The New York State Senate

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

                                 5062--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 11, 2015
                               ___________

Introduced by M. of A. GOTTFRIED, ABINANTI, BARRON, BENEDETTO, BICHOTTE,
  BLAKE,  BRONSON,  COLTON,  COOK,  CRESPO, CYMBROWITZ, DINOWITZ, ENGLE-
  BRIGHT, GANTT, HIKIND, JAFFEE,  JEAN-PIERRE,  JOYNER,  KAVANAGH,  KIM,
  LAVINE,  LIFTON,  LINARES,  LUPARDO,  MOSLEY,  PEOPLES-STOKES,  PERRY,
  PICHARDO, RAMOS, RODRIGUEZ, ROSENTHAL,  RUSSELL,  SCHIMEL,  SEAWRIGHT,
  SEPULVEDA,  STECK,  STIRPE,  TITONE, TITUS, WALKER, WEINSTEIN, WEPRIN,
  DILAN, GJONAJ, RICHARDSON, MOYA,  SIMOTAS,  HUNTER,  MILLER,  HYNDMAN,
  RIVERA  -- Multi-Sponsored by -- M. of A. ABBATE, ARROYO, AUBRY, BREN-
  NAN, CAHILL, DAVILA, FAHY, FARRELL, GLICK,  GUNTHER,  HOOPER,  LENTOL,
  MAGEE,  MAGNARELLI, MARKEY, MAYER, McDONALD, O'DONNELL, ORTIZ, PAULIN,
  PRETLOW, QUART, ROBINSON, ROZIC, SIMON,  SKARTADOS,  SOLAGES,  THIELE,
  WRIGHT -- read once and referred to the Committee on Health -- ordered
  to  a  third  reading  --  recommitted  to  the Committee on Health in
  accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

AN ACT to amend the public health law and  the  state  finance  law,  in
  relation to enacting the "New York health act" and to establishing New
  York Health

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

  Section 1. Short title. This act shall be known and may  be  cited  as
the "New York health act".
  S  2.  Legislative  findings  and  intent.  1.  The state constitution
states: "The protection and promotion of the health of  the  inhabitants
of  the state are matters of public concern and provision therefor shall
be made by the state and by such of its subdivisions and in such manner,
and by such means as the legislature shall from time to time determine."
(Article XVII, S3.) The legislature finds and declares  that  all  resi-
dents  of  the  state  have the right to health care.  While the federal
Affordable Care Act brought many improvements in health care and  health

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07764-05-6

A. 5062--A                          2

coverage,  it  still  leaves  many  New Yorkers without coverage or with
inadequate coverage.  New  Yorkers  -  as  individuals,  employers,  and
taxpayers  -  have  experienced  a  rise  in the cost of health care and
coverage  in  recent  years,  including rising premiums, deductibles and
co-pays, restricted provider networks and high  out-of-network  charges.
Businesses  have  also experienced increases in the costs of health care
benefits for their employees, and many employers are shifting  a  larger
share  of  the  cost of coverage to their employees or dropping coverage
entirely.  Health care providers are also affected by inadequate  health
coverage  in  New  York  state.  A large portion of voluntary and public
hospitals, health centers and other providers now experience substantial
losses due to the provision of care that is  uncompensated.  Individuals
often  find that they are deprived of affordable care and choice because
of decisions by health plans guided by the plan's economic needs  rather
than  their  health  care needs. To address the fiscal crisis facing the
health care system and the state and to assure New Yorkers can  exercise
their right to health care, affordable and comprehensive health coverage
must  be  provided.  Pursuant  to the state constitution's charge to the
legislature to provide for the health of New Yorkers,  this  legislation
is  an  enactment  of  state  concern  for the purpose of establishing a
comprehensive universal single-payer health care coverage program and  a
health  care cost control system for the benefit of all residents of the
state of New York.
  2. It is the intent of the Legislature to create the New  York  Health
program  to provide a universal health plan for every New Yorker, funded
by broad-based revenue based on ability to pay.  The state shall work to
obtain waivers and other approvals relating to  Medicaid,  Child  Health
Plus,  Medicare,  the  Affordable  Care  Act,  and any other appropriate
federal programs, under which federal funds  and  other  subsidies  that
would  otherwise be paid to New York State, New Yorkers, and health care
providers for health coverage that will be equaled or  exceeded  by  New
York Health will be paid by the federal government to New York State and
deposited  in  the  New  York  Health  trust fund, and for other program
modifications (including  elimination  of  cost  sharing  and  insurance
premiums).    Under  such  waivers  and approvals, health coverage under
those programs will be replaced and merged into New York  Health,  which
will operate as a true single-payer program.
  If  any  necessary waiver or approval is not obtained, the state shall
use state plan amendments and seek waivers and  approvals  to  maximize,
and  make  as  seamless as possible, the use of federally-matched health
programs and federal health programs in New York  Health.    Thus,  even
where  other  programs  such  as  Medicaid or Medicare may contribute to
paying for care, it is the goal of this legislation  that  the  coverage
will  be  delivered  by  New  York  Health and, as much as possible, the
multiple sources of funding will be pooled with other  New  York  Health
funds  and  not  be apparent to New York Health members or participating
providers.  This program will promote movement away from fee-for-service
payment, which tends to reward quantity and requires excessive  adminis-
trative  expense,  and  towards alternate payment methodologies, such as
global or capitated payments to providers or health care  organizations,
that  promote  quality, efficiency, investment in primary and preventive
care, and innovation and integration in the organizing of health care.
  3. This act does not  create  any  employment  benefit,  nor  does  it
require, prohibit, or limit the providing of any employment benefit.
  4. In order to promote improved quality of, and access to, health care
services and promote improved clinical outcomes, it is the policy of the

A. 5062--A                          3

state  to  encourage cooperative, collaborative and integrative arrange-
ments among health care providers who might  otherwise  be  competitors,
under  the  active  supervision of the commissioner of health. It is the
intent  of  the state to supplant competition with such arrangements and
regulation only to the extent necessary to accomplish  the  purposes  of
this  act,  and  to  provide  state  action immunity under the state and
federal antitrust laws  to  health  care  providers,  particularly  with
respect  to  their  relations with the single-payer New York Health plan
created by this act.
  S 3. Article 50 and sections 5000, 5001, 5002 and 5003 of  the  public
health  law  are renumbered article 80 and sections 8000, 8001, 8002 and
8003, respectively, and a new article 51 is added to read as follows:
                                ARTICLE 51
                             NEW YORK HEALTH
SECTION 5100. DEFINITIONS.
        5101. PROGRAM CREATED.
        5102. BOARD OF TRUSTEES.
        5103. ELIGIBILITY AND ENROLLMENT.
        5104. BENEFITS.
        5105. HEALTH CARE PROVIDERS; CARE COORDINATION; PAYMENT  METHOD-
                OLOGIES.
        5106. HEALTH CARE ORGANIZATIONS.
        5107. PROGRAM STANDARDS.
        5108. REGULATIONS.
        5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS.
        5110. ADDITIONAL PROVISIONS.
        5111. REGIONAL ADVISORY COUNCILS.
  S  5100.  DEFINITIONS.  AS  USED  IN THIS ARTICLE, THE FOLLOWING TERMS
SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT  CLEARLY  REQUIRES
OTHERWISE:
  1.  "BOARD" MEANS THE BOARD OF TRUSTEES OF THE NEW YORK HEALTH PROGRAM
CREATED BY SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE, AND  "TRUSTEE"
MEANS A TRUSTEE OF THE BOARD.
  2.  "CARE  COORDINATION" MEANS SERVICES PROVIDED BY A CARE COORDINATOR
UNDER SUBDIVISION TWO OF SECTION FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE.
  3. "CARE COORDINATOR"  MEANS  AN  INDIVIDUAL  OR  ENTITY  APPROVED  TO
PROVIDE  CARE  COORDINATION  UNDER  SUBDIVISION TWO OF SECTION FIFTY-ONE
HUNDRED FIVE OF THIS ARTICLE.
  4. "FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM" MEANS THE MEDICAL ASSIST-
ANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE  SOCIAL  SERVICES
LAW,  THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED SIXTY-NINE-GG
OF THE SOCIAL SERVICES LAW, AND THE  CHILD  HEALTH  PLUS  PROGRAM  UNDER
TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  5.  "HEALTH CARE ORGANIZATION" MEANS AN ENTITY THAT IS APPROVED BY THE
COMMISSIONER UNDER SECTION FIFTY-ONE HUNDRED  SIX  OF  THIS  ARTICLE  TO
PROVIDE HEALTH CARE SERVICES TO MEMBERS UNDER THE PROGRAM.
  6. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
  7. "IMPLEMENTATION PERIOD" MEANS THE PERIOD UNDER SUBDIVISION THREE OF
SECTION  FIFTY-ONE  HUNDRED ONE OF THIS ARTICLE DURING WHICH THE PROGRAM
WILL BE SUBJECT TO SPECIAL ELIGIBILITY AND FINANCING PROVISIONS UNTIL IT
IS FULLY IMPLEMENTED UNDER THAT SECTION.
  8. "LONG TERM CARE" MEANS LONG TERM CARE, TREATMENT,  MAINTENANCE,  OR
SERVICES  NOT  COVERED UNDER CHILD HEALTH PLUS, AS APPROPRIATE, WITH THE
EXCEPTION OF SHORT TERM REHABILITATION, AS DEFINED BY THE COMMISSIONER.

A. 5062--A                          4

  9. "MEDICAID" OR "MEDICAL ASSISTANCE" MEANS TITLE  ELEVEN  OF  ARTICLE
FIVE  OF  THE  SOCIAL  SERVICES  LAW AND THE PROGRAM THEREUNDER.  "CHILD
HEALTH PLUS" MEANS TITLE ONE-A OF ARTICLE TWENTY-FIVE  OF  THIS  CHAPTER
AND  THE PROGRAM THEREUNDER. "MEDICARE" MEANS TITLE XVIII OF THE FEDERAL
SOCIAL SECURITY ACT AND THE PROGRAMS THEREUNDER.  "BASIC HEALTH PROGRAM"
MEANS SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW AND
THE PROGRAM THEREUNDER.
  10. "MEMBER" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE PROGRAM.
  11.  "NEW YORK HEALTH TRUST FUND" MEANS THE NEW YORK HEALTH TRUST FUND
ESTABLISHED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE LAW.
  12. "OUT-OF-STATE HEALTH CARE SERVICE" MEANS  A  HEALTH  CARE  SERVICE
PROVIDED  TO A MEMBER WHILE THE MEMBER IS OUT OF THE STATE AND (A) IT IS
MEDICALLY NECESSARY THAT THE HEALTH CARE SERVICE BE PROVIDED  WHILE  THE
MEMBER IS OUT OF THE STATE, OR (B) IT IS CLINICALLY APPROPRIATE THAT THE
HEALTH  CARE  SERVICE  BE  PROVIDED BY A PARTICULAR HEALTH CARE PROVIDER
LOCATED OUT OF THE STATE RATHER THAN IN THE STATE.  HOWEVER, ANY  HEALTH
CARE  SERVICE  PROVIDED  TO  A NEW YORK HEALTH ENROLLEE BY A HEALTH CARE
PROVIDER QUALIFIED UNDER PARAGRAPH (A) OF SUBDIVISION THREE  OF  SECTION
FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE THAT IS LOCATED OUTSIDE THE STATE
SHALL  NOT BE CONSIDERED AN OUT-OF-STATE SERVICE AND SHALL BE COVERED AS
OTHERWISE PROVIDED IN THIS ARTICLE.
  13. "PARTICIPATING PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY THAT IS  A
HEALTH  CARE  PROVIDER  QUALIFIED  UNDER  SUBDIVISION  THREE  OF SECTION
FIFTY-ONE HUNDRED  FIVE  OF  THIS  ARTICLE  THAT  PROVIDES  HEALTH  CARE
SERVICES TO MEMBERS UNDER THE PROGRAM, OR A HEALTH CARE ORGANIZATION.
  14.  "AFFORDABLE  CARE  ACT"  MEANS THE FEDERAL PATIENT PROTECTION AND
AFFORDABLE CARE ACT, PUBLIC LAW 111-148, AS AMENDED BY THE  HEALTH  CARE
AND  EDUCATION  RECONCILIATION  ACT  OF 2010, PUBLIC LAW 111-152, AND AS
OTHERWISE AMENDED AND ANY REGULATIONS OR GUIDANCE ISSUED THEREUNDER.
  15. "PERSON" MEANS ANY INDIVIDUAL OR NATURAL PERSON,  TRUST,  PARTNER-
SHIP,  ASSOCIATION,  UNINCORPORATED  ASSOCIATION,  CORPORATION, COMPANY,
LIMITED LIABILITY COMPANY, PROPRIETORSHIP, JOINT  VENTURE,  FIRM,  JOINT
STOCK ASSOCIATION, DEPARTMENT, AGENCY, AUTHORITY, OR OTHER LEGAL ENTITY,
WHETHER FOR-PROFIT, NOT-FOR-PROFIT OR GOVERNMENTAL.
  16.  "PROGRAM"  MEANS  THE  NEW YORK HEALTH PROGRAM CREATED BY SECTION
FIFTY-ONE HUNDRED ONE OF THIS ARTICLE.
  17. "PRESCRIPTION AND NON-PRESCRIPTION DRUGS" MEANS PRESCRIPTION DRUGS
AS DEFINED IN SECTION TWO HUNDRED SEVENTY OF THIS CHAPTER, AND NON-PRES-
CRIPTION SMOKING CESSATION PRODUCTS OR DEVICES.
  18. "RESIDENT" MEANS AN INDIVIDUAL WHOSE PRIMARY PLACE OF ABODE IS  IN
THE  STATE,  WITHOUT  REGARD  TO THE INDIVIDUAL'S IMMIGRATION STATUS, AS
DETERMINED ACCORDING TO REGULATIONS OF THE COMMISSIONER.
  S 5101. PROGRAM CREATED. 1. THE NEW  YORK  HEALTH  PROGRAM  IS  HEREBY
CREATED  IN  THE DEPARTMENT. THE COMMISSIONER SHALL ESTABLISH AND IMPLE-
MENT THE PROGRAM UNDER THIS ARTICLE. THE PROGRAM SHALL  PROVIDE  COMPRE-
HENSIVE HEALTH COVERAGE TO EVERY RESIDENT WHO ENROLLS IN THE PROGRAM.
  2.  THE  COMMISSIONER SHALL, TO THE MAXIMUM EXTENT POSSIBLE, ORGANIZE,
ADMINISTER AND MARKET THE PROGRAM AND SERVICES AS A SINGLE PROGRAM UNDER
THE NAME "NEW YORK HEALTH" OR SUCH OTHER NAME AS THE COMMISSIONER  SHALL
DETERMINE,  REGARDLESS  OF UNDER WHICH LAW OR SOURCE THE DEFINITION OF A
BENEFIT IS FOUND INCLUDING (ON A VOLUNTARY BASIS) RETIREE  HEALTH  BENE-
FITS.    IN  IMPLEMENTING THIS SUBDIVISION, THE COMMISSIONER SHALL AVOID
JEOPARDIZING FEDERAL FINANCIAL PARTICIPATION IN THESE PROGRAMS AND SHALL
TAKE CARE TO PROMOTE PUBLIC UNDERSTANDING  AND  AWARENESS  OF  AVAILABLE
BENEFITS AND PROGRAMS.

