[ ] is old law to be omitted.
LBD12571-04-3
S. 2606--B 2 A. 3006--B
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 organ-
izations 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 enroll-
ment 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 recruit-
ment 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 require-
ment; 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 eligi-
bility 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 inpa-
tient 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 expendi-
tures, in relation to the effectiveness thereof; in relation to elimi-
nating the 2013-2014 trend factor and thereafter; to repeal certain
provisions of the social services law and the public health law relat-
ing 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
S. 2606--B 3 A. 3006--B
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 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
S. 2606--B 4 A. 3006--B
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 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-
S. 2606--B 5 A. 3006--B
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-
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); to amend chapter 57
of the laws of 2006, relating to establishing a cost of living adjust-
ment for designated human services programs, in relation to foregoing
such adjustment during the 2013-2014 state fiscal year (Part N); and
to authorize the actions necessary to manage the loss of federal
revenue and create the Mental Hygiene Stabilization Fund (Part O)
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 O. 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
S. 2606--B 6 A. 3006--B
"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-
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:
S. 2606--B 7 A. 3006--B
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
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. 2606--B 8 A. 3006--B
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,
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
S. 2606--B 9 A. 3006--B
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. Paragraph (g) of subdivision 1 of section 189 of the state
finance law, as amended by chapter 379 of the laws of 2010, is amended
to read as follows:
(g) knowingly makes, uses, or causes to be made or used, a false
record or statement material to an obligation to pay or transmit money
or property to the state or a local government, OR KNOWINGLY CONCEALS OR
KNOWINGLY AND IMPROPERLY AVOIDS OR DECREASES AN OBLIGATION TO PAY OR
TRANSMIT MONEY OR PROPERTY TO THE STATE OR A LOCAL GOVERNMENT, shall be
liable to the state or a local government, as applicable, for a civil
penalty of not less than six thousand dollars and not more than twelve
thousand dollars, plus three times the amount of all damages, including
consequential damages, which the state or local government sustains
because of the act of that person.
S 9. Subparagraphs (d) and (e) of subdivision 2 of section 190 of the
state finance law, paragraph (d) as amended by chapter 379 of the laws
of 2010, paragraph (e) as amended by section 39 of part C of chapter 58
of the laws of 2007, are amended to read as follows:
(d) If the state notifies the court that it intends to file a
complaint against the defendant and thereby be substituted as the plain-
tiff in the action, or to permit a local government to do so, such
complaint, WHETHER FILED SEPARATELY OR AS AN AMENDMENT TO THE QUI TAM
PLAINTIFF'S COMPLAINT, must be filed within thirty days after the
notification to the court. For statute of limitations purposes, any such
complaint filed by the state or a local government shall relate back to
the filing date of the complaint of the qui tam plaintiff, to the extent
that the cause of action of the state or local government arises out of
the conduct, transactions, or occurrences set forth, or attempted to be
set forth, in the [prior] complaint of the qui tam plaintiff.
(e) If the state notifies the court that it intends to intervene in
the action, or to permit a local government to do so, then such motion
[for intervention] TO INTERVENE, WHETHER FILED SEPARATELY OR AS AN
AMENDMENT TO THE QUI TAM PLAINTIFF'S COMPLAINT, shall be filed within
thirty days after the notification to the court. FOR STATUTE OF LIMITA-
TIONS PURPOSES, ANY COMPLAINT FILED BY THE STATE OR A LOCAL GOVERNMENT,
WHETHER FILED SEPARATELY OR AS AN AMENDMENT TO THE QUI TAM PLAINTIFF'S
COMPLAINT, SHALL RELATE BACK TO THE FILING DATE OF THE COMPLAINT OF THE
QUI TAM PLAINTIFF, TO THE EXTENT THAT THE CAUSE OF ACTION OF THE STATE
OR LOCAL GOVERNMENT ARISES OUT OF THE CONDUCT, TRANSACTIONS, OR OCCUR-
RENCES SET FORTH, OR ATTEMPTED TO BE SET FORTH, IN THE COMPLAINT OF THE
QUI TAM PLAINTIFF.
S 9-a. Subdivision 4 of section 190 of the state finance law, as added
by section 39 of part C of chapter 58 of the laws of 2007, is amended to
read as follows:
4. Related actions. When a person brings a qui tam action under this
section, no person other than the attorney general, or a local govern-
ment attorney acting pursuant to subdivision one of this section or
paragraph (b) of subdivision two of this section, may intervene or bring
a related civil action based upon the facts underlying the pending
action[, unless such other person has first obtained the permission of
the attorney general to intervene or to bring such related action];
provided, however, that nothing in this subdivision shall be deemed to
S. 2606--B 10 A. 3006--B
deny persons the right, upon leave of court, to file briefs amicus curi-
ae.
S 9-b. Subdivision 7 of section 190 of the state finance law, as added
by section 39 of part C of chapter 58 of the laws of 2007, is amended to
read as follows:
7. Costs, expenses, disbursements and attorneys' fees. In any action
brought pursuant to this article, the court [may] SHALL award the attor-
ney general, on behalf of the people of the state of New York, and any
local government that participates as a party in the action, and any
person who is a qui tam plaintiff, an amount for reasonable expenses
which the court finds to have been necessarily incurred, plus reasonable
attorneys' fees, plus costs pursuant to article eighty-one of the civil
practice law and rules. All such expenses, fees and costs shall be
awarded directly against the defendant and shall not be charged from the
proceeds[, but shall only be awarded if the state or a local government
or the qui tam civil action plaintiff prevails in the action].
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-
S. 2606--B 11 A. 3006--B
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
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
S. 2606--B 12 A. 3006--B
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-
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-
S. 2606--B 13 A. 3006--B
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
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
S. 2606--B 14 A. 3006--B
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.
(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
S. 2606--B 15 A. 3006--B
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-
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;
S. 2606--B 16 A. 3006--B
(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
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
S. 2606--B 17 A. 3006--B
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.
(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. 2606--B 18 A. 3006--B
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
THOUSAND FOURTEEN. SUCH FUNDS SHALL BE USED TO DEVELOP ENHANCED SYSTEMS
TO SUPPORT HEALTH HOME OPERATIONS INCLUDING ASSIGNMENTS, WORKFLOW, AND
TRANSMISSION OF DATA. FUNDING WILL ALSO BE DISBURSED PURSUANT TO A
FORMULA ESTABLISHED BY THE COMMISSIONER TO BE DESIGNATED HEALTH HOMES.
SUCH FORMULA MAY CONSIDER PRIOR ACCESS TO SIMILAR FUNDING OPPORTUNITIES,
GEOGRAPHIC AND DEMOGRAPHIC FACTORS, INCLUDING THE POPULATION SERVED, AND
PREVALENCE OF QUALIFYING CONDITIONS, 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-
S. 2606--B 19 A. 3006--B
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-
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. 2606--B 20 A. 3006--B
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
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 33-a. Subparagraphs (ii) and (x) of paragraph (b) 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, are amended to read as
follows:
(ii) Only those two thousand five base year costs which relate to the
cost of services provided to Medicaid inpatients, as determined by the
applicable ratio of costs to charges methodology, shall be utilized for
rate-setting purposes, PROVIDED, HOWEVER, THAT THE COMMISSIONER MAY
UTILIZE UPDATED MEDICAID INPATIENT RELATED BASE YEAR COSTS AND STATIS-
TICS AS NECESSARY TO ADJUST INPATIENT RATES IN ACCORDANCE WITH CLAUSE
(C) OF SUBPARAGRAPH (X) OF THIS PARAGRAPH;
S. 2606--B 21 A. 3006--B
(x) Such regulations shall provide for administrative rate appeals,
but only with regard to: (A) the correction of computational errors or
omissions of data, including with regard to the hospital specific compu-
tations pertaining to graduate medical education, wage equalization
factor adjustments, [and] (B) capital cost reimbursement, AND, (C)
CHANGES TO THE BASE YEAR STATISTICS AND COSTS USED TO DETERMINE THE
DIRECT AND INDIRECT GRADUATE MEDICAL EDUCATION COMPONENTS OF THE RATES
AS A RESULT OF NEW TEACHING PROGRAMS AT NEW TEACHING HOSPITALS AND/OR AS
A RESULT OF RESIDENTS DISPLACED AND TRANSFERRED AS A RESULT OF TEACHING
HOSPITAL CLOSURES;
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.
