S T A T E O F N E W Y O R K
________________________________________________________________________
9067
I N A S S E M B L Y
January 21, 2016
___________
Introduced by M. of A. CRESPO, SEPULVEDA, RAMOS, DAVILA, PICHARDO,
ARROYO, RIVERA, MOYA, DILAN, LINARES, RODRIGUEZ -- read once and
referred to the Committee on Health
AN ACT to amend the public health law, in relation to including certain
respiratory diseases and obesity within disease management demon-
stration programs directing the health research science board to study
respiratory diseases and obesity; to amend the social services law, in
relation to child day care facilities; and to amend the insurance law,
in relation to expanding the kinds of qualified wellness programs that
can be offered to enrollees
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivisions 2 and 4 of section 2111 of the public health
law, as added by section 21 of part C of chapter 58 of the laws of 2004,
are amended to read as follows:
2. The department shall establish the criteria by which individuals
will be identified as eligible for enrollment in the demonstration
programs. Persons eligible for enrollment in the disease management
demonstration program shall be limited to individuals who: receive
medical assistance pursuant to title eleven of article five of the
social services law and may be eligible for benefits pursuant to title
18 of the social security act (Medicare); are not enrolled in a Medicaid
managed care plan, including individuals who are not required or not
eligible to participate in Medicaid managed care programs pursuant to
section three hundred sixty-four-j of the social services law; are diag-
nosed with chronic health problems as may be specified by the entity
undertaking the demonstration program, including, but not limited to one
or more of the following: congestive heart failure, chronic obstructive
pulmonary disease, asthma, CHRONIC BRONCHITIS, OTHER CHRONIC RESPIRATORY
DISEASES, diabetes, ADULT AND CHILDHOOD OBESITY, or other chronic health
conditions as may be specified by the department; or have experienced or
are likely to experience one or more hospitalizations or are otherwise
expected to incur excessive costs and high utilization of health care
services.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13293-02-6
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4. The demonstration program shall offer evidence-based services and
interventions designed to ensure that the enrollees receive high quali-
ty, preventative and cost-effective care, aimed at reducing the necessi-
ty for hospitalization or emergency room care or at reducing lengths of
stay when hospitalization is necessary. The demonstration program may
include screening of eligible enrollees, developing an individualized
care management plan for each enrollee and implementing that plan.
Disease management demonstration programs that utilize information tech-
nology systems that allow for continuous application of evidence-based
guidelines to medical assistance claims data and other available data to
identify specific instances in which clinical interventions are justi-
fied and communicate indicated interventions to physicians, health care
providers and/or patients, and monitor physician and health care provid-
er response to such interventions, shall have the enrollees, or groups
of enrollees, approved by the department for participation. The services
provided by the demonstration program as part of the care management
plan may include, but are not limited to, case management, social work,
individualized health counselors, multi-behavioral goals plans, claims
data management, health and self-care education, drug therapy management
and oversight, personal emergency response systems and other monitoring
technologies, SYSTEMATIC CHRONIC HEALTH CONDITIONS IDENTIFIED FOR MONI-
TORING, telehealth services and similar services designed to improve the
quality and cost-effectiveness of health care services.
S 2. Paragraphs (a), (b) and (c) of subdivision 1 of section 2411 of
the public health law, as amended by section 5 of part A of chapter 60
of the laws of 2014, are amended to read as follows:
(a) Survey state agencies, boards, programs and other state govern-
mental entities to assess what, if any, relevant data has been or is
being collected which may be of use to researchers engaged in breast
cancer research, OR ADULT AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRON-
CHITIS OR OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
(b) Consistent with the survey conducted pursuant to paragraph (a) of
this subdivision, compile a list of data collected by state agencies
which may be of assistance to researchers engaged in breast cancer
research as established in section twenty-four hundred twelve of this
title, AND ADULT AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRONCHITIS OR
OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
(c) Consult with the Centers for Disease Control and Prevention, the
National Institutes of Health, the Federal Agency For Health Care Policy
and Research, the National Academy of Sciences and other organizations
or entities which may be involved in cancer research to solicit both
information regarding breast cancer research projects, AND ADULT AND
CHILDHOOD OBESITY, ASTHMA, CHRONIC BRONCHITIS OR OTHER CHRONIC RESPIR-
ATORY DISEASE RESEARCH PROJECTS that are currently being conducted and
recommendations for future research projects;
S 3. Paragraph (a) of subdivision 2-a of section 390 of the social
services law, as added by chapter 416 of the laws of 2000, is amended to
read as follows:
(a) The office of children and family services shall promulgate regu-
lations which establish minimum quality program requirements for
licensed and registered child day care homes, programs and facilities.