A. 5062--A                          5

  3. THE COMMISSIONER SHALL DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLL-
ING IN THE PROGRAM. THERE SHALL BE AN IMPLEMENTATION PERIOD, WHICH SHALL
BEGIN  ON  THE  DATE THAT INDIVIDUALS MAY BEGIN ENROLLING IN THE PROGRAM
AND SHALL END AS DETERMINED BY THE COMMISSIONER.
  4. AN INSURER AUTHORIZED TO PROVIDE COVERAGE PURSUANT TO THE INSURANCE
LAW  OR  A  HEALTH MAINTENANCE ORGANIZATION CERTIFIED UNDER THIS CHAPTER
MAY, IF OTHERWISE AUTHORIZED, OFFER  BENEFITS  THAT  DO  NOT  COVER  ANY
SERVICE  FOR WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER THE PROGRAM,
BUT MAY NOT OFFER BENEFITS THAT COVER ANY SERVICE FOR WHICH COVERAGE  IS
OFFERED  TO  INDIVIDUALS UNDER THE PROGRAM. PROVIDED, HOWEVER, THAT THIS
SUBDIVISION SHALL NOT PROHIBIT (A) THE OFFERING OF ANY  BENEFITS  TO  OR
FOR  INDIVIDUALS, INCLUDING THEIR FAMILIES, WHO ARE EMPLOYED OR SELF-EM-
PLOYED IN THE STATE BUT WHO ARE NOT RESIDENTS OF THE STATE, OR  (B)  THE
OFFERING OF BENEFITS DURING THE IMPLEMENTATION PERIOD TO INDIVIDUALS WHO
ENROLLED OR MAY ENROLL AS MEMBERS OF THE PROGRAM, OR (C) THE OFFERING OF
RETIREE HEALTH BENEFITS.
  5.  A  COLLEGE, UNIVERSITY OR OTHER INSTITUTION OF HIGHER EDUCATION IN
THE STATE MAY PURCHASE COVERAGE UNDER THE PROGRAM FOR  ANY  STUDENT,  OR
STUDENT'S DEPENDENT, WHO IS NOT A RESIDENT OF THE STATE.
  6.  TO  THE  EXTENT ANY PROVISION OF THIS CHAPTER, THE SOCIAL SERVICES
LAW OR THE INSURANCE LAW:
  (A) IS INCONSISTENT WITH ANY PROVISION OF THIS ARTICLE OR THE LEGISLA-
TIVE INTENT OF THE NEW YORK HEALTH ACT, THIS  ARTICLE  SHALL  APPLY  AND
PREVAIL, EXCEPT WHERE EXPLICITLY PROVIDED OTHERWISE BY THIS ARTICLE; AND
  (B) IS CONSISTENT WITH THE PROVISIONS OF THIS ARTICLE AND THE LEGISLA-
TIVE  INTENT OF THE NEW YORK HEALTH ACT, THE PROVISION OF THAT LAW SHALL
APPLY.
  S 5102. BOARD OF TRUSTEES. 1. THE NEW YORK HEALTH BOARD OF TRUSTEES IS
HEREBY CREATED IN THE DEPARTMENT. THE BOARD OF TRUSTEES  SHALL,  AT  THE
REQUEST  OF  THE  COMMISSIONER,  CONSIDER  ANY  MATTER TO EFFECTUATE THE
PROVISIONS AND PURPOSES OF THIS ARTICLE, AND MAY ADVISE THE COMMISSIONER
THEREON; AND IT MAY, FROM TIME TO TIME, SUBMIT TO THE  COMMISSIONER  ANY
RECOMMENDATIONS  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTI-
CLE. THE COMMISSIONER MAY PROPOSE REGULATIONS  UNDER  THIS  ARTICLE  AND
AMENDMENTS THERETO FOR CONSIDERATION BY THE BOARD. THE BOARD OF TRUSTEES
SHALL  HAVE  NO EXECUTIVE, ADMINISTRATIVE OR APPOINTIVE DUTIES EXCEPT AS
OTHERWISE PROVIDED BY LAW. THE BOARD OF TRUSTEES  SHALL  HAVE  POWER  TO
ESTABLISH,  AND  FROM  TIME TO TIME, AMEND REGULATIONS TO EFFECTUATE THE
PROVISIONS AND PURPOSES OF THIS ARTICLE,  SUBJECT  TO  APPROVAL  BY  THE
COMMISSIONER.
  2. THE BOARD SHALL BE COMPOSED OF:
  (A)  THE  COMMISSIONER,  THE SUPERINTENDENT OF FINANCIAL SERVICES, AND
THE DIRECTOR OF THE BUDGET, OR THEIR DESIGNEES, AS EX OFFICIO MEMBERS;
  (B) NINETEEN TRUSTEES APPOINTED BY THE GOVERNOR;
  (I) FIVE OF WHOM SHALL BE  REPRESENTATIVES  OF  HEALTH  CARE  CONSUMER
ADVOCACY  ORGANIZATIONS WHICH HAVE A STATEWIDE OR REGIONAL CONSTITUENCY,
WHO HAVE BEEN INVOLVED IN ACTIVITIES RELATED  TO  HEALTH  CARE  CONSUMER
ADVOCACY, INCLUDING ISSUES OF INTEREST TO LOW- AND MODERATE-INCOME INDI-
VIDUALS;
  (II)  TWO  OF  WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL ORGANIZA-
TIONS REPRESENTING PHYSICIANS;
  (III) TWO OF WHOM SHALL BE REPRESENTATIVES OF  PROFESSIONAL  ORGANIZA-
TIONS  REPRESENTING  LICENSED  OR  REGISTERED  HEALTH CARE PROFESSIONALS
OTHER THAN PHYSICIANS;
  (IV) THREE OF WHOM SHALL BE REPRESENTATIVES OF HOSPITALS, ONE OF  WHOM
SHALL BE A REPRESENTATIVE OF PUBLIC HOSPITALS;

A. 5062--A                          6

  (V) ONE OF WHOM SHALL BE REPRESENTATIVE OF COMMUNITY HEALTH CENTERS;
  (VI)  TWO  OF  WHOM  SHALL BE REPRESENTATIVES OF HEALTH CARE ORGANIZA-
TIONS; AND
  (VII) TWO OF WHOM SHALL BE REPRESENTATIVES OF ORGANIZED LABOR;
  (VIII) TWO OF WHOM SHALL HAVE DEMONSTRATED EXPERTISE  IN  HEALTH  CARE
FINANCE;
  (C)  TEN  TRUSTEES  APPOINTED  BY  THE  GOVERNOR;  FOUR  OF WHOM TO BE
APPOINTED ON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY; FOUR  OF
WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
THE  SENATE;  ONE  OF  WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE
MINORITY LEADER OF THE ASSEMBLY; AND ONE OF WHOM TO BE APPOINTED ON  THE
RECOMMENDATION OF THE MINORITY LEADER OF THE SENATE.
  3.  AFTER  THE  END OF THE IMPLEMENTATION PERIOD, NO PERSON SHALL BE A
TRUSTEE UNLESS HE OR SHE IS A MEMBER OF THE PROGRAM, EXCEPT THE EX OFFI-
CIO TRUSTEES. EACH TRUSTEE SHALL SERVE AT THE PLEASURE OF THE APPOINTING
OFFICER, EXCEPT THE EX OFFICIO TRUSTEES.
  4. THE CHAIR OF THE BOARD SHALL BE APPOINTED, AND MAY  BE  REMOVED  AS
CHAIR,  BY THE GOVERNOR FROM AMONG THE TRUSTEES. THE BOARD SHALL MEET AT
LEAST FOUR TIMES EACH CALENDAR YEAR. MEETINGS SHALL  BE  HELD  UPON  THE
CALL  OF  THE  CHAIR  AND  AS  PROVIDED  BY THE BOARD. A MAJORITY OF THE
APPOINTED TRUSTEES SHALL BE A QUORUM OF THE BOARD, AND  THE  AFFIRMATIVE
VOTE  OF A MAJORITY OF THE TRUSTEES VOTING, BUT NOT LESS THAN TEN, SHALL
BE NECESSARY FOR ANY ACTION TO BE TAKEN BY  THE  BOARD.  THE  BOARD  MAY
ESTABLISH AN EXECUTIVE COMMITTEE TO EXERCISE ANY POWERS OR DUTIES OF THE
BOARD AS IT MAY PROVIDE, AND OTHER COMMITTEES TO ASSIST THE BOARD OR THE
EXECUTIVE  COMMITTEE.  THE  CHAIR OF THE BOARD SHALL CHAIR THE EXECUTIVE
COMMITTEE AND SHALL APPOINT THE CHAIR AND MEMBERS OF ALL  OTHER  COMMIT-
TEES. THE BOARD OF TRUSTEES MAY APPOINT ONE OR MORE ADVISORY COMMITTEES.
MEMBERS OF ADVISORY COMMITTEES NEED NOT BE MEMBERS OF THE BOARD OF TRUS-
TEES.
  5.  TRUSTEES  SHALL SERVE WITHOUT COMPENSATION BUT SHALL BE REIMBURSED
FOR THEIR NECESSARY AND ACTUAL EXPENSES INCURRED WHILE  ENGAGED  IN  THE
BUSINESS OF THE BOARD.
  6. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, NO OFFICER OR
EMPLOYEE OF THE STATE OR ANY LOCAL GOVERNMENT SHALL FORFEIT OR BE DEEMED
TO  HAVE  FORFEITED HIS OR HER OFFICE OR EMPLOYMENT BY REASON OF BEING A
TRUSTEE.
  7. THE BOARD AND ITS COMMITTEES AND ADVISORY  COMMITTEES  MAY  REQUEST
AND  RECEIVE  THE  ASSISTANCE  OF  THE DEPARTMENT AND ANY OTHER STATE OR
LOCAL GOVERNMENTAL ENTITY IN EXERCISING ITS POWERS AND DUTIES.
  8. NO LATER THAN TWO YEARS AFTER THE EFFECTIVE DATE OF THIS ARTICLE:
  (A) THE BOARD SHALL DEVELOP A PROPOSAL, CONSISTENT WITH THE PRINCIPLES
OF THIS ARTICLE, FOR PROVISION BY THE PROGRAM OF LONG-TERM  CARE  COVER-
AGE,  INCLUDING THE DEVELOPMENT OF A PROPOSAL, CONSISTENT WITH THE PRIN-
CIPLES OF THIS ARTICLE, FOR ITS FUNDING.   IN DEVELOPING  THE  PROPOSAL,
THE  BOARD  SHALL  CONSULT  WITH AN ADVISORY COMMITTEE, APPOINTED BY THE
CHAIR OF THE BOARD, INCLUDING REPRESENTATIVES OF CONSUMERS AND POTENTIAL
CONSUMERS OF LONG-TERM CARE, PROVIDERS OF  LONG-TERM  CARE,  LABOR,  AND
OTHER  INTERESTED  PARTIES.  THE BOARD SHALL PRESENT ITS PROPOSAL TO THE
GOVERNOR AND THE LEGISLATURE.
  (B) THE BOARD SHALL DEVELOP PROPOSALS FOR: (I)  INCORPORATING  RETIREE
HEALTH  BENEFITS INTO NEW YORK HEALTH; (II) ACCOMMODATING EMPLOYER RETI-
REE HEALTH BENEFITS FOR PEOPLE WHO HAVE BEEN MEMBERS OF NEW YORK  HEALTH
BUT  LIVE AS RETIREES OUT OF THE STATE; AND (III) ACCOMMODATING EMPLOYER
RETIREE HEALTH BENEFITS FOR PEOPLE WHO EARNED OR ACCRUED  SUCH  BENEFITS