(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
S. 2606--B 22 A. 3006--B
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 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. 2606--B 23 A. 3006--B
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
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:
S. 2606--B 24 A. 3006--B
(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;
(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]
S. 2606--B 25 A. 3006--B
(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:
(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
S. 2606--B 26 A. 3006--B
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
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.
S. 2606--B 27 A. 3006--B
(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
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.
S. 2606--B 28 A. 3006--B
(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:
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
S. 2606--B 29 A. 3006--B
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
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. 2606--B 30 A. 3006--B
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;
(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
S. 2606--B 31 A. 3006--B
(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
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
S. 2606--B 32 A. 3006--B
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
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
S. 2606--B 33 A. 3006--B
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
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:
S. 2606--B 34 A. 3006--B
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
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. 2606--B 35 A. 3006--B
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
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-
S. 2606--B 36 A. 3006--B
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
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-
S. 2606--B 37 A. 3006--B
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 THIRTY-TWO 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
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:
S. 2606--B 38 A. 3006--B
(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
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. 2606--B 39 A. 3006--B
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 ESTAB-
LISHED 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. THE COMMISSIONER
OF HEALTH SHALL NOT BE REQUIRED TO REVIEW ON A COMPARATIVE BASIS APPLI-
CATIONS 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.
(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-
S. 2606--B 40 A. 3006--B
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-
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
S. 2606--B 41 A. 3006--B
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;
(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;
S. 2606--B 42 A. 3006--B
(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
(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
S. 2606--B 43 A. 3006--B
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.
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
S. 2606--B 44 A. 3006--B
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-
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.
S. 2606--B 45 A. 3006--B
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.
(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
S. 2606--B 46 A. 3006--B
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-
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
S. 2606--B 47 A. 3006--B
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:
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
S. 2606--B 48 A. 3006--B
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.
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
S. 2606--B 49 A. 3006--B
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 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
S. 2606--B 50 A. 3006--B
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;
1-b. section thirty-three-a of this act shall take effect January 1,
2014;
2. any rules or regulations necessary to implement the provisions of
this act may be promulgated and any procedures, forms, or instructions
necessary for such implementation may be adopted and issued on or after
the date this act shall have become a law;
3. this act shall not be construed to alter, change, affect, impair or
defeat any rights, obligations, duties or interests accrued, incurred or
conferred prior to the effective date of this act;
4. the commissioner of health and the superintendent of financial
services and any appropriate council may take any steps necessary to
implement this act prior to its effective date;
5. notwithstanding any inconsistent provision of the state administra-
tive procedure act or any other provision of law, rule or regulation,
the commissioner of health and the superintendent of financial services
and any appropriate council is authorized to adopt or amend or promul-
gate on an emergency basis any regulation he or she or such council
determines necessary to implement any provision of this act on its
effective date;
6. the 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
S. 2606--B 51 A. 3006--B
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;
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; and
12. the provisions of this act shall apply to any pending cause of
action brought pursuant to article 13 of the state finance law, and
shall further apply to claims, records, statements or obligations, as
defined by section 188 of the state finance law, that were made, used,
or existing prior to, on or after April 1, 2007.
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
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
S. 2606--B 52 A. 3006--B
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,
(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
S. 2606--B 53 A. 3006--B
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:
(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
S. 2606--B 54 A. 3006--B
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,
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
S. 2606--B 55 A. 3006--B
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:
(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
S. 2606--B 56 A. 3006--B
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,
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,
S. 2606--B 57 A. 3006--B
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.
(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.
S. 2606--B 58 A. 3006--B
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
(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
S. 2606--B 59 A. 3006--B
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.
(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.
S. 2606--B 60 A. 3006--B
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
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
S. 2606--B 61 A. 3006--B
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
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. 2606--B 62 A. 3006--B
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
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. 2606--B 63 A. 3006--B
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 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. 2606--B 64 A. 3006--B
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, EXCEPT
FOR FUNDS DISTRIBUTED PURSUANT TO SUBPARAGRAPH (V) OF PARAGRAPH (B) OF
SUBDIVISION FIVE-B OF THIS SECTION, AND ALL FUNDS AVAILABLE FOR DISTRIB-
UTION PURSUANT TO 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.
(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.
S. 2606--B 65 A. 3006--B
(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
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
S. 2606--B 66 A. 3006--B
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. The opening paragraph of subparagraph (i) of paragraph (i) of
subdivision 35 of section 2807-c of the public health law, as added by
section 3-a of part B of chapter 109 of the laws of 2010, is amended to
read as follows:
Notwithstanding any inconsistent provision of this subdivision or any
other contrary provision of law and subject to the availability of
federal financial participation, for the period July first, two thousand
ten through March thirty-first, two thousand eleven, and each state
fiscal year period thereafter, the commissioner shall make additional
inpatient hospital payments up to the aggregate upper payment limit for
inpatient hospital services after all other medical assistance payments,
but not to exceed two hundred thirty-five million five hundred thousand
dollars for the period July first, two thousand ten through March thir-
ty-first, two thousand eleven [and], three hundred fourteen million
dollars for each state fiscal year BEGINNING APRIL FIRST, TWO THOUSAND
ELEVEN, THROUGH MARCH THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND NO LESS
THAN THREE HUNDRED THIRTY-NINE MILLION DOLLARS FOR EACH STATE FISCAL
YEAR thereafter, to general hospitals, other than major public general
hospitals, providing emergency room services and including safety net
hospitals, which shall, for the purpose of this paragraph, be defined as
having either: a Medicaid share of total inpatient hospital discharges
of at least thirty-five percent, including both fee-for-service and
managed care discharges for acute and exempt services; or a Medicaid
share of total discharges of at least thirty percent, including both
fee-for-service and managed care discharges for acute and exempt
services, and also providing obstetrical services. Eligibility to
receive such additional payments shall be based on data from the period
two years prior to the rate year, as reported on the institutional cost
S. 2606--B 67 A. 3006--B
report submitted to the department as of October first of the prior rate
year. Such payments shall be made as medical assistance payments for
fee-for-service inpatient hospital services pursuant to title eleven of
article five of the social services law for patients eligible for feder-
al financial participation under title XIX of the federal social securi-
ty act and in accordance with the following:
S 5. 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, two and four 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:
(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
S. 2606--B 68 A. 3006--B
INCOME, THE SUM OF THE MAGI-BASED INCOME OF EVERY PERSON INCLUDED IN THE
INDIVIDUAL'S MAGI HOUSEHOLD, 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 ELIGI-
BILITY 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.
