F)  "EXTRAORDINARY  FINANCIAL  ASSISTANCE"  SHALL  MEAN  STATE  FUNDS
PROVIDED TO A FACILITY UPON SUCH FACILITY'S REQUEST FOR THE  PURPOSE  OF
ASSISTING  THE  FACILITY TO ADDRESS SERIOUS FINANCIAL INSTABILITY.  SUCH
FUNDS MAY BE DERIVED  FROM  EXISTING  PROGRAMS  WITHIN  THE  DEPARTMENT,
SPECIAL APPROPRIATIONS, OR OTHER FUNDS.
  2.(A)  IN THE EVENT THAT: (I) A FACILITY SEEKS EXTRAORDINARY FINANCIAL
ASSISTANCE AND THE COMMISSIONER FINDS THAT THE FACILITY IS  EXPERIENCING
SERIOUS FINANCIAL INSTABILITY THAT IS JEOPARDIZING EXISTING OR CONTINUED
ACCESS  TO  ESSENTIAL SERVICES WITHIN THE COMMUNITY, OR (II) THE COMMIS-
SIONER FINDS THAT THERE ARE CONDITIONS WITHIN THE FACILITY THAT SERIOUS-
LY ENDANGER THE LIFE, HEALTH OR SAFETY OF  RESIDENTS  OR  PATIENTS,  THE
COMMISSIONER MAY APPOINT A TEMPORARY OPERATOR TO ASSUME SOLE CONTROL AND
SOLE RESPONSIBILITY FOR THE OPERATIONS OF THAT FACILITY. THE APPOINTMENT
OF  THE TEMPORARY OPERATOR SHALL BE EFFECTUATED PURSUANT TO THIS SECTION
AND SHALL BE IN ADDITION TO ANY OTHER REMEDIES PROVIDED BY LAW.
  (B) THE ESTABLISHED OPERATOR OF A FACILITY MAY AT ANY TIME REQUEST THE
COMMISSIONER TO APPOINT A TEMPORARY  OPERATOR.  UPON  RECEIVING  SUCH  A
REQUEST,  THE  COMMISSIONER  MAY,  IF  HE OR SHE DETERMINES THAT SUCH AN
ACTION IS NECESSARY TO RESTORE OR MAINTAIN THE PROVISION OF QUALITY CARE
TO THE RESIDENTS OR  PATIENTS  OR  ALLEVIATE  THE  FACILITY'S  FINANCIAL
INSTABILITY,  ENTER  INTO AN AGREEMENT WITH THE ESTABLISHED OPERATOR FOR
THE APPOINTMENT OF A TEMPORARY OPERATOR TO ASSUME SOLE CONTROL AND  SOLE
RESPONSIBILITY FOR THE OPERATIONS OF THAT FACILITY.
  3.  (A) A TEMPORARY OPERATOR APPOINTED PURSUANT TO THIS SECTION SHALL,
PRIOR TO HIS OR HER  APPOINTMENT  AS  TEMPORARY  OPERATOR,  PROVIDE  THE
COMMISSIONER  WITH  A  WORK  PLAN  SATISFACTORY  TO  THE COMMISSIONER TO
ADDRESS THE FACILITY'S DEFICIENCIES AND  SERIOUS  FINANCIAL  INSTABILITY
AND A SCHEDULE FOR IMPLEMENTATION OF SUCH PLAN. A WORK PLAN SHALL NOT BE
REQUIRED  PRIOR TO THE APPOINTMENT OF THE TEMPORARY OPERATOR PURSUANT TO
CLAUSE (II) OF PARAGRAPH (A) OF SUBDIVISION TWO OF THIS SECTION  IF  THE
COMMISSIONER  HAS  DETERMINED THAT THE IMMEDIATE APPOINTMENT OF A TEMPO-
RARY OPERATOR IS NECESSARY BECAUSE PUBLIC HEALTH OR SAFETY IS  IN  IMMI-
NENT  DANGER  OR  THERE EXISTS ANY CONDITION OR PRACTICE OR A CONTINUING
PATTERN OF CONDITIONS OR PRACTICES WHICH POSES IMMINENT  DANGER  TO  THE
HEALTH  OR SAFETY OF ANY PATIENT OR RESIDENT OF THE FACILITY. WHERE SUCH
IMMEDIATE APPOINTMENT HAS BEEN FOUND  TO  BE  NECESSARY,  THE  TEMPORARY
OPERATOR SHALL PROVIDE THE COMMISSIONER WITH A WORK PLAN SATISFACTORY TO
THE COMMISSIONER AS SOON AS PRACTICABLE.
  (B) THE TEMPORARY OPERATOR SHALL USE HIS OR HER BEST EFFORTS TO IMPLE-
MENT  THE  WORK PLAN PROVIDED TO THE COMMISSIONER, IF APPLICABLE, AND TO
CORRECT OR ELIMINATE ANY DEFICIENCIES OR FINANCIAL  INSTABILITY  IN  THE
FACILITY  AND  TO  PROMOTE  THE QUALITY AND ACCESSIBILITY OF HEALTH CARE

S. 2606                            160                           A. 3006

SERVICES IN THE COMMUNITY SERVED BY THE  FACILITY.  SUCH  CORRECTION  OR
ELIMINATION  OF  DEFICIENCIES OR SERIOUS FINANCIAL INSTABILITY SHALL NOT
INCLUDE MAJOR ALTERATIONS OF THE PHYSICAL  STRUCTURE  OF  THE  FACILITY.
DURING  THE TERM OF HIS OR HER APPOINTMENT, THE TEMPORARY OPERATOR SHALL
HAVE THE SOLE AUTHORITY TO DIRECT THE MANAGEMENT OF THE FACILITY IN  ALL
ASPECTS  OF  OPERATION AND SHALL BE AFFORDED FULL ACCESS TO THE ACCOUNTS
AND RECORDS OF THE FACILITY. THE TEMPORARY OPERATOR SHALL,  DURING  THIS
PERIOD,  OPERATE  THE FACILITY IN SUCH A MANNER AS TO PROMOTE SAFETY AND
THE QUALITY AND ACCESSIBILITY OF HEALTH  CARE  SERVICES  OR  RESIDENTIAL
CARE  IN  THE  COMMUNITY  SERVED BY THE FACILITY. THE TEMPORARY OPERATOR
SHALL HAVE THE POWER TO LET CONTRACTS  THEREFOR  OR  INCUR  EXPENSES  ON
BEHALF OF THE FACILITY, PROVIDED THAT WHERE INDIVIDUAL ITEMS OF REPAIRS,
IMPROVEMENTS  OR  SUPPLIES  EXCEED  TEN  THOUSAND DOLLARS, THE TEMPORARY
OPERATOR SHALL OBTAIN PRICE QUOTATIONS FROM  AT  LEAST  THREE  REPUTABLE
SOURCES.  THE TEMPORARY OPERATOR SHALL NOT BE REQUIRED TO FILE ANY BOND.
NO SECURITY INTEREST IN ANY REAL OR  PERSONAL  PROPERTY  COMPRISING  THE
FACILITY  OR  CONTAINED  WITHIN  THE  FACILITY, OR IN ANY FIXTURE OF THE
FACILITY, SHALL BE IMPAIRED OR DIMINISHED IN PRIORITY BY  THE  TEMPORARY
OPERATOR. NEITHER THE TEMPORARY OPERATOR NOR THE DEPARTMENT SHALL ENGAGE
IN  ANY ACTIVITY THAT CONSTITUTES A CONFISCATION OF PROPERTY WITHOUT THE
PAYMENT OF FAIR COMPENSATION.
  4. THE TEMPORARY OPERATOR SHALL BE ENTITLED TO A  REASONABLE  FEE,  AS
DETERMINED  BY  THE COMMISSIONER, AND NECESSARY EXPENSES INCURRED DURING
HIS OR HER PERFORMANCE AS TEMPORARY OPERATOR, TO BE PAID FROM THE REVEN-
UE OF THE  FACILITY.  THE  TEMPORARY  OPERATOR  SHALL  COLLECT  INCOMING
PAYMENTS  FROM  ALL  SOURCES AND APPLY THEM TO THE REASONABLE FEE AND TO
COSTS INCURRED IN THE PERFORMANCE OF HIS OR HER FUNCTIONS  AS  TEMPORARY
OPERATOR  IN  CORRECTING  DEFICIENCIES  AND  CAUSES OF SERIOUS FINANCIAL
INSTABILITY.  THE TEMPORARY OPERATOR SHALL BE LIABLE ONLY IN HIS OR  HER
CAPACITY  AS  TEMPORARY  OPERATOR  FOR  INJURY TO PERSON AND PROPERTY BY
REASON OF CONDITIONS OF THE FACILITY IN  A  CASE  WHERE  AN  ESTABLISHED
OPERATOR  WOULD HAVE BEEN LIABLE; HE OR SHE SHALL NOT HAVE ANY LIABILITY
IN HIS OR HER PERSONAL CAPACITY, EXCEPT FOR GROSS NEGLIGENCE AND  INTEN-
TIONAL ACTS.
  5.  (A)  THE INITIAL TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR
SHALL NOT EXCEED ONE HUNDRED EIGHTY DAYS. AFTER ONE HUNDRED EIGHTY DAYS,
IF THE COMMISSIONER DETERMINES THAT TERMINATION OF THE TEMPORARY  OPERA-
TOR  WOULD  CAUSE SIGNIFICANT DETERIORATION OF THE QUALITY OF, OR ACCESS
TO, HEALTH CARE OR RESIDENTIAL CARE IN THE COMMUNITY OR THAT  REAPPOINT-
MENT  IS  NECESSARY  TO  CORRECT THE CONDITIONS WITHIN THE FACILITY THAT
SERIOUSLY ENDANGER THE LIFE, HEALTH OR SAFETY OF RESIDENTS OR  PATIENTS,
OR THE FINANCIAL INSTABILITY THAT REQUIRED THE APPOINTMENT OF THE TEMPO-
RARY OPERATOR, THE COMMISSIONER MAY AUTHORIZE UP TO TWO ADDITIONAL NINE-
TY-DAY TERMS.
  (B)  UPON  THE  COMPLETION  OF  THE TWO NINETY-DAY TERMS REFERENCED IN
PARAGRAPH (A) OF THIS SUBDIVISION, IF THE COMMISSIONER  DETERMINES  THAT
THE  TEMPORARY OPERATOR REQUIRES ADDITIONAL TERMS TO MEET THE OBJECTIVES
OF THE WORK  PLAN  SUBMITTED  PURSUANT  TO  SUBDIVISION  THREE  OF  THIS
SECTION, THE COMMISSIONER MAY REAPPOINT THE TEMPORARY OPERATOR FOR ADDI-
TIONAL  NINETY-DAY  TERMS,  PROVIDED THAT THE COMMISSIONER SHALL PROVIDE
FOR NOTICE AND A HEARING AS SET FORTH IN SUBDIVISION SIX OF THIS  SUBDI-
VISION.
  (C)  WITHIN FOURTEEN DAYS PRIOR TO THE TERMINATION OF EACH TERM OF THE
APPOINTMENT OF THE TEMPORARY  OPERATOR,  THE  TEMPORARY  OPERATOR  SHALL
SUBMIT  TO  THE  COMMISSIONER  AND  TO THE ESTABLISHED OPERATOR A REPORT
DESCRIBING:

S. 2606                            161                           A. 3006

  (I) THE ACTIONS TAKEN DURING THE APPOINTMENT TO ADDRESS SUCH DEFICIEN-
CIES AND FINANCIAL INSTABILITY,
  (II)  OBJECTIVES FOR THE CONTINUATION OF THE TEMPORARY OPERATORSHIP IF
NECESSARY AND A SCHEDULE FOR SATISFACTION OF SUCH OBJECTIVES, AND
  (III) RECOMMENDED ACTIONS FOR THE ONGOING OPERATION  OF  THE  FACILITY
SUBSEQUENT  TO  THE  TERM  OF  THE  TEMPORARY OPERATOR. THE REPORT SHALL
REFLECT BEST EFFORTS TO PRODUCE A FULL AND COMPLETE ACCOUNTING.
  (D) THE TERM OF THE INITIAL APPOINTMENT AND OF  ANY  SUBSEQUENT  REAP-
POINTMENT  MAY  BE  TERMINATED PRIOR TO THE EXPIRATION OF THE DESIGNATED
TERM, IF THE ESTABLISHED OPERATOR AND THE COMMISSIONER AGREE ON  A  PLAN
OF CORRECTION AND THE IMPLEMENTATION OF SUCH PLAN.
  6.  (A)  THE  COMMISSIONER,  UPON  MAKING A DETERMINATION TO APPOINT A
TEMPORARY OPERATOR PURSUANT TO PARAGRAPH (A) OF SUBDIVISION TWO OF  THIS
SECTION  SHALL,  PRIOR TO THE COMMENCEMENT OF THE APPOINTMENT, CAUSE THE
ESTABLISHED OPERATOR OF THE FACILITY TO BE NOTIFIED OF THE DETERMINATION
BY REGISTERED OR CERTIFIED MAIL ADDRESSED TO THE PRINCIPAL OFFICE OF THE
ESTABLISHED  OPERATOR.  SUCH  NOTIFICATION  SHALL  INCLUDE  A   DETAILED
DESCRIPTION  OF  THE  FINDINGS UNDERLYING THE DETERMINATION TO APPOINT A
TEMPORARY OPERATOR, AND THE DATE AND TIME OF A REQUIRED MEETING WITH THE
COMMISSIONER AND/OR HIS OR HER DESIGNEE WITHIN TEN BUSINESS DAYS OF  THE
DATE  OF  SUCH  NOTICE.  AT SUCH MEETING, THE ESTABLISHED OPERATOR SHALL
HAVE THE OPPORTUNITY TO REVIEW AND DISCUSS  ALL  RELEVANT  FINDINGS.  AT
SUCH  MEETING  OR  WITHIN TEN ADDITIONAL BUSINESS DAYS, THE COMMISSIONER
AND THE ESTABLISHED OPERATOR SHALL ATTEMPT TO DEVELOP A MUTUALLY  SATIS-
FACTORY PLAN OF CORRECTION AND SCHEDULE FOR IMPLEMENTATION. IN THE EVENT
SUCH  PLAN  OF  CORRECTION IS AGREED UPON, THE COMMISSIONER SHALL NOTIFY
THE ESTABLISHED OPERATOR THAT THE  COMMISSIONER  NO  LONGER  INTENDS  TO
APPOINT  A  TEMPORARY OPERATOR. A MEETING SHALL NOT BE REQUIRED PRIOR TO
THE APPOINTMENT OF THE TEMPORARY OPERATOR PURSUANT  TO  CLAUSE  (II)  OF
PARAGRAPH (A) OF SUBDIVISION TWO OF THIS SECTION IF THE COMMISSIONER HAS
DETERMINED  THAT  THE  IMMEDIATE  APPOINTMENT OF A TEMPORARY OPERATOR IS
NECESSARY BECAUSE PUBLIC HEALTH OR SAFETY IS IN IMMINENT DANGER OR THERE
EXISTS ANY CONDITION OR PRACTICE OR A CONTINUING PATTERN  OF  CONDITIONS
OR  PRACTICES WHICH POSES IMMINENT DANGER TO THE HEALTH OR SAFETY OF ANY
PATIENT OR RESIDENT OF THE FACILITY. WHERE  SUCH  IMMEDIATE  APPOINTMENT
HAS  BEEN  FOUND  TO  BE  NECESSARY,  THE COMMISSIONER SHALL PROVIDE THE
ESTABLISHED OPERATOR WITH A NOTICE AS REQUIRED UNDER THIS  PARAGRAPH  ON
THE DATE OF THE APPOINTMENT OF THE TEMPORARY OPERATOR.
  (B)  SHOULD THE COMMISSIONER AND THE ESTABLISHED OPERATOR BE UNABLE TO
ESTABLISH A PLAN OF CORRECTION PURSUANT TO PARAGRAPH (A) OF THIS  SUBDI-
VISION,  OR  SHOULD  THE  ESTABLISHED  OPERATOR  FAIL  TO RESPOND TO THE
COMMISSIONER'S INITIAL  NOTIFICATION,  A  TEMPORARY  OPERATOR  SHALL  BE
APPOINTED  AS  SOON  AS IS PRACTICABLE AND SHALL OPERATE PURSUANT TO THE
PROVISIONS OF THIS SECTION.
  (C) THE ESTABLISHED OPERATOR SHALL BE AFFORDED AN OPPORTUNITY  FOR  AN
ADMINISTRATIVE  HEARING ON THE COMMISSIONER'S DETERMINATION TO APPOINT A
TEMPORARY OPERATOR. SUCH ADMINISTRATIVE HEARING  SHALL  OCCUR  PRIOR  TO
SUCH APPOINTMENT, EXCEPT THAT THE HEARING SHALL NOT BE REQUIRED PRIOR TO
THE  APPOINTMENT  OF  THE  TEMPORARY OPERATOR PURSUANT TO CLAUSE (II) OF
PARAGRAPH (A) OF SUBDIVISION TWO OF THIS SECTION IF THE COMMISSIONER HAS
DETERMINED THAT THE IMMEDIATE APPOINTMENT OF  A  TEMPORARY  OPERATOR  IS
NECESSARY BECAUSE PUBLIC HEALTH OR SAFETY IS IN IMMINENT DANGER OR THERE
EXISTS  ANY  CONDITION OR PRACTICE OR A CONTINUING PATTERN OF CONDITIONS
OR PRACTICES WHICH POSES IMMINENT DANGER TO THE HEALTH OR SAFETY OF  ANY
PATIENT  OR  RESIDENT  OF  THE  FACILITY.  AN  ADMINISTRATIVE HEARING AS
PROVIDED FOR UNDER THIS PARAGRAPH SHALL BEGIN NO LATER THAN  SIXTY  DAYS

S. 2606                            162                           A. 3006

FROM THE DATE OF THE NOTICE TO THE ESTABLISHED OPERATOR AND SHALL NOT BE
EXTENDED  WITHOUT THE CONSENT OF BOTH PARTIES. ANY SUCH HEARING SHALL BE
STRICTLY LIMITED TO THE  ISSUE  OF  WHETHER  THE  DETERMINATION  OF  THE
COMMISSIONER TO APPOINT A TEMPORARY OPERATOR IS SUPPORTED BY SUBSTANTIAL
EVIDENCE. A COPY OF THE DECISION SHALL BE SENT TO THE ESTABLISHED OPERA-
TOR.
  (D) THE COMMISSIONER SHALL, UPON MAKING A DETERMINATION TO REAPPOINT A
TEMPORARY OPERATOR FOR THE FIRST OF AN ADDITIONAL NINETY-DAY TERM PURSU-
ANT  TO  PARAGRAPH  (A)  OF  SUBDIVISION FIVE OF THIS SECTION, CAUSE THE
ESTABLISHED OPERATOR OF THE FACILITY TO BE NOTIFIED OF THE DETERMINATION
BY REGISTERED OR CERTIFIED MAIL ADDRESSED TO THE PRINCIPAL OFFICE OF THE
ESTABLISHED OPERATOR. IF THE  COMMISSIONER  DETERMINES  THAT  ADDITIONAL
REAPPOINTMENTS  PURSUANT  TO  PARAGRAPH  (B) OF SUBDIVISION FIVE OF THIS
SECTION ARE REQUIRED, THE COMMISSIONER SHALL AGAIN CAUSE THE ESTABLISHED
OPERATOR OF THE FACILITY TO BE NOTIFIED OF SUCH DETERMINATION BY  REGIS-
TERED  OR CERTIFIED MAIL ADDRESSED TO THE PRINCIPAL OFFICE OF THE ESTAB-
LISHED OPERATOR AT THE COMMENCEMENT OF THE FIRST OF EVERY TWO ADDITIONAL
TERMS. UPON RECEIPT OF SUCH NOTIFICATION AT THE PRINCIPAL OFFICE OF  THE
ESTABLISHED  OPERATOR  AND BEFORE THE EXPIRATION OF TEN DAYS THEREAFTER,
THE ESTABLISHED OPERATOR MAY REQUEST AN ADMINISTRATIVE  HEARING  ON  THE
DETERMINATION  TO  BEGIN  NO  LATER THAN SIXTY DAYS FROM THE DATE OF THE
REAPPOINTMENT OF THE TEMPORARY  OPERATOR.  ANY  SUCH  HEARING  SHALL  BE
STRICTLY  LIMITED  TO  THE  ISSUE  OF  WHETHER  THE DETERMINATION OF THE
COMMISSIONER  TO  REAPPOINT  THE  TEMPORARY  OPERATOR  IS  SUPPORTED  BY
SUBSTANTIAL EVIDENCE.
  7.  NO  PROVISION CONTAINED IN THIS SECTION SHALL BE DEEMED TO RELIEVE
THE ESTABLISHED OPERATOR OR ANY OTHER PERSON OF ANY  CIVIL  OR  CRIMINAL
LIABILITY  INCURRED,  OR  ANY  DUTY IMPOSED BY LAW, BY REASON OF ACTS OR
OMISSIONS OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON PRIOR  TO  THE
APPOINTMENT  OF  ANY  TEMPORARY  OPERATOR  HEREUNDER; NOR SHALL ANYTHING
CONTAINED IN THIS SECTION BE CONSTRUED TO SUSPEND DURING THE TERM OF THE
APPOINTMENT OF THE TEMPORARY OPERATOR ANY OBLIGATION OF THE  ESTABLISHED
OPERATOR OR ANY OTHER PERSON FOR THE PAYMENT OF TAXES OR OTHER OPERATING
AND MAINTENANCE EXPENSES OF THE FACILITY NOR OF THE ESTABLISHED OPERATOR
OR ANY OTHER PERSON FOR THE PAYMENT OF MORTGAGES OR LIENS.
  S  51. The mental hygiene law is amended by adding a new section 32.20
to read as follows:
S 32.20 TEMPORARY OPERATOR.  1. FOR THE PURPOSES OF THIS SECTION:
  (A) "CHEMICAL DEPENDENCE  TREATMENT  PROGRAM"  SHALL  MEAN  A  PROGRAM
CERTIFIED PURSUANT TO SECTION 32.05 OF THIS ARTICLE;
  (B)  "ESTABLISHED  OPERATOR"  SHALL  MEAN  THE  OPERATOR OF A CHEMICAL
DEPENDENCE TREATMENT PROGRAM THAT HAS BEEN  ESTABLISHED  AND  ISSUED  AN
OPERATING CERTIFICATE PURSUANT TO SECTION 32.05 OF THIS ARTICLE;
  (C)  "TEMPORARY OPERATOR" SHALL MEAN ANY OASAS STAFF MEMBER, PERSON OR
ENTITY THAT:
  (I) AGREES TO OPERATE A PROGRAM ON  A  TEMPORARY  BASIS  IN  THE  BEST
INTERESTS OF ITS PATIENTS AND THE COMMUNITY SERVED BY THE PROGRAM;
  (II) HAS DEMONSTRATED THAT HE OR SHE HAS THE CHARACTER, COMPETENCE AND
ABILITY  TO OPERATE AN OASAS-CERTIFIED PROGRAM IN COMPLIANCE WITH APPLI-
CABLE STANDARDS; AND
  (III) PRIOR TO HIS OR HER APPOINTMENT AS TEMPORARY OPERATOR,  DEVELOPS
WITH  GUIDANCE  FROM THE COMMISSIONER A SATISFACTORY PLAN TO ADDRESS THE
PROGRAM'S DEFICIENCIES;
  (D) "SERIOUS FINANCIAL INSTABILITY" SHALL INCLUDE BUT NOT  BE  LIMITED
TO DEFAULTING OR VIOLATING KEY COVENANTS OF BOND ISSUES, MISSED MORTGAGE
PAYMENTS,  GENERAL UNTIMELY PAYMENT OF DEBTS, FAILURE TO PAY ITS EMPLOY-

S. 2606                            163                           A. 3006

EES OR  VENDORS,  INSUFFICIENT  FUNDS  TO  MEET  THE  GENERAL  OPERATING
EXPENSES  OF  THE  PROGRAM AND/OR FACILITY, FAILURE TO MAINTAIN REQUIRED
DEBT SERVICE COVERAGE RATIOS AND/OR, AS APPLICABLE,  FACTORS  THAT  HAVE
TRIGGERED  A WRITTEN EVENT OF DEFAULT NOTICE TO THE OFFICE BY THE DORMI-
TORY AUTHORITY OF THE STATE OF NEW YORK; AND
  (E)  "EXTRAORDINARY  FINANCIAL  ASSISTANCE"  SHALL  MEAN  STATE  FUNDS
PROVIDED  TO,  OR  REQUESTED  BY,  A  PROGRAM FOR THE EXPRESS PURPOSE OF
PREVENTING THE CLOSURE  OF  THE  PROGRAM  THAT  THE  COMMISSIONER  FINDS
PROVIDES ESSENTIAL AND NECESSARY SERVICES WITHIN THE COMMUNITY.
  2.  (A)  IN  THE  EVENT  THAT:  (I)  THE OFFICE IMPOSED A PENALTY ON A
PROGRAM WITHIN THE PRIOR TWELVE MONTHS;  (II)  THE  PROGRAM  IS  SEEKING
EXTRAORDINARY  FINANCIAL  ASSISTANCE;  (III) OFFICE COLLECTED DATA INDI-
CATES THAT THE PROGRAM IS  EXPERIENCING  SERIOUS  FINANCIAL  INSTABILITY
ISSUES; (IV) OFFICE COLLECTED DATA INDICATES THAT THE PROGRAM'S BOARD OF
DIRECTORS OR ADMINISTRATION ARE UNABLE OR UNWILLING TO ENSURE THE PROPER
OPERATION  OF THE PROGRAM; (V) THE PROGRAM HAS VIOLATED THE TERMS OF ITS
CONTRACT WITH THE STATE; OR (VI) OFFICE COLLECTED DATA  INDICATES  THERE
ARE CONDITIONS THAT SERIOUSLY ENDANGER OR JEOPARDIZE CONTINUED ACCESS TO
NECESSARY  CHEMICAL  DEPENDENCE TREATMENT SERVICES WITHIN THE COMMUNITY,
THE COMMISSIONER SHALL NOTIFY THE ESTABLISHED OPERATOR  OF  HIS  OR  HER
INTENTION  TO APPOINT A TEMPORARY OPERATOR TO ASSUME SOLE RESPONSIBILITY
FOR THE PROGRAM'S TREATMENT OPERATIONS OF THAT FACILITY  FOR  A  LIMITED
PERIOD  OF TIME. THE APPOINTMENT OF A TEMPORARY OPERATOR SHALL BE EFFEC-
TUATED PURSUANT TO THIS SECTION, AND SHALL BE IN ADDITION TO  ANY  OTHER
REMEDIES PROVIDED BY LAW.
  (B)  THE ESTABLISHED OPERATOR OF A PROGRAM MAY AT ANY TIME REQUEST THE
COMMISSIONER TO APPOINT A TEMPORARY  OPERATOR.  UPON  RECEIVING  SUCH  A
REQUEST,  THE  COMMISSIONER  MAY,  IF  HE OR SHE DETERMINES THAT SUCH AN
ACTION IS NECESSARY, ENTER INTO AN AGREEMENT WITH THE ESTABLISHED OPERA-
TOR FOR THE APPOINTMENT OF A TEMPORARY OPERATOR TO RESTORE  OR  MAINTAIN
THE  PROVISION  OF  QUALITY  CARE  TO THE PATIENTS UNTIL THE ESTABLISHED
OPERATOR CAN RESUME OPERATIONS WITHIN THE DESIGNATED  TIME  PERIOD;  THE
PATIENTS  MAY  BE TRANSFERRED TO OTHER OASAS-CERTIFIED PROVIDERS; OR THE
PROGRAM OPERATIONS OF THAT FACILITY SHOULD BE COMPLETELY DISCONTINUED.
  3. (A) A TEMPORARY OPERATOR APPOINTED PURSUANT TO THIS  SECTION  SHALL
USE  HIS  OR  HER  BEST EFFORTS TO IMPLEMENT THE PLAN DEVELOPED WITH THE
GUIDANCE OF THE COMMISSIONER TO CORRECT OR ELIMINATE ANY DEFICIENCIES IN
THE PROGRAM AND TO PROMOTE THE QUALITY  AND  ACCESSIBILITY  OF  CHEMICAL
DEPENDENCE TREATMENT SERVICES IN THE COMMUNITY SERVED BY THE PROGRAM.
  (B)  IF THE IDENTIFIED PROGRAM DEFICIENCIES CANNOT BE ADDRESSED IN THE
TIME PERIOD DESIGNATED IN THE PLAN, THE PATIENTS SHALL BE TRANSFERRED TO
OTHER OASAS-CERTIFIED PROVIDERS.
  (C) DURING THE TERM OF HIS OR HER APPOINTMENT, THE TEMPORARY  OPERATOR
SHALL  HAVE THE AUTHORITY TO DIRECT THE PROGRAM STAFF OF THE FACILITY IN
ALL  ASPECTS  NECESSARY  TO  APPROPRIATELY  TREAT  AND/OR  TRANSFER  THE
PATIENTS.  THE TEMPORARY OPERATOR SHALL, DURING THIS PERIOD, OPERATE THE
PROGRAM IN SUCH A MANNER AS TO PROMOTE SAFETY AND THE QUALITY AND ACCES-
SIBILITY OF CHEMICAL DEPENDENCE  TREATMENT  SERVICES  IN  THE  COMMUNITY
SERVED  BY THE FACILITY UNTIL EITHER THE ESTABLISHED OPERATOR CAN RESUME
PROGRAM OPERATIONS OR UNTIL THE PATIENTS ARE  APPROPRIATELY  TRANSFERRED
TO OTHER OASAS-CERTIFIED PROVIDERS.
  (D)  THE TEMPORARY OPERATOR SHALL NOT BE REQUIRED TO FILE ANY BOND. NO
SECURITY INTEREST IN ANY REAL OR PERSONAL PROPERTY COMPRISING THE FACIL-
ITY OR CONTAINED WITHIN THE FACILITY OR IN ANY FIXTURE OF THE  FACILITY,
SHALL  BE  IMPAIRED OR DIMINISHED IN PRIORITY BY THE TEMPORARY OPERATOR.