A. 5062--A                          7

WHILE  RESIDING  IN  THE  STATE  PRIOR TO THE IMPLEMENTATION OF NEW YORK
HEALTH AND LIVE AS RETIREES OUT OF THE STATE.
  (C) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK HEALTH COVERAGE OF
HEALTH  CARE  SERVICES  COVERED  UNDER  THE  WORKERS'  COMPENSATION LAW,
INCLUDING WHETHER AND HOW TO CONTINUE FUNDING FOR THOSE  SERVICES  UNDER
THAT  LAW  AND  WHETHER  AND HOW TO INCORPORATE AN ELEMENT OF EXPERIENCE
RATING.
  S 5103. ELIGIBILITY AND ENROLLMENT. 1. EVERY  RESIDENT  OF  THE  STATE
SHALL BE ELIGIBLE AND ENTITLED TO ENROLL AS A MEMBER UNDER THE PROGRAM.
  2.  NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM OR OTHER CHARGE FOR
ENROLLING IN OR BEING A MEMBER UNDER THE PROGRAM.
  S 5104. BENEFITS. 1. THE PROGRAM SHALL  PROVIDE  COMPREHENSIVE  HEALTH
COVERAGE  TO  EVERY MEMBER, WHICH SHALL INCLUDE ALL HEALTH CARE SERVICES
REQUIRED TO BE COVERED UNDER ANY OF THE  FOLLOWING,  WITHOUT  REGARD  TO
WHETHER  THE  MEMBER  WOULD  OTHERWISE BE ELIGIBLE FOR OR COVERED BY THE
PROGRAM OR SOURCE REFERRED TO:
  (A) CHILD HEALTH PLUS;
  (B) MEDICAID;
  (C) MEDICARE;
  (D) ARTICLE FORTY-FOUR  OF  THIS  CHAPTER  OR  ARTICLE  THIRTY-TWO  OR
FORTY-THREE OF THE INSURANCE LAW;
  (E)  ARTICLE  ELEVEN OF THE CIVIL SERVICE LAW, AS OF THE DATE ONE YEAR
BEFORE THE BEGINNING OF THE IMPLEMENTATION PERIOD;
  (F) ANY COST INCURRED DEFINED IN PARAGRAPH ONE OF  SUBSECTION  (A)  OF
SECTION  FIFTY-ONE  HUNDRED TWO OF THE INSURANCE LAW, PROVIDED THAT THIS
COVERAGE SHALL NOT REPLACE  COVERAGE  UNDER  ARTICLE  FIFTY-ONE  OF  THE
INSURANCE LAW;
  (G)  ANY  ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED TO THE
PROGRAM'S BENEFITS BY THE PROGRAM; AND
  (H) PROVIDED THAT NONE OF THE ABOVE  SHALL  INCLUDE  LONG  TERM  CARE,
UNTIL  A  PROPOSAL  UNDER  PARAGRAPH (A) OF SUBDIVISION EIGHT OF SECTION
FIFTY-ONE HUNDRED TWO OF THIS ARTICLE IS ENACTED INTO LAW.
  2. NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM, DEDUCTIBLE, CO-PAY-
MENT OR CO-INSURANCE UNDER THE PROGRAM.
  3. THE PROGRAM SHALL PROVIDE FOR PAYMENT UNDER THE PROGRAM  FOR  EMER-
GENCY AND TEMPORARY HEALTH CARE SERVICES PROVIDED TO MEMBERS OR INDIVID-
UALS  ENTITLED  TO BECOME MEMBERS WHO HAVE NOT HAD A REASONABLE OPPORTU-
NITY TO BECOME A MEMBER OR TO ENROLL WITH A CARE COORDINATOR.
  S 5105. HEALTH CARE PROVIDERS; CARE  COORDINATION;  PAYMENT  METHODOL-
OGIES.   1. CHOICE OF HEALTH CARE PROVIDER. (A) ANY HEALTH CARE PROVIDER
QUALIFIED TO PARTICIPATE UNDER THIS  SECTION  MAY  PROVIDE  HEALTH  CARE
SERVICES  UNDER  THE  PROGRAM, PROVIDED THAT THE HEALTH CARE PROVIDER IS
OTHERWISE LEGALLY AUTHORIZED TO PERFORM THE HEALTH CARE SERVICE FOR  THE
INDIVIDUAL AND UNDER THE CIRCUMSTANCES INVOLVED.
  (B)  A  MEMBER  MAY  CHOOSE  TO RECEIVE HEALTH CARE SERVICES UNDER THE
PROGRAM FROM ANY PARTICIPATING PROVIDER, CONSISTENT WITH  PROVISIONS  OF
THIS  ARTICLE  RELATING  TO  CARE COORDINATION AND HEALTH CARE ORGANIZA-
TIONS, THE WILLINGNESS OR  AVAILABILITY  OF  THE  PROVIDER  (SUBJECT  TO
PROVISIONS  OF  THIS ARTICLE RELATING TO DISCRIMINATION), AND THE APPRO-
PRIATE CLINICALLY-RELEVANT CIRCUMSTANCES.
  2. CARE COORDINATION.
  (A) CARE COORDINATION SHALL INCLUDE, BUT NOT BE LIMITED TO,  MANAGING,
REFERRING   TO,  LOCATING,  COORDINATING,  AND  MONITORING  HEALTH  CARE
SERVICES FOR THE MEMBER TO ASSURE THAT ALL  MEDICALLY  NECESSARY  HEALTH
CARE  SERVICES  ARE  MADE  AVAILABLE  TO AND ARE EFFECTIVELY USED BY THE
MEMBER IN A TIMELY MANNER, CONSISTENT WITH PATIENT AUTONOMY. CARE  COOR-

A. 5062--A                          8

DINATION  IS  NOT  A REQUIREMENT FOR PRIOR AUTHORIZATION FOR HEALTH CARE
SERVICES AND REFERRAL SHALL NOT BE REQUIRED FOR A MEMBER  TO  RECEIVE  A
HEALTH CARE SERVICE.
  (B) A CARE COORDINATOR MAY BE AN INDIVIDUAL OR ENTITY THAT IS APPROVED
BY THE PROGRAM THAT IS:
  (I)  A  HEALTH CARE PRACTITIONER WHO IS: (A) THE MEMBER'S PRIMARY CARE
PRACTITIONER; (B) AT THE OPTION OF A FEMALE MEMBER, THE MEMBER'S PROVID-
ER OF PRIMARY GYNECOLOGICAL CARE; OR (C) AT THE OPTION OF A  MEMBER  WHO
HAS  A  CHRONIC  CONDITION  THAT  REQUIRES  SPECIALTY CARE, A SPECIALIST
HEALTH CARE PRACTITIONER WHO REGULARLY AND CONTINUALLY  PROVIDES  TREAT-
MENT FOR THAT CONDITION TO THE MEMBER;
  (II)  AN ENTITY LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR
CERTIFIED UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER, A MANAGED LONG  TERM
CARE  PLAN  UNDER  SECTION FORTY-FOUR HUNDRED THREE-F OF THIS CHAPTER OR
OTHER PROGRAM MODEL UNDER PARAGRAPH (B) OF  SUBDIVISION  SEVEN  OF  SUCH
SECTION, OR, WITH RESPECT TO A MEMBER WHO RECEIVES CHRONIC MENTAL HEALTH
CARE SERVICES, AN ENTITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL
HYGIENE LAW OR OTHER ENTITY APPROVED BY THE COMMISSIONER IN CONSULTATION
WITH THE COMMISSIONER OF MENTAL HEALTH;
  (III) A HEALTH CARE ORGANIZATION;
  (IV) A TAFT-HARTLEY FUND, WITH RESPECT TO ITS MEMBERS AND THEIR FAMILY
MEMBERS;  PROVIDED THAT THIS PROVISION SHALL NOT PRECLUDE A TAFT-HARTLEY
FUND FROM BECOMING A CARE COORDINATOR UNDER  SUBPARAGRAPH  (V)  OF  THIS
PARAGRAPH  OR A HEALTH CARE ORGANIZATION UNDER SECTION FIFTY-ONE HUNDRED
SIX OF THIS ARTICLE; OR
  (V) ANY NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY APPROVED BY THE PROGRAM.
  (C) HEALTH CARE SERVICES PROVIDED TO A MEMBER SHALL NOT BE SUBJECT  TO
PAYMENT  UNDER  THE  PROGRAM  UNLESS  THE MEMBER IS ENROLLED WITH A CARE
COORDINATOR AT THE TIME THE HEALTH  CARE  SERVICE  IS  PROVIDED,  EXCEPT
WHERE PROVIDED UNDER SUBDIVISION THREE OF SECTION FIFTY-ONE HUNDRED FOUR
OF  THIS ARTICLE. EVERY MEMBER SHALL ENROLL WITH A CARE COORDINATOR THAT
AGREES TO PROVIDE CARE COORDINATION TO THE  MEMBER  PRIOR  TO  RECEIVING
HEALTH  CARE SERVICES TO BE PAID FOR UNDER THE PROGRAM. THE MEMBER SHALL
REMAIN ENROLLED WITH THAT CARE  COORDINATOR  UNTIL  THE  MEMBER  BECOMES
ENROLLED  WITH  A  DIFFERENT  CARE COORDINATOR OR CEASES TO BE A MEMBER.
MEMBERS HAVE THE RIGHT TO CHANGE THEIR  CARE  COORDINATOR  ON  TERMS  AT
LEAST   AS  PERMISSIVE  AS  THE  PROVISIONS  OF  SECTION  THREE  HUNDRED
SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW RELATING TO AN INDIVIDUAL CHANG-
ING HIS OR HER PRIMARY CARE PROVIDER OR MANAGED CARE PROVIDER.
  (D) CARE COORDINATION SHALL BE PROVIDED TO THE MEMBER BY THE  MEMBER'S
CARE COORDINATOR.  A CARE COORDINATOR MAY EMPLOY OR UTILIZE THE SERVICES
OF  OTHER  INDIVIDUALS  OR  ENTITIES TO ASSIST IN PROVIDING CARE COORDI-
NATION FOR THE MEMBER, CONSISTENT WITH REGULATIONS OF THE COMMISSIONER.
  (E) A HEALTH CARE ORGANIZATION MAY ESTABLISH RULES  RELATING  TO  CARE
COORDINATION FOR MEMBERS IN THE HEALTH CARE ORGANIZATION, DIFFERENT FROM
THIS  SUBDIVISION  BUT  OTHERWISE CONSISTENT WITH THIS ARTICLE AND OTHER
APPLICABLE LAWS. NOTHING IN THIS SUBDIVISION SHALL AUTHORIZE  ANY  INDI-
VIDUAL TO ENGAGE IN ANY ACT IN VIOLATION OF TITLE EIGHT OF THE EDUCATION
LAW.
  (F) THE COMMISSIONER SHALL DEVELOP AND IMPLEMENT PROCEDURES AND STAND-
ARDS FOR AN INDIVIDUAL OR ENTITY TO BE APPROVED TO BE A CARE COORDINATOR
IN  THE  PROGRAM,  INCLUDING BUT NOT LIMITED TO PROCEDURES AND STANDARDS
RELATING TO THE REVOCATION,  SUSPENSION,  LIMITATION,  OR  ANNULMENT  OF
APPROVAL ON A DETERMINATION THAT THE INDIVIDUAL OR ENTITY IS INCOMPETENT
TO  BE  A CARE COORDINATOR OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH

A. 5062--A                          9

EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
STANDARDS  SHALL  NOT  LIMIT  APPROVAL  TO  BE A CARE COORDINATOR IN THE
PROGRAM  FOR ECONOMIC PURPOSES AND SHALL BE CONSISTENT WITH GOOD PROFES-
SIONAL PRACTICE. IN DEVELOPING THE PROCEDURES AND STANDARDS, THE COMMIS-
SIONER SHALL: (I) CONSIDER  EXISTING  STANDARDS  DEVELOPED  BY  NATIONAL
ACCREDITING  AND  PROFESSIONAL  ORGANIZATIONS;  AND  (II)  CONSULT  WITH
NATIONAL AND LOCAL ORGANIZATIONS WORKING ON CARE COORDINATION OR SIMILAR
MODELS, INCLUDING HEALTH CARE  PRACTITIONERS,  HOSPITALS,  CLINICS,  AND
CONSUMERS  AND  THEIR  REPRESENTATIVES. WHEN DEVELOPING AND IMPLEMENTING
STANDARDS OF APPROVAL OF CARE  COORDINATORS  FOR  INDIVIDUALS  RECEIVING
CHRONIC MENTAL HEALTH CARE SERVICES, THE COMMISSIONER SHALL CONSULT WITH
THE  COMMISSIONER OF MENTAL HEALTH. AN INDIVIDUAL OR ENTITY MAY NOT BE A
CARE COORDINATOR UNLESS THE SERVICES INCLUDED IN CARE  COORDINATION  ARE
WITHIN  THE  INDIVIDUAL'S PROFESSIONAL SCOPE OF PRACTICE OR THE ENTITY'S
LEGAL AUTHORITY.
  (G) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A CARE  COORDINATOR  MUST:
(I)  RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSIONER; AND
(II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY THE  COMMISSIONER  TO
ENABLE  THE  COMMISSIONER TO EVALUATE THE IMPACT OF CARE COORDINATORS ON
QUALITY, OUTCOMES AND COST.
  3. HEALTH CARE PROVIDERS. (A) THE  COMMISSIONER  SHALL  ESTABLISH  AND
MAINTAIN PROCEDURES AND STANDARDS FOR HEALTH CARE PROVIDERS TO BE QUALI-
FIED  TO PARTICIPATE IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO PROCE-
DURES AND STANDARDS RELATING TO THE REVOCATION, SUSPENSION,  LIMITATION,
OR ANNULMENT OF QUALIFICATION TO PARTICIPATE ON A DETERMINATION THAT THE
HEALTH  CARE PROVIDER IS AN INCOMPETENT PROVIDER OF SPECIFIC HEALTH CARE
SERVICES OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS EITHER INCONSIST-
ENT WITH PROGRAM STANDARDS AND REGULATIONS OR WHICH EXHIBITS AN  UNWILL-
INGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS A POTENTIAL THREAT
TO  THE PUBLIC HEALTH OR SAFETY. SUCH PROCEDURES AND STANDARDS SHALL NOT
LIMIT HEALTH CARE PROVIDER PARTICIPATION IN  THE  PROGRAM  FOR  ECONOMIC
PURPOSES  AND  SHALL  BE CONSISTENT WITH GOOD PROFESSIONAL PRACTICE. ANY
HEALTH CARE PROVIDER WHO IS QUALIFIED  TO  PARTICIPATE  UNDER  MEDICAID,
CHILD HEALTH PLUS OR MEDICARE SHALL BE DEEMED TO BE QUALIFIED TO PARTIC-
IPATE IN THE PROGRAM, AND ANY HEALTH CARE PROVIDER'S REVOCATION, SUSPEN-
SION, LIMITATION, OR ANNULMENT OF QUALIFICATION TO PARTICIPATE IN ANY OF
THOSE  PROGRAMS  SHALL APPLY TO THE HEALTH CARE PROVIDER'S QUALIFICATION
TO PARTICIPATE IN THE PROGRAM; PROVIDED  THAT  A  HEALTH  CARE  PROVIDER
QUALIFIED  UNDER  THIS  SENTENCE  SHALL  FOLLOW THE PROCEDURES TO BECOME
QUALIFIED UNDER THE PROGRAM BY THE END OF THE IMPLEMENTATION PERIOD.
  (B) THE COMMISSIONER SHALL ESTABLISH AND MAINTAIN PROCEDURES AND STAN-
DARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUT OF THE STATE FOR
PURPOSES OF PROVIDING COVERAGE UNDER THE PROGRAM FOR OUT-OF-STATE HEALTH
CARE SERVICES.
  4. PAYMENT FOR HEALTH CARE SERVICES. (A) THE COMMISSIONER  MAY  ESTAB-
LISH  BY  REGULATION  PAYMENT METHODOLOGIES FOR HEALTH CARE SERVICES AND
CARE COORDINATION PROVIDED TO MEMBERS UNDER THE PROGRAM BY PARTICIPATING
PROVIDERS, CARE COORDINATORS, AND HEALTH CARE ORGANIZATIONS.  THERE  MAY
BE  A VARIETY OF DIFFERENT PAYMENT METHODOLOGIES, INCLUDING THOSE ESTAB-
LISHED ON A DEMONSTRATION BASIS. ALL PAYMENT  RATES  UNDER  THE  PROGRAM
SHALL  BE  REASONABLE  AND REASONABLY RELATED TO THE COST OF EFFICIENTLY
PROVIDING THE HEALTH CARE SERVICE AND ASSURING AN ADEQUATE AND  ACCESSI-
BLE  SUPPLY  OF  HEALTH CARE SERVICE.   UNTIL AND UNLESS ANOTHER PAYMENT
METHODOLOGY IS ESTABLISHED, HEALTH CARE  SERVICES  PROVIDED  TO  MEMBERS

A. 5062--A                         10

UNDER  THE  PROGRAM SHALL BE PAID FOR ON A FEE-FOR-SERVICE BASIS, EXCEPT
FOR CARE COORDINATION.
  (B)  THE  PROGRAM  SHALL ENGAGE IN GOOD FAITH NEGOTIATIONS WITH HEALTH
CARE PROVIDERS' REPRESENTATIVES UNDER TITLE III OF ARTICLE FORTY-NINE OF
THIS CHAPTER, INCLUDING, BUT NOT LIMITED TO, IN  RELATION  TO  RATES  OF
PAYMENT AND PAYMENT METHODOLOGIES.
  (C)  NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, PAYMENT FOR
DRUGS PROVIDED BY PHARMACIES UNDER THE PROGRAM SHALL BE MADE PURSUANT TO
TITLE ONE OF ARTICLE TWO-A OF THIS CHAPTER. HOWEVER, THE  PROGRAM  SHALL
PROVIDE  FOR  PAYMENT  FOR  PRESCRIPTION DRUGS UNDER SECTION 340B OF THE
FEDERAL PUBLIC SERVICE ACT WHERE APPLICABLE.  PAYMENT  FOR  PRESCRIPTION
DRUGS  PROVIDED  BY HEALTH CARE PROVIDERS OTHER THAN PHARMACIES SHALL BE
PURSUANT TO OTHER PROVISIONS OF THIS ARTICLE.
  (D) PAYMENT FOR HEALTH CARE SERVICES ESTABLISHED  UNDER  THIS  ARTICLE
SHALL  BE CONSIDERED PAYMENT IN FULL. A PARTICIPATING PROVIDER SHALL NOT
CHARGE ANY RATE IN EXCESS OF THE PAYMENT ESTABLISHED UNDER THIS  ARTICLE
FOR  ANY  HEALTH CARE SERVICE UNDER THE PROGRAM PROVIDED TO A MEMBER AND
SHALL NOT SOLICIT OR ACCEPT PAYMENT FROM ANY MEMBER OR THIRD  PARTY  FOR
ANY SUCH SERVICE EXCEPT AS PROVIDED UNDER SECTION FIFTY-ONE HUNDRED NINE
OF THIS ARTICLE.  HOWEVER, THIS PARAGRAPH SHALL NOT PRECLUDE THE PROGRAM
FROM  ACTING AS A PRIMARY OR SECONDARY PAYER IN CONJUNCTION WITH ANOTHER
THIRD-PARTY PAYER WHERE PERMITTED UNDER SECTION FIFTY-ONE  HUNDRED  NINE
OF THIS ARTICLE.
  (E)  THE  PROGRAM MAY PROVIDE IN PAYMENT METHODOLOGIES FOR PAYMENT FOR
CAPITAL RELATED EXPENSES FOR SPECIFICALLY  IDENTIFIED  CAPITAL  EXPENDI-
TURES  INCURRED  BY  NOT-FOR-PROFIT  OR  GOVERNMENTAL ENTITIES CERTIFIED
UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER. ANY CAPITAL RELATED  EXPENSE
GENERATED  BY  A  CAPITAL EXPENDITURE THAT REQUIRES OR REQUIRED APPROVAL
UNDER ARTICLE TWENTY-EIGHT OF  THIS  CHAPTER  MUST  HAVE  RECEIVED  THAT
APPROVAL  FOR  THE  CAPITAL  RELATED  EXPENSE  TO  BE PAID FOR UNDER THE
PROGRAM.
  (F) PAYMENT METHODOLOGIES AND RATES SHALL INCLUDE A DISTINCT COMPONENT
OF REIMBURSEMENT FOR DIRECT AND INDIRECT GRADUATE MEDICAL  EDUCATION  AS
DEFINED,  CALCULATED  AND  IMPLEMENTED  PURSUANT TO SECTION TWENTY-EIGHT
HUNDRED SEVEN-C OF THIS CHAPTER.
  (G) THE COMMISSIONER SHALL PROVIDE BY  REGULATION FOR PAYMENT  METHOD-
OLOGIES AND PROCEDURES FOR PAYING FOR OUT-OF-STATE HEALTH CARE SERVICES.
  S  5106.  HEALTH  CARE ORGANIZATIONS. 1. A MEMBER MAY CHOOSE TO ENROLL
WITH AND RECEIVE HEALTH CARE SERVICES UNDER THE PROGRAM  FROM  A  HEALTH
CARE ORGANIZATION.
  2.  A  HEALTH  CARE  ORGANIZATION SHALL BE A NOT-FOR-PROFIT OR GOVERN-
MENTAL ENTITY THAT IS APPROVED BY THE COMMISSIONER THAT IS:
  (A) AN ACCOUNTABLE CARE ORGANIZATION UNDER  ARTICLE  TWENTY-NINE-E  OF
THIS CHAPTER; OR
  (B)  A  TAFT-HARTLEY  FUND  (I)  WITH RESPECT TO ITS MEMBERS AND THEIR
FAMILY MEMBERS, AND (II) IF ALLOWED BY APPLICABLE LAW  AND  APPROVED  BY
THE  COMMISSIONER,  FOR  OTHER MEMBERS OF THE PROGRAM; PROVIDED THAT THE
COMMISSIONER SHALL PROVIDE BY REGULATION THAT WHERE A TAFT-HARTLEY  FUND
IS  ACTING UNDER THIS SUBPARAGRAPH THERE ARE PROTECTIONS FOR HEALTH CARE
PROVIDERS AND PATIENTS COMPARABLE TO  THOSE  APPLICABLE  TO  ACCOUNTABLE
CARE ORGANIZATIONS.
  3.  A  HEALTH  CARE ORGANIZATION MAY BE RESPONSIBLE FOR ALL OR PART OF
THE HEALTH CARE SERVICES TO WHICH ITS MEMBERS  ARE  ENTITLED  UNDER  THE
PROGRAM, CONSISTENT WITH THE TERMS OF ITS APPROVAL BY THE COMMISSIONER.
  4.  (A)  THE  COMMISSIONER  SHALL DEVELOP AND IMPLEMENT PROCEDURES AND
STANDARDS FOR AN ENTITY TO BE APPROVED TO BE A HEALTH CARE  ORGANIZATION