IN DETERMINING THE ELIGIBILITY OF AN INDIVIDUAL FOR THE MAGI ELIGIBILITY
GROUP WITH THE HIGHEST INCOME STANDARD UNDER WHICH THE INDIVIDUAL MAY
QUALIFY, AN AMOUNT EQUIVALENT TO FIVE PERCENTAGE POINTS OF THE FEDERAL
POVERTY LEVEL FOR THE APPLICABLE FAMILY SIZE WILL BE DEDUCTED FROM THE
HOUSEHOLD 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
(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
S. 2606--B 69 A. 3006--B
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.
(7) A CHILD WHO IS NINETEEN OR TWENTY YEARS OF AGE LIVING WITH HIS OR
HER PARENT WILL BE ELIGIBLE FOR STANDARD COVERAGE IF THE SUM OF THE
MAGI-BASED INCOME OF EVERY PERSON INCLUDED IN THE CHILD'S MAGI HOUSEHOLD
EXCEEDS ONE HUNDRED THIRTY-THREE PERCENT, BUT DOES NOT EXCEED ONE
HUNDRED FIFTY PERCENT, OF THE FEDERAL POVERTY LINE FOR THE APPLICABLE
FAMILY SIZE.
(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)
S. 2606--B 70 A. 3006--B
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
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
S. 2606--B 71 A. 3006--B
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
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.
S. 2606--B 72 A. 3006--B
(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
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.
S. 2606--B 73 A. 3006--B
(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 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 ASSISTANCE 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.
(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
S. 2606--B 74 A. 3006--B
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.
(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.
S. 2606--B 75 A. 3006--B
(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 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
S. 2606--B 76 A. 3006--B
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
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
S. 2606--B 77 A. 3006--B
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 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
S. 2606--B 78 A. 3006--B
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-
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. 2606--B 79 A. 3006--B
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.
(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
S. 2606--B 80 A. 3006--B
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 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. Section 369-ee of the social services law is REPEALED.
S 15-a. Section 369-ff of the social services law is 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
S. 2606--B 81 A. 3006--B
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,
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 STANDARD 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
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
S. 2606--B 82 A. 3006--B
(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,
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
S. 2606--B 83 A. 3006--B
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
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. 2606--B 84 A. 3006--B
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-
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,
S. 2606--B 85 A. 3006--B
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.
(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.
S. 2606--B 86 A. 3006--B
(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-
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
S. 2606--B 87 A. 3006--B
(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)
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
S. 2606--B 88 A. 3006--B
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
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
S. 2606--B 89 A. 3006--B
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:
(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:
S. 2606--B 90 A. 3006--B
(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
(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
S. 2606--B 91 A. 3006--B
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-
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
S. 2606--B 92 A. 3006--B
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 40-a. Paragraph 1 of subsection (d) of section 3221 of the insurance
law is amended to read as follows:
(1) The superintendent may approve any form of certificate to be
issued under a blanket accident and health insurance policy as defined
in section four thousand two hundred thirty-seven of this chapter, which
omits or modifies any of the provisions hereinbefore required, if [he]
THE SUPERINTENDENT deems such omission or modification suitable for the
character of such insurance and not unjust to the persons insured there-
under. CERTIFICATES ISSUED UNDER A POLICY OR CONTRACT OF STUDENT ACCI-
DENT AND HEALTH INSURANCE AS DEFINED IN SECTION THREE THOUSAND TWO
HUNDRED FORTY OF THIS ARTICLE SHALL COMPLY WITH SUCH SECTION.
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
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) AN INSURER OR CORPORATION SHALL CONDITION ELIGIBILITY INCLUDING
CONTINUING ELIGIBILITY, ON THE COVERED INDIVIDUAL BEING ENROLLED AS A
STUDENT IN AN INSTITUTION OF HIGHER EDUCATION TO WHICH THE STUDENT ACCI-
DENT AND HEALTH INSURANCE POLICY OR CONTRACT IS ISSUED.
(D) 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).
S. 2606--B 93 A. 3006--B
(E) AN INSURER OR CORPORATION SHALL NOT REFUSE TO RENEW OR OTHERWISE
TERMINATE A STUDENT ACCIDENT AND HEALTH INSURANCE POLICY OR CONTRACT
EXCEPT FOR ONE OR MORE OF THE REASONS SET FORTH IN:
(1) SUBPARAGRAPHS (A), (B), (D) OR (G) OF PARAGRAPH TWO OF SUBSECTION
(P) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS ARTICLE; OR
(2) SUBPARAGRAPHS (A), (B), (D) OR (G) OF PARAGRAPH TWO OF SUBSECTION
(J) OF SECTION FOUR THOUSAND THREE HUNDRED FIVE OF THIS CHAPTER.
(F) 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.
(G) 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.
(H) 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.
(I) 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:
(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 43-a. Item (i) of subparagraph (C) of paragraph 2 of subsection (c)
of section 4304 of the insurance law, as amended by section 9 of part A
of chapter 1 of the laws of 2002, is amended to read as follows:
S. 2606--B 94 A. 3006--B
(i) Discontinuance of a class of contract upon not less than five
months' prior written notice[, except for subscribers to direct pay
major medical or similar comprehensive-type coverage issued by a corpo-
ration organized pursuant to this article, or any successor corporation
organized through a conversion pursuant to subsection (j) of section
four thousand three hundred one of this article, and in effect prior to
January first, nineteen hundred ninety-six who are ineligible to
purchase policies offered after such date pursuant to section four thou-
sand three hundred twenty-one or four thousand three hundred twenty-two
of this article due to the provisions of 42 U.S.C. 1395ss in effect on
the effective date of this item. In the event any such subscriber
becomes eligible to purchase policies offered pursuant to section four
thousand three hundred twenty-one or four thousand three hundred twen-
ty-two of this article, then such subscriber may be discontinued upon
not less than five months' prior written notice]. In exercising the
option to discontinue coverage pursuant to this item, the corporation
must act uniformly without regard to any health status-related factor of
enrolled individuals or individuals who may become eligible for such
coverage and must offer to subscribers or group remitting agents, as may
be appropriate, the option to purchase all other individual health
insurance coverage currently being offered by the corporation to appli-
cants in that market.
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-
S. 2606--B 95 A. 3006--B
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 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.
S. 2606--B 96 A. 3006--B
(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
(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 ORGANIZATION ON AND AFTER OCTOBER FIRST, TWO THOUSAND THIR-
TEEN. (A) ON AND AFTER OCTOBER FIRST, TWO THOUSAND THIRTEEN, EVERY
HEALTH MAINTENANCE ORGANIZATION ISSUED A CERTIFICATE OF AUTHORITY UNDER
ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR LICENSED UNDER THIS ARTI-
CLE 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, EXCEPT AS OTHERWISE REQUIRED
UNDER SUBSECTION (L) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR OF THIS
ARTICLE, OR A HEALTH MAINTENANCE ORGANIZATION EXCLUSIVELY SERVING INDI-
VIDUALS 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 ORGANIZA-
TION 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
S. 2606--B 97 A. 3006--B
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
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,
SUBJECT TO 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, ONLY 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 ALSO OFFER AT LEAST ONE
INDIVIDUAL 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), OUTSIDE THE HEALTH BENEFIT EXCHANGE TO INDIVIDUALS NOT ELIGI-
BLE 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 OCTOBER FIRST, TWO THOUSAND THIRTEEN OR PREVENT HEALTH
MAINTENANCE ORGANIZATIONS FROM DISCONTINUING INDIVIDUAL DIRECT PAYMENT
CONTRACTS ISSUED PRIOR TO OCTOBER FIRST, TWO THOUSAND THIRTEEN. 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
S. 2606--B 98 A. 3006--B
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 COVERAGE ARE NECESSARY TO MEET THE NEEDS OF THE PUBLIC.
