S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10252
 
                           I N  A S S E M B L Y
 
                              March 27, 2018
                                ___________
 
 Introduced  by M. of A. ORTIZ -- read once and referred to the Committee
   on Health
 
 AN ACT to amend the public health law, in relation to in-utero  exposure
   to tobacco smoke prevention and including certain respiratory diseases
   within  disease  management  demonstration  programs; and to amend the
   insurance law, in relation to health insurers' wellness programs

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The  public health law is amended by adding a new article
 13-I to read as follows:
                               ARTICLE 13-I
               IN-UTERO EXPOSURE TO TOBACCO SMOKE PREVENTION
 SECTION 1399-XX. IN-UTERO TOBACCO EXPOSURE PREVENTION.
         1399-YY. PROGRAMS.
   §  1399-XX.  IN-UTERO  TOBACCO  EXPOSURE  PREVENTION.  1.  APPROPRIATE
 HEALTHCARE  PROVIDERS  AND  PREGNANCY  PROGRAMS  SHALL  BE ENCOURAGED TO
 DISTRIBUTE INFORMATION ON THE ADVERSE HEALTH EFFECTS OF  SMOKING  DURING
 AND  AFTER  PREGNANCY  FOR  BOTH FIRSTHAND AND SECONDHAND TOBACCO SMOKE.
 SUCH ADVERSE EFFECTS TO THE INFANT INCLUDE  LOWER  BIRTH  RATES,  HIGHER
 INCIDENCE OF ASTHMA AND OBESITY, AND COGNITIVE AND DEVELOPMENTAL DAMAGE.
   2.  APPROPRIATE  HEALTHCARE  PROVIDERS  SHALL BE ENCOURAGED TO MONITOR
 EXPECTANT MOTHERS' SMOKING STATUSES AND TO OFFER  TO  EXPECTANT  MOTHERS
 TAILORED  SERVICES, COUNSELING AND DISCUSSION ON THE ADVANTAGES TO QUIT-
 TING TOBACCO SMOKING DURING AND AFTER THEIR PREGNANCY.
   § 1399-YY. PROGRAMS. THE FOLLOWING PROGRAMS SHALL BE ADDED TO EXISTING
 TOBACCO CONTROL PROGRAMS  FOR  PREGNANT  WOMEN  OR  TO  OTHER  PREGNANCY
 RELATED PROGRAMS:
   1. CARBON MONOXIDE MONITORING;
   2. REFERRALS FOR SMOKING CESSATION FOR HOUSEHOLD MEMBERS;
   3. ONGOING SUPPORT BY COUNSELING AND EDUCATIONAL MATERIALS; AND
   4.  FINANCIAL  INCENTIVES INCLUDING, BUT NOT LIMITED TO, ITEMS SUCH AS
 DIAPERS OR OTHER BABY CARE PRODUCTS OR COUPONS  TO  ENCOURAGE  EXPECTANT
 MOTHERS TO QUIT SMOKING FOR TWO OR MORE WEEKS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11362-03-7

 A. 10252                            2
 
   § 2. 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, EMPHYSEMA, CHRONIC BRONCHITIS, OTHER RESPIR-
 ATORY DISEASES, diabetes or other chronic health conditions  as  may  be
 specified  by the department; or have experienced or are likely to expe-
 rience one or more hospitalizations or are otherwise expected  to  incur
 excessive costs and high utilization of health care services.
   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.
   § 3. Subsections (a), (b) and (c) of section  3239  of  the  insurance
 law,  subsection  (a)  as  added by chapter 592 of the laws of 2008, and
 subsections (b) and (c) as amended by chapter 180 of the laws  of  2016,
 are amended to read as follows:
   (a)  An  insurer  licensed  to  write accident and health insurance, a
 corporation organized pursuant to article forty-three of this chapter, a
 health maintenance organization certified pursuant to article forty-four
 of the public health law and a  municipal  cooperative  health  benefits
 plan  may  establish a wellness program in conjunction with its issuance
 of a group accident and health  insurance  policy  or  group  subscriber
 contract.  A  "wellness program" is a program designed to promote health
 and prevent disease that may contain rewards and incentives for  partic-

 A. 10252                            3
 
 ipation.  Participation  in  the  wellness program shall be available to
 similarly-situated members of the group and shall be  voluntary  on  the
 part  of the member. The SPECIFIC terms of the wellness program shall be
 set  forth in the policy or contract, OR IN A SEPARATE DOCUMENT PROVIDED
 TO INSUREDS AND MEMBERS WHICH SHALL BE CONSISTENT WITH THE PROVISIONS OF
 THIS SECTION.
   (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;
   (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[.];
   (11) ASSISTANCE, FINANCIAL OR OTHERWISE, PROVIDED TO AN  EMPLOYER  FOR
 HEALTH PROMOTION AND DISEASE PREVENTION; AND
   (12) INCENTIVES FOR INSUREDS OR MEMBERS TO ACCESS PREVENTIVE SERVICES,
 SUCH AS ASTHMA, OBESITY AND MAMMOGRAPHY SCREENING.
   (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, weight management, stress and/or hypertension, worker
 injury prevention, ASTHMA MITIGATION OR TREATMENT, 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;
   (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.

 A. 10252                            4
 
   §  4. This act shall take effect immediately, except that sections one
 and three of this act shall take effect on the one hundred eightieth day
 after this act shall have become a law. Provided, that  effective  imme-
 diately rules and regulations, and other measures necessary to implement
 the  provisions  of this act on its effective date may be promulgated or
 taken on or before such date.