senate Bill S6446

2013-2014 Legislative Session

Relates to medicaid payment for co-payments due under Medicare Part D

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 24, 2014 referred to health

S6446 - Bill Details

See Assembly Version of this Bill:
A5349
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd §273, Pub Health L; amd §§367-a & 365-a, Soc Serv L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A5349, A576
2009-2010: A884

S6446 - Bill Texts

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Relates to medicaid payment for co-payments due under Medicare Part D; authorizes the commissioner of health to create a system to incorporate co-payments billed to a recipient under Medicare Part D towards the recipient's total annual co-payments under medical assistance.

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BILL NUMBER:S6446

TITLE OF BILL: An act to amend the public health law and the social
services law, in relation to medicaid payment for co-payments due under
Medicare Part D

PURPOSE OR GENERAL IDEA OF BILL:

To aid dual-eligible Medicare Part D recipients with prescription drug
co-payments.

SUMMARY OF SPECIFIC PROVISIONS:

The bill provides for Medicaid to pay the Medicare Part D co-payments
for dual-eligible Medicare-Medicaid recipients, once the recipient has
reached the Medicaid $200-a-year co-payment cap (counting Part D co-pay-
ments). Coverage for these co-payments would be exempt from Medicaid
prior authorization. it directs the Commissioner of Health to create a
system that allows pharmacists to register a dual-eligible individual's
Medicare Part D co-payments in the Medicaid system, and establishes that
Medicaid shall provide for payment of the Part D co-payment after $200
in co-payments have been made.

JUSTIFICATION:

Medicaid's co-payment system has always allowed an individual to receive
their medications, even if they do not have the ability to pay their
co-payment. But under Medicare Part D (which they are required to
participate in), these individuals are required to pay the co-payments
required by their Part D plan. When they cannot afford to pay, they go
without necessary medications and then receive much more costly medical
care, at the expense of the Medicaid program. This law will remove a
loophole from the Medicaid law, where individuals who are eligible for
both Medicare and Medicaid receive an inferior level of care than those
only eligible for Medicaid by extending the co-payment can to
prescription drugs provided under the Part D program, a right that all
other Medicaid recipients currently enjoy.

PRIOR LEGISLATIVE HISTORY:

2006: A11377 (Friedman) - passed Assembly
2007: A3598-A (Gottfried) - referred to Ways and Means
2008: A3598-A (Gottfried) - referred to Ways and Means
2009-10: A.884 - referred to Ways and Means
2011-12; A.576 - referred to Health

FISCAL IMPLICATIONS:

Minimal

EFFECTIVE DATE:

This bill shall take effect on the first of April next succeeding the
data on which it shall have become law.

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

                                  6446

                            I N  S E N A T E

                            January 24, 2014
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the social  services  law,  in
  relation to medicaid payment for co-payments due under Medicare Part D

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

  Section 1. Subdivision 7 of section 273 of the public health  law,  as
amended  by  section  7  of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
  7. No prior authorization under the preferred drug  program  shall  be
required when a prescriber prescribes a drug on the preferred drug list,
OR  WHEN  MEDICAL  ASSISTANCE  PAYMENT  IS  MADE, UNDER PARAGRAPH (G) OF
SUBDIVISION TWO OF SECTION THREE  HUNDRED  SIXTY-FIVE-A  OF  THE  SOCIAL
SERVICES  LAW SOLELY FOR THE CO-PAYMENT FOR PRESCRIPTIONS PROVIDED UNDER
PART D OF TITLE XVIII OF THE  FEDERAL  SOCIAL  SECURITY  ACT;  provided,
however,  that  the  commissioner  may  identify [such] a drug for which
prior authorization is required pursuant to the provisions of the  clin-
ical  drug review program established under section two hundred seventy-
four of this article.
  S 2. Subparagraph (ii) of paragraph (f) of subdivision  6  of  section
367-a  of the social services law, as amended by section 42 of part C of
chapter 58 of the laws of 2005, is amended to read as follows:
  (ii) In the year commencing April first, two  thousand  five  and  for
each  year thereafter, no recipient shall be required to pay more than a
total of two hundred dollars in co-payments, INCLUDING THOSE required by
this subdivision[, nor] AND, FOR RECIPIENTS ELIGIBLE FOR COVERAGE  UNDER
PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT (REFERRED TO IN
THIS  SECTION AS "MEDICARE PART D"), THOSE CO-PAYMENTS REQUIRED BY MEDI-
CARE PART D. NOR shall reductions  in  payments  as  a  result  of  such
co-payments  exceed  two hundred dollars for any recipient.  THE COMMIS-
SIONER OF HEALTH SHALL CREATE A SYSTEM TO INCORPORATE CO-PAYMENTS BILLED
TO A RECIPIENT UNDER MEDICARE PART D TOWARDS THE RECIPIENT'S TOTAL ANNU-
AL CO-PAYMENTS UNDER MEDICAL ASSISTANCE.  AS PART OF THIS SYSTEM,  PHAR-
MACISTS SHALL RECORD ALL CO-PAYMENTS DUE UNDER MEDICARE PART D FROM SUCH

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04596-01-3

S. 6446                             2

RECIPIENTS  WITH  THE  MEDICAL  ASSISTANCE  PROGRAM, THROUGH THE MEDICAL
ASSISTANCE ELECTRONIC BILLING SYSTEM.  THE COMMISSIONER OF HEALTH  SHALL
INCLUDE  THE  CO-PAYMENTS  BILLED  UNDER  MEDICARE PART D ALONG WITH THE
CO-PAYMENTS  REQUIRED  UNDER  THIS  SUBDIVISION  IN DETERMINING WHEN THE
RECIPIENT'S TOTAL ANNUAL CO-PAYMENTS HAVE REACHED TWO HUNDRED DOLLARS.
  S 3. 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,  FOR  RECIPIENTS  ELIGIBLE
FOR  COVERAGE UNDER PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY
ACT (REFERRED TO IN THIS SECTION AS "MEDICARE PART D"), PAYMENT  OF  THE
CO-PAYMENT FOR DRUGS PROVIDED BY A MEDICARE PART D PLAN, AFTER THE INDI-
VIDUAL  HAS REACHED THE ANNUAL CAP ON CO-PAYMENTS AS DEFINED IN SUBPARA-
GRAPH (II) OF PARAGRAPH (F) OF SUBDIVISION SIX OF SECTION THREE  HUNDRED
SIXTY-SEVEN-A  OF THIS TITLE, 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 availability 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 quantities no greater than
a thirty day supply or one hundred doses, whichever is greater; provided
further  that  the commissioner of health is authorized to require prior
authorization for any refill of a prescription when less  than  seventy-
five  percent  of  the  previously dispensed amount per fill should have
been used were the product used as normally indicated; provided  further
that  the commissioner of health is authorized to require prior authori-
zation  of  prescriptions  of  opioid  analgesics  in  excess  of   four
prescriptions  in  a  thirty-day  period  in accordance with section two
hundred seventy-three of the public health law; medical assistance shall
not include any drug provided on other  than  an  in-patient  basis  for
which  a  recipient  is  charged  or  a  claim  is made in the case of a
prescription drug, in excess of the maximum reimbursable amounts  to  be
established  by  department  regulations  in  accordance  with standards
established by the secretary of the United States department  of  health
and  human  services,  or,  in  the  case  of  a  drug  not  requiring a
prescription, in excess of the maximum reimbursable  amount  established
by  the  commissioner of health pursuant to paragraph (a) of subdivision
four of this section;
  S 4. This act shall take effect on the first of April next  succeeding
the date on which it shall have become a law.

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