S 46-a. Paragraph 5 of subsection (c) of section 3216 of the insurance
law is amended to read as follows:
(5) (A) Any family policy providing hospital or surgical expense
insurance (but not including such insurance against accidental injury
only) shall provide that, in the event such insurance on any person,
other than the policyholder, is terminated because the person is no
longer within the definition of the family as set forth in the policy
but before such person has attained the limiting age, if any, for cover-
age of adults specified in the policy, such person shall be entitled to
have issued to [him] THAT PERSON by the insurer, without evidence of
insurability, upon application therefor and payment of the first premi-
um, within [thirty-one] SIXTY days after such insurance shall have
terminated, an individual conversion policy. The conversion privilege
afforded herein shall also be available upon the divorce or annulment of
the marriage of the policyholder to the former spouse of such policy-
holder.
(B) Written notice of entitlement to a conversion policy shall be
given by the insurer to the policyholder at least fifteen and not more
than sixty days prior to the termination of coverage due to the initial
limiting age of the covered dependent. Such notice shall include an
explanation of the rights of the dependent with respect to [his] THE
DEPENDENT being enrolled in an accredited institution of learning or his
incapacity for self-sustaining employment by reason of mental illness,
developmental disability or mental retardation as defined in the mental
hygiene law or physical handicap.
(C) Such individual conversion policy shall be subject to the follow-
ing terms and conditions:
(i) The premium shall be that applicable to the [class of risk to
which such person belongs, to the age of such person and to the] form
and amount of insurance therefor.
(ii) [Such policy shall provide, on a basis specified in the family
policy, the same or substantially the same benefits as those provided in
the family policy or such benefits as are provided in a policy specif-
ically approved as an individual conversion policy by the superinten-
dent.
(iii)] The benefits provided under such policy shall become effective
upon the date that such person was no longer eligible under the family
policy.
[(iv) The policy may exclude any condition excluded by the family
policy for such person at the time of the termination of his insurance
thereunder. The policy shall not exclude any other pre-existing condi-
tions, but the benefits paid under such policy may be reduced by the
amount of any such benefits payable under the family policy after the
termination of such person's insurance thereunder and, during the first
policy year of the conversion policy, the benefits payable under the
policy may be reduced so that they are not in excess of those that would
have been payable had such person's insurance under the family policy
remained in force and effect.
S. 2606--B 99 A. 3006--B
(v)] (III) No insurer shall be required to issue a conversion policy
if it appears that the person applying for such policy shall have at
that time in force another insurance policy or hospital service or
medical expense indemnity contract providing similar benefits or is
covered by or is eligible for coverage by a group insurance policy or
contract providing similar benefits or shall be covered by similar bene-
fits required by any statute or provided by any welfare plan or program,
which together with the conversion policy would result in over insurance
or duplication of benefits according to standards on file with the
superintendent relating to individual policies.
[(vi) The policy may include a provision whereby the insurer may
request information at any premium due date of the policy of the person
covered thereunder as to whether he is then covered by another policy or
hospital service or medical expense indemnity corporation subscriber
contract providing similar benefits or is then covered by a group
contract or policy providing similar benefits or is then provided with
similar benefits required by any statute or provided by any welfare plan
or program. If any such person is so covered or so provided and fails to
furnish the details of such coverage when requested, the benefits paya-
ble under the conversion policy may be based on the hospital surgical or
medical expenses actually incurred after excluding expenses to the
extent they are payable under such other coverage or provided under such
statute, plan, or program.]
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] SIXTY days after such termi-
nation, 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, [whichever 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:
S. 2606--B 100 A. 3006--B
(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
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
S. 2606--B 101 A. 3006--B
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 3 of subsection (e) of section 4304 of the insurance
law is REPEALED and paragraphs 4 and 5 are renumbered paragraphs 3 and
4, and paragraphs 1 and 2 of such subsection (e), paragraph 1 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, are 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
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] SIXTY
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 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
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 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.
(2) The corporation shall not be required to issue any such converted
individual direct payment contract if its issuance would result in over-
S. 2606--B 102 A. 3006--B
insurance or duplication of benefits according to standards on file with
the superintendent and approved by [him] THE SUPERINTENDENT with regard
to such contracts. [The individual direct payment contract may include a
provision whereby the corporation may request information when any
payment is due under the contract of the person covered thereunder as to
whether he is then covered by another individual contract providing
similar benefits or is then covered by a group contract policy providing
similar benefits or is then provided with similar benefits required by
any statute or provided by any welfare plan or program which together
with the converted individual direct payment contract would result in
overinsurance or duplication of benefits according to the standards on
file with the superintendent relating to individual contracts. If any
such person is so covered or so provided and fails to furnish the
details of such coverage when requested, the benefits provided under the
converted individual direct payment contract may be based on the hospi-
tal, surgical or medical expenses actually incurred after excluding
expenses to the extent they are payable under such other coverage or
provided under such statute, plan or program.]
S 52. Paragraphs 1 and 2 of subsection (d) of section 4305 of the
insurance law, paragraph 1 as amended by chapter 504 of the laws of 1995
and paragraphs 1 and 2 as further amended by section 104 of part A of
chapter 62 of the laws of 2011, are 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] SIXTY days
after termination of the coverage, an individual direct payment
contract, covering such member and [his] THE MEMBER'S eligible depen-
dents 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 financial 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 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 AFFORDA-
BLE 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
S. 2606--B 103 A. 3006--B
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.
(2) The effective date of the coverage provided by the individual
direct payment contract shall be the date of the termination of the
individual's coverage under the group contract. [The individual direct
payment converted contract may exclude any condition excluded by the
group contract. The individual direct payment contract shall not exclude
any other pre-existing conditions but the benefits provided under the
individual direct payment converted contract may be reduced by the
amount of any such benefits provided under the group contract after the
termination of the individual's coverage thereunder and during the first
contract year of such individual direct payment converted contract the
benefits provided under the contract may be reduced so that they are not
in excess of those that would have been provided had the individual's
contract under the group contract remained in force and effect.] The
corporation shall not be required to issue such individual direct
payment converted contract covering any person if it appears that such
person shall then be covered by another individual contract providing
similar coverage or if it shall appear that such person is covered by or
eligible to be covered by a group contract or policy providing similar
benefits or is provided with similar benefits required by any statute or
provided by any welfare plan or program, which together with the indi-
vidual direct payment converted contract would result in over-insurance
or duplication of benefits according to standards on file with the
superintendent of financial services relating to individual contracts.
[The individual direct payment converted contract may include a
provision whereby the corporation may request information when any
payment is due under the contract of any person covered thereunder as to
whether he is then covered by another contract or by a policy providing
similar benefits or is then covered by a group contract or policy
providing similar benefits or is then provided with similar benefits
required by any statute or provided by any welfare plan or program. If
any such person is so covered or so provided and fails to furnish the
details of such coverage when requested, the benefits payable under the
individual direct payment converted contract may be based on the hospi-
tal, surgical or medical expenses actually incurred after excluding
expenses to the extent they are payable under such other coverage or
provided under such statute, plan or program.
In the event the benefits provided or payable are reduced in accord-
ance with the provisions of this subsection the corporation shall return
such portion of the premium paid as shall exceed the pro rata portion of
the benefits thus determined.]