S. 2606                            164                           A. 3006

NEITHER THE TEMPORARY OPERATOR NOR THE OFFICE SHALL ENGAGE IN ANY ACTIV-
ITY THAT CONSTITUTES A CONFISCATION OF PROPERTY.
  4.  THE  TEMPORARY  OPERATOR SHALL BE ENTITLED TO A REASONABLE FEE, AS
DETERMINED BY THE COMMISSIONER, AND NECESSARY EXPENSES  INCURRED  DURING
HIS  OR  HER  PERFORMANCE  AS TEMPORARY OPERATOR. THE TEMPORARY OPERATOR
SHALL BE LIABLE ONLY IN HIS OR HER CAPACITY AS TEMPORARY OPERATOR OF THE
PROGRAM FOR INJURY TO PERSON AND PROPERTY BY REASON OF HIS OR HER OPERA-
TION OF SUCH PROGRAM; HE OR SHE SHALL NOT HAVE ANY LIABILITY IN  HIS  OR
HER PERSONAL CAPACITY, EXCEPT FOR GROSS NEGLIGENCE AND INTENTIONAL ACTS.
  5.  (A)  THE INITIAL TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR
SHALL NOT EXCEED NINETY DAYS. AFTER NINETY  DAYS,  IF  THE  COMMISSIONER
DETERMINES  THAT  TERMINATION  OF  THE  TEMPORARY  OPERATOR  WOULD CAUSE
SIGNIFICANT DETERIORATION OF THE QUALITY OF, OR ACCESS TO,  HEALTH  CARE
IN THE COMMUNITY OR THAT REAPPOINTMENT IS NECESSARY TO CORRECT THE DEFI-
CIENCIES  THAT  REQUIRED  THE APPOINTMENT OF THE TEMPORARY OPERATOR, THE
COMMISSIONER MAY AUTHORIZE AN ADDITIONAL NINETY-DAY TERM. HOWEVER,  SUCH
AUTHORIZATION  SHALL INCLUDE THE COMMISSIONER'S REQUIREMENTS FOR CONCLU-
SION OF THE TEMPORARY OPERATORSHIP TO BE SATISFIED WITHIN THE ADDITIONAL
TERM.
  (B) WITHIN FOURTEEN DAYS PRIOR TO THE TERMINATION OF EACH TERM OF  THE
APPOINTMENT  OF  THE  TEMPORARY  OPERATOR,  THE TEMPORARY OPERATOR SHALL
SUBMIT TO THE COMMISSIONER AND TO  THE  ESTABLISHED  OPERATOR  A  REPORT
DESCRIBING:
  (I)  THE  ACTIONS TAKEN DURING THE APPOINTMENT TO ADDRESS: THE IDENTI-
FIED PROGRAM DEFICIENCIES; THE RESUMPTION OF PROGRAM OPERATIONS  BY  THE
ESTABLISHED   OPERATOR;  OR  THE  TRANSFER  OF  THE  PATIENTS  TO  OTHER
OASAS-CERTIFIED PROVIDERS;
  (II) OBJECTIVES FOR THE CONTINUATION OF THE TEMPORARY OPERATORSHIP  IF
NECESSARY AND A SCHEDULE FOR SATISFACTION OF SUCH OBJECTIVES; AND
  (III) IF APPLICABLE, THE RECOMMENDED ACTIONS FOR THE ONGOING OPERATION
OF THE PROGRAM SUBSEQUENT TO THE TEMPORARY OPERATORSHIP.
  (C)  THE  TERM  OF THE INITIAL APPOINTMENT AND OF ANY SUBSEQUENT REAP-
POINTMENT MAY BE TERMINATED PRIOR TO THE EXPIRATION  OF  THE  DESIGNATED
TERM,  IF  THE ESTABLISHED OPERATOR AND THE COMMISSIONER AGREE ON A PLAN
OF CORRECTION AND THE IMPLEMENTATION OF SUCH PLAN.
  6. (A) THE COMMISSIONER SHALL,  UPON  MAKING  A  DETERMINATION  OF  AN
INTENTION  TO  APPOINT A TEMPORARY OPERATOR PURSUANT TO PARAGRAPH (A) OF
SUBDIVISION TWO OF THIS SECTION CAUSE THE ESTABLISHED  OPERATOR  OF  THE
FACILITY TO BE NOTIFIED OF THE INTENTION BY REGISTERED OR CERTIFIED MAIL
ADDRESSED  TO  THE  PRINCIPAL  OFFICE  OF THE ESTABLISHED OPERATOR. SUCH
NOTIFICATION SHALL INCLUDE A DETAILED DESCRIPTION OF THE FINDINGS UNDER-
LYING THE INTENTION TO APPOINT A TEMPORARY OPERATOR, AND  THE  DATE  AND
TIME  OF  A  REQUIRED  MEETING  WITH  THE COMMISSIONER AND/OR HIS OR HER
DESIGNEE WITHIN TEN BUSINESS DAYS OF THE RECEIPT OF SUCH NOTICE. AT SUCH
MEETING, THE ESTABLISHED OPERATOR SHALL HAVE THE OPPORTUNITY  TO  REVIEW
AND DISCUSS ALL RELEVANT FINDINGS. AT SUCH MEETING, THE COMMISSIONER AND
THE  ESTABLISHED  OPERATOR SHALL ATTEMPT TO DEVELOP A MUTUALLY SATISFAC-
TORY PLAN OF CORRECTION AND SCHEDULE FOR IMPLEMENTATION. IN SUCH  EVENT,
THE  COMMISSIONER SHALL NOTIFY THE ESTABLISHED OPERATOR THAT THE COMMIS-
SIONER WILL ABSTAIN FROM APPOINTING A TEMPORARY OPERATOR CONTINGENT UPON
THE ESTABLISHED OPERATOR REMEDIATING THE IDENTIFIED DEFICIENCIES  WITHIN
THE AGREED UPON TIMEFRAME.
  (B)  SHOULD THE COMMISSIONER AND THE ESTABLISHED OPERATOR BE UNABLE TO
ESTABLISH A PLAN OF CORRECTION PURSUANT TO PARAGRAPH (A) OF THIS  SUBDI-
VISION,  OR  SHOULD  THE  ESTABLISHED  OPERATOR  FAIL  TO RESPOND TO THE
COMMISSIONER'S INITIAL NOTIFICATION, THERE SHALL  BE  AN  ADMINISTRATIVE

S. 2606                            165                           A. 3006

HEARING ON THE COMMISSIONER'S DETERMINATION TO APPOINT A TEMPORARY OPER-
ATOR  TO  BEGIN NO LATER THAN THIRTY DAYS FROM THE DATE OF THE NOTICE TO
THE ESTABLISHED OPERATOR. ANY SUCH HEARING SHALL BE STRICTLY LIMITED  TO
THE  ISSUE OF WHETHER THE DETERMINATION OF THE COMMISSIONER TO APPOINT A
TEMPORARY OPERATOR IS SUPPORTED BY SUBSTANTIAL EVIDENCE. A COPY  OF  THE
DECISION SHALL BE SENT TO THE ESTABLISHED OPERATOR.
  (C)  IF  THE  DECISION  TO APPOINT A TEMPORARY OPERATOR IS UPHELD SUCH
TEMPORARY OPERATOR SHALL BE APPOINTED AS  SOON  AS  IS  PRACTICABLE  AND
SHALL OPERATE THE PROGRAM PURSUANT TO THE PROVISIONS OF THIS SECTION.
  7. NOTWITHSTANDING THE APPOINTMENT OF A TEMPORARY OPERATOR, THE ESTAB-
LISHED  OPERATOR  REMAINS  OBLIGATED  FOR THE CONTINUED OPERATION OF THE
FACILITY SO THAT THE  PROGRAM  CAN  FUNCTION  IN  A  NORMAL  MANNER.  NO
PROVISION  CONTAINED  IN  THIS  SECTION  SHALL  BE DEEMED TO RELIEVE THE
ESTABLISHED OPERATOR OR ANY  OTHER  PERSON  OF  ANY  CIVIL  OR  CRIMINAL
LIABILITY  INCURRED,  OR  ANY  DUTY IMPOSED BY LAW, BY REASON OF ACTS OR
OMISSIONS OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON PRIOR  TO  THE
APPOINTMENT  OF  ANY  TEMPORARY  OPERATOR  OF THE PROGRAM HEREUNDER; NOR
SHALL ANYTHING CONTAINED IN THIS SECTION BE CONSTRUED TO SUSPEND  DURING
THE TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR OF THE PROGRAM ANY
OBLIGATION OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON FOR THE MAIN-
TENANCE  AND  REPAIR  OF  THE  FACILITY,  PROVISION OF UTILITY SERVICES,
PAYMENT OF TAXES OR OTHER OPERATING  AND  MAINTENANCE  EXPENSES  OF  THE
FACILITY,  NOR  OF  THE ESTABLISHED OPERATOR OR ANY OTHER PERSON FOR THE
PAYMENT OF MORTGAGES OR LIENS.
  S 52. Section 3000 of the public health law, as amended by chapter 804
of the laws of 1992, is amended to read as follows:
  S 3000. Declaration of policy and statement of purpose. The furnishing
of medical assistance in an emergency AND NON-EMERGENCY SITUATION  is  a
matter of vital concern affecting the public health, safety and welfare.
Prehospital  emergency  medical care, the provision of prompt and effec-
tive communication among ambulances, ADVANCED LIFE SUPPORT SERVICES  and
hospitals and safe and effective care and transportation of the sick and
injured are essential public health services.
  It  is  the purpose of this article to promote [the] public health AND
WELLNESS, safety and welfare  by  providing  for  certification  of  all
advanced  life  support  first response services and ambulance services;
the creation of regional emergency medical services [councils]  ADVISORY
BOARDS;  and a New York state emergency medical services [council] ADVI-
SORY BOARD to [develop] ADVISE THE DEPARTMENT AND  THE  COMMISSIONER  IN
THE  DEVELOPMENT  OF  minimum  training  standards  for  certified first
responders, emergency medical technicians and advanced emergency medical
technicians  and  minimum  equipment  and  communication  standards  for
advanced life support first response services and ambulance services.
  S  53.  Subdivision 2 and paragraphs (a), (c) and (e) of subdivision 3
of section 3000-b of the public health law, subdivision 2 as amended  by
chapter  583  of  the  laws  of  1999, paragraph (a) of subdivision 3 as
amended by chapter 243 of the laws of 2010 and paragraphs (c) and (e) of
subdivision 3 as added by chapter 552 of the laws of 1998,  are  amended
to read as follows:
  2.  Collaborative  agreement.  A  person,  firm, organization or other
entity may purchase, acquire, possess and operate an automated  external
defibrillator  pursuant  to  a collaborative agreement with an emergency
health care provider. The collaborative agreement shall include a  writ-
ten  agreement  and  written practice protocols, and policies and proce-
dures that shall assure compliance with this section. The public  access
defibrillation provider shall file a copy of the collaborative agreement

S. 2606                            166                           A. 3006

with  the  department  and with the appropriate regional [council] BOARD
prior to operating the automated external defibrillator.
  (a)  No  person may operate an automated external defibrillator unless
the person has successfully completed a training course in the operation
of an automated external defibrillator approved by  a  nationally-recog-
nized  organization  or  the  [state emergency medical services council]
COMMISSIONER AND THE COMPLETION OF THE COURSE WAS RECENT ENOUGH TO STILL
BE EFFECTIVE UNDER THE STANDARDS OF THE APPROVING ORGANIZATION.   Howev-
er,  this  section shall not prohibit operation of an automated external
defibrillator, (i) by a health care practitioner licensed  or  certified
under  title  VIII of the education law or a person certified under this
article acting within his or her lawful scope of  practice;  (ii)  by  a
person  acting  pursuant  to a lawful prescription; or (iii) by a person
who operates the automated external defibrillator other than as part  of
or  incidental to his or her employment or regular duties, who is acting
in good faith, with reasonable care, and without expectation of monetary
compensation, to provide first aid that includes operation of  an  auto-
mated  external  defibrillator;  nor  shall  this section limit any good
samaritan protections provided in section three thousand-a of this arti-
cle.
  (c) The public access defibrillation provider shall notify the  APPRO-
PRIATE  regional  [council] BOARD of the existence, location and type of
any automated external defibrillator it possesses.
  (e) The emergency  health  care  provider  shall  participate  in  the
regional  quality  improvement  program  pursuant  to subdivision one of
section three thousand [four-a] FOUR of this article.
  S 54. Subdivision 2 and paragraph (a)  of  subdivision  3  of  section
3000-c  of the public health law, as added by chapter 578 of the laws of
1999, are amended to read as follows:
  2. Collaborative agreement. Any eligible person, firm, organization or
other entity may purchase, acquire, possess and use epinephrine auto-in-
jector devices pursuant to a collaborative agreement with  an  emergency
health  care provider. The collaborative agreement shall include a writ-
ten agreement that incorporates written practice protocols, and policies
and procedures that shall ensure compliance with the provisions of  this
section.  The  person, firm, organization or entity shall file a copy of
the collaborative agreement with the department and with the appropriate
regional [council] BOARD prior to using  any  epinephrine  auto-injector
device.
  (a)  No  person  shall  use an epinephrine auto-injector device unless
such person shall have successfully completed a training course  in  the
use  of  epinephrine  auto-injector devices approved by the commissioner
[pursuant to the rules of the department]. This section does not prohib-
it the use of an epinephrine auto-injector device (i) by a  health  care
practitioner  licensed  or  certified under title eight of the education
law acting within the scope of his or her practice, or (ii) by a  person
acting pursuant to a lawful prescription.
  S 55. Section 3001 of the public health law, as amended by chapter 804
of the laws of 1992, subdivisions 13 and 15 as amended by chapter 445 of
the laws of 1993, is amended to read as follows:
  S  3001.  Definitions.  As  used  in  this article, unless the context
otherwise requires:
  1. "Emergency medical service" means  initial  emergency  AND  OUT  OF
HOSPITAL medical assistance including, but not limited to, the treatment
of  trauma,  burns, respiratory, circulatory [and], obstetrical emergen-
cies AND RESPONSE IN DISASTERS.

S. 2606                            167                           A. 3006

  1-A.  "PEDIATRIC  CARE"  MEANS  MEDICAL  CARE  PROVIDED  TO  NEONATES,
INFANTS, TODDLERS, PRESCHOOLERS, SCHOOL AGERS AND ADOLESCENTS.
  1-B. "TRAUMA CARE" MEANS HEALTH CARE PROVIDED TO PATIENTS AT HIGH RISK
OF DEATH OR DISABILITY FROM MULTIPLE AND SEVERE INJURIES.
  1-C.  "DISASTER  CARE"  MEANS  CARE  PROVIDED  TO PATIENTS WHO ARE THE
VICTIMS OF NATURAL OR MAN-MADE DISASTERS, INCLUDING BUT NOT  LIMITED  TO
BIOLOGIC, NUCLEAR, INCENDIARY, CHEMICAL AND EXPLOSIVE DISASTERS.
  2.  "Ambulance service" means an individual, partnership, association,
corporation, municipality or any legal or public entity  or  subdivision
thereof  engaged in providing emergency AND OUT OF HOSPITAL medical care
and the transportation of sick or  injured  persons  by  motor  vehicle,
aircraft  or  other forms of transportation to, from, or between general
hospitals or other health care facilities.
  3. "Voluntary ambulance service" means an ambulance service (i)  oper-
ating  not  for  pecuniary profit or financial gain, and (ii) no part of
the assets or income of which is distributable  to,  or  enures  to  the
benefit  of,  its  members,  directors  or officers except to the extent
permitted under this article.
  4. "Voluntary advanced life  support  first  response  service"  means
advanced life support first response service (i) operating not for pecu-
niary profit or financial gain, and (ii) no part of the assets or income
of  which is distributable to, or enures to the benefit of, its members,
directors or officers except to the extent permitted under this article.
  5. "Certified first responder" means an individual who meets the mini-
mum TRAINING, EDUCATION AND CERTIFICATION  requirements  established  by
[regulations pursuant to section three thousand two of this article] THE
COMMISSIONER  and  who is responsible for administration of initial life
saving care of sick and injured persons.
  6. "Emergency medical technician" means an individual  who  meets  the
minimum  TRAINING,  EDUCATION AND CERTIFICATION requirements established
by [regulations pursuant to section three thousand two of this  article]
THE  COMMISSIONER  and  who  is responsible for administration or super-
vision of initial emergency medical care and transportation of  sick  or
injured persons.
  7.  "Advanced emergency medical technician" means an emergency medical
technician who [has  satisfactorily  completed  an  advanced  course  of
training  approved  by  the  state council under regulations pursuant to
section three thousand two of this article] MEETS THE MINIMUM  TRAINING,
EDUCATION AND CERTIFICATION REQUIREMENTS ESTABLISHED BY THE COMMISSIONER
AND  WHO  IS  RESPONSIBLE  FOR ADMINISTRATION OR SUPERVISION OF ADVANCED
EMERGENCY AND OUT OF HOSPITAL MEDICAL CARE AND TRANSPORTATION OF SICK OR
INJURED PERSONS.
  7-A. "PARAMEDIC" MEANS AN INDIVIDUAL THAT MEETS THE MINIMUM  TRAINING,
EDUCATION AND CERTIFICATION REQUIREMENTS ESTABLISHED BY THE COMMISSIONER
AND  WHO  IS  RESPONSIBLE  FOR ADMINISTRATION OR SUPERVISION OF ADVANCED
EMERGENCY CARE, OUT OF HOSPITAL MEDICAL CARE AND TRANSPORTATION OF  SICK
OR INJURED PERSONS.
  8.  "State [council] BOARD" means the New York state emergency medical
services [council] ADVISORY BOARD established pursuant to this article.
  9. "Regional [council]  BOARD"  means  a  regional  emergency  medical
services [council] ADVISORY BOARD established pursuant to this article.
  10.  "Enrolled  member"  means  any  member  of  a voluntary ambulance
service or voluntary advanced life support first  response  service  who
provides  emergency  medical  care  or transportation of sick or injured
persons without expectation of monetary compensation.

S. 2606                            168                           A. 3006

  11. "Advanced life support care" means definitive acute  medical  care
provided,  under  medical control, by advanced emergency medical techni-
cians within an advanced life support system.
  12.  "Advanced  life  support system" means an organized acute medical
care system to provide advanced life support care on site  or  en  route
to, from, or between general hospitals or other health care facilities.
  13. "Advanced life support mobile unit" means an ambulance or advanced
life  support  first  response vehicle approved to provide advanced life
support services pursuant to this article.
  14. "Qualified medical and health personnel" means physicians,  regis-
tered  professional  nurses  and  advanced emergency medical technicians
competent in the management of patients requiring advanced life  support
care.
  15.  "Medical  control"  means: (a) advice and direction provided by a
physician or under the direction  of  a  physician  to  certified  first
responders,  emergency medical technicians or advanced emergency medical
technicians who are providing medical care at the scene of an  emergency
or  en route to a health care facility; and (b) indirect medical control
including the written policies, procedures, and protocols for  prehospi-
tal  emergency  medical  care and transportation developed by [the state
emergency medical advisory committee, approved by  the  state  emergency
medical  services  council  and]  the  commissioner,  and implemented by
regional EMERGENCY medical advisory committees.
  16. "Regional EMERGENCY medical advisory committee" means a  group  of
five  or  more physicians, and one or more non-voting individuals repre-
sentative of each  of  the  following:  hospitals,  basic  life  support
providers,   advanced  life  support  providers  and  emergency  medical
services training sponsor medical directors  approved  by  the  affected
regional [emergency medical services councils] BOARDS.
  17.  "Advanced life support first response service" means an organiza-
tion which provides advanced life support care, but does  not  transport
patients.
  18.  ["EMS program agency" means a not-for-profit corporation or muni-
cipality designated by the state council and approved  by  the  affected
regional council or councils to facilitate the development and operation
of  an  emergency medical services system within a region as directed by
the regional council under this article.
  19.] "Operator" means any person who by reason of a direct or indirect
ownership interest (whether of record or beneficial)  has  the  ability,
acting  either alone or in concert with others with ownership interests,
to direct or cause the direction of the management  or  policies  of  an
ambulance service or advanced life support first response service.
  [20]  19.    "Mutual aid agreement" means a written agreement, entered
into by two or more ambulance services or advanced  life  support  first
response  services  possessing valid [ambulance service or advanced life
support first response service certificates or statements  of  registra-
tion]  OPERATING  AUTHORITY,  FIRE  SERVICES  AS  DEFINED BY SECTION TWO
HUNDRED NINE-B OF THE GENERAL MUNICIPAL LAW, OR THE  GOVERNING  BODY  OF
ANY  CITY,  TOWN OR VILLAGE, for the organized, SUPERVISED, coordinated,
and  cooperative  reciprocal  mobilization  of   personnel,   equipment,
services, or facilities for [back-up or support upon request as required
pursuant to a written mutual aid plan] OUTSIDE SERVICE UPON REQUEST.  An
ambulance  service  and advanced life support first response service may
participate in one or more mutual aid agreements.
  [21] 20.  "Primary territory" means the geographic  area  or  subdivi-
sions listed on an ambulance service certificate [or statement of regis-

S. 2606                            169                           A. 3006

tration  within  which  the  ambulance  service may receive patients for
transport].
  S  56.  Section  3002  of  the public health law is REPEALED and a new
section 3002 is added to read as follows:
  S 3002. NEW YORK STATE EMERGENCY MEDICAL SERVICES ADVISORY  BOARD.  1.
THERE  IS  HEREBY  CREATED  WITHIN THE DEPARTMENT OF HEALTH THE NEW YORK
STATE EMERGENCY MEDICAL SERVICES ADVISORY BOARD. THE BOARD SHALL CONSIST
OF THIRTY-ONE MEMBERS, APPOINTED  BY  THE  COMMISSIONER,  WHO  SHALL  BE
REPRESENTATIVE  OF  THE  DIVERSITY  OF  THE EMERGENCY MEDICAL AND TRAUMA
SYSTEM IN THE STATE,  PARTICULARLY  REGARDING  DIVERSITY  IN  GEOGRAPHY,
INDUSTRY  AND  PATIENT  CARE. MEMBERS SHALL SERVE AT THE PLEASURE OF THE
COMMISSIONER FOR THREE YEAR TERMS, EXCEPT THAT THE TERM OF ELEVEN OF THE
INITIAL ADVISORY MEMBERS SHALL BE FOR TWO YEARS; PROVIDED THAT A  MEMBER
SHALL  CONTINUE  TO SERVE IN FULL CAPACITY UNTIL SUCH TIME AS THE MEMBER
RESIGNS, IS REMOVED OR REPLACED. NO PERSON MAY SERVE  AS  A  MEMBER  FOR
MORE  THAN TWO CONSECUTIVE TERMS TOTAL. THE COMMISSIONER SHALL APPOINT A
CHAIR AND A VICE-CHAIR. MEMBERS OF THE  STATE  BOARD  SHALL  RECEIVE  NO
COMPENSATION FOR THEIR SERVICES AS MEMBERS.
  2.  NO  CIVIL ACTION SHALL BE BROUGHT IN ANY COURT AGAINST ANY MEMBER,
OFFICER OR EMPLOYEE OF THE STATE BOARD FOR ANY ACT DONE, FAILURE TO ACT,
OR STATEMENT OR OPINION MADE, WHILE DISCHARGING HIS OR HER DUTIES  AS  A
MEMBER,  OFFICER  OR  EMPLOYEE  OF THE STATE BOARD, WITHOUT LEAVE FROM A
JUSTICE OF THE SUPREME COURT, FIRST HAD AND OBTAINED. IN NO EVENT  SHALL
SUCH  MEMBER,  OFFICER  OR  EMPLOYEE  BE  LIABLE FOR DAMAGES IN ANY SUCH
ACTION IF HE OR SHE SHALL HAVE ACTED IN GOOD FAITH, WITH REASONABLE CARE
AND UPON PROBABLE CAUSE.
  3. THE STATE BOARD SHALL ADVISE THE DEPARTMENT ON  ISSUES  RELATED  TO
EMERGENCY  MEDICAL  SERVICES,  PEDIATRIC  CARE, TRAUMA CARE AND DISASTER
CARE, AND ASSIST IN THE COORDINATION OF SUCH, INCLUDING BUT NOT  LIMITED
TO  THE  DEVELOPMENT,  PERIODIC  REVISION,  AND APPLICATION OF RULES AND
REGULATIONS, APPROPRIATENESS REVIEW STANDARDS, AND  QUALITY  IMPROVEMENT
GUIDELINES,  AS  THE  COMMISSIONER  AND  THE DEPARTMENT MAY REQUEST. THE
STATE BOARD SHALL HAVE THE SAME AUTHORITY GRANTED TO REGIONAL BOARDS  BY
THE ARTICLE IN ANY REGION OF THE STATE IN WHICH A REGIONAL BOARD HAS NOT
BEEN ESTABLISHED. THE STATE BOARD MAY MEET AS FREQUENTLY AS REQUESTED BY
THE DEPARTMENT.
  4. UPON APPEAL FROM ANY CONCERNED PARTY, THE STATE BOARD MAY RECOMMEND
AMENDMENT,  MODIFICATION  AND REVERSAL OF DETERMINATIONS OF THE REGIONAL
BOARDS AND REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEES MADE  PURSUANT
TO ANY SECTION OF THIS ARTICLE. THE COMMISSIONER SHALL REVIEW ALL RECOM-
MENDATIONS OF THE STATE BOARD AND MAY APPROVE, DISAPPROVE OR MODIFY SUCH
RECOMMENDATIONS.  ALL  RECOMMENDATIONS APPROVED, DISAPPROVED OR MODIFIED
BY THE COMMISSIONER SHALL BE SUBJECT TO REVIEW AS  PROVIDED  IN  ARTICLE
SEVENTY-EIGHT  OF THE CIVIL PRACTICE LAW AND RULES. APPLICATION FOR SUCH
REVIEW MUST BE MADE WITHIN SIXTY DAYS AFTER  SERVICE  IN  PERSON  OR  BY
REGISTERED OR CERTIFIED MAIL.
  5.  THE COMMISSIONER MAY APPOINT A TECHNICAL ADVISORY GROUP TO COMPILE
AND REVIEW DATA, DRAFT DOCUMENTS, OR PERFORM OTHER TASKS RELATED TO  THE
DISCOVERY  OR  PRODUCTION  OF  INFORMATION NEEDED IN ORDER FOR THE STATE
BOARD TO PROPERLY CONSIDER A MATTER. TECHNICAL ADVISORY GROUPS SHALL  BE
APPOINTED  ONLY FOR A LIMITED AND DEFINED PERIOD OF TIME IN THE PERFORM-
ANCE OF A SPECIFIC TASK IN RELATION TO A  SPECIFIC  MATTER.  INFORMATION
OBTAINED  OR  PRODUCED BY THE TECHNICAL ADVISORY GROUP SHALL BE PROVIDED
TO AND EXAMINED BY THE STATE ADVISORY BOARD.
  S 57. Section 3002-a of the public health law is REPEALED.

S. 2606                            170                           A. 3006

  S 58. Section 3003 of the public health law, as added by chapter  1053
of  the  laws  of  1974, subdivision 1 as amended by chapter 1054 of the
laws of 1974, subdivisions 2 and 5 as amended by chapter 445 of the laws
of 1993, subdivisions 3 and 5-a as added and paragraph (a)  of  subdivi-
sion  10 as amended by chapter 804 of the laws of 1992, subdivision 4 as
amended by chapter 580 of the laws of 2007 and subdivision 10  as  added
by chapter 1016 of the laws of 1981, is amended to read as follows:
  S  3003.  Regional  emergency  medical  services  [councils]  ADVISORY
BOARDS. 1. The commissioner[, with the approval of the  state  council,]
shall  designate  regional  emergency  medical  services [councils on or
before January first, nineteen hundred seventy-eight] BOARDS but  in  no
event  shall  the number of regional [councils] BOARDS exceed [eighteen]
TEN.  Such A regional [councils] BOARD shall be established on the basis
of application for designation as A regional [councils] BOARD  submitted
by  local organizations, the members of which are knowledgeable in vari-
ous aspects  of  emergency  medical  services.  Such  application  shall
describe the geographic area to be served and contain a list of nominees
for  appointment  to  membership on such regional [councils] BOARD and a
statement as to the proposed method of operation in such detail  as  the
commissioner[, with the approval of the state council,] shall prescribe.
  2.  Each  regional  [council]  BOARD  shall  be  comprised of at least
fifteen but not more than thirty members to be  initially  appointed  by
the  commissioner, [with the approval of the state council] IN CONSULTA-
TION WITH THE STATE BOARD, from nominations submitted by local organiza-
tions applying for establishment as the regional [council]  BOARD.  SUCH
MEMBERS  SHALL  BE  REPRESENTATIVE OF THE DIVERSITY OF EMERGENCY MEDICAL
SERVICES IN THE  REGION;  PARTICULARLY  WITH  RESPECT  TO  DIVERSITY  IN
GEOGRAPHY,  INDUSTRY  AND PATIENT CARE.   Not less than one-third of the
membership of the regional [councils] BOARDS shall be representatives of
ambulance services and the remaining membership of the  regional  [coun-
cils] BOARDS shall consist of, but not be limited to, representatives of
existing  local  emergency  medical care committees, physicians, nurses,
hospitals, health  planning  agencies,  fire  department  emergency  and
rescue squads, public health officers and the general public. The county
EMS  coordinator,  established  pursuant  to section two hundred twenty-
three-b of the county law, of any county within the region  shall  serve
as  an  ex  officio  member  of  the regional [council] BOARD; provided,
however, nothing in this subdivision shall prevent a county EMS  coordi-
nator  from  serving  as  a voting member of a regional [council] BOARD.
Members of each regional [council] BOARD shall be residents living with-
in the geographic area to be served by the regional [council] BOARD. The
presence of a majority of members shall constitute a quorum.
  3. Each regional [council] BOARD shall ASSIST THE  REGIONAL  EMERGENCY
MEDICAL ADVISORY COMMITTEES, OTHER REGIONAL BOARDS, STATE BOARD, DEPART-
MENT  AND COMMISSIONER, AS REQUIRED BY THIS ARTICLE AND REQUESTED BY THE
DEPARTMENT AND COMMISSIONER, IN CARRYING  OUT  THE  PROVISIONS  OF  THIS
ARTICLE, AND SHALL have the power to:
  (a) [have a seal and alter the same at pleasure;
  (b) acquire, lease, hold, and dispose of real and personal property or
any interest therein for its purposes;
  (c)  make  and alter by-laws for its organization and internal manage-
ment, and rules and regulations governing the exercise of its powers and
the fulfillment of its purposes under this article; such rules and regu-
lations must be filed with the secretary of  state  and  the  state  EMS
council;

S. 2606                            171                           A. 3006

  (d) enter into contracts for employment of such officers and employees
as  it  may  require  for  the performance of its duties; and to fix and
determine their qualifications, duties, and compensation, and to  retain
and  employ  such  personnel  as  may  be required for its purposes; and
private  consultants on a contract basis or otherwise, for the rendering
of professional or technical services and advice;
  (e) enter into contracts, leases, and subleases  and  to  execute  all
instruments  necessary  or  convenient  for the conduct of its business,
including contracts with the commissioner and any state agency or munic-
ipal entity;  and  contracts  with  hospitals  and  physicians  for  the
purposes of carrying out its powers under this article;
  (f)]  undertake or cause to be undertaken plans, surveys, analyses and
studies necessary, convenient or desirable for the effectuation  of  its
purposes  and  powers,  and  to  prepare  recommendations and reports in
regard thereto;
  [(g)] (B) fix and collect reasonable fees, rents,  and  other  charges
for the use of its equipment and the provision of its services;
  [(h)  contract  for  and  to accept any gifts or grants, subsidies, or
loans of funds or property, or financial or other aid in any  form  from
the  federal or state government or any agency or instrumentality there-
of; or from any other source, public or private, and to comply,  subject
to  the provisions of this article, with the terms and conditions there-
of; provided, however, that the councils may  contract  for  payment  of
debt  evidenced  by  bonds  or  notes or other evidence of indebtedness,
either directly or through a lease purchase agreement;
  (i)] (C) recommend to the department approval of training course spon-
sors within its region, and to develop, promulgate and implement annual-
ly an EMS training plan which addresses the needs of its region;
  [(j)] (D) enter into [contracts or memoranda of agreement]  AGREEMENTS
with  other regional [councils] BOARDS to provide services in a joint or
cooperative manner; and [to enter into contracts or memoranda of  agree-
ment  with an EMS program agency to carry out one or more of its respon-
sibilities under this article;
  (k) procure insurance against any loss or liability in connection with
the use, management, maintenance, and operation  of  its  equipment  and
facilities,  in  such  amounts  and  from such insurers as it reasonably
deems necessary;
  (l)  approve]  (E)  RECOMMEND  TO  THE  COMMISSIONER  INDIVIDUALS  FOR
APPOINTMENT TO ITS regional medical advisory committee [nominees;
  (m)  provide  focused technical assistance and support to those volun-
tary ambulance services  operating  under  exemptions,  to  assist  such
services  in progressing toward the uniform standards established pursu-
ant to this section. Such assistance and support shall include, but  not
be limited to, volunteer recruitment and management training; and
  (n) do all things necessary, convenient and desirable to carry out its
purposes and for the exercise of the powers granted in this article].
  4.  Each  regional  [council]  BOARD  shall have the responsibility to
coordinate  emergency  medical  services  programs  within  its  region,
including  but  not  limited  to, the establishment of emergency medical
technician courses and the issuance of uniform emergency medical techni-
cian insignia and certificates. Such  training  courses  shall  be  made
available by video or computer to the maximum extent possible.
  5.  [The]  EACH regional [council] BOARD shall have the responsibility
to make determinations of public need for  the  establishment  of  addi-
tional  emergency  medical  services  and  ambulance services WITHIN ITS
GEOGRAPHIC AREA and  to  make  the  determinations  of  public  need  as

S. 2606                            172                           A. 3006

provided  in  section three thousand eight OF THIS ARTICLE. The regional
[council] BOARD shall make such determination by an affirmative vote  of
a majority of all of those members consisting of voting members.
  [5-a. The regional emergency medical services council is authorized to
grant  an  exemption  from  the  staffing standards set forth in section
three thousand five-a of this article to a voluntary  ambulance  service
operating solely with enrolled members or paid emergency medical techni-
cians  which  has demonstrated a good faith effort to meet the standards
and is unable to meet such standards because of factors deemed appropri-
ate by the regional council. An exemption shall be for a period  not  to
exceed  two  years  and shall be conditioned on the participation by the
voluntary service in a program to achieve compliance which shall include
technical assistance and support from the regional council  tailored  to
the needs and resources at the local level, as provided by paragraph (m)
of subdivision three of this section, to be funded by the New York state
emergency  medical  services  training  account  established pursuant to
section ninety-seven-q of the state finance law, such account as  funded
by a chapter of the laws of nineteen hundred ninety-three. Nothing shall
prevent  the  regional  council from issuing subsequent exemptions. Such
exemptions shall have no effect whatsoever on the  insurability  of  the
organization  receiving  such  exemption and such exemption shall not be
used as a basis for increasing insurance rates or premiums related ther-
eto, notwithstanding any other provision of law,  rule,  regulation,  or
commissioner's  ruling  or advisory to the contrary. Prior to issuing an
exemption, the regional council shall provide written notice  by  certi-
fied  mail  to the chief executive officers of all general hospitals and
municipalities in the  county  or  counties  within  which  the  service
requesting  an exemption operates. Such notice shall provide opportunity
for comment on the issuance of the exemption.   Notice of  the  determi-
nation  of the regional council shall be provided within ten days of the
determination to the applicant, the department, and any party  receiving
notification  of  the  application  who  requests notice of the determi-
nation. The applicant, the department, or any concerned party may appeal
the determination of the regional council to the  state  council  within
thirty days after the regional council makes its determination.]
  6.  The  term  of  office  of members of [the] EACH regional [council]
BOARD shall be four years, except that of those members first appointed,
at least one-half but not more than two-thirds shall be  for  [terms]  A
TERM not to exceed two years.
  7. Each regional [council] BOARD shall meet as frequently as its busi-
ness may require.
  8. [The commissioner, upon request of the regional council, may desig-
nate an officer or employee of the department to act as secretary of the
regional  council, and may assign from time to time such other employees
as the regional council may require.
  9.] No civil action shall be brought in any court against any  member,
officer  or  employee of any designated regional [council] BOARD for any
act done, failure to act, or statement or opinion made, while  discharg-
ing  his  duties as a member, officer or employee of the regional [coun-
cil] BOARD, without leave from a justice of the supreme court, first had
and obtained. In any event such member, officer or employee shall not be
liable for damages in any such action if he shall  have  acted  in  good
faith, with reasonable care and upon probable cause.
  [10.  (a)  The department shall provide each regional council with the
funds necessary to enable such regional council to carry out its respon-

S. 2606                            173                           A. 3006

sibilities as mandated under this section  within  amounts  appropriated
therefor.
  (b) Such funds shall be provided upon approval by the department of an
application  submitted  by  a  regional  council.  The application shall
contain such information and be in such form as the  commissioner  shall
require  pursuant  to  rules  and  regulations which he shall promulgate
after consultation with  the  state  council  in  order  to  effect  the
purposes and provisions of this subdivision.]
  9.  ALL  DETERMINATIONS  OF THE REGIONAL BOARDS MAY BE APPEALED TO THE
STATE BOARD PURSUANT TO SUBDIVISION THREE OF SECTION THREE THOUSAND  TWO
OF THIS ARTICLE.
  S 59. Section 3003-a of the public health law is REPEALED.
  S 60. Section 3004-a of the public health law, as added by chapter 804
of  the  laws of 1992, subdivision 4 as added by chapter 445 of the laws
of 1993, is renumbered section 3004 and amended to read as follows:
  S 3004. Regional emergency medical advisory  committees.  1.  Regional
emergency  medical  advisory  committees  shall develop policies, proce-
dures, and triage, treatment, and transportation protocols FOR EMERGENCY
MEDICAL SERVICES which are consistent with the STATE-WIDE MINIMUM stand-
ards [of the state emergency medical advisory committee] ESTABLISHED  BY
THE COMMISSIONER IN CONSULTATION WITH THE STATE BOARD, and which address
specific  local conditions.  Regional emergency medical advisory commit-
tees may also approve physicians to provide  on  line  medical  control,
coordinate  the  development  of  regional  medical control systems, and
participate in quality  improvement  activities  addressing  system-wide
concerns.  Hospitals  and  prehospital  medical  care  services shall be
authorized to release patient outcome information to regional  emergency
medical  advisory  committees for purposes of assessing prehospital care
concerns. Regional quality improvement programs shall be presumed to  be
an  extension  of  the  quality improvement program set forth in section
three thousand six of this article, and the provisions  of  subdivisions
two  and  three  of  such section three thousand six shall apply to such
programs.
  2. [The committee shall nominate to the commissioner a physician  with
demonstrated  knowledge  and experience in emergency medical services to
serve on the state emergency medical advisory committee.
  3.] No civil action shall be brought in any court against any  member,
officer  or  employee of the committee for any act done, failure to act,
or statement or opinion made, while discharging his or her duties  as  a
member,  officer,  or  employee  of  the committee, without leave from a
justice of the supreme court, first had and obtained.  In no event shall
such member, officer, or employee be liable  for  damages  in  any  such
action if he or she shall have acted in good faith, with reasonable care
and upon probable cause.
  [4.]  3. Any decision of a regional emergency medical advisory commit-
tee regarding provision of a level of care, including staffing  require-
ments,  may be appealed to the state [emergency medical advisory commit-
tee] BOARD by any  regional  [EMS  council]  BOARD,  ambulance  service,
advanced  life  support  service,  certified  first responder, emergency
medical technician, or advanced emergency medical  technician  adversely
affected.    No  action shall be taken to implement a decision regarding
existing levels of care or staffing while an appeal of such decision  is
pending. [Any decision of the state emergency medical advisory committee
may  be appealed pursuant to subdivision two-a of section three thousand
two-a of this article.]