A. 5062--A                         11

IN  THE  PROGRAM,  INCLUDING BUT NOT LIMITED TO PROCEDURES AND STANDARDS
RELATING TO THE REVOCATION,  SUSPENSION,  LIMITATION,  OR  ANNULMENT  OF
APPROVAL  ON  A  DETERMINATION  THAT  THE  ENTITY IS INCOMPETENT TO BE A
HEALTH  CARE  ORGANIZATION OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH
EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
STANDARDS  SHALL  NOT LIMIT APPROVAL TO BE A HEALTH CARE ORGANIZATION IN
THE PROGRAM FOR ECONOMIC PURPOSES AND  SHALL  BE  CONSISTENT  WITH  GOOD
PROFESSIONAL  PRACTICE.  IN DEVELOPING THE PROCEDURES AND STANDARDS, THE
COMMISSIONER  SHALL:  (I)  CONSIDER  EXISTING  STANDARDS  DEVELOPED   BY
NATIONAL  ACCREDITING  AND  PROFESSIONAL ORGANIZATIONS; AND (II) CONSULT
WITH NATIONAL AND LOCAL ORGANIZATIONS WORKING IN  THE  FIELD  OF  HEALTH
CARE  ORGANIZATIONS,  INCLUDING  HEALTH  CARE  PRACTITIONERS, HOSPITALS,
CLINICS, AND CONSUMERS AND THEIR REPRESENTATIVES.  WHEN  DEVELOPING  AND
IMPLEMENTING  STANDARDS  OF  APPROVAL  OF HEALTH CARE ORGANIZATIONS, THE
COMMISSIONER SHALL CONSULT WITH THE COMMISSIONER OF  MENTAL  HEALTH  AND
THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES.
  (B) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A HEALTH CARE ORGANIZATION
MUST:  (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSION-
ER; AND (II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY  THE  COMMIS-
SIONER  TO ENABLE THE COMMISSIONER TO EVALUATE THE HEALTH CARE ORGANIZA-
TION IN RELATION  TO  QUALITY  OF  HEALTH  CARE  SERVICES,  HEALTH  CARE
OUTCOMES, AND COST.
  5.  THE  COMMISSIONER  SHALL  MAKE REGULATIONS RELATING TO HEALTH CARE
ORGANIZATIONS CONSISTENT WITH AND TO ENSURE COMPLIANCE WITH  THIS  ARTI-
CLE.
  6.  THE  PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY A
HEALTH CARE ORGANIZATION THROUGH HEALTH  CARE  PROVIDERS  SHALL  NOT  BE
CONSIDERED  THE PRACTICE OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCA-
TION LAW BY THE HEALTH CARE ORGANIZATION.
  S  5107.  PROGRAM  STANDARDS.  1.  THE  COMMISSIONER  SHALL  ESTABLISH
REQUIREMENTS AND STANDARDS FOR THE PROGRAM AND FOR HEALTH CARE ORGANIZA-
TIONS,  CARE  COORDINATORS,  AND  HEALTH CARE PROVIDERS, CONSISTENT WITH
THIS ARTICLE, INCLUDING REQUIREMENTS AND STANDARDS FOR, AS APPLICABLE:
  (A) THE SCOPE, QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES;
  (B) RELATIONS BETWEEN HEALTH CARE ORGANIZATIONS OR HEALTH CARE PROVID-
ERS AND MEMBERS; AND
  (C) RELATIONS  BETWEEN  HEALTH  CARE  ORGANIZATIONS  AND  HEALTH  CARE
PROVIDERS,  INCLUDING  (I) CREDENTIALING AND PARTICIPATION IN THE HEALTH
CARE ORGANIZATION; AND (II) TERMS, METHODS AND RATES OF PAYMENT.
  2. REQUIREMENTS AND STANDARDS UNDER THE PROGRAM SHALL INCLUDE, BUT NOT
BE LIMITED TO, PROVISIONS TO PROMOTE THE FOLLOWING:
  (A) SIMPLIFICATION, TRANSPARENCY, UNIFORMITY, AND FAIRNESS  IN  HEALTH
CARE  PROVIDER  CREDENTIALING AND PARTICIPATION IN HEALTH CARE ORGANIZA-
TION NETWORKS, REFERRALS, PAYMENT PROCEDURES AND RATES, CLAIMS  PROCESS-
ING, AND APPROVAL OF HEALTH CARE SERVICES, AS APPLICABLE;
  (B)  PRIMARY  AND  PREVENTIVE  CARE,  CARE COORDINATION, EFFICIENT AND
EFFECTIVE HEALTH CARE  SERVICES,  QUALITY  ASSURANCE,  COORDINATION  AND
INTEGRATION  OF HEALTH CARE SERVICES, INCLUDING USE OF APPROPRIATE TECH-
NOLOGY, AND PROMOTION OF PUBLIC, ENVIRONMENTAL AND OCCUPATIONAL HEALTH;
  (C) ELIMINATION OF HEALTH CARE DISPARITIES;
  (D) NON-DISCRIMINATION WITH RESPECT TO MEMBERS AND HEALTH CARE PROVID-
ERS ON THE BASIS OF RACE, ETHNICITY, NATIONAL ORIGIN, RELIGION, DISABIL-
ITY, AGE, SEX, SEXUAL ORIENTATION, GENDER  IDENTITY  OR  EXPRESSION,  OR
ECONOMIC  CIRCUMSTANCES;  PROVIDED  THAT  HEALTH  CARE SERVICES PROVIDED

A. 5062--A                         12

UNDER THE PROGRAM SHALL BE APPROPRIATE TO THE PATIENT'S CLINICALLY-RELE-
VANT CIRCUMSTANCES; AND
  (E)  ACCESSIBILITY  OF  CARE  COORDINATION,  HEALTH  CARE ORGANIZATION
SERVICES AND HEALTH CARE SERVICES, INCLUDING  ACCESSIBILITY  FOR  PEOPLE
WITH DISABILITIES AND PEOPLE WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND
ENGLISH,  AND  THE PROVIDING OF CARE COORDINATION, HEALTH CARE ORGANIZA-
TION SERVICES AND HEALTH CARE SERVICES IN A CULTURALLY COMPETENT MANNER.
  3. ANY PARTICIPATING PROVIDER OR CARE COORDINATOR THAT IS ORGANIZED AS
A FOR-PROFIT ENTITY SHALL BE REQUIRED TO MEET THE SAME REQUIREMENTS  AND
STANDARDS AS ENTITIES ORGANIZED AS NOT-FOR-PROFIT ENTITIES, AND PAYMENTS
UNDER  THE  PROGRAM  PAID  TO  SUCH  ENTITIES SHALL NOT BE CALCULATED TO
ACCOMMODATE THE GENERATION OF PROFIT OR REVENUE FOR DIVIDENDS  OR  OTHER
RETURN ON INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT BE PAID BY A
NOT-FOR-PROFIT ENTITY.
  4.  EVERY  PARTICIPATING  PROVIDER  SHALL  FURNISH TO THE PROGRAM SUCH
INFORMATION TO, AND PERMIT EXAMINATION OF ITS RECORDS BY,  THE  PROGRAM,
AS  MAY  BE  REASONABLY REQUIRED FOR PURPOSES OF REVIEWING ACCESSIBILITY
AND UTILIZATION OF HEALTH CARE SERVICES,  QUALITY  ASSURANCE,  AND  COST
CONTAINMENT, THE MAKING OF PAYMENTS, AND STATISTICAL OR OTHER STUDIES OF
THE  OPERATION OF THE PROGRAM OR FOR PROTECTION AND PROMOTION OF PUBLIC,
ENVIRONMENTAL AND OCCUPATIONAL HEALTH.
  5. IN DEVELOPING REQUIREMENTS AND STANDARDS AND  MAKING  OTHER  POLICY
DETERMINATIONS  UNDER  THIS ARTICLE, THE COMMISSIONER SHALL CONSULT WITH
REPRESENTATIVES OF MEMBERS, HEALTH CARE  PROVIDERS,  CARE  COORDINATORS,
HEALTH CARE ORGANIZATIONS AND OTHER INTERESTED PARTIES.
  6.    THE  PROGRAM  SHALL MAINTAIN THE CONFIDENTIALITY OF ALL DATA AND
OTHER INFORMATION COLLECTED UNDER THE PROGRAM WHEN SUCH  DATA  WOULD  BE
NORMALLY  CONSIDERED CONFIDENTIAL DATA BETWEEN A PATIENT AND HEALTH CARE
PROVIDER.  AGGREGATE DATA OF THE PROGRAM WHICH IS DERIVED FROM CONFIDEN-
TIAL DATA BUT DOES NOT VIOLATE PATIENT CONFIDENTIALITY SHALL  BE  PUBLIC
INFORMATION.
  S  5108.  REGULATIONS.  THE  COMMISSIONER  MAY APPROVE REGULATIONS AND
AMENDMENTS THERETO, UNDER SUBDIVISION ONE OF SECTION  FIFTY-ONE  HUNDRED
TWO OF THIS ARTICLE. THE COMMISSIONER MAY MAKE REGULATIONS OR AMENDMENTS
THERETO  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTICLE ON AN
EMERGENCY BASIS UNDER SECTION TWO HUNDRED TWO OF THE  STATE  ADMINISTRA-
TIVE  PROCEDURE  ACT, PROVIDED THAT SUCH REGULATIONS OR AMENDMENTS SHALL
NOT BECOME PERMANENT UNLESS ADOPTED UNDER  SUBDIVISION  ONE  OF  SECTION
FIFTY-ONE HUNDRED TWO OF THIS ARTICLE.
  S 5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS. 1. THE COMMIS-
SIONER  SHALL  SEEK  ALL FEDERAL WAIVERS AND OTHER FEDERAL APPROVALS AND
ARRANGEMENTS AND SUBMIT STATE PLAN AMENDMENTS NECESSARY TO  OPERATE  THE
PROGRAM CONSISTENT WITH THIS ARTICLE.
  2.  (A)  THE  COMMISSIONER  SHALL APPLY TO THE SECRETARY OF HEALTH AND
HUMAN SERVICES OR OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS  OF
REQUIREMENTS,  AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY FEDERAL-
LY-MATCHED PUBLIC HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER
FEDERAL PROGRAMS THAT PROVIDE FEDERAL FUNDS FOR PAYMENT FOR HEALTH  CARE
SERVICES,  THAT  ARE  NECESSARY TO ENABLE ALL NEW YORK HEALTH MEMBERS TO
RECEIVE ALL BENEFITS UNDER THE PROGRAM THROUGH THE PROGRAM TO ENABLE THE
STATE TO IMPLEMENT THIS ARTICLE AND TO RECEIVE AND DEPOSIT  ALL  FEDERAL
PAYMENTS  UNDER  THOSE PROGRAMS (INCLUDING FUNDS THAT MAY BE PROVIDED IN
LIEU OF PREMIUM TAX CREDITS, COST-SHARING SUBSIDIES, AND SMALL  BUSINESS
TAX  CREDITS) IN THE STATE TREASURY TO THE CREDIT OF THE NEW YORK HEALTH
TRUST FUND CREATED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE  LAW
AND  TO  USE  THOSE  FUNDS  FOR  THE  NEW  YORK HEALTH PROGRAM AND OTHER

A. 5062--A                         13

PROVISIONS UNDER THIS ARTICLE. TO THE EXTENT POSSIBLE, THE  COMMISSIONER
SHALL  NEGOTIATE  ARRANGEMENTS WITH THE FEDERAL GOVERNMENT IN WHICH BULK
OR LUMP-SUM FEDERAL PAYMENTS ARE PAID TO NEW YORK  HEALTH  IN  PLACE  OF
FEDERAL  SPENDING  OR TAX BENEFITS FOR FEDERALLY-MATCHED HEALTH PROGRAMS
OR FEDERAL HEALTH PROGRAMS.
  (B) THE COMMISSIONER MAY REQUIRE MEMBERS OR APPLICANTS TO  BE  MEMBERS
TO  PROVIDE  INFORMATION  NECESSARY  FOR  THE PROGRAM TO COMPLY WITH ANY
WAIVER OR ARRANGEMENT UNDER THIS SUBDIVISION.
  3. (A) IF ACTIONS TAKEN UNDER SUBDIVISION TWO OF THIS SECTION  DO  NOT
ACCOMPLISH ALL RESULTS INTENDED UNDER THAT SUBDIVISION, THEN THIS SUBDI-
VISION SHALL APPLY AND SHALL AUTHORIZE ADDITIONAL ACTIONS TO EFFECTIVELY
IMPLEMENT   NEW  YORK  HEALTH  TO  THE  MAXIMUM  EXTENT  POSSIBLE  AS  A
SINGLE-PAYER PROGRAM CONSISTENT WITH THIS ARTICLE.
  (B) THE COMMISSIONER MAY TAKE ACTIONS CONSISTENT WITH THIS ARTICLE  TO
ENABLE  NEW  YORK HEALTH TO ADMINISTER MEDICARE IN NEW YORK STATE AND TO
BE A PROVIDER OF DRUG  COVERAGE  UNDER  MEDICARE  PART  D  FOR  ELIGIBLE
MEMBERS OF NEW YORK HEALTH.
  (C)  THE  COMMISSIONER  MAY  WAIVE  OR  MODIFY  THE  APPLICABILITY  OF
PROVISIONS OF THIS SECTION  RELATING  TO  ANY  FEDERALLY-MATCHED  PUBLIC
HEALTH  PROGRAM  OR  MEDICARE  AS  NECESSARY  TO IMPLEMENT ANY WAIVER OR
ARRANGEMENT UNDER THIS SECTION OR TO MAXIMIZE THE  BENEFIT  TO  THE  NEW
YORK  HEALTH PROGRAM UNDER THIS SECTION, PROVIDED THAT THE COMMISSIONER,
IN CONSULTATION WITH THE DIRECTOR OF THE BUDGET,  SHALL  DETERMINE  THAT
SUCH  WAIVER  OR  MODIFICATION  IS  IN THE BEST INTERESTS OF THE MEMBERS
AFFECTED BY THE ACTION AND THE STATE.
  (D)   THE   COMMISSIONER   MAY   APPLY   FOR   COVERAGE   UNDER    ANY
FEDERALLY-MATCHED  PUBLIC  HEALTH  PROGRAM  ON  BEHALF OF ANY MEMBER AND
ENROLL THE MEMBER IN THE  FEDERALLY-MATCHED  PUBLIC  HEALTH  PROGRAM  OR
MEDICARE   IF   THE  MEMBER  IS  ELIGIBLE  FOR  IT.    ENROLLMENT  IN  A
FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE SHALL NOT CAUSE  ANY
MEMBER TO LOSE ANY HEALTH CARE SERVICE PROVIDED BY THE PROGRAM OR DIMIN-
ISH ANY RIGHT THE MEMBER WOULD OTHERWISE HAVE.
  (E) THE COMMISSIONER SHALL BY REGULATION INCREASE THE INCOME ELIGIBIL-
ITY  LEVEL,  INCREASE  OR  ELIMINATE  THE RESOURCE TEST FOR ELIGIBILITY,
SIMPLIFY ANY PROCEDURAL OR DOCUMENTATION REQUIREMENT FOR ENROLLMENT, AND
INCREASE THE BENEFITS FOR ANY FEDERALLY-MATCHED PUBLIC  HEALTH  PROGRAM,
AND  FOR ANY PROGRAM TO REDUCE OR ELIMINATE AN INDIVIDUAL'S COINSURANCE,
COST-SHARING OR PREMIUM OBLIGATIONS OR INCREASE AN  INDIVIDUAL'S  ELIGI-
BILITY  FOR  ANY  FEDERAL  FINANCIAL  SUPPORT RELATED TO MEDICARE OR THE
AFFORDABLE CARE ACT NOTWITHSTANDING ANY LAW OR REGULATION TO THE CONTRA-
RY. THE COMMISSIONER MAY  ACT  UNDER  THIS  PARAGRAPH  UPON  A  FINDING,
APPROVED BY THE DIRECTOR OF THE BUDGET, THAT THE ACTION (I) WILL HELP TO
INCREASE  THE  NUMBER  OF  MEMBERS  WHO ARE ELIGIBLE FOR AND ENROLLED IN
FEDERALLY-MATCHED PUBLIC HEALTH PROGRAMS, OR FOR ANY PROGRAM  TO  REDUCE
OR  ELIMINATE AN INDIVIDUAL'S COINSURANCE, COST-SHARING OR PREMIUM OBLI-
GATIONS OR INCREASE AN INDIVIDUAL'S ELIGIBILITY FOR ANY  FEDERAL  FINAN-
CIAL  SUPPORT  RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT; (II) WILL
NOT DIMINISH ANY INDIVIDUAL'S ACCESS TO ANY HEALTH CARE SERVICE OR RIGHT
THE INDIVIDUAL WOULD OTHERWISE HAVE; (III) IS IN  THE  INTEREST  OF  THE
PROGRAM; AND (IV) DOES NOT REQUIRE OR HAS RECEIVED ANY NECESSARY FEDERAL
WAIVERS  OR APPROVALS TO ENSURE FEDERAL FINANCIAL PARTICIPATION. ACTIONS
UNDER THIS PARAGRAPH SHALL NOT APPLY TO ELIGIBILITY FOR PAYMENT FOR LONG
TERM CARE.
  (F) TO ENABLE THE COMMISSIONER TO APPLY FOR COVERAGE UNDER ANY  FEDER-
ALLY-MATCHED  PUBLIC  HEALTH PROGRAM OR MEDICARE ON BEHALF OF ANY MEMBER
AND ENROLL THE MEMBER IN THE FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM  OR