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. 2606--B 104 A. 3006--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 OR ASSOCIATION 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);
(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; AND
(4) "ASSOCIATION GROUP" MEANS A GROUP DEFINED IN SUBPARAGRAPHS (B),
(D), (H), (K), (L) OR (M) OF PARAGRAPH ONE OF SUBSECTION (C) OF SECTION
FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER, PROVIDED THAT:
(A) THE GROUP INCLUDES ONE OR MORE INDIVIDUAL MEMBERS; OR
(B) THE GROUP INCLUDES ONE OR MORE MEMBER EMPLOYERS OR OTHER MEMBER
GROUPS THAT ARE SMALL GROUPS.
(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 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),
subsection (hh), as added by chapter 597 of the laws of 2011, is relet-
tered to be subsection (kk) and two new subsections (ll) and (mm) are
added to read as follows:
(LL) EVERY SMALL GROUP CONTRACT OR ASSOCIATION GROUP CONTRACT DELIV-
ERED OR ISSUED FOR DELIVERY IN THIS STATE THAT PROVIDES COVERAGE FOR
HOSPITAL, MEDICAL OR SURGICAL EXPENSE INSURANCE AND IS NOT A GRANDFA-
THERED HEALTH PLAN 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:
(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-
S. 2606--B 105 A. 3006--B
SAND SIXTEEN, "SMALL GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER
EMPLOYEES OR MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND
(4) "ASSOCIATION GROUP" MEANS A GROUP DEFINED IN SUBPARAGRAPHS (B),
(D), (H), (K), (L) OR (M) OF PARAGRAPH ONE OF SUBSECTION (C) OF SECTION
FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER, PROVIDED THAT:
(A) THE GROUP INCLUDES ONE OR MORE INDIVIDUAL MEMBERS; OR
(B) THE GROUP INCLUDES ONE OR MORE MEMBER EMPLOYERS OR OTHER MEMBER
GROUPS THAT ARE SMALL GROUPS.
(MM) 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-
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
S. 2606--B 106 A. 3006--B
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
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-
S. 2606--B 107 A. 3006--B
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
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;
S. 2606--B 108 A. 3006--B
(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;
(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;
S. 2606--B 109 A. 3006--B
(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
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
S. 2606--B 110 A. 3006--B
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
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,
S. 2606--B 111 A. 3006--B
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.
[(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
S. 2606--B 112 A. 3006--B
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
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
S. 2606--B 113 A. 3006--B
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
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
S. 2606--B 114 A. 3006--B
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-
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-
S. 2606--B 115 A. 3006--B
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
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
S. 2606--B 116 A. 3006--B
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
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.]
S. 2606--B 117 A. 3006--B
(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
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.
S. 2606--B 118 A. 3006--B
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:
(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:
S. 2606--B 119 A. 3006--B
(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] JULY 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 superintendent
may direct the insurer to take corrective action, which may include the
submission of a rate filing to reduce future premiums, or to issue divi-
dends, 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] JULY THIRTY-FIRST
of each year, every corporation subject to this subparagraph shall annu-
ally 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 corporation to take correc-
tive 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:
(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:
S. 2606--B 120 A. 3006--B
(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) NOTWITHSTANDING PARAGRAPH THREE OF THIS SUBSECTION, 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 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. THE WRITTEN
NOTICE SHALL BE IN SUCH FORM AND CONTAIN SUCH INFORMATION THE SUPER-
INTENDENT 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
S. 2606--B 121 A. 3006--B
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) NOTWITHSTANDING PARAGRAPH THREE OF THIS SUBSECTION, 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 CORPORATION:
(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-
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 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, 42 U.S.C. S 300GG-6 THAT
BECOME EFFECTIVE JANUARY FIRST, TWO THOUSAND FOURTEEN. THE WRITTEN
NOTICE SHALL BE IN SUCH FORM AND CONTAIN SUCH INFORMATION THE SUPER-
INTENDENT REQUIRES.
S. 2606--B 122 A. 3006--B
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
ISSUED ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, SPECIFIED IN
SUBSECTION (L) OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, OF THIS
ARTICLE must be accepted at all times throughout the year for any hospi-
tal and/or medical coverage offered by the insurer to individuals or
small groups in this state. (3) Once accepted for coverage, an individ-
ual 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 a group of fifty or
fewer employees, OR BETWEEN ONE AND ONE HUNDRED EMPLOYEES FOR POLICIES
ISSUED OR RENEWED ON OR AFTER JANUARY FIRST, TWO THOUSAND SIXTEEN, 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]
IF permitted by this article, and once accepted for coverage, an indi-
vidual 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 INDIVIDUALS OR SMALL GROUPS COVERED BY
MEDICARE SUPPLEMENTAL INSURANCE. FOR MEDICARE SUPPLEMENTAL INSURANCE
COVERAGE, "COMMUNITY RATED" MEANS A RATING METHODOLOGY IN WHICH THE
PREMIUMS 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 WITHOUT REGARD TO AGE, SEX, HEALTH STATUS,
S. 2606--B 123 A. 3006--B
TOBACCO USAGE OR OCCUPATION. CATASTROPHIC HEALTH INSURANCE 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 MAY SET STANDARD PREMIUM TIERS AND
STANDARD RATING RELATIVITIES BETWEEN TIERS APPLICABLE TO ALL POLICIES
SUBJECT TO THIS SECTION. THE SUPERINTENDENT MAY SET A STANDARD RELATIVI-
TY APPLICABLE TO CHILD-ONLY POLICIES ISSUED PURSUANT TO SECTION 1302(F)
OF THE AFFORDABLE CARE ACT, 42 U.S.C. S 18022(F). THE RELATIVITY 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 RELATIVITIES PERI-
ODICALLY BASED UPON THE AGGREGATE EXPERIENCE OF INSURERS ISSUING 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 proprie-
tors 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
spouses and dependents. FOR POLICIES ISSUED OR RENEWED ON OR AFTER JANU-
ARY FIRST, TWO THOUSAND FOURTEEN, IF THE GROUP INCLUDES ONE OR MORE
MEMBER SMALL GROUP EMPLOYERS ELIGIBLE FOR COVERAGE SUBJECT TO THIS
SECTION, THEN SUCH MEMBER EMPLOYERS 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
PARAGRAPH TWO OF THIS SUBSECTION.
(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
S. 2606--B 124 A. 3006--B
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 RENEWED PURSUANT
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-
age INCLUDING MEDICARE SUPPLEMENTAL INSURANCE, BUT NOT INCLUDING COVER-
AGE ISSUED ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN SPECIFIED IN
SUBSECTION (L) OF SECTION FOUR THOUSAND THREE HUNDRED FOUR, AND SECTION
FOUR THOUSAND THREE HUNDRED TWENTY-EIGHT OF THIS CHAPTER, 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 individuals 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 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
S. 2606--B 125 A. 3006--B
contract form] OF ALL INDIVIDUALS OR SMALL GROUPS COVERED BY THE CORPO-
RATION without regard to age, sex, health status, TOBACCO USAGE or occu-
pation EXCLUDING THOSE INDIVIDUALS OF SMALL GROUPS COVERED BY MEDICARE
SUPPLEMENTAL INSURANCE. FOR MEDICARE SUPPLEMENTAL INSURANCE COVERAGE,
"COMMUNITY RATED" MEANS A RATING METHODOLOGY IN WHICH THE PREMIUMS 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 WITHOUT REGARD TO AGE, SEX, HEALTH STATUS, TOBACCO USAGE
OR OCCUPATION. 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 MAY SET STANDARD PREMIUM TIERS AND
STANDARD RATING RELATIVITIES BETWEEN TIERS APPLICABLE TO ALL CONTRACTS
SUBJECT TO THIS SECTION. THE SUPERINTENDENT MAY 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
INSURANCE, CORPORATIONS SHALL USE STANDARDIZED REGIONS ESTABLISHED BY
THE SUPERINTENDENT.