S. 2606                            174                           A. 3006

  S 61. Section 3005 of the public health law, as amended by chapter 804
of the laws of 1992, subdivision 5 as amended and subdivision 8 as added
by chapter 445 of the laws of 1993, is amended to read as follows:
  S 3005. Ambulance service certificates. 1. No ambulance service [oper-
ating  for  profit,  hospital  ambulance  service or municipal ambulance
service of a city of over one million population  shall  operate  on  or
after September first, nineteen hundred seventy-five unless it possesses
a  valid  ambulance service certificate issued pursuant to this article.
Effective January first, nineteen  hundred  ninety-seven,  no  ambulance
service  shall be operated unless it possesses a valid ambulance service
operating certificate issued pursuant to this article or has been issued
a statement of registration. No advanced  life  support  first  response
service  shall operate unless it possesses a valid advanced life support
first responder service operating certificate. Effective January  first,
two  thousand,  no  ambulance  service]  OR  ADVANCED LIFE SUPPORT FIRST
RESPONSE SERVICE shall be operated unless it possesses a valid operating
certificate.
  2. [The department shall issue an initial certificate to an  ambulance
service  certified  prior  to  the  effective  date of this section upon
submission of proof that it is the holder of a valid  ambulance  service
certificate  and  is  otherwise in compliance with provisions of section
three thousand nine of this article.
  2-a. Prior to January first, two thousand, the department shall  issue
an  initial  certificate to a registered ambulance service in possession
of a valid registration provided that such service has  been  issued  an
exemption issued by a regional council pursuant to subdivision five-a of
section three thousand three of this article.
  3.  The  department  shall issue an initial certificate to an advanced
life support first response service upon submission of proof  that  such
advanced  life support first response service is staffed and equipped in
accordance with rules and regulations promulgated pursuant to this arti-
cle and is otherwise in compliance  with  provisions  of  section  three
thousand nine of this article.
  4.]  A certificate issued BY THE DEPARTMENT to an ambulance service or
advanced life support first response service  shall  be  valid  for  two
years. The initial certification fee shall be one hundred dollars. Ther-
eafter the biennial fee shall be in accordance with the schedule of fees
established by the commissioner pursuant to this article. However, there
shall be no initial or renewal certification fee required of a voluntary
ambulance  service  or  voluntary  advanced  life support first response
service.
  [5.] 3. No initial certificate [(except  initial  certificates  issued
pursuant to subdivision two of this section)] shall be issued unless the
commissioner finds that the proposed operator or operators are competent
and  fit  to  operate  the  service  and  that  the ambulance service or
advanced life support first response service is staffed and equipped  in
accordance with rules and regulations promulgated pursuant to this arti-
cle.
  [6.]  4.  No ambulance service or advanced life support first response
service shall begin operation without prior approval of the  appropriate
regional  [council] BOARD, or if there is no appropriate regional [coun-
cil] BOARD established such ambulance service or advanced  life  support
first response service shall apply for approval from the state [council]
BOARD  as  to  the public need for the establishment of additional ambu-
lance service or advanced life support first response service,  pursuant
to section three thousand eight of this article.

S. 2606                            175                           A. 3006

  [7.]  5.  Applications for a certificate shall be made by the owner of
an ambulance service or advanced life  support  first  response  service
operating  for  profit  or the responsible official of a voluntary ambu-
lance service or advanced life support first response service upon forms
provided  by  the department.   The application shall state the name and
address of the owner and PROVIDE such other information as  the  depart-
ment may require pursuant to rules and regulations.
  [8.]  6.  For  purposes  of  this  article,  competent  means that any
proposed operator of any ambulance  service  or  advanced  life  support
first  response  service  who is already or had been within the last ten
years an incorporator,  director,  sponsor,  principal  stockholder,  or
operator  of  any  ambulance service, hospital, private proprietary home
for adults, residence for adults, or non-profit home  for  the  aged  or
blind  which  has  been  issued  an  operating  certificate by the state
department of social services, or a  halfway  house,  hostel,  or  other
residential  facility or institution for the care, custody, or treatment
of the mentally disabled subject to the approval by  the  department  of
mental  hygiene, or any invalid coach service subject to approval by the
department of transportation, is rendering or did render a substantially
consistent high level of care. For purposes  of  this  subdivision,  the
[state emergency medical services council] COMMISSIONER, IN CONSULTATION
WITH  THE  STATE BOARD, shall [adopt] PROMULGATE rules and regulations[,
subject to the approval of the commissioner,] to establish the  criteria
to  be  used  to define substantially consistent high level of care with
respect  to  ambulance  services[,]  AND  advanced  life  support  first
response  services,  [and invalid coaches,] except that the commissioner
may not find that a consistently high level of care  has  been  rendered
where  there have been violations of the state EMS code, or other appli-
cable rules and regulations, that (i) threatened to directly affect  the
health,  safety,  or  welfare of any patient, and (ii) were recurrent or
were not promptly corrected. For purposes of  this  article,  the  rules
adopted  by  the  state  [hospital  review  and planning council] PUBLIC
HEALTH AND HEALTH PLANNING COUNCIL with respect to subdivision three  of
section  twenty-eight hundred one-a of this chapter shall apply to other
types of operators. Fit means that the operator or proposed operator (a)
has not been convicted of a crime or pleaded nolo contendere to a felony
charge involving murder, manslaughter,  assault,  sexual  abuse,  theft,
robbery,  fraud,  embezzlement,  drug abuse, or sale of drugs and (b) is
not or was not subject to a state or federal administrative order relat-
ing to fraud or embezzlement, unless the commissioner  finds  that  such
conviction  or  such order does not demonstrate a present risk or danger
to patients or the public.
  S 62. Section 3005-a of the public health law, as added by chapter 804
of the laws of 1992, subdivision 1 as amended by chapter 445 of the laws
of 1993, is amended to read as follows:
  S 3005-a. Staffing standards; ambulance  services  and  advanced  life
support  first  response services.   1. The following staffing standards
shall be in effect unless otherwise provided by this section:
  [(a) effective January first, nineteen hundred ninety-seven the  mini-
mum  staffing  standard  for  a  registered ambulance service shall be a
certified first responder with the patient;
  (b) effective January first, two thousand, the] THE  minimum  staffing
standard  for [a voluntary] EACH ambulance service shall be an emergency
medical technician with the patient;
  [(c) the minimum staffing standard for all  other  ambulance  services
shall be an emergency medical technician with the patient; and

S. 2606                            176                           A. 3006

  (d)]  2.  the  minimum  staffing standard for an advanced life support
first response service shall be an advanced emergency medical technician
with the patient. Circumstances  permitting  other  than  advanced  life
support  care  by an advanced life support first response service may be
established  by  rule  PROMULGATED by [the state council, subject to the
approval of] the commissioner, IN CONSULTATION WITH THE STATE BOARD.
  [2. Any service granted an exemption by the regional council  pursuant
to  subdivision  five-a  of section three thousand three of this article
shall be subject to the standards and terms of the exemption.
  3. Notwithstanding any other provision of this article, the  effective
date  of  the  standards established by this section shall be delayed by
one year for each fiscal year, prior to January first, two thousand,  in
which  the amounts appropriated are less than that which would have been
expended pursuant to the provisions of  section  ninety-seven-q  of  the
state finance law.]
  S 63. Section 3005-b of the public health law is REPEALED.
  S  64.  Section 3006 of the public health law, as added by chapter 804
of the laws of 1992, subdivision 1 as amended and subdivision 4 as added
by chapter 445 of the laws of 1993, is amended to read as follows:
  S 3006. Quality improvement program.  1. [By January  first,  nineteen
hundred  ninety-seven,  every] EVERY ambulance service and advanced life
support first response service shall establish or participate in a qual-
ity improvement program, which shall be an ongoing system to monitor and
evaluate the quality and appropriateness of the medical care provided by
the ambulance service or advanced life support first  response  service,
and  which  shall  pursue  opportunities  to improve patient care and to
resolve identified problems. The  quality  improvement  program  may  be
conducted  independently  or  in collaboration with other services, with
the appropriate regional [council, with an EMS  program  agency]  BOARD,
with  a  hospital,  or with another appropriate organization approved by
the department. Such program shall include a committee of at least  five
members,  at  least three of whom do not participate in the provision of
care by the service. At least one member shall be a physician,  and  the
others  shall  be  nurses, or emergency medical technicians, or advanced
emergency medical technicians, or other appropriately  qualified  allied
health  personnel.  The  quality  improvement  committee  shall have the
following responsibilities:
  (a) to review the care rendered  by  the  service,  as  documented  in
prehospital  care  reports and other materials. The committee shall have
the authority to use such information to review and to recommend to  the
governing body changes in administrative policies and procedures, as may
be  necessary,  and shall notify the governing body of significant defi-
ciencies;
  (b) to periodically review the  credentials  and  performance  of  all
persons providing emergency medical care on behalf of the service;
  (c)  to  periodically  review  information  concerning compliance with
standard of care procedures and protocols,  grievances  filed  with  the
service  by  patients or their families, and the occurrence of incidents
injurious or potentially injurious to patients.  A  quality  improvement
program shall also include participation in the department's prehospital
care reporting system and the provision of continuing education programs
to  address  areas  in which compliance with procedures and protocols is
most deficient and to inform personnel  of  changes  in  procedures  and
protocols.  Continuing education programs may be provided by the service
itself or by other organizations; and

S. 2606                            177                           A. 3006

  (d) to present data to the regional EMERGENCY medical advisory commit-
tee and to participate in system-wide evaluation.
  1-A.  THE DEPARTMENT SHALL DEVELOP AND MAINTAIN STATEWIDE AND REGIONAL
QUALITY  IMPROVEMENT  PROGRAMS FOR TRAUMA AND DISASTER CARE, WHICH SHALL
BE INTEGRATED WITH THE QUALITY IMPROVEMENT PROGRAM FOR EMERGENCY MEDICAL
SERVICES, AND INCORPORATE QUALITY IMPROVEMENT PROGRAMS FROM  ALL  COMPO-
NENTS  OF  THE TRAUMA SYSTEM, INCLUDING, BUT NOT LIMITED TO, FULLY INTE-
GRATED STATEWIDE AND REGIONAL TRAUMA REGISTRIES.
  2. The information required to be collected and maintained,  including
[information from the prehospital care reporting system which identifies
an  individual]  PATIENT  IDENTIFYING  INFORMATION  AND PROTECTED HEALTH
INFORMATION, shall be kept confidential and shall not be released except
to the department or pursuant to section three thousand [four-a] FOUR of
this article.
  3. Notwithstanding any other provisions of law, none  of  the  MEDICAL
records,  documentation,  or  [committee] actions or records required OF
ANY QUALITY IMPROVEMENT COMMITTEE pursuant  to  this  section  shall  be
subject  to  disclosure  under article six of the public officers law or
article thirty-one of the civil practice law and rules, except as  here-
inafter provided or as provided in any other provision of law. No person
in  attendance  at a meeting of any [such] QUALITY IMPROVEMENT committee
shall be required to testify as to what transpired thereat.  The  prohi-
bition  related to disclosure of testimony shall not apply to the state-
ments made by any person in attendance at such a meeting who is a  party
to  an  action  or  proceeding  the subject of which was reviewed at the
meeting.  The prohibition of disclosure of information from the  prehos-
pital  care  reporting  system shall not apply to information which does
not identify a particular ambulance service or individual.
  4. Any person who in good faith and without malice  provides  informa-
tion  to  further  the purpose of this section or who, in good faith and
without malice, participates on the quality improvement committee  shall
not  be  subject  to  any  action for civil damages or other relief as a
result of such activity.
  S 65. Section 3008 of the public health law, as added by chapter  1053
of  the  laws of 1974, subdivisions 1 and 2 as amended by chapter 804 of
the laws of 1992, subdivision 3 as amended by chapter 252 of the laws of
1981, subdivision 6 as added by chapter 850 of the laws of 1992,  subdi-
vision  7  as added by chapter 510 of the laws of 1997 and paragraph (b)
of subdivision 7 as amended by chapter 464  of  the  laws  of  2012,  is
amended to read as follows:
  S  3008.  Applications  for  determinations of public need.   1. Every
application for a determination of public need shall be made in  writing
to  the  appropriate regional [council] BOARD, shall specify the primary
territory within which the applicant requests to  operate,  be  verified
under  oath,  and  shall be in such form and contain such information as
required by the rules and regulations promulgated pursuant to this arti-
cle.
  2. Notice of the application  shall  be  forwarded  by  registered  or
certified  mail by the appropriate regional [council] BOARD to the chief
executive officers of all general  hospitals,  ambulance  services,  and
municipalities  operating  within  the same county or counties where the
services seeks to operate. The  notice  shall  provide  opportunity  for
comment.
  3.  Notice  pursuant  to  this  section shall be deemed filed with the
ambulance service and municipality upon being mailed by the  appropriate
regional BOARD or state [council] BOARD by registered or certified mail.

S. 2606                            178                           A. 3006

  4.  The  appropriate  regional  [council] BOARD or the state [council]
BOARD shall make its determination of  public  need  within  sixty  days
after receipt of the application.
  5.  The  applicant or any concerned party may appeal the determination
of the appropriate regional [council] BOARD to the state council  within
thirty days after the regional [council] BOARD makes its determination.
  6. [In the case of an application for certification under this article
by  a  municipal  ambulance service to serve the area within the munici-
pality, and the municipal ambulance service meets appropriate  training,
staffing and equipment standards, there should be a presumption in favor
of approving the application.
  7.]  (a) Notwithstanding any other provision of law and subject to the
provisions of this article, any municipality within this state, or  fire
district  acting  on behalf of any such municipality, and acting through
its local legislative body, is hereby authorized and empowered to  adopt
and amend local laws, ordinances or resolutions to establish and operate
advanced  life  support first [responder] RESPONSE services or municipal
ambulance services within the municipality, upon  meeting  or  exceeding
all  standards  set by the department for appropriate training, staffing
and equipment, and upon  filing  with  the  [New  York  state  emergency
medical services council] DEPARTMENT, a written request for such author-
ization.  Upon  such filing, THE DEPARTMENT SHALL DETERMINE WHETHER such
municipal advanced life support first [responder]  RESPONSE  service  or
municipal  ambulance service [shall be deemed to have] HAS satisfied any
and all requirements for determination of public need for the establish-
ment of additional emergency medical services pursuant to  this  article
[for  a  period of two years following the date of such filing]. Nothing
in this article shall  be  deemed  to  [exclude]  EXEMPT  the  municipal
advanced  life  support  first [responder] RESPONSE service or municipal
ambulance service authorized to be established and operated pursuant  to
this  article  from  [complying with] APPROPRIATE TRAINING, STAFFING AND
EQUIPMENT STANDARDS AND any other requirement or provision of this arti-
cle or any other applicable provision of law.
  (b) [In the case of an application for certification pursuant to  this
subdivision,  for  a  municipal advanced life support or municipal ambu-
lance service, to serve the area  within  the  municipality,  where  the
proposed service meets or exceeds the appropriate training, staffing and
equipment  standards,  there  shall  be a strong presumption in favor of
approving the application.] Notwithstanding any other provision of  this
article,  FOR  APPLICATIONS SUBMITTED PRIOR TO APRIL FIRST, TWO THOUSAND
THIRTEEN, any city with a population of fourteen thousand seven  hundred
or  sixty-two  thousand  two  hundred  thirty-five, according to the two
thousand ten federal decennial census, or fire district acting on behalf
of any such city, that applies for permanent certification  pursuant  to
this  section  at the conclusion of the two year period provided in this
subdivision, shall not be required to apply to  its  regional  emergency
medical services council or the state emergency medical services council
for  a  determination of need, and the application shall be submitted to
and approved by the commissioner unless the commissioner finds that  the
municipal  advanced  life  support  first responder service or municipal
ambulance service has failed to meet the appropriate training,  staffing
and equipment standards.
  S 66. Section 3009 of the public health law is REPEALED.
  S 67. Section 3010 of the public health law, as amended by chapter 804
of the laws of 1992, subdivision 1 as amended by chapter 588 of the laws

S. 2606                            179                           A. 3006

of  1993  and subdivisions 2 and 3 as amended by chapter 445 of the laws
of 1993, is amended to read as follows:
  S  3010. Area of operation; transfers.  1. Every ambulance OR ADVANCED
LIFE SUPPORT FIRST RESPONSE service certificate [or statement of  regis-
tration]  issued  under this article shall specify the primary territory
within which the ambulance  OR  ADVANCED  LIFE  SUPPORT  FIRST  RESPONSE
service  shall  be  permitted  to operate. An ambulance OR ADVANCED LIFE
SUPPORT FIRST RESPONSE service shall receive patients  only  within  the
primary  territory  specified  on its ambulance OR ADVANCED LIFE SUPPORT
FIRST RESPONSE  service  certificate  [or  statement  of  registration],
except: (a) when receiving a patient which it initially transported to a
facility  or location outside its primary territory; (b) as required for
the fulfillment of a mutual aid agreement  authorized  by  the  regional
[council]  BOARD, DEPARTMENT AND COMMISSIONER; (c) upon express approval
of the  department  and  the  appropriate  regional  [emergency  medical
services council] BOARD for a maximum of sixty days if necessary to meet
an  emergency  need;  provided  that in order to continue such operation
beyond the sixty day maximum period necessary to meet an emergency need,
the ambulance OR ADVANCED  LIFE  SUPPORT  FIRST  RESPONSE  service  must
satisfy  the  requirements  of  this article, regarding determination of
public need and specification of the primary territory on the  ambulance
OR ADVANCED LIFE SUPPORT FIRST RESPONSE service certificate or statement
of  registration;  or  (d) an ambulance service or advanced life support
first response service organization formed to serve  the  need  for  the
provision of emergency medical services in accordance with the religious
convictions  of a religious denomination may serve such needs in an area
adjacent to such primary territory and, while responding to a  call  for
such service, the needs of other residents of such area at the emergency
scene.  Any  ambulance  OR  ADVANCED LIFE SUPPORT FIRST RESPONSE service
seeking to operate in more than one region  shall  make  application  to
each  appropriate  regional [council] BOARD.  Whenever an application is
made simultaneously to more  than  one  regional  [council]  BOARD,  the
applications  submitted to the regional [councils] BOARDS shall be iden-
tical, or copies of each application  shall  be  submitted  to  all  the
regional [councils] BOARDS involved.
  2.  No  ambulance  OR  ADVANCED  LIFE  SUPPORT  FIRST RESPONSE service
certificate shall be transferable unless the  regional  [council]  BOARD
and  the department [reviews] REVIEW and [approves] APPROVE the transfer
as follows:
  a. Any change in the individual who is the sole proprietor of an ambu-
lance OR ADVANCED LIFE SUPPORT FIRST  RESPONSE  service  shall  only  be
approved  upon  a determination that the proposed new operator is compe-
tent and fit to operate the service.
  b. Any change in a partnership which is the owner of an  ambulance  OR
ADVANCED  LIFE  SUPPORT  FIRST  RESPONSE service shall be approved based
upon a determination that the new partner or partners are competent  and
fit  to operate the service. The remaining partners shall not be subject
to a character and fitness review.
  c. Any transfer, assignment or other disposition  of  ten  percent  or
more  of the stock or voting rights thereunder of a corporation which is
the owner of an  ambulance  OR  ADVANCED  LIFE  SUPPORT  FIRST  RESPONSE
service,  or  any transfer, assignment or other disposition of the stock
or voting rights thereunder of such a corporation which results  in  the
ownership  or  control  of  ten  percent  or more of the stock or voting
rights thereunder by any person, shall be approved based upon a determi-
nation that the new stockholder or stockholder proposing to  obtain  ten

S. 2606                            180                           A. 3006

percent  or more of the stock or voting rights thereunder of such corpo-
ration is competent and fit to operate the service. The remaining stock-
holders shall not be subject to a character and fitness review.
  d.  Any transfer of all or substantially all of the assets of a corpo-
ration which owns or operates a [certified] ambulance OR  ADVANCED  LIFE
SUPPORT  FIRST  RESPONSE service shall be approved based upon a determi-
nation that the individual, partnership,  or  corporation  proposing  to
obtain  all  or  substantially  all  of the assets of the corporation is
competent and fit to operate the service.
  e. Any transfer affected in the absence of  the  review  and  approval
required  by  this section shall be null and void and the certificate of
such ambulance OR ADVANCED LIFE SUPPORT FIRST RESPONSE service shall  be
subject to revocation or suspension.
  3.  Nothing  contained  in this section shall be construed to prohibit
any voluntary ambulance OR ADVANCED LIFE SUPPORT FIRST RESPONSE  service
authorized  by  its  governing  authority to do so from transporting any
sick or injured resident of  its  primary  territory  from  any  general
hospital  or  other  health  care  facility  licensed by the department,
whether or not such general hospital or health care facility  is  within
the service's primary territory, to any other general hospital or health
care  facility  licensed  by the department for further care, or to such
resident's home. Nothing contained in this section shall be construed to
prohibit any  proprietary  ambulance  OR  ADVANCED  LIFE  SUPPORT  FIRST
RESPONSE  service  authorized by its governing body to do so from trans-
porting any sick or injured patient from any general hospital  or  other
health  care  facility  licensed  by  the department whether or not such
general hospital or health care facility is within the service's primary
territory, to  any  other  general  hospital  or  health  care  facility
licensed  by  the  department within the service's primary territory for
further care, or to such patient's home, if such patient's home is with-
in its primary territory. Any ambulance OR ADVANCED LIFE  SUPPORT  FIRST
RESPONSE  service  owned  by  or  under  contract  to a general hospital
licensed by the department may transport any specialty patient from  any
other  general  hospital or health care facility licensed by the depart-
ment to the hospital owning such  ambulance  OR  ADVANCED  LIFE  SUPPORT
FIRST  RESPONSE  service, or with which it has a contract. Categories of
specialty patients shall be defined by rule PROMULGATED  by  [the  state
emergency  medical  services  council,  subject  to the approval of] the
commissioner.
  4. No ambulance  OR  ADVANCED  LIFE  SUPPORT  FIRST  RESPONSE  service
certificate  of  an  ambulance  OR  ADVANCED LIFE SUPPORT FIRST RESPONSE
service which has discontinued operations for  a  continuous  period  in
excess  of thirty days shall be transferable without the approval of the
appropriate regional [council] BOARD AND THE DEPARTMENT.
  S 68. Section 3011 of the public health law, as amended by chapter 804
of the laws of 1992, subdivision 3 as amended  and  subdivision  3-a  as
added  by  chapter 501 of the laws of 2000, subdivision 10 as amended by
chapter 206 of the laws of 2008 and subdivision 11 as added  by  chapter
542 of the laws of 1995, is amended to read as follows:
  S  3011.  Powers and duties of the department and the commissioner. 1.
THE COMMISSIONER SHALL ISSUE CERTIFICATION FOR CERTIFIED  FIRST  RESPON-
DER,  EMERGENCY MEDICAL TECHNICIAN OR ADVANCED EMERGENCY MEDICAL TECHNI-
CIAN TO AN INDIVIDUAL WHO MEETS THE MINIMUM REQUIREMENTS ESTABLISHED  BY
REGULATIONS.
  2.  THE  COMMISSIONER  SHALL  ISSUE  CERTIFICATION  FOR  AMBULANCE AND
ADVANCED LIFE SUPPORT FIRST RESPONSE SERVICES WHO HAVE RECEIVED A DETER-

S. 2606                            181                           A. 3006

MINATION OF NEED BY THE APPROPRIATE REGIONAL ADVISORY BOARD AND MEET THE
MINIMUM REQUIREMENTS ESTABLISHED BY REGULATIONS.
  3. The department may inquire into the operation of ambulance services
and  advanced  life support first response services and conduct periodic
inspections of facilities, communication  services,  vehicles,  methods,
procedures,  materials,  [staff  and]  STAFFING,  RECORDS, equipment AND
QUALITY ASSURANCE ACTIVITIES AND DOCUMENTATION.   It may  also  evaluate
data  received  from  ambulance services and advanced life support first
response services.
  [2.] 4. The department may require  ambulance  services  and  advanced
life support first response services to submit periodic reports of calls
received, services performed and such other information as may be neces-
sary to carry out the provisions of this article.
  [3.]  5. THE COMMISSIONER, IN CONSULTATION WITH THE STATE BOARD, SHALL
DEVELOP STATEWIDE MINIMUM STANDARDS FOR: (A) MEDICAL CONTROL; (B)  SCOPE
OF  PREHOSPITAL  CARE PRACTICE; (C) TREATMENT, TRANSPORTATION AND TRIAGE
PROTOCOLS, INCLUDING PROTOCOLS FOR  INVASIVE  PROCEDURES  AND  INFECTION
CONTROL; AND (D) THE USE OF REGULATED MEDICAL DEVICES AND DRUGS BY EMER-
GENCY  MEDICAL  SERVICES  PERSONNEL  CERTIFIED PURSUANT TO THIS ARTICLE.
THE COMMISSIONER MAY ISSUE ADVISORY GUIDELINES IN ANY  OF  THESE  AREAS.
THE  DEPARTMENT  SHALL  REVIEW PROTOCOLS DEVELOPED BY REGIONAL EMERGENCY
MEDICAL ADVISORY COMMITTEES FOR CONSISTENCY WITH STATEWIDE STANDARDS.
  6. The commissioner, [with the advice and consent of the  state  coun-
cil] IN CONSULTATION WITH THE STATE BOARD, shall designate not more than
[eighteen]  TEN  geographic  areas  within  the state wherein a regional
[emergency medical services council]  BOARD  shall  be  established.  In
making  the  determination  of a geographic area, the commissioner shall
take into consideration the presence  of  ambulance  services,  hospital
facilities,  existing  emergency  medical  services  committees, trained
health personnel, health planning agencies and communication and  trans-
portation  facilities[;  and shall establish separate regional emergency
medical services councils for the counties of Nassau  and  Westchester].
The  commissioner  shall  [promote  and  encourage the establishment of]
ESTABLISH a regional [emergency medical services council] BOARD in  each
of said designated areas.
  [3-a. Notwithstanding any inconsistent provision of this article:
  a.  The creation of any regional council or emergency medical services
program agency on or after January first, two thousand shall not  dimin-
ish  any  then existing funding appropriated after the effective date of
this subdivision to regional  councils  or  emergency  medical  services
program agencies;
  b. Subject to the provisions of paragraph c of this subdivision, fund-
ing  for  regional councils and emergency medical services program agen-
cies existing on or after January first, two thousand shall be increased
in proportion to any funding appropriated therefor by the department and
in such proportion as determined by the department;
  c. Funding for any regional  council  or  emergency  medical  services
program  agency created on or after January first, two thousand shall be
in addition to any funds appropriated on  the  effective  date  of  this
subdivision  for regional councils or emergency medical services program
agencies existing on  January  first,  two  thousand.  Funding  for  any
regional  council  or  emergency medical services program agency created
after January first, two thousand shall be in an amount at  least  equal
to  the minimum funding level appropriated to regional councils or emer-
gency medical services program agencies existing on such date, or in  an
amount  equal  to the proportion that such new regional council or emer-

S. 2606                            182                           A. 3006

gency medical services program agency represented on the basis of  popu-
lation  in  its  former  regional  council or emergency medical services
program agency, whichever is larger.
  4.  The  commissioner may propose rules and regulations and amendments
thereto for consideration by the state  council.]  7.  The  commissioner
shall  establish a schedule of certification fees for ambulance services
and advanced life support first response services other  than  voluntary
ambulance  services  and  voluntary advanced life support first response
services.
  [5.] 8. For the purpose of promoting the  public  health,  safety  and
welfare  the commissioner is hereby authorized and empowered to contract
with [voluntary ambulance services and municipal ambulance services,  or
with the fire commissioners of fire districts operating voluntary] ambu-
lance  services,  upon such terms and conditions as he OR SHE shall deem
appropriate and within amounts made available therefor,  for  reimburse-
ment  of  the  necessary and incidental costs incurred by such ambulance
services in order to effectuate the provisions of this article.
  [6.] 9. The commissioner is hereby authorized,  for  the  purposes  of
effectuating  the  provisions  of  this  article in the development of a
statewide emergency medical service system, to contract with  any  ambu-
lance service or with the fire commissioners of fire districts operating
certified  voluntary  ambulance services for the use of necessary equip-
ment upon such terms and  conditions  as  the  commissioner  shall  deem
appropriate.
  [7.]  10.  THE  DEPARTMENT AND COMMISSIONER SHALL PREPARE, AND PERIOD-
ICALLY UPDATE AS NECESSARY, A STATEWIDE EMERGENCY MEDICAL SERVICES MOBI-
LIZATION PLAN, WHICH PROVIDES FOR THE IDENTIFICATION AND  DEPLOYMENT  OF
EMERGENCY  MEDICAL SERVICES PERSONNEL AND RESOURCES THROUGHOUT THE STATE
IN RESPONSE TO A LOCAL OR REGIONAL REQUEST.  UPON  NOTIFICATION  TO  THE
STATE  BOARD,  THE  REGIONAL  BOARDS, AND THE REGIONAL EMERGENCY MEDICAL
ADVISORY COMMITTEES, THE  PLAN  SHALL  BECOME  THE  STATEWIDE  EMERGENCY
MEDICAL SERVICES MOBILIZATION PLAN.
  11. The commissioner [may recommend to the state council minimum qual-
ifications]  SHALL,  IN  CONSULTATION  WITH THE STATE BOARD, ESTABLISH A
MINIMUM  SCOPE  OF  PRACTICE,  EDUCATION,  TRAINING,  CERTIFICATION  AND
CREDENTIALING  QUALIFICATIONS  for  certified  first  responders [(which
shall not exceed fifty-one hours)], emergency  medical  technicians  and
advanced  emergency  medical  technicians  in  all  phases  of emergency
medical technology including but not limited to,  communications,  first
aid,   equipment,  maintenance,  emergency  techniques  and  procedures,
patient management and knowledge of procedures and equipment  for  emer-
gency medical care.
  [8.  The  commissioner shall provide every certified ambulance service
and advanced life support first response service with an official insig-
nia which may be attached to every vehicle owned or operated by a certi-
fied ambulance service or advanced life support first response service.
  9. The department shall provide the state council with such assistance
as the council may request in order to carry out its responsibilities as
set forth in subdivision two-a of section three  thousand  two  of  this
article.
  10.]  12.  THE  DEPARTMENT  SHALL  REQUIRE  EVERY  CERTIFIED AMBULANCE
SERVICE AND ADVANCED LIFE SUPPORT FIRST RESPONSE SERVICE TO  DISPLAY  AN
OFFICIAL INSIGNIA WHICH MUST BE ATTACHED TO EVERY VEHICLE OWNED OR OPER-
ATED  BY  A  CERTIFIED  AMBULANCE SERVICE OR ADVANCED LIFE SUPPORT FIRST
RESPONSE SERVICE.