Such requirements shall include but not be limited to (i) the need for
age appropriate activities, materials and equipment to promote cogni-
tive, educational, social, cultural, physical, emotional, language and
recreational development of children in care in a safe, healthy and
caring environment (ii) principles of childhood development (iii) appro-
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priate staff/child ratios for family day care homes, group family day
care homes, school age day care programs and day care centers, provided
however that such staff/child ratios shall not be less stringent than
applicable staff/child ratios as set forth in part four hundred four-
teen, four hundred sixteen, four hundred seventeen or four hundred eigh-
teen of title eighteen of the New York code of rules and regulations as
of January first, two thousand (iv) appropriate levels of supervision of
children in care (v) minimum standards for sanitation, health, infection
control, nutrition, buildings and equipment, safety, security proce-
dures, first aid, fire prevention, fire safety, evacuation plans and
drills, prevention of child abuse and maltreatment, staff qualifications
and training, record keeping, and child behavior management AND (VI) MAY
INCLUDE GUIDELINES OR STANDARDS ON APPROPRIATE LEVELS OF PHYSICAL ACTIV-
ITY AND NUTRITIONAL OFFERINGS TO ENCOURAGE HEALTHY EATING AND LIVING
HABITS TO HELP TO LOWER THE INCIDENCE OF CHILDHOOD OBESITY.
S 4. Section 390-a of the social services law is amended by adding a
new subdivision 6 to read as follows:
6. NO FAMILY DAY CARE HOME, GROUP FAMILY DAY CARE HOME, SCHOOL AGE
CHILD CARE PROGRAM OR CHILD DAY CARE CENTER SHALL DISCOURAGE ACTIVITIES
RELATING TO BREAST FEEDING A CHILD OR FEEDING A CHILD WITH EXPRESSED
BREAST MILK.
S 5. Subsections (b) and (c) of section 3239 of the insurance law, as
added by chapter 592 of the laws of 2008, paragraphs 6 and 7 of
subsection (b) and subparagraphs (C) and (D) of paragraph 2 of
subsection (c) as amended, and paragraph 8 of subsection (b) and subpar-
agraphs (E) and (F) of paragraph 2 of subsection (c) as added by chapter
519 of the laws of 2013, are amended to read as follows:
(b) A wellness program may include, but is not limited to, the follow-
ing programs or services:
(1) the use of a health risk assessment tool;
(2) a smoking cessation program;
(3) a weight management program;
(4) a stress AND/OR HYPERTENSION management program;
(5) a worker injury prevention program;
(6) a nutrition education program;
(7) health or fitness incentive programs; [and]
(8) a coordinated weight management, nutrition, stress management and
physical fitness program to combat the high incidence of adult and
childhood obesity, asthma and other chronic respiratory conditions[.];
(9) A SUBSTANCE OR ALCOHOL ABUSE CESSATION PROGRAM; AND
(10) A PROGRAM TO MANAGE AND COPE WITH CHRONIC PAIN.
(c)(1) A wellness program may use rewards and incentives for partic-
ipation provided that where the group health insurance policy or
subscriber contract is required to be community-rated, the rewards and
incentives shall not include a discounted premium rate or a rebate or
refund of premium.
(2) Permissible rewards and incentives MAY include:
(A) full or partial reimbursement of the cost of participating in
smoking cessation [or], weight management, STRESS AND/OR HYPERTENSION,
WORKER INJURY PREVENTION, NUTRITION EDUCATION, SUBSTANCE OR ALCOHOL
ABUSE CESSATION, OR CHRONIC PAIN MANAGEMENT AND COPING programs;
(B) full or partial reimbursement of the cost of membership in a
health club or fitness center;
(C) the waiver or reduction of copayments, coinsurance and deductibles
for preventive services covered under the group policy or subscriber
contract;
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(D) monetary rewards in the form of gift cards or gift certificates,
so long as the recipient of the reward is encouraged to use the reward
for a product or a service that promotes good health, such as healthy
cook books, over the counter vitamins or exercise equipment;
(E) full or partial reimbursement of the cost of participating in a
stress management program or activity; and
(F) full or partial reimbursement of the cost of participating in a
health or fitness program.
(3) Where the reward involves a group member's meeting a specified
standard based on a health condition, the wellness program must meet the
requirements of 45 CFR Part 146.
(4) A reward or incentive which involves a discounted premium rate or
a rebate or refund of premium shall be based on actuarial demonstration
that the wellness program can reasonably be expected to result in the
overall good health and well being of the group.
S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided that, effective immediately any
rules and regulations necessary to implement the provisions of this act
on its effective date are authorized and directed to be added, amended
and/or repealed on or before such date.