(d) (1) 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. FOR CONTRACTS
ISSUED OR RENEWED ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, IF
THE GROUP INCLUDES ONE OR MORE MEMBER SMALL GROUP EMPLOYERS ELIGIBLE FOR
COVERAGE SUBJECT TO THIS SECTION, THEN SUCH MEMBER EMPLOYERS 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 PARAGRAPH TWO OF THIS SUBSECTION.
(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
S. 2606--B 126 A. 3006--B
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
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
S. 2606--B 127 A. 3006--B
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 RENEWED PURSUANT
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
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
S. 2606--B 128 A. 3006--B
(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-a, forty-one,
forty-six-a, 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, 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-three-a, 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, fifty-eight, sixty-one and sixty-two of this act
shall take effect January 1, 2015;
e-1. section fifteen-a of this act shall take effect January 1, 2014;
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;
S. 2606--B 129 A. 3006--B
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;
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;
S. 2606--B 130 A. 3006--B
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; and
p. the amendments made to subparagraph (7) of paragraph (b) of subdi-
vision 1 of section 366 of the social services law made by section one
of this act shall expire and be deemed repealed October 1, 2019.
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
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
S. 2606--B 131 A. 3006--B
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
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.
S. 2606--B 132 A. 3006--B
(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
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;
S. 2606--B 133 A. 3006--B
[(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
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
S. 2606--B 134 A. 3006--B
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) A PARTIAL EVALUATION SHALL INCLUDE THE PROCEDURES SET FORTH IN
PARAGRAPHS (A) THROUGH (D) OF SUBDIVISION FOUR OF THIS SECTION. 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 PARAGRAPH (E) OF SUBDI-
VISION 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
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.
S. 2606--B 135 A. 3006--B
[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 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
S. 2606--B 136 A. 3006--B
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 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
S. 2606--B 137 A. 3006--B
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
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. 2606--B 138 A. 3006--B
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
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.
S. 2606--B 139 A. 3006--B
(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 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
S. 2606--B 140 A. 3006--B
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
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-
S. 2606--B 141 A. 3006--B
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,
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
S. 2606--B 142 A. 3006--B
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;
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;
S. 2606--B 143 A. 3006--B
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.
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:
S. 2606--B 144 A. 3006--B
(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 DISEASE PREVENTION, 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
(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. 2606--B 145 A. 3006--B
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.
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. 2606--B 146 A. 3006--B
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
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. 2606--B 147 A. 3006--B
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:
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
S. 2606--B 148 A. 3006--B
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
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.
S. 2606--B 149 A. 3006--B
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
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
S. 2606--B 150 A. 3006--B
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
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. 2606--B 151 A. 3006--B
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]
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.
S. 2606--B 152 A. 3006--B
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
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
S. 2606--B 153 A. 3006--B
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
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. 2606--B 154 A. 3006--B
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, IN THE AREA OF CHRONIC DISEASE, WHICH
SHALL BE DESIGNED TO IMPLEMENT EVIDENCE AND BEST PRACTICE BASED
APPROACHES TO CHRONIC DISEASE THAT EMPHASIZE THE IMPORTANCE OF PREVEN-
TIVE 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;
(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.
S. 2606--B 155 A. 3006--B
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, STD,
AND HEPATITIS C, WHICH SHALL BE DESIGNED TO IMPLEMENT EVIDENCE AND BEST
PRACTICE BASED APPROACHES TO HIV, AIDS, STD AND HEPATITIS C 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;
(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.
S. 2606--B 156 A. 3006--B
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
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
S. 2606--B 157 A. 3006--B
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) A CHANGE IN CAPACITY, THE TYPES OF SERVICES PROVIDED,
MAJOR MEDICAL EQUIPMENT; (B) FACILITY REPLACEMENT; OR (C) 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
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;
S. 2606--B 158 A. 3006--B
(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:
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
S. 2606--B 159 A. 3006--B
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
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
S. 2606--B 160 A. 3006--B
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.
[(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
S. 2606--B 161 A. 3006--B
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
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
S. 2606--B 162 A. 3006--B
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:
(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
S. 2606--B 163 A. 3006--B
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
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
S. 2606--B 164 A. 3006--B
(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:
(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
S. 2606--B 165 A. 3006--B
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
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
S. 2606--B 166 A. 3006--B
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:
(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
S. 2606--B 167 A. 3006--B
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
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
S. 2606--B 168 A. 3006--B
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-
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.
S. 2606--B 169 A. 3006--B
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.
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.
S. 2606--B 170 A. 3006--B
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
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.
S. 2606--B 171 A. 3006--B
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
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
S. 2606--B 172 A. 3006--B
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.
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
S. 2606--B 173 A. 3006--B
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.
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.
S. 2606--B 174 A. 3006--B
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-
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
S. 2606--B 175 A. 3006--B
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 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
S. 2606--B 176 A. 3006--B
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;
(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;
S. 2606--B 177 A. 3006--B
(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
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
S. 2606--B 178 A. 3006--B
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-
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. 2606--B 179 A. 3006--B
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 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
S. 2606--B 180 A. 3006--B
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.
[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
S. 2606--B 181 A. 3006--B
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
(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
S. 2606--B 182 A. 3006--B
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
(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.
S. 2606--B 183 A. 3006--B
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.
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
S. 2606--B 184 A. 3006--B
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
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
S. 2606--B 185 A. 3006--B
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
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
S. 2606--B 186 A. 3006--B
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-
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
S. 2606--B 187 A. 3006--B
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-
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 OR ADVANCED LIFE SUPPORT FIRST RESPONSE services, upon such terms
and conditions as he OR SHE shall deem appropriate and within amounts
S. 2606--B 188 A. 3006--B
made available therefor, for reimbursement of the necessary and inci-
dental costs incurred by such ambulance OR ADVANCED LIFE SUPPORT FIRST
RESPONSE 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 OR ADVANCED LIFE SUPPORT FIRST RESPONSE service or with the fire
commissioners of fire districts operating certified voluntary ambulance
services for the use of necessary equipment upon such terms and condi-
tions 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.
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
S. 2606--B 189 A. 3006--B
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
(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
S. 2606--B 190 A. 3006--B
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
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. 2606--B 191 A. 3006--B
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 BE
AUTHORIZED TO 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
MEANS BY WHICH SUCH PERSONNEL, INCLUDING INSTRUCTOR LEVEL PERSONNEL, MAY
BE TRAINED AND CERTIFIED. THE PROGRAM MAY INCLUDE MEANS THAT ALLOW FOR
RECERTIFICATION 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
S. 2606--B 192 A. 3006--B
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]
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-
S. 2606--B 193 A. 3006--B
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
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. 2606--B 194 A. 3006--B
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
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
S. 2606--B 195 A. 3006--B
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, AND SUCH AGENCY OR PROGRAM IS APPROVED BY THE
DEPARTMENT FOR PARTICIPATION IN THE DEMONSTRATION PROGRAM DEVELOPED
PURSUANT TO THIS SUBPARAGRAPH; (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 AND IDENTI-
FYING PERMISSIBLE TASKS AND ACTIVITIES TO BE PERFORMED BY ADVANCED HOME
HEALTH AIDES PURSUANT TO PARAGRAPH (I) OF SUBDIVISION ONE OF SECTION
SIXTY-NINE HUNDRED EIGHT OF THE EDUCATION LAW, CERTIFY ADVANCED HOME
HEALTH AIDES.