A. 5062--A                         14

MEDICARE  IF THE MEMBER IS ELIGIBLE FOR IT, THE COMMISSIONER MAY REQUIRE
THAT EVERY MEMBER OR APPLICANT TO BE A MEMBER SHALL PROVIDE  INFORMATION
TO  ENABLE THE COMMISSIONER TO DETERMINE WHETHER THE APPLICANT IS ELIGI-
BLE  FOR A FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM AND FOR MEDICARE (AND
ANY PROGRAM OR BENEFIT UNDER MEDICARE). THE PROGRAM SHALL MAKE A REASON-
ABLE EFFORT TO NOTIFY MEMBERS OF THEIR OBLIGATIONS UNDER THIS PARAGRAPH.
AFTER A REASONABLE EFFORT HAS BEEN  MADE  TO  CONTACT  THE  MEMBER,  THE
MEMBER  SHALL  BE  NOTIFIED  IN WRITING THAT HE OR SHE HAS SIXTY DAYS TO
PROVIDE SUCH REQUIRED INFORMATION. IF SUCH INFORMATION IS  NOT  PROVIDED
WITHIN THE SIXTY DAY PERIOD, THE MEMBER'S COVERAGE UNDER THE PROGRAM MAY
BE TERMINATED.
  (G)  AS  A CONDITION OF CONTINUED ELIGIBILITY FOR HEALTH CARE SERVICES
UNDER THE PROGRAM, A MEMBER WHO IS ELIGIBLE FOR BENEFITS UNDER  MEDICARE
SHALL ENROLL IN MEDICARE, INCLUDING PARTS A, B AND D.
  (H)  THE  PROGRAM  SHALL  PROVIDE  PREMIUM  ASSISTANCE FOR ALL MEMBERS
ENROLLING IN A MEDICARE PART D DRUG  COVERAGE  UNDER  SECTION  1860D  OF
TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT LIMITED TO THE LOW-INCOME
BENCHMARK PREMIUM AMOUNT ESTABLISHED BY THE FEDERAL CENTERS FOR MEDICARE
AND MEDICAID SERVICES AND ANY OTHER AMOUNT WHICH SUCH AGENCY ESTABLISHES
UNDER  ITS  DE MINIMIS PREMIUM POLICY, EXCEPT THAT SUCH PAYMENTS MADE ON
BEHALF OF MEMBERS ENROLLED IN A MEDICARE ADVANTAGE PLAN MAY  EXCEED  THE
LOW-INCOME  BENCHMARK  PREMIUM AMOUNT IF DETERMINED TO BE COST EFFECTIVE
TO THE PROGRAM.
  (I) IF THE COMMISSIONER HAS  REASONABLE  GROUNDS  TO  BELIEVE  THAT  A
MEMBER  COULD  BE  ELIGIBLE  FOR AN INCOME-RELATED SUBSIDY UNDER SECTION
1860D-14 OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT,  THE  MEMBER
SHALL  PROVIDE,  AND AUTHORIZE THE PROGRAM TO OBTAIN, ANY INFORMATION OR
DOCUMENTATION REQUIRED TO ESTABLISH THE MEMBER'S  ELIGIBILITY  FOR  SUCH
SUBSIDY,  PROVIDED THAT THE COMMISSIONER SHALL ATTEMPT TO OBTAIN AS MUCH
OF THE INFORMATION AND DOCUMENTATION AS POSSIBLE FROM RECORDS  THAT  ARE
AVAILABLE TO HIM OR HER.
  (J)  THE  PROGRAM  SHALL MAKE A REASONABLE EFFORT TO NOTIFY MEMBERS OF
THEIR OBLIGATIONS UNDER THIS SUBDIVISION. AFTER A REASONABLE EFFORT  HAS
BEEN MADE TO CONTACT THE MEMBER, THE MEMBER SHALL BE NOTIFIED IN WRITING
THAT  HE  OR SHE HAS SIXTY DAYS TO PROVIDE SUCH REQUIRED INFORMATION. IF
SUCH INFORMATION IS NOT  PROVIDED  WITHIN  THE  SIXTY  DAY  PERIOD,  THE
MEMBER'S COVERAGE UNDER THE PROGRAM MAY BE TERMINATED.
  S  5110.  ADDITIONAL  PROVISIONS.   1. THE COMMISSIONER SHALL CONTRACT
WITH NOT-FOR-PROFIT ORGANIZATIONS TO PROVIDE:
  (A) CONSUMER ASSISTANCE TO INDIVIDUALS WITH RESPECT TO SELECTION OF  A
CARE  COORDINATOR  OR  HEALTH  CARE  ORGANIZATION,  ENROLLING, OBTAINING
HEALTH CARE SERVICES, DISENROLLING, AND OTHER MATTERS  RELATING  TO  THE
PROGRAM;
  (B) HEALTH CARE PROVIDER ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING
AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, HEALTH CARE SERVICES
UNDER THE PROGRAM, WITH RESPECT TO PARTICIPATING IN A HEALTH CARE ORGAN-
IZATION AND DEALING WITH A HEALTH CARE ORGANIZATION; AND
  (C) CARE COORDINATOR ASSISTANCE TO INDIVIDUALS AND ENTITIES  PROVIDING
AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, CARE COORDINATION TO
MEMBERS.
  2. THE COMMISSIONER SHALL PROVIDE GRANTS FROM FUNDS IN  THE  NEW  YORK
HEALTH  TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE, TO HEALTH
SYSTEMS AGENCIES UNDER SECTION TWENTY-NINE HUNDRED FOUR-B OF THIS  CHAP-
TER TO SUPPORT THE OPERATION OF SUCH HEALTH SYSTEMS AGENCIES.
  3. THE COMMISSIONER SHALL PROVIDE FUNDS FROM THE NEW YORK HEALTH TRUST
FUND  OR  OTHERWISE APPROPRIATED FOR THIS PURPOSE TO THE COMMISSIONER OF

A. 5062--A                         15

LABOR FOR A PROGRAM FOR RETRAINING  AND  ASSISTING  JOB  TRANSITION  FOR
INDIVIDUALS  EMPLOYED  OR  PREVIOUSLY  EMPLOYED  IN  THE FIELD OF HEALTH
INSURANCE AND OTHER THIRD-PARTY PAYMENT FOR  HEALTH  CARE  OR  PROVIDING
SERVICES  TO  HEALTH  CARE PROVIDERS TO DEAL WITH THIRD-PARTY PAYERS FOR
HEALTH CARE, WHOSE JOBS MAY BE OR HAVE BEEN ENDED AS  A  RESULT  OF  THE
IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM, CONSISTENT WITH OTHERWISE
APPLICABLE LAW.
  4. THE COMMISSIONER SHALL, DIRECTLY AND THROUGH GRANTS TO NOT-FOR-PRO-
FIT ENTITIES, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH THE NEW YORK
HEALTH PROGRAM, TO PROMOTE AND PROTECT PUBLIC, ENVIRONMENTAL AND OCCUPA-
TIONAL  HEALTH,  INCLUDING  COOPERATION  WITH  OTHER DATA COLLECTION AND
RESEARCH PROGRAMS OF THE DEPARTMENT, CONSISTENT WITH  THIS  ARTICLE  AND
OTHERWISE APPLICABLE LAW.
  S  5111.  REGIONAL ADVISORY COUNCILS.  1. THE NEW YORK HEALTH REGIONAL
ADVISORY COUNCILS (EACH REFERRED TO IN THIS ARTICLE AS A "REGIONAL ADVI-
SORY COUNCIL") ARE HEREBY CREATED IN THE DEPARTMENT.
  2. THERE SHALL BE A REGIONAL ADVISORY COUNCIL ESTABLISHED IN  EACH  OF
THE FOLLOWING REGIONS:
  (A) LONG ISLAND, CONSISTING OF NASSAU AND SUFFOLK COUNTIES;
  (B) NEW YORK CITY;
  (C)  HUDSON  VALLEY, CONSISTING OF DELAWARE, DUTCHESS, ORANGE, PUTNAM,
ROCKLAND, SULLIVAN, ULSTER, WESTCHESTER COUNTIES;
  (D) NORTHERN, CONSISTING OF ALBANY, CLINTON, COLUMBIA,  ESSEX,  FRANK-
LIN, FULTON, GREENE, HAMILTON, MONTGOMERY, OTSEGO, RENSSELAER, SARATOGA,
SCHENECTADY, SCHOHARIE, WARREN, WASHINGTON COUNTIES;
  (E)  CENTRAL,  CONSISTING  OF BROOME, CAYUGA, CHEMUNG, CHENANGO, CORT-
LAND, HERKIMER, JEFFERSON, LEWIS, LIVINGSTON, MADISON,  MONROE,  ONEIDA,
ONONDAGA,  ONTARIO,  OSWEGO,  SCHUYLER,  SENECA,  ST. LAWRENCE, STEUBEN,
TIOGA, TOMPKINS, WAYNE, YATES COUNTIES; AND
  (F) WESTERN, CONSISTING OF ALLEGANY,  CATTARAUGUS,  CHAUTAUQUA,  ERIE,
GENESEE, NIAGARA, ORLEANS, WYOMING COUNTIES.
  3.  EACH REGIONAL ADVISORY COUNCIL SHALL BE COMPOSED OF NOT FEWER THAN
TWENTY-SEVEN MEMBERS, AS DETERMINED BY THE COMMISSIONER AND  THE  BOARD,
AS  NECESSARY  TO APPROPRIATELY REPRESENT THE DIVERSE NEEDS AND CONCERNS
OF THE REGION. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE RESIDENTS
OF OR HAVE THEIR PRINCIPAL PLACE OF BUSINESS IN THE REGION SERVED BY THE
REGIONAL ADVISORY COUNCIL.
  4. APPOINTMENT OF MEMBERS OF THE REGIONAL ADVISORY COUNCILS.
  (A) THE TWENTY-SEVEN MEMBERS SHALL BE APPOINTED AS FOLLOWS:
  (I) NINE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR;
  (II) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMENDA-
TION OF THE SPEAKER OF THE ASSEMBLY;
  (III) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE  RECOMMEN-
DATION OF THE TEMPORARY PRESIDENT OF THE SENATE;
  (IV) THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
DATION OF THE MINORITY LEADER OF THE ASSEMBLY; AND
  (V)  THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
DATION OF THE MINORITY LEADER OF THE SENATE.  WHERE A REGIONAL  ADVISORY
COUNCIL HAS MORE THAN TWENTY-SEVEN MEMBERS, THE ADDITIONAL MEMBERS SHALL
BE  APPOINTED  AND RECOMMENDED BY THESE OFFICIALS IN THE SAME PROPORTION
AS THE TWENTY-SEVEN MEMBERS.
  WHERE A REGIONAL ADVISORY COUNCIL HAS MORE THAN TWENTY-SEVEN  MEMBERS,
ADDITIONAL MEMBERS SHALL BE APPOINTED AND RECOMMENDED BY THESE OFFICIALS
IN THE SAME PROPORTION AS THE TWENTY-SEVEN MEMBERS.
  (B)  REGIONAL  ADVISORY  COUNCIL  MEMBERSHIP  SHALL INCLUDE BUT NOT BE
LIMITED TO:

A. 5062--A                         16

  (I) REPRESENTATIVES OF HEALTH  CARE  CONSUMER  ADVOCACY  ORGANIZATIONS
WITH  A REGIONAL CONSTITUENCY, WHO SHALL REPRESENT AT LEAST ONE THIRD OF
THE MEMBERSHIP OF EACH REGIONAL COUNCIL;
  (II) REPRESENTATIVES OF PROFESSIONAL ORGANIZATIONS REPRESENTING PHYSI-
CIANS;
  (III)   REPRESENTATIVES  OF  PROFESSIONAL  ORGANIZATIONS  REPRESENTING
HEALTH CARE PROFESSIONALS OTHER THAN PHYSICIANS;
  (IV) REPRESENTATIVES OF GENERAL HOSPITALS, INCLUDING PUBLIC HOSPITALS;
  (V) REPRESENTATIVES OF COMMUNITY HEALTH CENTERS;
  (VI) REPRESENTATIVES OF HEALTH CARE ORGANIZATIONS;
  (VII) REPRESENTATIVES OF ORGANIZED LABOR; AND
  (VIII) REPRESENTATIVES OF MUNICIPAL AND COUNTY GOVERNMENT.
  5. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE APPOINTED FOR TERMS
OF THREE YEARS PROVIDED, HOWEVER, THAT OF THE MEMBERS  FIRST  APPOINTED,
ONE-THIRD  SHALL  BE APPOINTED FOR ONE YEAR TERMS AND ONE-THIRD SHALL BE
APPOINTED FOR TWO YEAR TERMS. VACANCIES SHALL  BE  FILLED  IN  THE  SAME
MANNER AS ORIGINAL APPOINTMENTS FOR THE REMAINDER OF ANY UNEXPIRED TERM.
NO  PERSON  SHALL  BE AN APPOINTED MEMBER OF A REGIONAL ADVISORY COUNCIL
FOR MORE THAN SIX YEARS IN ANY PERIOD OF TWELVE CONSECUTIVE YEARS.
  6. MEMBERS OF THE  REGIONAL  ADVISORY  COUNCILS  SHALL  SERVE  WITHOUT
COMPENSATION  BUT  SHALL  BE  REIMBURSED  FOR THEIR NECESSARY AND ACTUAL
EXPENSES INCURRED WHILE ENGAGED IN THE BUSINESS OF  THE  ADVISORY  COUN-
CILS.  THE PROGRAM SHALL PROVIDE FINANCIAL SUPPORT FOR SUCH EXPENSES AND
OTHER EXPENSES OF THE REGIONAL ADVISORY COUNCILS.
  7. EACH REGIONAL ADVISORY COUNCIL SHALL MEET AT LEAST QUARTERLY.  EACH
REGIONAL  ADVISORY COUNCIL MAY FORM COMMITTEES TO ASSIST IT IN ITS WORK.
MEMBERS OF A COMMITTEE NEED NOT BE  MEMBERS  OF  THE  REGIONAL  ADVISORY
COUNCIL.    THE  NEW  YORK  CITY  REGIONAL ADVISORY COUNCIL SHALL FORM A
COMMITTEE FOR EACH BOROUGH OF NEW YORK  CITY,  TO  ASSIST  THE  REGIONAL
ADVISORY COUNCIL IN ITS WORK AS IT RELATES PARTICULARLY TO THAT BOROUGH.
  8.  EACH  REGIONAL  ADVISORY COUNCIL SHALL ADVISE THE COMMISSIONER,THE
BOARD, THE GOVERNOR AND THE LEGISLATURE ON ALL MATTERS RELATING  TO  THE
DEVELOPMENT AND IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM.
  9.  EACH  REGIONAL ADVISORY COUNCIL SHALL ADOPT, AND FROM TIME TO TIME
REVISE, A COMMUNITY HEALTH IMPROVEMENT  PLAN  FOR  ITS  REGION  FOR  THE
PURPOSE OF:
  (A)  PROMOTING  THE  DELIVERY  OF  HEALTH CARE SERVICES IN THE REGION,
IMPROVING THE QUALITY AND  ACCESSIBILITY  OF  CARE,  INCLUDING  CULTURAL
COMPETENCY,  CLINICAL  INTEGRATION  OF  CARE  BETWEEN  SERVICE PROVIDERS
INCLUDING BUT NOT LIMITED TO PHYSICAL, MENTAL,  AND  BEHAVIORAL  HEALTH,
PHYSICAL AND DEVELOPMENTAL DISABILITY SERVICES, AND LONG-TERM CARE;
  (B) FACILITY AND HEALTH SERVICES PLANNING IN THE REGION;
  (C) IDENTIFYING GAPS IN REGIONAL HEALTH CARE SERVICES; AND
  (D)  PROMOTING INCREASED PUBLIC KNOWLEDGE AND RESPONSIBILITY REGARDING
THE AVAILABILITY AND APPROPRIATE UTILIZATION OF  HEALTH  CARE  SERVICES.
EACH COMMUNITY HEALTH IMPROVEMENT PLAN SHALL BE SUBMITTED TO THE COMMIS-
SIONER AND THE BOARD AND SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE.
  10.  EACH  REGIONAL  ADVISORY  COUNCIL SHALL HOLD AT LEAST FOUR PUBLIC
HEARINGS ANNUALLY ON MATTERS RELATING TO THE NEW YORK HEALTH PROGRAM AND
THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY  HEALTH  IMPROVEMENT
PLAN.
  11.  EACH  REGIONAL ADVISORY COUNCIL SHALL PUBLISH AN ANNUAL REPORT TO
THE COMMISSIONER AND THE BOARD ON THE PROGRESS OF THE  COMMUNITY  HEALTH
IMPROVEMENT  PLAN.  THESE  REPORTS  SHALL  BE POSTED ON THE DEPARTMENT'S
WEBSITE.

A. 5062--A                         17

  12. ALL MEETINGS OF THE  REGIONAL  ADVISORY  COUNCILS  AND  COMMITTEES
SHALL BE SUBJECT TO ARTICLE SIX OF THE PUBLIC OFFICERS LAW.
  S 4. Financing of New York Health. 1. The governor shall submit to the
legislature  a  revenue plan and legislative bills to implement the plan
(referred to collectively in this section as the "revenue proposal")  to
provide the revenue necessary to finance the New York Health program, as
created  by  article  51  of  the public health law (referred to in this
section as the "program"), taking into consideration anticipated federal
revenue available for the program. The revenue proposal shall be submit-
ted to the legislature as part of the executive budget under article VII
of the state constitution, for the fiscal year commencing on  the  first
day  of April in the calendar year after this act shall become a law. In
developing the revenue proposal, the governor shall consult with  appro-
priate officials of the executive branch; the temporary president of the
senate; the speaker of the assembly; the chairs of the fiscal and health
committees  of the senate and assembly; and representatives of business,
labor, consumers and local government.
  2. (a) Basic structure. The basic structure of  the  revenue  proposal
shall  be as follows: Revenue for the program shall come from two premi-
ums (referred to collectively in this section as the "premiums"). First,
there shall be a progressively graduated  premium  on  all  payroll  and
self-employed income (referred to in this section as the "payroll premi-
um"),  paid  by  employers,  employees and self-employed, similar to the
Medicare tax. Higher brackets of income subject to this premium shall be
assessed at a higher marginal rate than lower brackets.   Second,  there
shall  be  a  progressively graduated premium on taxable income (such as
interest, dividends, and capital  gains)  not  subject  to  the  payroll
premium  (referred to in this section as the "non-payroll premium"). The
premiums will be set at levels anticipated to produce sufficient revenue
to finance the program and other provisions of article 51 of the  public
health  law,  to be scaled up as enrollment grows, taking into consider-
ation anticipated federal revenue available for the  program.  Provision
shall be made for state residents (who are eligible for the program) who
are  employed  out-of-state, and non-residents (who are not eligible for
the program) who are employed in the state.
  (b) Payroll premium. The income to be subject to the  payroll  premium
shall  be  all  income subject to the Medicare tax. The premium shall be
set at a percentage of that income, which shall be progressively  gradu-
ated,  so  the  percentage  is  higher on higher brackets of income. For
employed individuals, the employer  shall  pay  eighty  percent  of  the
premium and the employee shall pay twenty percent of the premium, except
that  an  employer may agree to pay all or part of the employee's share.
A self-employed individual shall pay the full premium.
  (c) Non-payroll income premium. There shall be  a  premium  on  upper-
bracket  taxable  personal  income  that  is  not subject to the payroll
premium. It shall be set at a percentage of that income, which shall  be
progressively  graduated, so the percentage is higher on higher brackets
of income.
  (d) Phased-in rates. Early in the program, when enrollment is growing,
the amount of the premiums shall be at an appropriate level,  and  shall
be  raised  as anticipated enrollment grows, to cover the actual cost of
the program and other provisions of article 51 of the public health law.
The revenue proposal shall include a mechanism for determining the rates
of the premiums.
  (e) Cross-border employees. (i) State residents employed out-of-state.
If an individual is employed out-of-state by an employer that is subject

A. 5062--A                         18

to New York state law, the employer and employee shall  be  required  to
pay the payroll premium as to that employee as if the employment were in
the state. If an individual is employed out-of-state by an employer that
is  not  subject  to  New  York  state  law, either (A) the employer and
employee shall voluntarily comply with the premium or (B)  the  employee
shall pay the premium as if he or she were self-employed.
  (ii)  Out-of-state  residents  employed in the state.  (A) The payroll
premium shall apply to any out-of-state  resident  who  is  employed  or
self-employed in the state.  (B) In the case of an out-of-state resident
who is employed or self-employed in the state, such individual and indi-
vidual's  employer  shall  be  able to take a credit against the payroll
premiums they would otherwise pay, as to the individual for amounts they
spend on health benefits for the  individual  that  would  otherwise  be
covered  by  the program if the individual were a member of the program.
For employers, the credit shall be available regardless of the  form  of
the  health benefit (e.g., health insurance, a self-insured plan, direct
services, or reimbursement for services), to make sure that the  revenue
proposal  does  not  relate  to  employment benefits in violation of the
federal ERISA.  For non-employment-based spending  by  individuals,  the
credit  shall be available for and limited to spending for health cover-
age (not out-of-pocket health spending). The credit shall  be  available
without  regard  to  how  little is spent or how sparse the benefit. The
credit may only be taken against the payroll premiums. Any excess amount
may not be applied to other tax liability. For  employment-based  health
benefits,  the  credit  shall  be  distributed  between the employer and
employee in the same proportion as the spending by each for the benefit.
The employer and employee may each apply their respective portion of the
credit to their respective portion of the premium. If any  provision  of
this  clause  or any application of it shall be ruled to violate federal
ERISA, the provision or the application of it shall be null and void and
the ruling shall not affect any other provision or application  of  this
section or the act that enacted it.
  3.   The  revenue  proposal  shall  include  a  plan  and  legislative
provisions  for  ending  the  requirement  for  local  social   services
districts  to  pay  part  of  the  cost  of Medicaid and replacing those
payments with revenue from the premiums under the revenue proposal.
  4. To the extent that the revenue proposal differs from the  terms  of
subdivision two of this section, the revenue proposal shall state how it
differs  from those terms and reasons for and the effects of the differ-
ences.
  5. All revenue from the premiums shall be deposited in  the  New  York
Health trust fund account under section 89-i of the state finance law.
  S  5.   Article 49 of the public health law is amended by adding a new
title 3 to read as follows:
                                TITLE III
          COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
                             NEW YORK HEALTH
SECTION 4920. DEFINITIONS.
        4921. COLLECTIVE NEGOTIATION AUTHORIZED.
        4922. COLLECTIVE NEGOTIATION REQUIREMENTS.
        4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
        4924. CERTAIN COLLECTIVE ACTION PROHIBITED.
        4925. FEES.
        4926. CONFIDENTIALITY.
        4927. SEVERABILITY AND CONSTRUCTION.
  S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:

A. 5062--A                         19

  1. "NEW YORK HEALTH" MEANS THE PROGRAM UNDER ARTICLE FIFTY-ONE OF THIS
CHAPTER.
  2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
OTHER LEGAL ENTITY.
  3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY THAT IS
AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON  THEIR  BEHALF  WITH
NEW  YORK  HEALTH  OVER TERMS AND CONDITIONS AFFECTING THOSE HEALTH CARE
PROVIDERS.
  4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
RECT, BY A BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS  MADE  ON  AN
EMPLOYER.
  5.  "HEALTH  CARE PROVIDER" MEANS A PERSON WHO IS LICENSED, CERTIFIED,
REGISTERED OR AUTHORIZED TO PRACTICE A HEALTH CARE  PROFESSION  PURSUANT
TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRACTICES THAT PROFESSION AS
A  HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR OR WHO IS AN OWNER,
OFFICER, SHAREHOLDER, OR PROPRIETOR OF A HEALTH  CARE  PROVIDER;  OR  AN
ENTITY  THAT EMPLOYS OR UTILIZES HEALTH CARE PROVIDERS TO PROVIDE HEALTH
CARE SERVICES, INCLUDING BUT NOT LIMITED TO A  HOSPITAL  LICENSED  UNDER
ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR AN ACCOUNTABLE CARE ORGANIZATION
UNDER  ARTICLE  TWENTY-NINE-E  OF  THIS  CHAPTER. A HEALTH CARE PROVIDER
UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
HEALTH CARE PROVIDER SHALL NOT BE DEEMED  A  HEALTH  CARE  PROVIDER  FOR
PURPOSES OF THIS TITLE.
  S  4921.  COLLECTIVE  NEGOTIATION AUTHORIZED. 1. HEALTH CARE PROVIDERS
MAY MEET AND COMMUNICATE FOR THE  PURPOSE  OF  COLLECTIVELY  NEGOTIATING
WITH  NEW YORK HEALTH ON ANY MATTER RELATING TO NEW YORK HEALTH, INCLUD-
ING BUT NOT LIMITED TO RATES OF PAYMENT AND PAYMENT METHODOLOGIES.
  2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
ALTERATION OF THE TERMS OF THE INTERNAL AND EXTERNAL  REVIEW  PROCEDURES
SET FORTH IN LAW.
  3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF NEW
YORK HEALTH BY HEALTH CARE PROVIDERS.
  4.  NOTHING  IN  THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE
TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF NEW YORK HEALTH TO
OBTAIN OR RETAIN ACCREDITATION BY THE  NATIONAL  COMMITTEE  FOR  QUALITY
ASSURANCE OR A SIMILAR BODY OR TO COMPLY WITH APPLICABLE STATE OR FEDER-
AL LAW.
  S 4922. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
  (A)  HEALTH  CARE  PROVIDERS  MAY  COMMUNICATE  WITH OTHER HEALTH CARE
PROVIDERS REGARDING THE TERMS AND CONDITIONS TO BE NEGOTIATED  WITH  NEW
YORK HEALTH;
  (B)  HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
REPRESENTATIVES;
  (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY  AUTHOR-
IZED  TO  NEGOTIATE  WITH  NEW  YORK HEALTH ON BEHALF OF THE HEALTH CARE
PROVIDERS AS A GROUP;
  (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE  TERMS  AND  CONDITIONS
NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
  (E)  IN  COMMUNICATING  OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
REPRESENTATIVE, NEW YORK HEALTH IS ENTITLED TO OFFER AND PROVIDE DIFFER-
ENT TERMS AND CONDITIONS TO INDIVIDUAL COMPETING HEALTH CARE PROVIDERS.
  2. NOTHING IN THIS TITLE SHALL AFFECT OR LIMIT THE RIGHT OF  A  HEALTH
CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY PETITION
A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.

A. 5062--A                         20

  3.  NOTHING  IN  THIS TITLE SHALL AFFECT OR LIMIT COLLECTIVE ACTION OR
COLLECTIVE BARGAINING ON THE PART OF ANY HEALTH CARE PROVIDER  WITH  HIS
OR  HER  EMPLOYER  OR  ANY  OTHER LAWFUL COLLECTIVE ACTION OR COLLECTIVE
BARGAINING.
  S 4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE. BEFORE
ENGAGING  IN  COLLECTIVE  NEGOTIATIONS WITH NEW YORK HEALTH ON BEHALF OF
HEALTH CARE PROVIDERS, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  SHALL
FILE  WITH THE COMMISSIONER, IN THE MANNER PRESCRIBED BY THE COMMISSION-
ER, INFORMATION IDENTIFYING  THE  REPRESENTATIVE,  THE  REPRESENTATIVE'S
PLAN OF OPERATION, AND THE REPRESENTATIVE'S PROCEDURES TO ENSURE COMPLI-
ANCE WITH THIS TITLE.
  S  4924.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
IN  RESPONSE TO A HEALTH CARE PROVIDERS' REPRESENTATIVE'S DISCUSSIONS OR
NEGOTIATIONS WITH NEW YORK HEALTH EXCEPT AS AUTHORIZED BY OTHER LAW.
  2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
MENT THAT EXCLUDES, LIMITS THE PARTICIPATION  OR  REIMBURSEMENT  OF,  OR
OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
PROVIDER  OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE PERFORM-
ANCE OF SERVICES THAT ARE WITHIN THE HEALTH  CARE  PROVIDER'S  SCOPE  OF
PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
  S  4925. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OF NEGOTIAT-
ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
A REPRESENTATIVE. THE COMMISSIONER, BY RULE, SHALL SET FEES  IN  AMOUNTS
DEEMED  REASONABLE  AND  NECESSARY  TO  COVER  THE COSTS INCURRED BY THE
DEPARTMENT IN ADMINISTERING THIS TITLE.
  S 4926. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
BE REPORTED TO THE DEPARTMENT UNDER THIS TITLE SHALL NOT BE  SUBJECT  TO
DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
  S 4927. SEVERABILITY AND CONSTRUCTION. IF ANY PROVISION OR APPLICATION
OF  THIS  TITLE  SHALL BE HELD TO BE INVALID, OR TO VIOLATE OR BE INCON-
SISTENT WITH ANY APPLICABLE FEDERAL LAW OR REGULATION,  THAT  SHALL  NOT
AFFECT OTHER PROVISIONS OR APPLICATIONS OF THIS TITLE WHICH CAN BE GIVEN
EFFECT  WITHOUT  THAT  PROVISION  OR  APPLICATION;  AND TO THAT END, THE
PROVISIONS AND APPLICATIONS OF THIS TITLE ARE SEVERABLE. THE  PROVISIONS
OF  THIS  TITLE  SHALL  BE  LIBERALLY  CONSTRUED  TO  GIVE EFFECT TO THE
PURPOSES THEREOF.
  S 6. Subdivision 11 of section  270  of  the  public  health  law,  as
amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
amended to read as follows:
  11. "State public health plan" means the  medical  assistance  program
established  by  title eleven of article five of the social services law
(referred to in this article as "Medicaid"), the elderly  pharmaceutical
insurance  coverage program established by title three of article two of
the elder law (referred to in this article as "EPIC"), and  the  [family
health  plus  program established by section three hundred sixty-nine-ee
of the social services law to the extent that section provides that  the
program shall be subject to this article] NEW YORK HEALTH PROGRAM ESTAB-
LISHED BY ARTICLE FIFTY-ONE OF THIS CHAPTER.
  S  7. The state finance law is amended by adding a new section 89-i to
read as follows:
  S 89-I. NEW YORK HEALTH TRUST FUND. 1. THERE IS HEREBY ESTABLISHED  IN
THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSIONER OF TAXA-
TION  AND  FINANCE  A  SPECIAL REVENUE FUND TO BE KNOWN AS THE "NEW YORK
HEALTH TRUST FUND", HEREINAFTER KNOWN AS "THE FUND". THE DEFINITIONS  IN

A. 5062--A                         21

SECTION  FIFTY-ONE  HUNDRED OF THE PUBLIC HEALTH LAW SHALL APPLY TO THIS
SECTION.
  2. THE FUND SHALL CONSIST OF:
  (A)  ALL MONIES OBTAINED FROM PREMIUMS PURSUANT TO LEGISLATION ENACTED
AS PROPOSED UNDER SECTION THREE OF THE NEW YORK HEALTH ACT;
  (B) FEDERAL PAYMENTS RECEIVED AS A RESULT OF ANY  WAIVER  OF  REQUIRE-
MENTS  GRANTED  OR  OTHER  ARRANGEMENTS  AGREED  TO BY THE UNITED STATES
SECRETARY OF HEALTH AND HUMAN  SERVICES  OR  OTHER  APPROPRIATE  FEDERAL
OFFICIALS  FOR  HEALTH  CARE  PROGRAMS  ESTABLISHED  UNDER MEDICARE, ANY
FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM, OR THE AFFORDABLE CARE ACT;
  (C) THE AMOUNTS PAID BY THE DEPARTMENT OF HEALTH THAT  ARE  EQUIVALENT
TO  THOSE  AMOUNTS  THAT  ARE  PAID ON BEHALF OF RESIDENTS OF THIS STATE
UNDER MEDICARE, ANY FEDERALLY-MATCHED  PUBLIC  HEALTH  PROGRAM,  OR  THE
AFFORDABLE  CARE  ACT FOR HEALTH BENEFITS WHICH ARE EQUIVALENT TO HEALTH
BENEFITS COVERED UNDER NEW YORK HEALTH;
  (D) FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION OF  SERVICES
AUTHORIZED  UNDER TITLE XX OF THE FEDERAL SOCIAL SECURITY ACT THAT WOULD
OTHERWISE BE COVERED UNDER ARTICLE FIFTY-ONE OF THE PUBLIC  HEALTH  LAW;
AND
  (E)  STATE  MONIES THAT WOULD OTHERWISE BE APPROPRIATED TO ANY GOVERN-
MENTAL AGENCY, OFFICE, PROGRAM,  INSTRUMENTALITY  OR  INSTITUTION  WHICH
PROVIDES  HEALTH  SERVICES,  FOR SERVICES AND BENEFITS COVERED UNDER NEW
YORK HEALTH. PAYMENTS TO THE FUND PURSUANT TO THIS PARAGRAPH SHALL BE IN
AN AMOUNT EQUAL TO THE MONEY  APPROPRIATED  FOR  SUCH  PURPOSES  IN  THE
FISCAL  YEAR  BEGINNING  IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF THE
NEW YORK HEALTH ACT.
  3. MONIES IN THE FUND SHALL ONLY  BE  USED  FOR  PURPOSES  ESTABLISHED
UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW.
  S 8. Temporary commission on implementation. 1. There is hereby estab-
lished  a  temporary commission on implementation of the New York Health
program, hereinafter to  be  known  as  the  commission,  consisting  of
fifteen  members:  five members, including the chair, shall be appointed
by the governor; four members shall be appointed by the temporary presi-
dent of the senate, one member shall be appointed by the senate minority
leader; four members shall be appointed by the speaker of the  assembly,
and  one  member shall be appointed by the assembly minority leader. The
commissioner of health, the superintendent of  financial  services,  and
the commissioner of taxation and finance, or their designees shall serve
as non-voting ex-officio members of the commission.
  2.  Members  of the commission shall receive such assistance as may be
necessary from other state agencies  and  entities,  and  shall  receive
necessary  expenses  incurred  in  the  performance of their duties. The
commission may employ staff as needed, prescribe their duties,  and  fix
their compensation within amounts appropriated for the commission.
  3.  The commission shall examine the laws and regulations of the state
and make such recommendations as are necessary to conform the  laws  and
regulations  of the state and article 51 of the public health law estab-
lishing the New York Health program and other provisions of law relating
to the New York  Health  program,  and  to  improve  and  implement  the
program. The commission shall report its recommendations to the governor
and the legislature.  The commission shall immediately begin development
of  proposals  consistent  with  the  principles  of  this  article  for
provision of long-term care coverage; health care services covered under
the workers' compensation law; and incorporation of retiree health bene-
fits, as described in paragraphs (a), (b) and (c) of  subdivision  eight
of  section  fifty-one hundred two of this article. The commission shall

A. 5062--A                         22

provide its work product and assistance to the board established  pursu-
ant  to section fifty-one hundred two of this article upon completion of
the appointment of the board.
  S  9.  Severability. If any provision or application of this act shall
be held to be invalid, or to violate or be inconsistent with any  appli-
cable  federal law or regulation, that shall not affect other provisions
or applications of this act which  can  be  given  effect  without  that
provision  or  application; and to that end, the provisions and applica-
tions of this act are severable.
  S 10. This act shall take effect immediately.