S. 2606                            183                           A. 3006

  13. The commissioner is hereby authorized and empowered to extend  the
certification  for  emergency  medical  technicians,  advanced emergency
medical technicians or certified first responders who have been  ordered
to active military duty, other than for training, [on or after the elev-
enth  day  of  September, two thousand one] and whose certification will
expire during their military duty [or within the six months  immediately
following  separation from military service]. The extended certification
shall be for the period of military duty and  for  twelve  months  after
they have been released from active military duty.
  [11.]  14. The commissioner, [with the advice and consent of the state
council] IN CONSULTATION WITH THE STATE BOARD,  shall  promulgate  rules
and  regulations  necessary  to ensure compliance with the provisions of
subdivision two of section sixty-seven hundred thirteen of the education
law; AND MAY FACILITATE DEVELOPMENT AND PERIODIC REVISION  OF  APPROPRI-
ATENESS  REVIEW  STANDARDS  FOR EMERGENCY MEDICAL SERVICES AND EMERGENCY
DEPARTMENTS, PEDIATRIC SERVICES AND PEDIATRIC CENTERS,  TRAUMA  SERVICES
AND  TRAUMA  CENTERS,  BURN SERVICES AND BURN CENTERS, AND DISASTER CARE
UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER, FOR ADOPTION BY THE  COMMIS-
SIONER  OR STATE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL, AS APPROPRI-
ATE.
  15. THE DEPARTMENT AND COMMISSIONER, IN CONSULTATION  WITH  THE  STATE
BOARD,  SHALL CONTINUE THE CATEGORIZATION OF GENERAL HOSPITALS AND OTHER
HEALTH CARE FACILITIES FOR EMERGENCY MEDICAL CARE AND TRAUMA CARE  UNDER
ARTICLE  TWENTY-EIGHT  OF THIS CHAPTER, AND THE DESIGNATION OF EMERGENCY
FACILITIES IN GENERAL HOSPITALS AND OTHER  HEALTH  CARE  FACILITIES,  AS
EMERGENCY  DEPARTMENTS  OR  EMERGENCY SERVICES APPROPRIATE FOR EMERGENCY
MEDICAL CARE AND GENERAL HOSPITALS AND OTHER HEALTH CARE  FACILITIES  AS
TRAUMA  CENTERS  OR  TRAUMA  STATIONS APPROPRIATE FOR TRAUMA CARE, BASED
UPON SUCH CATEGORIZATION.
  16.  THE DEPARTMENT AND COMMISSIONER, IN CONSULTATION WITH  THE  STATE
BOARD,  SHALL DEVELOP AND MAINTAIN A STATEWIDE SYSTEM FOR RECOGNITION OF
FACILITIES ABLE TO PROVIDE SUSTENTATIVE OR DEFINITIVE  SPECIALTY  PEDIA-
TRIC  EMERGENCY MEDICAL AND TRAUMA CARE FOR SUDDEN CHILDHOOD ILLNESS AND
INJURY AND FOR PREFERENTIAL TRANSPORT OF SUDDENLY ILL OR  INJURED  CHIL-
DREN TO SUCH FACILITIES, AND SHALL PROMOTE THE USE OF SUCH FACILITIES IN
ACCORDANCE WITH WRITTEN PROTOCOLS OR TRANSFER AGREEMENTS AS APPROPRIATE.
  17.  UPON  APPEAL OF ANY INTERESTED PARTY, THE COMMISSIONER MAY AMEND,
MODIFY, AND REVERSE DECISIONS OF THE STATE BOARD, ANY REGIONAL BOARD, OR
ANY REGIONAL EMERGENCY MEDICAL  ADVISORY  COMMITTEE;  PROVIDED  THAT  IN
CONSIDERATION OF A REGIONAL BOARD OR REGIONAL EMERGENCY MEDICAL ADVISORY
COMMITTEE  DECISION,  THE  COMMISSIONER SHALL CONSULT THE STATE ADVISORY
BOARD.
  S 69. Section 3012 of the public health law, as added by chapter  1053
of the laws of 1974, subdivision 1 as amended by chapter 445 of the laws
of 1993, subdivision 2 as amended by chapter 804 of the laws of 1992 and
subdivisions  3  and 4 as amended by chapter 252 of the laws of 1981, is
amended to read as follows:
  S 3012. Enforcement.   1.  Any  ambulance  service  or  advanced  life
support  first  response  service certificate issued pursuant to section
three thousand five of this article may be revoked,  suspended,  limited
or  annulled  by  the department upon proof that the operator or certif-
icate holder or one or more enrolled members or one or more  persons  in
his OR HER employ:
  (a)  has been guilty of misrepresentation in obtaining the certificate
or in the operation of the ambulance service or  advanced  life  support
first response service; or

S. 2606                            184                           A. 3006

  (b)  has  not  been  competent  in the operation of the service or has
shown inability to provide adequate ambulance services or advanced  life
support first response service; or
  (c)  has  failed  to  pay  the  biennial certification fee as required
[except in the case of any  voluntary  ambulance  service  or  voluntary
advanced life support first response service]; or
  (d)  has  failed to file any report required by the provisions of this
article or the rules and regulations promulgated thereunder; or
  (e) has violated  or  aided  and  abetted  in  the  violation  of  any
provision  of  this  article,  the  rules and regulations promulgated or
continued thereunder, or the state sanitary code; or
  (f) had discontinued operations for a period in excess of  one  month;
or
  (g)  a  voluntary ambulance service or voluntary advanced life support
first response service has failed to meet the minimum staffing  standard
and  has  not  been  issued  an exemption[, except that such certificate
shall not be suspended or revoked unless the commissioner finds that  an
adequate alternative service exists. The commissioner shall consider the
recommendation  of  the  regional  emergency medical services council in
making a finding]; or
  (h) an ambulance service operating for profit has failed to  meet  the
minimum staffing standard; or
  (i)  has  been  convicted  of  a crime or pleaded nolo contendere to a
felony charge involving murder,  manslaughter,  assault,  sexual  abuse,
theft,  robbery,  fraud,  embezzlement,  drug  abuse,  or sale of drugs,
unless the commissioner finds that such conviction does not  demonstrate
a present risk or danger to patients or the public; or
  (j)  is  or  was  subject  to  a state or federal administrative order
relating to fraud or embezzlement, unless the  commissioner  finds  that
such  order does not demonstrate a present risk or danger to patients or
the public.
  2. Proceedings under this section may  be  initiated  by  any  person,
corporation, association, or public officer, or by the department by the
filing  of written charges with the department.  Whenever the department
seeks revocation or suspension of a certificate of an ambulance  service
or an advanced life support first response service, a copy of the charg-
es  shall  be  referred  to the appropriate regional [council] BOARD for
review and recommendation to the department prior to  a  hearing.  [Such
recommendation  shall  include  a determination as to whether the public
need would be served by a revocation, suspension, annulment  or  limita-
tion. If there is no appropriate regional council established, the state
council  shall make such determination and present to the department its
recommendations.]
  3. No certificate shall be revoked, [suspended,] limited  or  annulled
without a hearing. However, a certificate may be [temporarily] suspended
without  a  hearing and without the [approval] REVIEW of the appropriate
regional [council] BOARD or state [council] BOARD for a  period  not  in
excess  of  [thirty]  NINETY  days upon notice to the certificate holder
following a finding by the department that the public health, safety  or
welfare is in imminent danger.
  4.  The  [commissioner]  DEPARTMENT shall fix a time and place for the
hearing. A copy of the charges and the recommendations of the  appropri-
ate  regional [council] BOARD or state [council] BOARD together with the
notice of the time and place of the hearing,  shall  be  mailed  to  the
certificate holder by registered or certified mail, at the address spec-
ified  on  the  certificate, at least fifteen days before the date fixed

S. 2606                            185                           A. 3006

for the hearing. The appropriate regional [council] BOARD may be a party
to such hearing. The certificate holder may file  with  the  department,
not  less  than  five days prior to the hearing, a written answer to the
charges.
  S 70. Section 3016 of the public health law, as amended by chapter 252
of the laws of 1981, is amended to read as follows:
  S  3016.  Continuance  of rules and regulations.   All rules and regu-
lations heretofore adopted by the commissioner pertaining to  all  ambu-
lance  OR ADVANCED LIFE SUPPORT RESPONSE services shall continue in full
force and effect as rules and regulations until duly modified or  super-
seded  by  rules  and  regulations  hereafter adopted and enacted by the
[state council pursuant to section three thousand two of  this  article]
COMMISSIONER.
  S 71. Section 3017 of the public health law is REPEALED.
  S 72. Intentionally omitted.
  S  73.  Section 3030 of the public health law, as added by chapter 439
of the laws of 1979, is amended to read as follows:
  S 3030.  Advanced  life  support  services.    Advanced  life  support
services  provided by an advanced emergency medical technician, shall be
(1) provided under the direction of qualified medical and health person-
nel utilizing patient information  and  data  transmitted  by  voice  or
telemetry,  (2)  limited  to  the  category  or  categories in which the
advanced emergency medical technician  is  certified  pursuant  to  this
article,  [and]  (3)  recorded for each patient, on an individual treat-
ment-management record, AND (4) LIMITED TO PARTICIPATION IN  AN  ADVANCE
LIFE SUPPORT SYSTEM.
  S  74.  Section 3031 of the public health law, as added by chapter 439
of the laws of 1979, is amended to read as follows:
  S 3031. Advanced life support system.   Advanced life  support  system
must  (1)  be under the overall supervision and direction of a qualified
physician [with respect to the advanced life support services provided],
(2) UTILIZE ADVANCED LIFE SUPPORT PROTOCOLS DEVELOPED  BY  THE  REGIONAL
EMERGENCY  MEDICAL  ADVISORY COMMITTEE AND APPROVED BY THE COMMISSIONER,
(3) be staffed by qualified medical  and  health  personnel,  [(3)]  (4)
utilize  advanced  emergency  medical technicians whose certification is
appropriate to the advanced life support services  provided,  [(4)]  (5)
utilize  advanced  support mobile units appropriate to the advanced life
support services provided, [(5)]  (6)  maintain  a  treatment-management
record  for  each  patient receiving advanced life support services, and
[(6)] (7) be integrated with a hospital emergency, intensive care, coro-
nary care or other appropriate service.
  S 75. Section 3032 of the public health law, as amended by chapter 445
of the laws of 1993, is amended to read as follows:
  S 3032. Rules and regulations.  The [state council, with the  approval
of  the]  commissioner,  IN  CONSULTATION  WITH  THE  STATE BOARD, shall
promulgate rules and regulations to effectuate the purposes of  sections
three thousand thirty and three thousand thirty-one of this article.
  S  76.  Section 3052 of the public health law, as added by chapter 727
of the laws of 1986, is amended to read as follows:
  S 3052. Establishment of a  training  program  for  emergency  medical
services  personnel.   1. There is hereby established a training program
for emergency medical services personnel including, but not limited  to,
first  responders,  emergency  medical  technicians,  advanced emergency
medical technicians and emergency vehicle operators.
  1-A. SUCH TRAINING PROGRAM MAY  USE  ANY  COMBINATION  OF  COURSEWORK,
TESTING,  CONTINUING  EDUCATION  AND  CONTINUOUS PRACTICE TO PROVIDE THE

S. 2606                            186                           A. 3006

MEANS BY WHICH SUCH PERSONNEL, INCLUDING INSTRUCTOR LEVEL PERSONNEL, MAY
BE TRAINED AND CERTIFIED. THE PROGRAM MAY INCLUDE MEANS THAT  ALLOW  FOR
CERTIFICATION  OF  EMERGENCY  MEDICAL TECHNICIANS AND ADVANCED EMERGENCY
MEDICAL TECHNICIANS WITHOUT THE REQUIREMENT OF PRACTICAL SKILLS OR WRIT-
TEN EXAMINATION.
  1-B.  THE  COMMISSIONER,  IN  CONSULTATION WITH THE STATE BOARD, SHALL
DEVELOP SUCH TRAINING PROGRAM, PROMULGATING RULES AND REGULATIONS AS MAY
BE NECESSARY FOR ADMINISTRATION AND COMPLIANCE.
  2. The commissioner shall provide state aid within the  amount  appro-
priated  to  entities  such  as  local  governments, regional [emergency
medical services councils] BOARDS, and voluntary agencies and  organiza-
tions to conduct training courses for emergency medical services person-
nel  and  to  conduct  practical  examinations for certification of such
personnel. The commissioner shall establish a schedule  for  determining
the amount of state aid provided pursuant to this section.
  [a.  Such  schedule  may include varying rates for distinct geographic
areas of the state and for various course sizes, giving special  consid-
eration  to  areas  with  the most need for additional emergency medical
technicians. In determining the need for  additional  emergency  medical
technicians, the commissioner shall use measurements such as the average
number of emergency medical technicians per ambulance service, the ratio
of  emergency medical technicians per square mile, the average number of
calls per service and the percentage of  calls  to  which  an  emergency
medical technician has responded, provided such data is available to the
commissioner.
  b.]  Such  schedule  shall  provide sufficient reimbursement to permit
sponsors to offer  basic  emergency  medical  technician  courses  which
adhere  to  curricula  approved by the [New York state emergency medical
services council and  the]  commissioner  without  the  need  to  charge
tuition to participants.
  3.  Upon  request, the [commissioner] DEPARTMENT shall provide manage-
ment advice and technical  assistance  to  regional  [emergency  medical
services  councils]  BOARDS, county emergency medical services coordina-
tors, and course sponsors and instructors to stimulate  the  improvement
of  training  courses  and  the  provision  of courses in a manner which
encourages participation.  Such  advice  and  technical  assistance  may
relate  to,  but  need  not  be  limited to the location, scheduling and
structure of courses.
  4. The department is authorized, either directly or through contractu-
al arrangement, to develop and distribute training materials for use  by
course  instructors  and sponsors, to recruit additional instructors and
sponsors and to provide training courses for instructors.
  [5. The commissioner  shall  conduct  a  public  service  campaign  to
recruit  additional  volunteers  to  join ambulance services targeted to
areas in need for additional emergency medical technicians.]
  S 77. Section 3053 of the public health law, as amended by chapter 445
of the laws of 1993, is amended to read as follows:
  S 3053. Reporting.  Advanced life support first response services  and
ambulance  services [registered or] certified pursuant to article thirty
of this chapter shall submit detailed individual call reports on a  form
to  be [provided] DETERMINED by the department, or may submit data elec-
tronically in a format approved by the department.  The [state emergency
medical services council, with the approval  of  the]  commissioner,  IN
CONSULTATION  WITH  THE  STATE  BOARD,  may  adopt rules and regulations
permitting or  requiring  ambulance  AND  ADVANCED  LIFE  SUPPORT  FIRST
RESPONSE  services whose volume exceeds [twenty thousand calls per year]

S. 2606                            187                           A. 3006

A SPECIFIED ANNUAL THRESHOLD to submit call report data  electronically.
Such  rules  shall  define  the  data  elements to be submitted, and may
include requirements that assure availability of data  to  the  REGIONAL
BOARDS AND regional emergency medical advisory [committee] COMMITTEES.
  S 78. Articles 30-B and 30-C of the public health law are REPEALED.
  S  79.  Subdivisions 3 and 4 of section 97-q of the state finance law,
as added by chapter 804 of the laws of 1992,  are  amended  to  read  as
follows:
  3.  Moneys  of  the account, when allocated, shall be available to the
department of health for the purpose of funding the training of emergen-
cy medical services personnel, and  funding  as  shall  be  provided  by
appropriation for the [state] OPERATION OF THE STATE'S emergency medical
services  [council,  regional emergency medical services councils, emer-
gency medical services  program  agencies  or  other  emergency  medical
services  training  programs] SYSTEM, in order to carry out the purposes
of articles thirty and thirty-A of the public health law.
  4. [Not less than fifty percent of the]  THE  monies  of  the  account
shall  be  expended  for the direct costs of providing emergency medical
services training at the local level.  [The legislature  shall  annually
appropriate  from  the remaining available monies, funding for the state
emergency medical  services  council,  the  regional  emergency  medical
services  councils, the emergency medical services program agencies and]
ANNUAL APPROPRIATIONS SHALL BE USED TO ENABLE the department  of  health
[in  order  to carry out] TO ACHIEVE the purposes of articles thirty and
thirty-A of the public health law. At the end of any  fiscal  year,  any
funds  not  encumbered  for  these purposes shall be reallocated for the
costs of training advanced life support personnel.
  S 80. Paragraph 4 of subdivision a of section 19-162.2 of the adminis-
trative code of the city of New York, as added by local law number 40 of
the city of New York for the year 1997, is amended to read as follows:
  4. "certified first responder" shall mean an individual who meets  the
minimum  requirements  established  by  [regulations pursuant to section
three thousand two] THE COMMISSIONER OF HEALTH PURSUANT TO ARTICLE THIR-
TY of the public health law and who is responsible for administration of
initial life saving care of sick and injured persons.
  S 81. Subdivision 1-a of section 122-b of the general  municipal  law,
as  amended  by  chapter  303 of the laws of 1980, is amended to read as
follows:
  1-a. As used in this section:
  (a) "Emergency medical technician" means an individual who  meets  the
minimum  requirements  established  by  [regulations pursuant to section
three thousand two] THE COMMISSIONER OF HEALTH PURSUANT TO ARTICLE THIR-
TY of the public health law and who is responsible for administration or
supervision of initial emergency medical  assistance  and  handling  and
transportation of sick, disabled or injured persons.
  (b) "Advanced emergency medical technician" means an emergency medical
technician who has satisfactorily completed an advanced course of train-
ing approved by the [state council under regulations pursuant to section
three thousand two] COMMISSIONER OF HEALTH PURSUANT TO ARTICLE THIRTY of
the public health law.
  S  82. Subparagraph (iii) of paragraph (e) of subdivision 3 of section
219-e of the general municipal law, as added by chapter 514 of the  laws
of 1998, is amended to read as follows:
  (iii)  A volunteer ambulance worker appointed to serve on the New York
state emergency medical services [council, the state  emergency  medical
advisory   committee]  ADVISORY  BOARD,  a  regional  emergency  medical

S. 2606                            188                           A. 3006

services [council] ADVISORY BOARD or a regional emergency medical  advi-
sory  committee,  established  pursuant  to article thirty of the public
health law shall also be eligible to receive one point per meeting.
  S  83. Subparagraph (iii) of paragraph (e) of subdivision 3 of section
219-m of the general municipal law, as added by chapter 558 of the  laws
of 1998, is amended to read as follows:
  (iii)  A volunteer ambulance worker appointed to serve on the New York
state emergency medical services [council, the state  emergency  medical
advisory   committee]  ADVISORY  BOARD,  a  regional  emergency  medical
services [council] ADVISORY BOARD or a regional emergency medical  advi-
sory  committee,  established  pursuant  to article thirty of the public
health law shall also be eligible to receive one point per meeting.
  S 84. Subdivision 2 of section 10 of the workers' compensation law, as
added by chapter 872 of the laws of 1985, is amended to read as follows:
  2. Notwithstanding any other provisions of  this  chapter,  an  injury
incurred  by  an  individual  currently employed as an emergency medical
technician or an advanced emergency medical technician who is  certified
pursuant  to  [section  three thousand two] ARTICLE THIRTY of the public
health law,  while  voluntarily  and  without  expectation  of  monetary
compensation  rendering  medical  assistance at the scene of an accident
shall be deemed to have arisen out of and in the course of  the  employ-
ment  with  that  emergency  medical  technician  or  advanced emergency
medical technician's current employer.
  S 85. Subdivision 1 of section 580 of the executive law, as amended by
chapter 40 of the laws of 2012, is amended to read as follows:
  1. Creation; members. There is hereby created  in  the  department  of
state  an  emergency services council, the members of which shall be the
directors of the office of fire prevention and control,  the  bureau  of
emergency  medical  services  and the state emergency management office,
the superintendent of state police,  the  commissioner  of  health,  the
secretary  of  state, the director of the state office for the aging and
the director of state operations who shall  be  the  chairperson  unless
otherwise  appointed by the governor.  There shall also be two represen-
tatives appointed by the  state  emergency  medical  services  [council]
ADVISORY BOARD, one of whom shall be a representative of volunteer ambu-
lance  service  and one of whom shall be a representative of proprietary
ambulance service; two representatives appointed by  the  fire  advisory
board,  one  of  which shall be representative of volunteer fire service
and one of which shall be  representative  of  paid  fire  service;  one
representative  shall  be appointed by the disaster preparedness commis-
sion; one physician shall be appointed by the [state  emergency  medical
advisory  committee]  COMMISSIONER  OF  HEALTH; one appointment shall be
made by the governor; one appointment shall be  made  by  the  temporary
president of the senate; and one appointment shall be made by the speak-
er of the assembly.
  S  86.  Section 804-d of the education law, as added by chapter 315 of
the laws of 2005, is amended to read as follows:
  S 804-d. Automated external  defibrillator  instruction.  Instructions
regarding  the  correct use of an automated external defibrillator shall
be included as a part of the health education curriculum in  all  senior
high  schools  when  cardiopulmonary  resuscitation instruction is being
provided as authorized by section eight hundred four-c of this  article.
In  addition  to  the  requirement that all teachers of health education
shall be certified to teach health, persons instructing  pupils  in  the
correct  use  of  automated  external defibrillators shall possess valid
certification by a nationally  recognized  organization  or  the  [state

S. 2606                            189                           A. 3006

emergency  medical  services  council]  COMMISSIONER  OF HEALTH offering
certification in the operation of an  automated  external  defibrillator
and in its instruction.
  S  87.  Subparagraph  (iv)  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 and a new subparagraph (v) is added to read as follows:
  (iv) the furnishing of nursing assistance in case of an emergency; OR
  (V)  MEDICATION ADMINISTRATION SERVICES PROVIDED BY A HOME HEALTH AIDE
WHEN SUCH SERVICES ARE PERFORMED UNDER THE SUPERVISION OF  A  REGISTERED
PROFESSIONAL  NURSE  EMPLOYED BY A HOME CARE SERVICES AGENCY LICENSED OR
CERTIFIED PURSUANT TO ARTICLE THIRTY-SIX OR  HOSPICE  PROGRAM  CERTIFIED
PURSUANT TO ARTICLE FORTY OF THE PUBLIC HEALTH LAW, IN ACCORDANCE WITH A
DEMONSTRATION  PROGRAM  DEVELOPED BY THE DEPARTMENT IN CONSULTATION WITH
THE DEPARTMENT OF HEALTH; PROVIDED THAT: (A)  MEDICATION  ADMINISTRATION
SERVICES  MUST BE IN ACCORDANCE WITH AND PURSUANT TO AN AUTHORIZED PRAC-
TITIONER'S ORDERED CARE; (B) ONLY AN  INDIVIDUAL  WHO  HAS  SUCCESSFULLY
COMPLETED  A COMPETENCY EXAMINATION SATISFACTORY TO THE COMMISSIONER MAY
PROVIDE MEDICATION ADMINISTRATION SERVICES AS PERMITTED BY THIS SUBPARA-
GRAPH; (C) SUCH HOME HEALTH AIDE DOES NOT HOLD HIMSELF OR  HERSELF  OUT,
OR ACCEPT EMPLOYMENT AS, A PERSON LICENSED TO PRACTICE NURSING UNDER THE
PROVISIONS OF THIS ARTICLE; (D) A HOME CARE SERVICES AGENCY OR A HOSPICE
PROGRAM  MAY  NOT  PERMIT  MEDICATION  ADMINISTRATION SERVICES BY A HOME
HEALTH AIDE UNDER THIS SUBPARAGRAPH UNLESS SUCH AGENCY  OR  PROGRAM  HAS
DEMONSTRATED  TO THE SATISFACTION OF THE DEPARTMENT THAT DESPITE REASON-
ABLE EFFORTS TO SECURE AN APPROPRIATE  LEVEL  OF  NURSING  SERVICES  FOR
PURPOSES OF ADMINISTERING MEDICATION, PARTICIPATION IN THE DEMONSTRATION
PROGRAM  IS  WARRANTED;  (E)  ONLY  MEDICATIONS  WHICH  ARE  ROUTINE AND
PREMEASURED OR OTHERWISE PACKAGED IN A  MANNER  THAT  PROMOTES  RELATIVE
EASE  OF  ADMINISTRATION  MAY  BE  ADMINISTERED  UNDER THE DEMONSTRATION
PROGRAM DEVELOPED PURSUANT TO THIS SUBPARAGRAPH; (F)  SUCH  HOME  HEALTH
AIDE  IS NOT REQUIRED NOR PERMITTED TO ASSESS THE MEDICATION NEEDS OF AN
INDIVIDUAL; AND (G) SUCH DEMONSTRATION PROGRAM SHALL BE FOR A  TWO  YEAR
PERIOD,  AT THE CONCLUSION OF WHICH THE DEPARTMENT, IN CONSULTATION WITH
THE DEPARTMENT OF HEALTH, SHALL REPORT ON THE RESULTS  OF  SUCH  PROGRAM
AND  RECOMMEND  WHETHER IT SHOULD BE CONTINUED OR EXPANDED TO ADDITIONAL
HEALTH CARE SETTINGS;
  S 88. Subdivision 1 of section 6908 of the education law is amended by
adding a new paragraph i to read as follows:
  I. AS PROHIBITING THE PRACTICE OF NURSING IN THIS STATE BY AN ADVANCED
HOME HEALTH AIDE, CERTIFIED PURSUANT TO SUBDIVISION SIX OF SECTION THIR-
TY-SIX HUNDRED TWELVE OF THE PUBLIC HEALTH LAW, WHEN SUCH  SERVICES  ARE
PROVIDED TO A SELF-DIRECTING INDIVIDUAL, ASSIGNED BY AND PERFORMED UNDER
THE  SUPERVISION  OF  A REGISTERED PROFESSIONAL NURSE EMPLOYED BY A HOME
CARE  SERVICES  AGENCY  LICENSED  OR  CERTIFIED  PURSUANT   TO   ARTICLE
THIRTY-SIX OR HOSPICE PROGRAM CERTIFIED PURSUANT TO ARTICLE FORTY OF THE
PUBLIC  HEALTH LAW, AND PURSUANT TO AN AUTHORIZED PRACTITIONER'S ORDERED
CARE; PROVIDED THAT SUCH HOME HEALTH  AIDE  DOES  NOT  HOLD  HIMSELF  OR
HERSELF  OUT,  OR  ACCEPT  EMPLOYMENT  AS, A PERSON LICENSED TO PRACTICE
NURSING UNDER THE PROVISIONS OF THIS ARTICLE.
  S 89. Subdivisions 6 and 7 of section 3612 of the public  health  law,
subdivision  7  as  renumbered  by  chapter 606 of the laws of 2003, are
renumbered subdivisions 7 and 8 and a new subdivision 6 is added to read
as follows:
  6. THE COMMISSIONER SHALL, PURSUANT TO REGULATIONS ESTABLISHING  MINI-
MUM  TRAINING  AND  QUALIFICATION OF ADVANCED HOME HEALTH AIDES, CERTIFY
ADVANCED HOME HEALTH AIDES.

S. 2606                            190                           A. 3006

  S 90. Subdivision 1 of section 6605-b of the education law,  as  added
by chapter 437 of the laws of 2001, is amended to read as follows:
  1.  [A] NOTWITHSTANDING ANY PROVISION HEREIN TO THE CONTRARY, A dental
hygienist shall not administer or monitor  nitrous  oxide  analgesia  or
local  infiltration anesthesia in the practice of dental hygiene without
a dental hygiene restricted local infiltration anesthesia/nitrous  oxide
analgesia  certificate  and  except  under the personal supervision of a
dentist and in conjunction with the performance of dental hygiene proce-
dures authorized by law and in accordance with  regulations  promulgated
by the commissioner. Personal supervision, for purposes of this section,
means  that  the  supervising dentist remains in the dental office where
the local infiltration anesthesia or nitrous  oxide  analgesia  services
are  being  performed,  personally  authorizes and prescribes the use of
local infiltration anesthesia or nitrous oxide analgesia for the patient
and, before dismissal of the patient, personally examines the  condition
of the patient after the use of local infiltration anesthesia or nitrous
oxide  analgesia  is  completed.  It  is  professional  misconduct for a
dentist to fail to provide the supervision required by this section, and
any dentist  found  guilty  of  such  misconduct  under  the  procedures
prescribed  in  section  sixty-five  hundred  ten of this title shall be
subject to the penalties prescribed in section sixty-five hundred eleven
of this title.
  S 91. Subdivision 1 of section 6606 of the education law,  as  amended
by chapter 437 of the laws of 2001, is amended to read as follows:
  1.  The practice of the profession of dental hygiene is defined as the
performance of dental services which shall include  removing  calcareous
deposits,  accretions  and stains from the exposed surfaces of the teeth
which begin at the epithelial attachment  and  applying  topical  agents
indicated for a complete dental prophylaxis, removing cement, placing or
removing  rubber  dam,  removing sutures, placing matrix band, providing
patient education, applying topical  medication,  placing  and  exposing
DIAGNOSTIC  DENTAL X-ray films, performing topical fluoride applications
and topical anesthetic applications,  polishing  teeth,  taking  medical
history,  charting  caries,  taking impressions for study casts, placing
and  removing  temporary  restorations,  administering  and   monitoring
nitrous  oxide  analgesia  and administering and monitoring local infil-
tration anesthesia, subject to certification in accordance with  section
sixty-six  hundred five-b of this article, and any other function in the
definition of the practice  of  dentistry  as  may  be  delegated  by  a
licensed  dentist  in  accordance  with  regulations  promulgated by the
commissioner. The practice of dental hygiene may  be  conducted  in  the
office  of  any licensed dentist or in any appropriately equipped school
or public institution but must be done EITHER under the supervision of a
licensed dentist OR, IN THE CASE OF A REGISTERED DENTAL HYGIENIST  WORK-
ING  FOR  A  HOSPITAL  AS  DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC
HEALTH LAW, PURSUANT TO A  COLLABORATIVE  ARRANGEMENT  WITH  A  LICENSED
DENTIST  PURSUANT TO REGULATIONS PROMULGATED PURSUANT TO ARTICLE TWENTY-
EIGHT OF THE PUBLIC HEALTH LAW.
  S 92. Section 6608 of the education law, as amended by chapter 300  of
the laws of 2006, is amended to read as follows:
  S 6608. Definition  of  practice  of  certified  dental assisting. The
practice of certified dental assisting is defined as providing  support-
ive  services  to  a  dentist  in his/her performance of dental services
authorized under this article.  Such  support  shall  include  providing
patient  education, taking preliminary medical histories and vital signs
to be reviewed by the dentist, placing and removing rubber dams, select-

S. 2606                            191                           A. 3006

ing and prefitting provisional crowns, selecting and  prefitting  ortho-
dontic bands, removing orthodontic arch wires and ligature ties, placing
and  removing  matrix bands, taking impressions for study casts or diag-
nostic  casts,  removing  periodontal  dressings,  and such other dental
supportive services authorized by  the  dentist  consistent  with  regu-
lations  promulgated  by  the commissioner, provided that such functions
are performed under  the  direct  personal  supervision  of  a  licensed
dentist  in  the  course  of  the  performance  of dental services. Such
services shall not include diagnosing and/or performing surgical  proce-
dures,  irreversible  procedures or procedures that would alter the hard
or soft tissue of the oral and maxillofacial area or  any  other  proce-
dures  determined  by  the  department. The practice of certified dental
assisting may be conducted in the office of any licensed dentist  or  in
any appropriately equipped school or public institution but must be done
under  the  direct  personal  supervision of a licensed dentist.  Direct
personal supervision, for purposes of this section, means supervision of
dental procedures based on instructions given by a licensed  dentist  in
the  course  of  a  procedure who remains in the dental office where the
supportive services are being performed, personally diagnoses the condi-
tion to be treated, personally authorizes  the  procedures,  and  before
dismissal of the patient, who remains the responsibility of the licensed
dentist, evaluates the services performed by the dental assistant. Noth-
ing  herein authorizes a dental assistant to perform any of the services
or functions defined as part  of  the  practice  of  dental  hygiene  in
accordance  with  the provisions of subdivision one of section sixty-six
hundred six of this article, except those functions authorized  pursuant
to this section. All dental supportive services provided in this section
may  be  performed  by  currently  registered dental hygienists [under a
dentist's supervision], as defined in regulations of the commissioner.
  S 93. Subdivisions 7 and 10 of section  6611  of  the  education  law,
subdivision 7 as amended by chapter 649 of the laws of 2006 and subdivi-
sion  10  as  amended  by chapter 65 of the laws of 2011, are amended to
read as follows:
  7. Any dentist or dental hygienist WORKING UNDER THE SUPERVISION OF  A
DENTIST,  who in the performance of dental services, x-rays the mouth or
teeth of a patient shall during the performance of  such  x-rays  shield
the  torso and thyroid area of such patient including but not limited to
the gonads and other reproductive  organs  with  a  lead  apron  thyroid
collar,  or  other similar protective garment or device. Notwithstanding
the provisions of this subdivision, if  in  the  dentist's  professional
judgment  the  use  of a thyroid collar would be inappropriate under the
circumstances, because of the nature of the patient, the type  of  x-ray
being taken, or other factors, the dentist or A dental hygienist WORKING
UNDER THE SUPERVISION OF THE DENTIST need not shield the thyroid area.
  10.  [Beginning  January  first, two thousand nine, each] EACH dentist
AND REGISTERED DENTAL HYGIENIST WORKING FOR A  HOSPITAL  AS  DEFINED  IN
ARTICLE  TWENTY-EIGHT  OF THE PUBLIC HEALTH LAW WHO PRACTICES IN COLLAB-
ORATION WITH A LICENSED DENTIST shall become certified  in  cardiopulmo-
nary  resuscitation (CPR) from an approved provider and thereafter main-
tain current certification, which shall be  included  in  the  mandatory
hours  of  continuing  education  acceptable  for dentists to the extent
provided in the commissioner's regulations. In the event the dentist  OR
REGISTERED  DENTAL  HYGIENIST cannot physically perform CPR, the commis-
sioner's regulations  shall  allow  the  dentist  OR  REGISTERED  DENTAL
HYGIENIST  to  make arrangements for another individual in the office to

S. 2606                            192                           A. 3006

administer CPR. All dental facilities shall have an  automatic  external
defibrillator or other defibrillator at the facility.
  S  94.  Subdivision 2 of section 903 of the education law, as added by
chapter 281 of the laws of 2007, is amended to read as follows:
  2. a. A  dental  health  certificate  shall  be  requested  from  each
student.    Each student is requested to furnish a dental health certif-
icate at the same time that health certificates are required.  An  exam-
ination  and  dental health history of any child may be requested by the
local school authorities at any time in their discretion to promote  the
educational interests of such child. Each certificate shall be signed by
a  duly  licensed  dentist  who is authorized by law to practice in this
state, and consistent with any applicable written practice agreement, or
by a duly licensed dentist OR REGISTERED DENTAL HYGIENIST who is author-
ized to practice in the jurisdiction in which the examination was given,
provided that the commissioner has determined that such jurisdiction has
standards of licensure and practice comparable to  those  of  New  York.
Each  such certificate shall describe the dental health condition of the
student when the examination was made, which  shall  not  be  more  than
twelve  months prior to the commencement of the school year in which the
examination is requested, and shall state whether such student is in fit
condition of dental health to permit his or her attendance at the public
schools.
  b. A notice  of  request  for  dental  health  certificates  shall  be
distributed  at  the  same  time  that  parents  or  person  in parental
relationship to students are notified of health examination requirements
and shall state that a list of DENTAL PRACTICES, dentists AND REGISTERED
DENTAL HYGIENISTS to which children [who need comprehensive dental exam-
inations] may be referred for [treatment] DENTAL SERVICES on a  free  or
reduced  cost basis is available upon request at the child's school. The
department shall,  in  collaboration  with  the  department  of  health,
compile and maintain a list of DENTAL PRACTICES, dentists AND REGISTERED
DENTAL HYGIENISTS to which children [who need comprehensive dental exam-
inations]  may  be referred for [treatment] DENTAL SERVICES on a free or
reduced cost basis. Such list shall be  made  available  to  all  public
schools and be made available to parents or person in parental relation-
ship upon request. The department shall promulgate regulations to ensure
the  gathering and dissemination of the proper information to interested
parties.
  S 95. Paragraph (a) of subdivision 3 of section 6902 of the  education
law,  as added by chapter 257 of the laws of 1988, is amended to read as
follows:
  (a) The practice of registered professional nursing by a nurse practi-
tioner, certified under section [six thousand nine]  SIXTY-NINE  hundred
ten  of  this article, may include the diagnosis of illness and physical
conditions and the performance of therapeutic  and  corrective  measures
within  a  specialty  area of practice, in collaboration with a licensed
physician qualified to collaborate in the specialty  involved,  provided
such services are performed in accordance with a written practice agree-
ment  and  written  practice  protocols.  The written practice agreement
shall include explicit provisions for the resolution of any disagreement
between the collaborating physician and the nurse practitioner regarding
a matter of diagnosis or treatment that is within the scope of  practice
of  both. To the extent the practice agreement does not so provide, then
the collaborating physician's diagnosis or treatment shall prevail.   NO
WRITTEN  PRACTICE  AGREEMENT  OR  WRITTEN  PRACTICE  PROTOCOLS  SHALL BE
REQUIRED FOR NURSE PRACTITIONERS WHO PROVIDE ONLY PRIMARY CARE  SERVICES