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
S. 2606--B 196 A. 3006--B
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-
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
S. 2606--B 197 A. 3006--B
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 OR BY A REGISTERED DENTAL HYGIENIST WORKING FOR A
HOSPITAL AS DEFINED IN ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW WHO
PRACTICES IN COLLABORATION WITH A LICENSED DENTIST IN ACCORDANCE WITH
SUBDIVISION ONE OF SECTION SIXTY-SIX HUNDRED SIX OF THIS ARTICLE, as
defined in regulations of the commissioner.
S 93. Subdivision 10 of section 6611 of the education law, as amended
by chapter 65 of the laws of 2011, is amended to read as follows:
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
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] ASSESSMENT 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, OR A REGISTERED
DENTAL HYGIENIST 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 authorized to
practice in the jurisdiction in which the [examination] ASSESSMENT was
given, provided that the commissioner has determined that such jurisdic-
tion has standards of licensure and practice comparable to those of New
S. 2606--B 198 A. 3006--B
York. Each such certificate shall describe the dental health condition
of the student when the [examination] ASSESSMENT was made, which shall
not be more than twelve months prior to the commencement of the school
year in which the [examination] ASSESSMENT 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
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
S. 2606--B 199 A. 3006--B
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
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
S. 2606--B 200 A. 3006--B
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,
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
S. 2606--B 201 A. 3006--B
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
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
S. 2606--B 202 A. 3006--B
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
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-
S. 2606--B 203 A. 3006--B
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
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
S. 2606--B 204 A. 3006--B
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.
(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. Paragraph (b) of subdivision 2 of section 1676 of the public
authorities law is amended by adding a new undesignated paragraph to
read as follows:
SUCH BUSINESS CORPORATIONS AS ARE ESTABLISHED PURSUANT TO SUBDIVISION
EIGHTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A OF THE PUBLIC HEALTH LAW
FOR THE ACQUISITION, CONSTRUCTION, RECONSTRUCTION, REHABILITATION AND
S. 2606--B 205 A. 3006--B
IMPROVEMENT, OR OTHERWISE PROVIDING, FURNISHING AND EQUIPPING OF A
HOSPITAL OR HOSPITALS.
S 105-a. Subdivision 1 of section 1680 of the public authorities law
is amended by adding a new undesignated paragraph to read as follows:
SUCH BUSINESS CORPORATIONS AS ARE ESTABLISHED PURSUANT TO SUBDIVISION
EIGHTEEN OF SECTION TWENTY-EIGHT HUNDRED ONE-A OF THE PUBLIC HEALTH LAW
FOR THE ACQUISITION, CONSTRUCTION, RECONSTRUCTION, REHABILITATION AND
IMPROVEMENT, OR OTHERWISE PROVIDING, FURNISHING AND EQUIPPING OF A
HOSPITAL OR HOSPITALS.
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:
(I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
S. 2606--B 206 A. 3006--B
(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) STARTING WITH THE POLICY YEAR BEGINNING JULY FIRST, TWO THOUSAND
THIRTEEN, AND AT LEAST ONCE EVERY FIVE YEARS THEREAFTER, THE SUPERINTEN-
DENT OF FINANCIAL SERVICES SHALL RANK EACH SPECIALTY AND GEOGRAPHIC
LOCATION COMBINATION USED FOR THE PURPOSE OF APPORTIONING PREMIUMS FOR
POLICIES PURCHASED FROM FUNDS AVAILABLE IN THE EXCESS MEDICAL MALPRAC-
TICE LIABILITY COVERAGE POOL ACCORDING TO RISK, FROM HIGHEST TO LOWEST.
ANNUALLY, THE SUPERINTENDENT SHALL DETERMINE THE SPECIALITY AND
GEOGRAPHIC LOCATION COMBINATIONS WITHIN WHICH A POLICY OR POLICIES FOR
EXCESS INSURANCE COVERAGE, OR FOR EQUIVALENT EXCESS INSURANCE COVERAGE,
MAY BE PURCHASED FOR ELIGIBLE PHYSICIANS OR DENTISTS WITHIN THE LIMITS
OF THE APPROPRIATION FOR THE EXCESS MEDICAL MALPRACTICE LIABILITY COVER-
AGE POOL. THE SUPERINTENDENT SHALL GRANT PRIORITY FOR PURCHASING POLI-
CIES IN EACH POLICY YEAR IN DESCENDING ORDER BEGINNING WITH THE HIGHEST
RISK SPECIALITY AND GEOGRAPHIC LOCATION COMBINATION. THE SUPERINTENDENT
AND COMMISSIONER SHALL NOT BE OBLIGATED TO PURCHASE ANY MORE POLICIES
THAN THE NUMBER OF POLICIES THAT CAN BE PURCHASED AT ACTUARIALLY DETER-
MINED ADEQUATE RATES WITHIN THE LIMITS OF THE APPROPRIATION. ONCE THE
BALANCE OF THE APPROPRIATION BECOMES INSUFFICIENT TO COVER ALL PHYSI-
CIANS AND DENTISTS WITHIN A PARTICULAR SPECIALITY AND GEOGRAPHIC
S. 2606--B 207 A. 3006--B
LOCATION COMBINATION, THE REMAINING FUNDS FOR THAT COMBINATION SHALL BE
ALLOCATED TO GENERAL HOSPITALS IN PROPORTION TO THEIR SHARE OF THE TOTAL
NUMBER OF PHYSICIANS OR DENTISTS PRACTICING IN SUCH SPECIALTY AND
GEOGRAPHIC LOCATION COMBINATION WHO WERE CERTIFIED BY THE GENERAL HOSPI-
TALS, AND FOR WHOM POLICIES WERE PURCHASED, IN THE PRIOR YEAR, PROVIDED
THAT ANY SHARE LESS THAN ONE PHYSICIAN OR DENTIST SHALL BE DEEMED TO
EQUAL ZERO. FOR THE PURPOSES OF THE FOREGOING SENTENCE, WITH REGARD TO
POLICIES ISSUED FOR THE COVERAGE PERIOD BEGINNING JULY FIRST, TWO THOU-
SAND THIRTEEN, PRIOR YEAR SHALL MEAN THE POLICY YEAR THAT BEGAN ON JULY
FIRST, TWO THOUSAND ELEVEN.
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
S. 2606--B 208 A. 3006--B
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
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
S. 2606--B 209 A. 3006--B
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
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. 2606--B 210 A. 3006--B
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
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
S. 2606--B 211 A. 3006--B
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;
(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-two, thirty-three, thirty-four, thirty-five, thir-
ty-six, thirty-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;
(i-1) sections forty-three, forty-four, forty-six, forty-seven,
forty-eight and one hundred one of this act shall take effect on the one
hundred eightieth day after it shall have become a law;
(j) sections eighty-seven, eighty-eight, eighty-nine, ninety, ninety-
one, ninety-three, ninety-four and ninety-five of this act shall take
effect April 1, 2014, provided that effective immediately, the addition,
amendment and/or repeal of any rule or regulation necessary 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;
(j-1) section ninety-six of this act shall take effect on the nineti-
eth day after it shall have become a law;
(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
S. 2606--B 212 A. 3006--B
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:
[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 services in such county or city.]
"LOCAL GOVERNMENTAL UNIT" SHALL HAVE THE SAME MEANING AS THAT CONTAINED
IN ARTICLE FORTY-ONE OF THIS CHAPTER.
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-
S. 2606--B 213 A. 3006--B
cy or], ASSUMED by or on behalf of a [substance abuse program] VOLUNTARY
AGENCY or a PROGRAM OPERATED BY A local [agency to finance capital costs
for substance abuse program facilities] GOVERNMENTAL UNIT.
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 PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT OR A VOLUNTARY AGENCY
WITH RESPECT TO THE ACQUISITION OF REAL PROPERTY ESTATES, INTERESTS, AND
COOPERATIVE INTERESTS IN REALTY, THEIR DESIGN, CONSTRUCTION, RECON-
STRUCTION, 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.
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] PROGRAM OPERATED
BY A local [agency] GOVERNMENTAL UNIT OR VOLUNTARY AGENCY up to one
hundred per centum of the APPROVED NET operating costs of such [program]
PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT 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 PROGRAM OPERATED BY A
LOCAL GOVERNMENTAL UNIT OR A VOLUNTARY AGENCY FOR CAPITAL COSTS ASSOCI-
ATED 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 PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT 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 OPERATING 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 finan-
cial support for approved chemical 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.
S. 2606--B 214 A. 3006--B
(D) NOTHING IN THIS SECTION SHALL BE CONSTRUED TO REQUIRE THE STATE TO
INCREASE SUCH STATE AID SHOULD A LOCAL GOVERNMENTAL UNIT 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 PROGRAM OPERATED BY A local [agency] GOVERNMENTAL UNIT 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.
(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
S. 2606--B 215 A. 3006--B
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 PROGRAM OPERATED BY
A local [agency] GOVERNMENTAL UNIT 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 opera-
tion of such program or agency, or the other resources available for use
in the operation of the program or agency.
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 PROGRAM OPERATED BY A local [agency] GOVERNMENTAL UNIT 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 A LOCAL
GOVERNMENTAL UNIT.
[(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
S. 2606--B 216 A. 3006--B
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 GOVERNMENTAL UNITS IN THE FOLLOWING MANNER:
(A) LOCAL GOVERNMENTAL UNITS SHALL BE GRANTED STATE AID BY A STATE AID
FUNDING AUTHORIZATION LETTER ISSUED BY THE OFFICE FOR APPROVED NET OPER-
ATING 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 GOVERNMENTAL UNIT 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 GOVERN-
MENTAL UNIT PURSUANT TO ARTICLE FORTY-ONE OF THIS CHAPTER, THE AREAS TO
BE SERVED AND INCLUDE A DESCRIPTION OF THE VOLUNTARY AGENCY CONTRIB-
UTIONS AND LOCAL GOVERNMENTAL UNIT FUNDING PROVIDED. THE LOCAL GOVERN-
MENTAL UNIT SHALL ENTER INTO CONTRACTS WITH THE VOLUNTARY AGENCIES
RECEIVING SUCH STATE AID. SUCH CONTRACTS SHALL INCLUDE FUNDING REQUIRE-
MENTS SET BY THE OFFICE INCLUDING BUT NOT LIMITED TO RESPONSIBILITIES OF
VOLUNTARY AGENCIES RELATING TO WORK SCOPES, PROGRAM PERFORMANCE AND
OPERATIONS, APPLICATION OF PROGRAM INCOME, PROHIBITED USE OF FUNDS,
RECORDKEEPING AND AUDIT OBLIGATIONS. UPON DESIGNATION BY THE OFFICE,
LOCAL GOVERNMENTAL UNITS SHALL NOTIFY VOLUNTARY AGENCIES AS TO THE
SOURCE OF FUNDING RECEIVED BY SUCH VOLUNTARY AGENCIES.
(B) STATE AID MADE AVAILABLE TO A LOCAL GOVERNMENTAL UNIT 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 PROGRAM OPERATED BY A LOCAL GOVERNMENTAL UNIT OR VOLUN-
TARY AGENCY HAS FAILED TO MEET MINIMUM PERFORMANCE STANDARDS AND
REQUIREMENTS OF THE OFFICE INCLUDING, BUT NOT LIMITED TO, MAINTAINING
SERVICE UTILIZATION RATES AND PRODUCTIVITY 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 GOVERNMENTAL
UNIT, 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
S. 2606--B 217 A. 3006--B
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 PROGRAM OPERATED BY A local [agency] GOVERNMENTAL UNIT or
[substance abuse program] VOLUNTARY AGENCY shall, unless a specific
written waiver of this requirement is made by the office, cause applica-
tions 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 PROGRAM OPER-
ATED BY A local [agency] GOVERNMENTAL UNIT or a [substance abuse
program] VOLUNTARY AGENCY shall furnish to the office such other data as
may be required and shall render such cooperation as may be necessary to
maximize such potential federal aid. All information concerning the
identity of individuals obtained and provided pursuant to this subdivi-
sion 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
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 A PROGRAM OPERATED BY
A local [agencies] GOVERNMENTAL UNIT 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 A PROGRAM OPERATED BY A local [agencies] GOVERNMENTAL UNIT any
federal aid received by the state which is attributable to the activ-
ities financed by such programs and agencies.
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 treatment programs]
VOLUNTARY AGENCIES AND PROGRAMS OPERATED BY LOCAL GOVERNMENTAL UNITS
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
S. 2606--B 218 A. 3006--B
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
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
S. 2606--B 219 A. 3006--B
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.
(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
S. 2606--B 220 A. 3006--B
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
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
S. 2606--B 221 A. 3006--B
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 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.
S. 2606--B 222 A. 3006--B
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
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-
S. 2606--B 223 A. 3006--B
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
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.
S. 2606--B 224 A. 3006--B
(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 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
S. 2606--B 225 A. 3006--B
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
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
mental 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 mental 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:
S. 2606--B 226 A. 3006--B
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.
PART O
Section 1. Legislative findings and purpose. Recent actions by the
United States Center for Medicare and Medicaid Services impact the
stability of New York state's mental hygiene system. While the state
must embark on a deliberate path to replace the existing, long-standing
financing system for developmental disability services, replacement of
the sudden loss of $1.1 billion in federal revenue is too significant to
be solved solely by actions within the mental hygiene system. A partner-
ship with the entire health care community is needed to manage this loss
over time. Accordingly, this part authorizes the actions necessary and
creates the Mental Hygiene Stabilization Fund that will be supported by
department of health medicaid resources under the Global Cap in annual
amounts not to exceed $730,000,000 in state fiscal year 2013-14,
$445,000,000 in 2014-15, $267,000,000 in 2015-16, and $267,000,000 in
2016-17.
S 2. Notwithstanding any contrary provision of law, the commissioner
of health may, in consultation with the director of the budget, annul
implementation of the reimbursement reductions authorized by section one
of part A of this act with regard to any period between April 1, 2013
and March 31, 2015 if it is determined by the commissioner of health, in
consultation with the director of the budget, that such annulment may be
accomplished consistent with the implementation of the provisions of
section 92 of part H of chapter 59 of the laws of 2011, as amended.
S 3. Notwithstanding any contrary provision of law, implementation of
the provisions of sections twenty-two, twenty-three, and/or twenty-four
of part A of this act shall be delayed to the state fiscal year begin-
ning April 1, 2014, provided, however, that the commissioner of health
may, in consultation with the director of the budget, implement one or
more of such provisions during the 2013-14 state fiscal year if it is
determined that such implementation may be accomplished consistent with
the implementation of the provisions of section 92 of part H of chapter
59 of the laws of 2011, as amended.
S. 2606--B 227 A. 3006--B
S 4. 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 5. 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, as
amended, 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 6. 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 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 7. This act shall take effect immediately and shall be deemed to
have been in full force and effect on and after April 1, 2013.
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 O of this act shall be
as specifically set forth in the last section of such Parts.