S. 2606                            193                           A. 3006

AS  DETERMINED  BY THE COMMISSIONER OF HEALTH AND WHO DEMONSTRATE TO THE
DEPARTMENT OF HEALTH, IN THE MANNER AND MEANS REQUIRED BY  SUCH  DEPART-
MENT  IN  CONSULTATION  WITH  THE  EDUCATION  DEPARTMENT, THAT IT IS NOT
REASONABLE TO REQUIRE SUCH AGREEMENT OR PRACTICE PROTOCOLS.
  S  96.  Subdivisions  3 and 5 of section 6542 of the education law, as
amended by chapter 48 of the laws  of  2012,  are  amended  to  read  as
follows:
  3.  No physician shall employ or supervise more than [two] FOUR physi-
cian assistants in his or her private practice.
  5. Notwithstanding any other provision of this article, nothing  shall
prohibit a physician employed by or rendering services to the department
of corrections and community supervision under contract from supervising
no  more than [four] SIX physician assistants in his or her practice for
the department of corrections and community supervision.
  S 97. The opening paragraph, and paragraphs (k) and (l) of subdivision
1 of section 3510 of the public health law, as added by chapter  175  of
the  laws of 2006, are amended and four new paragraphs (m), (n), (o) and
(p) are added to read as follows:
  The  license,  registration  or  intravenous  contrast  administration
certificate of a [radiological] RADIOLOGIC technologist may be suspended
for  a  fixed  period,  revoked  or annulled, or such licensee censured,
reprimanded, subject to a civil  penalty  not  to  exceed  two  thousand
dollars  for  every such violation, or otherwise disciplined, in accord-
ance with the provisions and procedures defined in  this  article,  upon
decision  after due hearing that the individual is guilty of the follow-
ing misconduct:
  (k) using the prefix "Dr.", the word "doctor" or any suffix  or  affix
to  indicate  or imply that the licensee is a duly licensed practitioner
as defined in this article when not so licensed; [or]
  (l) incompetence or negligence[.];
  (M) BEING CONVICTED OF COMMITTING AN ACT CONSTITUTING  A  CRIME  UNDER
(I)  NEW  YORK  STATE LAW; (II) FEDERAL LAW; OR (III) THE LAW OF ANOTHER
JURISDICTION AND WHICH, IF  COMMITTED  WITHIN  THIS  STATE,  WOULD  HAVE
CONSTITUTED A CRIME UNDER NEW YORK STATE LAW;
  (N)  HAVING  BEEN  FOUND  GUILTY  OF IMPROPER PROFESSIONAL PRACTICE OR
PROFESSIONAL MISCONDUCT BY A DULY AUTHORIZED  PROFESSIONAL  DISCIPLINARY
AGENCY  OF  ANOTHER  STATE  WHERE THE CONDUCT UPON WHICH THE FINDING WAS
BASED, IF COMMITTED IN NEW YORK  STATE,  WOULD  CONSTITUTE  PROFESSIONAL
MISCONDUCT UNDER THE LAWS OF NEW YORK STATE;
  (O)  HAVING BEEN FOUND GUILTY IN AN ADJUDICATORY PROCEEDING OF VIOLAT-
ING A STATE OR FEDERAL STATUTE OR REGULATION, PURSUANT TO A FINAL  DECI-
SION  OR  DETERMINATION,  AND WHEN NO APPEAL IS PENDING, OR AFTER RESOL-
UTION OF THE PROCEEDING  BY  STIPULATION  OR  AGREEMENT,  AND  WHEN  THE
VIOLATION WOULD CONSTITUTE PROFESSIONAL MISCONDUCT UNDER THE LAWS OF NEW
YORK STATE; OR
  (P) HAVING HIS OR HER LICENSE TO PRACTICE AS A RADIOLOGIC TECHNOLOGIST
REVOKED,  SUSPENDED OR HAVING OTHER DISCIPLINARY ACTION TAKEN, OR HAVING
HIS OR HER APPLICATION FOR A LICENSE REFUSED, REVOKED  OR  SUSPENDED  OR
HAVING  VOLUNTARILY  OR OTHERWISE SURRENDERED HIS OR HER LICENSE AFTER A
DISCIPLINARY ACTION WAS INSTITUTED BY  A  DULY  AUTHORIZED  PROFESSIONAL
DISCIPLINARY AGENCY OF ANOTHER STATE, WHERE THE CONDUCT RESULTING IN THE
REVOCATION,  SUSPENSION  OR  OTHER  DISCIPLINARY  ACTION  INVOLVING  THE
LICENSE OR REFUSAL, REVOCATION OR SUSPENSION OF  AN  APPLICATION  FOR  A
LICENSE  OR THE SURRENDER OF THE LICENSE WOULD, IF COMMITTED IN NEW YORK
STATE, CONSTITUTE PROFESSIONAL MISCONDUCT UNDER THE  LAWS  OF  NEW  YORK
STATE.  A RADIOLOGIC TECHNOLOGIST LICENSED IN NEW YORK STATE WHO IS ALSO

S. 2606                            194                           A. 3006

LICENSED OR SEEKING LICENSURE IN ANOTHER STATE MUST  IMMEDIATELY  REPORT
TO  THE  DEPARTMENT  ANY  REVOCATION,  SUSPENSION  OR OTHER DISCIPLINARY
ACTION INVOLVING THE OUT-OF-STATE  LICENSE  OR  REFUSAL,  REVOCATION  OR
SUSPENSION  OF AN APPLICATION FOR AN OUT-OF-STATE LICENSE OR THE SURREN-
DER OF THE OUT-OF-STATE LICENSE.
  S 98. Section 9 of chapter 420 of the laws of 2002 amending the educa-
tion law relating to the profession of social work, as amended by  chap-
ter 132 of the laws of 2010, is amended to read as follows:
  S  9.  [a.] Nothing in this act shall prohibit or limit the activities
or services on the part of any person in the  employ  of  a  program  or
service  operated,  regulated,  funded, or approved by the department of
mental hygiene, the office of children and family services, the  depart-
ment  of  [correctional services] CORRECTIONS AND COMMUNITY SUPERVISION,
the state office for the aging, the department of  health,  or  a  local
governmental  unit  as  that term is defined in article 41 of the mental
hygiene law or a social services district as defined in  section  61  of
the  social  services  law,  provided,  however,  this section shall not
authorize the use of any title authorized pursuant to article 154 of the
education law[, except that this section shall  be  deemed  repealed  on
July  1,  2013; provided, further, however, that on or before October 1,
2010, each state agency identified in this subdivision shall  submit  to
the commissioner of education data, in such form and detail as requested
by  the commissioner of education, concerning the functions performed by
its service provider workforce and the service provider workforce of the
local governmental units and social services  districts  as  defined  in
this  subdivision  over which the agency has regulatory authority. After
receipt of such data, the commissioner shall convene a workgroup of such
state agencies for the purpose of reviewing such data and also  to  make
recommendations  regarding  amendments to law, rule or regulation neces-
sary to clarify which tasks and activities must  be  performed  only  by
licensed  or  otherwise  authorized  personnel. No later than January 1,
2011, after consultation with such work group,  the  commissioner  shall
develop  criteria  for  the report required pursuant to subdivision b of
this section and shall work with such state agencies by providing advice
and guidance regarding which tasks and activities must be performed only
by licensed or otherwise authorized personnel.
  b. On or before July 1, 2011, each such state agency, after  consulta-
tion  with  local  governmental  units  and social services districts as
defined in subdivision a of this section over which the agency has regu-
latory authority, shall submit to the commissioner of education a report
on the utilization of  personnel  subject  to  the  provisions  of  this
section. Such report shall include but not be limited to: identification
of tasks and activities performed by such personnel categorized as tasks
and  functions  restricted to licensed personnel and tasks and functions
that do not require a license under article 154 of  the  education  law;
analysis  of costs associated with employing only appropriately licensed
or otherwise authorized personnel to perform tasks  and  functions  that
require  licensure  under  such  article 154, including salary costs and
costs associated with  providing  support  to  unlicensed  personnel  in
obtaining  appropriate  licensure.  Such  report  shall  also include an
action plan detailing measures through which each such entity shall,  no
later  than July 1, 2013, comply with professional licensure laws appli-
cable to services provided and make recommendations on alternative path-
ways toward licensure.
  c.  The commissioner of education shall, after receipt of  the  report
required under this section, and after consultation with state agencies,

S. 2606                            195                           A. 3006

not-for-profit  providers,  professional  associations,  consumers,  and
other key stakeholders, submit a report to the governor, the speaker  of
the  assembly,  the temporary president of the senate, and the chairs of
the  senate  and assembly higher education committees by July 1, 2012 to
recommend any amendments to law, rule or regulation necessary  to  fully
implement  the  requirements for licensure by July 1, 2013.  Other state
agency commissioners shall be provided an opportunity to include  state-
ments or alternative recommendations in such report].
  S  99.  Section  17-a  of chapter 676 of the laws of 2002 amending the
education law relating to the practice  of  psychology,  as  amended  by
chapter 130 of the laws of 2010, subdivision b as amended by chapter 132
of the laws of 2010, is amended to read as follows:
  S  17-a.    [a.] In relation to activities and services provided under
article 153 of the education law, nothing in this act shall prohibit  or
limit  such  activities  or  services  on  the part of any person in the
employ of a program or service operated, regulated, funded, or  approved
by the department of mental hygiene or the office of children and family
services,  or a local governmental unit as that term is defined in arti-
cle 41 of the mental hygiene  law  or  a  social  services  district  as
defined in section 61 of the social services law.  In relation to activ-
ities  and  services  provided  under  article 163 of the education law,
nothing in this act shall prohibit or limit such activities or  services
on  the  part  of any person in the employ of a program or service oper-
ated, regulated,  funded,  or  approved  by  the  department  of  mental
hygiene,  the  office of children and family services, the department of
correctional services, the state office for the aging and the department
of health or a local governmental unit as that term is defined in  arti-
cle  41  of  the  mental  hygiene  law  or a social services district as
defined in section 61 of the social services law, pursuant to  authority
granted  by  law.  This section shall not authorize the use of any title
authorized pursuant to article 153 or 163 of the education  law  by  any
such  employed  person,  except  as  otherwise provided by such articles
respectively.
  [b. This section shall be  deemed  repealed  July  1,  2013  provided,
however, that on or before October 1, 2010, each state agency identified
in  subdivision  a  of  this section shall submit to the commissioner of
education data, in such form and detail as requested by the commissioner
of education, concerning the functions performed by its service provider
workforce and the service provider workforce of the  local  governmental
units  and social services districts as defined in subdivision a of this
section over which the agency has regulatory authority. After receipt of
such data, the commissioner shall convene  a  workgroup  of  such  state
agencies  for the purpose of reviewing such data and also to make recom-
mendations regarding amendments to law, rule or regulation necessary  to
clarify which tasks and activities must be performed only by licensed or
otherwise  authorized  personnel.  No  later than January 1, 2011, after
consultation with such workgroup, the commissioner shall develop  crite-
ria  for  the report required pursuant to paragraph one of this subdivi-
sion and shall work with such state agencies  by  providing  advice  and
guidance  regarding which tasks and activities must be performed only by
licensed or otherwise authorized personnel.
  1. On or before July 1, 2011, each such state agency, after  consulta-
tion  with  local  governmental  units  and social services districts as
defined in subdivision a of this section over which the agency has regu-
latory authority, shall submit to the commissioner of education a report
on the utilization of  personnel  subject  to  the  provisions  of  this

S. 2606                            196                           A. 3006

section. Such report shall include but not be limited to: identification
of tasks and activities performed by such personnel categorized as tasks
and  functions  restricted to licensed personnel and tasks and functions
that  do not require a license under article 153 or 163 of the education
law; analysis of costs  associated  with  employing  only  appropriately
licensed  or  otherwise  authorized personnel to perform tasks and func-
tions that require licensure under such article 153  or  163,  including
salary  costs  and costs associated with providing support to unlicensed
personnel in obtaining appropriate licensure.  Such  report  shall  also
include an action plan detailing measures through which each such entity
shall,  no  later  than July 1, 2013, comply with professional licensure
laws applicable to services provided and make recommendations on  alter-
native pathways toward licensure.
  2.   The commissioner of education shall, after receipt of the reports
required under this section, and after consultation with state agencies,
not-for-profit  providers,  professional  associations,  consumers,  and
other  key stakeholders, submit a report to the governor, the speaker of
the assembly, the temporary president of the senate, and the  chairs  of
the  senate  and assembly higher education committees by July 1, 2012 to
recommend any amendments to law, rule or regulation necessary  to  fully
implement  the  requirements for licensure by July 1, 2013.  Other state
agency commissioners shall be provided an opportunity to include  state-
ments or alternative recommendations in such report.]
  S  100.  Section  16  of  chapter 130 of the laws of 2010 amending the
education law and other laws relating to the  registration  of  entities
providing  certain  professional  services  and the licensure of certain
professions, as amended by chapter 132 of the laws of 2010,  is  amended
to read as follows:
  S  16.  This act shall take effect immediately; provided that sections
thirteen, fourteen and fifteen of this act shall take effect immediately
and shall be deemed to have been in full force and effect on  and  after
June  1,  2010 [and such sections shall be deemed repealed July 1, 2013;
provided further that the amendments to section 9 of chapter 420 of  the
laws  of  2002  amending the education law relating to the profession of
social work made by section thirteen of this act  shall  repeal  on  the
same  date as such section repeals; provided further that the amendments
to section 17-a of chapter 676 of the laws of 2002 amending  the  educa-
tion law relating to the practice of psychology made by section fourteen
of this act shall repeal on the same date as such section repeals].
  S  101. Section 2801-a of the public health law is amended by adding a
new subdivision 17 to read as follows:
  17. (A) DIAGNOSTIC OR TREATMENT CENTERS ESTABLISHED TO PROVIDE  HEALTH
CARE SERVICES WITHIN THE SPACE OF A RETAIL BUSINESS OPERATION, SUCH AS A
PHARMACY,  A STORE OPEN TO THE GENERAL PUBLIC OR A SHOPPING MALL, MAY BE
OPERATED BY LEGAL ENTITIES FORMED UNDER  THE  LAWS  OF  NEW  YORK  WHOSE
STOCKHOLDERS  OR  MEMBERS,  AS  APPLICABLE,  ARE NOT NATURAL PERSONS AND
WHOSE PRINCIPAL STOCKHOLDERS AND MEMBERS, AS APPLICABLE, AND CONTROLLING
PERSONS COMPLY WITH ALL APPLICABLE  REQUIREMENTS  OF  THIS  SECTION  AND
DEMONSTRATE,  TO  THE SATISFACTION OF THE PUBLIC HEALTH AND HEALTH PLAN-
NING COUNCIL, SUFFICIENT EXPERIENCE AND  EXPERTISE  IN  DELIVERING  HIGH
QUALITY  HEALTH  CARE  SERVICES.  SUCH  DIAGNOSTIC AND TREATMENT CENTERS
SHALL BE REFERRED TO IN THIS SECTION AS "LIMITED SERVICES CLINICS".  FOR
PURPOSES  OF  THIS  SUBDIVISION,  THE  PUBLIC HEALTH AND HEALTH PLANNING
COUNCIL SHALL ADOPT AND AMEND RULES AND REGULATIONS, NOTWITHSTANDING ANY
INCONSISTENT PROVISION OF THIS SECTION, TO ADDRESS ANY MATTER  IT  DEEMS
PERTINENT  TO  THE  ESTABLISHMENT  OF LIMITED SERVICES CLINICS; PROVIDED

S. 2606                            197                           A. 3006

THAT SUCH RULES AND REGULATIONS SHALL INCLUDE, BUT NOT  BE  LIMITED  TO,
PROVISIONS  GOVERNING OR RELATING TO: (I) ANY DIRECT OR INDIRECT CHANGES
OR TRANSFERS OF OWNERSHIP INTERESTS OR VOTING RIGHTS IN SUCH ENTITIES OR
THEIR  STOCKHOLDERS  OR  MEMBERS,  AS APPLICABLE, AND PROVIDE FOR PUBLIC
HEALTH AND HEALTH PLANNING COUNCIL APPROVAL OF ANY CHANGE IN CONTROLLING
INTERESTS, PRINCIPAL STOCKHOLDERS, CONTROLLING PERSONS,  PARENT  COMPANY
OR  SPONSORS;  (II)  OVERSIGHT  OF  THE OPERATOR AND ITS SHAREHOLDERS OR
MEMBERS, AS  APPLICABLE,  INCLUDING  LOCAL  GOVERNANCE  OF  THE  LIMITED
SERVICES CLINICS; AND (III) RELATING TO THE CHARACTER AND COMPETENCE AND
QUALIFICATIONS  OF, AND CHANGES RELATING TO, THE DIRECTORS AND OFFICERS,
THE OPERATOR AND ITS PRINCIPAL STOCKHOLDERS, CONTROLLING PERSONS, COMPA-
NY OR SPONSORS.
  (B) THE FOLLOWING PROVISIONS OF THIS SECTION SHALL NOT APPLY TO LIMIT-
ED SERVICES CLINICS OPERATED PURSUANT TO THIS SUBDIVISION: (I) PARAGRAPH
(B) OF SUBDIVISION THREE OF THIS SECTION, RELATING TO  STOCKHOLDERS  AND
MEMBERS;  (II) PARAGRAPH (C) OF SUBDIVISION FOUR OF THIS SECTION, RELAT-
ING TO THE DISPOSITION OF STOCK OR VOTING RIGHTS;  AND  (III)  PARAGRAPH
(E)  OF  SUBDIVISION  FOUR OF THIS SECTION, RELATING TO THE OWNERSHIP OF
STOCK OR MEMBERSHIP.
  (C) A LIMITED SERVICES CLINIC SHALL BE DEEMED TO  BE  A  "HEALTH  CARE
PROVIDER"  FOR  THE PURPOSES OF TITLE TWO-D OF ARTICLE TWO OF THIS CHAP-
TER. A PRESCRIBER PRACTICING IN A LIMITED SERVICES CLINIC SHALL  NOT  BE
DEEMED TO BE IN THE EMPLOY OF A PHARMACY OR PRACTICING IN A HOSPITAL FOR
PURPOSES  OF SUBDIVISION TWO OF SECTION SIXTY-EIGHT HUNDRED SEVEN OF THE
EDUCATION LAW.
  (D) THE COMMISSIONER SHALL PROMULGATE REGULATIONS SETTING FORTH OPERA-
TIONAL AND PHYSICAL PLANT STANDARDS FOR LIMITED SERVICES CLINICS,  WHICH
MAY BE DIFFERENT FROM THE REGULATIONS OTHERWISE APPLICABLE TO DIAGNOSTIC
OR  TREATMENT  CENTERS,  INCLUDING,  BUT  NOT LIMITED TO: DESIGNATING OR
LIMITING THE DIAGNOSES AND SERVICES THAT MAY  BE  PROVIDED;  PROHIBITING
THE PROVISION OF SERVICES TO PATIENTS TWENTY-FOUR MONTHS OF AGE OR YOUN-
GER; AND REQUIREMENTS OR GUIDELINES FOR ADVERTISING AND SIGNAGE, DISCLO-
SURE  OF OWNERSHIP INTERESTS, INFORMED CONSENT, RECORD KEEPING, REFERRAL
FOR TREATMENT AND CONTINUITY OF CARE, CASE REPORTING  TO  THE  PATIENT'S
PRIMARY  CARE  OR  OTHER  HEALTH  CARE  PROVIDERS, DESIGN, CONSTRUCTION,
FIXTURES, AND EQUIPMENT. IN MAKING REGULATIONS UNDER THIS  SECTION,  THE
COMMISSIONER  MAY  CONSULT WITH A WORKGROUP INCLUDING BUT NOT LIMITED TO
REPRESENTATIVES OF PROFESSIONAL SOCIETIES  OF  APPROPRIATE  HEALTH  CARE
PROFESSIONALS, INCLUDING THOSE IN PRIMARY CARE AND OTHER SPECIALTIES AND
SHALL  PROMOTE  AND STRENGTHEN PRIMARY CARE; THE INTEGRATION OF SERVICES
PROVIDED BY LIMITED SERVICES CLINICS WITH THE SERVICES PROVIDED  BY  THE
PATIENT'S  OTHER  HEALTH CARE PROVIDERS; AND THE REFERRAL OF PATIENTS TO
APPROPRIATE HEALTH CARE PROVIDERS, INCLUDING APPROPRIATE TRANSMISSION OF
PATIENT HEALTH RECORDS.
  S 102. Intentionally omitted.
  S 103. Intentionally omitted.
  S 104. Section 2801-a of the public health law is amended by adding  a
new subdivision 18 to read as follows:
  18. (A) THE COMMISSIONER IS AUTHORIZED TO ESTABLISH A PILOT PROGRAM TO
ASSIST  IN  RESTRUCTURING  HEALTH  CARE DELIVERY SYSTEMS BY ALLOWING FOR
INCREASED CAPITAL INVESTMENT IN HEALTH CARE FACILITIES. PURSUANT TO  THE
PILOT  PROGRAM,  THE  PUBLIC  HEALTH  AND  HEALTH PLANNING COUNCIL SHALL
APPROVE THE ESTABLISHMENT, IN ACCORDANCE WITH THE PROVISIONS OF SUBDIVI-
SION THREE OF THIS SECTION, OF NO MORE THAN  TWO  BUSINESS  CORPORATIONS
FORMED  UNDER  THE  BUSINESS  CORPORATION LAW, ONE OF WHICH SHALL BE THE
OPERATOR OF A HOSPITAL OR HOSPITALS IN KINGS COUNTY  AND  ONE  SHALL  BE

S. 2606                            198                           A. 3006

ELSEWHERE IN THE STATE.  SUCH BUSINESS CORPORATIONS SHALL AFFILIATE, THE
EXTENT  OF THE AFFILIATION TO BE DETERMINED BY THE COMMISSIONER, WITH AT
LEAST ONE ACADEMIC MEDICAL INSTITUTION APPROVED BY THE COMMISSIONER.
  (B)  NOTWITHSTANDING  ANY  PROVISION  OF LAW TO THE CONTRARY, BUSINESS
CORPORATIONS ESTABLISHED PURSUANT TO THIS SUBDIVISION  SHALL  BE  DEEMED
ELIGIBLE  TO  PARTICIPATE  IN  DEBT  FINANCING PROVIDED BY THE DORMITORY
AUTHORITY OF THE STATE OF NEW YORK, LOCAL DEVELOPMENT  CORPORATIONS  AND
ECONOMIC DEVELOPMENT CORPORATIONS.
  (C)  THE FOLLOWING PROVISIONS OF THIS CHAPTER SHALL NOT APPLY TO BUSI-
NESS CORPORATIONS ESTABLISHED PURSUANT TO THIS  SUBDIVISION:  (I)  PARA-
GRAPH  (B)  OF SUBDIVISION THREE OF THIS SECTION, RELATING TO STOCKHOLD-
ERS; (II) PARAGRAPH (C) OF SUBDIVISION FOUR OF THIS SECTION, RELATING TO
THE DISPOSITION OF STOCK OR VOTING RIGHTS; (III) PARAGRAPH (E) OF SUBDI-
VISION FOUR OF THIS SECTION, RELATING TO THE  OWNERSHIP  OF  STOCK;  AND
(IV) PARAGRAPH (A) OF SUBDIVISION THREE OF SECTION FOUR THOUSAND FOUR OF
THIS  CHAPTER,  RELATING TO THE OWNERSHIP OF STOCK.  NOTWITHSTANDING THE
FOREGOING, THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL MAY REQUIRE THE
DISCLOSURE OF THE IDENTITY OF STOCKHOLDERS, PROVIDED THAT THE NUMBER  OF
STOCKHOLDERS DOES NOT EXCEED THIRTY-FIVE.
  (D) THE CORPORATE POWERS AND PURPOSES OF A BUSINESS CORPORATION ESTAB-
LISHED  AS  AN OPERATOR PURSUANT TO THIS SUBDIVISION SHALL BE LIMITED TO
THE OWNERSHIP AND OPERATION, OR OPERATION, OF A  HOSPITAL  OR  HOSPITALS
SPECIFICALLY  NAMED  AND  THE LOCATION OR LOCATIONS OF WHICH ARE SPECIF-
ICALLY DESIGNATED BY STREET ADDRESS, CITY, TOWN, VILLAGE OR LOCALITY AND
COUNTY; PROVIDED, HOWEVER, THAT THE CORPORATE POWERS  AND  PURPOSES  MAY
ALSO  INCLUDE  THE OWNERSHIP AND OPERATION, OR OPERATION, OF A CERTIFIED
HOME HEALTH AGENCY OR LICENSED HOME CARE SERVICES AGENCY OR AGENCIES  AS
DEFINED  IN  ARTICLE THIRTY-SIX OF THIS CHAPTER OR A HOSPICE OR HOSPICES
AS DEFINED IN ARTICLE FORTY OF THIS  CHAPTER,  IF  THE  CORPORATION  HAS
RECEIVED  ALL  APPROVALS  REQUIRED UNDER SUCH LAW TO OWN AND OPERATE, OR
OPERATE, SUCH HOME CARE  SERVICES  AGENCY  OR  AGENCIES  OR  HOSPICE  OR
HOSPICES.  SUCH  CORPORATE  POWERS  AND  PURPOSES SHALL NOT BE MODIFIED,
AMENDED OR DELETED WITHOUT THE PRIOR APPROVAL OF THE COMMISSIONER.
  (E) (1) IN DISCHARGING THE DUTIES OF THEIR RESPECTIVE  POSITIONS,  THE
BOARD OF DIRECTORS, COMMITTEES OF THE BOARD AND INDIVIDUAL DIRECTORS AND
OFFICERS OF A BUSINESS CORPORATION ESTABLISHED PURSUANT TO THIS SUBDIVI-
SION SHALL CONSIDER THE EFFECTS OF ANY ACTION UPON:
  (A) THE ABILITY OF THE BUSINESS CORPORATION TO ACCOMPLISH ITS PURPOSE;
  (B) THE SHAREHOLDERS OF THE BUSINESS CORPORATION;
  (C) THE EMPLOYEES AND WORKFORCE OF THE BUSINESS;
  (D) THE INTERESTS OF PATIENTS OF THE HOSPITAL OR HOSPITALS;
  (E)  COMMUNITY  AND  SOCIETAL  CONSIDERATIONS,  INCLUDING THOSE OF ANY
COMMUNITY IN WHICH FACILITIES OF THE CORPORATION ARE LOCATED;
  (F) THE LOCAL AND GLOBAL ENVIRONMENT; AND
  (G) THE SHORT-TERM AND LONG-TERM INTERESTS OF THE CORPORATION, INCLUD-
ING BENEFITS THAT MAY ACCRUE  TO  THE  CORPORATION  FROM  ITS  LONG-TERM
PLANS.
  (2)  THE CONSIDERATION OF INTERESTS AND FACTORS IN THE MANNER REQUIRED
BY PARAGRAPH ONE OF THIS PARAGRAPH:
  (A) SHALL NOT CONSTITUTE A VIOLATION  OF  THE  PROVISIONS  OF  SECTION
SEVEN  HUNDRED FIFTEEN OR SEVEN HUNDRED SEVENTEEN OF THE BUSINESS CORPO-
RATION LAW; AND
  (B) IS IN ADDITION TO THE ABILITY OF DIRECTORS TO  CONSIDER  INTERESTS
AND  FACTORS AS PROVIDED IN SECTION SEVEN HUNDRED SEVENTEEN OF THE BUSI-
NESS CORPORATION LAW.

S. 2606                            199                           A. 3006

  (F) A SALE, LEASE, CONVEYANCE, EXCHANGE, TRANSFER, OR  OTHER  DISPOSI-
TION  OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION SHALL
NOT BE EFFECTIVE UNLESS THE TRANSACTION IS APPROVED BY THE COMMISSIONER.
  (G)  NO  LATER  THAN  TWO  YEARS AFTER THE ESTABLISHMENT OF A BUSINESS
CORPORATION UNDER THIS SUBDIVISION, THE COMMISSIONER SHALL  PROVIDE  THE
GOVERNOR,  THE  MAJORITY  LEADER  OF  THE  SENATE AND THE SPEAKER OF THE
ASSEMBLY WITH A WRITTEN EVALUATION OF THE PILOT PROGRAM. SUCH EVALUATION
SHALL ADDRESS THE OVERALL EFFECTIVENESS OF THE PROGRAM IN  ALLOWING  FOR
ACCESS  TO  CAPITAL  INVESTMENT IN HEALTH CARE FACILITIES AND THE IMPACT
SUCH ACCESS MAY HAVE ON THE QUALITY OF CARE PROVIDED BY HOSPITALS  OPER-
ATED BY BUSINESS CORPORATIONS ESTABLISHED UNDER THIS SUBDIVISION.
  S 105. Intentionally omitted.
  S  106.  Section  18  of chapter 266 of the laws of 1986, amending the
civil practice law and rules and other  laws  relating  to  medical  and
dental malpractice, is REPEALED.
  S  107.  Any rules or regulations promulgated by the superintendent of
insurance or the commissioner of health pursuant to  the  provisions  of
section 18 of chapter 266 of the laws of 1986 shall survive such repeal,
and  shall  be  applicable  to  the excess medical malpractice liability
coverage pool and related provisions as created by section  one  hundred
eight of this act.
  The  repeal of section 18 of chapter 266 of the laws of 1986 as effec-
tuated by section one hundred six of  this  act  shall  not  affect  the
rights  or  obligations  of  any  physician, dentist, insurer or general
hospital related to  excess  or  equivalent  excess  coverage  purchased
pursuant  to  the provisions of section 18 of chapter 266 of the laws of
1986 that were in effect prior to the date this act  takes  effect;  nor
shall  the  repeal  of  section 18 of chapter 266 of the laws of 1986 as
effectuated by section one hundred six of this act affect the rights  or
obligations of any claimant against excess or equivalent excess coverage
that  was  purchased pursuant to the provisions of section 18 of chapter
266 of the laws of 1986 that were in effect prior to the date  this  act
takes effect.
  S  108. The public health law is amended by adding a new section 23 to
read as follows:
  S 23. EXCESS MEDICAL MALPRACTICE LIABILITY  COVERAGE  POOL.  1.    THE
HOSPITAL  EXCESS  LIABILITY  POOL  ESTABLISHED  BY  SUBDIVISION  FIVE OF
SECTION EIGHTEEN OF CHAPTER TWO HUNDRED SIXTY-SIX OF THE LAWS  OF  NINE-
TEEN  HUNDRED EIGHTY-SIX, AS AMENDED BY CHAPTER TWO HUNDRED FIFTY-SIX OF
THE LAWS OF NINETEEN HUNDRED NINETY-THREE  SHALL  BE  CONTINUED  AND  IS
HEREBY RENAMED THE "EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL."
THE EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL SHALL BE OVERSEEN
BY  THE  SUPERINTENDENT  OF FINANCIAL SERVICES AND THE COMMISSIONER, AND
SHALL CONSIST OF FUNDS CURRENTLY IN OR OWED TO THE EXCESS LIABILITY POOL
AS OF THE EFFECTIVE DATE OF THIS SECTION, AND FUNDS APPROPRIATED FOR THE
PURPOSES OF THE EXCESS MEDICAL MALPRACTICE LIABILITY COVERAGE POOL.
  2. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE  HUNDRED
TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTIONS
ONE HUNDRED FORTY-TWO AND ONE HUNDRED FORTY-THREE OF THE ECONOMIC DEVEL-
OPMENT  LAW,  OR ANY OTHER CONTRARY PROVISION OF LAW, THE SUPERINTENDENT
OF FINANCIAL SERVICES MAY ENTER INTO A CONTRACT OR CONTRACTS UNDER  THIS
SUBDIVISION  WITHOUT  A COMPETITIVE BID OR REQUEST FOR PROPOSAL PROCESS,
PROVIDED, HOWEVER, THAT:
  (A) THE DEPARTMENT OF FINANCIAL SERVICES SHALL POST  ON  ITS  WEBSITE,
FOR A PERIOD OF NO LESS THAN THIRTY DAYS:

S. 2606                            200                           A. 3006

  (I)  A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
  (II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
  (III)  THE  PERIOD  OF  TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
SEEK SELECTION, WHICH SHALL BE NO  LESS  THAN  THIRTY  DAYS  AFTER  SUCH
INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
  (IV)  THE  MANNER  BY  WHICH  A  PROSPECTIVE  CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
  (B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE  RECEIVED  FROM
PROSPECTIVE  CONTRACTORS  IN  TIMELY  FASHION  SHALL  BE REVIEWED BY THE
SUPERINTENDENT OF FINANCIAL SERVICES; AND
  (C)  THE  SUPERINTENDENT  OF  FINANCIAL  SERVICES  SHALL  SELECT  SUCH
CONTRACTOR  OR  CONTRACTORS  THAT,  IN  THE  SUPERINTENDENT OF FINANCIAL
SERVICES' DISCRETION, ARE BEST SUITED TO  SERVE  THE  PURPOSES  OF  THIS
SUBDIVISION.
  3.  (A)  THE SUPERINTENDENT OF FINANCIAL SERVICES AND THE COMMISSIONER
OR THEIR DESIGNEES SHALL, FROM FUNDS AVAILABLE  IN  THE  EXCESS  MEDICAL
MALPRACTICE  LIABILITY COVERAGE POOL CREATED PURSUANT TO SUBDIVISION ONE
OF THIS SECTION, PURCHASE A POLICY  OR  POLICIES  FOR  EXCESS  INSURANCE
COVERAGE, OR FOR EQUIVALENT EXCESS COVERAGE, FOR MEDICAL OR DENTAL MALP-
RACTICE OCCURRENCES BETWEEN THE FIRST OF JULY OF A GIVEN YEAR AND ENDING
THE  THIRTIETH  OF  JUNE  OF THE NEXT SUCCEEDING YEAR, OR TO REIMBURSE A
GENERAL HOSPITAL WHERE THE HOSPITAL PURCHASES EQUIVALENT EXCESS COVERAGE
FOR MEDICAL OR DENTAL MALPRACTICE OCCURRENCES BETWEEN THE FIRST OF  JULY
IN  A GIVEN YEAR AND ENDING THE THIRTIETH OF JUNE IN THE SUCCEEDING YEAR
FOR ELIGIBLE PHYSICIANS OR DENTISTS AS CERTIFIED BY A  GENERAL  HOSPITAL
LICENSED  PURSUANT TO ARTICLE TWENTY-EIGHT OF THIS CHAPTER FOR EACH SUCH
PERIOD OR PERIODS, PROVIDED THE RATES AND PREMIUMS PAID FOR SUCH  POLICY
OR  POLICIES  ARE ACTUARIALLY SOUND AND NOT DISCOUNTED, AS DETERMINED BY
THE SUPERINTENDENT OF FINANCIAL SERVICES OR HIS OR HER DESIGNATED  ACTU-
ARY.
  (B)  SUCH  POLICIES MAY BE PURCHASED PURSUANT TO SECTION FIVE THOUSAND
FIVE HUNDRED TWO OF THE INSURANCE LAW, OR FROM AN INSURER, DULY LICENSED
IN THIS STATE TO WRITE PERSONAL INJURY LIABILITY INSURANCE AND  ACTUALLY
WRITING MEDICAL MALPRACTICE INSURANCE IN THIS STATE.
  (C) NO SINGLE INSURER SHALL WRITE MORE THAN FIFTY PERCENT OF THE TOTAL
EXCESS  PREMIUM  FOR  A  GIVEN  POLICY  YEAR, UNLESS UPON REQUEST BY THE
INSURER, THE SUPERINTENDENT OF FINANCIAL SERVICES IN WRITING  DETERMINED
THAT  EXCEEDING  SUCH LIMIT WOULD NOT BE HARMFUL TO THE POLICYHOLDER AND
THE PEOPLE OF THE STATE.
  (D) ANNUALLY FOLLOWING THE PASSAGE OF THE  STATE  BUDGET,  THE  SUPER-
INTENDENT OF FINANCIAL SERVICES SHALL DETERMINE THE NUMBER OF PHYSICIANS
OR DENTISTS FOR WHOM A POLICY OR POLICIES FOR EXCESS INSURANCE COVERAGE,
OR FOR EQUIVALENT EXCESS COVERAGE, MAY BE PURCHASED FROM FUNDS AVAILABLE
IN  THE  EXCESS  MEDICAL MALPRACTICE LIABILITY COVERAGE POOL. THE SUPER-
INTENDENT SHALL GRANT PRIORITY FOR PURCHASING POLICIES IN THE NEXT POLI-
CY YEAR TO THE HIGHEST RISK CLASS OF PHYSICIANS OR  DENTISTS  PRACTICING
IN  THE  HIGHEST  RISK  TERRITORIES. THE SUPERINTENDENT AND COMMISSIONER
SHALL NOT BE OBLIGATED TO PURCHASE ANY MORE POLICIES THAN THE NUMBER  OF
POLICIES  AT  ACTUARIALLY  SOUND  RATES THAT CAN BE SUPPORTED WITHIN THE
LIMITS OF THE APPROPRIATION. AFTER THE INITIAL ENROLLMENT PERIOD, SHOULD
THE SUPERINTENDENT DETERMINE THAT ADDITIONAL POLICIES CAN  BE  PURCHASED
FOR  AN ADDITIONAL CLASS OF PHYSICIANS OR DENTISTS OR A DIFFERENT TERRI-
TORY OF PRACTICE, THE SUPERINTENDENT SHALL MAKE POLICIES AVAILABLE ON  A
FIRST  COME  FIRST SERVED BASIS UP TO THE NUMBER OF POLICIES THAT CAN BE
SUPPORTED BY THE APPROPRIATION.

S. 2606                            201                           A. 3006

  4. (A) FOR THE  PURPOSES  OF  THIS  SECTION,  "ELIGIBLE  PHYSICIAN  OR
DENTIST" SHALL MEAN A PHYSICIAN OR DENTIST WHO:
  (I) HAS PROFESSIONAL PRIVILEGES IN THE GENERAL HOSPITAL THAT IS CERTI-
FYING THE PHYSICIAN'S OR DENTIST'S ELIGIBILITY;
  (II)  FROM TIME TO TIME PROVIDES EMERGENCY MEDICAL OR DENTAL SERVICES,
INCLUDING EMERGENCY MEDICAL SCREENING EXAMINATIONS, TREATMENT FOR  EMER-
GENCY MEDICAL CONDITIONS, INCLUDING LABOR AND DELIVERY, OR TREATMENT FOR
EMERGENCY  DENTAL CONDITIONS TO PERSONS IN NEED OF SUCH TREATMENT AT THE
GENERAL HOSPITAL THAT IS CERTIFYING THEIR ELIGIBILITY;
  (III) ACCEPT MEDICAID; AND
  (IV) (1) HAS IN FORCE COVERAGE UNDER AN  INDIVIDUAL  POLICY  OR  GROUP
POLICY  WRITTEN  IN  ACCORDANCE WITH THE PROVISIONS OF THE INSURANCE LAW
FROM AN INSURER LICENSED IN THIS STATE TO WRITE PERSONAL INJURY  LIABIL-
ITY  INSURANCE,  OF PRIMARY MALPRACTICE INSURANCE COVERAGE IN AMOUNTS OF
NO LESS THAN ONE MILLION THREE HUNDRED THOUSAND DOLLARS FOR EACH  CLAIM-
ANT  AND  THREE  MILLION NINE HUNDRED THOUSAND DOLLARS FOR ALL CLAIMANTS
UNDER THAT POLICY AND COVERING THE SAME TIME PERIOD AS THE EXCESS INSUR-
ANCE COVERAGE; OR,
  (2) IS ENDORSED AS AN ADDITIONAL INSURED UNDER A  VOLUNTARY  ATTENDING
PHYSICIAN ("CHANNELING") PROGRAM PREVIOUSLY PERMITTED BY THE SUPERINTEN-
DENT  OF  INSURANCE  AND COVERING THE SAME TIME PERIOD AS THE EQUIVALENT
EXCESS COVERAGE.
  (B) THE EXCESS COVERAGE OR  EQUIVALENT  EXCESS  COVERAGE  SHALL,  WHEN
COMBINED WITH THE PHYSICIAN'S OR DENTIST'S PRIMARY MALPRACTICE INSURANCE
COVERAGE  OR  COVERAGE  PROVIDED THROUGH A VOLUNTARY ATTENDING PHYSICIAN
("CHANNELING") PROGRAM PREVIOUSLY PERMITTED  BY  THE  SUPERINTENDENT  OF
INSURANCE,  TOTAL  AN  AGGREGATE  LEVEL OF COVERAGE OF TWO MILLION THREE
HUNDRED THOUSAND DOLLARS FOR EACH CLAIMANT AND SIX MILLION NINE  HUNDRED
THOUSAND  DOLLARS  FOR  ALL CLAIMANTS WITH RESPECT TO OCCURRENCES DURING
THE POLICY PERIOD.
  (C) THE EQUIVALENT EXCESS COVERAGE  SHALL  PROVIDE  FOR  PAYMENT  ONLY
AFTER  COVERAGE  AVAILABLE  THROUGH  THE  VOLUNTARY  ATTENDING PHYSICIAN
("CHANNELING") PROGRAM HAS BEEN EXHAUSTED DURING THE POLICY PERIOD.
  (D) IN THE EVENT THAT AN ELIGIBLE PHYSICIAN  OR  DENTIST  HAS  PROFES-
SIONAL  PRIVILEGES  IN MORE THAN ONE GENERAL HOSPITAL, THE CERTIFICATION
OF THE PHYSICIAN'S OR DENTIST'S ELIGIBILITY SHALL  BE  PROVIDED  BY  THE
GENERAL  HOSPITAL DESIGNATED BY SUCH PHYSICIAN OR DENTIST AS THE GENERAL
HOSPITAL WITH WHICH THE PHYSICIAN OR DENTIST IS PRIMARILY AFFILIATED, AS
MAY BE DEFINED PURSUANT TO REGULATIONS PROMULGATED BY THE COMMISSIONER.
  5. FOR THE PURPOSES OF THIS SECTION "EQUIVALENT EXCESS COVERAGE" SHALL
MEAN A POLICY OR POLICIES  OF  INSURANCE  FOR  A  PHYSICIAN  OR  DENTIST
INSURED  UNDER  A  VOLUNTARY  ATTENDING PHYSICIAN ("CHANNELING") PROGRAM
PREVIOUSLY PERMITTED BY  THE  SUPERINTENDENT  OF  INSURANCE  INSURING  A
PHYSICIAN  OR  DENTIST  AGAINST  MEDICAL  OR  DENTAL MALPRACTICE WITH AN
AGGREGATE LEVEL OF COVERAGE PROVIDING NOT LESS THAN  TWO  MILLION  THREE
HUNDRED  THOUSAND DOLLARS FOR EACH CLAIMANT AND SIX MILLION NINE HUNDRED
THOUSAND DOLLARS FOR ALL CLAIMANTS DURING THE POLICY PERIOD. SUCH COVER-
AGE LIMITS SHALL BE REDUCED BY PAYMENTS MADE ON BEHALF OF SUCH PHYSICIAN
OR DENTIST UNDER A HOSPITAL PROFESSIONAL LIABILITY POLICY WRITTEN PURSU-
ANT TO A VOLUNTARY ATTENDING PHYSICIAN ("CHANNELING") PROGRAM PREVIOUSLY
PERMITTED BY THE SUPERINTENDENT OF INSURANCE, IN AN AMOUNT NOT TO EXCEED
TWO MILLION THREE HUNDRED THOUSAND DOLLARS FOR  EACH  CLAIMANT  AND  SIX
MILLION  NINE  HUNDRED  THOUSAND  DOLLARS  FOR ALL CLAIMANTS DURING SUCH
POLICY PERIOD FOR EACH SUCH PHYSICIAN OR DENTIST.
  6. (A) TO THE EXTENT FUNDS AVAILABLE TO THE EXCESS MEDICAL MALPRACTICE
LIABILITY COVERAGE POOL PURSUANT TO SUBDIVISION ONE OF THIS SECTION  ARE

S. 2606                            202                           A. 3006

INSUFFICIENT  TO  MEET  THE COSTS OF EXCESS INSURANCE COVERAGE OR EQUIV-
ALENT EXCESS COVERAGE FOR COVERAGE PERIODS  DURING  THE  PERIOD  BETWEEN
JULY  FIRST  OF  A  GIVEN YEAR AND JUNE THIRTIETH OF THE NEXT SUCCEEDING
YEAR,  BEGINNING JULY FIRST, TWO THOUSAND THIRTEEN AND ENDING JUNE THIR-
TIETH, TWO THOUSAND FIFTEEN EACH PHYSICIAN OR DENTIST FOR WHOM A  POLICY
FOR EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS COVERAGE IS PURCHASED
FOR  SUCH  PERIOD  SHALL  BE  RESPONSIBLE FOR PAYMENT TO THE PROVIDER OF
EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS COVERAGE OF AN  ALLOCABLE
SHARE  OF  SUCH  INSUFFICIENCY,  BASED ON THE RATIO OF THE TOTAL COST OF
SUCH COVERAGE FOR SUCH PHYSICIAN OR DENTIST TO THE SUM OF THE TOTAL COST
OF SUCH COVERAGE FOR ALL PHYSICIANS OR DENTISTS APPLIED TO SUCH INSUFFI-
CIENCY.
  (B) EACH PROVIDER OF EXCESS INSURANCE COVERAGE  OR  EQUIVALENT  EXCESS
COVERAGE COVERING THE PERIOD BETWEEN JULY FIRST OF A GIVEN YEAR AND JUNE
THIRTIETH  OF  THE NEXT SUCCEEDING YEAR, BEGINNING JULY FIRST, TWO THOU-
SAND THIRTEEN AND ENDING JUNE  THIRTIETH,  TWO  THOUSAND  FIFTEEN  SHALL
NOTIFY  A  COVERED  PHYSICIAN  OR DENTIST BY MAIL, MAILED TO THE ADDRESS
SHOWN ON THE LAST APPLICATION FOR EXCESS INSURANCE  COVERAGE  OR  EQUIV-
ALENT  EXCESS  COVERAGE,  OF  THE  AMOUNT DUE TO SUCH PROVIDER FROM SUCH
PHYSICIAN OR DENTIST FOR SUCH COVERAGE PERIOD DETERMINED  IN  ACCORDANCE
WITH  PARAGRAPH  (A)  OF THIS SUBDIVISION. SUCH AMOUNT SHALL BE DUE FROM
SUCH PHYSICIAN OR DENTIST TO SUCH PROVIDER OF EXCESS INSURANCE  COVERAGE
OR  EQUIVALENT  EXCESS  COVERAGE  IN A TIME AND MANNER DETERMINED BY THE
SUPERINTENDENT OF FINANCIAL SERVICES.
  (C) IF A PHYSICIAN OR DENTIST LIABLE FOR PAYMENT OF A PORTION  OF  THE
COSTS  OF EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS COVERAGE COVER-
ING THE PERIOD BETWEEN JULY FIRST OF A GIVEN YEAR AND JUNE THIRTIETH  OF
THE  NEXT  SUCCEEDING  YEAR, BEGINNING JULY FIRST, TWO THOUSAND THIRTEEN
AND ENDING JUNE THIRTIETH, TWO THOUSAND FIFTEEN DETERMINED IN ACCORDANCE
WITH PARAGRAPH (A) OF THIS SUBDIVISION FAILS,  REFUSES  OR  NEGLECTS  TO
MAKE  PAYMENT TO THE PROVIDER OF EXCESS INSURANCE COVERAGE OR EQUIVALENT
EXCESS COVERAGE IN SUCH TIME AND MANNER AS DETERMINED BY THE SUPERINTEN-
DENT OF FINANCIAL SERVICES PURSUANT TO PARAGRAPH (B)  OF  THIS  SUBDIVI-
SION,  EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS COVERAGE PURCHASED
FOR SUCH PHYSICIAN OR DENTIST IN ACCORDANCE WITH THIS SECTION  FOR  SUCH
COVERAGE  PERIOD SHALL BE CANCELLED AND SHALL BE NULL AND VOID AS OF THE
FIRST DAY ON OR AFTER THE COMMENCEMENT OF  A  POLICY  PERIOD  WHERE  THE
LIABILITY FOR PAYMENT PURSUANT TO THIS SUBDIVISION HAS NOT BEEN MET.
  (D)  EACH  PROVIDER  OF EXCESS INSURANCE COVERAGE OR EQUIVALENT EXCESS
COVERAGE SHALL NOTIFY THE SUPERINTENDENT OF FINANCIAL SERVICES  AND  THE
COMMISSIONER  OR  THEIR  DESIGNEE OF EACH PHYSICIAN AND DENTIST ELIGIBLE
FOR PURCHASE OF A POLICY FOR EXCESS  INSURANCE  COVERAGE  OR  EQUIVALENT
EXCESS  COVERAGE  COVERING THE PERIOD BETWEEN JULY FIRST OF A GIVEN YEAR
AND JUNE THIRTIETH OF THE NEXT SUCCEEDING YEAR,  BEGINNING  JULY  FIRST,
TWO  THOUSAND  THIRTEEN  AND ENDING JUNE THIRTIETH, TWO THOUSAND FIFTEEN
THAT HAS MADE PAYMENT TO SUCH PROVIDER OF EXCESS INSURANCE  COVERAGE  OR
EQUIVALENT  EXCESS  COVERAGE  IN  ACCORDANCE  WITH PARAGRAPH (B) OF THIS
SUBDIVISION AND OF EACH PHYSICIAN AND DENTIST WHO HAS FAILED, REFUSED OR
NEGLECTED TO MAKE SUCH PAYMENT.
  (E) A PROVIDER OF  EXCESS  INSURANCE  COVERAGE  OR  EQUIVALENT  EXCESS
COVERAGE SHALL REFUND TO THE EXCESS MEDICAL MALPRACTICE LIABILITY COVER-
AGE  POOL  ANY  AMOUNT  ALLOCABLE  TO THE PERIOD BETWEEN JULY FIRST OF A
GIVEN YEAR AND JUNE THIRTIETH OF THE  NEXT  SUCCEEDING  YEAR,  BEGINNING
JULY  FIRST,  TWO THOUSAND THIRTEEN AND ENDING JUNE THIRTIETH, TWO THOU-
SAND FIFTEEN RECEIVED FROM  THE  EXCESS  MEDICAL  MALPRACTICE  LIABILITY
COVERAGE  POOL  FOR  PURCHASE OF EXCESS INSURANCE COVERAGE OR EQUIVALENT

S. 2606                            203                           A. 3006

EXCESS COVERAGE COVERING THE PERIOD BETWEEN JULY FIRST OF A  GIVEN  YEAR
AND  JUNE  THIRTIETH  OF THE NEXT SUCCEEDING YEAR, BEGINNING JULY FIRST,
TWO THOUSAND THIRTEEN AND ENDING JUNE THIRTIETH,  TWO  THOUSAND  FIFTEEN
FOR  A  PHYSICIAN  OR  DENTIST  WHERE  SUCH EXCESS INSURANCE COVERAGE OR
EQUIVALENT EXCESS COVERAGE IS CANCELLED IN ACCORDANCE WITH PARAGRAPH (C)
OF THIS SUBDIVISION.
  (F) A POLICY OR POLICIES OF EXCESS MEDICAL MALPRACTICE COVERAGE ISSUED
TO OR ON BEHALF OF AN ELIGIBLE PHYSICIAN OR  DENTIST  PURSUANT  TO  THIS
SECTION SHALL BE WRITTEN UPON AND GIVE EFFECT TO THE CHOICE OF AN INSUR-
ER  BY  THE  PHYSICIAN  OR  DENTIST, PROVIDED, HOWEVER, THAT SUCH CHOICE
SHALL BE MADE AMONG INSURERS WRITING EXCESS COVERAGE POLICIES IN ACCORD-
ANCE WITH THIS SECTION AND FURTHER PROVIDED THAT NO PHYSICIAN OR DENTIST
SHALL BE COMPELLED TO BE INSURED BY AN INSURER PROVIDING PRIMARY  COVER-
AGE  NOR SHALL SUCH INSURER PROVIDING SUCH PRIMARY COVERAGE BE COMPELLED
TO WRITE COVERAGE OF SUCH ELIGIBLE PHYSICIAN OR DENTIST FOR SUCH  EXCESS
COVERAGE,  IN  WHICH  CASE  THE ELIGIBLE PHYSICIAN OR DENTIST MAY SELECT
ANOTHER INSURER WRITING SUCH EXCESS COVERAGE  IN  ACCORDANCE  WITH  THIS
SECTION.
  7.  ANY INSURER ISSUING POLICIES OF EXCESS OR EQUIVALENT EXCESS COVER-
AGE IN ACCORDANCE WITH SUBDIVISION ONE OF  THIS  SECTION  MAY,  NOTWITH-
STANDING  ANY  PROVISIONS  OF THE INSURANCE LAW, RETURN TO THE STATE, IN
WHOLE OR IN PART, THE MONEYS REIMBURSED BY THE STATE IN ACCORDANCE  WITH
THIS  SECTION  FOR SPECIFIED POLICY PERIODS, UPON A CERTIFICATION TO THE
INSURER BY THE SUPERINTENDENT OF FINANCIAL  SERVICES  THAT  THERE  IS  A
REASONABLE  LIKELIHOOD  ON  AN  ACTUARIAL BASIS THAT THE MONEYS RETURNED
WILL NOT BE NEEDED TO PAY FOR THE EXPECTED LIABILITIES INCURRED  BY  THE
INSURER FOR SUCH POLICY PERIODS.
  8.  THE  SUPERINTENDENT OF FINANCIAL SERVICES AND THE COMMISSIONER MAY
ADOPT AND MAY AMEND SUCH REGULATIONS AS ARE NECESSARY TO EFFECTUATE  THE
PROVISIONS OF THIS SECTION.
  S 109. Intentionally omitted.
  S 110. Intentionally omitted.
  S 111. Intentionally omitted.
  S 112. Intentionally omitted.
  S 113. Intentionally omitted.
  S 114. Intentionally omitted.
  S 115. Intentionally omitted.
  S 116. Intentionally omitted.
  S 117. Intentionally omitted.
  S 118. Intentionally omitted.
  S  119.  Notwithstanding  any  inconsistent  provision of law, rule or
regulation, for purposes of implementing the provisions  of  the  public
health law and the social services law, references to titles XIX and XXI
of  the  federal  social  security  act in the public health law and the
social services law shall be deemed to include  and  also  to  mean  any
successor titles thereto under the federal social security act.
  S  120.  Notwithstanding  any  inconsistent  provision of law, rule or
regulation, the effectiveness of the provisions  of  sections  2807  and
3614  of  the  public health law, section 18 of chapter 2 of the laws of
1988, and 18 NYCRR 505.14(h), as they relate to time frames for  notice,
approval  or certification of rates of payment, are hereby suspended and
without force or effect for purposes of implementing the  provisions  of
this act.
  S  121. Severability. If any clause, sentence, paragraph, subdivision,
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

S. 2606                            204                           A. 3006

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 the  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 122. This act shall take effect immediately and shall be  deemed  to
have been in full force and effect on and after April 1, 2013; provided,
however, that the provisions of this act shall apply only to actions and
proceedings  commenced  on  or  after  such  effective  date;  provided,
further, that:
  (a) the amendments to paragraph (a) of subdivision 2 of  section  2544
of  the  public  health  law  made  by section four of this act, as such
amendments pertain to  authorizing  a  parent  to  select  an  evaluator
subject  to the provisions of section 2545-a of the public health law as
added by section seven of this act shall apply on and after  January  1,
2014;
  (b)  the  amendments  to  subdivision 10 of section 2545 of the public
health law made by section six of this act shall take effect on the same
date and in the same manner as section 2-a of part A of  chapter  56  of
the laws of 2012, takes effect;
  (c) subdivision 2 of section 2545-a of the public health law, as added
by  section seven of this act, section eleven of this act, paragraph (c)
as it pertains to requiring health maintenance organizations to  provide
municipalities  and  service  coordinators  with a list of participating
providers who are approved under  the  early  intervention  program  and
paragraph  (g) of subdivision 6 of section 4406 of the public health law
as added by section twelve of this act, subsection  (c)  as  amended  to
require insurers to provide municipalities and service coordinators with
a  list  of  participating  providers  who  are approved under the early
intervention program and subsections (e) and (h) of  section  3235-a  of
the  insurance law, as added by section thirteen of this act, shall take
effect  October  1,  2013;  provided  however,  that  the   requirements
contained  in  paragraph  (g)  of  subdivision  6 of section 4406 of the
public health law as added by section twelve of this act and  subsection
(h)  of section 3235-a of the insurance law as added by section thirteen
of this act shall apply only to policies, benefit packages and contracts
issued, renewed, modified, altered or amended on or after the  effective
date of such paragraph and such subsection;
  (d)  paragraph  (b)  of  subdivision  6  of section 4406 of the public
health law as added by section twelve of this act and subsection (b)  of
section  3235-a  of  the insurance law as amended by section thirteen of
this act shall take effect April 1,  2013,  provided  however  that  the
requirements  contained  therein,  as  they  apply  to  prohibiting  the
reduction of the number of visits available to  the  covered  person  or
enrollee's  parents  and family members who are covered under the policy
or contract  by  the  number  of  visits  used  for  early  intervention
services,  shall  apply only to policies, benefit packages and contracts
issued, renewed, modified, altered or amended on or after the  effective
date of such paragraph and such subsection;
  (e)  paragraph  (f)  of  subdivision  6  of section 4406 of the public
health law, as added by section twelve of this act,  shall  take  effect
January 1, 2014;
  (f)  the  amendments  to  subdivision  7 of section 2510 of the public
health law made by section ten of this act shall be subject to the expi-
ration and revision of such subdivision and shall expire therewith;

S. 2606                            205                           A. 3006

  (g) subsection (f) of section 3235-a of the insurance law, as added by
section thirteen of this act, shall take effect January 1, 2014;
  (h) sections thirty-three, thirty-four, thirty-five, thirty-six, thir-
ty-seven,  thirty-nine,  forty,  and  forty-one  of  this act shall take
effect immediately;
  (i) sections five, nine, ten, fourteen, fifteen,  sixteen,  seventeen,
eighteen,  nineteen, twenty, twenty-one, twenty-two, twenty-three, twen-
ty-four, twenty-six, twenty-seven, twenty-eight, twenty-nine, and thirty
of this act shall take effect January 1, 2014;
  (j) sections eighty-seven, eighty-eight and eighty-nine  of  this  act
shall  take  effect  April 1, 2014, provided that effective immediately,
the addition, amendment and/or repeal of any rule or  regulation  neces-
sary  for  the  implementation of such sections on the effective date of
this act are authorized and directed to be  made  and  completed  on  or
before such effective date;
  (k)  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;
  (l) 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;
  (m)  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;
  (n)  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
determines  necessary  to  implement  any  provision  of this act on its
effective date; and
  (o) the provisions of this act shall become effective  notwithstanding
the  failure  of  the  commissioner  of  health or the superintendent of
financial services or any council to adopt or amend or promulgate  regu-
lations implementing this act.

                                 PART F

  Section  1. Section 19.16 of the mental hygiene law, as added by chap-
ter 223 of the laws of 1992, is amended to read as follows:
S 19.16 Methadone Registry.
  The office shall establish and maintain, either  directly  or  through
contract, a central registry for purposes of preventing multiple enroll-
ment,  ENSURING  ACCURATE  DOSAGE  DELIVERY  AND  FACILITATING  DISASTER
MANAGEMENT in methadone programs. The office shall require all methadone
programs to utilize such registry and shall have  the  power  to  assess
methadone programs such fees as are necessary and appropriate.
  S 2. This act shall take effect April 1, 2013.

                                 PART G

  Section 1. Article 26 of the mental hygiene law is REPEALED.
  S  2.  The article heading of article 25 of the mental hygiene law, as
added by chapter 471 of the laws of 1980, is amended to read as follows:

S. 2606                            206                           A. 3006

                 [FUNDING FOR SUBSTANCE ABUSE SERVICES]
          FUNDING FOR SERVICES OF THE OFFICE OF ALCOHOLISM AND
                        SUBSTANCE ABUSE SERVICES
  S  3.  Paragraphs 1, 2, 3 and 4 of subdivision (a) of section 25.01 of
the mental hygiene law, paragraph 1 as added by chapter 471 of the  laws
of 1980, and paragraphs 2, 3 and 4 as amended by chapter 223 of the laws
of 1992, are amended, and four new paragraphs 5, 6, 7 and 8 are added to
read as follows:
  1. "Local  agency"  shall mean a county governmental unit for a county
not wholly within a city, and a city governmental unit for a city having
a population of one million or more, designated by such county  or  city
as responsible for substance [abuse] USE DISORDER services in such coun-
ty or city.
  2. "Operating  [costs]  EXPENSES"  shall mean expenditures[, excluding
capital costs and debt service, subject to the approval of the  office,]
APPROVED BY THE OFFICE AND incurred for the maintenance and operation of
substance  [abuse]  USE  DISORDER programs, including but not limited to
expenditures for treatment, administration, personnel,  AND  contractual
services[,  rental,  depreciation  and  interest  expenses  incurred, in
connection with the design, construction,  acquisition,  reconstruction,
rehabilitation or improvement of a substance abuse program facility, and
payments  made  to  the facilities development corporation for substance
abuse program facilities; provided that where the].  OPERATING  EXPENSES
DO  NOT  INCLUDE CAPITAL COSTS AND DEBT SERVICE UNLESS SUCH EXPENSES ARE
RELATED  TO  THE  rent,  financing  or  refinancing   of   the   design,
construction, acquisition, reconstruction, rehabilitation or improvement
of  a  substance  [abuse]  USE DISORDER program facility [is through the
facilities development corporation, operating costs  shall  include  the
debt service to be paid to amortize obligations, including principal and
interest,  issued  by the New York State medical care facilities finance
agency to finance or refinance the capital  costs  of  such  facilities]
PURSUANT  TO  THE  MENTAL HYGIENE FACILITIES FINANCE PROGRAM THROUGH THE
DORMITORY AUTHORITY OF THE STATE OF NEW YORK (DASNY;  SUCCESSOR  TO  THE
FACILITIES  DEVELOPMENT  CORPORATION),  OR  OTHERWISE  APPROVED  BY  THE
OFFICE.
  3. "Debt service" shall mean amounts, subject to the approval  of  the
office,  [as  shall  be]  required  to  be  paid to amortize obligations
including principal and interest [issued by the New York  state  housing
finance agency, the New York State medical care facilities finance agen-
cy or], ASSUMED by or on behalf of a [substance abuse program] VOLUNTARY
AGENCY  or  a local [agency to finance capital costs for substance abuse
program facilities] GOVERNMENT.
  4. "Capital costs" shall mean [expenditures, subject to  the  approval
of the office, as shall be obligated to acquire, construct, reconstruct,
rehabilitate  or  improve a substance abuse program facility.] THE COSTS
OF A LOCAL GOVERNMENT OR A VOLUNTARY AGENCY WITH RESPECT TO THE ACQUISI-
TION OF REAL PROPERTY ESTATES, INTERESTS, AND COOPERATIVE  INTERESTS  IN
REALTY,  THEIR  DESIGN, CONSTRUCTION, RECONSTRUCTION, REHABILITATION AND
IMPROVEMENT, ORIGINAL FURNISHINGS AND EQUIPMENT, SITE  DEVELOPMENT,  AND
APPURTENANCES OF A FACILITY.
  5. "STATE AID" SHALL MEAN FINANCIAL SUPPORT PROVIDED THROUGH APPROPRI-
ATIONS  OF THE OFFICE TO SUPPORT THE PROVISION OF SUBSTANCE USE DISORDER
TREATMENT, COMPULSIVE GAMBLING, PREVENTION OR OTHER AUTHORIZED SERVICES,
WITH THE EXCLUSION OF APPROPRIATIONS FOR THE PURPOSE OF MEDICAL  ASSIST-
ANCE.

S. 2606                            207                           A. 3006

  6.  "VOLUNTARY  AGENCY  CONTRIBUTIONS"  SHALL  MEAN REVENUE SOURCES OF
VOLUNTARY AGENCIES EXCLUSIVE OF STATE AID AND LOCAL TAX LEVY.
  7.  "APPROVED  NET  OPERATING  COST" SHALL MEAN THE REMAINDER OF TOTAL
OPERATING EXPENSES APPROVED BY THE OFFICE, LESS ALL SOURCES OF  REVENUE,
INCLUDING VOLUNTARY AGENCY CONTRIBUTIONS AND LOCAL TAX LEVY.
  8.  "VOLUNTARY  AGENCY" SHALL MEAN A CORPORATION ORGANIZED OR EXISTING
PURSUANT TO THE  NOT-FOR-PROFIT  CORPORATION  LAW  FOR  THE  PURPOSE  OF
PROVIDING   SUBSTANCE  USE  DISORDER,  TREATMENT,  COMPULSIVE  GAMBLING,
PREVENTION OR OTHER AUTHORIZED SERVICES.
  S 4. Subdivisions (a) and (b) of section 25.03 of the  mental  hygiene
law,  subdivision  (a) as amended by chapter 558 of the laws of 1999 and
subdivision (b) as amended by chapter 223  of  the  laws  of  1992,  are
amended and a new subdivision (d) is added to read as follows:
  (a)  In  accordance  with  the  provisions of this article, AND WITHIN
APPROPRIATIONS  MADE  AVAILABLE,  the  office  may  provide   [financial
support]  STATE  AID  to a [substance abuse program or a] local [agency]
GOVERNMENT OR VOLUNTARY AGENCY up to  one  hundred  per  centum  of  the
APPROVED  NET  operating  costs  of  such  [program] LOCAL GOVERNMENT or
VOLUNTARY agency, and [either fifty per centum of the  capital  cost  or
fifty  per centum of the debt service,] STATE AID MAY ALSO BE GRANTED TO
A LOCAL GOVERNMENT OR A VOLUNTARY AGENCY FOR  CAPITAL  COSTS  ASSOCIATED
WITH THE PROVISION OF SERVICES AT A RATE OF UP TO ONE HUNDRED PERCENT OF
APPROVED  CAPITAL  COSTS. SUCH STATE AID SHALL NOT BE GRANTED UNLESS AND
UNTIL SUCH LOCAL GOVERNMENT OR VOLUNTARY AGENCY IS  IN  COMPLIANCE  WITH
ALL  REGULATIONS PROMULGATED BY THE COMMISSIONER REGARDING THE FINANCING
OF CAPITAL PROJECTS. SUCH STATE AID for approved [services] NET  OPERAT-
ING  COSTS  SHALL  BE MADE AVAILABLE by way of advance or reimbursement,
through EITHER contracts  entered  into  between  the  office  and  such
[program  or]  VOLUNTARY  agency[, upon such terms and conditions as the
office shall deem appropriate, except as provided in  section  25.07  of
this  article,  provided,  however,  that, upon issuance of an operating
certificate in accordance with article thirty-two of  this  chapter,  if
required, the office shall provide financial support for approved chemi-
cal  dependence  services  in accordance with article twenty-six of this
title.] OR BY DISTRIBUTION  OF  SUCH  STATE  AID  TO  LOCAL  GOVERNMENTS
THROUGH A GRANT PROCESS PURSUANT TO SECTION 25.11 OF THIS ARTICLE.
  (b)  Financial  support by the office shall be subject to the approval
of the director of the budget AND WITHIN AVAILABLE APPROPRIATIONS.
  (D) NOTHING IN THIS SECTION SHALL BE CONSTRUED TO REQUIRE THE STATE TO
INCREASE SUCH STATE AID SHOULD A LOCAL GOVERNMENT CHOOSE TO  REMOVE  ANY
PORTION  OF  ITS  LOCAL TAX LEVY SUPPORT OF VOLUNTARY AGENCIES, ALTHOUGH
THE STATE MAY CHOOSE TO DO SO TO  ADDRESS  AN  URGENT  PUBLIC  NEED,  OR
CONVERSELY, MAY CHOOSE TO REDUCE ITS STATE AID.
  S  5.  Section  25.05 of the mental hygiene law, as amended by chapter
223 of the laws of 1992, is amended to read as follows:
S 25.05 Reimbursement from other sources.
  The office shall not provide a  [substance  abuse  program]  VOLUNTARY
AGENCY or a local agency with financial support for obligations incurred
by  or  on  behalf  of  such program or agency for substance [abuse] USE
DISORDER services for which reimbursement is or may be claimed under any
provision of law other than this article.
  S 6. The section heading and subdivisions (a) and (c) of section 25.06
of the mental hygiene law, as amended by chapter  223  of  the  laws  of
1992, are amended to read as follows:
Disclosures  by  closely allied entities of [substance abuse programs] A
          VOLUNTARY AGENCY.

S. 2606                            208                           A. 3006

  (a) A closely allied entity of a [substance abuse  program]  VOLUNTARY
AGENCY  that  is funded or has applied for funding from the office shall
provide the office with the following information:
  1.  A  schedule  of the dates, nature and amounts of all fiscal trans-
actions between the closely  allied  entity  and  the  [substance  abuse
program] VOLUNTARY AGENCY that is funded or has applied for funding from
the office.
  2.  A  copy  of the closely allied entity's certified annual financial
statements.
  3. With respect to any lease  agreement  between  the  closely  allied
entity,  as  lessor,  and the [substance abuse program] VOLUNTARY AGENCY
that is funded or has applied for funding from the office, as lessee, of
real or personal property:
  (i) A certified statement by an independent outside entity providing a
fair market appraisal of the real property space to be rented,  as  well
as of any rental of personal property.
  (ii)  A  statement  of  projected operating costs of the allied entity
relative to any such leased property for the budget period. The  closely
allied  entity must furnish the office with a certified statement of its
actual operating costs relative to the leased property.
  4. A statement of the funds received by the closely allied  entity  in
connection  with  its fund raising activities conducted on behalf of the
substance [abuse] USE DISORDER program that is funded or has applied for
funding from the office which clearly identifies how such funds were and
will be distributed or applied to such program.
  5. Any other data or information which the office may  deem  necessary
for purposes of making a funding decision.
  (c)  For  purposes  of  this  section, a "closely allied entity" shall
mean, but not be limited to, a corporation, partnership or unincorporat-
ed association or other body that has been formed  or  is  organized  to
provide  financial  assistance  and  aid for the benefit of a [substance
abuse program] VOLUNTARY AGENCY that is funded or has applied for  fund-
ing  from  the  office  AND  which  FINANCIAL  ASSISTANCE  AND AID shall
include, but not be limited to, engaging  in  fund  raising  activities,
administering  funds, holding title to real property, having an interest
in personal property of any nature whatsoever, and engaging in any other
activities for the benefit of any such program.    Moreover,  an  entity
shall  be deemed closely allied to a [substance abuse program] VOLUNTARY
AGENCY that is funded or has applied for funding from the office to  the
extent  that such entity and applicable fiscal transactions are required
to be disclosed within the annual financial statements of the [substance
abuse program] VOLUNTARY AGENCY that is funded or has applied for  fund-
ing  from  the office, under the category of related party transactions,
as defined by and in accordance with generally accepted accounting prin-
ciples (GAAP) and  generally  accepted  auditing  standards  (GAAS),  as
promulgated  by  the  American institute of certified public accountants
(AICPA).
  S 7. Section 25.07 of the mental hygiene law, as added by chapter  471
of the laws of 1980, is amended to read as follows:
S 25.07 Non-substitution.
  A  [substance  abuse  program]  VOLUNTARY  AGENCY  or a local [agency]
GOVERNMENT shall not substitute state  monies  for  cash  contributions,
federal  aid  otherwise committed to or intended for use in such program
or by such agency, revenues derived from the operation of  such  program
or  agency, or the other resources available for use in the operation of
the program or agency.

S. 2606                            209                           A. 3006

  S 8. Section 25.09 of the mental hygiene law, as  amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.09 Administrative costs.
  Subject  to  the  approval  of  the director of the budget, the office
shall establish a limit on the amount of financial support which may  be
advanced  or  reimbursed to a [substance abuse program] VOLUNTARY AGENCY
or a local [agency] GOVERNMENT for the administration  of  a  [substance
abuse] program.
  S  9. Section 25.11 of the mental hygiene law, as added by chapter 471
of the laws of 1980, subdivision (a) as amended by chapter  223  of  the
laws of 1992, is amended to read as follows:
S 25.11 [Comprehensive  plan] DISTRIBUTION OF STATE AID TO LOCAL GOVERN-
          MENTS.
  [(a) A local agency intending  to  seek  financial  support  from  the
office  shall no later than July first of each year submit to the office
a comprehensive substance abuse services plan, which shall describe  the
programs  and  activities planned for its ensuing fiscal year. Such plan
shall indicate to the extent possible, the nature of the services to  be
provided,  whether  such  services  are to be provided directly, through
subcontract, or through the utilization of  existing  public  resources,
the  area  or  areas  to  be served, and an estimate of the cost of such
services, including amounts to be provided other than by  office  finan-
cial  support, specifically identifying the amount of local governmental
funds committed to substance abuse programs during  its  current  fiscal
year,  and  a  commitment  that no less than such an amount will be used
from such funds for the operation  of  such  programs  during  the  next
fiscal  year.  Such  plan shall make provisions for all needed substance
abuse services and for the  evaluation  of  the  effectiveness  of  such
services.
  (b)  When  a comprehensive plan includes a local school district based
substance abuse program such  plan  shall  include  the  details  of  an
adequate  distribution of in-school and community-wide preventive educa-
tion services, including, but not limited to, services to be provided by
local drug abuse prevention councils, and shall  emphasize  the  use  of
other  volunteer agency services as may be available. The description of
the program and activities thereunder shall be  separately  stated,  and
the  data  and  information required to be provided shall conform to the
provisions of subdivision (a) of this section except that the period  to
be  covered  may,  notwithstanding  the fiscal year of the local agency,
conform to the school year.] NOTWITHSTANDING SECTION ONE HUNDRED  TWELVE
OF  THE  STATE  FINANCE LAW, THE OFFICE IS AUTHORIZED TO GRANT STATE AID
ANNUALLY TO LOCAL GOVERNMENTS IN THE FOLLOWING MANNER:
  (A) LOCAL GOVERNMENTS SHALL BE GRANTED STATE AID BY A STATE AID  FUND-
ING AUTHORIZATION LETTER ISSUED BY THE OFFICE FOR APPROVED NET OPERATING
COSTS  FOR  VOLUNTARY  AGENCIES  TO SUPPORT THE BASE AMOUNT OF STATE AID
PROVIDED TO SUCH VOLUNTARY AGENCIES FOR THE PRIOR YEAR PROVIDED THAT THE
LOCAL GOVERNMENT HAS APPROVED AND SUBMITTED BUDGETS  FOR  THE  VOLUNTARY
AGENCIES  TO THE OFFICE. THE VOLUNTARY AGENCY BUDGETS SHALL IDENTIFY THE
NATURE OF THE SERVICES TO BE PROVIDED WHICH MUST BE CONSISTENT WITH  THE
LOCAL  SERVICES PLAN SUBMITTED BY THE LOCAL GOVERNMENT PURSUANT TO ARTI-
CLE FORTY-ONE OF THIS CHAPTER, THE AREAS TO  BE  SERVED  AND  INCLUDE  A
DESCRIPTION  OF  THE VOLUNTARY AGENCY CONTRIBUTIONS AND LOCAL GOVERNMENT
FUNDING PROVIDED. THE LOCAL GOVERNMENT SHALL ENTER INTO  CONTRACTS  WITH
THE  VOLUNTARY  AGENCIES  RECEIVING SUCH STATE AID. SUCH CONTRACTS SHALL
INCLUDE FUNDING REQUIREMENTS SET BY THE OFFICE INCLUDING BUT NOT LIMITED
TO RESPONSIBILITIES OF  VOLUNTARY  AGENCIES  RELATING  TO  WORK  SCOPES,

S. 2606                            210                           A. 3006

PROGRAM  PERFORMANCE  AND  OPERATIONS,  APPLICATION  OF  PROGRAM INCOME,
PROHIBITED USE OF  FUNDS,  RECORDKEEPING  AND  AUDIT  OBLIGATIONS.  UPON
DESIGNATION  BY  THE  OFFICE,  LOCAL  GOVERNMENTS SHALL NOTIFY VOLUNTARY
AGENCIES  AS  TO  THE SOURCE OF FUNDING RECEIVED BY SUCH VOLUNTARY AGEN-
CIES.
  (B) STATE AID MADE AVAILABLE TO A LOCAL GOVERNMENT  FOR  APPROVED  NET
OPERATING  COSTS FOR A VOLUNTARY AGENCY MAY BE REDUCED WHERE A REVIEW OF
SUCH VOLUNTARY AGENCY'S PRIOR YEAR'S  BUDGET  AND/OR  PERFORMANCE  INDI-
CATES:
  (1)  THAT  THE LOCAL GOVERNMENT OR VOLUNTARY AGENCY HAS FAILED TO MEET
MINIMUM PERFORMANCE STANDARDS AND REQUIREMENTS OF THE OFFICE  INCLUDING,
BUT NOT LIMITED TO, MAINTAINING SERVICE UTILIZATION RATES AND PRODUCTIV-
ITY STANDARDS AS SET BY THE OFFICE;
  (2)  THAT THE VOLUNTARY AGENCY HAS HAD AN INCREASE IN VOLUNTARY AGENCY
CONTRIBUTIONS THAT REDUCES THE APPROVED NET OPERATING COSTS NECESSARY;
  (3) THAT THE OFFICE, UPON  CONSULTATION  WITH  THE  LOCAL  GOVERNMENT,
OTHERWISE  DETERMINES  THERE IS A NEED TO REDUCE THE AMOUNT OF STATE AID
AVAILABLE.
  S 10. Section 25.13 of the mental hygiene law, as amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.13 Office is authorized state agency.
  (a)  The  office  when designated by the governor is the agency of the
state to administer and/or supervise the state plan or plans  concerning
substance  [abuse]  USE  DISORDER services specified in the federal drug
abuse office and treatment act of nineteen hundred  seventy-two  and  to
cooperate  with the duly designated federal authorities charged with the
administration thereof.
  (b) The office and all entities to which it provides financial support
shall do all that is required and shall render necessary cooperation  to
ensure  optimum  use  of  federal aid for substance [abuse] USE DISORDER
services.
  (c) The commissioner is authorized and empowered to take  such  steps,
not  inconsistent  with  law,  as  may  be  necessary for the purpose of
procuring for the people of this state all of the benefits  and  assist-
ance,  financial  and  otherwise, provided, or to be provided for, by or
pursuant to any act of congress relating to substance [abuse] USE DISOR-
DER services.
  S 11. Section 25.15 of the mental hygiene law, as amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.15 Optimizing federal aid.
  (a) A local [agency] GOVERNMENT or [substance abuse program] VOLUNTARY
AGENCY  shall,  unless  a specific written waiver of this requirement is
made by the office, cause applications to be completed on such forms and
in such manner as directed by the office and  submit  the  same  to  the
office for the purpose of causing a determination to be made whether the
cost of the services provided individuals and groups qualify for federal
aid  which may be available for services provided pursuant to titles IV,
XVI, XIX and XX of the federal social security act, or any other federal
law. A local [agency] GOVERNMENT or a [substance abuse  program]  VOLUN-
TARY  AGENCY  shall  furnish  to  the  office  such other data as may be
required and shall render such cooperation as may be necessary to  maxi-
mize such potential federal aid. All information concerning the identity
of  individuals obtained and provided pursuant to this subdivision shall
be kept confidential.
  (b) To the extent that federal aid may be available for any  substance
[abuse]  USE  DISORDER  services,  the office, notwithstanding any other

S. 2606                            211                           A. 3006

inconsistent provision of law, and with the approval of the director  of
the  budget,  is hereby authorized to seek such federal aid on behalf of
[substance abuse  programs]  VOLUNTARY  AGENCIES  and  local  [agencies]
GOVERNMENTS  either  directly  or  through  the  submission of claims to
another state agency authorized to submit the  same  to  an  appropriate
federal  agency. The office is further authorized to certify for payment
to [substance abuse programs] VOLUNTARY AGENCIES  and  local  [agencies]
GOVERNMENTS  any federal aid received by the state which is attributable
to the activities financed by such programs and [agencies] GOVERNMENTS.
  S 12. Section 25.17 of the mental hygiene law, as amended  by  chapter
223 of the laws of 1992, is amended to read as follows:
S 25.17 Fees for services.
  Local [agencies] GOVERNMENTS and substance [abuse] USE DISORDER treat-
ment  programs funded in whole or in part by the office shall establish,
subject to the approval of  the  office,  fee  schedules  for  substance
[abuse]  USE  DISORDER  services,  not specifically covered by the rates
established pursuant to article twenty-eight of the public health law or
title two of article five of the social services law. Such fees shall be
charged for substance [abuse] USE DISORDER services furnished to persons
who are financially able to pay the same, provided, that  such  services
shall  not  be  refused  to  any  person because of his inability to pay
therefor.
  S 13. Subdivision (d) of section 41.18 of the mental hygiene  law,  as
amended  by  chapter  558  of  the  laws  of 1999, is amended to read as
follows:
  (d) The liability of the state in any state fiscal year for state  aid
pursuant  to  this  section  shall exclude chemical dependence services,
which are subject to article [twenty-six] TWENTY-FIVE of  this  chapter,
and  shall  be limited to the amounts appropriated for such state aid by
the legislature for such state fiscal year.
  S 14. This act shall take effect April  1,  2013;  provided,  however,
that  effective  immediately,  any  rule or regulation necessary for the
implementation of this act on  its  effective  date  is  authorized  and
directed to be made and completed on or before such effective date.

                                 PART H

  Section  1. Subdivision (b) of section 7.17 of the mental hygiene law,
as amended by section 1 of part O of chapter 56 of the laws of 2012,  is
amended to read as follows:
  (b)  There  shall  be  in the office the hospitals named below for the
care, treatment and rehabilitation of persons with  mental  illness  and
for  research  and  teaching  in the science and skills required for the
care, treatment and rehabilitation of such persons with mental illness.
  Greater Binghamton Health Center
  Bronx Psychiatric Center
  Buffalo Psychiatric Center
  Capital District Psychiatric Center
  Central New York Psychiatric Center
  Creedmoor Psychiatric Center
  Elmira Psychiatric Center
  Kingsboro Psychiatric Center
  Kirby Forensic Psychiatric Center
  Manhattan Psychiatric Center
  Mid-Hudson Forensic Psychiatric Center
  Mohawk Valley Psychiatric Center

S. 2606                            212                           A. 3006

  Nathan S. Kline Institute for Psychiatric Research
  New York State Psychiatric Institute
  Pilgrim Psychiatric Center
  Richard H. Hutchings Psychiatric Center
  Rochester Psychiatric Center
  Rockland Psychiatric Center
  St. Lawrence Psychiatric Center
  South Beach Psychiatric Center
  New York City Children's Center
  Rockland Children's Psychiatric Center
  Sagamore Children's Psychiatric Center
  Western New York Children's Psychiatric Center
  The  New  York  State  Psychiatric  Institute  and The Nathan S. Kline
Institute for Psychiatric Research are designated as institutes for  the
conduct  of medical research and other scientific investigation directed
towards furthering knowledge of the etiology, diagnosis,  treatment  and
prevention  of  mental  illness.  [Whenever  the  term  Bronx Children's
Psychiatric Center, Brooklyn Children's Psychiatric  Center  and  Queens
Children's  Psychiatric Center is referred to or designated in any regu-
lation, contract or document pertaining to the functions, powers,  obli-
gations  and  duties  hereby transferred and assigned, such reference or
designation shall be deemed to refer to the  New  York  City  Children's
Center.]
  S  2.  Section 4 of part O of chapter 56 of the laws of 2012, amending
the mental hygiene law relating to the closure and the reduction in size
of certain facilities serving persons with mental  illness,  is  amended
and a new section 1-a is added to read as follows:
  S 1-A. WHENEVER THE TERM BRONX CHILDREN'S PSYCHIATRIC CENTER, BROOKLYN
CHILDREN'S PSYCHIATRIC CENTER OR QUEENS CHILDREN'S PSYCHIATRIC CENTER IS
REFERRED  TO  OR  DESIGNATED  IN  ANY  REGULATION,  CONTRACT OR DOCUMENT
PERTAINING TO THE  FUNCTIONS,  POWERS,  OBLIGATIONS  AND  DUTIES  HEREBY
TRANSFERRED  AND ASSIGNED PURSUANT TO THIS ACT, SUCH REFERENCE OR DESIG-
NATION SHALL BE DEEMED TO REFER TO THE NEW YORK CITY CHILDREN'S CENTER.
  S 4. This act shall take effect immediately and  shall  be  deemed  to
have  been in full force and effect on and after April 1, 2012; provided
that the date for any closure or  consolidation  pursuant  to  this  act
shall  be  on a date certified by the commissioner of mental health; and
provided further, however, that SECTION TWO OF this act shall expire and
be deemed repealed March 31, 2013.
  S 3.  Notwithstanding the provisions of subdivisions (b)  and  (e)  of
section 7.17 of the mental hygiene law or any other law to the contrary,
the office of mental health is authorized to close, consolidate, reduce,
transfer  or  otherwise redesign services of hospitals, other facilities
and programs operated by the office of mental health, and  to  implement
significant  service  reductions  and reconfigurations according to this
section as shall be determined by the commissioner of mental  health  to
be  necessary  for  the  cost-effective  and efficient operation of such
hospitals, other facilities and programs. One of the intents of  actions
taken  that  result  in  closure,  consolidation, reduction, transfer or
other redesign of services of hospitals  is  to  reinvest  savings  such
that,  to the extent practicable, comparable or greater levels of commu-
nity based mental health services  will  be  provided  to  persons  with
mental  illness  in  need of services within the catchment areas of such
hospitals, as determined by  the  commissioner  of  mental  health  with
approval from the director of the division of the budget.

S. 2606                            213                           A. 3006

  (a) In addition to the closure, consolidation or merger of one or more
facilities,  the  commissioner of mental health is authorized to perform
any significant service  reductions  that  would  reduce  inpatient  bed
capacity,  which  shall include but not be limited to, closures of wards
at  a  state-operated  psychiatric  center  or the conversion of beds to
transitional placement programs, provided that the commissioner  provide
at least 45 days notice of such reductions to the temporary president of
the  senate and the speaker of the assembly and simultaneously post such
notice upon its public website.  In assessing which significant services
reductions to undertake, the commissioner shall consider data related to
inpatient census, indicating  nonutilization  or  under  utilization  of
beds, and the efficient operation of facilities.
  (b)  At  least 75 days prior to the anticipated closure, consolidation
or merger of any hospitals named in subdivision (b) of section  7.17  of
the  mental hygiene law, the commissioner of mental health shall provide
notice of such closure, consolidation or merger to the temporary  presi-
dent  of  the  senate,  and speaker of the assembly, the chief executive
officer of the county in which the facility is located, and  shall  post
such  notice upon its public website.  The commissioner shall be author-
ized to conduct any and all preparatory actions which may be required to
effectuate such closures during such 75 day period.  In assessing  which
of  such hospitals to close, the commissioner shall consider the follow-
ing factors:  (1) the size, scope and type of services provided  by  the
hospital; (2) the relative quality of the care and treatment provided by
the  hospital,  as  may  be  informed by internal or external quality or
accreditation reviews; (3) the current and anticipated  long  term  need
for  the types of services provided by the facility within its catchment
area, which may include, but not limited  to,  services  for  adults  or
children,  or other specialized services, such as forensic services; (4)
the availability of staff sufficient to address the current  and  antic-
ipated  long  term  service  needs; (5) the long term capital investment
required to ensure that the facility meets relevant  state  and  federal
regulatory  and capital construction requirements, and national accredi-
tation standards; (6) the proximity of the facility to other  facilities
with space that could accommodate anticipated need, the relative cost of
any  necessary renovations of such space, the relative potential operat-
ing efficiency of such facilities, and the  size,  scope  and  types  of
services provided by the other facilities; (7) anticipated savings based
upon  economies  of  scale or other factors; (8) community mental health
services available in the facility catchment area  and  the  ability  of
such  community  mental  health  services  to meet the behavioral health
needs of the impacted consumers; (9) the obligations  of  the  state  to
place persons with mental disabilities in community settings rather than
in  institutions,  when  appropriate; and (10) the anticipated impact of
the closure on access to mental health services.
  (c) Any transfers of inpatient capacity or any resulting  transfer  of
functions  shall  be authorized to be made by the commissioner of mental
health and any transfer of personnel upon such transfer of  capacity  or
transfer  of  functions  shall  be  accomplished  in accordance with the
provisions of section 70 of the civil service law.
  S 4. 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

S. 2606                            214                           A. 3006

2 of part C of chapter 111 of the laws of 2010, is amended  to  read  as
follows:
  S 7. This act shall take effect immediately and shall expire March 31,
[2013]  2014  when  upon  such  date the provisions of this act shall be
deemed repealed.
  S 5. Severability clause. If any clause, sentence, paragraph, subdivi-
sion, section or part of this act shall be  adjudged  by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall  be  confined  in
its  operation  to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  6. This act shall take effect April 1, 2013; provided, however that
if this act shall become a law after April 1, 2013, this act shall  take
effect  immediately  and  shall be deemed to have been in full force and
effect on and after April 1,  2013;  provided  that  the  date  for  any
closure  or  consolidations  pursuant to this act shall be on or after a
date certified by the commissioner of mental health.

                                 PART I

  Section 1. Subdivisions (d), (e), (f) and (g) of section 41.44 of  the
mental  hygiene  law  are relettered subdivisions (e), (f), (g), and (h)
and a new subdivision (d) is added to read as follows:
  (D) THE COMMISSIONER IS AUTHORIZED TO RECOVER FUNDING  FROM  PROVIDERS
OF  COMMUNITY  RESIDENCES  LICENSED  BY  THE  OFFICE  OF  MENTAL HEALTH,
CONSISTENT WITH CONTRACTUAL OBLIGATIONS OF SUCH PROVIDERS, AND  NOTWITH-
STANDING  ANY  OTHER INCONSISTENT PROVISION OF LAW TO THE CONTRARY, SUCH
RECOVERY AMOUNT SHALL  EQUAL  FIFTY  PERCENT  OF  THE  MEDICAID  REVENUE
RECEIVED  BY  SUCH  PROVIDERS  WHICH  EXCEEDS THE FIXED AMOUNT OF ANNUAL
MEDICAID REVENUE LIMITATIONS, AS ESTABLISHED BY THE COMMISSIONER.
  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, 2013.

                                 PART J

  Section  1. Subdivision (a) of section 7.19 of the mental hygiene law,
as amended by chapter 307 of the laws of 1979, is  amended  to  read  as
follows:
  (a)  The  commissioner  OR HIS OR HER DESIGNEE may, within the amounts
appropriated therefor, appoint and remove in  accordance  with  law  and
applicable  rules  of  the state civil service commission, such officers
and employees of the office of mental health [and facility officers  and
employees  who  are  designated  managerial  or confidential pursuant to
article fourteen of the civil service law] as are  necessary  for  effi-
cient  administration AND SHALL ADMINISTER THE OFFICE'S PERSONNEL SYSTEM
IN ACCORDANCE WITH SUCH LAW AND  RULES.  IN  EXERCISING  THE  APPOINTING
AUTHORITY,  THE  COMMISSIONER  SHALL  TAKE  ALL REASONABLE AND NECESSARY
STEPS, CONSISTENT WITH ARTICLE TWENTY-THREE-A OF THE CORRECTION LAW,  TO
ENSURE  THAT  ANY SUCH PERSON SO APPOINTED HAS NOT PREVIOUSLY ENGAGED IN
ANY ACT IN VIOLATION OF ANY LAW WHICH COULD COMPROMISE  THE  HEALTH  AND
SAFETY OF PATIENTS.

S. 2606                            215                           A. 3006

  S  2.  Subdivision  (a)  of section 7.21 of the mental hygiene law, as
amended by chapter 434 of the laws  of  1980,  is  amended  to  read  as
follows:
  (a) The director of a facility under the jurisdiction of the office of
mental  health  shall be its chief executive officer. Each such director
shall be in the noncompetitive class and designated as  confidential  as
defined  by  subdivision two-a of section forty-two of the civil service
law and shall be appointed by and serve at the pleasure of  the  commis-
sioner.  [Except  for facility officers and employees for which subdivi-
sion (a) of section 7.19 of this  article  makes  the  commissioner  the
appointing and removing authority, the director of a facility shall have
the  power,  within amounts appropriated therefor, to appoint and remove
in accordance with law and applicable rules of the state  civil  service
commission  such  officers  and employees of the facility of which he is
director as are necessary for its efficient administration. He shall  in
exercising this appointing authority take, consistent with article twen-
ty-three-A  of the correction law, all reasonable and necessary steps to
insure that any such person so appointed has not previously  engaged  in
any  act  in  violation of any law which could compromise the health and
safety of patients in the facility of which he is director.] He  OR  SHE
shall  manage the facility [and administer its personnel system] subject
to applicable law and the regulations  of  the  commissioner  of  mental
health  [and  the  rules of the state civil service commission].  Before
the commissioner shall issue any such regulation  or  any  amendment  or
revision  thereof,  he  OR SHE shall consult with the FACILITY directors
[of the office's hospitals]  regarding  its  suitability.  The  director
shall  maintain  effective  supervision of all parts of the facility and
over all persons employed therein or coming thereon and shall  generally
direct  the  care and treatment of patients. Directors presently serving
at office of mental health facilities shall continue to serve under  the
terms of their original appointment.
  S 3. This act shall take effect April 1, 2013.

                                 PART K

  Section  1.  Subdivisions  (a),  (b)  and  (c) of section 10.09 of the
mental hygiene law, subdivisions (a) and (c) as added by  chapter  7  of
the  laws  of 2007 and subdivision (b) as amended by section 3 of part P
of chapter 56 of the laws of 2012, are amended to read as follows:
  (a) The commissioner shall provide  the  respondent  and  counsel  for
respondent  with  [an  annual] A written notice of the right to petition
the court for discharge, WHICH SHALL BE PROVIDED NO  LATER  THAN  ELEVEN
MONTHS  AFTER  THE  DATE ON WHICH THE SUPREME OR COUNTY COURT JUDGE LAST
ORDERED OR CONFIRMED THE NEED FOR CONTINUED CONFINEMENT PURSUANT TO THIS
ARTICLE. The notice shall contain a form for the waiver of the right  to
petition for discharge.
  (b)  The commissioner shall also assure that each respondent committed
under this article shall have an examination for evaluation  of  his  or
her  mental  condition made [at least once every] NO LATER THAN ONE year
[(calculated from] AFTER the date on which the supreme or  county  court
judge  last  ordered  or  confirmed  the  need for continued confinement
pursuant to this article [or the date on which the respondent waived the
right to petition for discharge pursuant to this section,  whichever  is
later, as applicable)]. SUCH EXAMINATION SHALL BE conducted by a psychi-
atric  examiner  who shall report to the commissioner his or her written
findings as to whether the  respondent  is  currently  a  dangerous  sex

S. 2606                            216                           A. 3006

offender  requiring confinement. At such time, the respondent also shall
have the right to be evaluated by an independent  psychiatric  examiner.
If the respondent is financially unable to obtain an examiner, the court
shall  appoint  an examiner of the respondent's choice to be paid within
the limits prescribed by law. Following such evaluation, each  psychiat-
ric  examiner shall report his or her findings in writing to the commis-
sioner and to counsel for  respondent.  The  commissioner  shall  review
relevant records and reports, along with the findings of the psychiatric
examiners,  and  shall make a determination in writing as to whether the
respondent is currently a dangerous sex offender requiring confinement.
  (c) The commissioner shall [annually] forward the  notice  and  waiver
form,  along with a report including the commissioner's written determi-
nation and the findings of the psychiatric examination, to  the  supreme
or county court where the respondent is located, WHICH SHALL BE PROVIDED
NO  LATER  THAN  ONE  YEAR AFTER THE DATE ON WHICH THE SUPREME OR COUNTY
COURT JUDGE LAST ORDERED OR CONFIRMED THE NEED FOR CONTINUED CONFINEMENT
PURSUANT TO THIS ARTICLE.
  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, 2013.

                                 PART L

  Section  1.  The mental hygiene law is amended by adding a new section
31.37 to read as follows:
S 31.37 MENTAL HEALTH INCIDENT REVIEW PANELS.
  (A) THE COMMISSIONER IS AUTHORIZED TO ESTABLISH A MENTAL HEALTH  INCI-
DENT  REVIEW  PANEL  FOR  THE  PURPOSES OF REVIEWING IN CONJUNCTION WITH
LOCAL REPRESENTATION, THE CIRCUMSTANCES AND EVENTS RELATED TO A  SERIOUS
INCIDENT  INVOLVING  A PERSON WITH MENTAL ILLNESS.  FOR PURPOSES OF THIS
SECTION, A "SERIOUS INCIDENT INVOLVING A  PERSON  WITH  MENTAL  ILLNESS"
MEANS  AN  INCIDENT  OCCURRING IN THE COMMUNITY IN WHICH A PERSON WITH A
SERIOUS MENTAL ILLNESS IS PHYSICALLY INJURED OR CAUSES  PHYSICAL  INJURY
TO  ANOTHER PERSON, OR SUFFERS A SERIOUS AND PREVENTABLE MEDICAL COMPLI-
CATION OR BECOMES INVOLVED IN A CRIMINAL INCIDENT INVOLVING VIOLENCE.  A
PANEL  SHALL  CONDUCT A REVIEW OF SUCH SERIOUS INCIDENT IN AN ATTEMPT TO
IDENTIFY PROBLEMS OR GAPS IN MENTAL HEALTH DELIVERY SYSTEMS AND TO  MAKE
RECOMMENDATIONS  FOR  CORRECTIVE  ACTIONS  TO  IMPROVE  THE PROVISION OF
MENTAL HEALTH OR RELATED SERVICES, TO IMPROVE  THE  COORDINATION,  INTE-
GRATION  AND ACCOUNTABILITY OF CARE IN THE MENTAL HEALTH SERVICE SYSTEM,
AND TO ENHANCE INDIVIDUAL AND PUBLIC SAFETY.
  (B) A MENTAL HEALTH INCIDENT REVIEW PANEL SHALL INCLUDE, BUT NEED  NOT
BE  LIMITED TO, REPRESENTATIVES FROM THE OFFICE OF MENTAL HEALTH AND THE
LOCAL GOVERNMENTAL UNIT WHERE THE SERIOUS INCIDENT  INVOLVING  A  PERSON
WITH  A  MENTAL  ILLNESS OCCURRED. A MENTAL HEALTH INCIDENT REVIEW PANEL
MAY ALSO INCLUDE, IF DEEMED APPROPRIATE BY THE COMMISSIONER BASED ON THE
NATURE OF THE SERIOUS INCIDENT BEING REVIEWED,  ONE  OR  MORE  REPRESEN-
TATIVES  FROM  MENTAL  HEALTH  PROVIDERS,  LOCAL  DEPARTMENTS  OF SOCIAL
SERVICES, HUMAN SERVICES PROGRAMS, HOSPITALS, LOCAL  SCHOOLS,  EMERGENCY
MEDICAL  OR MENTAL HEALTH SERVICES, THE OFFICE OF THE COUNTY ATTORNEY, A
COUNTY PROSECUTOR'S OFFICE, STATE OR LOCAL LAW ENFORCEMENT AGENCIES, THE
OFFICE OF THE MEDICAL EXAMINER OR THE OFFICE OF THE CORONER, THE JUDICI-
ARY, OR OTHER APPROPRIATE STATE OR LOCAL OFFICIALS.
  (C) NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY AND  TO
THE  EXTENT CONSISTENT WITH FEDERAL LAW, A MENTAL HEALTH INCIDENT REVIEW
PANEL SHALL HAVE  ACCESS  TO  THOSE  CLIENT-IDENTIFIABLE  MENTAL  HEALTH
RECORDS,  AS  WELL AS ALL RECORDS, DOCUMENTATION AND REPORTS RELATING TO

S. 2606                            217                           A. 3006

THE INVESTIGATION OF AN INCIDENT BY A FACILITY IN ACCORDANCE WITH  REGU-
LATIONS  OF  THE COMMISSIONER, WHICH ARE NECESSARY FOR THE INVESTIGATION
OF THE INCIDENT AND THE PREPARATION OF A  REPORT  OF  THE  INCIDENT,  AS
PROVIDED    IN SUBDIVISION (E) OF THIS SECTION. A MENTAL HEALTH INCIDENT
REVIEW PANEL ESTABLISHED PURSUANT TO THIS SECTION SHALL BE PROVIDED WITH
ACCESS TO ALL OTHER RECORDS IN THE POSSESSION OF STATE  OR  LOCAL  OFFI-
CIALS  OR  AGENCIES,  WITHIN  TWENTY-ONE  DAYS  OF RECEIPT OF A REQUEST,
EXCEPT: (1) THOSE RECORDS PROTECTED BY SECTION 190.25  OF  THE  CRIMINAL
PROCEDURE  LAW; AND (2) WHERE PROVISION OF LAW ENFORCEMENT RECORDS WOULD
INTERFERE WITH AN ONGOING  LAW  ENFORCEMENT  INVESTIGATION  OR  JUDICIAL
PROCEEDING,  IDENTIFY  A  CONFIDENTIAL  SOURCE  OR DISCLOSE CONFIDENTIAL
INFORMATION RELATING TO AN ONGOING CRIMINAL INVESTIGATION, HIGHLY SENSI-
TIVE CRIMINAL INVESTIGATIVE TECHNIQUES OR PROCEDURES,  OR  ENDANGER  THE
SAFETY OR WELFARE OF AN INDIVIDUAL.
  (D) MENTAL HEALTH INCIDENT REVIEW PANELS, MEMBERS OF THE REVIEW PANELS
AND PERSONS WHO PRESENT INFORMATION TO A REVIEW PANEL SHALL HAVE IMMUNI-
TY  FROM  CIVIL AND CRIMINAL LIABILITY FOR ALL REASONABLE AND GOOD FAITH
ACTIONS TAKEN PURSUANT TO THIS SECTION, AND SHALL NOT BE  QUESTIONED  IN
ANY  CIVIL  OR  CRIMINAL  PROCEEDING  REGARDING ANY OPINIONS FORMED AS A
RESULT OF A MEETING OF SUCH REVIEW PANEL. NOTHING IN THIS SECTION  SHALL
BE  CONSTRUED  TO  PREVENT  A  PERSON  FROM TESTIFYING AS TO INFORMATION
OBTAINED INDEPENDENTLY OF A MENTAL  HEALTH  INCIDENT  REVIEW  PANEL,  OR
INFORMATION WHICH IS PUBLIC.
  (E)  NOTWITHSTANDING  ANY  OTHER PROVISION OF LAW TO THE CONTRARY, ALL
MEETINGS CONDUCTED, ALL REPORTS AND RECORDS MADE AND MAINTAINED AND  ALL
BOOKS AND PAPERS OBTAINED BY A MENTAL HEALTH INCIDENT REVIEW PANEL SHALL
BE  CONFIDENTIAL,  AND  SHALL  NOT  BE OPEN OR MADE AVAILABLE, EXCEPT BY
COURT ORDER OR AS SET FORTH IN SUBDIVISION (G)  OF  THIS  SECTION.  EACH
MENTAL  HEALTH INCIDENT REVIEW PANEL SHALL DEVELOP A REPORT OF THE INCI-
DENT INVESTIGATED. SUCH REPORT SHALL NOT CONTAIN ANY INDIVIDUALLY  IDEN-
TIFIABLE  INFORMATION  AND  SHALL  BE  PROVIDED  TO THE OFFICE OF MENTAL
HEALTH UPON COMPLETION. SUCH REPORTS MUST BE APPROVED BY THE  OFFICE  OF
MENTAL HEALTH PRIOR TO BECOMING FINAL.
  (F) IF QUALITY PROBLEMS OF PARTICULAR MENTAL HEALTH PROGRAMS ARE IDEN-
TIFIED  BASED  ON SUCH REVIEWS, THE COMMISSIONER IS AUTHORIZED, PURSUANT
TO THE RELEVANT PROVISIONS OF THIS CHAPTER, TO TAKE APPROPRIATE  ACTIONS
REGARDING  THE  LICENSURE OF PARTICULAR PROVIDERS, TO REFER THE ISSUE TO
OTHER RESPONSIBLE PARTIES FOR INVESTIGATION, OR TO TAKE OTHER  APPROPRI-
ATE ACTION.
  (G)  IN HIS OR HER DISCRETION, THE COMMISSIONER SHALL BE AUTHORIZED TO
PROVIDE THE FINAL REPORT OF A REVIEW PANEL OR PORTIONS  THEREOF  TO  ANY
INDIVIDUAL  OR  ENTITY  FOR  WHOM  THE  REPORT MAKES RECOMMENDATIONS FOR
CORRECTIVE OR OTHER APPROPRIATE ACTIONS THAT SHOULD BE TAKEN. ANY  FINAL
REPORT OR PORTION THEREOF SHALL NOT BE FURTHER DISSEMINATED BY THE INDI-
VIDUAL OR ENTITY RECEIVING SUCH REPORT.
  (H)  THE  COMMISSIONER SHALL SUBMIT AN ANNUAL CUMULATIVE REPORT TO THE
GOVERNOR AND THE LEGISLATURE INCORPORATING THE DATA IN THE MENTAL HEALTH
INCIDENT REVIEW PANEL REPORTS AND INCLUDING A SUMMARY  OF  THE  FINDINGS
AND  RECOMMENDATIONS  MADE  BY SUCH REVIEW PANELS. THE ANNUAL CUMULATIVE
REPORTS MAY THEREAFTER BE MADE AVAILABLE TO THE PUBLIC.
  S 2. Subdivision (c) of section 33.13 of the  mental  hygiene  law  is
amended by adding a new paragraph 16 to read as follows:
  16.  TO  A  MENTAL  HEALTH  INCIDENT REVIEW PANEL, OR MEMBERS THEREOF,
ESTABLISHED BY THE COMMISSIONER PURSUANT TO SECTION 31.37 OF THIS TITLE,
IN CONNECTION WITH INCIDENT REVIEWS CONDUCTED BY SUCH PANEL.

S. 2606                            218                           A. 3006

  S 3. Subdivision 3 of section 6527 of the education law, as amended by
chapter 257 of the laws of 1987, is amended to read as follows:
  3. No individual who serves as a member of (a) a committee established
to  administer  a  utilization  review  plan  of a hospital, including a
hospital as defined in article twenty-eight of the public health law  or
a  hospital  as defined in subdivision ten of section 1.03 of the mental
hygiene law, or (b) a committee having the responsibility of the  inves-
tigation of an incident reported pursuant to section 29.29 of the mental
hygiene  law  or  the  evaluation and improvement of the quality of care
rendered in a hospital as defined in article twenty-eight of the  public
health  law  or a hospital as defined in subdivision ten of section 1.03
of the mental hygiene law,  or  (c)  any  medical  review  committee  or
subcommittee thereof of a local, county or state medical, dental, podia-
try  or  optometrical  society,  any such society itself, a professional
standards review organization or  an  individual  when  such  committee,
subcommittee,  society,  organization  or  individual  is performing any
medical or quality assurance review function including the investigation
of an incident reported pursuant to section 29.29 of the mental  hygiene
law,  either  described  in  clauses  (a)  and  (b) of this subdivision,
required by law, or involving any controversy or dispute between  (i)  a
physician,  dentist, podiatrist or optometrist or hospital administrator
and a patient concerning  the  diagnosis,  treatment  or  care  of  such
patient  or  the  fees or charges therefor or (ii) a physician, dentist,
podiatrist or optometrist or hospital administrator and  a  provider  of
medical,  dental,  podiatric  or  optometrical  services  concerning any
medical or health charges or fees of such physician, dentist, podiatrist
or optometrist, or (d) a committee appointed pursuant to  section  twen-
ty-eight  hundred  five-j of the public health law to participate in the
medical and dental malpractice prevention program, or (e) any individual
who participated in the preparation of incident reports required by  the
department  of health pursuant to section twenty-eight hundred five-l of
the public health law, or (f) a committee established  to  administer  a
utilization  review  plan,  or  a committee having the responsibility of
evaluation and improvement of the quality of care rendered, in a  health
maintenance  organization  organized  under  article  forty-four  of the
public health law or article forty-three of the insurance law, including
a committee of an  individual  practice  association  or  medical  group
acting  pursuant  to a contract with such a health maintenance organiza-
tion, OR (G) A MENTAL HEALTH INCIDENT REVIEW PANEL CONVENED PURSUANT  TO
SECTION  31.37  OF THE MENTAL HYGIENE LAW, shall be liable in damages to
any person for any action taken or recommendations made, by him  OR  HER
within  the  scope of his OR HER function in such capacity provided that
(a) such individual has taken action or made recommendations within  the
scope  of his OR HER function and without malice, and (b) in the reason-
able belief after reasonable investigation that the act  or  recommenda-
tion was warranted, based upon the facts disclosed.
  Neither  the  proceedings nor the records relating to performance of a
medical or a quality assurance review function  or  participation  in  a
medical  and  dental  malpractice  prevention  program  nor  any  report
required by the department of health pursuant  to  section  twenty-eight
hundred  five-l of the public health law described herein, including the
investigation of an incident reported pursuant to section 29.29  of  the
mental  hygiene  law OR REVIEWED PURSUANT TO SECTION 31.37 OF THE MENTAL
HYGIENE LAW, shall be subject to disclosure under article thirty-one  of
the  civil  practice  law and rules except as hereinafter provided or as
provided by any other provision of law. No person  in  attendance  at  a

S. 2606                            219                           A. 3006

meeting  when  a  medical or a quality assurance review or a medical and
dental malpractice prevention program or an incident reporting  function
described  herein was performed, including the investigation of an inci-
dent  reported pursuant to section 29.29 of the mental hygiene law OR AN
INCIDENT REVIEWED PURSUANT TO SECTION 31.37 OF THE MENTAL  HYGIENE  LAW,
shall be required to testify as to what transpired thereat. The prohibi-
tion  relating  to  discovery of testimony shall not apply to the state-
ments made by any person in attendance at such a meeting who is a  party
to  an  action or proceeding the subject matter of which was reviewed at
such meeting.
  S 4. This act shall take effect on the sixtieth  day  after  it  shall
have become a law.

                                 PART M

  Section 1. Section 20 of chapter 723 of the laws of 1989, amending the
metal  hygiene  law  and  other  laws  relating  to the establishment of
comprehensive psychiatric emergency programs, is REPEALED.
  S 2. Subdivision (c) of section 7.15  of  the  metal  hygiene  law  is
REPEALED.
  S  3.    Subdivision (c) of section 13.15 of the mental hygiene law is
REPEALED.
  S 4. Paragraph 3 of subdivision (d) of section  16.19  of  the  mental
hygiene law is REPEALED.
  S 5. This act shall take effect April 1, 2013.

                                 PART N

  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 H of chapter 56 of the  laws  of  2012,  is
amended to read as follows:
  3-b.  Notwithstanding  any  inconsistent  provision  of law, beginning
April 1, 2009 and ending March 31, [2013] 2014, 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, [2013] 2014 and ending March 31, [2016] 2017, 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,
[2016] 2017; provided, further, that sections two and three of this  act
shall expire and be deemed repealed December 31, 2009.
  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, 2013; provided,
however, that the amendments to section 1 of part C of chapter 57 of the
laws of 2006 made by section one of this act shall not affect the repeal
of such section and shall be deemed repealed therewith.

S. 2606                            220                           A. 3006

  S 2. Severability clause. If any clause, sentence, paragraph, subdivi-
sion, section or part of this act shall be  adjudged  by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall  be  confined  in
its  operation  to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  3.  This  act shall take effect immediately provided, however, that
the applicable effective date of Parts A through N of this act shall  be
as specifically set forth in the last section of such Parts.

S2606A - Bill Details

Law Section:
Budget Bills
Laws Affected:
Amd Various Laws, generally

S2606A - Bill Texts

view summary

Relates to the cap on local Medicaid expenditures; relates to the determination of rates of payments by certain state governmental agencies; relates to the medical assistance information and payment system; relates to managed care programs and managed long term care plans; relates to participation in the state health insurance exchange; relates to liability for certain acts under the false claims act; relates to civil actions pursuant to the false claims act; relates to the delay of certain administrative costs; relates to the preferred drug program; relates to antipsychotic therapeutic drugs; authorizes the commissioner of health to implement an incontinence supply utilization management program; relates to the funding of health home infrastructure development; relates to general hospital inpatient reimbursement; relates to managed care programs; relates to rates of payment for residential health care facilities and rates of reimbursement for inpatient detoxification and withdrawal services; relates to hospital inpatient base years; relates to the Medicaid managed care inpatient psychiatric care default rate; relates to the Medicaid managed care default rate; moves rate setting for child health plus to the department of health; requires the use of an enrollment broker for counties that are mandated Medicaid managed care and managed long term care; repeals the twentieth day of the month enrollment cut-off for managed long term care enrollees; relates to the nursing home financially disadvantaged program; eliminates the recruitment and retention attestation requirement for certain certified home health agencies; extends the office of the Medicaid inspector general's power to audit rebasing rates; relates to rebasing transition payments; relates to payment of claims; establishes the home and community-based care work group; relates to critical access hospitals; eliminates the bed hold requirement; relates to eligibility for Medicaid; relates to treatment of income and resources of institutionalized persons; relates to the people; repeals certain provisions of law relating to the pharmacy and therapeutics committee; relates to payments to hospital assessments; relates to the effectiveness of eligibility for medical assistance and the family health plus program; extends various plans and programs; relates to rates of payment by state governmental agencies; relates to reports on chronic illness demonstration projects and reports by the commissioner of health on health homes; relates to rates of payment for long term home health care programs; extends a demonstration program for physicians suffering from alcoholism, drug abuse or mental illness; relates to indigent care; relates to permitting online and telephone Medicaid applications; allows administrative renewals and self-attestation of residency; ends applications for family health plus; establishes a methodology for modified adjusted gross income; centralizes child health plus eligibility determinations; requires audit standards for eligibility; relates to residency and income attestation and verification for child health plus; eliminates temporary enrollment in child health plus; expands the child health plus social security number requirement to lawfully residing children; requires a status report on the health benefit exchange; relates to health benefit exchange navigators and clarifies the identity of persons to whom insurance licensing requirements apply; relates to coverage limitations requirements and student accident and health insurance; relates to standardization of individual enrollee direct payment contracts; ensures that group and individual insurance policy provisions conform to applicable requirements of federal law; relates to the general public health work program; consolidates the excess medical malpractice liability coverage pool; relates to the addition to the methadone registry of dosage and such other information as is necessary to facilitate disaster management; relates to state aid funding authorization of services funded by the office of alcoholism and substance abuse services; vests all authority to appoint and remove officers and employees of the office of mental health; creates mental health incident review panels; relates to psychiatric emergency programs; relates to foregoing a cost-of-living adjustment during the 2013-2014 state fiscal year; authorizes the actions necessary to manage the loss of federal revenue and create the mental hygiene stabilization fund; provides medical assistance to certain retirees of the New York city off-track betting corporation; and relates to funding to SUNY Downstate Medical Center and directing the restructuring of the hospital.

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

    S. 2606--A                                            A. 3006--A

                      S E N A T E - A S S E M B L Y

                            January 22, 2013
                               ___________

IN  SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
  cle seven of the Constitution -- read twice and ordered  printed,  and
  when  printed to be committed to the Committee on Finance -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

IN ASSEMBLY -- A BUDGET BILL, submitted  by  the  Governor  pursuant  to
  article  seven  of  the  Constitution -- read once and referred to the
  Committee on Ways and Means --  committee  discharged,  bill  amended,
  ordered reprinted as amended and recommitted to said committee

AN  ACT  to  amend  chapter  59 of the laws of 2011, amending the public
  health law and other laws relating to general  hospital  reimbursement
  for  annual  rates,  in relation to the cap on local Medicaid expendi-
  tures; to amend the public health law, in relation to general hospital
  inpatient reimbursement; to amend the social services law, in relation
  to the medical assistance information and payment system; to amend the
  social services law, in relation to certain contracts entered into  by
  the  commissioner  of health for the purpose of implementing the Medi-
  caid redesign team initiatives; to amend the  public  health  law,  in
  relation  to  the  preferred  drug program; to amend the public health
  law, in relation to antipsychotic  therapeutic  drugs;  to  amend  the
  social  services  law,  in relation to reducing pharmacy reimbursement
  for name brand drugs; to amend the public health law, in  relation  to
  eliminating the summary posting requirement for the pharmacy and ther-
  apeutic  committee;  to  amend the social services law, in relation to
  early refill of prescriptions; to amend the social  services  law,  in
  relation  to  authorizing  the  commissioner of health to implement an
  incontinence supply  utilization  management  program;  to  amend  the
  social  services  law, in relation to certain individual psychotherapy
  services; to amend the social services law, in relation to the funding
  of health home infrastructure development; to amend the public  health
  law, in relation to general hospital inpatient reimbursement; to amend
  the  social  services  law,  in  relation to managed care programs; to
  amend section 2 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 the  effectiveness  thereof;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD12571-02-3

S. 2606--A                          2                         A. 3006--A

  to  amend  the  public health law, in relation to rates of payment for
  residential health  care  facilities  and  in  relation  to  rates  of
  reimbursement for inpatient detoxification and withdrawal services; to
  amend  the  public  health law, in relation to hospital inpatient base
  years; to amend the public health law, in  relation  to  the  Medicaid
  managed  care  inpatient  psychiatric  care default rate; to amend the
  public health law, in relation to the Medicaid  managed  care  default
  rate;  to  amend  the  public  health  law, in relation to moving rate
  setting for child health plus to the department of  health;  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 repealing the twentieth  day  of
  the  month enrollment cut-off for managed long term care enrollees; to
  amend the public health law, in relation to the  nursing  home  finan-
  cially  disadvantaged  program;  to  amend  the  public health law, in
  relation to eliminating  the  recruitment  and  retention  attestation
  requirement  for  certain certified home health agencies; to amend the
  public health law, in relation to extending the office of the Medicaid
  inspector general's power to audit rebasing rates; to amend the public
  health law, in relation to rebasing transition payments; to amend  the
  public health law, in relation to capital cost reimbursement for nurs-
  ing  homes; to amend the public health law, in relation to eliminating
  the bed hold requirement; to amend the public health law, in  relation
  to  authorizing  upper  payment  limits  for certain nursing homes; to
  amend the public health law, in relation to rates for specialty  nurs-
  ing  homes; to amend the social services law, in relation to eliminat-
  ing spousal refusal of medical care; to amend the social services law,
  in relation to eligibility for Medicaid; to amend the social  services
  law,  in relation to treatment of income and resources of institution-
  alized persons; to amend the public health law, in relation to certain
  payments for certain home care agencies and  services;  to  amend  the
  social  services  law,  in  relation to Medicaid eligibility; to amend
  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 gener-
  al  hospital inpatient reimbursement, in relation to the effectiveness
  thereof; to amend subdivision 1 of section 92 of part H of chapter  59
  of  the  laws  of  2011, amending the public health law and other laws
  relating to known and projected department of health state funds Medi-
  caid expenditures,  in  relation  to  the  effectiveness  thereof;  in
  relation  to eliminating the 2013-2014 trend factor and thereafter; to
  repeal certain provisions of the social services law  and  the  public
  health  law  relating  to managed care programs; and to repeal certain
  provisions of the public health law and the social services law relat-
  ing to the pharmacy and  therapeutics  committee;  providing  for  the
  repeal  of  certain  provisions  upon  expiration thereof (Part A); to
  amend the public health law,  in  relation  to  payments  to  hospital
  assessments;  to amend part C of chapter 58 of the laws of 2009 amend-
  ing the public health law relating to payment by governmental agencies
  for general hospital inpatient services, in relation to the effective-
  ness of eligibility for medical assistance and the family health  plus
  program; to amend chapter 474 of the laws of 1996, amending the educa-
  tion  law  and other laws relating to rates for residential healthcare
  facilities, in relation to reimbursements; to amend chapter 884 of the
  laws of 1990, amending the public health law relating  to  authorizing
  bad  debt  and charity care allowances for certified home health agen-

S. 2606--A                          3                         A. 3006--A

  cies, in relation to the effectiveness thereof; to amend the long term
  care integration and finance act of 1997, in relation to extending the
  expiration of operating demonstrations operating a managed  long  term
  care  plan;  to  amend  chapter  81  of the laws of 1995, amending the
  public health law and other laws relating to medical reimbursement and
  welfare reform, in relation to reimbursements  and  the  effectiveness
  thereof;  to  amend  the  public  health  law,  in relation to capital
  related inpatient expenses; to amend part C of chapter 58 of the  laws
  of  2007,  amending the social services law and other laws relating to
  enacting the major components of legislation  necessary  to  implement
  the  health  and  mental hygiene budget for the 2007-2008 state fiscal
  year, in relation to rates of payment by state  governmental  agencies
  and  the effectiveness of certain provisions of such chapter; to amend
  the social services law, in relation to  reports  on  chronic  illness
  demonstration  projects;  to  amend  chapter  451 of the laws of 2007,
  amending the public health law, the social services law and the insur-
  ance  law,  relating  to  providing  enhanced  consumer  and  provider
  protections,  in  relation  to  extending the effectiveness of certain
  provisions thereof; to amend the public health  law,  in  relation  to
  rates  of  payment  for  long term home health care programs; to amend
  chapter 2 of the laws of 1998, amending  the  public  health  law  and
  other  laws  relating to expanding the child health insurance plan, in
  relation to the effectiveness of certain provisions thereof; to  amend
  chapter 426 of the laws of 1983, amending the public health law relat-
  ing to professional misconduct proceedings and chapter 582 of the laws
  of  1984, amending the public health law relating to regulating activ-
  ities of physicians, in relation to making such provisions  permanent;
  to  amend  the  public  health  law, in relation to extending a demon-
  stration program for physicians suffering from alcoholism, drug  abuse
  or  mental illness; to amend part X2 of chapter 62 of the laws of 2003
  amending the public health law relating to allowing the use  of  funds
  of  the  office  of professional medical conduct for activities of the
  patient health information and quality improvement  act  of  2000,  in
  relation to the effectiveness of certain provisions thereof; to repeal
  subdivision  8  of  section  364-l of the social services law relating
  thereto; to repeal certain provisions of chapter 81  of  the  laws  of
  1995 amending the public health law and other laws relating to medical
  reimbursement  and welfare relating to the effectiveness thereof (Part
  B); to amend the public health law, in relation to indigent care (Part
  C); to amend the social  services  law,  in  relation  to  eligibility
  conditions;  to  amend the social services law, in relation to permit-
  ting online and telephone Medicaid applications; to amend  the  social
  services  law,  in  relation  to  allowing administrative renewals and
  self-attestation of residency; to amend the social  services  law,  in
  relation  to  ending applications for family health plus; to amend the
  social services law, in relation to modified adjusted gross income and
  Medicaid eligibility groups;  to  amend  the  public  health  law,  in
  relation  to  establishing  methodology  for  modified  adjusted gross
  income; to amend the public health law, in  relation  to  centralizing
  child  health  plus  eligibility  determinations;  to amend the public
  health law, in relation to requiring audit standards for  eligibility;
  to  amend  the  public health law, in relation to residency and income
  attestation and verification for  child  health  plus;  to  amend  the
  public  health law, in relation to eliminating temporary enrollment in
  child health plus; to amend the public  health  law,  in  relation  to
  expanding  the child health plus social security number requirement to

S. 2606--A                          4                         A. 3006--A

  lawfully residing  children;  to  amend  the  public  health  law,  in
  relation to modified adjusted gross income under child health plus; to
  amend  the public health law, in relation to personal interviews under
  child  health  plus;  to amend the social services law, in relation to
  amendment of contracts awarded by the commissioner of health; to amend
  the insurance law, in relation to clarifying the identity  of  persons
  to whom insurance licensing requirements apply; to amend the insurance
  law,  in  relation  to  coverage  limitations requirements and student
  accident and health insurance; to amend the insurance law, in relation
  to standardization of individual enrollee direct payment contracts; to
  amend the insurance law, in relation to ensuring that group and  indi-
  vidual  insurance policy provisions conform to applicable requirements
  of federal law and to make  conforming  changes;  to  repeal  sections
  369-ee  and  369-ff of the social services law, relating to the family
  health plus program; to repeal certain other provisions of the  social
  services  law  relating  thereto;  to repeal certain provisions of the
  insurance law relating thereto; providing for the  repeal  of  certain
  provisions  upon  expiration  thereof  (Part  D);  to amend the public
  health law and the insurance law, in  relation  to  the  early  inter-
  vention  program  for infants and toddlers with disabilities and their
  families; to amend the public health law, in relation to  the  general
  public  health  work program; to amend chapter 577 of the laws of 2008
  amending the public health law, relating to expedited partner  therapy
  for  persons  infected  with chlamydia trachomatis, in relation to the
  effectiveness of such chapter; to amend  the  public  health  law,  in
  relation  to  outcome based contracting and outcome based health plan-
  ning; to amend the public health law, the mental hygiene law  and  the
  executive  law,  in relation to consolidating the excess medical malp-
  ractice liability coverage  pool;  to  amend  the  insurance  law,  in
  relation  to  the  appointment of members of the board of the New York
  state health foundation and the investment  of  funds;  to  amend  the
  insurance  law  and the general municipal law, in relation to malprac-
  tice and professional misconduct; to amend the administrative code  of
  the  city  of  New  York, in relation to the definition of a certified
  first responder; to amend the workers' compensation law,  in  relation
  to an injury incurred by an emergency medical technician; to amend the
  education  law and the state finance law, in relation to medical malp-
  ractice reform; and to repeal sections 3002, 3002-a,  3003-a,  3005-b,
  3009,  3017 and articles 30-B and 30-C of the public health law relat-
  ing to emergency medical services; to amend chapter 420 of the laws of
  2002 amending the education law relating to the profession  of  social
  work;  chapter  676  of  the  laws  of 2002 amending the education law
  relating to the practice of psychology; and chapter 130 of the laws of
  2010 amending the education law and other laws relating to the  regis-
  tration  of  entities  providing certain professional services and the
  licensure of certain professions, in relation  to  reporting  require-
  ments  and  expiration  dates;  and to amend the public health law, in
  relation to consolidating the  excess  medical  malpractice  liability
  coverage  pool; and to repeal section 18 of chapter 266 of the laws of
  1986, amending the civil practice law and rules and other laws  relat-
  ing  to  medical  and  dental malpractice, relating thereto; to repeal
  certain provisions of the public health law relating to state aid  for
  certain  public  health  programs  and provisions relating to sexually
  transmitted diseases (Part E); to amend the  mental  hygiene  law,  in
  relation  to the addition to the methadone registry of dosage and such
  other information as is necessary to  facilitate  disaster  management

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  (Part  F);  to  amend the mental hygiene law, in relation to state aid
  funding authorization of services funded by the office  of  alcoholism
  and  substance abuse services; to repeal article 26 of such law relat-
  ing  thereto  (Part G); to amend the mental hygiene law and chapter 56
  of the laws of 2012, amending the mental hygiene law relating  to  the
  closure  and  the  reduction  in  size  of  certain facilities serving
  persons with mental illness, in  relation  to  references  to  certain
  former  children's psychiatric centers in the city of New York, and in
  relation to the expiration and repeal of certain  provisions  thereof;
  to  authorize  the  office  of  mental  health  to close, consolidate,
  reduce, transfer and otherwise redesign its programs; 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 work-
  force reinvestment program, the membership of subcommittees for mental
  health of community services boards and the duties of such  subcommit-
  tees  and creating the community mental health and workforce reinvest-
  ment account, in relation to extending such provisions relating there-
  to (Part H); to amend the mental  hygiene  law,  in  relation  to  the
  recovery of exempt income by the office of mental health for community
  residential  programs  (Part  I);  to amend the mental hygiene law, in
  relation to vesting all authority to appoint and remove  officers  and
  employees of the office of mental health (Part J); to amend the mental
  hygiene law, in relation to an annual examination and notice of rights
  provided  to  respondent  sex  offenders  who are confined in a secure
  treatment facility (Part K); to amend the mental hygiene law  and  the
  education  law,  in relation to creating mental health incident review
  panels (Part L); to repeal certain provisions of  the  mental  hygiene
  law  and certain provisions of chapter 723 of the laws of 1989, amend-
  ing the mental hygiene law and other laws relating to  the  establish-
  ment  of  comprehensive  psychiatric  emergency  programs, relating to
  eliminating the annual reports on the comprehensive psychiatric  emer-
  gency program; family care; and the confinement, care and treatment of
  persons with developmental disabilities (Part M); and to amend chapter
  57  of  the  laws  of  2006, relating to establishing a cost of living
  adjustment for designated human  services  programs,  in  relation  to
  foregoing such adjustment during the 2013-2014 state fiscal year (Part
  N)

  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 2013-2014
state  fiscal  year.  Each  component  is wholly contained within a Part
identified as Parts A through N. 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

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  Section 1. Subdivision (a) of section 90 of part H of  chapter  59  of
the  laws of 2011, amending the public health law and other laws, relat-
ing to general hospital inpatient reimbursement  for  annual  rates,  is
amended to read as follows:
  (a)  Notwithstanding  any  other provision of law to the contrary, for
the state fiscal years beginning April 1, 2011 and ending on  March  31,
[2013]  2015,  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 [year] YEARS 2012-13, 2013-14  AND
2014-15  except  as  hereinafter  provided, for services provided on and
after April 1, 2011 through March 31,  [2013]  2015.    Any  alternative
methods  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
implementation is expected to begin. Nothing in this  section  shall  be
deemed  to  prevent  all or part of such alternative reduction plan from
taking effect retroactively, to the  extent  permitted  by  the  federal
centers for medicare and medicaid services.
  S  2.  Subdivision 1 of section 91 of part H of chapter 59 of the laws
of 2011, amending the public health  law  and  other  laws  relating  to
general hospital reimbursement for annual rates, as amended by section 5
of  part  F  of  chapter  56  of the laws of 2012, is amended to read as
follows:
  1. Notwithstanding any inconsistent provision of state  law,  rule  or
regulation  to  the  contrary,  subject to federal approval, the year to
year rate of growth of department of health state funds Medicaid  spend-
ing  shall not exceed the ten year rolling average of the medical compo-
nent of the consumer price index  as  published  by  the  United  States
department  of  labor, bureau of labor statistics, for the preceding ten
years[.]; PROVIDED, HOWEVER, THAT FOR STATE FISCAL YEAR 2013-14 AND  FOR
EACH  FISCAL  YEAR  THEREAFTER, THE MAXIMUM ALLOWABLE ANNUAL INCREASE IN
THE AMOUNT OF DEPARTMENT OF HEALTH STATE FUNDS MEDICAID  SPENDING  SHALL
BE  CALCULATED BY MULTIPLYING THE DEPARTMENT OF HEALTH STATE FUNDS MEDI-
CAID SPENDING FOR THE PREVIOUS YEAR, MINUS THE AMOUNT OF ANY  DEPARTMENT
OF  HEALTH  STATE OPERATIONS SPENDING INCLUDED THEREIN, BY SUCH TEN YEAR
ROLLING AVERAGE.
  S 3.  Subdivision 1 of section 92 of part H of  chapter 59 of the laws
of 2011, amending the public health law and other laws relating to known
and projected department of health state funds Medicaid expenditures, as
amended by section 57 of part D of chapter 56 of the laws  of  2012,  is
amended to read as follows:
  1.  For  state  fiscal  years 2011-12 through [2013-14] 2014-2015, 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

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budget determines that such expenditures are expected to cause  medicaid
disbursements  for  such  period  to  exceed the projected department of
health medicaid state funds disbursements in the enacted  budget  finan-
cial  plan  pursuant to subdivision 3 of section 23 of the state finance
law, the commissioner of health, in consultation with  the  director  of
the  budget,  shall  develop a medicaid savings allocation plan to limit
such spending to the aggregate limit  level  specified  in  the  enacted
budget  financial  plan,  provided,  however,  such  projections  may be
adjusted by the director of the budget to account for any changes in the
New York state federal medical assistance percentage amount  established
pursuant  to the federal social security act, changes in provider reven-
ues, reductions to local social  services  district  medical  assistance
administration, and beginning April 1, 2012 the operational costs of the
New York state medical indemnity fund.
  S  4.  Subdivision  10  of  section 2807-c of the public health law is
amended by adding a new paragraph (d) to read as follows:
  (D)(I) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS  SECTION  OR
ANY  OTHER  CONTRARY PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY OF
FEDERAL FINANCIAL PARTICIPATION, EFFECTIVE FOR MEDICAID RATE PERIODS  ON
AND  AFTER  APRIL  FIRST, TWO THOUSAND THIRTEEN, NO TREND FACTOR ADJUST-
MENTS SHALL BE AVAILABLE WITH  REGARD  TO  REIMBURSEMENT  FOR  INPATIENT
SERVICES OTHERWISE SUBJECT TO THE PROVISIONS OF THIS SECTION.
  (II)  NOTWITHSTANDING  ANY  INCONSISTENT  PROVISION  OF  THIS SECTION,
SECTION TWENTY-ONE OF CHAPTER ONE OF THE LAWS OF NINETEEN HUNDRED  NINE-
TY-NINE,  OR  ANY  OTHER  CONTRARY  PROVISION  OF LAW AND SUBJECT TO THE
AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION, EFFECTIVE FOR  MEDICAID
RATE  PERIODS  ON AND AFTER APRIL FIRST, TWO THOUSAND THIRTEEN, NO TREND
FACTOR ADJUSTMENTS SHALL BE AVAILABLE WITH REGARD TO  REIMBURSEMENT  FOR
THE FOLLOWING:
  (A)  RESIDENTIAL HEALTH CARE FACILITY INPATIENT SERVICES AND ADULT DAY
HEALTH CARE OUTPATIENT SERVICES PROVIDED PURSUANT TO THIS ARTICLE;
  (B) HOSPITAL OUTPATIENT SERVICES AND DIAGNOSTIC AND  TREATMENT  CENTER
SERVICES PROVIDED PURSUANT TO THIS ARTICLE, EXCEPT AS REQUIRED BY FEDER-
AL  LAW WITH REGARD TO SERVICES REIMBURSED PURSUANT TO SUBDIVISION EIGHT
OF SECTION TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE;
  (C) CERTIFIED HOME HEALTH AGENCIES AND  LONG  TERM  HOME  HEALTH  CARE
PROGRAMS  PURSUANT  TO SECTION THIRTY-SIX HUNDRED FOURTEEN OF THIS CHAP-
TER;
  (D) PERSONAL CARE SERVICES PROVIDED PURSUANT TO SECTION THREE  HUNDRED
SIXTY-SEVEN-I OF THE SOCIAL SERVICES LAW;
  (E) ADULT DAY HEALTH CARE SERVICES PROVIDED TO PATIENTS DIAGNOSED WITH
AIDS AS DEFINED BY APPLICABLE REGULATIONS;
  (F)  PERSONAL  CARE  SERVICES  PROVIDED IN THOSE LOCAL SOCIAL SERVICES
DISTRICTS, INCLUDING NEW YORK CITY, WHOSE  RATES  OF  PAYMENT  FOR  SUCH
SERVICES  ARE ESTABLISHED BY SUCH LOCAL SOCIAL SERVICES DISTRICTS PURSU-
ANT TO A RATE-SETTING EXEMPTION ISSUED BY THE COMMISSIONER TO SUCH LOCAL
SOCIAL SERVICES DISTRICTS IN ACCORDANCE WITH APPLICABLE REGULATIONS;
  (G) ASSISTED LIVING PROGRAM SERVICES; AND
  (H) HOSPICE SERVICES.
  S 5. Paragraph (a) of subdivision 8 of section  367-b  of  the  social
services  law, as amended by chapter 109 of the laws of 2007, is amended
to read as follows:
  (a) For the purpose  of  orderly  and  timely  implementation  of  the
medical  assistance  information  and  payment system, the department is
hereby authorized to enter into agreements with fiscal intermediaries or
fiscal agents for the design,  development,  implementation,  operation,

S. 2606--A                          8                         A. 3006--A

processing,  auditing  and  making  of payments, subject to audits being
conducted by the state in accordance with the terms of such  agreements,
for medical assistance claims under the system described by this section
in  any  social  services  district.  Such agreements shall specifically
provide that the state shall have complete oversight responsibility  for
the  fiscal  intermediaries'  or fiscal agents' performance and shall be
solely responsible for establishing eligibility requirements for recipi-
ents,  provider  qualifications,  rates  of  payment,  investigation  of
suspected  fraud and abuse, issuance of identification cards, establish-
ing and maintaining recipient eligibility files, provider profiles,  and
conducting  state  audits  of  the  fiscal intermediaries' or agents' at
least once annually. The system described in this subdivision  shall  be
operated  by  [a]  ONE  OR  MORE fiscal [intermediary] INTERMEDIARIES or
fiscal [agent] AGENTS in accordance with  this  subdivision  unless  the
department  is  otherwise  authorized by a law enacted subsequent to the
effective date of this subdivision to  operate  the  system  in  another
manner.  In  no  event  shall  such intermediary or agent be a political
subdivision of the state or any other  governmental  agency  or  entity.
NOTWITHSTANDING  THE  FOREGOING,  THE  DEPARTMENT MAY MAKE PAYMENTS TO A
PROVIDER UPON THE COMMISSIONER'S  DETERMINATION  THAT  THE  PROVIDER  IS
TEMPORARILY  UNABLE  TO COMPLY WITH BILLING REQUIREMENTS. The department
shall consult with the office of Medicaid  inspector  general  regarding
any  activities undertaken by the fiscal intermediaries or fiscal agents
regarding investigation of suspected fraud and abuse.
  S 6. Section 365-l of the social services law is amended by  adding  a
new subdivision 9 to read as follows:
  9.  ANY  CONTRACT  OR  CONTRACTS  ENTERED  INTO BY THE COMMISSIONER OF
HEALTH PRIOR TO JANUARY FIRST, TWO THOUSAND THIRTEEN PURSUANT TO  SUBDI-
VISION 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 PURPOSE OF IMPLEMENTING MEDICAID REDESIGN  TEAM  INITI-
ATIVES, INCLUDING THOSE RELATED TO MANAGED CARE, MANAGED LONG TERM CARE,
MEDICAL  ASSISTANCE  WAIVERS, AND THE MEDICAL ASSISTANCE GLOBAL SPENDING
CAP.
  S 7. Section 368-d of the social services law is amended by  adding  a
new subdivision 7 to read as follows:
  7.  ANY  CONTRACT  OR  CONTRACTS  ENTERED  INTO BY THE COMMISSIONER OF
HEALTH PRIOR TO JANUARY FIRST, TWO THOUSAND THIRTEEN PURSUANT TO  SUBDI-
VISION FIVE OF THIS SECTION OR SUBDIVISION FOUR OF SECTION THREE HUNDRED
SIXTY-EIGHT-E  OF THIS TITLE 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 PURPOSE OF IMPLEMENTING MEDICAID REDESIGN TEAM INITI-
ATIVES, INCLUDING THOSE RELATED TO MANAGED CARE, MANAGED LONG TERM CARE,
MEDICAL ASSISTANCE WAIVERS, AND THE MEDICAL ASSISTANCE  GLOBAL  SPENDING
CAP.
  S 8. Intentionally Omitted
  S 9. Intentionally Omitted

S. 2606--A                          9                         A. 3006--A

  S  10.  Subdivision  25 of section 364-j of the social services law is
REPEALED.
  S  11.  Paragraph  (b)  of  subdivision 3 of section 273 of the public
health law, as added by section 10 of part C of chapter 58 of  the  laws
of 2005, is amended to read as follows:
  (b)  In the event that the patient does not meet the criteria in para-
graph (a) of this subdivision, the  prescriber  may  provide  additional
information  to  the  program  to justify the use of a prescription drug
that is not on the preferred drug list.  The  program  shall  provide  a
reasonable opportunity for a prescriber to reasonably present his or her
justification  of  prior authorization. [If, after consultation with the
program, the prescriber, in his or her reasonable professional judgment,
determines that the use of a  prescription  drug  that  is  not  on  the
preferred  drug  list is warranted, the prescriber's determination shall
be final.]
  S 12. 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 SIX 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,  EXCEPT
THAT  PRIOR  AUTHORIZATION  MAY  BE  DENIED IF THE DEPARTMENT OF HEALTH,
AFTER GIVING THE PRESCRIBER A REASONABLE OPPORTUNITY TO PRESENT A JUSTI-
FICATION, DETERMINES THAT THE ADDITIONAL PRESCRIPTION IS  NOT  MEDICALLY
NECESSARY;  medical  assistance  shall  not include any drug provided on
other than an in-patient basis for which a recipient  is  charged  or  a
claim is made in the case of a prescription drug, in excess of the maxi-
mum  reimbursable amounts to be established by department regulations in
accordance with standards established by the  secretary  of  the  United
States  department  of  health  and human services, or, in the case of a
drug not requiring a prescription, in excess of the maximum reimbursable
amount established by the commissioner of health pursuant  to  paragraph
(a) of subdivision four of this section;
  S  13.  Subparagraph (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 amen